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 agree with my hon. Friend. One of the things that has struck me while I have been doing this work is how much added value there is in the presence of a serviceman from today’s Army on the battlefield tours that we have been running, and in seeing the faces of the young people for whom the tours were principally designed. One understands that they get it—in that moment, they get it—and there is a bridge between today’s servicemen and those who served 100 years ago. That is very powerful. I am very pleased to see that so many colleagues from Northern Ireland are present. As I was preparing my speech, I asked myself, “Who can I reasonably expect to see in the House during this debate?” I am not surprised, and I am not disappointed.”
“Nevertheless, I hope he will allow me the indulgence on this occasion, because I, too, disagree with him. It is certainly the case that idealism did not die on the Somme; neither did the lights entirely go out across Europe. If we are to avoid the loss of our 21st century lives and loves in the mud and blood of continental Europe, we need to ensure that we have eternal vigilance across all the Parliaments and Assemblies of our continent. I think that should be our tribute to the fallen this evening—lest we forget.”
“We have had a debate of superlative quality this evening, with 20 right hon. and hon. Members speaking extremely movingly on this the eve of the centenary of the bloodiest day in British military history. The 19th century French army officer and author, Alfred de Vigny, spoke in his book “The Servitude and Grandeur of Arms” of military service as the most fearsome of contracts. It was true then; it was true in 1916; it was true in 1982, as my hon. and gallant Friend the Member for Beckenham (Bob Stewart) so movingly reminded us; and it remains true today. The hon. and gallant Member for Barnsley Central (Dan Jarvis) quoted AJP Taylor and disagreed with him. I think the hon. Gentleman is allowed to disagree with him; I am not sure that I am.”
“I thank the Minister for his email on Monday about superfast broadband which I am sending out to my parishes. May I raise with him the problem of not spots in rural areas? What is being done following the cessation of the mobile infrastructure project run by Arqiva?”
“The Tobacco and Related Products Regulations 2016 were dealt with under the negative resolution procedure. Despite the statutory instrument’s provenance, much of it is commendable and will help in the fight against tobacco-related disease. However, may we have a debate on the paragraphs relating to e-cigarettes and vaping? ASH, Cancer Research UK, the Faculty of Public Health and the Royal College of Physicians are concerned that the paragraphs will be unhelpful in reducing the toll that tobacco takes.”
“The Minister is clearly putting a great deal of energy into ironing out this particular glitch, but he needs to be seen to be fair to both sides, given the likely closeness of the result on 23 June. How much energy is he therefore applying to quantifying the number of non-eligible EU nationals who have been sent postal votes? Clearly, after the event some in the leave camp may call things into question if we have not quantified what correspondence was sent out in error.”
“The process that the Minister has outlined is correct, but does she recognise that the French Government have already approved Truvada for pre-exposure prophylaxis, and does she understand the urgency in this? The results of the UK PROUD study, funded by the MRC, are quite unequivocal, so we really need to get this going. Will she also reflect on the fact that the study showed no difference in the incidence of other sexually transmitted diseases, because Truvada does not protect against them, so the message has to go out that a condom is absolutely essential?”
“The Joint Committee spent a lot of time on ICRs and IP address resolution; then along came clause 222, which gave us some comfort because the matter can be reviewed in five years. Some of us are of the view that ICRs will not, in any event, prove to be as useful as we might hope and as Ministers certainly hope. The Danish experience was that they were not useful and their collection was therefore dropped. It is quite possible that that will come to pass here, and that in five years’ time we will review this matter. Does the right hon. Gentleman agree that clause 222 persuades some of us who are a bit doubtful about the utility and value of ICRs that we should allow the provision because it will be reviewed in five years’ time?”
“I certainly rise to support this measure, which has improved enormously during its passage. I cannot think of a measure in my 15 years here that has been more thoroughly scrutinised than this one. Our constituents are going to be very pleased with what we have been doing over the past weeks and months. I have to say to the right hon. Member for Orkney and Shetland (Mr Carmichael), whom I respect very much, that one thing our constituents dislike most about this place is the perpetual protest in opposition, which we hear too often, particularly from his party. It does him no good. This Bill is—”
“I am convinced that that overwhelming majority of our constituents will be pleased with the assiduity we have applied to this measure and, in particular, with the consensual nature of our debate. It is a great measure. It will give our constituents the protection that they undoubtedly need, while safeguarding their historic liberties.”
“Clause 222 has not been debated at great length, but again it is vital because it allows us in five years’ time to come back to this measure to see what more needs to be done and what might be removed. That is particularly relevant in the context of ICRs. We have heard that one outstanding issue relates to the definition and use of ICRs, and I know that the other place will debate that at some length. My right hon. Friend the Minister for Security has referred to it and he is right to do so. I firmly believe that we will want to come back to it in any event in five years’ time, as technology will have changed so much in that period. In summary, I very much welcome this measure—it is absolutely right.”
“Certainly not. This Bill has been characterised by consensus, and I have been heartened by the constructive attitude that the Labour Front Benchers have taken to this measure, moving from a position of abstention on Second Reading to one of support now. It does them a great deal of credit and has made this Bill very much better. The double lock was a turning point in this measure as far as I am concerned, but may I also say that the privacy clause, new clause 5, is essential for many of us? The Home Secretary pointed that out. We have not had an opportunity to debate it very much today, but new clause 14, on health matters, has also been particularly important for a number of us who had concerns.”
“The UK’s position in its Euro Health Consumer Index has always been mediocre, but in January the UK was ranked 14th out of 35—just above Slovenia, Croatia and Estonia, and below European countries that most Britons would regard as peers.”
“However, healthcare is not just about reducing deaths. What about other measures of quality? Measures such as post-operative sepsis, pulmonary embolism, deep vein thrombosis, obstetric trauma and diabetic complications are worryingly unimpressive in the UK, compared with countries we would consider to be in our peer group. Although the teenage pregnancy rate has improved in recent years, the UK bumps along the bottom of the EU league table with recent accession states. The list goes on. The Swedish-based and well-respected, if drug firm-funded, Health Consumer Powerhouse has been reporting on the performance of Europe’s healthcare economies since 2005.”
“Success will mean closing the gap between healthcare outcomes here and in northern European countries with which we can reasonably be compared, and therein lies the “What next?” In July 2010, the Government White Paper “Equity and excellence” exposed relatively poor health outcomes in the UK, compared with other countries. Our healthcare system was delivering poorer results in terms of mortality and morbidity. The most recent OECD statistics, published last year, have confirmed Britain’s relatively poor performance across pretty well the complete spectrum of common diseases—common cancers, ischaemic heart disease, cerebrovascular disease and the rest. Crucially, the number of unnecessary deaths—mortality amenable to healthcare—is substantially higher in the UK than in neighbouring countries.”
“When those 51-year-olds enter the danger zone in a few years’ time, what will success look like? Success will mean accommodating the great advances in medicine that we believe we are on the cusp of achieving, and that we hope will add years to life and life to years, and I know that my hon. Friend the Minister is particularly exercised about those matters. Success will mean dealing with the healthcare needs of an ageing demographic, an expanding population, and more chronic diseases of lifestyle, which will amount to a 3% per annum uplift in demand, according to NHS England and the Nuffield Trust. Success will mean satisfying the legitimate demands of a less deferential, consumerist, better educated society that will not be content with second best.”
“I need to start by confessing an interest as a doctor. We are now 18 months into the five year forward view, and the big question really is: what next? “What next?” really means bringing English healthcare outcomes up to the standard enjoyed in peer group European nations, and I am afraid that means much more money. I hope that, in the next few minutes, I can suggest how we might go about achieving that. The average age of Members of Parliament is 51. That means that most Members of this House have tipped, or are tipping, into the demographic twilight zone in which the incidence of common and chronic diseases begins to accelerate—it is sad but true. That focuses the mind on what a successful healthcare economy looks like and what it delivers for patients.”
“I hope that the Minister will agree that the proposal for a commission and associated national conversation—made by me and others in this House, in the other place and elsewhere—has merit. I warmly congratulate Ministers on successfully arguing the NHS’s corner at a time of austerity. However, I urge the Government to give serious thought to establishing a commission that will examine how we can properly and sustainably fund healthcare and close the widening gap that exists between us and our European neighbours.”
“Either way, gathering a consensus on this most sensitive and complex of public policy areas, using a vehicle on a spectrum from royal commission to non-departmental public body, surely makes sense. As a model, may I suggest the influential Pensions Commission, chaired by Adair Turner, during the last Labour Government? If the NHS is the closest we have to a national religion, its critical friends are often seen as heretics. We saw that even at the height of the Mid Staffs scandal. How, then, are we to uphold this rallying point for national morality, decency and righteousness with the more prosaic imperatives to save and lengthen life, make sick people better, prevent ill health and match health outcomes in comparable countries?”
“But affirming that the great bulk of healthcare in the UK should continue to be funded through general taxation does not just mean more of the same. A variable hypothecated tax would be an easier sell to the public than a general tax hike. Treasury officials, or course, hate hypothecation, but the Treasury has been softening its approach in recent years and we are now, of course, wedded to the far less economically literate practice of hypothecated spend as a proportion of GDP for selected areas of public expenditure. Despite the Treasury’s reluctance, if we are talking about several pence in the pound to bring UK health spending up to the average of neighbouring similar countries, we have to find a politically acceptable and publicly palatable way of doing so.”
“For my part, I cannot see how the transaction costs implicit in insurance-based models or large-scale schemes of co-payment would improve productivity or efficiency in our NHS—this despite the fact that the UK healthcare economy is distinguished from others by the small scale of its private provision. For me, the Bismarck versus Beveridge debate is pretty much settled. However, I would expect a commission to examine all possible funding streams, drawing on experience from other countries. I would expect it to look closer to home at incentives that can be given to encourage subscription to mutuals, such as the Benenden Healthcare Society, formed in 1905 by and for Post Office workers, whose headquarters in York I visited recently.”
“Although I have every confidence in my right hon. Friend the Chancellor, a precipitous growth in the economy seems unlikely, and further borrowing should not be an option. In fact, half the £350 million per week that we send to the EU—a figure, net of rebate and subsidy, that I personally rely on—would, by my reckoning, halve the difference. I fervently hope that it will be in play after 23 June, but it would still leave a gap. How will that gap be closed? It is said that if we want a social healthcare system, we must choose between Bismarck and Beveridge.”
“That eye-watering sum may be toned down a little bit by the new Office for National Statistics method for calculating healthcare spend, but probably not greatly if the comparison we actually want to make is with our closest European neighbours France, Germany and the Netherlands. So, if we accept that big fistfuls of money are needed, the question becomes, “How are we to get it?” The Labour party does not know. It has yet to say how much it thinks the NHS budget should be, despite every encouragement from me and others to do so. All we know is that the party opposed the Stevens uplift at the general election. Maybe the unaccustomed reticence about pledging money from the party of fiscal incontinence is an indication of the sheer scale of the spending challenge that even Labour has perceived in a rare lucid moment.”
“Of course, none of this accountancy changes by one penny the amount spent on care, but it impacts on the international spending league table. It means that we overtake southern European countries such as Spain, Portugal, Italy and Greece. However, we still lag well behind Germany, France and the Netherlands—my chosen basket of similar European countries. So what next? Data from the Kings Fund and the Institute for Fiscal Studies suggest that income tax must rise by at least 3p in the pound simply to offset the fall in NHS spending as a proportion of GDP predicted over the rest of the decade. But all that will do is arrest the UK’s relative downward trajectory towards being the sick man of Europe. To bring spend up to the EU15 average would now involve an 8p increase.”
“Both, in the event, have been impacted by cuts to local government funding—cuts that I supported and accept were entirely necessary to repair the public finances, but cuts nevertheless. So “what next?” will inevitably mean a step change in input—in money—if not by the end of the five year forward view period, then without doubt during the next decade and beyond. Here again, it is instructive to look across the channel, where we find some good news for Ministers. The Office for National Statistics has just tweaked its approach to health accounting to comply more closely with that of the OECD, and obligingly, this increases the UK’s spend on public and private healthcare combined from 8.7% of GDP to 9.9%. Most of this is due to re-badging a slice of publicly funded social care as healthcare spend.”
“If it is fairly efficient, we will not be able to squeeze many more efficiencies from it beyond the Stevens assumptions, but we will still be left with relatively poor outcomes and still needing to know “what next?” Simon Stevens still believes that we can squeeze £22 billion in efficiencies from the NHS. Much of this, presumably, is predicated on productivity gains that are contingent on holding down salaries and wages—a challenge if incomes in the economy rise. This is what I think he means by “strong performance”—strong indeed, because the implied productivity gains of 2.4% are well in excess of anything that has been achieved by the NHS historically and well beyond expectations for the wider economy. It also depends on sustained spending on social services and public and preventive health.”
“Given that the nature of our system means that insurance and transactional costs are very low, that is hardly something to crow about. Other markers of efficiency rely on patient and practitioner surveys and include items such as time spent filling out financial transaction forms. UK-relevant metrics, such as rehospitalisation rates, were found to be comparatively poor. I conclude that it would be unsafe to make claims about the relative efficiency of the NHS based on contestable reports like that of New York’s Commonwealth Fund. Let us suppose for one moment that the NHS is fairly efficient—not very efficient, because Carter and others suggest that that would be unwise, but fairly efficient. Indeed, I have no reason to suppose that it is institutionally profligate.”
“I do not know what is in the Minister’s speaking notes, but there is a very good chance that he will use the New York-based Commonwealth Fund analysis on comparative healthcare to support a contention that the NHS is very efficient and thus ameliorates the relatively low UK spend on healthcare. The report’s methodology rewards close examination. I am sure he will have read it thoroughly, but if not, I commend it to him. In my opinion, its methodology renders the sorts of deductions that have been made unsafe. The only reliable element of the analysis that is used to claim that the NHS is relatively efficient is the percentage of national expenditure spent on administration and insurance, meaning that the UK comes in at fifth out of 11.”
“I would be very surprised if it did not conclude that the answer is to bring spend up to the level enjoyed in countries such as France, Germany and Holland. After all, closing the gap with the EU15 in health spending as a proportion of GDP was a goal explicitly set in 2000. However, Conservative Members tend to be somewhat wary of making spend a proxy for outcome. It is not enough just to write big cheques and consider the job done. Can we do better with what we have? There are apologists for our low spending on health who cite the supposed efficiency of the NHS, but simply asserting that the NHS is more efficient than health services in other countries does not make it true.”
“Tenth out of 11 sophisticated healthcare economies is not where I want the UK to be, and not where the Minister wants the UK to be either. The British public would expect us to be doing rather better against a raft of healthcare outcomes where the UK is firmly in the wake of our immediate northern-European neighbours France, Germany, Holland, Belgium and Denmark. Can we explain why UK healthcare outcomes are not as good as those of peer group nations through differences in the level of healthcare funding? We can expect an opinion from the House of Lords, which last week set up a Select Committee under Lord Patel to examine the sustainability of the NHS—that is, the “what next?” question.”
“Despite the UK’s innovative cancer drugs fund, Health Consumer Powerhouse found, for example, relatively poor availability of the latest oncology interventions and therapeutics, including radiotherapy. Sadly, that rings true, and we remember the high-profile case of Ashya King, the five-year-old with medulloblastoma, who was taken by his parents in 2014 from Southampton general hospital to Spain and then the Czech Republic for proton beam therapy, which was not available here. The much-vaunted Commonwealth Fund report that some use to claim that the NHS is super-efficient and effective actually contains just one element that deals directly with health outcomes—a composite of deaths amenable to medical care, of infant mortality and of life expectancy at 60, it puts the UK 10th out of 11, the US being bottom.”
“I think the hon. Gentleman and I are on the same side of the Brexit debate, and I certainly would welcome the extra money that would be spent on the NHS in the event that we leave the European Union, so fingers crossed for 23 June. The Health Consumer Powerhouse report highlights poor accessibility and an “autocratic top-down management culture” here, in contrast to top-performing Holland’s removal of what Health Consumer Powerhouse calls “healthcare amateurs”—that is to say, politicians and bureaucrats—from decision making. Unhappily, that sounds rather familiar. Earlier this year, Dame Julie Moore slated fellow senior NHS managers for “gross incompetence” and poor leadership. The question is, what, apart from its management, accounts for the UK’s lacklustre ranking?”
“My hon. Friend is absolutely right: we are lagging behind. I hope that in the course of my remarks I have made it very clear that we are lagging behind countries with which we can reasonably be compared, particularly Germany, France and the Netherlands. The challenge is to bring our spend up to that level and to anticipate new developments and technologies. We should welcome that, because it will extend our lives and it will make us healthier for longer, but we do have to decide where the money will come from. Since the sums, I fear, will be so great, I believe that a commission would be a reasonable way to approach this matter and to have the conversation with the public about how the money will be raised. The sands are fast running through the five year forward view hourglass. I believe it is time for Ministers to consider, “what next?””
“My right hon. Friend is being ever so slightly modest in relation to new clause 5, which is aimed primarily at protecting personal privacy. Clearly he has been listening, since one of the concerns expressed by industry is that interference and hacking may cause a failure of business confidence in IT. Subsection (2)(b) will go some way to protect the interests of such companies and businesses, since it states explicitly that the public authority must have regard to the public interest in such matters, including the viability of those undertakings.”
“I have a great deal of sympathy for what my hon. Friend has to say, but does he share my concern that the Speaker might be seen as a rather in-house arbiter in these matters? In recent times we have seen where that leads us. Does my hon. Friend not have more confidence in the double-lock arrangement that the Front-Bench team has rightly instituted?”
“I am listening with great interest to the hon. and learned Lady. She will be aware that the Joint Committee on the National Security Strategy has long been trying to define “national security” but has failed to come up with an answer. Will she not accept that the term must necessarily remain loose?”
“Yesterday, the other place appointed a Select Committee to consider long-term NHS sustainability. Given pressures on our national health service, can we consider whether such a Committee might be established in the elected House?”
“I congratulate my hon. Friend on securing the debate and on the support that I know she gives to the naval historic dockyard in Portsmouth. I know she has seen this already, but I commend her on the wonderful exhibition “36 Hours: Jutland 1916, The Battle That Won The War”, which all right hon. and hon. Members should see. It is open for three years.”
“I do not disagree with the hon. Lady that there are big pressures on the horizon, but can she say how much, beyond Simon Stevens’ predicted costs, her party is now pledged to spend on the national health service, because so far all we have heard is prevarication?”
“The reason I do not envy the Secretary of State for Health is that he is going to have to grip the reality that in this country we spend very much less than countries with which we can reasonably be compared—8.5% of our GDP compared with 11% in the Netherlands, Germany and France. I have no easy solution for that, but I do suggest, ever so gently, that we need to look a little more broadly at potential solutions. We could think, perhaps, of having a non-partisan commission that may grapple with this extraordinarily difficult and complex matter, because one thing is for sure—the institution that is held most closely in the public affection is our national health service, and we must fund it properly.”
“A lot of the remedy has to do with considering how to network hospitals, and perhaps reconfigure our national health service estate, in order to ensure that when people are acutely unwell they go to a unit that is capable of managing their healthcare needs in the most efficient and effective manner and ensuring that they have the very best chances of leaving hospital in good order. We are faced with the reality of a healthcare system that is working at full tilt, and of which we are enormously proud, but delivers healthcare outcomes that could be better by international standards. Part of the reason is that we do not spend enough on healthcare.”
“I am much more persuaded that we need to look at items of clinical service to underpin the argument for a seven-day NHS. I am thinking particularly of things like palliative care services. I am thinking about the fact that there are no routine endoscopy lists on a Saturday and a Sunday. That has huge implications for people who have had an upper gastro-intestinal bleed on a Friday, for example. The upper gastro-intestinal endoscopy example is a good one, since it touches on Bruce Keogh’s standards 5 and 6, which recommended endoscopy within 24 hours of a bleed. That is not happening in many of our acute hospitals.”
“In this, there is some hope for squaring the budget, since if there is such a wide variation across the national health service, there must surely be capacity to improve practice across the service and thus generate efficiencies. However, it appears that Carter has stalled, and we need to have a proper plan for the future on how the differences may be dealt with and, we hope, erased. Beyond some useful sharing data, it is not clear that Carter has been progressed in the way that we might want. I fear that if we do not give it a bit of oomph, there is a risk that it will go the same way as Wanless, which would be a great pity. I very much support the seven-day-a-week national health service. As I have said in the past, I am not terribly convinced by the mortality data that underpin it.”
“We need to bear that in mind when we assess how realistic is the £22 billion figure, which, by his own admission at the time, required what he described as a “strong performance” by the national health service. “Five Year Forward View” talked of a “radical upgrade” of public health and prevention, stating that public health was its first priority. Many of us can remember the Wanless report by the late Derek Wanless, which said that improvements in public health and prevention were absolutely essential if his “fully engaged” scenario was to be enacted. The recent Carter review showed a considerable unwanted variation across our national health service.”
“We are now 18 months into the five year forward view, and the £22 billion in savings looks challenging, to put it mildly. Those savings are predicated on a number of assumptions—in particular, a continuing input into public health—and yet, necessarily, the local government grant has been squeezed this year. According to the Health Foundation, we also have a £6 billion social care cost funding gap. All this impacts on health generically. Simon Stevens made his prognostications based on continuing spend on public health and on social services, both of which have been squeezed. I make no criticism of the Government on that, since it is absolutely necessary to deal with the economy, as I said in my opening remarks. It has happened, nevertheless, and therefore, I am afraid, undermines much of what Simon Stevens had to say.”
“The Secretary of State has a very tough job, in my opinion. He has to improve outcomes—which are not good in this country compared with countries with which we can reasonably be compared—and deal with increased public expectations, demographic change, and economic stringency. I am very pleased that I do not have his job. If I may say so, the strain is showing—on the national health service, I hasten to add, not on the Secretary of State—since we know from last week’s data that there is a £2.5 billion deficit that involves two thirds of trusts being in the red. That is set to endure, since we have a real issue in reconciling the money going into the national health service, welcome though it is, with the extra demands being put on the health service all the time through the demographic changes that I mentioned.”
“It is absolutely right that the Government should be attempting to roll out Sir Bruce Keogh’s 10 clinical standards, particularly the four he has identified as most important in this matter. The seven-day working week is essential to being able to do that in a comprehensive fashion. I commend the Government for the efforts that they have put into this for the past several months. I also welcome the commitment to dealing with sugar. We heard earlier about the perils of obesity and the time bomb, as it were, that this presents to the younger generation. If we are going to be true to our mission on public health and preventive health, it is absolutely right that we should send out the right message to those who sell fizzy drinks—sugary drinks—and ensure that we try to reduce consumption of those things.”
“Members about precisely what figure they would be prepared to commit to our health service, since at the last general election they opposed the Government’s spending plans, and had they been in government now, enacting their proposals made only a few months ago, our national health service would have little chance of seeing the £30 billion overall extra spend to the end of this decade that it so desperately requires. I very much welcome the commitment to the so-called seven-day NHS. As it happens, I was visiting a constituent in a busy hospital ward this weekend, and from the activity that I saw, it seemed that the NHS was working at full tilt. However, in some important respects, our health service is different at the weekends from how it is midweek.”
“I wonder what he would make of the financial illiteracy displayed this afternoon by Labour Front Benchers, who must answer the fundamental question about what they would want to spend on our national health service beyond Simon Stevens’ five year forward view. On a number of occasions they have been pressed on this matter and failed to come up with an adequate answer. I say ever so gently that Labour Front Benchers must answer the point being made by me and other hon.”
“I look forward, in particular, to my rural constituents and their small businesses being able to access 21st-century technology in the very near future. On behalf of those constituents, I thank the Minister for all his hard work. I am a doctor, as you know, Mr Deputy Speaker, and I have to declare that interest since most of my contribution will be about healthcare. The Gracious Speech rightly began with the economy, however, and we found out why that might be over the weekend when Simon Stevens, the head of the NHS in England, made it very clear that without a sound economy one cannot have an effective healthcare system. That is absolutely fundamental to the delivery of public services in general, and particularly to the national health service. It is perhaps ironic that Simon Stevens was once a Labour councillor.”