Dr Andrew Murrison
MP for South West Wiltshire · Conservative · United Kingdom
“It is good to hear that the Government plan to replenish the dwindling stocks of Patriot missiles in Ukraine, which I suspect it will need this winter. However, Patriot is low volume and high cost. What the Ukrainians need is high volume and low cost.”
“Currently, the Royal Navy has an offshore patrol vessel permanently stationed in the Falkland Islands, but given the threat that is being faced and our need to demonstrate resolve—the sort of thing that, sadly, we did not demonstrate in the early 1980s, which led to miscalculation—will the Minister consider speaking to her MOD colleagues…”
“Since the Foreign Secretary is not going to get the co-operation, fulsome or otherwise, of the Israeli state in differentiating goods and services made in the settlements from those that are assembled, repackaged, produced and grown in Israel itself, how is he going to distinguish the one from the other?”
“The Government insisted on applying the social time preference rate to the disastrous Chagos deal to make an appalling deal look slightly better.”
“Will the First Secretary of State’s exercise in delivering democracy and local accountability and empowering local people include a look at large organisations that cannot be described as governmental or as quangos but that nevertheless exist firmly within the public domain, are established by statute, serve the public and are big employe…”
“I congratulate the Government on the hiring of Alistair Burt—he is a good hire and will do great things for some of these most complex of cases—but does the Minister agree that many of these cases are extremely difficult and exceptionally traumatic, and that it is far better to prevent them happening in the first place?”
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“I declare an interest similar to that of my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). Does the Secretary of State agree that there is an opportunity with integrated care boards and panels to ensure the end of the awful spectacle of people at end of life and frail elderly people coming towards the end of their days being expected to live out those days in an acute hospital ward, when they should be looked after in more homely settings in the community? That has gone on for too long and consecutive pieces of legislation have failed to address it. We have an opportunity here, probably with the help of the other place, to sculpt the measure we are considering today to ensure that stops.”
“Will my right hon. and learned Friend reaffirm that the priority for Her Majesty’s Government remains upholding the Belfast agreement, even if the European Union appears to hold it so lightly? On the subject of bad faith, cited by the right hon. Member for Orkney and Shetland (Mr Carmichael), what does my right hon. and learned Friend make of the fact that 20% of the European Union’s checks still occur in relation to goods going from GB to NI, despite Northern Ireland having the equivalent of 0.5% of the European Union’s population? Does he agree that the bad faith the European Union is exercising in this matter makes it absolutely essential that we continue to keep under consideration the rescinding of articles 5, 7, 8 and 10, as outlined by the July Command Paper?”
“My right hon. Friend is right to say that not every city, town and village will benefit from this plan, but one thing is for sure, which is that they will all be paying for it and there are opportunity costs. Does he understand the disquiet of my constituents about HS2 and now this plan, given that he has limited bandwidth and what he is spending on one project is not being spent on upgrading services elsewhere? Will he throw my constituents a small crumb by delaying the planned closure of services from Bristol Temple Meads to Waterloo via Trowbridge and Salisbury, pending a proper consultation that will show very clearly that the Great Western Railway service he thinks duplicates services run by South Western Railway is over capacity now and certainly will be once he closes the GWR service?”
“It would reduce the burden on the national health service very substantially indeed, and address the health inequalities that sadly mean the life expectancy of the richest and poorest in this country are currently separated by upwards of 10 years.”
“I warmly congratulate my hon. Friend on bringing forward this debate. On the point about the 70,000 deaths, is it not important to understand that that is year after year after year? Would he set that in contrast with the awful toll we have had from covid and the terrible restrictions that we have necessarily placed upon the population of this country, and agree with me that getting rid of this horrible substance would be far less of an intrusion on people’s liberties than the sort of things we have seen over the past 18 months? Over time, that would have a far greater impact on health, wellbeing and people’s ability to go about their daily lives.”
“Pandemics are by definition international, and the UK—along with France, Germany and the World Health Organisation—has rightly called for an international pandemic treaty. Can my right hon. Friend say what form that treaty will take, and within what sort of timeframe? Will it cover, for instance, the availability of personal protective equipment in a timely fashion to those who need it, and the avoidance of the use of vaccines to exert diplomatic leverage, which we have seen in the case of AstraZeneca and the threatened use of article 16 of the Northern Ireland protocol?”
“I congratulate the Prime Minister on his Glasgow achievements. Can he say what is being done to remedy the international shortage of critical minerals to make semiconductors, without which the achievement of our 2035 targets will be impossible? What more can he do to grow our own silicon valleys to reduce our reliance on China and Taiwan?”
“I declare my interest as a vaccinator. I support the Government’s position, but will my right hon. Friend the Secretary of State tell us what assessment he has made of the risk of transmission of coronavirus from an apparently healthy person to a vulnerable person? As with hepatitis B, the only justification for the measure must be that there is a significant risk of transmission. Furthermore, will he reassess his position on flu following the comments of his two predecessors, which I support? Will he ensure that we do nothing to trespass on the rights of individuals unless it is absolutely essential to keep vulnerable people safe? Finally, will he say why he has gone for 1 April? If this has to be done, it is better to do it quickly. By the spring, we will clearly be past the winter pressures that we are all concerned about.”
“Will the Minister ensure that an obsession with non-pharmaceutical interventions, such as mask wearing, does not obscure the central message that the way out of this is through the continuation of the UK’s excellent vaccination programme? Will she ensure that the wind is not taken out of the sails of that vaccination programme as we enter a perilous part of this cycle in the winter months? And will she ensure that the evidence that monoclonal antibodies and antivirals given to test-positive vulnerable people before hospitalisation reduces their mortality is rolled out into recommendations so that such people can receive interventions that stand every chance of reducing their mortality and ensuring their recovery, thus reducing the burden on the national health service?”
“I congratulate my right hon. Friend on sponsoring this important debate. Does he agree with me that if our colleague’s concerns were correct then—they certainly were—they would be even greater now, since a difficult Government in Tehran have been replaced by a Government who are simply beyond the pale in their principlist agenda, and in their view, as articulated by President Raisi, that sanctions are an opportunity for Iran, rather than something to be feared? Does my right hon. Friend fear, as I do, that dealing with a man who deservedly has the title of the “Butcher of Tehran” is going to be murderously difficult, notwithstanding the fact that the Biden Administration are far more positive than their predecessors when it comes to advancing the JCPOA?”
“My right hon. Friend is being very generous and is right to say that technical understanding and knowledge cannot be unpicked. That, in a sense, is more important than the quantum of enriched uranium. Does he agree with me that Naftali Bennett and Yair Lapid are right to be deeply concerned about what is going on? I am sure my right hon. Friend agrees with me that the state of Israel has to be protected against an existential threat from what is happening in Iran.”
“Would my right hon. Friend go a little further? As a medical support worker, I can tell him that there has been very little effort to follow through on a programme begun last year to encourage people to return to being patient-facing. They need to remain engaged; the Act is a good start in that process, but it does not appear to have been developed in any way. I agree absolutely that my right hon. Friend needs to keep those provisions in the Act, but he needs to develop them more than has been done so far—particularly because if we face a bad winter and possibly the resurgence of this or another virus, we will need those people. They need to remain engaged.”
“I always listen to the right hon. Gentleman’s comments with the greatest of interest. He is concerned that there is not sufficient scrutiny. Will he compare and contrast the attendance in this short debate on the Government Benches with that on the Labour Benches? I count three of his Back-Bench colleagues at the moment.”
“When the hon. Gentleman says vaccination, I hope he also means vaccination against seasonal flu, which is currently at the front of my mind as this morning I had my jab in the Attlee Room in Portcullis House. Seasonal flu will potentially cause more of a problem this winter than covid. It is important to get that message across. Does the hon. Gentleman share my concern that we are currently not where we really ought to be in vaccinating people against flu?”
“Will my hon. Friend also scrutinise the Bill, as a number of colleagues have mentioned this afternoon, to find those bits that were inserted as expedients but probably need to be refined a little and perhaps given a different statutory basis, such as the certificates in section 19, which for many years have been a nice little money-earner for members of my profession but a burden on the deceased’s estate and which really are not necessary?”
“In addressing the energy trilemma of cost, security and decarbonisation, what account is my right hon. Friend taking of the 10,000 MW, 4,500 km power link between Australia and the Association of Southeast Asian Nations? Does he feel that there is any read across for what the UK might do to address the problems we will likely face, if not this winter, in the very near future?”
“It is obviously right that we crack through this casework as soon as possible, particularly in relation to UK nationals and those who come under the scope of the ARAP scheme. That is a UK responsibility and we will be faced with a refugee crisis—of that there is no question. We will therefore need a much bigger programme to take as many people as is reasonable, with our partners. The expert in this matter is the United Nations, which has of course provided triage, relatively recently and contemporaneously, in the Syrian resettlement programme, so what discussion has the Minister had with the UN about how to manage this situation, particularly in relation to those who have now fled Afghanistan?”
“It is therefore perfectly reasonable for the Government to put this Bill before the House in order to anticipate the funds that will be necessary and a prerequisite for the proposals that we imagine will be fleshed out as part of the White Paper. There is some urgency in this. Question put and agreed to.”
“It is very clear to most of our constituents that, after 18 months, there will need to be a tax rise to pay for service items that the NHS has not been able to provide because it has been dealing with the pandemic. There is also an expectation that we will improve social care, and most people would say that that comes with a price tag. It seems to me entirely reasonable for the Government to say that they will publish a White Paper to flesh out the finer detail, after consultation, on matters that my hon. Friend the Member for Basildon and Billericay (Mr Baron) and my right hon. Friend the Member for Wokingham (John Redwood) have just described. However, I think we have to assume that it will come with a not insignificant price tag.”
“The hon. Gentleman has been speaking for some time, but he has not said what taxes he would raise. Why was it okay for Labour to raise national insurance to pay for healthcare in 2003, when there was not a pandemic and we did not have the scale of social care need that we have today? If it was right then, why is it not right now?”
“I am loth to give the hon. Gentleman an extra minute, but I must ask him how much he would put on income tax. I know that his party was famously keen on putting a penny on income tax, but he has just made a whole load of spending commitments—particularly raising incomes for care staff. I assume he has costed that. If so, will he say how many pennies on income tax he proposes to burden our constituents with?”
“Of course, we have also had a wealth tax in the form of the removal of indexation allowance on capital gains tax for some years now, which is very substantial over time.”
“I hope that Ministers, in their White Paper and subsequently, will insist on some way of limiting and moderating such frontloading; otherwise I fear that many of the advantages we want for our constituents and their families in this situation will be eroded. We need an indicative sum on, for example, hotel costs. Please do not assume that all within this sector are acting for pure and altruistic reasons. They are businesses and will respond as all businesses do. I support the levy, as it is the right thing to do. No alternative has been put forward that is remotely credible, and I will strongly support the Government this evening.”
“As a Conservative, I loathe putting my hand in other people’s pockets, but there is a general expectation, after the pandemic, that money will have to be raised from somewhere. The only question that I would concede is when should we do that? I would like to put one or two points to the Minister, having given him my support. We are fundamentally changing the health and social care system by providing this increase in funds and an alternative way of paying for health and social care through a hypothecated levy. It is likely that the social care industry will respond, as all businesses will. I am ever so slightly worried that things like hotel costs will be ramped up, as they are not covered by this, to the disadvantage of our constituents, and that costs will be frontloaded to about, say, £86,000.”
“It is no good Opposition Members professing their support for our model of socialised medicine while excepting the growing burden of ill health that tends to attend advanced years. That is chiefly what lies at the heart of this measure today. If we are all agreed that it is invidious to except dementia and the frailty of old age from the provision that we have celebrated since 1948, we have to find an equitable way of paying for it, and that implies the use of a broad tax base. It is not clear to me from anything that has been said this afternoon that anyone other than those on the Government Front Bench has a clue as to how that alternative balance sheet would stack up. Despite interventions that I have made, I am none the wiser about what their alternative would be. Nobody enjoys taxation.”
“I will certainly be supporting the Government in the Lobby this evening, and the reason is this: in 1948, we instituted a system of socialised medicine, which has the support of all major political parties in this country, for all medical conditions save just a few. They tend to be things such as dementia, the general frailty of old age and associated conditions such as Parkinson’s. Nobody in this place has any cause to hector or lecture on these subjects unless they have had personal caring experience for somebody with that spectrum of conditions, because I can tell them that it alters your perspective dramatically on what is needed to improve services for an increasing proportion of our population.”
“The fact that the social care levy will be introduced in 2023 and not 2022, and that in the interim we will have to rely on national insurance, suggests that creating it will involve quite a lot of work and expense. How much is it going to cost to introduce the levy, beyond national insurance? Based on that, we will need to make an assessment as to whether it is worth while putting the 1.25% levy on people who are past state retirement age. If it is costly, we should not do it and simply rely on national insurance contributions. Allied to that, how much does my right hon. Friend think the 1.25% levy is going to raise from people who are beyond state retirement age?”
“On clause 2, in 2014 we passed the Care Act and accepted the Dilnot proposals; slightly less than two years later, we canned the central part of the Dilnot proposals, in that it was decided that local government should in fact have the social care uplift, which had been anticipated in 2014. What certainty do we have that the measures we are passing today will not be dealt with in a similar way if, in two or three years’ time, we find that the pressures on local government are so acute, which they may well be, that we have to can some of the measures we discussed earlier?”
“We are getting more granularity in the proposals that Opposition Front Benchers have in their heads for funding the uplift, which I think we all agree is necessary for health and social care, but can I probe the hon. Gentleman to describe the nature of the landlords or property-based businesses he has in his crosshairs for the levy of the moneys that he has in mind? Does he mean, for example, the mom and pop organisation that has bought a small residential property because it has no public sector pension, for example, and is relying on that for income in old age, or does he have in mind a business like any other business that has large numbers of commercial properties? How much does he think he is going to raise from the alternative that he has suggested?”
“I have been listening carefully to my hon. Friend and what he has said has a great deal of merit. Does he agree, however, that while the Government’s aim is to integrate health and social care, which arguably have been divorced one from the other since 1948, to the great detriment of the people we represent, the system he suggests might exacerbate that problem? That would be in contrast to the provisions of clause 2, which leave it up the Treasury to decide how moneys raised by the levy should be apportioned. Surely it is better that the Treasury can do that so that it can facilitate the integration of health and those elements of social care that relate to care as opposed to residential costs.”
“I am listening carefully to my right hon. Friend. Does he share my concern that there may be an element of gaming by the social care sector, in so far as hotel costs are clearly exempted? Our constituents who may be listening might not be fully aware of that. There is a real possibility and risk that the sector will seek to enhance and embellish those costs so that they become a bigger and bigger proportion of the total take. Does that not need to be made explicit? Does my right hon. Friend think that in the White Paper process that we are about to embark on, there would be merit in limiting that cost in some way to ensure that the potential market exploitation of the Bill’s proposals is avoided?”
“My right hon. Friend is being very generous in giving way. May I just clarify my intent? It would be reasonable to have an indicative cost. After all, in the case of most of our constituents who are living in a residential set-up—we are talking, basically, about a bedsit—what is usually involved, in my experience, is fairly basic food and some heating. The cost of that is not enormous, and it is the sort of thing that we would be expected to fund in any event were we living in our own homes; probably rather more so. Would it not be reasonable to have an indicative amount that it is felt reasonable for homes to be charging people—particularly, I have to say, if they are being funded through local government?”
“The British Army is one of the biggest employers of HGV drivers; it has about 2,000. What discussion has the Secretary of State had with our right hon. Friend the Defence Secretary about the use of some of those drivers to preserve critical supply chains were that to be necessary, and also about the impact of this crisis on retention? At the moment, supermarket chains are paying upwards of £60,000 to drivers, which is a very powerful inducement for people to leave the Army.”
“I welcome the statement. Many of those fleeing the Taliban will be highly skilled people who will want to integrate rapidly into the workforce so that they can become contributors, not just supplicants. Will the Minister unpack a little the £20,520 per person in core funding that she announced, and tell us what proportion of that she envisages being used for further education to enable people, where necessary, to upskill? What conversations has she had with her ministerial colleagues at the Department for Education to see what more colleges in localities can do to ensure that these people are able to do what they aspire to do, which is to enter the workforce and be contributors?”
“I thank the Government for responding positively to the representations I have made on behalf of Afghans at risk. May I ask my right hon. Friend about what will happen? Given that the Taliban will increase their grip and become less and less helpful, the only way for people to get out of the country will be to run to the border. That brings them into the scope of neighbouring jurisdictions and the United Nations. What discussion has he had with the UN about trying to assist people to leave to appropriate countries, such as the UK, and specifically triage them, as has happened with the Syria resettlement programme?”
“Will he ensure that the institutional cloak of invisibility that the MOD traditionally operates does not apply in their case, since if they are allowed to get away with it, as it were, we will not get to grips with the cultural issues that have dogged defence procurement for years?”
“May I commend the Minister for the forensic way in which he has tried to get to the bottom of a mess that is not of his making? The Royal Dragoon Guards based at Battlesbury barracks in my constituency operate, or are meant to operate, the Ajax fighting vehicle, and many of them will be very concerned at the hand-arm vibration syndrome and noise-induced hearing loss that some of them may be victims of. It is a betrayal of the military covenant. He knows very well that there are senior members of the Ministry of Defence, serving and retired, who knew full well the risk of this vehicle at an early stage.”
“If the hon. Lady is so against this increase in national insurance contributions, why did she vote for one in 2003? Can she say what happened to NHS productivity as a result in the decade that succeeded it? I can, and it wasn’t pretty.”
“I always listen very carefully to what the hon. Gentleman has to say. Why, then, does he think that Gordon Brown did something remarkably similar to what my right hon. and hon. Friends are proposing—on that occasion, in 2003—for exactly the same reason: to raise the spend on our national health service and care services? Was he wrong?”
“Nevertheless, in raising sufficient funds for spending on something we all agree is vital, Gordon Brown and Tony Blair made the right call in 2003, and I find it dispiriting, saddening and disheartening that Opposition Front Benchers should on this occasion decide, for their own purposes, not to support it.”
“I am disappointed that Labour Members should have taken the line they have, because I recall their doing something really rather similar in 2003 with national insurance contributions, presumably because Gordon Brown and Tony Blair at that time decided this broad-based tax was the fairest and most equitable way of dealing with this and, crucially, of raising significant amounts of money. We can debate whether the money was then well spent, and the statistics and figures suggest that that was not the case at least for the rest of that decade, and productivity in the NHS only started picking up in the following decade.”
“May I congratulate the Government on dealing with unfinished business? Since 1948, we have pooled our risk for the management of the consequences of poor health except for things such as dementia and the general frailty that for some of us attends old age. This could be a historic moment in which we sort that out, and I will most certainly be enthusiastically supporting the Government tonight. It is grossly unfair that certain conditions should be excluded from our provision, and I am so hopeful that this will finally, after 70 years, complete the job begun by our predecessors.”
“We need more service work to be done by professions allied to medicine. We need more artificial intelligence, data analysis and robotics. We need to crack down on variations in healthcare and to have zero tolerance for practitioners who diverge from it. We need to cut treatments and procedures of marginal benefit. We need early switching to generics. We must stop the revolving door between social care and the acute sector—something I am afraid the industry exploits to its advantage. Over time we must revisit the disastrous doctors’ contracts that I am afraid have meant, over the past several years, that people like me at the peak of our powers are retiring early or going part time, grossly reducing productivity in our national health service.”
“How will that incentivise the domiciliary care market, which could turn out to be extremely positive? How will it affect the current 40% cross-subsidy from fee payers to local government-funded customers? How can it grow a vibrant insurance product market that will cover the delta—the £20,000 to £100,000 difference—and what will be done with actuaries and underwriters to that end? Can I finish by saying that all of this depends on improving productivity in the national health service? It is a challenge that has evaded many over seven decades, but one that must be grasped if we are to complete this and ensure that we do indeed set the foundations—and I am confident we will—for proper social care. We need, for example, to drive down sickness absence, which is very high in the national health service.”
“In some eyes it represents a flawed tax, since as Conservatives we of course always want to remove as little money as possible from the pockets of all of our constituents. There is also a traditional disconnect in healthcare between money in and services out. We found that in 2003, and the challenge for the Government today, which I am fully confident they are up for, is to turn the money they have announced yesterday and today into the output we so badly need, and which indeed is vital if we are to turn this around in two years’ time and use this money for social care. There is some concern about the extent to which the money that has been announced for this will distort the social care market, and I would be interested in Ministers’ views on that. Will the industry load hotel costs, and will it front-load charges up to the £86,000 cap?”
“I am grateful for that intervention, because additional rate taxpayers, who I think make up about 2% of taxpayers in this country, will be paying a fifth of the whole receipts for this measure and 14% of taxpayers will be providing half of it. That is progressive, which is presumably why Gordon Brown and Tony Blair, all those years ago, decided to levy this on national insurance. I am extremely grateful to the hon. Member for raising and underscoring that point. However, I do have some concerns, as Ministers would expect me to have. One of those concerns was expressed by our right hon. Friend the Member for Rossendale and Darwen (Jake Berry), which is that this is a one-way tax, because there is no way that in the future we are ever going to attack a tax hypothecated to health and social care.”
“I congratulate my right hon. Friend on grasping an issue that his predecessors have been ducking for decades. Does he agree that what has been announced restores some equity to a system that relies on pooling our risk and that, in particular, people who have been excluded with dementia, neurodegenerative disease, Parkinson’s disease and the general frailty of old age, and their relatives, can look forward with some confidence to the system that has been there for others also applying to them?”
“Has he engaged with other countries, as we engage with Turkey, for example, in trying to ensure that we take those who are most vulnerable and relocate them back to the UK, to locations such as Wiltshire, where my constituency has done its part in helping people from that particularly challenged part of the world?”
“Congratulations to all involved in Operation Pitting, including my right hon. Friend. It seems unlikely that the Taliban are going to continue to co-operate on the safe passage of Afghans to the UK—in order to safeguard those individuals from the Taliban—so the focus will shift, sadly, to refugee camps in countries surrounding Afghanistan. What read-across does he see between this situation and the highly successful Syrian resettlement programme? In particular, what measures has he discussed with the UN to triage people, so that we take from among the most vulnerable, as we do with the Syrian programme?”
“Six years ago we lost 28,000 people to seasonal flu. Can the Minister assure me that we will not prioritise the jabbing of 12 to 15-year-olds over the seasonal flu programme, given that the number of children whom we would lose to covid would be vanishingly small in any event? Can he also assure me that in his planning he has considered not only the 15-minute wait that the Pfizer jab requires, but the extra time and effort that are required to get truly informed consent from children whose motivation cannot be clinical, must be altruistic, and may be subject to peer pressure?”