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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“Does my right hon. Friend agree that the continuous at-sea nuclear deterrent has kept us free from aggression day in, day out since 1968, and that we owe a huge debt of gratitude to the men and women who operate it?”
“The Secretary of State rightly pointed out that 1970s’ industrial strategy was flawed by the fact that it almost exclusively focused on big industry. Will he ensure that his industrial strategy does not repeat that mistake by focusing exclusively on large, mature economies at the expense of medium-sized, emerging economies? Together, they represent the future.”
“I always enjoy listening to the hon. Lady’s well-informed remarks. I agree that most people do not want to go to A&E if they can avoid it. Does she agree that part of the problem is that when people phone general practices, they tend not to be offered an appointment that they regard as being within a reasonable timeframe, or they cannot get to see the doctor with whom they are closely associated, which particularly applies to people with chronic and long-term conditions? As today’s National Audit Office report makes clear, we need to address that as a matter of urgency. Paradoxically, seven-day-a-week general practice may militate against being able to provide people with such continuity of care during core hours.”
“The hon. Lady is being very generous in giving way. I have to disagree with her, because winter pressures and the pressures we are seeing at the moment tend to involve not people with short-term, self-limiting conditions, but the chronically sick. Those people in particular, and with good reason, want to have a relationship with a particular practitioner who understands their needs and their family context. That is surely the essence of general practice.”
“Does the right hon. Lady agree that it is not so much meeting the target that is important as getting patients seen expeditiously and well? There is not an A&E department in this country that does not want to improve its position in the league table of response times. The difference that now applies, and which perhaps did not apply quite so much when she was a Minister, is that the level of informatics and comparison is much improved. I suggest to her, ever so gently, that while the four-hour target was important when she was a Minister, its importance has degraded over time, because everybody is trying to see patients more quickly.”
“Would those people fall within the four-hour target? That lies at the heart of the debate. Should the four-hour target cover both urgent and more elective problems that people present to casualty departments?”
“We need to determine how we are going to make up the delta—the difference—between the efficiency measures that the NHS can reasonably achieve and those projected two years ago. I want to finish by congratulating the Minister and the Government on achieving what they have. We have heard how things have improved in recent years, particularly in relation to such things as activity and hospital infections, but there is much more to do. In particular, I hope he will look closely at the funding issue.”
“That is the bottom line. It is no good people saying we spend 1% above the OECD average. That is not good enough, given that the OECD includes countries with which most people in this country would not wish to be compared. As the Government of the day made clear several years ago now, we need to close the gap with the EU 15, particularly with countries such as Germany, France and the Netherlands, whose outcomes are much better than ours. It is no coincidence that they spend much more on healthcare. Today, the chief executive of the NHS is being examined by the Public Accounts Committee. I hope he will be examined on the £22 billion efficiency measures that he felt might be achievable in the five year forward view. Two years in and it is clear that those savings will not be met—they never were going to be met.”
“I would not be one to oppose a closure, reorganisation or reconfiguration for its own sake. We have always to understand that resources are finite and that we need to get the best service and outcomes for the money available. I say gently to the Minister that we need to look at funding. He will be aware of the campaign by the right hon. Member for North Norfolk (Norman Lamb), which I support, in relation to a commission or convention. It seems a non-partisan way of trying to approach the very difficult conundrum of how we will fund the NHS going forward. I commend it to the Minister. I was pleased to hear the Prime Minister say at lunchtime that she was prepared to meet colleagues concerned about the issue to see whether this proposal could be a productive and helpful way forward. We do not spend as much on the NHS as we need to.”
“As Members of Parliament, we are all sometimes faced with the political choice of whether to oppose, for our own expediency, the closure or reorganisation of services. I have faced that in my constituency. I was pleased to hear my right hon. Friend the Member for Chelmsford (Sir Simon Burns) say that sometimes we need to be brave when approaching such matters. If we want to drive up standards and outcomes in our NHS, we will have to look increasingly at specialist centres, which will inevitably mean service reconfiguration and probably some closures. That will be disagreeable to many colleagues, but specialist centres certainly improve standards and outcomes for things such as cancer, strokes and heart attacks, and that implies regional and sub-regional services.”
“I have community hospitals in my area. In particular, there is one serving my constituency at Shaftesbury that is threatened with bed closures under the STP. We need to be very careful about short-term funding cuts that might appear expedient, when we have not properly costed the service. Providing that the case mix is right—and traditionally case mixes have been pretty appalling in the NHS—community hospital beds can provide a cost-effective means of treating people, particularly the elderly, in a setting close to their homes rather than in large acute hospitals, which are the wrong places for elderly sick people. Community hospitals can deal quite effectively with some of the delayed discharge problems currently afflicting our system.”
“I encourage Ministers to produce the tobacco control plan, which is now overdue, as soon as possible, as we need to deal with this issue. I hope that the plan will contain some helpful remarks on the tobacco duty escalator and the licensing of retailers and involve serious conversations with supermarkets. The aim must be to reduce the availability of tobacco, reduce consumption and therefore reduce the burden of diseases that are affecting our NHS and having appalling consequences for citizens. I very much support the Government’s amendment to the motion. I was not present when the hon. Member for Central Ayrshire (Dr Whitford), who speaks for the SNP, was speaking about community hospitals. I am sorry about that, because community hospitals are particularly important to me and I would have liked to respond to some of her remarks.”
“We need to prepare for them. We also need to militate against those cases. One thing that has not been discussed very much this afternoon is prevention and public health: our need to ensure that we deal with things that are avoidable. The Prime Minister, in her excellent speech on Monday on the shared society, rightly said: “We live in a country where if you’re born poor, you will die on average 9 years earlier than others.” That is absolutely appalling and we should all be ashamed. Half that health inequality is due to tobacco consumption. Someone in a manual occupation is far more likely to be a smoker or to smoke more than a professional or managerial person. We have to be serious about controlling the scourge of tobacco.”
“This has been an absolutely first-rate debate, with a number of extremely fine contributions. I was particularly taken, as ever, by the remarks of my hon. Friend the Member for Totnes (Dr Wollaston), the Chairman of the Select Committee. She rightly pointed out that we are all living longer, which is a great thing, but that unfortunately our healthy lives are not expanding. This causes real problems for A&E, which has to deal with that. Although we talk about large numbers of people passing through A&E departments—they are dealing with more people all the time—the truth of the matter is that it is those with chronic long-term and complicated conditions who tend to assume the lion’s share of A&E resources and those of the rest of the secondary care system. As we get older, there will be more and more of such cases.”
“I hesitate to interrupt the right hon. Gentleman, because he is making a powerful speech, and I congratulate him on it. Given the number of years that he has cited—20, 30 or 40 years—does he agree that if we accept this principle about harrying and pursuing members of the armed forces, then there is no reason to stop there? Some of my constituents who served in Cyprus and Korea, or even further back, are saying, “In the fullness of time, perhaps we will be questioned about what we got up to, under the rules and norms of today rather than those that applied at the time.””
“He needs to say in clear terms what he will do to unpick that narrative, because the message at the moment is that the awful things that happened during the troubles were predominantly caused by members of the armed forces, which is truly remarkable, given the statistics shared by the right hon. Member for Lagan Valley (Sir Jeffrey M. Donaldson). That must be dealt with now. It needs to be nipped in the bud, otherwise our colleagues at the Ministry of Defence will find it ever more difficult to recruit the young men and women needed to serve the forces of the Crown.”
“First, I hold soldiers to a far higher standard of service than I do terrorists—that needs to be understood. However, I have to say that what is happening at the moment is the worst possible recruiting sergeant imaginable. Having 70-year-old veterans being hauled out of their beds at 3 o’clock in the morning to answer for things that may or may not have happened 40 years ago is remarkable. I can scarcely remember what I was doing last year; I certainly cannot remember what happened 40 years ago. I am really worried about the quality of available evidence for investigations of this sort. The Secretary of State for Northern Ireland has talked, and is worried, about a “twisted narrative”.”
“Will the Minister not accept, though, that because terrorists do not keep records and are not going to respond to letters from the Ministry of Defence inviting them to unburden themselves, there will be a mismatch in the information available to the courts? That means that successful prosecutions may be brought against servicemen—a small number, I suspect—but there is no chance, realistically, of a commensurate number of prosecutions being brought against terrorists.”
“Had the historical investigations unit not been structured as it was, the Stormont House agreement would have failed and, in all likelihood, so would the Executive in 2014. Now that the Executive have apparently failed, does the Secretary of State share my sadness that the unit was set up as it was and had to investigate chronologically, meaning that servicemen were bound to be the subject of most of its investigations as terrorists sadly do not keep any records, and they certainly do not respond to letters from the Ministry of Defence inviting them to unburden themselves?”
“On the changes to the four-hour standard that the Secretary of State heralded, what can be done to incentivise and upskill GPs who may wish to take a closer interest in minor and moderate illnesses, including the use of nurse-led minor injury units?”
“With acute hospital bed blocking at a record high, do Ministers agree that it is a great pity that so very few of the 40 sustainability and transformation plans now in the public domain deal directly with step-down care and, in particular, with community hospitals?”
“The Secretary of State will know how traumatic it is for students and teachers to get children through GCSE maths and English resits, which can often blight their post-GCSE studies. Can we have a curriculum that is vocationally based for numeracy and literacy, which would give people the skills they need for work—without having to go through this traumatic and often wasteful experience?”
“What are the chances that the proposed European defence fund will add new money to collective European defence and security, and what is the Prime Minister’s attitude to the linked matter of the revision of the Athena mechanism that is due next year?”
“Some reports suggest that up to 75% of the inmate population have one or more mental health problem. Does the Secretary of State agree that we are unlikely to be able to reform our prisons fundamentally until we get to grips with mental health in the criminal justice system?”
“What analysis has the Defence Secretary made of the humanitarian consequences of the illicit redistribution of cluster munitions, including BL755, from chaotic, failed and post-conflict states, on civilian populations throughout the middle east and north Africa, and much further afield?”
“I am pleased to hear what the Minister has to say about students in the UK. Has he had any indication from his interlocutors in the rest of Europe about the status of the increasing number of British school leavers who wish to study in European countries, and the relatively favourable fees that they are expected to pay?”
“I particularly welcome the Secretary of State’s reference in her statement to sparsity and mobility. It is great news for constituencies such as mine. Does she agree that one of the most mobile pupil populations are the children of our armed forces families? How will she promote the pupil premium that we introduced in 2011 in the funding formula?”
“I know that the Prime Minister shares my concern at the level of acute hospital bed blocking. Does she agree that part of the solution is to promote community hospital beds, where they still exist in places such as Warminster and Shaftesbury, as part of the sustainability and transformation planning process?”
“Tomorrow, we must look for a big cash injection to sort this out, but I submit that we then need a long-term commission—perhaps not a royal commission, as royal commissions take for ever and cost the earth—that will involve a debate about how we pay for our health service in the long term, given the pressures that we face. That might involve a hypothecated tax. The end to the triple lock could save £2.1 billion by 2020-21, and that money could then be hypothecated to the NHS in the interests of generational fairness, given that the elderly consume the largest portion of healthcare spend. We also need to look at fiscal incentives relating to employees’ private medical insurance. But we need to do all this within a Beveridge envelope that delivers an NHS that is free at the point of need.”
“The National Audit Office report published today suggests strongly that this process is not likely to result in anything like £22 billion and that those savings are “untested”—that is polite speak for unachievable. We know that the deficit is being dealt with through a transfer from capital to revenue, and from the sustainability element of the sustainability and transformation fund. That is not sustainable in the long term. We want more transformation; we do not want to have to rely increasingly on the sustainability bit.”
“Friend, relates to which year we use to baseline, which year we use to base our prices on, and whether we include or exclude the money that has been removed from the public health function of local government and from Health Education England. I would contend, as I believe she would, that those moneys need to be included in the sum total for healthcare in this country, and I think that that is what our constituents would understand as the totality of healthcare. That alternative figure therefore seems to be more reasonable. I am also worried about the £22 billion in savings on which Simon Stevens based his five year forward view.”
“Friend the Member for Totnes (Dr Wollaston), I am increasingly cautious about the £10 billion figure, so I urge my Front-Bench colleagues to provide clarity on it. We need to be clear about what it actually relates to. I commend the Government for spending this amount on our NHS, despite the opposition from Labour Members. If we are to have a collaborative and collegiate debate, we need some humility from them on this point, as Labour undoubtedly opposed such an amount at the last general election. However, we need to understand what the £10 billion is and what it is not. According to the Nuffield Trust, the King’s Fund and the Health Foundation, we are more likely to be talking about £4.5 billion. The reason for that, which was elegantly laid out by my hon.”
“I start by commending all the hard-working people in our national health service—doctors and nurses—for the increased activity in our NHS over the past several years. The NHS has never worked harder. We have never seen so many patients treated in our NHS and standards are certainly improving. However, we must face up to the fact that indices of mortality and morbidity that are amenable to healthcare are poor against reasonable international comparators. I am not satisfied by comparing the UK with the OECD average; I want to compare the UK with countries with which my constituents would wish it to be compared, such as France, Germany, Holland, Belgium and Denmark. I am afraid that our performance is behind the curve on such comparisons, and that is the challenge that we face. Like my hon.”
“How much worse does the hon. Gentleman think that the deficit in South West Wiltshire would have been had Labour won in 2015 and uprated NHS spending by just £2.5 billion, rather than the figure we are currently enjoying?”
“Does my hon. Friend agree that there are countries in the Muslim world that have been very positive about Jews? I am thinking particularly of relatively enlightened countries such as the Kingdom of Morocco, which has always welcomed Jews and treated them extremely well.”
“What can be done to reduce the effect of winter pressures on the bed state of our acute hospitals and thus reduce the awful phenomenon of bed blocking this winter?”
“The Foreign Secretary spoke about the training of soldiers and vetted forces, and the hon. Member for Islington South and Finsbury (Emily Thornberry) explained why that was necessary. Will my right hon. Friend confirm that that training will take place in theatre and not in the UK, as we would not want to repeat the mistakes of 2014 in respect of Libyan forces in Bassingbourn barracks in Cambridgeshire?”
“Surely the hon. Gentleman accepts that we have to get the most efficiencies we possibly can from the system? His party colleague the right hon. Member for Doncaster Central (Dame Rosie Winterton) made a serious point about engaging with pharmacies to see how we can do it better. Does he agree—I would be interested to know why this is not in his motion—that category M clawbacks, which are levied exclusively on small independent pharmacies, might be extended to vertically integrated wholesalers as a way of making sure the system is more efficient than at present?”
“I certainly support the amendment on the Order Paper today, but does the Minister agree that, in relation to efficiencies, the issue of category M clawback is an important one? I tried to extract an answer to that question from the hon. Member for Leicester South (Jonathan Ashworth) earlier. Also, I ask the Minister to think again about the ownership-blind point that he just made. There is not an equal playing field at the moment, and there is a real risk that small independent pharmacies will continue to be done in.”
“The Secretary of State is absolutely right to stand up for independence, regulation and arbitration, but the consultation she has announced today will of course delay, at best, section 40. Does she not agree, therefore, that it would be reasonable to accept Baroness Hollins’s amendments to clause 8 of the Investigatory Powers Bill?”
“The solution, of course, would be for the Government to accept Baroness Hollins’s amendments, and then the Bill would be secured, since all of us in this place are broadly supportive of its stated intentions. Many of us have sat through these debates at great length for a very long time.”
“My hon. Friend is right to say so. Does the Minister accept that the only objection to this measure that the Government are putting forward is that it is in the wrong place? That appears to be a fairly slim argument. Can he assure people like me who are perhaps wavering on this matter that the terms of reference of the consultation that the Secretary of State for Culture, Media and Sport announced earlier will be sufficiently robust and give a steer on the Government’s good intentions on section 40, because then we might be tempted to be a little more patient in the hope that that consultation will result in an outcome that makes Baroness Hollins’s amendments redundant?”
“As ever, I am listening to my hon. Friend’s comments with a great deal of interest. I fear, however, that he may be over-egging things a little bit. There are, of course, very large organisations behind the apparently small media outlets that he refers to. He probably received a note this morning, as I did, from News Media Association, pressing the case of smaller newspapers. In truth, it represents a smokescreen for the interests of larger press organisations. Does he not share my concern that we need to disentangle the very small press outlets that we heard about earlier from regional press, which tends to be controlled by larger operations?”
“Does my right hon. Friend agree that there is some help for us in this extremely big Bill at clause 232, on review of the operation of the Act? Although we cannot tell what the consultation on Leveson will come up with—there are four options in the document I have just read—we can come back in five years’ time and, if we are concerned about the implementation of section 40 of the 2013 Act, in our review of the Act this Bill will become we might be able to revisit a Baroness Hollins-type amendment from the other place.”
“Will my right hon. Friend explain how small press outlets will be impacted by the Hollins amendments? As the hon. and learned Member for Edinburgh South West (Joanna Cherry) rightly pointed out, small papers do not hack.”
“It is not a question of being forced. The hon. Lady may recall that this measure was subject to a Joint Committee on the draft Bill. There can be no Bill in recent memory that has had more scrutiny than this one. Will she also note clause 232, which establishes a review of this measure after five years—a most unusual mechanism for a Bill of this sort—and give the Government credit for doing everything in their power to reconcile the need to protect our liberties with the need to protect the press?”
“On the question of proportionality, does the hon. and learned Lady agree that the proposals must be put into some sort of context? As Lord Rooker pointed out yesterday, the problem is that we have a commercial sector with a large number of commercial providers who are busy harvesting data all the time in order to advertise things to us. Since the powers that the state is taking to itself are similar in some respects, it is important to bear that in mind when trying to ensure that we have some level of proportionality.”
“What assessment has my right hon. Friend made of the impact this Bill might have on the parallel trade in pharmaceuticals, which he will know has both costs and benefits for the NHS and for patient care?”
“Does my hon. Friend agree that the key problem is the price that service families have to pay for their accommodation? It has been creeping up and up, and I am not aware—perhaps she can enlighten me—whether the Armed Forces Pay Review Body has factored that into its annual determination.”
“I am very grateful to the hon. and learned Lady for giving way. Nobody is suggesting that anybody is going to be ejected from the United Kingdom. She is simply setting hares running. Does she understand and admit that there is a layer of complexity that she has completely ignored? If she is giving rights to people, which I think we would all accept, what effective date is she going to choose? What then happens when people go outside the UK and seek to return? All these things are also relevant to British nationals, on behalf of whom the Government have to negotiate.”