House of Commons
Monday 1 July 2019
The House met at half-past Two o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
Work and Pensions
Universal Credit: Roll-out
The national roll-out of universal credit was completed in December 2018. As of May 2019, there are now more than 2 million people claiming universal credit, and of those, 34% are in work. We now plan to begin “the move to UC” pilot later this month.
The right hon. Lady’s Government promised that
“universal credit should not leave councils out of pocket.”
Yet Highland Council has nearly £3 million of additional costs, including £640,000 of indisputable administration costs, directly as a result of universal credit. Despite letters, questions and meetings with officials and Ministers, where details and data have all been provided, there is still no settlement. When will this debt to highland households finally be repaid?
I am aware that the hon. Gentleman has raised this matter before and has had a number of meetings with the Minister for Employment. As a result of some of those meetings, we have already increased the additional funds available to councils such as the one to which he refers. There has been an increase in the total amount of new burdens money that has been paid out, but we have also said that we will investigate further. I want to reassure him that this is not finished yet, and that I will continue to look at it myself to ensure that there is satisfaction.
May I thank my right hon. Friend for her very successful visit to Stirling last Thursday and Friday? When we met the work coaches and the other staff of the Department of Work and Pensions team at Randolphfield, was she struck, as I was once again, by their degree of dedication and their genuine concern for the claimants with whom they work? They are a credit to themselves and to the DWP team. Does she agree that, rather than spread fear and scaremongering, Scottish National party Members should be encouraging the people who live in their constituencies to go to the DWP to get the help that they need, confident that they will be respected and treated with genuine dignity?
I thank my hon. Friend for his important question and for setting up the visit, which was so useful and purposeful. I do note that when I went to the jobcentre and met the work coaches, they were passionate about delivering the right outcomes for their constituents. When we asked them what they would change about universal credit, they said the publicity, because they are so committed to getting the right outcomes for the right people. These are people who are doing good work for good people.
Will the Secretary of State confirm for the record that any EU national who has been granted settled status in the United Kingdom is regarded as being habitually resident for the purposes of applying for and receiving universal credit?
That is largely correct. The only issue here is about the evidence that people now have to supply which they did not have to supply before. I know that there are a number of places where people were able to claim benefits and they now no longer qualify for universal credit. We are looking at those individually to see whether it is an issue with their application for settled status or something else.
In answer to the first part of the hon. Gentleman’s question, which is about assistance in getting the applications through, we announced in April this year the help-to-claim arrangements so that applicants who are struggling to apply for universal credit can have the additional support they need from citizens advice bureaux. I hope that he will find that that is working well in his local bureau. On the second part about getting money to people earlier, as he will be aware, we have made advances available and we are extending the amount of time over which people have to repay it and the amount that is deducted from their core amounts so that they do not feel it as badly as they would have previously.
Research released last week from the Child Poverty Action Group and the Church of England shows that women are being forced to choose between poverty and an abortion because of this Government’s two-child cap—that is the reality facing families with three or more children. It appears unlikely that the Secretary of State will face another Work and Pensions Question Time, so will she make it her legacy to scrap the two-child cap and avoid impoverishing half of all children in those families?
I will try not to be distracted by the hon. Gentleman’s slightly personal remarks. He might know that I visited Scotland last week, and the Scottish Government have taken their own steps on what they feel is the way to address child poverty. Those of us on the Government side of the House feel that the best way to address child poverty is to help more people into work. I am proud of the fact that there are now 1 million more people in work and that over 600,000 children are no longer in houses where no people work.
I note that the Secretary of State did not answer my question. I would like to compare and contrast, because CPAG has said of the two-child cap,
“you could not design a policy better to increase child poverty”,
but last week it described the new Scottish child benefit, to which the Secretary of State referred, as
“an absolute game changer in the fight to end child poverty”.
Therefore, on the 20th anniversary of the reconvened Scottish Parliament, is this not yet another example of where Holyrood empowers, Westminster impoverishes?
Again, I point to the fact that there are different ways of addressing poverty, both child poverty and family poverty: one is to hand out money, which is what the Scottish Government have chosen to do; and another is to focus, with laser-like attention, on ensuring that we build the economy and create employment and that there are good jobs so that people can support their family.
There has been no such assessment. As one Department, we have rolled out universal credit, providing a holistic benefits system to ensure that everyone is given the support they need. As one Department, we have seen record levels of employment and the lowest unemployment rate since the 1970s.
I thank the Secretary of State for that answer. However, she will be aware that there is a significant difference between the benefits of universal credit, disability benefits and pensions. She will also be aware that certain newspapers are prone, when talking about the allegedly outrageous amounts of money that people on unemployment or disability benefits get, to look only at the Department’s overall spend. Of course, as she will be aware, 90% of that spend is on pensions. Would it not be simpler, easier and more straightforward simply to split DWP into two Departments, so that both can focus on what they should be focusing on?
Although I recognise the good work that the hon. Gentleman has done in many of these areas, I respectfully disagree. I think that it is right that those elements are held together in one Department. If we look at the results, we are seeing record levels of pensioner poverty—[Interruption.]
I very much welcome the recent decision to move the Office for Disability Issues into the Cabinet Office, creating a super-hub of all equalities work right across Government. Will the new hub be leading the reform to statutory sick pay so that it is better enforced, more flexible and covers the lowest-paid workers, and when will the consultation on this vital reform take place?
I thank my hon. Friend for that question, and may I take this opportunity to pay homage to the extraordinary work that she did to ensure that took place? The point of having an equalities hub in the Cabinet Office is to ensure that we have strong enforcement to deliver on the disabilities changes across Government. With her help, following the work she put in, we are able to do that.
And my tie has whales on it, Mr Speaker—Japan comes to mind. The fact of the matter is that the Secretary of State knows that she has some really good people working in her Department—certainly the people working in my patch are very good—but the trouble is that they are not well managed or well led. Splitting is not the answer; the answer is to get in some managers who can tackle things such as the awful situation for people on universal credit who do not have a bank account, because she has still not tackled that.
I can reassure the hon. Gentleman that we are working with Lloyds, for instance, to ensure that basic bank accounts are more available. May I also take this opportunity to join him in praising the work of the staff at the jobcentre in Huddersfield to help people in his constituency?
Tackling poverty will always be a priority for this Government, and I take these numbers extremely seriously. In the latest low income statistics, child poverty increased in three of the four measures. The evidence shows that work is the best route out of poverty, and there are 667,000 fewer children in workless households compared with 2010.
Summer holidays are fast approaching, and far too many families will be struggling to feed their children. The Childhood Trust states that two thirds of London children living in poverty—that will be 2,000 in Kensington—could go hungry without access to charitable donations. While the Mayor’s Fund for London supports hungry children across the capital, what is the Minister doing, long term, to tackle the causes of child poverty, including in-work poverty?
As I have said, the latest statistics show that full-time work substantially reduces the chance of poverty. The absolute poverty rate of a child where both parents work full-time is only 4% compared with 44% where one or more parents are in part-time work. We are supporting people into full-time work where possible—for example, by offering 30 hours of free childcare to parents of three and four-year-olds. Over three quarters of the growth in employment since 2010 has been in full-time work.
Without knowing the exact figure, it is too many. My role within the Department, and the role of the Department itself, is to address that. My hon. Friend will know too well that the best route out of poverty is work. That is why our focus is on universal credit. Universal credit is working in terms of getting more people into work, and more people are staying in work.
The best way out of poverty is probably properly paid work. The real problem for many of my constituents and their children is the fact that they have very low levels of savings, so when somebody loses their job, perhaps because a company closes, the real danger is that when they go on to universal credit they have to wait for five weeks for a payment and have nothing to fall back on. I really do beg the Government to reconsider the issue of the five weeks. The worst possible thing of all is saying, “You can borrow some money”, because suddenly a family ends up in debt, and that is when the children end up not having food unless it comes from a food bank.
I recognise the passion with which the hon. Gentleman raises his point, but, in terms of the five-week wait, nobody has to wait for their first payment of universal credit, as 100% of their indicative advance is available on day one. It is interest-free, repayable over 12 months—and, as the Secretary of State has said, that will in future be moving to 16 months. That is available and about 60% of people are currently taking it up.
Given that the majority of families affected by the two-child limit are working, why did the Department for Work and Pensions make the following statement in response to the recent report by the Child Poverty Action Group and the Church of England:
“This policy helps to ensure fairness by asking parents receiving benefits to face the same financial choices as those in work”?
Could the Minister clear up this confusion for the House?
The policy to provide support for a maximum of two children helps to ensure fairness by asking parents receiving benefits to face the same financial choices as those in work. Safeguards are in place and we have made changes this year to make the policy fairer. Tackling poverty remains a priority. We are spending over £95 billion a year on welfare and providing free school meals to more than 1 million children.
People with Disabilities: Employment
We support disabled people into work through initiatives like the Work and Health programme, the Personal Support Package, and the new Intensive Personalised Employment Support programme launching at the end of 2019. Access to Work approved support for nearly 34,000 disabled workers last year, and we engage with employers through the Disability Confident campaign.
The 19% disability employment gap in Cheadle highlights our untapped talent and the challenge facing the Government in getting a further 1 million disabled people into work over the next eight years. Greater flexibility in working hours, managing time and accommodating medical appointments are just some of the ways to close the gap, but there is clearly more to be done. Does my hon. Friend agree that employers should be encouraged to think creatively about how to make work more accommodating to disabled people?
My hon. Friend is spot on. I was at Employability Day on Friday, celebrating, meeting disabled people who had got into work and, crucially, meeting employers who had often made very small changes. The key message was that it is a win-win. The 950,000 more disabled people who we have got into work are making a real difference to businesses that have taken those steps.
I recently met the charity Root Experience at Chichester library, where it was launching a book called “Hidden Stories”. The book puts a spotlight on hidden disabilities such as epilepsy or autism and how they impact people on a day-to-day basis. Would my hon. Friend be happy to receive a copy of the book? What steps is the DWP taking to promote education and awareness of hidden disabilities in the workplace?
I thank my hon. Friend for highlighting that fantastic book. My hon. and learned Friend the Member for South Swindon (Robert Buckland) and I recently went to Swindon Council library and were handed a copy of this excellent book. It is currently sitting on the back seat of my car. It is a brilliant edition, and I hope that as many MPs as possible can see this proactive and constructive way to champion opportunities that people with hidden disabilities can offer.
I am sure the Minister will agree that we want all our pupils to stay in full-time education until they are 18, including those with special needs and disabilities. However, at 16 these pupils face the change of moving from disability living allowance to personal independence payment. That is out of step with changes faced by other children. For example, other children aged 16 in full-time education are able to continue to claim free prescriptions, free eye tests and free dental checks, but children with special needs and disabilities have to face this change in benefits at 16. This is extremely stressful—it is stressful enough for these children to be going on to college, let alone having to change benefits. Will the Minister look at changing that, so that children in full-time education at 16 do not change benefits until they finish?
I thank the hon. Lady for raising that important point. I recognise the points that she made, but it is a balance. The decision to do this has been in place for a long time, to allow for everything in be in place for when they get to 18, but I am happy to meet her to discuss this further.
Can the Minister explain the very long delays in the limited work capability assessment to qualify for the working element of universal credit, and why disabled people who are trying to work are being penalised because of the apparent inefficiency of the contractor, Maximus?
Under universal credit, from the initial conversation with a work coach, individual claimants—including those with disabilities—can get support. We continue to make improvements to the work capability assessment, following the five independent reviews. Over 100 different recommendations have been taken on board. I work very closely with stakeholders, as do all the ministerial team. We look to continue to improve the process.
Support for disabled people in work should be a top priority for this Government, but on several occasions I have raised with Ministers a fundamental flaw under universal credit for disabled people in work, which is that to qualify for in-work support, such as the work allowance, one must be found unfit for work under the work capability assessment. That contrasts with legacy social security, where someone qualifies for in-work support by being in receipt of DLA or PIP. Does the Minister agree that this is absurd, and will he commit today to rectifying this illogical and damaging policy?
I will commit to continuing to do everything we can to ensure that all people with disabilities and long-term health conditions have the maximum chance to get into work. I am very proud of the fact that over the last five years alone, 950,000 more disabled people are in work, and we continue to make good progress towards our target of a further 1 million disabled people in work by 2027.
Universal Credit: Food Banks
There are a range of reasons why people make use of food banks. The key for the DWP is to ensure that welfare claimants are able to access funds in a timely manner. That is why advances are available, so that no one has to wait five weeks for their first universal credit payment.
Even before universal credit was rolled out in Hull, the use of the Hull food bank was very high because we have widescale in-work poverty, and a third of the children in Hull are living in poverty. The Trussell Trust has said that nearly half of all food bank referrals are due to a delay in benefits being paid when universal credit is rolled out, which happened in Hull before Christmas. Does the Minister now accept that, and what is he going to do about it?
I thank the hon. Lady for her question. We continue to provide a strong safety net through the welfare system for those who need extra support and, as I have said, people use food banks for many and varied reasons. We review research carried out by organisations, including the Trussell Trust, to add to our understanding of food bank use. I intend to work far more closely with the Trussell Trust and other food bank providers, including other stakeholders in this area. I want food bank providers and jobcentres to work far more closely together so that we can better understand the issues and then put in place the interventions to make the situation better.
A few weeks ago, I and a colleague of mine visited a major food bank in Coventry. One of the lessons we learned from the food bank in Coventry—it has nine outlets throughout Coventry and Warwickshire—is that universal credit is forcing people to use food banks. What is the Minister going to do to sort out the problem that people have who are forced to use food banks? Surely we should have another look at universal credit and abolish it, because it is not working.
I am sorry to hear the hon. Gentleman’s example. If I get a chance to visit his local food bank, I will certainly do so, but I have to stress that no claimant needs to wait more than five weeks to receive their first regular universal credit payment. We have listened to feedback on how we can support our claimants and made improvements, such as extending advances, removing waiting days and introducing housing benefit run-on. I will continue to work with the Trussell Trust and others to improve our system in any way we can.
I am afraid to say to the Minister that the advance payment is missing the point. The biggest driver of people going to food banks is the five-week wait. Because of the benefit freeze, the basic amount people have to live on, particularly the very vulnerable, is not enough. We cannot then expect them to live on less by taking away their advance payment, which is a debt. There is a simple way to deal with this. Some 60% of claimants are already taking advance payment, which tells us they cannot wait. The money is already going out of the DWP’s door. Make it a grant. It should not be repayable for the most vulnerable people in society.
I respect the hon. Lady’s knowledge in this area on the Select Committee, but I would say that advances are not loans from a separate fund; they are the claimant’s benefit paid early, which is then recovered over an agreed period. So they are in place to ensure that those in genuine need are able to receive financial support and are not reliant on illegal or high-cost lenders. But if a claimant considers they are facing financial hardship because of the amount that is being deducted from their universal credit award, they can ask the Department to consider reducing their deductions. As of October this year, the maximum deduction goes down from 40% to 30%.
Universal Credit: Working People’s Incomes
One of the key transformations that universal credit provides is to support people who are in work, ensuring they can increase their earnings and develop in their career. It removes the 16-hour cliff edge, which held so many back on legacy benefits, and gives improved, tailored support through jobcentre work coaches.
Will the Minister join me in thanking the excellent DWP staff on the Isle of Wight, some of whom I met in Newport a few weeks ago? I am sure he and the team will seek to make further improvements to universal credit, but it was clear to me, talking to those staff, that universal credit enables them to do more good for more people than the inflexible system that preceded it.
I thank my hon. Friend for being a huge champion for the Isle of Wight and working so well with his local jobcentre. I am very pleased about that and he is absolutely right. As a result of universal credit, people are able to get the support—that one-to-one support—that is so vital. Since 2016, an extra £10 billion has gone into the system.
My constituent, Amanda, who is a single mum with significant mental health problems, had her UC claim closed—unknown to her—at the beginning of May. She was told by the DWP that this was a sanction because she failed to complete an online review. I should also mention that she was in the last few weeks of her pregnancy. Given that Amanda is clearly a vulnerable person, will the Secretary of State commit to ensure that all work coaches are aware of their obligations following last year’s High Court judgment, which demands that they should treat vulnerable claimants appropriately?
Of course. The Secretary of State, I and all colleagues want to ensure that absolutely every single person claiming universal credit gets the appropriate support and the right level of support. I would be very happy to look at that individual case with the hon. Lady. I would just say on sanctions that these are not just handed out; there is a clear process. I can tell her that, in February 2019, only 2.45% of those who were under conditionality requirements actually had a sanction and the average sanction’s length was 30 days. But I will look at that case for her.
My constituent, Craig Ferguson, has Asperger’s, but works in retail. He broke his leg, was not entitled to statutory sick pay and was advised to switch to UC. He then lost his severe disability premium. His UC has automatic deductions for an employment support allowance overpayment and, at times, he receives no UC award at all, which means that he has to depend on savings. How is that fair? Can his case be reviewed?
Local Housing Allowance
Welfare reforms were designed to ensure a fair balance between public spending and supporting vulnerable people to meet their housing costs. LHA rates are not intended to meet all rents in all areas. However, the Secretary of State and I have committed to end the freeze to LHA in March 2020.
Local housing allowance is supposed to cover the lowest 30% of market rents, but research by Shelter found that that is not possible in 97% of England. For example, in south-east London, local housing allowance will cover only the bottom 10% of rents. We have a housing crisis across the country and local housing allowance is not fit for purpose. Does the Minister agree that it must be raised to reflect the true cost of renting?
I thank the hon. Lady for her question. As I said, LHA rates are not intended to meet all rents in all areas. Housing benefit claimants have to make the same decisions about where to live as people who do not receive benefit. In 2019-20, targeted affordability funding has been used to increase over 80% of rates in London. Nevertheless, we recognise that this is an issue. The Secretary of State and I are alive to it and we are looking at several options ahead of a spending review bid.
Does the Minister recognise that recent changes to the tax treatment of the private rented sector, particularly the buy-to-let sector, will mean an increase in rents across the board? That will have a very real read-across to the local housing allowance. Will he give some assessment of what allowance he will make for that increase?
That is, of course, a question for the Treasury. Any rise or potential rise in LHA rates has to go hand in hand with addressing supply. I urge my hon. Friend to address that issue with my counterparts in the Ministry of Housing, Communities and Local Government, and, indeed, the Chancellor and Chief Secretary to the Treasury.
I welcome what the Minister said the other day about reviewing how local housing allowance areas need to be redefined. Does he accept that, because Stroud is in the same area as Gloucester, we are now losing a significant number of people from the private sector because they cannot afford to top up? Will he therefore look at this as a matter of urgency?
I thank the hon. Gentleman for his question. He is right that the broad market rental areas have some anomalies. I have officials looking into this. It is a huge and complex piece of work, given that there are approximately 900 of those areas. It is therefore not something that can be done quickly, but I recognise the issue and I am working on it.
The overall trend in the percentage of pensioners living in poverty has fallen dramatically over recent decades. Relative pensioner poverty rates before housing costs have halved since 1990 and rates of material deprivation for pensioners are also at record lows. We want to maintain this achievement.
On Friday, I met constituents and campaigners from Women Against State Pension Inequality Campaign Scotland. Those women told me that they are suffering poverty, distress and significant inequality as a result of a pension decision taken in the name of equality. At a time when the Tory leadership candidates are promising billions of pounds of public spending, those women would like to know why the Government cannot find the cash to right the wrong done to the WASPI women.
It is not the Government’s intention to change the Pensions Act 1995, the Pensions Act 2007 or the Pensions Act 2011. There was a £1.1 billion concession in 2011. The policy was conceived in 1993, continued under the Labour Government for 13 years, continued under the coalition and will continue under this Government. I should also point out that a judicial review is pending. I cannot comment any further than that.
The reality of the state pension in this country is that it has risen by £1,600 in real terms through the triple lock. It also needs to be looked at in the context of the significant high private pensions that, thanks to automatic enrolment and other reforms, show that this is comparable to many other European countries.[Official Report, 9 July 2019, Vol. 663, c. 2MC.]
Free TV licences for older pensioners used to be a proud part of DWP policy. Ministers were warned that they would go under the Government’s TV licence plans, so please do not tell us that pension credits are the answer when thousands of pensioners in our area have small occupational or widows’ pensions, which mean that they are just above the threshold but are still on tight budgets. They will be hit by the free TV licence being taken away. What are the Government going to do to support those pensioners and to reverse this unfair plan?
The right hon. Lady will be aware that this is a matter for the Department for Digital, Culture, Media and Sport. In the 2015 funding settlement the Government agreed with the BBC that responsibility for the concession would transfer to the BBC after June 2020. I reassure the House that the Government recognise the importance of this, but we are very disappointed with the BBC and we expect it to continue the concession.
The hon. Member for Birmingham, Erdington (Jack Dromey), who is a keen young pup in the House, is perched as though he is about to expatiate. However, I had him down as coming in on the next question. [Interruption.] He wishes to expatiate now. Well, our delight is unanimous.
The pensioners who built Britain deserve nothing but the best in retirement, yet there are 1 million households in poverty because, according to research conducted by Independent Age, the Government have held on to a staggering £7 billion since the general election in unclaimed pension credit, increasing to over £17 billion by 2022— £10 million a day. What has been the Government’s response? An online toolkit used by 2,000 people last year. How do the Government begin to justify plunging 1 million pensioners into poverty? What will they do to ensure that all pensioners get the security and dignity they deserve?
The hon. Gentleman will know that, actually, pension credit applications are up significantly. It is also the case that successive Governments have attempted to promote pension credit. I share the frustration of colleagues that it is not higher than it presently is, but I want to emphasise that the DWP uses a variety of means to communicate and we urge all pensioners to apply for pension credit through the usual manner, whether through trusted third parties, jobcentres, local authorities or the like.
Due to automatic enrolment, 10 million workers have been automatically enrolled into a workplace pension, including 17,000 in my hon. Friend’s Walsall North constituency. In addition, the Government’s commitment to the triple lock has meant that the full basic state pension is now worth about £1,600 a year more in cash terms than it was in 2010.
I thank the Minister for that answer, but 3,440 households in my constituency will lose their free TV licence as a result of the BBC’s recent decision. Can he assure my constituents that pensioners with increased costs will be at the forefront of the Department’s decision making during the comprehensive spending review?
Clearly, I cannot comment on the specifics of the comprehensive spending review—I suspect that will be for the new Prime Minister—but the reality of the situation is that the triple lock and the various reforms we have introduced have meant that pensioners have done considerably better. We spend £120 billion on pensioners, of which £99 billion is on the state pension. That is a record sum.
Pensioners who apply for disability living allowance after the age of 65 are not eligible for the higher mobility component and are therefore not able to access the Motability scheme. The regulations are not new—they date to 1991—but our understanding of what it is to live a good life in retirement has changed in the intervening three decades. Will Ministers reconsider the regulations, so that pensioners continue to have the opportunity for full social participation?
The Department does not publish statistics on the number of people who receive a state pension below the full new state pension amount. As of November 2018, the average amount of the new state pension that people received, including any protected payments, was £154.91 per week.
I thank the Minister for that answer. While he may not have that figure, I can tell him that two of the people who do not receive that amount are Bob and Hilary Heyes from my Stoke-on-Trent constituency. Had they started to claim their state pension under the new state pension, they would have received the full amount because they had 35 qualifying years, but because they were born before 1951 and 1953 respectively, they receive considerably less. What would the Minister have me tell Mr and Mrs Heyes when they come to constituency surgery next?
Disability Confident is a very effective voluntary scheme, so compulsory options have not been discussed with Cabinet colleagues. Public bodies are already subject to the public sector equality duty. All main Government Departments are level 3 Disability Confident leaders, and 80% of local authorities are Disability Confident.
I hope I can be forgiven for saying—because I am going to say it anyway—that the House of Commons is a Disability Confident employer. It is absolutely right that we should be, but in case there are Members here who were not aware of that fact, they are now.
Thank you, Mr Speaker. My Harlow constituent, Lacey-Rose Saamanthy—a deaf lady—had a catering assistant job offer retracted by the Mid Essex Hospital Services NHS Trust on the basis that it could not mitigate against the so-called risks of her employment. This is despicable, so what steps is the Department taking to ensure that all employers, including the NHS, are signed up to the Disability Confident scheme and are aware of the funding available through the Access to Work scheme, as advocated by the National Deaf Children’s Society and others?
I know my right hon. Friend has championed the case of Miss Saamanthy and I understand that the trust has contacted her to discuss alternative roles in the organisation, including roles that staff with hearing disabilities have successfully been recruited into. I also encourage that particular NHS trust to sign up to the Disability Confident campaign.
I take this opportunity to pay tribute to the Speaker’s parliamentary placement scheme, which offers paid internships with training. The graduates graduated just last week. The one that I had the joy of hosting did very well out of that, and that was on the disability strand, hence my question. Will the Minister add his support to the disability strand of the scheme and also look at strengthening the learning from that scheme, so that we can help more employers in the public sector be better employers under Disability Confident?
Absolutely, and I am really encouraged to hear about that. Through the Disability Confident scheme and the Access to Work scheme, we want to do everything that we can to support these new opportunities being created, because ultimately, the employers benefit when disabled people’s talents are unlocked.
Thanks for the “young”, Mr Speaker.
The Minister seeks, in the Government’s proposal, to promote Disability Confident employers, but does he not recognise that, in April 2019, 85% of all mandatory reconsiderations for personal independence payment modified the original decision? Does he not agree that there seems to be rank hypocrisy in promoting Disability Confident employers while the Government are impoverishing my constituents in West Dunbartonshire and those across the United Kingdom?
We have over 2 million claimants on PIP, and only 5% of the applications have been taken to appeal. I recognise that those who go through the independent appeal process will, more often than not, have a decision overturned, which is why we have been working extremely hard, through a series of pilots within PIP, on the mandatory reconsideration stage and the independent appeals stage, so that we can get hold of the additional oral and written evidence earlier, which is what is often used to get the decision changed. This is an absolute priority for the Secretary of State and we are making sure that we are doing everything we can, as quickly as we can.
Universal Credit: Vulnerable Claimants
Universal credit ensures that support goes to those who need it most by simplifying the previously complicated legacy system, allowing 700,000 more people to receive approximately £2.4 billion in unclaimed benefits. Since 1 April this year, the Citizens Advice and Citizens Advice Scotland Help to Claim service has been in place, providing free, confidential and impartial support to help people, including those who are vulnerable, to make a universal credit claim.
I acknowledge the work that the Minister and the Secretary of State have done to improve universal credit, though concern remains that the five-week wait for the first payment is presenting a serious challenge to many people. To address this, will he accept the recommendation of the Bright Blue think-tank for one-off, up-front helping hand payments?
Those moving to universal credit will get more than 25% of their award through two weeks of additional housing benefit and, as of next year, jobseeker’s allowance, employment and support allowance and income support. Advances are available to cover the interim period, but we recognise the concerns about the payments in arrears and would welcome further ideas.
Vulnerable universal credit claimants often need to travel, sometimes long distances, to regular hospital appointments. What can the Minister do to help give these people the financial security they need to attend those regular and important appointments?
Universal credit claimants may be able to claim a refund for the cost of travelling to a hospital for treatment through the NHS healthcare travel costs scheme. To claim travel costs, claimants should take travel receipts, as well as their appointment letter or card and proof they are receiving a qualifying benefit, to a nominated cashiers office, which will be located in the hospital or clinic that treats the claimant. I should advise my hon. Friend that costs can be claimed back up to three months after an appointment.
The requirement for explicit consent built into universal credit makes it difficult for organisations such as Macmillan to support claimants as they did those on legacy benefits. When will the Government meet their commitment to review this requirement with the Social Security Advisory Committee, how will they engage stakeholders and when do they expect to report their findings?
A constituent of mine, Claudette, lives with her son, who is disabled, in private rented accommodation. She is in receipt of universal credit, but she did not receive her April rent payment, and the Department is refusing to investigate. Prior to that and ever since, universal credit has covered her rent. Will the Minister meet me to review this case, as my constituent fears eviction?
At the last oral questions, I raised the case of single parent Alicia in my constituency, who had seen fraudsters claim universal credit for her. The Minister promised to investigate but still has not. In the meantime, we have seen hundreds more cases across Greater Manchester, including that of my constituent Sarah, who has now, in spite of reporting the fraud, been asked to attend an interview under caution and been further victimised by the Department. Will the Secretary of State please make sure that victims of fraud and crime are not further victimised by her Department?
The pilot of the Government’s ill-conceived managed migration of universal credit is meant to start this month, but the Government have been very slow in coming forward with details. Is this because the level of payment to severely disabled people who lost out when they transferred to universal credit was found to be unlawful by the High Court?
The Government have repeatedly responded to criticisms of social security cuts—and have done so today—by claiming that they are targeting those who need support the most. How does that accord with spending nearly £200,000 on legal battles with severely disabled people and single mothers who have lost out under universal credit?
Personal Independence Payment
Let me answer the hon. Gentleman’s question and provide an important update on the Government’s work with Motability.
When PIP was first introduced, the Government worked with Motability to design a £175 million transitional support package to support Motability scheme customers who have not been awarded the enhanced mobility component on reassessment from DLA to PIP. Motability announced today that it would provide substantial additional financial support, including £1,000 for customers who lose eligibility for the scheme as a result of a PIP reassessment. It will also fund grants for personal contributions to the Access to Work scheme, and will accelerate the programme that is being undertaken with Family Fund to help many more families with severely disabled children under the age of three. I pay tribute to the proactive and constructive work done by Motability Operations in further supporting disabled people in society.
Notwithstanding what the Minister has said, some 52% of UK claimants who were claiming a mobility element under DLA found that it was either reduced or stopped altogether when they moved to PIP, and 2,370 people in the highlands have been hit in that way. Obviously, getting around in the highlands is not easy, and access to transport is not easy. Will the Government please look at this issue? My constituents are losing out, and it seems to me extremely unfair that those figures are so high.
Among those who have made the transition from DLA to PIP, an extra 144,000 who did not qualify for the enhanced mobility rate under DLA now do so under PIP. We have continued to work with Motability in respect of the additional transitional support that it has announced, and we will continue to keep a close eye on this important area.
I absolutely commend my hon. Friend’s constituent for the work that she does in her community. I also congratulate Ms Fennell on receiving the British Empire Medal in the Queen’s birthday honours, as well as a national citizenship award in recognition of her work: a true tribute.
Universal Credit: Access to Legal Aid
The Ministry of Justice is responsible for access to legal aid, and we will continue to work closely with it as it reviews the means test for entitlement. However, that is not the only initiative on which we have been working together. For instance, I recently announced an ex-offenders pilot scheme, which will provide enhanced employment support and help with access to universal credit in order to lift people out of the cycle of reoffending.
Solicitors in my constituency have told me that the DWP is refusing to supply written confirmation in the precise legal format that is required for legal aid applications made by people on universal credit. It is a case of one Government body refusing to comply with the rules of another. Is the Secretary of State aware of how deep these problems go, and will she ensure that no universal credit claimant misses out on legal aid because the DWP cannot follow the rules of the Ministry of Justice?
I am surprised to hear that question from the hon. Lady. According to my experience and the evidence that I have received during my conversations with the Ministry of Justice, there is no problem and it has been possible to passport in the same way. I hope that that will continue, but, as the hon. Lady knows, the Ministry of Justice is conducting a review. If she will write to me about that particular case, I will look at it myself.
Pension Liabilities: Plumbing Industry
I met plumbing representatives from Lancashire recently, and those in Angus and Perth last year. We also debated this matter in the House last year. There are nearly 1,000 last man standing multi-employer schemes. Most respondents to the Green Paper on defined-benefit pensions felt that the current buy-out basis was a clear and fair way in which to calculate an employer debt.
I cannot speak on the specifics of the individual scheme, but the majority of the employers in these schemes are incorporated and are not personally liable for any debt. The flexible apportionment arrangement can be used to help unincorporated employers who wish to incorporate, and the plumbing pension trustee has a streamlined flexible apportionment arrangement process that employers can use. Alternatively, where the employer debt arises in multi-employer schemes as a result of an employer cessation event, there are a number of mechanisms in the occupational pension schemes employer debt regulations that can be of assistance.
Now that we have moved from the design to the implementation of universal credit we continue to seek ways to ensure that it is a fair, compassionate benefit that takes account of people’s circumstances. I know that there have been concerns across the House about how overpayments of benefits that result from fraud or error are recovered from claimants, and I pay tribute to the hon. Member for High Peak (Ruth George) and my hon. Friend the Member for South Ribble (Seema Kennedy) for alerting me to this issue.
I am able to announce today that in cases where a claimant has been convicted of defrauding the Department and their only considerable asset is their home, we will take account of this prior to instigating Crown court proceedings to recover assets under the Proceeds of Crime Act 2002. This ensures a proportional response that should not result in the claimant having to subsequently apply to the Department for housing benefit. We believe this provides the right balance between pursuing what is owed to the Department and acknowledging the deprivation debt recovery can cause some claimants.
I had intended to ask another question, but I want to refer to the answer given to me by the Minister for Disabled People, Health and Work; he is a very serious Minister but gave a very disappointing answer worthy of Sir Humphrey. The fact is that my constituent Lacey-Rose Samaanthy, who is deaf, was offered a job by the NHS in mid-Essex; I saw the letter. That job offer was then rescinded because it said it was too difficult. She then got another very similar job in another organisation and it was able to adapt to her needs. This sort of thing should not be happening; it is incredibly unjust, and I want to know what the Department is going to do about it by being humane and showing compassion to my constituent.
I thank my right hon. Friend for being such a great champion of people with disabilities and tackling the challenges they have in the workplace, and I must say that the example he has given is very disappointing, because we would always hope and expect employers to show compassion and support where they have applications and the opportunity to employ disabled people. The work that this Government are doing will always try to address that, and with my right hon. Friend’s help we will make sure we get it right.
The two men competing to be the next Prime Minister have both said they would be willing to push through a catastrophic no deal. That is despite long-running warnings that disabled people will be hit hard by a no deal, with risks to vital medical supplies and the recruitment of care workers and the loss of the European social fund. However, last week Ministers revealed that the Government have not carried out any assessment of the impact of no deal on disabled people, so will the Minister commit to carrying out such an assessment, and could he in good conscience be part of a Government who pushed through such a reckless act?
The hon. Lady may be aware that I have some concerns about no deal; I would much prefer that this country chooses to leave the European Union on the basis of a deal, and I am hopeful that when we have a new leader in place we will be able to arrive at that position, possibly even with the support of the hon. Lady, to try to ensure that we get an exit that supports disabled people as well as everyone else.
I thank my hon. Friend for the energy with which he is supporting his constituents on universal credit. One of the key performance indicators is, of course, payment timeliness, which has improved significantly over the past couple of years, and that progress is matched in Alloa jobcentre. His local jobcentre staff will be happy to interact with him and, of course, I am also happy to meet him.
I thank the hon. Gentleman for his work in this area, and I reassure him that there have been several meetings with Marie Curie on this subject. I will take an interest in the report that is coming out on Wednesday, and I can tell him that we are once more looking at this matter again.
As my hon. Friend knows, more people are in work now than ever before. Indeed, the employment rate is higher in every region of the country than in 2010, including in the Black Country. Specifically, he may already be aware that Willenhall jobcentre is working closely with major employers on employment opportunities and, of course, that our mentoring circles programme is being rolled out for 18 to 24-year-olds to help them increase their employability skills.
I am taking this case very seriously, and I have had the right hon. Gentleman’s letter. At the moment, we are doing an internal inquiry, and if the right hon Gentleman will leave that with me, I will come and talk to him if anything additional is required.
I thank my hon. Friend for highlighting such a fantastic proactive example that is making a real difference, and I support anything further that we can do. The number of applicants to the Access to Work programme with a learning disability increased by 22% in the last year alone. That is an encouraging trend, and we must do much more in this important area.
I saw the report, which was published last week, and noted the findings on page 15 and the four recommendations, many of which we are already doing. Whether through jobcentres, third parties, local authorities or our various other communications, we want more people to be claiming pension credit, and we are trying to do everything possible to make that happen.
Last week I had a meeting with a Parkinson’s support group in my constituency and was told about the many struggles that sufferers face. Will the Minister review the 20-metre rule, so that more people with Parkinson’s who have mobility problems can qualify for essential support, such as the blue badge scheme?
I thank my hon. Friend, and I would be happy to meet her to discuss this further. It is a rule of thumb, but we have to look at whether somebody can repeatedly, regularly and safely travel 20 metres. I welcome the fact that, under PIP, 55% of those with Parkinson’s qualify for the highest rate of support.
I understand why the hon. Lady raises that question but, under DLA, only 15% of claimants actually got the highest rate of support, whereas the rate under PIP is now 31%. One of the key things is that 70% of DLA claimants were on lifetime awards, yet one in three claimants’ condition had significantly changed within 12 months and they would have been entitled to a different rate—predominantly a higher rate, rather than a lower rate—and we do not want people to miss out. That is why, under PIP, we are now spending an additional £6 billion a year to support some of the most vulnerable people in society.
There has recently been a noticeable increase in the number of my constituents in receipt of personal independence payment who, on reassessment, have had it stopped or reduced. Will my right hon. Friend agree to meet me to discuss this worrying trend and to see what we can do to sort it out?
I would be happy to meet my hon. Friend. We work closely with stakeholders to look at how we can continue improving the system, but I repeat that we are now spending an additional £6 billion and that a significantly higher rate of claimants are now on the highest level of support, and rightly so.
I thank the hon. Lady for raising this question, and I am mindful of the Select Committee report that addressed some of it. We have now made changes so that women going into work for the first time from benefits—either universal credit or a legacy benefit—will be able to access advance payments for that first month so that they do not have to find the money themselves. I am making sure that work coaches have more independence to support people back into work; that is one of the changes I have made.
I thank my hon. Friend for that question. The Government remain committed to tackling poverty so that we can make a lasting difference to long-term outcomes. I am pleased to say that the Government have lifted 400,000 people out of absolute poverty since 2010, and income inequality has fallen.
We have made substantial responses to Philip Alston’s report. We have acknowledged some of his suggestions, and we will look at changing our assessments on poverty by using the Social Metrics Commission’s proposal. Otherwise, we are disappointed by the very political nature of his approach.
Will the Secretary of State confirm that, when fully rolled out, spending on universal credit will actually be £2 billion a year higher than is currently spent on the equivalent legacy benefits, and that this will be worth some £300 a year to each recipient family?
Okay, I will take the point of order now. The hon. Gentleman has been jumping up and down like a veritable Zebedee, and so I shall accommodate him on this occasion, but I advise him that in the ordinary course of events points of order tend to be taken after statements. [Interruption.] It is not obligatory, and the Secretary of State for Health and Social Care can wait for his statement. I know he has all sorts of other activities in which he wishes to be busily engaged, but I am afraid he will have to wait.
On a point of order, Mr Speaker. Thank you very much for finding the time for this. I am standing next to the Leader of the Opposition, whose fitness is legendary. I wonder whether you have received an application by a Minister to make a statement to the House on the principle of civil service neutrality. I ask following the undemocratic and unconstitutional public intervention attributed to senior civil servants and based on a falsehood printed in Saturday’s The Times. No doubt you will agree that since the 1854 Northcote-Trevelyan reforms the professionalism and objectivity of our public servants has been admired throughout the world, and it is a cornerstone of our democracy. But there must be no hesitation at all in condemning the kind of behaviour reported, and I would hope that the Government will root out any miscreants who have behaved in this way. Finally, I wonder whether you can do anything to encourage Ministers, if they have not already approached you, to make a statement in the House or arrange time for a debate about this very important principle.
I am very grateful to the hon. Gentleman for his point of order. I have not received any indication that a Minister is planning to make an oral statement in the House on this matter, although it is perfectly open to a Minister to offer to do so. The Northcote-Trevelyan principles are of the utmost importance, and I hope they will be upheld by Governments indefinitely. They have existed for a long time because the principles involved—permanence, anonymity and neutrality—are absolutely sacred. I simply suggest that the hon. Gentleman pursues the matter with his characteristic persistence and vigour, and I feel sure that, using the Order Paper and the resources provided by the Table Office, he will be happy to do so.
Further to that point of order, Mr Speaker. I just want to reassure the House that we have complete confidence in the fairness and independence of the civil service. It has said that it will respond and I frankly question the good judgment of the shadow Minister for bringing this up in the House at this stage, before it has had the chance to do so.
I do not want to dwell on this matter. Suffice it to say that the Leader of the Opposition looks perfectly healthy to me; I have known him a long time and he is a very healthy-living fellow in my experience. On a serious note, I do think that the convention is sacred and it really should not brook of any dispute across the House. It might be best to leave it there. I gently suggest to the hon. Gentleman that he has made his point with considerable lucidity and let us leave it there.
We come now to the statement from the Health and Social Care Secretary, which he has been eagerly awaiting. I know that he will want to deliver his own words with every ounce of aplomb at his disposal. I call Secretary Matt Hancock.
NHS Long-Term Plan: Implementation
Mr Speaker, I would like to update the House on the implementation of the NHS long-term plan and the delivery of improvements to the health service. Today marks the 100th anniversary of the Ministry of Health, founded under the Liberal and Conservative coalition of Lloyd George, and the Department has been staffed by brilliant, impartial civil servants ever since, and is today.
I can tell the House that on Thursday last the boards of NHS England and NHS Improvement agreed the long-term plan implementation framework. Alongside the clinical review of standards, and the interim workforce plan, published last month, this framework is a critical step in delivering on our 10-year vision for the NHS, and in transforming our health service with the record funding that this Government are putting in. The document sets out the framework within which each of the 300 commitments in the long-term plan will be delivered, and it also sets out the 20 headline commitments and how we will monitor the delivery of the plan. In the past, there have been criticisms that NHS plans have not led to full delivery. We are determined to ensure that the long-term plan fulfils its potential to transform the health service for the better, and I am placing a copy of the implementation framework in the Libraries of both Houses.
I wish to draw attention to three particular areas, the first of which is cancer care. I thank my hon. Friend the Member for Basildon and Billericay (Mr Baron) for his efforts to ensure that we focus on the vital indicator of cancer survival. The Prime Minister set out the ambition that by 2028 three quarters of all stageable cancers are detected at stage 1 or stage 2. Early detection and diagnosis are essential to the enhancement of people’s chances of surviving cancer.
Since 2010, rates of cancer survival have increased year on year. However, historically our survival rates in the UK have lagged behind the best-performing countries in Europe. The implementation framework sets out our goal of measuring the one-year cancer survival rates as one of the core metrics for the long-term plan. The one-year survival rate is how we measure our progress in achieving the ambitions set out in the plan. To realise those ambitions and ensure that we do everything we can to give people diagnosed with cancer the best chance of survival, the framework sets out first, a radical overhaul of screening programmes; secondly, new state-of-the-art technology to make diagnosis faster and more accurate; and thirdly, more investment in research and innovation.
From this year, we will start the roll-out of rapid diagnostic centres throughout the country, building on the success of a pilot with Cancer Research UK, so that we can catch cancer much earlier. NHS England is further extending lung health checks, targeting areas with the lowest survival rates, and Health Education England is increasing the cancer workforce, which will lead to 400 more clinical endoscopists and 300 more reporting radiographers by 2021. With these steps, our ambition is that 55,000 more people will survive cancer for five years, each year from 2028. Improving the one-year survival rate is how we ensure that the NHS remains at the forefront of cancer diagnosis and treatment and continues to deliver world-class care.
The second area is mental health. The Prime Minister and her predecessor rightly prioritised the treatment of mental health so that we can ensure that mental health finally gets parity with physical health. The £33.9 billion cash-terms settlement, which is the longest and largest cash settlement in the history of the NHS, includes a record £2.3 billion extra in real terms for the expansion of mental health services. The framework sets out how 380,000 more adults and 345,000 more children and young people will get access to mental health support. I pay tribute to the mental health Minister, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who has done so much work to put the issue on the agenda.
We are introducing four-week waiting-time targets for children and young people and testing four-week community mental health targets for adults. The implementation framework refers specifically to the vital improvements to community mental health services that we all know are needed. Those improvements include services for adults living with serious mental disorders, including eating disorders, and for those coping with substance misuse. The framework also sets out how we will create a new workforce of mental health support teams to work with schools and colleges to help to identify young people who need help and reach them faster. In all, it is a fundamental shift in how we treat mental illness and how the NHS will prioritise mental health services.
The third area that I wish to touch on is people. Three quarters of the NHS budget goes on staff, because people are the most valuable resource that we have in the NHS. We need not only the right numbers but to ensure that staff have the right support. The long-term plan sets out our ambition to recruit, train and retrain the right numbers of staff over the next decade. Last month, Baroness Dido Harding set out the interim people plan, which sets out how we will build the workforce we need and create the right culture, so that doctors, nurses and other NHS staff have the time to care for patients and for themselves.
Last week, the British Medical Association accepted in a referendum the new agreement with junior doctors that will improve both pay and working conditions. Thanks to the hard work of my predecessor, we are already taking steps to increase the number of clinical training places by opening five new medical schools and increasing the number of routes into nursing through apprenticeships and nursing associates. Last year, more than 5,000 nursing associates started training through apprenticeships. This year, it will be up to 7,500.
Those are just three of the most vital areas from the 10-year vision for the NHS set out in the long-term plan. Across England, based on the implementation framework, local strategic plans are now being developed and will be brought together as part of a national implementation plan by the end of the year, and all of this will be underpinned by technology. Today sees the official opening of NHSX, the new part of the NHS, which will drive digital transformation to give citizens and clinicians the technology they need and save and improve lives. I am delighted that NHSX has received such a warm welcome across the NHS because it has so much potential to transform every part of health and social care for patients and staff.
The forthcoming spending review will settle budgets for health education, public health and NHS capital investment, and the settlements will feed into the final implementation of this plan. As part of the spending review, we will also review the current functioning and structure of the better care fund, which is rising in line with NHS revenue growth.
On this the 100th anniversary of the foundation of the Ministry of Health, this framework sets out how we will go about securing the foundations of the national health service into the next century and the creation of an NHS that delivers world-class care for generations to come. I commend this statement to the House.
I am grateful to the Secretary of State for an advance copy of his statement. I had hoped for a greater sense of urgency from him. He talks about the 100-year anniversary of the Ministry of Health, but this year is the first time in 100 years that the advances in life expectancy have begun to stall, and even go backwards in the poorest areas. Just the other week, we saw that infant mortality rates have risen now for the third year in a row. As this is the first time that they have risen since the second world war, I would have hoped for a greater focus on health inequalities in his statement today, not least because public health services—the services that, in many ways, lead the charge against health inequalities—are being cut by £700 million. Now he says that we should wait for the spending review for the future of public health services, but we do not know when the spending review is. The Chief Secretary to the Treasury has said that it will be delayed, so it could be next year.
In the past, the Secretary of State has talked about a prevention Green Paper. Will that prevention Green Paper be before the spending review or after the spending review? Will he also tell us whether it is still the intention of the Department to insist that local authorities fund their public health obligations through the business rates?
At the time of the publication of the long-term plan last year, the then Secretary of State for Health said that we cannot have one plan for the NHS without a plan for social care, yet we still have no plan for social care. We have been promised a social care Green Paper umpteen times. We are more likely to see the Secretary of State riding Shergar at Newmarket than see the social care Green Paper. Where is it?
The Secretary of State talks about the better care fund revenue increase. May I press him further on that? Is he saying that the clinical commissioning group allocations to the better care fund, which tend to be the bulk of the better care fund, will increase in line with the NHS revenue increase, or is he saying that there will be new money available for the better care fund? Adult social care has been cut by £7 billion since 2010 under this Tory Government, which is why hundreds of thousands of elderly and vulnerable people are going without the social care support that they need. Presumably, we will have to wait for the spending review for proposals on social care.
The Secretary of State talks about the workforce. We have 100,000 vacancies across the NHS. We have heard about the interim people plan, but of course we have seen the bursary cut, the pay restraint, and the continuing professional development cut. That plan is all good and fine, but when will it be backed up by actual cash?
The Secretary of State talks about IT systems and apps—we know that he is very fond of that—but again he gives us no certainty on capital investment. Hospitals are facing a £6 billion repair bill—ceilings are falling in and pipes are bursting. The repair bill designated as serious risk has doubled to £3 billion. When will we have clarity on NHS capital?
We broadly welcome what the Secretary of State said about mental health, but 100,000 children are currently denied mental health treatment each year because their problems are not designated as serious enough, and over 500 children and young people wait more than a year for specialist mental health treatment. He talks of a fundamental shift, so can he guarantee that clinical commissioning groups will no longer be allowed to raid their child and adolescent mental health services budgets in order to fill wider gaps in health expenditure? On mental health resilience and prevention, only 1.6% of public health budgets is currently spent on mental health, so will he mandate local authorities, when setting their public health budgets, to increase the money they spend on mental health?
On cancer, we broadly welcome what the Secretary of State has said, but patients are waiting longer for treatment because of vacancies and out-of-date equipment. Today we learned that consultant oncologists with shares in private hospitals are referring growing numbers of patients to those hospitals. Is that not a conflict of interest? When will we see tougher regulation of the private healthcare sector?
The Secretary of State talked about the clinical review of standards that is being piloted in 14 hospitals, yet those hospitals are not publishing the data. If he wants to abandon the four-hour A&E target, will he insist that those pilot hospitals publish all the data? He did not mention waiting lists. We have seen CCGs rationing treatment because of the finances. We have seen 3,000 elderly people refused cataract removals. We have seen CCGs refusing applications for hip and knee replacements. We have even seen a hospital that until last week was inviting patients to pay up to £18,000 for a hip or knee replacement—procedures that used to be available on the NHS. When is he going to intervene to stop that rationing of treatment, which we are seeing expand across the country because of the finances?
Finally, there are many laudable things in the long-term plan that we welcome. Alcohol care teams were a Labour idea. Perinatal mental health services were a Labour idea. Gambling addiction clinics, which the Secretary of State announced last year, were a Labour idea. Today he is talking about bringing catering back in-house, which is also a Labour idea. Why does he not just let me be Heath Secretary, and then he could carry on being the press secretary for the right hon. Member for Uxbridge and South Ruislip (Boris Johnson)?
Well, it is great that by the end of his questions the hon. Gentleman finally got to the future of the NHS, which is what we are here to discuss. However, what I did not hear—unless I missed it—was a welcome for the extra £33.9 billion that we are putting into the NHS. I did not hear him welcome the fact that life expectancies are rising, or our plan to drive up healthy life expectancy still further. I did not hear him say whether the Labour party supports our efforts to ensure that the NHS is properly funded and supported not only now but into the future, because that is what this Government are delivering.
I will go through some of the questions that the hon. Gentleman did raise. He asked about the prevention Green Paper. Indeed, he will know that preventing people getting ill in the first place is a central objective of mine, and it will be forthcoming shortly. He mentioned the better care fund. I was very precise in what I said about the better care fund, because its funding is rising in line with NHS revenue growth. In fact, the overall funding available to deliver social care in this country has risen by 11% over the past three years. Of course there is more to do to ensure that we have a social care system that is properly funded and structured to ensure that everybody can have the dignity of the care they need in older age, and that people of working age get the social care they need, but the Labour party ought to welcome the increase in funding, as well as the aim of ensuring that we get the best possible value for every pound.
The hon. Gentleman mentioned the clinical review of standards, which he welcomed when it was announced recently. The pilots that he mentioned started just four weeks ago, and of course we will be assessing the results and ensuring that we get the right structures in place in future. I am glad that he welcomed it, but in relation to publishing data, after just four weeks it is unsurprising that we are still in the early stages.
The hon. Gentleman asked me to ensure that the increase in funding for mental health will happen and that CCGs will be required to see that increase flowing through to make sure that patients get better service. I can confirm that NHS England is already intervening. The £2.3 billion increase that we have set out in the long-term plan will be required to flow through to the frontline. This implementation framework is part of the system that we are putting in place to make sure that that happens.
I very much welcome the Secretary of State’s announcement on putting the one-year cancer metric at the very heart of cancer services as a means of encouraging earlier diagnosis. You will be well aware, Mr Speaker, that the all-party parliamentary group on cancer has long championed the need to put this metric at the very heart of our services in order to encourage earlier diagnosis. The inconvenient truth is that despite the best will of those on both sides of this debate on the need to focus on process targets, we have failed to close the gap on international averages in our cancer survival rates. I chaired the APPG for 10 years, and I know that the current chair, the hon. Member for Scunthorpe (Nic Dakin), is waiting to speak as well. Will the Secretary of State ensure that sufficient funds are allocated to the one-year metric, because history would suggest that this metric has been there, or thereabouts, in the mix before, but because the money has been attached to the process targets, local NHS systems have ignored it?
I pay tribute to the work that the APPG, so ably led, has done in putting the measurement of improvements of cancer services at the forefront of the debate. I particularly acknowledge the point about early diagnosis. Here in the UK, we are one of the best countries in the world at treating cancer once it is diagnosed, but we are behind the curve on early diagnosis. Putting a one-year cancer diagnosis metric at the heart of the implementation of the long-term plan is a critical step in making that happen. What is going to happen now is that each of the local systems will feed into the framework in terms of how they will be putting this into action. The full implementation plan, which will be published shortly after the spending review, will take that into account, as well as all the budgets that need to be settled in the spending review. I would recommend to my right hon. Friend—my hon. Friend—[Interruption.] Just for now. I recommend that he keep up this campaign, because we have made significant progress in the implementation framework but there is still more to do.
There is no reference to GPs in the statement—I have just been looking through it. This comes at a time when my constituents are telling me that they are having to wait three weeks to get a GP appointment. Faith House GP surgery on Beverley Road, which I have raised with the Secretary of State directly, is now due to close. It is all very well training doctors for the future, but what is he going to do about the crisis in primary care now?
I picked out three of the 20 areas that we are particularly focused on in this implementation framework, one of which is the number of GPs and the broader primary care workforce, because it is not just about GPs but about all those who also support primary care across the board. We have a clear target of 5,000 more GPs, based on the 2015 baseline. We have a record number of GPs in training. Last month, the Minister for Health, my hon. Friend the Member for Wimbledon (Stephen Hammond), announced the consultation on changes to the pension to remove some of the unintended consequences of pension tax changes for GPs to ensure that we retain our highly trained, highly qualified GPs. There is a whole load of work in the people plan being led by Baroness Dido Harding to make sure that we have the number of GPs that we need and the wider primary care health workforce that is necessary.
As my right hon. Friend said, the first Minister of Health was Christopher Addison, then a Liberal, who abolished his position as President of the Local Government Board to succeed himself as the first Minister of Health in 1919, but the first Secretary of State to hold up a White Paper saying “national health service” was the Conservative Sir Henry Willink in 1944. We must give credit to the Labour party for bringing in the health service, agreed by the coalition Government, in 1948, although we have to recognise that Aneurin Bevan decided to nationalise the hospitals and not the GPs, when most people expected it to be the other way round.
In the experience of my wife, who did five years as Minister for Health and Secretary of State for Health, we should be praising all those who support the clinicians—the support workers, administrators and others who help doctors, nurses and other professionals—to look after us at all stages of our lives. We must have the extra money. I am glad that we have gone beyond the Labour party’s ambitious targets to meet our own ambitious targets, and that we can look forward to doing more, because we have to recognise that health will require a greater proportion of our wealth as we live longer and want better services.
I wholeheartedly agree with the entirety of what my hon. Friend said. It is true that for the majority of its 71-year history—71 this week—the NHS has been run by Conservative Secretaries of State, and the largest cash injections have come from this party. It is a truly national institution that we should all support, and we have to support not only the doctors, who lead many parts of the NHS, and the nurses, but all the health service staff, because it is a true team effort.
The Secretary of State may remember that I brought a group of mental health reformers to see him, to make the case for culture change in mental health services to address clear human rights abuses such as locking people up when they do not need to be locked up, often for a long period, shunting people around the country in ways that would never happen with physical health and the endemic use of force in mental health services. We argued that ending inappropriate institutional care would free up money for better prevention and early intervention. He said he loved that approach. Is he doing anything to actually implement it?
Yes. First, in terms of the review led by Simon Wessely of the legal powers set by the Mental Health Act 1983, there will be a Government response and then legislation in due course. We want to get that legislation right and bring it forward on an open basis, to ensure that we get a consensus behind it before introducing it formally to the House. On the administrative side, a programme of work is under way to deliver exactly what the right hon. Gentleman mentioned. In my statement, I specifically referenced the expansion in community mental health services that must happen, which will be good value for money and, of course, much better for many patients.
I felt that my right hon. Friend’s announcement deserved a more enthusiastic response than the uncharacteristically churlish one it received from the shadow Health Secretary. In terms of mental health, I particularly welcome the introduction of four-week waiting time targets for children and young people, because I know how much distress has been caused to many of my constituents by undue delays in the assessment and treatment of young people with mental health problems. Can he tell the House when he plans to implement those new waiting time targets and how he will keep pressure on CCGs, so that the benefits are seen on the ground as soon as possible?
I thank my right hon. Friend for his question. The shadow Secretary of State is so nice behind the scenes that he sometimes has to get a bit spiky in public, just to prove to his masters in the Leader of the Opposition’s office that he is on their side.
Over the rest of this year, we will deliver the plan to ensure that these targets are put in place. The truth is that we can only manage what we measure, and having a target for access to mental health services and pilots on how we do that for children’s health services is an incredibly important part of ensuring that the system lines up behind the rapid availability of mental health services, which, as I imagine every Member knows from constituency casework, is critical.
I very much welcome the ambition of this plan, the recognition that it will need appropriate resources—it very much needs appropriate staffing, because the human resource is most important—and the emphasis on cancer and early diagnosis. May I ask the Secretary of State how he will ensure that improvements in early diagnosis for less survivable cancers are central to the target to diagnose 75% of cancers at stage 1 and stage 2? There is a concern that the less survivable cancers will get neglected, given the nature of the plan at the moment.
I am grateful to the hon. Gentleman for the tone that he takes, and he is absolutely right in his analysis. I know he met the cancer Minister, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for South Ribble (Seema Kennedy), last week on this point. We absolutely will address it, and we will not miss the less survivable cancers. Indeed, the focus on early diagnosis will of course help survivability, but it is also a focus across all cancers equally, rather than just on those where survivability has improved so much.
Yes, my hon. Friend is absolutely right. The plan is of the NHS by the NHS for the NHS. We in Government will absolutely facilitate it and support it, and of course we are putting in the money, but the NHS as a whole should be very proud of what this plan proposes and the way the implementation is being done in such a rigorous fashion.
May I press the Secretary of State a little further on the section of the plan that relates to prevention and early intervention? We are all waiting still for the prevention Green Paper. In particular, there are some diseases and illnesses, such as stroke, where apparently four out of five cases could be prevented by such early action, whether it is diagnosis of atrial fibrillation, or blood pressure and cholesterol testing devices. What more can be done for this Government to show they are serious about preventing ill health, such as stroke?
I completely agree with the hon. Gentleman. The whole plan—the whole NHS long-term plan—is about prevention as well as cure. The focus of the NHS needs to switch more towards prevention as well as, of course, helping people get better when they get ill. Taking the example of stroke, there is a lot on the prevention of stroke in the draft prevention Green Paper—just to give him a bit of a teaser for that. At the core of improving prevention of stroke is both behaviour change but also better use of data, because being able to spot people who have symptoms that are likely to lead to stroke can then help much more targeted interventions. I find it striking that with the big stroke charities, as with the big heart charities, their big ask is for better and more access to data.
May I thank my right hon. Friend for his statement and his commitment to this implementation plan, alongside the commitment to increase clinical standards? That is not a criticism of the medical professions; it is just a determination to make sure that the NHS is an infinite learning organisation and can learn from its mistakes. In that respect, will he recommit to HSIB—the healthcare safety investigation branch of his Department—which is devoted to doing clinical investigations without finding blame, so that these problems can be surfaced and the learning can be implemented across the NHS? In particular, will he recommit to the legislation, which has been through prelegislative scrutiny and is still waiting to be introduced?
Yes, I am looking forward to that legislation being introduced. The work that my hon. Friend’s Select Committee—the Joint Committee on the Draft Health Service Safety Investigations Bill—did in the prelegislative scrutiny was incredibly important. The HSIB Bill promises to improve patient safety, which is an important part of the agenda, and I look forward to its being brought forward to the House.
I have recently become the vice-chair of the all-party parliamentary group on sickle cell and thalassaemia. Sickle cell is very much a hidden disability which is lifelong. Some people take up to five medications a day, which is very costly. If they have a relapse, they can be hospitalised, but it is more cost-effective and preventive to have free prescriptions than to end up in hospital. Will the Secretary of State review the matter and do what is both best for those patients and in the public interest?
I will certainly look at the matter. When I was on a night shift with a London ambulance crew, we attended a patient who suffered from sickle cell, and it was horrific to see the degree of pain that they were in. I have therefore seen at first hand exactly how horrific the condition can be and I will look into the hon. Lady’s suggestion.
I was delighted to be able to show the Secretary of State the health and wellbeing hub in Budleigh Salterton and the opportunities at Ottery St Mary community hospital, and that he confirmed that both places had a role to play in the future of health provision in East Devon. However, last week, the National Audit Office found that community hospitals and GP surgeries were struggling to pay the rents charged by NHS Property Services and that, nationally, outstanding debt has almost tripled since 2014 to £576 million. If my right hon. Friend is interested in securing a legacy before he moves on to even higher political office, will he please look at that, particularly in advance of the review planned for 2021?