Health Bill (Sixth sitting)
I agree with much of what the hon. Lady has said. Does she therefore support amendment 57, which would ensure that such a consultation takes place?
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Health Bill (Sixth sitting)
Unfortunately, the Minister’s reassurances have not convinced me. In relation to change, “significant” means various things to different people. As for “proportionate”, what is “proportionate” to one person is not necessarily “proportionate” to another. Amendment 57 makes reasonable provision for a situation in which there is a change from national to local commissioning, or from local to—mostly, it is from national to local commissioning. Therefore, I would like to push it to a vote. Question put, That the amendment be made.
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Health Bill (Sixth sitting)
Clause 14 is very straightforward: it states that schedule 1 “confers functions on integrated care boards in relation to commissioning primary care services…transfers related functions from NHS England to the Secretary of State, and”— perhaps most interestingly— “contains other amendments relating to primary care services.” Schedule 1 essentially makes the following changes to the NHS Act 2006: it makes ICBs responsible for commissioning pharmacy services instead of NHS England; it amends section 99 to make ICBs responsible for commissioning dental services instead of NHS England; it amends section 83 to make ICBs responsible for commissioning primary medical services such as general practice instead of NHS England; and it amends section 115 to make ICBs responsible for commissioning ophthalmic services. Largely, this change is formalising existing delegation and the risk of disruption is therefore relatively low. Local commissioners can tailor decisions to local need, and it is better if decisions are taken closer to users. However, there are a few other things in there as well. Paragraph 12(2) amends section 97 of the 2006 Act containing local medical committees, which are statutory committees. The way it is phrased, “the whole or part of the ICB’s area”, does not allow for overlap. Is that the Government’s intention? The Government, in a broader sense, talk about the strategic authorities and having the mayoral authority level involved in the ICB. But in Lincolnshire, for example, an area that I represent part of, the local medical committee could not work in conjunction with the mayoral authority under this legislation, as far as I read it, because it essentially covers two ICB areas and two regions. The mayoral authority is the Greater Lincolnshire mayoral authority. That includes Lincolnshire’s upper-tier area, the Lincolnshire county council area. It also includes the areas around Scunthorpe, Grimsby and Immingham, which fall into the Yorkshire region as opposed to the midlands region, and therefore not a whole or part of any given ICB area. I wonder whether the Minister has any comment on whether that was the intention, because it is also the case with paragraph 24(2) of schedule 1, which amends section 113 of the 2006 Act on local dental committees. Again, although the ambition stated and discussed in the Health and Social Care Committee yesterday by the Minister for Care, who is responsible for primary care, was that ICBs were to be covered at strategic level, that would not be possible for local medical committees or local dental committees under my reading of paragraph 12(2).
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Health Bill (Sixth sitting)
Of course, my hon. Friend is right. One challenge with the Bill is that although not all the measures are a problem individually, the way they are being brought in is a problem. The planning and organisation that has gone into it has not been coherent. A 50% cut has been made to the budgets of ICBs, which has required many of them to merge, but that has been done before the local government reorganisation has been finished, which means that ICBs have been melded together in a way that is not the same as the local government reorganisation. Let me again give the example of Lincolnshire. Lincolnshire had an excellent ICB, run by chief executive John Turner. That has now merged with Nottinghamshire and Derbyshire. Nottinghamshire and Derbyshire form the East Midlands mayoralty, but Lincolnshire ICB, as was, forms part but not all of the Lincolnshire mayoralty—which, as I said, also includes part of what was the Yorkshire region. Because the cuts were done before the local authority reorganisation, and the left hand does not know what the right hand is doing, we have ended up with an incoherent pattern, which does not help, particularly for social care services that are delivered by local authorities. We will come back to that when we talk about who is on the ICB. The risk is that we end up spending money doing this twice—being forced to do it at short notice, because of the 50% cuts brought in overnight by Government, and then doing it again to try to sort out the mess and bring things back into line with the new local authorities as and when it is decided what they will be. Going on to the pharmaceutical arrangements—I should probably declare at this point that my brother is a rural dispensing GP—I share the concerns raised by the hon. Member for Bury St Edmunds and Stowmarket in relation to rural dispensing GPs. Let me give the Minister an example from my constituency. The Cliff Villages medical practice was an excellent medical practice. However, there was a doctor retirement and the illness of a doctor, and as a result the service reduced in quality quite substantially. The ICB was working alongside the surgery and the one remaining practice doctor—not swiftly enough, it must be said. What happened in the end was that the Care Quality Commission came in, found that the service was really not good enough and closed the surgery down overnight, in the middle of the week. It was closed with immediate effect and there were no appointments for any patients in my constituency. Then, because the surgery had been closed, the ICB worked very hard to get a new practice in straightaway, and it got that opened on the Monday, which was pretty quick in the circumstances; but people lost their dispensing GP. Living in a rural area—I have a dispensing GP myself, living in a rural area—people can go to the doctor’s, see the doctor and, if the doctor perhaps says, “You need some antibiotics,” they can go back to the waiting room and sit there for 10 minutes, be given the antibiotics and then leave. That is significantly more helpful to a rural constituent than having to drive eight or nine miles into the centre of town, park the car, find somewhere to get the prescription and then go all the way home again, which would take much longer. People really value that service—I saw how much when I held a public meeting with the ICB and the new provider to talk about what had happened at the surgery, and 250 people turned up to an evening event in the village hall at short notice. It is hugely important to people. Will the changes allow the Secretary of State to step in in such circumstances, where the medical contract has been lost due to that cut-off by the CQC? Will that sudden loss of service be able to be replaced with a new dispensing service? Could Ministers have therefore given dispensing rights to the new provider? At the moment, those rights are not transferable, and it means that the only way that my constituents who live in that area and attend that practice can maintain dispensing rights is either to move house—perhaps to next door and back again, but they have to move house—or to change practice immediately, that same day, to another dispensing practice. To be honest, that seems ridiculous. Could the Minister make any comment on how the provisions in the Bill will help that situation and what her views are? I am confused by new clause 23 and new schedule 1; the Minister has introduced them later than the rest of the Bill, but they seem quite significant. They would move pharmacy appeals from the first-tier tribunal to an NHS body specified by regulations made by the Secretary of State. I presume the regulations are not yet written, so we do not know what form that would take, but the first-tier tribunal is part of an independent judicial system and the appeals will now be under political control, within the Department. Could the Minister explain why they think that is fair? Why do the Government want to do that? Is it just about saving money? How will the judgments made by that new authority be properly enforceable and give people confidence, given the change from the first-tier tribunal in the judicial system to something more politically controlled? I move on to new clause 2, which would require the Secretary of State to establish within six months a scheme to give patients the right to a GP appointment within seven days of seeking one, or 24 hours if urgent. I would be interested to hear the Minister’s comments on that and how she thinks it could be achieved. Modelling by the Health Foundation suggests that 6,500 full-time equivalent GPs—37,800 in total—will be needed by 2030-31 to meet greater clinical need. We have already talked about the doubling of medical school places; I presume the Minister has sought correction since we last spoke on whether the Government have a plan to double those places or not, but the Government are not on track to have that number of GPs. Is it simply that they do not have the resources to deliver it? I would be interested to hear the Minister’s comments.
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Health Bill (Sixth sitting)
We Conservatives share the hon. Lady’s desire to ensure that patients get their appointments as soon as they need them to be had, but she is talking about a difference between urgent appointments, within 24 hours, and non-urgent appointments, within a week. Who is going to make the decision about whether the appointment is urgent? Will it be the clinician? Will it be the patient themselves? Has she thought about where that responsibility lies?
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Health Bill (Sixth sitting)
One thing that my hon. Friend mentions is the Government’s stated intention to bring things closer to home, as opposed to the reality of the Bill as drafted. Does he agree with me that the document that explains what will happen to the commissioning of specialist services, and that talks about seven regions and how ICBs could collaborate within those regions, might imply that the Government are looking forward to having seven areas in which most commissioning takes place? These are even larger areas than have been described in the mergers so far.
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Health Bill (Seventh sitting)
My right hon. Friend the Member for Melton and Syston and my hon. Friend the Member for Farnham and Bordon have covered my points so effectively that I will be very brief indeed. How do we ensure that the consultation is not just well meaning and ticking the legal boxes, but actually listened to, so that people’s voices are incorporated into the plans? Also, I appreciate that amendment 28 is a well-meaning intervention, but how do we ensure that all voices are heard in a co-production, not just those who are the most articulate or the most able to engage with a process that they see online?
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Health Bill (Seventh sitting)
I beg to move amendment 51, in clause 16, page 12, line 10, at end insert— “(3) The regulations must ensure that integrated care boards may not impose operational policies requiring patients to wait a minimum number of weeks before they may access treatment.” This amendment would prevent minimum waiting times for NHS treatment.
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Health Bill (Seventh sitting)
The Government say they are firmly committed to cutting waiting times and meeting the NHS’ 18-week target. It seems odd that, despite that, it is necessary for me to table an amendment to prevent systems from forcing patients to wait artificially longer for their care through the imposition of minimum waiting times. Last year, The Times reported that at least eight local ICBs had introduced policies to pay healthcare providers for treatments only once patients have waited 12 weeks or more. I cannot think of any clinical reason why someone should wait for 12 weeks before having any treatment. At the time, the Minister said that while there was “no formal national policy supporting minimum waits”, local areas may “choose to include minimum waiting times in Activity Planning Assumptions to ensure delivery of targets within agreed financial allocations…to support commissioners in managing activity to ensure they can sustainably manage within their budgets”. I do not understand why we would want to make people wait longer than necessary. The Royal College of Surgeons has expressed concerns and made clear that minimum waits prolong “pain and anxiety” for those made to wait longer, saying that it is “counterintuitive…to give commissioners the green light to impose 18-week waits, while simultaneously working to ensure patients begin treatment within 18 weeks.” Age UK deemed it a “rationing approach” that is “potentially harmful to the health and wellbeing of older people.” NHS England has made it clear that ICBs cannot introduce minimum waits of more than 18 weeks—that is longer than the target, so that makes sense—but waits between 12 and 18 weeks are permissible. Will the Minister explain why that is a good idea? Amendment 51 seeks to ban ICBs from introducing any operational policies requiring patients to wait a minimum number of weeks before they may access treatment. There are safety risks involved in introducing minimum waiting times. They distort clinical priorities and may make patients wait in unnecessary pain and anxiety. Treatment should be delivered when possible, based on clinical needs. If a patient has a high level of clinical need, they might need to be treated earlier than the minimum waiting time because of the suffering they are experiencing. Minimum waits are not only detrimental to patient experience by forcing people to live in greater pain and discomfort; in some cases, the delay may make the patient’s condition worse, and the treatment they need may be more extensive and even more expensive. Their condition may even become life-limiting or life-threatening as a result of the delay. The introduction of arbitrary minimum waiting times that do not have any relevance to patient clinical need raises worrying issues, clinically, professionally and ethically. Minimum waits will also hinder the NHS’ ability to cut waiting lists and get waits to within 18 weeks. Some providers will have a list of people who can be available at short notice for a procedure, who they can call on if there is a cancellation on the day. If that person has not waited the minimum, that may be left as a gap, and that operation or appointment may not happen. That is wasted NHS resource. Each month that goes by, many people are added to the waiting list, and some are removed from it. We are aware that there seem to be a lot of unexplained removals from the waiting list, and that has spiked recently. Among the people treated by NHS providers in April, around 600,000 were treated within eight weeks of referral, versus 74,000 who were treated between 14 and 18 weeks. The introduction of a minimum waiting time will therefore push back many people’s treatment by as much as 10 weeks. Minimum waits also worsen and entrench postcode lotteries, because patients who have differential waits, based on whether their ICB has decided to implement minimum waiting times, may experience differential levels of care because of where they live. They are also another way of undermining patient choice, because patients may want to be treated in one area or one hospital because of the waiting time. If they all have different minimum waiting times, that distorts patients’ ability to choose. Minimum waits are also completely contrary to the 10-year plan for health, in which choice and productivity were considered central features, along with the Government’s wider commitment to keep people healthy. I hope the Minister will agree with amendment 51, which would ensure that minimum waiting times cannot be instituted. Amendment 52 also concerns waiting times. You will no doubt have seen, Dr Huq, the many newspapers articles about the Government fiddling the figures on waiting times, and there has been a spike in removals from waiting lists. People have found themselves removed from lists or going back on lists, or have suddenly found out that their waiting time started more recently than they thought. Amendment 52 would require the Secretary of State to publish the number of patients who are taken off treatment waiting lists each month and why they were removed. It is important that we are able to explain to our constituents why the Government have decided to remove them.
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Health Bill (Seventh sitting)
I should say that I am on a waiting list for treatment myself. The validation process seems to involve phoning people to check if they still need treatment, which after a long period is perhaps not an unreasonable thing to do. However, if they then say yes, they are phoned again a few weeks later; and if they say yes again, they are again phoned a few weeks after that. That puts pressure on people to say, “Okay”. If they are then asked, for example: “Would you be happy to see the consultant so that he can check that you are still listed for the right procedure, given that your condition may have changed and you may want to do something else?” it feels entirely unreasonable to say anything other than “Yes” to that. Would my hon. Friend be surprised to hear that when some people do that they find that they do indeed need the same procedure, but that their waiting time has now gone back down to zero?
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Health Bill (Seventh sitting)
Does my hon. Friend agree that when somebody—particularly a vulnerable person—receives a call asking them whether they would be prepared to see a consultant to see whether they still need treatment, they are aware of all the noise in the media? They are aware that other people are waiting. People do not want to waste NHS resources. The first time, they may think it is a routine process but, when they receive the second or third call, they may start to think to themselves, “They are trying to tell me that they want to do something else. Maybe I don’t need it as much as other people.” They feel obliged and pressurised into saying they do not need the procedure when they do.
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Health Bill (Seventh sitting)
The hon. Member for Ashford talks about social media and social media comments. I wonder if, where the DHSC or the Government have put that waiting lists are falling, my hon. Friend has read any of the comments that come in from the general public below such proclamations.
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Health Bill (Seventh sitting)
If a person has been waiting more than 18 weeks, the trust calls them and asks them to see a consultant to check whether they still need the appointment or whether they need a different treatment. If, after having that appointment, they are told that they still need the treatment, that same day they go back on the waiting list as if it were day one. Therefore, they have not waited less than 18 weeks, even though the Minister’s statistics might suggest they have. Does she accept that?
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Health Bill (Seventh sitting)
The clause imposes a duty on ICBs to have regard to the likely impact of their commissioning decisions on areas of Wales and Scotland close to the border. In some respects, this is like other parts of the Bill—a statement of the obvious regarding a person’s job. Are we suggesting that the Secretary of State, and in particular ICBs, would not consider the effect of their decisions? I hope that they would, but, given that the clause is there, what teeth does it have? What if they do not? Is there any consequence in the Bill if they do not? As others have said, will the Minister confirm whether there is a reciprocal agreement with Wales and Scotland? If there is not, what negotiations has she entered into and what progress are they making?
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Health Bill (Seventh sitting)
I have one question for the Minister. Which ICBs does she envisage being abolished, or is this just a precaution for the future?
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Health Bill (Seventh sitting)
The Government’s explanatory notes state that the clause is intended to give ICBs the ability to provide a broad range of support to those involved in providing or administering the health service. The flexibility there aligns with the Government’s stated vision for more autonomy across the system. I have a couple of questions. If the ICB were to provide support in a way that was out of line with good practice or what is expected by the Department, what would be the recourse? Where will it be possible for right hon. and hon. Members to see the financial expenditure that ICBs make in any such circumstance?
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Health Bill (Seventh sitting)
As has been said, the clause replaces the part of the NHS Act that requires NHS England to carry out performance assessments of the ICBs and rewrites it so that the Secretary of State has to carry out those assessments. That makes some sense, but, as the Minister said, it takes out the criteria against which the ICBs will be assessed. I accept what the Minister says—she wants those criteria to be set out more flexibly than can be done in primary legislation—but it is not reasonable or fair to assess people against criteria that they do not know in advance. It will be important, will it not, that ICBs know in advance what those criteria will be? Given what she said to my right hon. Friend the Member for Melton and Syston about writing to him, will she commit to writing to us to say not only what the criteria will be at the moment, but how far in advance ICBs can expect to receive them before they are expected to work to them and then be assessed against them? Will variation be a factor in whether an ICB is deemed to have been performing well or not? We know that there is a tension in the Bill between the Secretary of State’s need to equalise provision and the ICBs’ desire and intention to vary it and innovate. Given that the Secretary of State is a political individual, how will the assessment process be conducted in a way that gives ICBs and their leaders confidence that there will not be political interference in it?
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Health Bill (Seventh sitting)
I beg to move amendment 46, in clause 21, page 15, leave out from line 33 to line 6 on page 16 and insert— “(2) The constitution must provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include— (a) at least one person nominated by one or more NHS trusts or NHS foundation trusts which provide services under arrangements made by the integrated care board, in accordance with regulations made under sub-paragraph (2A); (b) at least one person nominated by a body representative of providers of primary medical services whose area falls wholly or mainly within the area of the integrated care board, in accordance with regulations made under sub-paragraph (2A); (c) at least one person appointed by a local authority whose area falls wholly or partly within the area of the integrated care board; and (d) at least one member nominated by the mayor of each mayoral strategic authority whose area coincides with, or includes the whole or any part of, the integrated care board's area (if any). (2A) The Secretary of State may by regulations make provision about the nomination of ordinary members under sub-paragraph (2)(a) and (b), including provision about which NHS trusts, NHS foundation trusts or representative bodies are entitled to make nominations. (3) The constitution must set out the process for making nominations under sub-paragraph (2). (4) A person making a nomination under sub-paragraph (2) must have regard to any guidance published by the Secretary of State as to the selection of candidates.” This amendment modifies Clause 21 so that, rather than replacing the existing mandatory membership requirements in Schedule 1B to the National Health Service Act 2006 with a requirement for mayoral representation alone, the new sub-paragraph (2) reinstates and consolidates the full range of required ordinary members.
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Health Bill (Seventh sitting)
At present, integrated care boards will have a chair, a chief executive and at least three further ordinary members. Those three ordinary members will include a representative of the NHS trusts and NHS foundation trusts in the area, someone from the primary medical services in the area and someone nominated by the local authority areas within the ICB area. Under the clause, the requirement for those individuals is replaced with a requirement to have someone from each of the mayoral authorities. Because of the order in which the Government have done this—removing half the budget from the ICBs, which has caused them to merge in a way that is not coherent with the Government’s not-yet-complete local government reorganisation—we have a situation where representation is not even. For example, in my ICB area the Mayor of Greater Lincolnshire and the Mayor of the East Midlands will each be able to choose someone to represent them on the board, but the proportions of the population are not even. Lincolnshire will be over-represented, which is not an issue for my constituents, but it may be for those from Nottinghamshire and Derbyshire. Likewise, the northern part of Greater Lincolnshire, which is in a different region, has a small population relative to its ICB. Some mayors will therefore have representation that is not proportionate to their population size. There is surely a risk that the next step will be for the Government to say they want to make things more even, with ICBs working in relation to mayoral authority areas. Yesterday, the Minister for Care suggested at his appearance before the Health and Social Care Committee that the ICBs should be aligned with strategic authorities, but the only way in which that can happen once the Government have decided where the strategic authorities will be is if things are changed once again. That brings ongoing costs—financial costs, opportunity cost for service development, and cost to the people delivering these services. The people working hard to try to deliver the Government’s plan find themselves and their jobs threatened and chopped and changed all the time. We heard evidence that the concentration on reorganisation rather than service delivery, provision and development is causing distress to those people. We also heard about the effect on social care, which, certainly in Lincolnshire and in other places, is delivered by the upper-tier local authority, but not all mayors have any responsibility for health—our mayor does not. We will therefore have someone who is not responsible for health on the ICB while someone responsible for delivering social care will have their seat on the ICB removed. I am afraid that I simply do not understand that. I watched through several times the Minister for Care’s Select Committee appearance, and I still do not understand the rationale. I will be grateful if the Minister for Secondary Care could explain that.
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Health Bill (Seventh sitting)
Where a mayor is from one political party and local authorities are run by different political parties, the mayor, as part of the ICB, will be able to make decisions about spending done by authorities that are run by different parties. That will surely create a political conflict, or at least the potential for one.
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Business of the House
I thank the Leader of the House for announcing the business that we have scheduled. In addition to the business he has announced, on Thursday 9 July there will be a debate on a ban on trade with illegal Israeli settlements, followed by a further debate on which we await confirmation from the sponsor. On Thursday 16 July, assuming that we are given that date, there will be the annual Sir David Amess pre-recess Adjournment debate, which is very popular with all colleagues. As we await the implementation of the new Government, it seems that Government business is reasonably light. Early notice of any extra dates that we might get before the recess would be appreciated, as we have only just cleared requests for debates in the Chamber dating back to December. We have a large queue. Let me turn to the debates in Westminster Hall next week. On Tuesday 30 June, there will be a debate on Government support for removing unlawful storefronts and regenerating local high streets. On Thursday 2 July, there will be a debate on reducing premature deaths from heart disease and stroke, followed by a debate on Government plans to tackle air pollution. On Tuesday 7 July, there will be a debate on UK aid policy in the context of global funding trends. On Thursday 9 July, there will be a debate on Government support for the lobular moonshot project, and a further debate to be confirmed. I can announce in advance that on Thursday 16 July in Westminster Hall there will be a debate on the impact of national planning policy framework changes, followed by a debate on capital funding for Changing Places toilets. Given the recent hot weather, I have been inundated with reports of individuals trapped in their flats in high-rise buildings, lifts going out of action and people being trapped in stairwells and collapsing because of the heat. That is particularly prominent in social housing. Given that this is about the design and upkeep of properties, can we have an urgent statement from one of the Housing, Communities and Local Government Ministers on what action the Government will take to protect these very vulnerable people? I have to say that they are often from visible ethnic minorities and often have no recourse to the support that they need. This is an urgent matter. Given that the hot weather is likely to continue for some time to come over the summer, we must take urgent action.
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Steel Trade Measure
I thank the Minister for advance sight of his statement. We welcome the partial U-turns that have been announced, the engagement there has been and the reflection, even at this very late hour, that the original proposals from the Government would have done great damage to British manufacturing. This decision could, however, have come months ago. If not, it could have come weeks ago, when Members of the House and businesses started raising the alarm and engaging with the Department. It took this Government—if Members can remember—more than a year and three quarters to come up with their original steel strategy, yet the industry is now expected to adjust with less than one week to go. That is not a reasonable way on which to proceed. The Government have left untouched the 50% tariff rate, and that will do great damage to British manufacturing, house builders and those who construct the nation’s infrastructure. It will mean higher inflation, fewer jobs, fewer homes and fewer public projects. The Government have made some welcome concessions on how much steel can be brought in but conceded nothing on the rate that punishes imported steel the very moment that the quota is exceeded. I know, as does the Minister, that he has received significant private representations from industry on this issue, particularly from defence and aerospace, and I imagine that the Minister does understand that this measure will not be enough. Of the 60 codes that we believe are relevant to aerospace and space, just two codes have been removed, and while quota uplifts have been applied, they are not particularly useful to the small-scale, high-value defence manufacturers, as commodity buyers will snap up all those quotas at the start of the year before they get a look-in. As a result, we are, I am sad to say, putting the defence of this country at risk by imposing a shock to defence industry prices, and it will either be the Treasury or the Ministry of Defence that picks up the bill. Projects such as AUKUS, Tempest, drones and much-needed munition rearming will all be vulnerable as a consequence. Finally, let me put some questions to the Minister on behalf of the industry. Will he commit to publishing the impact assessment on downstream steel sectors before Parliament rises for the summer? Does the Minister understand that by not exempting pre-agreed purchase contracts, which may in some cases run for years, he is damaging good, decent British manufacturing firms, even those in Rhondda and Ogmore? His exclusions rest on a test of “no production, or production paused”, but will he explain how he justifies keeping specialist grades in scope when in some industries, such as aerospace, it takes years to certify suppliers? Can he confirm that the EU’s reciprocal quota for exports from the UK will fully protect the 2.4 million tonnes of annual British exports of steel that would otherwise be at risk?
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Steel Trade Measure
On a point of order, Madam Deputy Speaker. I know that in a former life, the Minister was punctilious about standards in this House, so I seek your advice as to how he may correct the record. He referred to a letter that I believe he said his office had received this morning or yesterday. In fact, the Department will have received copies of two letters, one which was sent a week ago, not on my behalf, but on behalf of hundreds of thousands of small manufacturing businesses that were desperately worried, with one week to go before the tariffs. There was a second letter on Tuesday, jointly from me and the shadow Defence Secretary, my hon. Friend the Member for South Suffolk (James Cartlidge), again, sent on behalf of this vital industry, which keeps us all safe. I have not yet received a reply to either of those. I would not necessarily have expected to, but it would not be right for the record to reflect that he had only received the letter this morning.
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Lord Mandelson Humble Address: Government Response
I am sure that danger and excitement await the Chief Secretary to the Prime Minister in whatever comes next. The Government have always maintained that they have withheld material from the Mandelson case only at the request of the Metropolitan police, but a fortnight ago, a Daily Mail journalist spoke to the Metropolitan police, who insist that they did not ask for a crucial series of messages to be withheld. Can the Chief Secretary to the Prime Minister explain why the Metropolitan police and the Government are saying different things?
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Lord Mandelson Humble Address: Government Response
Obviously the House does not want to do anything prejudicial to a case, but it appears that the Metropolitan police are saying that some documents could be released without that being prejudicial to the case. I know that things will soon move on, but the Humble Address will remain in force, even if there is a new Prime Minister. If there is a criminal trial—and even if there is not—it is likely that more information will be released. As this has been a particularly novel way of using and responding to a Humble Address, it is likely that there will be a Select Committee inquiry into how the process ran. Will the right hon. Gentleman give a commitment now, at the Dispatch Box, that there is no material that the Government have withheld that the Metropolitan police have not explicitly asked to be withheld?
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Topical Questions
This may be the last time I come up against the right hon. Gentleman during parliamentary questions. When we first faced each other nine months ago, I said that he was one of the most able performers in Government, and I still believe that to be the case. I think there will come a time when his party regrets the fact that he did not stand in this leadership contest. I think he would have lost—
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Topical Questions
I was just trying to be nice, Mr Speaker. We will do it privately. Given that we may have a new Prime Minister on 16 July, does the right hon. Gentleman think that that new Prime Minister should take questions in the House before he goes off for the summer break?
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Topical Questions
I am very glad to be the one to break the news that the right hon. Gentleman wants to keep his current job and not move to another role. This is a serious question. Does the right hon. Gentleman think it would be appropriate for the new Prime Minister to answer questions before the summer break? If so, will he make representations to the next Prime Minister?
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Engagements
Q15. From slashing winter fuel payments to surrendering the Chagos Islands, this Prime Minister has got every major decision wrong. It is no wonder that even his own MPs are now looking elsewhere for the answers. As this may be one of his final appearances at the Dispatch Box, will he make one final U-turn? Will he scrap Labour’s disastrous grey-belt policy and help protect the precious green-belt spaces and green areas across Aldridge-Brownhills? If not, his legacy will be that he was the Prime Minister who destroyed so many of our local communities.
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Farming Road Map and Profitability Review
I thank the Secretary of State for advance sight of her statement, and I repeat my sincere thanks to Baroness Batters for her thorough report. The Secretary of State presents a document for farming for the next 25 years, but this Government will not last even 25 days. Instead of using their 14 years in opposition to create this document, they have dithered and delayed for the past two years, but they did not dither and delay in making life harder for rural businesses. One of the first acts of this Government, of which Labour Members are all so proud, was to target family farms and family businesses with their death tax. As Labour MPs and Ministers in the Department for Environment, Food and Rural Affairs voted repeatedly for the family farm and family business taxes, DEFRA Ministers shut down farming payments without notice, including the SFI. Sadly, the record of this Government is rising food prices and a record number of farms closing. They broke the trust of farmers, and they have only themselves to blame. Yet the Secretary of State stands here today wanting to be thanked by rural communities for producing a document that could be shelved quietly by whoever comes next, just as the Government seem to have shelved the 10-year plan for the NHS. For all the talk—[Interruption.] Mark my words! For all the talk of the new SFI scheme and budgets, the fact is that they have cut the farming budget by £100 million. In another leap from reality, the Government’s negotiations with the EU get barely a mention in this document, despite the enormous consequences they will have for farming businesses. CropLife UK has estimated that this EU reset could drain £810 million from UK farms and sacrifice almost 9,000 jobs from our rural constituencies. The Food and Drink Federation states that the wholesale handover of our food laws to the EU will lead to at least 400 regulations needing to be changed. So how will the Government ensure that UK farmers, including our tenant and upland farmers, can compete against heavily subsidised EU farmers? This matters because food security is critical in this increasingly volatile world. What reassurance can the Secretary of State provide that the next Cabinet will prioritise farming and food production? We Conservatives view DEFRA as a vital economic Department, so we agree with its efforts to recalculate farming and food producers’ contributions to the economy. By the way, I note that Reform calls itself the farmer’s friend, yet there is not a single Reform MP in the Chamber. Had the Secretary of State attended Cereals 2026 at Diddly Squat, she would have seen for herself that the sector is already driving innovation. The Government are therefore playing catch-up, but we hope that the intention to work with the Department for Business and Trade to deliver reductions in compliance costs and to focus on innovation and technology will actually happen. The plan to bring DEFRA farming services into one integrated service is much needed, and this reflects Conservative calls for quangos and the Department to be overhauled. There are many questions still left unanswered in this report, and I hope that the Secretary of State will try to answer them rather than deflect, because that has been noticed. The plan looks to double the funding for Environment Agency inspections. Why are this Government focusing on bureaucracy rather than helping farmers survive? What does she say to the tenant farmer of a well-run dairy herd who has been told by the Environment Agency that they must invest up to £750,000 to guard against a “risk” that there “may” be a pollution event in 50 years’ time. As that tenant farmer said to me, there will not be a farm there in 50 years’ time, as they simply cannot afford that payment. There is also no mention of closing the flag loophole on food packaging to help our constituents to buy genuinely British food and to back British farmers. Why not? The report says there will be no cut to food production, but it also says there will be a reduction of 9% in the land available to produce food. How can the Secretary of State guarantee that our food production will be protected when key tools, such as gene editing to develop drought-resistant crops, are at risk in the negotiations with the EU. In her final act in this Department, will the Secretary of State please advise the right hon. Member for Makerfield (Andy Burnham) that the first thing he must do is axe the family farm and family business taxes completely? Otherwise, sadly, this will be a road map to nowhere for struggling farmers and food producers.
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Nottingham Maternity and Neonatal Services
I thank the Secretary of State for advance sight of his statement and Donna Ockenden and her team for the care and compassion with which they conducted the review. We had a meeting with her yesterday, and I have to say that it was probably one of the most difficult meetings that I have ever had. I pay tribute to the hon. Member for Sherwood Forest (Michelle Welsh). I can see how deeply personal and painful this is, and I admire her and all her colleagues from the region at what must be a very difficult moment. Let me say from the outset that I want to be constructive in opposition when it comes to this issue. We need to work together; we have to see improvements. I begin with the women, babies, fathers, partners and families whose lives sit behind the review’s findings. To them, we owe a profound apology for failing them when a family should feel safest, most supported and most able to trust the care around them. For too many, that trust was broken; women were not listened to, families were not believed and warning signs were missed. Some suffered the deepest lost, others were left physically unsafe and others psychologically scarred. No statement can repair that pain, but it can mark the point at which testimony becomes responsibility, and responsibility becomes action. The painful truth is not only that the failings occurred but that the themes are familiar: women not heard, families dismissed, poor communication, missed deterioration, weak governance and people unable to speak up. Maternity and neonatal safety has challenged Governments of both parties, but it would be wrong to let that history soften the urgency. Women and families are tired of telling their story, hearing promises and seeing the same themes return. The question is whether the system will move because of this review, and so I put three tests to the Secretary of State. The first is the listening test. Women and families were not consistently listened to. Their concerns were too often dismissed or not acted upon. That is not a soft issue; it is a safety issue. How will the Government embed listening as a clinical discipline? How will trusts measure whether women feel heard? Will complaints and near misses be treated as information for improvement? The second is the culture test. The review describes bullying, hierarchy and poor psychological safety affecting staff’s decisions and willingness to escalate. I pay tribute to those who were brave enough to do so. In maternity and neonatal care, minutes matter. If staff cannot challenge, safety is weakened. Staff cannot provide the care they want to if they are exhausted or unsupported, or if hierarchy matters more than candour. So I ask: how will boards be held accountable for that ward culture? The third test is the delivery test. Harm rarely followed one error; it usually followed a chain of poor communication, weak risk assessment, delayed escalation, staff pressure, inadequate governance and missed learning. The response cannot be a single announcement. It must be accompanied by a delivery plan, so will the Secretary of State publish a national implementation plan with named accountability, delivery dates and regular updates to this House? That plan must address the workforce so that staff have the support and information they need to fulfil their roles to the ability they wish. That plan must design services for today and the future, not rely on assumptions from the past. Women are having children older, pregnancies are more complex and more women are entering pregnancy with pre-existing conditions, previous loss, fertility treatment, mental health needs or circumstances shaping care. That means a need for practical, personalised care, informed choice and each woman being treated as a whole. The review also requires us to confront inequalities. The safety of a patient must not depend on confidence, class, ethnicity, language or an ability to fight through the system. The issue with our mortuaries is also really shocking. The horror stories that we have heard must never happen again. Is the Secretary of State working with colleagues in the Department of Justice to see what more needs to be done to overhaul this area? Finally, we must recognise the psychological harm caused through silence, poor communication, lack of bereavement support and the battle for honesty. We know that our mortuaries need to have the highest standards. Compassion after harm is not a courtesy; it is a duty. Trust is rebuilt when women feel the difference in the room, when words change decisions, when staff speak without fear, when risk is escalated in time and when boards are judged by results. Where the Government act to improve safety, accountability, staffing and family voice, they will have our support so that we can see this through together. Where they do not, they will face our scrutiny. This review began with families who had to fight to be heard. The task now is to ensure that no family has to fight so hard again.
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Farming: Financial Sustainability
I thank the hon. Member for securing a very good debate. On food security, in south Shropshire, just outside Onibury, there is a campaign to stop over 130 acres of solar panels going on good agricultural land. The plans would make it harder to be resilient and to provide food security as a country. Does he agree that no solar panels should go across good agricultural land?
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Farming Road Map and Profitability Review
South Shropshire farmers wanted to see an action plan that prioritised food production. The road map does not do that, and it will not happen unless the Government decide to do all food procurement through supply chains that prioritise South Shropshire farmers and other farmers around the country. Will the Secretary of State commit to prioritising British farmers in the Government procurement process?
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Violence against Women and Girls
Does the Minister agree that it is iniquitous that at least one of the doctors responsible for the intrusive examination of young women prior to their rape and sexual abuse by Mohammed Fayed is still practising in London? If she does, would she approach the General Medical Council to ask why that is?
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Media Green Paper
I urge the Secretary of State to keep a genuinely open mind on this consultation, and to be prepared to drop measures if the evidence does not stack up. The concept of prominence in particular will be very difficult to translate from a linear age to this age without imposing excessive costs and bureaucracy on broadcasters. As we have seen, the concept of trustworthy news is problematic, because one person’s “trustworthy news” is someone else’s propaganda. Just look at the debate between the BBC and GB News—frankly, right now, plenty of my constituents would trust GB News over the BBC. We cannot allow debate on this issue to become an echo chamber for liberal/left groupthink; otherwise, it will further undermine trust and confidence in this place.
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Media Green Paper
On a similar theme, undoubtedly near the top of the Secretary of State’s to-do list today is to answer written question No. 11584, which is due for answer tomorrow. The question is about the threat posed by the BBC World Service apparently discontinuing its longwave transmitters at Droitwich, Burghead and Westerglen. What we want to know is: how will closed societies like Russia be able to receive news information when they are subject to the suppression of all the internet-based routes?
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Nottingham Maternity and Neonatal Services
When whistleblowers tried to alert society to what was happening, was any action taken against them, and if it was, does that indicate that there needs to be strengthened protection for whistleblowers? At the other end of the spectrum, are those clinicians who refused point blank to take part in the review process going to be named?
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Nottingham Maternity and Neonatal Services
It is a matter of profound shame for all of us in the House that in a society that we call compassionate, a baby’s body could be disposed of as clinical waste. I add my thanks to the families and salute their courage, including the hon. Member for Sherwood Forest (Michelle Welsh), and particularly Jack and Sarah Hawkins, and all those families who have shown such courage in coming forward with these utterly appalling stories. I commissioned a number of maternity reviews, and I am afraid that today I feel a terrible sense of déjà-vu. I worry that a lot of the recommendations, and the things that I suspect the Government will end up doing, amount to central direction and central control, which we know usually does not work in the NHS. I was encouraged that the Secretary of State, in his thoughtful comments, used the word “accountability”, because the core problem is a lack of clinical accountability. For his solutions, will he consider a complete overhaul, so that every mother, the moment she knows she is pregnant, is given a small team, including a doctor and midwives, and is told, “This is the team, this is the person who is responsible for the safe birth of your child”, so that she always knows who to go to? That is where things are currently falling between the seams. Ensuring that people always know who is responsible and who to go to is the only way that we will stop these things happening time after time.
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Farming Road Map and Profitability Review
Once upon a time, it would not have been necessary for a Secretary of State for farming to come to the House to say that the primary purpose of farming was food production. The central recommendation of Minette Batters’ report was to make food security a national strategic priority. Does the Secretary of State not realise that unless her road map contains a commitment to make food security a national strategic priority, everything she says in that report will simply be like trying to fill up the bath with plug out? At a time when the generals are telling us that we could be at war in 10 years, surely it is time for the Government to commit to real, precise targets.
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Farming Road Map and Profitability Review
I think I am right in saying that the document, which is 70 pages long, mentions profitability just twice. Without profitability, which involves a hard-hearted look at agricultural economics—outputs less inputs—it will be much more difficult to achieve a number of the aspirations in this large document. Will the Secretary of State assure me that when she considers any changes to farming, she will at least consider profitability? By the way, I hope that she survives the reshuffle when it comes.