House of Commons
Monday 8 March 2021
The House met at half-past Two o’clock
[Mr Speaker in the Chair]
Virtual participation in proceedings continued (Order, 4 June and 30 December 2020).
[NB: [V] denotes a Member participating virtually.]
Oral Answers to Questions
Work and Pensions
The Secretary of State was asked—
Kickstart: Employer Accessibility
I am pleased to update the House that, after removing the threshold last month and allowing direct applications for any number of roles, we saw an increase of 3,000 employer applications throughout February, which is a jump of 75%. There will continue to be an important role for gateways as we progress to our ambition of 250,000 kickstart jobs, which we are well on the way to achieving, with almost 150,000 roles approved, more than 4,000 young people having started their roles and another 30,000 vacancies live right now.
I thank my right hon. Friend for her answer. Given the large number of small and medium-sized enterprises across the county, jobcentres in Bedfordshire, including the one in Biggleswade in my constituency, are raring to go to enable small businesses to take advantage of this change in Government policy. Can she advise me what she is doing to ensure that those small businesses are aware of the scheme and its benefits?
My hon. Friend should be aware that we have account managers working in all parts of the country to take up this scheme. In particular, we continue to work with a wide range of organisations closely connected to SMEs, including chambers of commerce and the Federation of Small Businesses, to get the message out there and make it straightforward to apply. We should recognise that, due to eligibility criteria, not all direct applications may be successful, and the support of a gateway is likely to be beneficial. We are also enabling applications through the gateway plus model, which will particularly help sole traders, and we will continue to advertise that.
I thank my right hon. Friend for her answer. I welcome the removal of the 30-person threshold, which will help even the smallest firm in my constituency. Since the launch of the kickstart scheme, our phenomenal Tees Valley Mayor Ben Houchen has been facilitating SMEs to access it, and he has helped 350 young people sign up. Will my right hon. Friend join me in commending Ben for the fantastic work he is doing to help young people in Darlington gain experience and employment?
I am very happy to agree with my hon. Friend that Ben Houchen is doing a fantastic job in his role as Mayor. In case people had not realised, as well as getting Treasury North in my hon. Friend’s constituency of Darlington—a project that I am sure my hon. Friend achieved with the Mayor—Ben Houchen is leading the way on making that difference to young people’s lives, which is really important. I have also seen it work well with Andy Street and, to be fair to other Mayors, I am confident that people like Steve Rotheram and others will continue to do so.
In Harrogate and Knaresborough, we have seen great organisations such as St Michael’s Hospice with North Yorkshire Hospice Care offer 30 roles in support services, from retail to catering, care and communications. Not everywhere is fortunate enough to have such a progressive organisation, so the policy change is welcome. I was originally going to ask my right hon. Friend about the increase that she has seen from this policy change, but she has answered that. Will she keep the House informed, so that Members of Parliament can help to promote this fantastic opportunity and see more people get the opportunities that kickstart can provide?
My hon. Friend is right to point out that removing the threshold has enabled a number of institutions to apply directly to kickstart. The example he highlights was already under way, but it just shows some of the fantastic opportunities that this scheme can offer young people. By creating so many of these roles, with the wider variety of roles that we are seeing, we are reducing the risk of long-term unemployment for hundreds of thousands of young people, and we will continue to keep the House updated on progress.
Kickstart is only for young people claiming universal credit. Many disabled young people claim employment and support allowance instead. Will the Secretary of State consider extending kickstart to include disabled young people who are not eligible for it at the moment?
The right hon. Gentleman will be aware that young people with disabilities can move on to universal credit, so there may be an incentive to do that, but this issue is under consideration. My hon. Friend the Minister for Disabled People, Health and Work has discussed this with me and the Minister for Employment, and we are considering it further.
PIP Application Process: Disabled People
We have made a series of improvements to the personal independence payment claimant experience following research and two independent reviews. Building on that, the forthcoming Green Paper on health and disability support is being influenced by the views of disabled people and representatives from disability organisations.
I wrote to the Minister last week telling him about the work of the Morecambe Bay Poverty Truth Commission, which has empowered people who have experienced the social security system to speak truth to power and try to improve the system. Will he meet the PIP claimants in my constituency who want to tell him about their experiences?
I thank the hon. Member for that question, and I would be delighted to do that. I know that she has been very proactive on a number of issues in my area over the years, and I would be delighted to have a meeting with her and her organisation to listen to their experiences.
Following the coroner’s damning prevention of future deaths report in the case of Philippa Day, who took an overdose and, sadly, passed away because of DWP and Capita failings, have the Government implemented the recommendations, and if not, when will they? As well as responding to the coroner, will the Minister keep this House updated, and do the Government not accept that, when so many people have to go through an inhumane assessment process, the system is flawed and it is time for a radical change?
While I cannot comment on individual cases, when we tackle any of these serious issues, we put a great amount of thought and care into doing so. That is why the Department set up the serious case panel, personally led by the Secretary of State, to look at the themes and to make sure, if there are any lessons that need to be learned, they are shared with the key decision makers quickly, and that we improve our support and our services for some of the most vulnerable people in society. It is a real priority for our Department.
As part of our estates expansion and renewal programme, the DWP by summer will have rapidly increased the number of Jobcentre Plus sites, placing them in new locations where they are needed. This will ensure that we bolster our face-to-face support in a covid-safe environment for both our claimants and our additional 13,500 new work coaches. As Members will appreciate, negotiations on some sites are ongoing, and I will update the House further when appropriate to do so. Meanwhile, MPs with a new site opening in their constituency are being notified.
Sadly, the pandemic has meant that many people in my constituency of Aylesbury have lost their job and, for the first time in decades, find themselves looking for work. How can my hon. Friend ensure that the Jobcentre Plus estate and its staff are equipped to help jobseekers who are in their 50s and 60s, who have paid their taxes and their national insurance for their whole working lives and now need bespoke personal assistance to find a new job and continue to contribute to the economy?
We are supporting people of all ages back into work in Aylesbury and beyond. The DWP has a network of 50-plus champions throughout our JCPs. These champions work with work coaches and stakeholders to focus help and support for the over-50s, highlighting the benefits of employing them and sharing best practice. Our plan for jobs provides new funding to ensure that everyone, including those 50 and over, get tailored support to build on their skills and move into work.
Many businesses in remote rural communities, as in North Devon, are a long way from a Jobcentre Plus, and therefore would not usually use the jobcentre to advertise vacancies, particularly given poor public transport. What assurances can my hon. Friend give that rural businesses will be actively engaged by Jobcentre Plus, as it is especially important that young people looking for work in such rural communities are able to access local jobs through the kickstart scheme?
Our JCPs are engaged with local recovery plans, including in rural areas. They are essential to help people of all ages into work and help all communities to thrive. In North Devon, the DWP is funding the youth flow partnership with local businesses and the chambers of commerce to help young people engage with opportunities such as kickstart. I was delighted to join my hon. Friend at her recent event with local businesses in her community to discuss kickstart and how we can tailor those opportunities for every area.
My hon. Friend will now be aware that we have signed a lease on a new jobcentre in Stockton’s Dunedin House. I am pleased to report that work is now under way on opening to support claimants, which is due by the end of this month. A total of 49 new work coaches have been recruited in my hon. Friend’s constituency to help local jobseekers, and 20 will be based in the new site, along with some of our more experienced work coaches and leadership, to ensure the sharing of best practice and helping people in Stockton to progress.
May I pay tribute to Worthing jobcentre, which has been very proactive in dealing with new benefit claimants and will have a lot of extra work, alas, with people who find themselves out of a job because of the pandemic.
Work coaches offer important support to a diverse range of claimants, but self-employed claimants can really benefit from the wisdom of someone who has direct experience of setting up their own business, so what specialist support will be available to UC claimants looking to boost their incomes through self-employment in the future?
DWP work coaches can refer claimants interested in moving into self-employment to our new enterprise allowance programme, and to other sources of local business advice and support as appropriate. The new enterprise allowance offers participants the important opportunity to develop that business, as my hon. Friend points out, to make that business plan and receive more than a year’s support from a business mentor to make a success of it, in Worthing and beyond.
May I start by thanking all the staff at Burnley jobcentre, who are doing an amazing job in supporting people day and night?
As a result of the pandemic, unemployment is increasing in Burnley, impacting on those who find themselves out of work for the first time as well as young people looking to enter the world of work. What steps is the Department taking to support people in Burnley who find themselves in that situation?
Alongside our plan for jobs, Burnley JCP recently held a virtual careers event for jobseekers, which I know my hon. Friend was brilliantly a part of. In Cumbria and Lancashire we have recruited almost 400 extra work coaches to assist customers, with a further 90 due to join in the next three months. We have also set up a DWP youth hub in partnership with Burnley Borough Council and Calico, and we are working with local employers to provide local kickstart placements such as with the East Lancashire Hospitals NHS Trust and Stanley Black and Decker.
Benefit Claimants: Repeat Assessments
We stopped regular assessments for people with severe conditions for work capability assessment and personal independence payment claimants with the highest level of needs which will not improve. We are continuing to remove pensioners on PIP on to ongoing awards at their award review, and the upcoming health and disability Green Paper will consult on further improvements to the assessment process.
My hon. Friend raises an important point. One lesson we can take from these unprecedented times is to look to extend the principle of the severe conditions criteria and, where possible, use clear evidence to remove unnecessary assessments. We will explore that further, working with disabled people and health and disability charities, in the upcoming health and disability Green Paper.
Review of Special Rules for Terminal Illness
The Department is committed to delivering an improved benefit system for claimants nearing the end of their lives, and we are working across government to bring forward changes.
Will the Minister urgently correct the anomaly whereby someone with a severe condition eligible for an ongoing award under the normal rules has a light-touch review after 10 years, but someone with a terminal illness such as motor neurone disease has to reapply after three years under the special rules or risk having their benefits stopped?
I thank the hon. Member for raising that important point, referring to someone who qualifies under special rules for terminal illness normally having an award for three years. The point was raised during the review of changing the rules around special rules; we are considering it and I welcome its having been raised.
Budget 2021: Departmental Policies
Since the start of the pandemic, our priority as a Government has been to protect lives and people’s livelihoods. That is why we are continuing to give our support, extending the temporary £20 a week increase in universal credit for a further six months, taking it well beyond the end of this national lockdown. I should point out to the House that total welfare spending in Great Britain for 2020-21 now stands at an estimated £238 billion, 11.4% of GDP. Alongside that, the Budget confirmed the ongoing measures that we will be taking as part of our plan for jobs, including the expected starting of the restart programme, particularly focused on long-term unemployed, before the summer recess.
The Budget was a kick in the teeth for people claiming legacy benefits, who have been unjustly denied the extra £20 per week in support since last March. The SNP has pressed UK Ministers on this countless times. Will the Secretary of State now answer a simple yes or no question? Yes or no—did she ask the Chancellor to extend the £20 uplift to legacy benefits in the Budget?
Discussions between Ministers are normally confidential, but the answer is no, the reason being that we have a process that was put in place as a temporary measure relating to covid. The rationale for that was set out last year. I encourage the hon. Lady to genuinely consider encouraging people who are still on legacy benefits to go to independent benefits calculators to see whether they would automatically be better off under universal credit. Universal credit has been a huge success during the last 12 months—if not the years before that, but it has particularly shown its worth—and I genuinely encourage people to really consider whether they would be financially better off moving benefits now rather than waiting, potentially, to be managed-migrated in the next few years.
I think the Minister has possibly given the game away there by linking an explanation of her refusal to ask for an uplift to legacy benefits to an attempt to pressurise my hon. Friend the Member for Motherwell and Wishaw (Marion Fellows) into pushing her constituents to move from a useless system of legacy benefits to an equally useless system of universal credit.
Does the Secretary of State not accept that the fact that universal credit had to be increased by £20 a week as soon as lockdown was imposed is a clear indication that the underlying rate of payment of universal credit is not adequate for people to live on? I defy anyone on the Conservative Benches to live on universal credit for more than a few weeks, never mind two to three years. Will the Secretary of State now accept that the underlying rate of universal credit is utterly inadequate and that the £20 uplift, as a minimum, should be made permanent with immediate effect?
No, I do not accept that, and I want to be clear. It has been explained to the House in multiple ways over the past year why that decision, which the Chancellor announced last year, was taken at the time. Let us be straight about this: universal credit is working and will continue to work. It worries me how many Members of Parliament criticise universal credit when it is clearly working. It has done what it was designed to do. For those people who have had their hours reduced, universal credit has kicked in and the payments have gone up. Frankly, unlike in the last recession, in 2008, when the Labour party did nothing to help with some of the financial instability that people were going through, I am very proud of what we have undertaken by investing over £7 billion extra in the welfare system in this last year.
Pensioners who have worked hard their whole lives have seen their life savings disappear after becoming the victims of some truly dreadful scams, which have happened both online and on the telephone. The Government say they want to protect the interests of savers. However, there is mounting evidence that they are failing to act sufficiently to curb some appalling abuses, and this was not mentioned in the Budget. Will the Secretary of State explain to the House just how these dreadful scams have happened, and will she commit to taking further action? She is taking action against scams on the phone; will she now also commit to taking action against scams online?
We have just passed the Pension Schemes Act 2021, and aspects of scams were considered in that legislative process, so the suggestion that somehow we are not doing things to tackle scams is far from the case. Indeed, the hon. Gentleman will be aware from the Budget of the ongoing support that we continue for pensioners in honouring our triple lock.
In extending the £20 uplift of universal credit, albeit for only six months, the British Government are clearly conceding that without the £20 uplift, universal credit is insufficient to meet people’s needs. I want to take the Secretary of State back to a point she made to my hon. Friends the Members for Glenrothes (Peter Grant) and for Motherwell and Wishaw (Marion Fellows). She said that claimants should move from the legacy system to universal credit. Will she stand up at the Dispatch Box and make it crystal clear that for some people that will mean being worse off, particularly when the £20 universal credit uplift is taken away? Can she clarify why she thinks that disabled people, for example, have lower bills as a result of the pandemic and why they were not worthy of the £20 uplift?
The hon. Member should be clear about what I did say. I encouraged people who were on legacy benefits to get an independent assessment, which is available through a number of organisations and online calculators, rather than wait to be managed across to universal credit. It is really important that MPs encourage their constituents to consider the ways they could be financially better off, rather than waiting for the Government to go through quite an arduous process during the next few years.
Benefit Claimants: Rent Arrears
We do not collect information about individuals’ rent accounts. For universal credit claimants with rent arrears, alternative payment arrangements and support with budgeting are available. In 2020-21, we are projected to spend almost £30 billion on housing benefit and the housing element of universal credit to support people with their housing costs.
I thank my hon. Friend for that answer. The evidence produced by the National Residential Landlords Association and a lot of housing charities demonstrates that rent arrears are growing and growing very fast such that they will probably never be repaid. What action will my hon. Friend take to ensure that rent arrears are eliminated and further assistance is provided to people who genuinely cannot afford to pay their rent?
I thank my hon. Friend for his question. He is a strong advocate on these issues. As I say, managed payment to a landlord is available where universal credit claimants are unable to manage monthly payments and are at risk of financial harm. That can be requested by the tenant, landlord or work coach. Our relatively new online tool makes it easier for landlords to request a managed payment to landlords. UC also enables a landlord to request recovery of rent when a UC claimant is in arrears or once a tenancy reaches two months’ rent arrears. I agree to some extent with my hon. Friend. Rent arrears concern me too and we continue to monitor the situation very closely.
Of the 1.3 million universal credit households who are claiming housing support for their properties in the private rented sector—that is, the people who are most at risk of homelessness as a consequence of rent arrears—in more than 700,000 cases, so more than half, there is a shortfall between the rent being charged and the help available. That number has grown by a quarter of a million since the start of the pandemic. With housing support being cut again in the Budget, will the Minister answer this one question? Will that number have gone up or fallen during the remainder of 2021?
We increased the local housing allowance rates in April 2020. We invested nearly £1 billion in LHA, lifting rates to the 30th percentile, giving an average increase of £600 more housing support per year than would otherwise have been received. For 2021-22, all LHA rates will be maintained at the increased level, ensuring that claimants continue to benefit from the increase. For those who require additional support, £140 million of discretionary housing payments are available next year.
The latest official statistics from the Office for National Statistics show the UK employment rate is at 75%. The package of support put in place by this Government, including the furlough scheme, has protected many jobs during the pandemic, but there have been difficult times for many. Meanwhile, in the Budget we announced that the furlough scheme has been extended to the end of September.
Unemployment has not really been a major issue in Cambridgeshire for some years, but with over 8,000 people furloughed in the city of Cambridge and 300 jobs in Chatteris lost recently, there is now real fear. Cambridge City Council is appointing an economic recovery officer, but overall where is the plan for Cambridgeshire and Peterborough? Where is the strategy to secure quality jobs in future?
I can absolutely assure the hon. Gentleman that we work with the local recovery plans and that we have a plan for jobs in Cambridge and beyond, so there is positive news in his constituency. We are doing our sector-based work academy programmes in construction, warehousing and care. We are working with our new job finding support service with the Papworth Trust. We are engaging with local companies on kickstart—indeed, we are working with Addenbrooke’s and a bunch of other local companies—and we have recruited 50 new work coaches for the Cambridge jobcentre since March, with 18 more to come, making an extra 68 to help in his constituency with that local recovery plan.
In June, the Prime Minister promised an opportunity guarantee for every young person. With 800,000 young people now not in education, employment or training, and only 4,000 kickstart placements to date, the Minister recently told the Work and Pensions Committee, “Watch this space”, and that details on the guarantee would land at the Budget. If the Prime Minister announced it and she supports it, did the Chancellor not get the memo or has the Treasury once again blocked support where it is needed? Can the Government not get their act together on a jobs promise such as the one Labour has proposed so that young people out of work or training at six months get the opportunities that they need?
I know the hon. Lady is committed to opportunities for young people, as am I, and our plan for jobs has multiple interventions: the £2 billion kickstart scheme, job finding support, JETS—job entry targeted support—the 13,500 new work coaches, our £150 million boost to the flexible support fund, and restart coming this summer. I assure her that our focus on youth continues. In her constituency, 17 employers are engaging with kickstart for young people, with 77 vacancies available and 11 starts. Of course, 140,000 opportunities are coming through the system now and I continue to have this focus on youth employment, as she rightly points out that we should, and I will continue to work across Government to highlight that.
Universal Credit: Monthly Assessment Period
We introduced legislation on 16 November so that monthly earnings can be reallocated to another assessment period, meaning that claimants affected by this issue will therefore have one salary payment taken into account in each assessment period. We have also produced guidance to help to ensure that claimants, staff and representatives are aware of different earning patterns and the impact on universal credit payment cycles.
People such as Mr B in my constituency and across the country have been forced to survive with little to no support, all because of an error through the Minister’s Department. Worse still, the pain has been prolonged by pursuing this through the courts. Will the Minister do the right thing and properly recompense those affected, such as Mr B, who suffered as a result of utilities being cut off and consequent costs as a result? And will the Minister meet me to discuss that specific case?
Of course, I will be very happy to meet the hon. Gentleman to discuss that individual case, and I am very sorry to hear of those circumstances. However, the Court of Appeal judgment was very specific and was limited to double earnings for those paid calendar-monthly caused by a non-banking day salary shift. We have chosen to go further and include all the monthly-paid who are affected by double earnings, but the judgment did not require the Department to apply the new arrangements retrospectively.
Kickstart: Departmental Discussions
The Northern Ireland Executive will be running the job start scheme to support young people to progress. Similar to the kickstart scheme available in England, Scotland and Wales, it is also focused on helping young people most at risk of long-term unemployment. The hon. Gentleman will be pleased to know that the DWP has been in regular contact with colleagues in Northern Ireland to discuss the development of the job start scheme and share progress and insight on the kickstart scheme.
The Minister is absolutely right that the kickstart scheme is a wonderful, innovative scheme, which should be applied to Northern Ireland, but it has not yet been rolled out there. I wonder whether the Minister will be honest with us and tell us whether that is the fault of the UK Government or the fault of the local Communities Minister, who has been allocated the money but has not yet applied it to the scheme? Will the hon. Lady encourage her to get on with applying this scheme to Northern Ireland in the next telephone call that she has with the Communities Minister in Northern Ireland?
The hon. Gentleman is absolutely right. Northern Ireland received Barnett consequentials to support the job start scheme, and our officials have been talking. The money is not ring-fenced, and I am keen to see all young people access this type of scheme across the United Kingdom so that they can get the support they need to progress. Should anybody need further support to make this happen in Northern Ireland, our officials continue to stand ready to see it start.
Covid-19: Support for Universal Credit Claimants
We have injected over £7 billion into our welfare system, including increasing the universal credit standard allowance for a further six months until September, providing claimants with an additional £1,560-worth of support over 18 months. We are extending the minimum income floor relaxation to July 2021 for all self-employed UC claimants affected by the economic impact of covid-19, and we are increasing the number of work coaches by 13,500 this financial year.
Universal credit has helped millions of people during covid, including thousands in Hastings and Rye. It is one of the positive news stories to come out of the pandemic, but it is clear that many universal credit claimants need ongoing support tailored to their specific circumstances. What steps is my hon. Friend taking to deliver a strengthened universal credit support service that meets the needs of claimants and ensures a consistent and streamlined service for claimants, not just in Hastings and Rye, but across the country?
I thank my hon. Friend for that question. She is a strong advocate for her constituents in Hastings and Rye. Since April 2019, and throughout the covid pandemic, we have provided funding to Citizens Advice and Citizens Advice Scotland to deliver Help to Claim, which gives specific and targeted support for those people needing additional support to successfully make a universal credit claim. I am pleased to say that we will be funding that support for a further 12 months.
Self-isolation: Financial Barriers
The Government have delivered an unprecedented package of support during the pandemic. Where eligible, financial support for those self-isolating in line with Government guidance includes access to employment and support allowance, universal credit, statutory sick pay and the test and trace support payments scheme, depending on individual circumstances.
The scientists on the Scientific Advisory Group for Emergencies have said that many people are still not self-isolating for financial reasons. What assessment has the Department made of the means-testing involved in the £500 payment? Does the Minister not agree that this should go, and that everybody should be eligible for that £500 payment, because we cannot allow a stop-start recovery as we come out of lockdown? Secondly, does he agree that statutory sick pay is pathetically low for those jobs that are eligible for it, and that there are far too many jobs where people do not even get basic statutory sick pay?
While the £500 test and trace scheme payment is rightly targeted at those most in need, we have also provided local authorities with £35 million for discretionary payments, and we will continue to provide local authorities with a further £20 million per month while this scheme carries on. The rate of statutory sick pay should not be looked at in isolation because, depending on eligibility, people may also be able to claim universal credit or new-style employment and support allowance, and the majority of employers pay more than the statutory minimum.
Contracted-out Health Assessments
Throughout the pandemic we have ensured that disability benefits remain open and we are committed to ensuring that claimants receive a high-quality, consistent and efficient service. We continue to complete paper-based assessments where possible and are now carrying out telephone assessments alongside a trial for video assessments.
The outsourcing of assessments for employment and support allowance and personal independence payments to companies such as Capita has been a travesty. Constituents tell me how they have been signed off work by their GP, only for non-specialist Capita assessors to refuse their claims. When they appeal, they are forced to wait absurd lengths of time for the decision, which causes severe financial hardship. Coventry Law Centre, which deals with the majority of appeals in the city, has found that a staggering 90% of appeals are successful. This pandemic has shown that things can be done differently, so will the Minister take this opportunity to scrap these cruel assessments, kick out outsourcing companies such as Capita and bring in a framework that treats disabled people with dignity and respect.
We have increased, in real terms, by £3 billion the support provided to those with disabilities and health conditions, through disability benefits. All of our assessors have at least two years’ experience and extensive training. The Department monitors closely the quality—this is carried out independently—and 92% of claimants have found their experience either satisfactory or better.
In April 2020, legacy benefits were increased by £600 million, and they will increase by a further £100 million as part of the Government’s annual uprating exercise. Support is also available for legacy claimants migrating across to universal credit. Since July 2020, a two-week run-on of housing benefit, income support and income-related employment and support allowance and income-based jobseeker’s allowance is paid to eligible claimants to provide additional support to move to UC.
Nearly 2 million sick and disabled people claiming ESA have missed out on £1,000 this year, at a time when they are facing increased costs. The Minister will know that for many of them a transition on to UC would see them significantly worse off. Will he review the Chancellor’s decision to continue to discriminate against those disabled people on legacy benefits? Almost a year into the crisis, what possible justification is there for this two-tier system?
The temporary UC standard allowance uplift was introduced to support those facing the most financial disruption due to the pandemic. Legacy benefits were uprated by CPI—the consumer prices index—last year and will be uprated again by CPI as part of the annual uprating exercise. Claimants on legacy benefits can make a claim for UC if they believe they will be better off. I encourage anybody to go on gov.uk and use one of the independent benefit calculators to check carefully their eligibility, because on applying for UC their entitlement to legacy benefit will cease.
Covid-19: Disabled People and their Carers
Disabled people and their carers have access to the full range of social security benefits according to their circumstances. DWP Ministers and officials regularly discuss support for disabled people and carers with their counterparts across government, and recognise and value the vital contribution made by carers in supporting some of the most vulnerable in society.
I thank the Minister for his answer. A recent survey of disabled people conducted by Inclusion London, a disability organisation based in my constituency, found that more than one in three disabled people had experienced a worsening financial situation during the lockdown, and recent research by Citizens Advice found that one in four disabled employees has faced redundancy since the pandemic started. We know that even before this pandemic, disabled people faced an employment gap of nearly 30% when compared with non-disabled workers. Will the Government commit to using the upcoming national disability strategy to bring forward comprehensive proposals to address the chronic employment insecurity that disabled people face in the wake of covid-19?
I thank the hon. Lady for raising a very important point about disability employment. The Government are very proud that we delivered record disability employment—it is up 1.4 million since 2014 alone. Even during these unprecedented challenging times, over the past 12 months 25,000 more disabled people are in work. But we recognise that there will be challenges going forward, which is why we have made changes to Access to Work so that people can get support working at home; we have increased our support through Disability Confident, sharing best practice and providing resources to employers to be able to make changes, often small ones, to take advantage of the huge talent pool available. This is a key area, and in both the forthcoming national strategy for disabled people and the health and disability Green Paper we will continue to look at ways in which we can support employers to offer more opportunities for disabled people of all ages.
This Government are committed to providing support to help young people move into work and avoid the scarring effects of long-term unemployment as we recover from the pandemic. The £30 billion plan for jobs includes new youth hubs and specific interventions targeted at young people. Our DWP youth offer and the kickstart programme are designed to move young people towards meaningful and sustained employment opportunities.
Happy International Women’s Day, Mr Speaker.
Last year, youth unemployment went up by 420,000, reaching 600,000, and it is set to reach 1 million, yet the Government’s kickstart programme has got only 4,000 young people into work, despite employers providing placements. Will the Minister explain by what date her Department’s own target of 200,000 placements will be met?
The hon. Lady is absolutely correct: we are converting more than 140,000 job placements into starts and 30,000 jobs are currently being advertised. In her area, the London Borough of Tower Hamlets has approval for more than 500 kickstart opportunities in a variety of sectors across the borough. A virtual youth hub is also operating in Tower Hamlets to support people and we hope it will move to face-to-face contact shortly. There are 119 new work coaches in Hoxton and a new temporary Jobcentre Plus is opening in Leman Street in Tower Hamlets in April. We take youth unemployment incredibly seriously. As we move into recovery, we will make sure that young people take up roles and move into work safely, to get those kickstart opportunities going.
The Minister for Pensions updated the House last week through a written ministerial statement on category pensions and the comprehensive correction exercise that we are undertaking. I am concerned by some of the ongoing accusations and assertions being made about how we are addressing the issue. I am very grateful to Sir Steven Webb for bringing his concerns to our attention last year, but it will not be lost on the House that he was Minister for Pensions from 2010 to 2015—indeed, he was a shadow Minister beforehand—when the issue was neither noticed nor tackled, including when the comprehensive reform of the pension system was under way.
I recognise that Ministers should expect the administration of pensions, however complex, to be undertaken accurately. I commend the Minister for Pensions, who is putting his shoulder to the wheel to put right this historical error. The House should be conscious that, when we became aware of the problem, we undertook a comprehensive investigation into its extent, which showed that the issue dated back many years and at a larger scale. We are now undertaking detailed, thorough processes for individual assessments that will take some time, but we will contact people whose payments should have been updated and they will receive any arrears.
As covid-19 restrictions are hopefully relaxed over the coming months, will my right hon. Friend support the establishment of a bricks-and-mortar youth hub in Bury, to offer invaluable support to all young people in my local area and build on the current virtual provision?
The economic forecasts that accompanied last week’s Budget painted a challenging picture for the Department for Work and Pensions over the next few years. Forecasts are not always correct but, if those are, we face a period of low growth and high unemployment. Based on what the Chancellor said about unemployment peaking at 6.5%, what would be the shortfall between the total number of young people out of work for more than six months and the maximum number of places available on the kickstart scheme?
I do not have that assessment to hand. The hon. Gentleman will be aware that the Office for Budget Responsibility significantly reduced its forecast in respect of the impact on unemployment, in recognition of the excellent provisions already made by the Government in the past few months and the ongoing measures set out in the Budget. We made a commitment to aim for a quarter of a million kickstart jobs to be in place by the end of this calendar year; we are well on track to doing that. We should recognise that kickstart is designed for those people who are furthest from the labour market. We will continue to use our excellent jobs army of work coaches, of whom we will have nearly 13,500 extra by the end this month, to help young people to get into work.
I am grateful to the Secretary of State for her reply. I appreciate that that might not be information that she has to hand. Perhaps she could write to me with the specific figure because matching the scale of the challenge is surely what we all want to see.
In the Budget, the Government also chose to align the end of furlough, the end of the self-employment support scheme and the end of the universal credit uplift, so they all now come to an end on 1 October. She knows that we believe that the uplift should stay in place until we can replace universal credit with a better, fairer system, which, by the way, would be one where people are not worse off if they move on to it from the legacy system. Given that we all expect the end of furlough to at least have some impact on unemployment, would it not have made sense even to this Government to keep the uplift in place to at least help absorb the end of the furlough scheme? As it stands, just when people will again really need it, out-of-work support will be reduced to the lowest level in 30 years.
The hon. Gentleman asks a fair question about why these have all been taken in parallel. I think that it is to give certainty and direction to the country and to employers, particularly when it comes to the operation of the furlough scheme. As I have said before, this is really the time for those employers to get their workers ready again to go back into work, ideally sooner than before the end of September. Thinking about the temporary £20 uplift that was applied to universal credit, I think it is also fair to say that that is not the only way that we have supported people on benefits in the last year. There are also things such as the increase in the local housing allowance rate, which is on a permanent setting in cash terms. Those are the sort of other measures that we have taken, including to help some people on low incomes with the cost of living.
My right hon. Friend is right to highlight the importance of the Child Maintenance Service in what we are trying to do to make sure that children have income coming ideally from both parents during their upbringing and to give them support. My noble Friend Baroness Stedman-Scot is actively working on ways to potentially improve aspects of the running of the Child Maintenance Service, which I am sure is something that the whole House will want her to continue to do.
Due to continued British Government inaction, more than 126,000 UK pensioners living in Canada have seen their state pension fall in real value year on year, with average payments as low as £46 a week. In November, the Government of Canada wrote to the British Government offering a reciprocal social security agreement. Has the UK responded to that letter and, if not, what message does the Secretary of State think it sends from global Britain of its attitude to UK pensioners who live in poverty overseas?
I have not yet responded to that letter—I understand that officials will be responding to the embassy —partly because, and some of the aspects of this have been raised, I wanted to explore some of what our policies—[Interruption.] The hon. Gentleman is trying to intervene and I am trying to give him an answer. [Interruption.] I think I have probably said enough as he does not want to hear the answer.
We welcome the involvement of all employers of all sizes in all sectors in the kickstart scheme. We have made it even easier to bring in small employers and sole traders by developing an important kickstart gateway-plus model to accommodate their specific needs. They can apply through an approved gateway-plus organisation that can provide a suitable pay-as-you-earn scheme process for young people on placements with them. With regard to working on agriculture, I am engaged with Department for Environment, Food and Rural Affairs Ministers on this and we are focused on supporting all sectors that need labour. There is a covid economy and growing jobs in some sectors and we are keen to support them.
I thank the hon. Member for this question. While there were delays to the review because of covid, we are committed to the three themes that have come out of the review: raising awareness, improving consistency and changing the six-month rule. I thank all the health and disability organisations and charities that have helped to support that review. I am committed to going further to explore extending the principle of the severe conditions criteria to remove unnecessary assessments as well as changing the six-month rule.
I thank my hon. Friend for that question. We understand how vital this support is to families who have suffered the loss of a loved one. We intend to take forward a remedial order to remove the incompatibilities from the legislation governing widowed parents allowance and bereavement support payment by extending those benefits to unmarried cohabiting couples with children. The order will be laid before the House in due course.
I thank the over 15,000 individuals and organisations who have already responded to the national strategy pre-consultation. However, this is only part of our extensive stakeholder engagement ahead of the forthcoming national strategy for disabled people. I have also written to all MPs of all parties to say that I am keen for them to host events either with me or with senior officials, depending on parliamentary business, to get more real lived experience, whether from individual disabled people, organisations or charities. I would be very happy if the hon. Member would agree to do one of those on behalf of her constituency.
My hon. Friend is right to praise the work coaches at his Jobcentre Plus, who are exactly the people who will help prepare people to get those opportunities as and when they arise. I was particularly pleased with the initiative of freeports, recognising not only the one that will help people in his constituency but the one—freeport east—that will benefit people in mine.
I thank my hon. Friend for that question. If the hon. Member for Glasgow East (David Linden) had not tried to intervene on me, perhaps I could have given the fuller answer that I intend to give now.
It is my intention that the Department will respond to the Canadian embassy on this matter. My hon. Friend will know that UK state pensions are payable worldwide and there is often a reciprocal arrangement in place where that is a legal requirement. For the last 70 years, it has not been the policy to initiate new agreements. However, I understand the points that he and other Members have made in their representations and we will continue to consider the matter carefully.
I echo my hon. Friend’s words and those of other Members who have praised the very hard work of all our DWP staff, especially of course in Bolton and Leigh. They include an additional new 41 work coaches recruited for jobcentres that serve my hon. Friend’s constituency. Thanks to their efforts, the kickstart scheme has so far seen the development of more than 300 roles across more than 50 employers in the Bolton and Prestwich area.
My hon. Friend is right to raise the issues that constituents face. I encourage him to engage directly with my noble Friend Baroness Stedman-Scott, who runs surgeries for MPs. As I said in response to my right hon. Friend the Member for Haltemprice and Howden (Mr Davis), I encourage my hon. Friend to recognise that we are looking into this issue and that we will continue to try to make progress to ensure that children get the money to which they are entitled.
The hon. Gentleman used the word “her”. I do not know if he is trying to suggest that I am corrupt in any way. That is not something that I would normally associate with him. However, just to be clear, I am very pleased to be working with my right hon. Friend the Secretary of State for Housing, Communities and Local Government on what we are doing about the initial element of the community fund, following into the UK shared prosperity fund. In that, the DWP will be particularly involved in making assessments for programmes that are targeted at helping those who are furthest from the labour market and not necessarily on benefits today. We want to try to ensure that as many people as possible get the opportunity to work and to take that follow-up to help UK plc’s productivity.
Although the vast majority of people who access their benefits get the outcome they were hoping for, we recognise the need for continuous improvements, which we make working hand in hand with health and disability charities, organisation users and frontline staff. In the forthcoming health and disability Green Paper, we will look at the specific themes of evidence, advocacy, assessment and the appeals system to ensure we continue to deliver those improvements.
NHS Staff Pay
This pandemic has asked so much of our health and care system. The whole country recognises how our NHS workforce have performed with distinction and gone the extra mile throughout this crisis, which has also had a huge impact on our economy. It has been and still is a tough time for businesses and all those who work in them.
As hon. Members will be aware, most of the public sector is having a pay freeze. However, even against that backdrop, we will continue to provide pay rises for NHS workers, as the Chancellor set out at the spending review. This follows a multi-year pay deal, which over a million NHS staff have benefited from and which includes a pay rise of over 12% for newly qualified nurses. We are also ramping up our investment in our NHS, with a £6.2 billion increase for 2021-22, as part of our £34 billion commitment by 2024-25, and £3 billion for supporting recovery and reducing waiting lists. As part of that, we are increasing the number of staff in the NHS, with over 6,500 more doctors, almost 10,600 more nurses, and over 18,700 more health support workers in the NHS now than a year ago. We are also on track to have 50,000 more nurses in the NHS by the end of the Parliament.
Last week, we submitted our evidence to the NHS pay review bodies, which are independent advisory bodies made up of industry experts. Their recommendations are based on an assessment of evidence from a range of stakeholders, including trade unions. They will report their recommendations in late spring, and we will carefully consider their recommendations when we receive them.
I can assure the House that we are committed to the NHS and to the amazing people who work in it. Just as they have been so vital throughout this pandemic, they will continue to be the very essence of our health service, together with all those who work in social care, as we come through this pandemic and build a health and care system for the future.
I am grateful to the Minister, but where is the Secretary of State? Why is the Secretary of State not here to defend a Budget that puts up tax for hard-working families and cuts pay for hard-working nurses? The Secretary of State has stood at that Dispatch Box repeatedly, waxing lyrical, describing NHS staff as heroes, saying they are the very best of us, and now he is cutting nurses’ pay.
Last summer, when asked by Andrew Marr if nurses deserved a real-terms pay rise, the Secretary of State replied:
“Well, of course I want to see people properly rewarded, absolutely.”
Yet now he is cutting nurses’ pay.
Last year, the Secretary of State brought to this House legislation to put into law the NHS long-term plan. He said from that Dispatch Box that his legislation represented
“certainty for the NHS about a minimum funding level over the next four years and certainty for the 1.4 million colleagues who work in our health service”.—[Official Report, 27 January 2020; Vol. 670, c. 571.]
That long-term plan was based on a 2.1% pay increase for all NHS staff. Every Tory MP voted for it, the Minister voted for it, and now every Tory MP is cutting nurses’ pay.
The Minister talked about the Budget. Where is the Chancellor? Where are his glossy tweets? Where is his video? Why did he not mention in the Budget that he was cutting nurses’ pay? Why did he sneak it out the day before in the small print?
This is happening at a time when our NHS staff are more pressured than ever before. In the midst of the biggest health crisis for a century, when there are 100,000 shortages, what does the Minister think cutting the pay of NHS staff will do the vacancy rates? Perhaps she can tell us.
The Minister talked about the pay review body, but she did not guarantee that the Government will implement any real-terms pay rise that the pay review body recommends. Why is that? It is because Ministers have already made up their minds to cut, in real terms, NHS pay in a pandemic. Our NHS staff deserve so much better. If this Government do not deliver a pay rise, it shows once again that you simply can’t trust the Tories with the NHS.
My apologies, Mr Speaker.
I do not think that we should play politics with these very serious questions as we come through a pandemic that has hit us and the world so hard, when people have lost their lives, people have lost their jobs, and we as a Government have had to spend so much to support the economy, individuals and, indeed, the NHS. I have been speaking to staff on the frontline of health and social care throughout this pandemic, and I and the Government are grateful to them and thank them from the bottom of our hearts for what they have done and are still doing. While so much of the public sector is having a pay freeze, NHS staff will get a pay rise.
In these difficult times, the Government have submitted their evidence to the pay review bodies and, as I said in my opening statement, they will report back to us. They will look at a wide range of evidence, including, for instance, evidence from trade unions, inflation, and the wider situation with the economy and pay levels, and we will of course look at their recommendations carefully.
The right hon. Gentleman talked about the vote that we had on the NHS Funding Act and, yes, we absolutely did vote for it. We are fulfilling our commitment to record investment in the NHS—£34 billion more. He also referred to the long-term plan and, although not something we voted on, the 2.1% increase within it will be invested in the NHS workforce this year. That will include not only these pay rises, but pay progression and further investment in the NHS workforce.
We will continue to invest in more doctors and more nurses for the NHS, and I wish that the right hon. Gentleman would welcome that. We will continue to support the recovery of our economy and restore our public finances, so that we can fund our NHS not just through the pandemic, but into the future.
The long-term plan budgeted for a 2.1% increase in salaries, which has now gone down to 1%, but an even bigger gap in last week’s Budget was identified by the Office for Budget Responsibility as a lack of funding from next year for annual covid vaccinations, for Test and Trace, for long covid and for millions of catch-up operations delayed by the pandemic. What discussions has the Health Secretary had with the Chancellor about that gap in funding, and where will that money come from?
I thank my right hon. Friend for his question. He mentions the 2.1% increase within the long-term plan. That figure covers not only this pay rise for the NHS workforce, but the pay deals that have been agreed for staff in other multi-year pay deals, pay progression, and other investment in the workforce. As for his question on funding for the broader extra covid costs, that is not in the main NHS budget. Just as we had £63 billion invested in those costs throughout this year, there is an extra £22 billion set aside for covid costs outside the NHS budget and also £3 billion specifically for recovery and bringing down waiting lists.
The proposal for a mere 1% pay rise suggests this Government do not value the risks taken and sacrifices made by health and care staff throughout the pandemic, nor the challenge that they will face to clear the backlog. Like their initial refusal to extend free school meals, it also shows the Government are out of touch with the public.
With a workforce crisis before the pandemic, does the Minister really believe that such a mean award will help recruit and retain healthcare staff? Senior band 5 nurses in England already earn up to £1,000 less than their Scottish counterparts, while the removal of the nursing bursary and imposition of tuition fees has saddled recently qualified nurses with up to £50,000 of debt. I am sure the Minister knows that shops do not accept claps instead of cash. Will this Government not give health and social care staff a decent pay rise and consider a one-off thank you payment, as in Scotland?
I am somewhat surprised by the language the hon. Lady used around 1%, because a 1% pay rise for this large number of staff will cost around three quarters of a billion pounds. She should remember that this all has to be paid for in the context of, sadly, around three quarters of a million people losing their jobs through the pandemic, while others are seeing pay cuts or reduced hours. We are in a time of huge economic uncertainty, but while much of the public sector is going to have a pay freeze, the NHS workforce is going to have a pay rise.
I acknowledge the very difficult decisions that the Government have had to take as a result of the pandemic, with the majority of public sector salaries being frozen this year. Will my hon. Friend confirm that our amazing NHS staff being the exception to that in part acknowledges their hard work, and that we should now await the outcome from the pay review bodies?
My hon. Friend is absolutely right. The NHS workforce is the exception to the pay freeze for the wider public sector, recognising the huge amount of work done and the lengths they have gone to in looking after us all during covid. He is absolutely right that we will wait for the response from the independent pay review bodies before we announce the pay settlement.
The Test and Trace programme, which the Scientific Advisory Group for Emergencies considers has had only a marginal impact on covid-19 transmission, will have had an almost 150% increase on its original £15 billion price tag following the small print buried in the Chancellor’s Budget last week. Is this Government’s claim that the 1% pay offer to NHS staff is all they can afford actually serious?
The first thing I would say to the hon. Member is that the Test and Trace programme is doing a truly phenomenal job. The other thing I would say is that in the pandemic what we absolutely need is an effective test and trace programme, so I make no apologies for the fact that we are making sure it is funded.
Although everyone in this Chamber would really like to give nurses a decent pay rise as much as possible, may I ask the Minister how that equates with equivalent grades in the police, the fire service and the armed forces, particularly given that, as she has already mentioned, they are on a pay freeze at the moment?
As my right hon. Friend says, most of the public sector—and that includes the police—is regrettably under a pay freeze for the coming year because of the challenging times we find ourselves in and in recognition that across the economy there are people who have lost their jobs and that we are having to spend a huge amount of money to support people’s incomes. It is against that backdrop that we are giving NHS staff a pay rise, but indeed these are difficult times that we are living through.
I have received literally hundreds of emails from constituents and from the Royal College of Nursing. The Democratic Unionist party and I support the campaign for a fair wage increase for NHS staff, because they have been at the forefront of the war against covid-19. They put their lives on the line day by day in defence of this great nation of the United Kingdom of Great Britain and Northern Ireland. Since 2010, average weekly pay in the private sector has grown by 22%, compared with only 17% in the public sector, so I ask the Minister, very gently and kindly, whether she will in the name of justice and for moral reasons consider reviewing the decision and deliver for NHS staff.
I am proud to play a small role on the NHS frontline, and this last, most recent wave has been particularly brutal on nurses, healthcare assistants and, especially this time round, ambulance crews. May I urge her, during this period while the review body is considering the matter, to open up discussions with the Treasury to look at what more we can do for our NHS staff, be that a one-off additional payment or other support, such as just giving people more rest and recuperation time? We should do everything we can and make every effort to go further than what has so far been recommended.
I thank my hon. Friend; I know that he does tremendous work on the frontline. He makes a really important point: beyond pay, the question of what other support we are giving to the NHS workforce is really important. Through the pandemic, there has been lots of extra support for the workforce, whether that is with practicalities such as hot food and drink—things that make work and long hours more manageable—or mental health support, which is so crucial for those who have had really traumatic experiences. We are absolutely looking at what continued support we can put in place in the months ahead.
NHS staff feel betrayed by this Government on pay. In July, the Secretary of State—who really ought to be in the Chamber today answering for his responsibilities—said the following:
“We absolutely want to reward NHS staff for what they have done.”
That is what he said, so can the Minister tell me how on earth delivering a real-terms pay cut meets that very clear promise from the Secretary of State?
As I say, this discussion is against the backdrop of many people receiving a pay cut in parts of our economy, people losing their jobs and a wider pay freeze in the public sector. Against that backdrop, we recognise the enormous work that the NHS workforce have done, and that is why they are exempt from the pay freeze and will be getting a pay rise.
I thank the Chancellor for the scale of economic intervention that he has provided for businesses and livelihoods in these unprecedented times, and I join others in paying tribute to our incredible NHS staff; the nation owes them a debt of gratitude for what they have done and continue to do. I understand that no decision on NHS pay will be made until May. Will the Minister wait for and heed the advice of the independent pay review body before confirming the scale of the pay rise that NHS staff can expect?
Absolutely. We submitted our evidence to the pay review body last week, which included the affordable pay envelope from the Government. The Pay Review Body will look at a wide range of evidence, and we will look at its response when it comes back to us.
This pay proposal for NHS staff has managed to be both wrong and unpopular. Over two thirds of those surveyed, including nearly 60% of Conservative voters, think that a 1% pay rise is less than our NHS staff deserve, and I believe that the Secretary of State should be in the Chamber answering this urgent question about it. Does the Minister agree that NHS staff are worth a real-terms pay increase? Does she consider that the billions wasted on ineffective or undelivered personal protective equipment could have been better spent on giving our NHS heroes a pay rise?
It is absolutely right that we invested in ensuring that we could supply PPE to the NHS and the social care workforce during this extremely challenging time. There was a global shortage of PPE, so it is right that we spent money on that. As we look ahead at the pay deal for the next year, it is right that we exempt NHS staff from the wider pay freeze for the public sector and ensure that they get the recognition they deserve for what they have done and are still doing.
I thank my hon. Friend for the answers she has given thus far. Clearly we have to await the results of the independent pay review body, but can she explain to the House the basis on which the Government have put forward the proposal of 1% and how that compares with the commitments that were made to dramatically increase salaries, particularly for nurses at the start of their careers?
We have delivered on the commitments in the multi-year pay deal for “Agenda for Change” staff, including nurses. That includes the 12% pay rise for newly qualified nurses, bringing the starting salary for a new nurse to almost £25,000. We are now going into a new pay settlement for the forthcoming year. As part of the spending review, the Budget will set the envelope to cover pay costs for that pay settlement, but there are extra pay costs for the growing number of staff as we increase our staff in the NHS, particularly nurses—as I said, we are on track to have 50,000 more nurses in the NHS by the end of this Parliament.
Together with my right hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne), I met nurses—members of the Royal College of Nursing—in the west midlands, and Catherine, a young intensive care nurse told, with tears in her eyes, how she had worked for months to save lives. She told how she went off for a week’s holiday because she was exhausted, and when she came back, three of the four people she had been caring for had died and a member of staff had died. Does the Minister not begin to understand the dismay and despair on the part of tens of thousands of nurses like Catherine that, having endured purgatory to save lives, their reward now is effectively a pay cut?
I disagree with the hon. Member about what he just said—as I said, we are committed to giving NHS staff a pay rise—but he actually made a really important point when he talked about Catherine and other frontline staff, who have been through incredibly difficult times. I speak to nurses and other healthcare workers all the time, and one of the things I have heard many times in recent weeks and months is how badly staff need time off, and many staff have not been able to take holiday because they have been putting in extra hours to help with the pandemic response. It is absolutely vital in the weeks and months ahead that staff get the annual leave they need to rest and recuperate, and I am working with the NHS to make sure that happens.
Hundreds of thousands of people have lost their jobs during this pandemic and will be looking to the Government to support them so they can start earning again for their families. Millions of people in this country are on furlough and are living with pay cuts of 10% or 20% and will be looking to the Government to continue to support their businesses through extension of the furlough programme. Thousands and thousands of small businesses have seen the value of their businesses evaporate over the last 12 months and will be looking to the Government to support the economy to rebuild their businesses. So will my hon. Friend remind us that it is the Government’s job to balance all of those calls on the taxpayer, and it is the job of the pay review body to come back with a recommendation?
My hon. Friend is absolutely right. So many businesses have been so hard hit by the pandemic, and it is vital that we support not only the livelihoods of individuals who work in the businesses that have been hit, but those businesses themselves, because they are what will help us come through this and recover from the economic pain of the pandemic. He is right that the Government are having to balance these enormous demands on the public finances, and we also need to take steps ourselves to recover those finances so that we have a strong economy for the future.
Does the Minister realise that there is a sense of the most enormous anger all across the country? Nurses have seen us through this crisis and have saved many lives, yet they are offered a pay cut as a result of it. Some are already having to resort to food banks to survive, and a third are thinking of leaving the profession unless they get a decent pay rise. Surely to goodness, if £37 billion can be found to pay Serco for a failed track and trace system, the money must be available to pay NHS staff properly. You cannot clap for them, and cut their pay at the same time. Surely we should just pay them properly, so that we can have a national health service that we can all be proud of and all rely on for all time in the future.
Actually, talking of anger, it is probably not very helpful for many of those on the Opposition Benches to be fuelling a level of anger by calling a pay rise a pay cut. We are being absolutely clear that NHS staff are getting a pay rise. I also say to the right hon. Member that we need an NHS Test and Trace system to control the virus and we need NHS staff.
I draw the attention of the House to my entry in the Register of Members’ Financial Interests and to the fact that my wife works in the NHS. NHS staff pay is and always will be a highly contentious issue—it was contentious during the junior doctor contract debate and we do not need the back end of a pandemic for it to be so at the moment—because of the mere existence of national pay contracts, pay awards and review bodies. As part of the implementation of the changes proposed in the future of health and care White Paper, will my hon. Friend view alternative models that allow decisions on individual staff pay to be set by local employers, such as NHS trusts themselves, so that they can be best suited to the employees and the services they work for?
I thank my hon. Friend, who makes a really important point. The balance between nationally set pay and local pay has been a point of much debate over the years. There are pros and cons to both ways. We do not want to have trusts competing directly all the time for workforce, but on the other hand there are higher costs of living, for instance, in some areas. That is why there is some flexibility in the system for different levels of pay according to different areas, as he will well know, and some extra support in areas where it is hard to retain staff. I always to listen to his expertise, which I really value.
Earlier this year, Baroness Harding defended giving £1,000 per day to private sector consultants on the failing test and trace programme. Now, the Minister says we cannot afford to give our NHS heroes a real-terms pay rise. Given that covid will be with us for years to come, given the outstanding non-covid backlog in treatment, and given the incredible pressure on NHS staff, the existing 100,000 NHS vacancies and the resulting reliance on expensive agency staff, can we really afford not to?
The hon. Lady talks about the NHS workforce. One of the fabulous things we have seen throughout the pandemic—I am really grateful to all those who work in the NHS for this—is a reduction in the leaver rates, so more people are staying and sticking with the NHS, which is truly phenomenal. We have to make sure we look after those people, and I talked earlier about some of the support for the NHS workforce as we recover. It is also fabulous to see such extra interest in careers in the NHS; for instance, over a third more people are applying to become nursing students this year compared with last year. I also want to make this point on the test and trace question: it is not either test and trace or the NHS workforce. We need to have a test and trace system, and, of course, pay our NHS workforce.
I had several bits of correspondence about NHS pay over the weekend. Can my hon. Friend confirm whether any decision has been made specifically about nurses’ pay and what the total allocation for NHS pay rises is in the Budget? Will she ensure that those on lower pay bands are prioritised in any pay awards?
I thank my hon. Friend very much for her question. Nurses are just a part of the workforce being considered in the pay review, which involves over 1 million staff. About 300,000 of those are nurses. The cost of a 1% pay rise is about three quarters of a billion pounds, but we will absolutely look at the recommendations from the pay review bodies when they come through later in the spring.
The Minister has today said that she is grateful to NHS staff for their hard work during the pandemic, yet the reward the Government have suggested is a real-terms pay cut. Does the Minister feel that that is the right response, both morally and economically?
In our submission to the pay review bodies we said we have a funding envelope to enable a 1% pay rise for NHS staff. As I have said to other Members, the pay review bodies will look at a wide range of evidence and at factors including inflation. They will also look at what is happening to pay levels across the economy.
My hon. Friend will be aware of the heroic efforts made by NHS staff at the Princess Alexandra Hospital and across Harlow during the pandemic; they put their health and lives at risk looking after Harlow residents. While absolutely recognising the economic constraints and the £2 trillion debt that our country owes, will she reconsider and at least propose a larger increase for lower-paid NHS workers?
I completely agree with my right hon. Friend about the heroic efforts of NHS staff at hospitals and primary care and community trusts across the country, including the Princess Alexandra Hospital. As I have said, we have submitted to the pay review body our envelope for funding—the 1% that the Government say they can afford—and we will look at its recommendations when they come back. I should also say that there was a commitment in the spending review to ensure that lower-paid staff would get at least a £250 pay rise, and that applies to those in the NHS as well.
We heard this weekend about nurses in particular wishing to leave the profession, so does the Minister have any figures on departures in recent years? Does she agree that the elephant in the room is not pay across the board but low pay in the NHS? Even a 10% pay rise on not very much is not very much. Do we not really need a grown-up conversation about what we pay those who do some of the least glamorous jobs across health and social care day in, day out, every single year?
My hon. Friend is absolutely right that we should be thinking about the whole workforce. As the Minister with oversight of social care, I have many conversations with that sector about the pay levels for people working in social care. I want to see us appropriately rewarding and recognising staff across our whole health and social care system, not only in pay terms but in the wider package of support that people get, and making sure that each day at work is a good day. That is something that I will continue to work on in this role.
It has not taken the Conservatives long to revert to type and forget the contribution that our NHS staff have made to fighting this pandemic over the last year. Since 2010, “Agenda for Change” staff have seen their pay cut in excess of 10% on most of the spine points on the column. What assessment has the Minister made of the effect that this pay increase will have on the retention and attraction of high-quality staff into the NHS? Surely, we need to attract those people into the NHS, and this will not do it.
The hon. Gentleman makes a really important point about the retention of staff. I am working to make sure that we have another 50,000 nurses in the NHS by the end of this Parliament. On one hand, that is about making sure that we have more newly qualified nurses graduating with nursing degrees; on the other, it is about making sure that we keep the nurses and the other NHS workforce that we have. We have seen an improvement in retention, but I want that to be maintained. That is why I am working with NHS England on making sure that we have the greatest possible package of support, including mental health support, for staff who have been through a really tough time.
May I first wish the House a happy Commonwealth Day and International Women’s Day? Will my hon. Friend outline how many pay rises we expect to see through pay progression by raising pay bands?
My hon. Friend is absolutely right that, in addition to the pay settlement that we will reach through this pay review process, there are many staff who will be eligible for pay progression. About 40% of the staff we are talking about are eligible for pay progression, so many of those will get a pay rise in addition to the figure that we get to through this process.
The Minister was right when she talked about the amazing people who work in the NHS who have, in her words, “gone the extra mile” for the country. Does she understand why they will see this real-terms pay cut as a kick in the teeth? She justified it by reference to the pay freeze for other key workers, but that was a decision of this Government. Should they not recognise that they have got it wrong on both counts, review the pay freeze and give NHS staff the pay rise they deserve?
I must remind the hon. Gentleman of the difficult times that we are living in: many thousands of people have, sadly, lost their jobs through covid and others have had pay cuts. We are in times of great economic uncertainty, and against that backdrop the Government have to make very difficult decisions. They have made the decision that there will be a pay freeze for much of the public sector, exempting those on the lowest pay and the NHS from that pay freeze—so the NHS workforce will get a pay rise.
Every 1% increase will cost the taxpayer £750 million, but I did not hear the shadow Health Secretary say by how much he would increase pay or indeed which taxes he would increase to pay for that. Does my hon. Friend the Minister agree that one way to increase resources for health and social care and remuneration for our care workers is by means of a German-style social care premium?
I thank my hon. Friend for his question. I am smiling, because it is not the first time that he has mentioned to me a German-style social care system. I absolutely appreciate the work he has done to look into that and say to him, as I have before, that we will bring forward proposals for social care reform. He is absolutely right that we also need to look at the whole health and social care system as we consider these difficult questions.
The efforts of NHS staff during the pandemic have been nothing short of heroic, and, although deserved, recognition and good will are no substitute for proper pay and investment. Given the current level of vacancies and the fact that the use of agency staff in Welsh health boards costs nearly £70 million a year, does the Minister not agree that a substantial pay award would not only be fair but would constitute an investment in the NHS workforce that could help recruitment and retention of staff, thereby reducing reliance on agency staff?
I am absolutely committed to increasing the NHS workforce. As I mentioned in my statement, we already have 10,000 more nurses than a year ago; and 6,500 more doctors and over 18,000 more health support workers. We saw fantastic growth in the number of students starting nursing degrees last autumn—nearly 30,000—and nearly 50,000 have applied to study nursing this autumn. I am absolutely determined that we will continue to increase the size of our NHS workforce to meet the healthcare needs of the population.
The process begins with the Secretary of State sending the pay review body a letter to set up its remit, which was done in December. We then submitted our evidence to the pay review body last week, which covered the point about the pay envelope as well as a whole load of information about, for instance, retention and staff levels and support for the workforce. The pay review body will consider that, along with other evidence from the NHS, trade unions and others, and will report back to us in late spring. We will carefully consider its recommendations and come to a decision.
By the end of the year, £37 billion of taxpayers’ money will have been spent on the Serco Test and Trace programme, which is not even fit for purpose. That is on top of the Government spending £10 billion more on PPE contracts than they should have spent. Given that waste, how do the Government justify the view that most of the 300,000 NHS nurses are worth only a £250 a year pay rise?
The pay conversation that we are having at the moment is indeed about nurses—who are a fabulous part of our NHS workforce, and I cannot thank them enough—but it is also about the wider NHS workforce, which includes paramedics and health support workers, and this pay settlement will also include some doctors. More than 1 million staff are being considered in this process, and that is why the cost is closer to £1 billion than the figure the hon. Lady mentioned; it is around £750 million. The Government were absolutely right to invest in PPE to protect staff in health and social care during the pandemic at a time when there was a global shortage of PPE, and we are absolutely right to have invested in a world-beating test and trace service, which is doing a phenomenal job and is essential to our country’s recovery from this pandemic.
Will the Minister confirm that the public sector pay review body can take into account the exceptional service and sacrifice of our nurses and medical staff over the last year, and that if it recommends a higher pay rise than 1%, the Government will look at funding that from new resources and not have to scrimp and save elsewhere in NHS to fund the difference?
I agree: our NHS workforce—in fact, our whole health and social care workforce—have done a phenomenal job through the pandemic and, we should not forget, continue to do so. I will not pre-empt the recommendations that we will receive from the pay review body, but I assure my hon. Friend that we will absolutely consider them carefully before coming to a decision.
Women’s Health Strategy
With permission, I would like to make a statement about the women’s health strategy. Today is International Women’s Day, and on this important day we must acknowledge that for generations women have lived with a healthcare system that is designed by men, for men. As a result, women have been underrepresented in research. Despite women making up 51% of the population, we still know little about some female-specific issues, and there is less evidence and data on how conditions affect women and men differently. Despite living longer than men, women spend a greater proportion of their lives in ill health and disability, and there are growing geographic inequalities in women’s life expectancy. That makes levelling up women’s health an imperative for us all, so we must meet our goal of extending healthy life expectancy by five years by 2035.
There is already a lot of excellent work under way to achieve that. The Government are working on the next strategy on tackling violence against women and girls, and we have announced plans for a new sexual and reproductive health strategy, led by the Minister responsible for prevention, public health and primary care—my hon. Friend the Member for Bury St Edmunds (Jo Churchill)—which we plan to publish later this year.
Although this focused work is vital, it is also important that we take an end-to-end look at women’s health from adolescence to older age. I am thrilled to inform the House that today we are embarking on the first Government-led national women’s health strategy for England. It will set an ambitious and positive new agenda to improve the health and wellbeing of women across England. As we know, not all women have the same experience, so we want to hear from as many women as possible, from all ages and backgrounds, about what works well and what we need to change as today we launch our call for evidence.
The call for evidence, running until 30 May, seeks to examine women’s experiences of the whole health and care system, including mental health, disabilities and healthy ageing, as well as female-specific issues such as gynaecological conditions, pregnancy and post-natal support, and the menopause. The call for evidence is based around six core themes, which cut across different areas of women’s health, and I would like to set them out briefly in the House.
The first pillar is placing women’s voices at the centre of their health and care. We know that damaging taboos and stigmas remain around many areas of women’s health, which can prevent women from starting conversations about their health or seeking support for healthcare. When women do speak about their health, all too often they are not listened to. As the Minister for patient safety, I regularly hear from and meet people who have been affected by issues of patient safety. As independent reports and inquiries have found, not least the Cumberlege review and the Paterson inquiry, it is often women whom the healthcare system fails to keep safe and fails to listen to, and this has to change.
The second pillar is improving the quality and accessibility of information and education on women’s health. If we are to tackle taboos and ensure that women’s voices are heard, the provision of high-quality information and education is imperative. To give a timely example, March is Endometriosis Awareness Month. Endometriosis is a common condition affecting one in 10 women of reproductive age, yet the average diagnosis time is seven to eight years. It greatly saddens me to hear how so many women think, or worse, are told that the debilitating pain and symptoms that they are experiencing are normal or imagined and that they must live with it. We must ensure that women have access to high-quality information about health concerns. We must also ensure that health and care professionals can access the necessary information to meet the needs of the women they provide care for.
The third pillar is making sure that the health and care system understands and is responsive to women’s health and care needs across their life course. Women have changing health and care needs across their lives, and we know that specific life events, or stages of life, can influence future health. For example, we know that women who have high blood pressure or pre-eclampsia during pregnancy are at greater risk of heart attack and stroke in future. We also know that women can find it difficult to access services that meet their specific needs, or that meet their needs in a convenient place or time, and that there are significant inequalities between different groups of women in terms of access to services, experience of services and health outcomes. For example, women of black ethnicity are four times more likely than white women to die in pregnancy and childbirth. That is why I recently established the maternity inequalities oversight forum to bring together experts to consider and address the inequalities of women and babies from different ethnic backgrounds and socioeconomic groups. There is still more to do, so levelling up women’s health must be a priority for us all.
The fourth pillar is maximising women’s health in the workplace. The pandemic has brought home just how important this is. Some 77% of the NHS workforce and 82% of the social care workforce are women, and throughout the pandemic women have been on the frontline, making sure that people receive the health support and care that they need.
There is some evidence that female-specific health conditions—such as heavy menstrual bleeding, endo-metriosis, pregnancy-related issues and the menopause —can affect women’s workforce participation, productivity and outcomes. There is little evidence on other health conditions and disabilities, although we know that common conditions that can lead to sickness absence—for example, mental health conditions and musculoskeletal conditions—are more prevalent in women. Investment in women’s health in the workplace is therefore essential to women’s ability to reach their full potential and contribute to the communities in which they live, so that is a fundamental pillar of our strategy.
The fifth pillar is ensuring that research, evidence and data support improvements in women’s health. We have a world-class research and development system in the UK, but women—particularly women from ethnic minorities, older women, women of childbearing age, those with disabilities, and LGBT women—have been under-represented in research. This has implications for the health support and care that women receive, their options for and awareness of treatments, and the support that they can access afterwards. We must work to ensure that women and women’s health issues are included in research and data collection and so finally end the data gap that sadly exists. The better the evidence, the better we can understand the health and care needs of women and deliver the change that we need to see.
Our sixth and final pillar is understanding and responding to the impacts of covid-19 on women’s health. This pandemic has taught us so much about our society and our health and care system. As we build back better after this pandemic, we must make sure that we fully understand the impact of covid-19 on women’s health issues and what we can do to take that understanding forward.
The call for evidence is about making women’s voices heard. We want to hear from women from all backgrounds and will be inviting all organisations and researchers with expertise in women’s health to provide written evidence, too. We will respond to the call for evidence after the summer and we aim to publish the strategy later this year. I hope that the strategy will be welcomed across the House.
I thank the Members who have been working with us on this vital agenda. I thank my hon. Friend the Member for Thurrock (Jackie Doyle-Price) for breaking down taboos around women’s health through her advocacy in the House, and my hon. Friend the Member for Gosport (Caroline Dinenage) for her initial work on the strategy. I also thank the Members who lead the all-party parliamentary groups on women’s health, on endometriosis, on sexual and reproductive health and on women and work, and many more. We will keep working with Members in all parties as we take forward this essential work.
This strategy marks a turning point for women in this country. We are making women’s voices heard and putting them at the very centre of their own care, so that we can make sure that our nation’s health system truly works for the whole nation. I commend this statement to the House.
I thank the Minister for the advance copy of the statement. I wish every woman in the House and throughout the country a very happy International Women’s Day.
It is welcome that the Government want to understand the plight of women throughout the country, but although the Minister said that this strategy is the first of its kind, in reality it is not. We heard much that was in this announcement when the Government launched the women’s mental health taskforce in 2017. If the Government took this matter seriously, it would be a first. The Minister responsible for mental health at the time, the hon. Member for Thurrock (Jackie Doyle-Price), said:
“This report is a call to action for all providers, commissioners and practitioners across the health care system to drive forward the ethos of trauma- and gender-informed mental health care.”
That echoes what the Minister just said, so why are the Government asking the exact same questions four years later?
A multitude of health concerns are unique to women and are often overlooked. In hospital, I hold the hands of women in their darkest times: young women and girls presenting with eating disorders; trans women admitted after suicide attempts and substance abuse because they had been made to feel as though they do not belong; and women of colour presenting far too late with conditions that could have been easily treatable if they had found healthcare more accessible. I meet many women victims of domestic violence. They use healthcare services more than non-abused women, so I hope to see the Government’s upcoming violence against women and girls strategy address their needs.
The coronavirus crisis has had a disastrous impact on many women, and I have been honoured to listen to colleagues share their heartbreaking experiences of baby loss. My heart breaks for all those women who have had to go through that alone during the pandemic. What support will be offered to women who experience baby loss without their partners by their side? Within maternity services there are huge inequalities. The Minister is right to highlight the fact that black women are four times more likely to die in pregnancy or childbirth, and I welcome the launch of the forum, but the Government have known about these inequalities for years, so why has there not been action sooner? The Government are running a separate sexual and reproductive health strategy; would it not have made more sense to bring it, as part of that working, into this? A part of this which is widely stigmatised is the menopause. How will the Government be seeking to engage women who have to go through difficulties throughout the menopause?
The “Five Year Forward View for Mental Health” recommended that by 2020-21, in England, 30,000 more women each year would be able
“to access evidence-based specialist mental health care during the perinatal period”
and said that that was important. Can the Minister tell us whether that target has been met? Today, it is huge news that a woman of colour has spoken about her mental health struggles during pregnancy. Many women face difficulties but stay silent, afraid to seek help. With stigma attached to mental illness, the Government must ensure that evidence is collected from all of our ethnically diverse communities.
Women are still being misdiagnosed in 2021. With male bodies being seen as the default body, there is a huge historical data gap in understanding women’s health needs. It is shocking that women are 50% more likely to be misdiagnosed following a heart attack simply because our symptoms differ from those of men. What research will the Government commission to bridge that divide?
Finally, pay is a gendered issue. Women are 82% of the social care workforce and 90% of the nurses. Can the Minister justify the real-terms pay cut to our frontline NHS staff? Will she end poverty wages in social care? We need healthcare to work for every woman across the UK—young and old, white and women of colour, cisgender and transgender. We cannot wait any longer. Women’s health and wellbeing should not be an annual PR exercise. We need action and we need action now.
I join the hon. Lady in wishing every woman across the world a happy International Women’s Day. She opened by talking about the mental health taskforce and saying it is not the first of its kind, but it absolutely is. It was a five-year project that the NHS used to bring together women and organisations from across the healthcare sector to develop a mental health plan—a five-year view—which it did and reported on. As she knows, partly as a result of that, we now have the long-term plan in mental health.
The hon. Lady also spoke passionately, as she always does, about the patients she meets as part of her work and the women who are suffering from eating disorders—sadly, that has been a tragic cost of covid. We know that two groups have been affected by the past 12 months in the mental health sphere: people, including women, with pre-existing mental illness; and, in particular, young women aged 15 to 26, in whom we have seen an explosion in the number of referrals—I believe the figure is 22% for young women seeking help with eating disorders. We have committed funding during the spending review, when £500 million was announced, and I announced £79 million on Friday. Part of that is going to deal with the problems that we have as a result of the pandemic, and with young women and girls—and in some cases young men—who are suffering from eating disorders.
The hon. Lady talked about the stillbirth and neonatal target of halving the number of stillbirths by 2025. We are way ahead of our target on that. The Office for National Statistics published new data last week, and I believe we are looking towards a 30% figure already. We are way ahead of target, and that is a result of the measures that have been put in place in the maternity safety arena, including the saving babies’ lives care bundle and the early notification scheme.
I reiterate that what we are announcing today is a call for evidence from women everywhere in the UK: from every organisation and every friend, every partner, every family of every woman.[Official Report, 12 March 2021, Vol. 690, c. 5MC.] The link has been published today. I published it on the Government website and it is on the Department of Health and Social Care website and on my Twitter feed. It is a link that women can easily access using their phones or their laptops, and it takes a few minutes to complete. We want to develop the first ever women’s health strategy within the Department of Health and Social Care that will deal with all the issues—there are too many for me to talk about now—and all the ways in which women have been affected. These will include research funding and cohorts of trials not using women, using all the information that we have from Paterson and Cumberlege and from women stating clearly that women are not listened to in the healthcare sector. To address that, we need to hear not just from the Paterson women and the mesh women who spoke to Cumberlege; we need to hear from all women everywhere, and that is why we have launched this call for evidence today, to develop this strategy before the end of the year.
I really welcome this call for evidence and my hon. Friend’s clear commitment to hear from all women everywhere. Can she please reassure me that the consultation will not just be about reproductive health, important though that is, and that it will include all conditions and ensure that women have the ability to express freely what they want to see from their strategy? I welcome the timescale of the strategy coming forward in September.
My right hon. Friend is a huge champion for women’s rights and a Committee Chair. I would ask her, following the work that was undertaken by the all-party parliamentary group on women’s health, to contact anybody that she knows who can help to get this dealt with or who she has liaised with throughout her time as Chair of the Women and Equalities Committee, so that they can help to get this message out to the people who they know, to encourage women everywhere—and, as I said, not just women but families and anybody who wants to contribute.
Within the first minutes of the link going live this morning, we instantly had 300 responses. I have not checked what the figure is now. We need huge numbers of women and yes, absolutely, it is not just about the usual issues that get talked about, although they are an important part of this. Menopause, menstrual health, maternity and neonatal issues are the things we talk about frequently, but this will be about everything. For example, we know that drugs that are used on women are trialled and developed using all-male cohorts, and that doctors are taught in medical school to recognise symptoms that are taken from men and not applied to women. We know about the inequalities, and we need to know about any subject from disability to mental health; anything that a woman experiences in a healthcare setting, we need to know about it.
I welcome the Minister’s statement, which is timely on International Women’s Day. I also refer the House to my entry in the Register of Members’ Financial Interests. A gender health gap has arisen during covid-19, and the Scottish Government are also developing a plan to address women’s health inequalities. Research indicates that young women in particular have been found to have increasing anxiety, depression, suicidal ideation and loneliness. With coping strategies and social support diminished, eating disorders are tragically on the rise with high levels of morbidity. Young women disproportionately struggle to be referred for treatment due to an antiquated medical model based on body mass index to identify eating disorders rather than on a psychological model, treating the whole person. Will the Minister work with the all-party group for eating disorders and cross-party parliamentarians who want urgently to address this matter via the funding announced, but also to ensure the timely access to treatments for those crying out for help and a diagnosis, saving the lives of young women, and, in many cases, those of young men, too.
I thank the hon. Lady for her question. In fact, we met recently to discuss this very subject, and I have also had meetings with a number of Members from across the House who have an interest in this area. I also thank her for the work that she does in this area. I think that, as a result of our private conversations, she understands both my commitment and that of the Government. I know that she is aware of the funding that we have allocated to assist with this surge of eating disorders that have presented of late and of our commitment in the long-term plan to assist young women with both mental health issues and eating disorders in particular. An eating disorder is the most deadly of all mental health illnesses and also one of the most difficult to treat. I am delighted to hear that this issue is being taken seriously in the devolved nations as well and that Scotland is also embarking on a similar path. I hope that, as we do on all issues related to health, we and the devolved nations will share data and the methods of collecting it, experience and the evidence to develop a women’s health strategy, which will one day be rolled out across the UK.[Official Report, 12 March 2021, Vol. 690, c. 5MC.]
I really congratulate my hon. Friend on her statement today, particularly on International Women’s Day. Does she agree that the women’s health strategy, including the detailed pillars that she has outlined, is the first of its kind and will mark a real step change in approach in the way that it centres women, their voices, their lived experiences, and their evidence in making real change to the future of health policy in England?