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?”
The complete record
Every one of 4,639 lines we hold for Dr Andrew Murrison, in date order, each linked to its source. Free to read, in full, without an account. Page 54 of 93.
“I followed the remarks of the hon. Member for Lewisham, Deptford (Vicky Foxcroft) with a great deal of interest. Clearly, I do not agree with many of them, but I do commend her for the passion with which she prosecuted them. This is a good Budget, and it is a good Budget for the next generation. I am the father of five children, so the next generation is important to me. I also represent a number of schools that have benefited from the pupil premium and other such changes, and a large number of service families who have been particular beneficiaries of them. I most certainly welcome the acceleration of the move towards fairer funding for schools. However, I am ever so slightly cautious about the maths thing. I noticed that we will be consulting on whether we should have maths to the age of 18.”
“My question to the right hon. Gentleman is this: why did it not occur to him on 4 November? On that date, he stood there and said: “Having listened carefully to what the Home Secretary has said today, I believe that she has responded to legitimate concerns and broadly got that…balance right.” —[ Official Report , 4 November 2015; Vol. 601, c. 974.] What has changed in the interim?”
“I admit my defeat, but this matter lies at the core of our discussions today and I hope that some clarity will be shed on it. For example, are we talking about Care.data or are we simply talking about telephone directories? It is important to know this. I am satisfied that the Bill has been significantly improved through pre-legislative scrutiny. Few Bills that I can recall have had quite so much scrutiny. I look forward to the remaining rough edges being knocked off in Committee and in the other place, and I will most certainly be supporting it tonight.”
“Those who are saying that we do not need such a measure should reflect on what that would mean for all our constituents. There has also been much talk about bulk powers—some of it informed, some of it rather less so. This is already covered by existing legislation, and the case for these provisions has been reinforced in an operational case that was recently published alongside the draft Bill and in the code of practice for bulk powers. I tried in Committee to get the Home Secretary to give me an idea of what she had in mind when she was talking about personal datasets. I failed completely. Indeed, the Chairman of the Intelligence and Security Committee also appears to have failed to clarify the meaning of “operational purposes”.”
“None of us can see what the situation five years hence is going to look like, although I think we can all guess that technology will occupy an entirely different space at that point. It is inevitable that we will have to review the legislation formally in five years’ time, and I am grateful that the Bill has been amended accordingly. There has been much debate about internet connection records. Those who say we do not need them must understand what the consequences of that would be. I accept that hard cases make for bad law, but when the National Centre for Missing and Exploited Children tells us that 862 of the 6,025 cases referred to it could not be progressed without a measure to retain ICRs, we have to think about that.”
“It is extraordinary that the right hon. Member for Leigh (Andy Burnham) should have flip-flopped since 4 November. I remember his speech well, and I remember thinking, “What a good speech! What a statesmanlike contribution!” Now, however, we have completely the reverse. The right hon. Gentleman is not in his place at the moment, but he is a decent man and I am sure that he will live to regret his abstention this evening. Since that time, we have had the introduction of the double lock, the nature and use of which have been clarified in Committee, certainly to my satisfaction. That would deal precisely with the sort of abuses that the right hon. Gentleman correctly cited in his speech. Clause 222 will institute post-legislative scrutiny, which is extremely important.”
“Let me begin by thanking an enlightened and beneficent Whips Office for appointing me to the Joint Committee that considered the draft Bill. The Whips may have come to regret that, but I thank them nevertheless. The Bill is largely an avowal of current practice. A blueprint for some “Nineteen Eighty-Four” dystopia it most certainly is not. However, it does improve transparency, oversight and authorisation. It does give our agencies the tools that they need to do their job, in an age when the number of terrorists may not be increasing in absolute terms, but the nature of that terrorism, and the number of tools available to the terrorists, most certainly are. Thanks to the Intelligence and Security Committee and the Joint Committee on which I had the privilege to serve, the Bill has been improved a great deal.”
“The UK still has relatively poor superfast broadband and far too many mobile “not spots”. Great work has been done, but what discussions will my right hon. Friend have with the Chancellor, in advance of next week’s Budget statement, about how we can improve coverage further, particularly for rural small businesses in areas such as mine?”
“I congratulate my right hon. Friend on his statement, although I hope that it draws on experience from other healthcare economies, as well as on the aerospace sector. When things go wrong, it is right that the NHS is frank about it and, where necessary, compensates people for what may be long-term management issues. Currently, negligence settlements are based on provision in the private sector and do not necessarily anticipate that people will be treated and managed in the NHS, which means that the service effectively pays twice for mistakes. As the Secretary of State seeks to close the Simon Stevens spending gap, perhaps he will reflect on that. I would be grateful if he could say to what extent he thinks that excessive negligence claims are influenced by the rather perverse way in which they are currently calculated.”
“I am really proud of the fact that this country is the biggest financial contributor in Europe to dealing with this crisis—a point that is too easily dismissed by Opposition parties. However, the Independent Commission for Aid Impact is far less sanguine about the contribution of the European Union. What can my right hon. Friend do to put pressure on her interlocutors to ensure that some of the money that the EU gives to loony projects is diverted to assist in this crisis within our own European borders?”
“I congratulate my hon. Friend on securing this debate. On the subject of getting the choreography right, it is great to do Stonehenge, which is what grabs the national news. However, would my hon. Friend observe that if we fix Stonehenge and merely shunt traffic a little bit further west, into the village of Chicklade, for example—a very real possibility, particularly if the economy takes a nose dive, which economies tend to do from time to time—my constituents will find a whopping great traffic jam landed on their doorstep, which would be an extremely bad thing and do nothing to sort out the problem with the superhighway to the south-west?”
“I listen to the Minister’s remarks with great interest. Does he agree that it would not be helpful if we sorted out the extraordinarily difficult conundrum of Stonehenge, which will be incredibly expensive, and yet did not deal with low-hanging fruit? I am thinking particularly of the village of Chicklade, since the problem will simply be shunted further west.”
“In making decisions on the general purpose frigate, will the Minister keep in mind the need to avoid the difficulties that the Type 45s have had in their electrical and mechanical propulsion systems?”
“I very much appreciate that the Minister has qualified and caveated some of the guidance that has recently been issued. Does he not agree, however, that there is a danger that without further clarification we could have the ludicrous situation where Freedom of Information Act requests, or requests made by Members of Parliament through parliamentary questions, could get information out of Ministers that those Ministers would have been denied by their own civil servants?”
“T4. Given the ongoing Russian incursion into Georgian sovereign territory, does my right hon. Friend absolutely condemn the situation in the southern Caucasus? Does he think that the situation in Abkhazia and South Ossetia must now be regarded as the new normal?”
“It is a very sad fact that in healthcare those professionals who add the most to the service do not necessarily receive the same acclamation as those working in more glamorous specialties. What does the Minister think can be done to improve the status of those working in mental healthcare and thus mental healthcare as an attractive career option?”
“Today, the report of the Joint Committee on the Draft Investigatory Powers Bill was published, and the Intelligence and Security Committee published a report on the Bill earlier this week. There is a lot of public interest in the matter. Will the Leader of the House ensure that sufficient parliamentary time is allotted to consideration of what the Prime Minister has described as the “most important” Bill of this Parliament, so that the matter can be properly explored and debated?”
“The BMA has taken the oversubscribed political sub-speciality of spin doctoring to a whole new level. May I express my admiration for the Secretary of State for his ability to keep his cool under the sort of provocation that he has had, and ask how a 13.5% increase in pensionable pay could possibly lead to problems with recruitment and retention?”
“I congratulate my hon. Friend on introducing this important subject. Does he agree that it is not so much that the project is at fault, but that perhaps it was a bit over-ambitious in the timeframes in which masts can be brought forward, noting difficulties with planning permission, which as he will fully know can be protracted, and issues around the powering up of masts? Perhaps he may want to encourage the Minister to extend the programme.”
“I am rather concerned, because the Minister seems to be beating himself up. The truth of the matter is that if his Department is guilty of anything, it is perhaps not having anticipated how long it takes to get infrastructure projects of this sort off the ground. All he needs to do is say that the project essentially is a good one but we need to allow it a little more time, so that projects of the sort to which my hon. Friend the Member for Salisbury (John Glen) alluded have a chance.”
“Does my right hon. Friend not agree that running costs in the NHS, which vary from £105 to £970 per square metre per year as highlighted by Lord Carter, are wholly unacceptable, and that the concept of a model hospital to bring the worst up to the standard of the best, which was also highlighted by Lord Carter, has great merit?”
“I very much support the Government’s stance on junior doctors, while acknowledging that most doctors—junior and senior—work well beyond their contracted hours. Does the Minister agree that it is not junior doctors but their seniors, and seniors’ terms and conditions, who really set the tempo in our national health service?”
“Tragically, whole generations of children have grown up in refugee camps, such as those in Tindouf in Algeria, with all that that means in terms of education and radicalisation. What can be done to prevent something similar from happening near Syria?”
“Really well done to the Secretary of State on the statement, the uplift in the rural services delivery grant and the review that he has announced. However, what assumptions has he made about the uplift in parish and town council precepts, given the assertion he made a few moments ago about the proportion of local government spend that would be consumed by the revenue support grant by the end of the decade? He will know that those precepts have gone up as the RSG has gone down, as in many places the council tax has been frozen.”
“I congratulate my hon. Friend on securing this important debate. He is talking about electrification in south Wales, but does he agree that it is also important to electrify at least part of the route from Paddington to Penzance? Does he welcome the proposal to bring forward AT300 Hitachi trains, which are bimodal? Given the speeding-up of the service that that would introduce, does he share my concern that we could be tempted to delete some stops along that route? That would be a pity—perhaps he will come on to this point—since it would mean that some of our constituencies would simply become transit corridors. Does he agree that Westbury station, which is a vital north-south-east-west hub, must not be deleted from any forthcoming plans in the new franchise?”
“T2. Despite progress having been made, many small businesses, particularly those in rural areas, are struggling because of poor broadband speeds. Does my right hon. Friend think that the time has come for Ofcom to consider splitting BT and Openreach or, if it feels that it cannot do that, refer the matter to the Competition and Markets Authority?”
“The reason why community hospitals went ever so slightly out of favour relates to the costs of the services they provided, which occurred because the case mix was all wrong. Too often, this became a convenient way of relieving social pressures, admitting people ostensibly for medical reasons to a medical bed when those people primarily needed social care. It always comes back to social care, and if we put people requiring social care into what remains a medical bed, it will of course become impossibly expensive. That is why it did not add up. I am afraid that the onus is on the practitioners and the controllers of those places—general practitioners—to ensure that the case mix is correct. If we do that, community hospitals will become both effective and efficient.”
“They have either immediacy of service just down the road to an institution that will give them sub-optimal care, or better outcomes of a sort that might reasonably be achieved in a regional or sub-regional centre. That is the choice. Part of the work of the commission suggested by the right hon. Member for North Norfolk will encompass that work of education. That is one reason why, however, I think his 12-month timeframe is very ambitious. I would certainly not want to have a commission reporting in five or 10 years’ time, but the right hon. Gentleman will have to be more realistic about how long this will take if it is going to be an iterative process. At a lower level, we need better step-up and step-down care. That is at the heart of our ability to unblock some of our acute centres. It is important to look at this issue again.”
“In order to get that level of specialisation, we must have critical mass, and the only way of achieving that is by having a smaller number of what might be seen as “clinical cathedrals”—large centres offering highly specialist services, geared towards improving outcomes. The downside is obviously where the cuts then come. Right-sizing the NHS estate inevitably means some will gain and some will lose in the process—in terms of the immediacy of services. Nobody wants to have to travel miles and miles to access services. We get complaints from our constituents about this all the time. There is a process of education for the public to go through. They need to make a choice.”
“That is bound to translate into poorer outcomes for a relatively common set of conditions. It seems to me that the only way we can achieve better outcomes in that kind of situation is to think about whether we need to move towards regional and sub-regional specialist centres rather than continue with the pretence that we can mirror those services in each one of our district general hospitals. More commonly, people talk about stroke and heart attack—and the same applies. It is simply not the case that people will get the same treatment regardless of the hospital they go to. This is professionally driven. It is the specialists themselves who are saying that we need increasingly to specialise. The day of the generalist is pretty well coming to a conclusion.”
“The issue remains relevant, but at the higher level we also need to talk about whether we are right-sized for acute or district general hospitals, and whether we should have these relatively small institutions across the country—far more than there would be in France, for example—offering, or attempting to offer, pretty much the same stuff. An example would be gastroenterology. The British Society of Gastroenterology has produced reports on this issue, pointing out that in many district general hospitals people are not guaranteed to have out-of-hours upper gastrointestinal endoscopy services available to them. I put it to the House that in the 21st century, not being sure that someone is going to be scoped if they have an acute upper GI bleed is simply not acceptable.”
“Sometimes change is great locally, because it means a spanking new hospital, but too often it means at least a perception of loss, and people feel that acutely. One of the first things I did when I was elected here 15 years ago was to introduce a ten-minute rule Bill called the bed-block Bill. I find to my horror that, 15 years on, the issues remain. In essence, my Bill was designed to promote community hospitals—cottage hospitals. I had four in my constituency at that time and I felt that each was, for different reasons, under threat. I was a strong advocate for them, and the bed-block Bill, which was designed to promote them and unblock acute hospitals, was duly presented and, like all these things, duly drifted into the sand.”
“Nevertheless, we need to examine all options if we are to do this for the very long term, as I believe is the intention. My hon. Friend the Member for Bracknell was right to focus on structure—something on which I believe there is a need for cross-party discussion and, I would hope, consensus. It is all very well talking about the NHS estate in general, but although what he described from his personal experience was terribly brave, I know from my personal experience that when that is translated into the specifics of our constituencies, for many Members it becomes extraordinarily difficult. It is the local that inspires many people in their love of the NHS. They would love to have their local hospital and local services that they identify with. When it comes to talking about the NHS estate, what we are really talking about is change.”
“It does not come close even if we stand still, let alone seek to improve outcomes in the way I have suggested we must. The question then is how on earth we close the gap—whether we do it through general taxation, national insurance, some sort of hypothecated system or a mutual, as applies in France, for example, or whether we go for co-payment. I suspect there is pretty much a consensus in the House that we can discount some of the options fairly easily, but it is important that the commission that the right hon. Member for North Norfolk seeks to set up should examine all options, even if there is a general understanding that some of them will not be palatable, for a variety of reasons, be it fairness, efficiency or not being geared sufficiently well to the lodestar of outcomes.”
“Member for Leicester West (Liz Kendall) mentioned the Barker report, and she was right to do so. The Barker report was useful. The hon. Lady will not be surprised to hear that I did not necessarily agree with all its conclusions; nevertheless, Kate Barker produced some figures that were useful. She pointed out that spending on health in this country is less than in some of the countries with which we can reasonably be compared. She talks of Canada, France and the Netherlands, and suggests that by 2025 we will need to spend a great deal more of our national wealth on health and, by implication, social care, and I agree with that. She suggested 11% to 12%, which, given the demographics, is probably reasonably modest. The dispute is about how we would deal with that, because £30 billion does not really come close, given what is happening.”
“The motion is relatively modest, because it tries to work out how we will square the gap towards the end of this decade. I think that, in the minds of those who wrote it, they are worried about the £30 billion—that will apply in five years’ time—but we are perhaps not looking forward to improve on where we are at the moment. There is too much talk, really, of marking time. The concern we have about the gap in funding makes us think that what we have now is good enough, but frankly it is not. We need to be much more ambitious, as we look ahead, about how we improve our health service right across the piece, including public health, to ensure that our health outcomes approximate the very best in Europe and not, in too many cases, the very worst. The hon.”
“Of course, the Commonwealth Fund report is quoted selectively by those who want to say that our system is the best there is, and that is fine: I trained in the NHS, I have worked in the NHS and I would be reliant on the NHS, so I defer to nobody in my admiration of the national health service and all that it stands for and does. However, it is naive to suppose that it is perfect in all respects, which is what I suspect really lies at the heart of this motion, as we look to the distant future. The Commonwealth Fund says that outcomes in this country are not good, and I think our people deserve much better. I want outcomes in this country to be among the very best in Europe, not, frankly, in the lower quartile, as is too often the case with common forms of disease. We are betraying those who put us here if we demand anything less than that.”
“Public health pervades all elements of the public service and needs to be addressed head on if we are to deal with some of the pressures we face in the acute sector, as well as ensuring that we meet some of the imperatives that apply to health in this country, which, as my hon. Friend the Member for Bracknell (Dr Lee) has pointed out, should mean being focused pretty much exclusively on healthcare outcomes. The right hon. Member for North Norfolk (Norman Lamb) mentioned outcomes almost in passing. Let me gently suggest that outcomes, mortality and healthcare experience throughout life are absolutely what we must be remorselessly focused on, and there the story is not a particularly good one, as the Commonwealth Fund made clear.”
“I suspect that its magisterial generality is probably by design; nevertheless, it fails to mention public health directly, which is an important part of the piece. If we are to consider the entirety of health and social care in this country, we need to talk about public health, which I think, if I am honest, has been neglected by consecutive Governments, largely because nobody fully understands what public health is. There is not really an accepted definition of “public health”. It means many things to many people. Some of us still believe, I suppose, that it is a rather old-fashioned thing, to do with the pre-1974 vision of medical officers of health, who dealt exclusively with infectious diseases. It is much bigger than that.”
“I rise to support the motion, and I hope in my contribution I will be able to explain why. I should first declare my interest as a licensed medical practitioner, albeit one who is in awe of my colleagues in the Chamber who regularly see patients, which is something I thoroughly commend. I think most of the people out there—apart from those who write for some of the more scurrilous parts of our national press—appreciate the fact that there are people in this place who are still engaged in medical practice of all sorts. It makes us relevant, it makes us current and it gives us some authority, as we have heard already today, when we talk about areas of expertise. There are some omissions in the motion, however.”
“He is right to say that party politicians meddle with this national religion of ours, the national health service, at their peril. If we accept that we face huge challenges in the long term, beyond 2020, it is important that we not only engage in a national debate so that we can address some of the difficult issues that we have discussed this afternoon—the estates, for example, and how we pay for healthcare—but try to gain that usually impossible goal of securing some level of cross-party consensus.”
“Very little of it is going to happen overnight, so it will not show up on people’s metrics—certainly not within an electorally obliging timeframe—but they nevertheless remain. If we are setting up a commission to look at how we do healthcare in the very long term, we most certainly need to focus on public health. We need to ensure that resources for public health are maintained and sustained. Those resources are not discretionary, but an essential part of what we should be doing for healthcare in this country—although I accept that when it comes to making economies, it will always be tempting to shave bits off public health services rather than cutting an acute service, which would be much more obvious to the public. I support the motion, and I congratulate the right hon. Member for North Norfolk on tabling it.”
“One of my worries about what has happened over the past several months is that we appear to have changed from a model in which healthcare is pretty much exclusively funded through general taxation—that is to say, national insurance and income tax—to one that is partly funded by local taxation, with all that means when it comes to cuts in hard times. In my view, the sort of public health interventions that are having bits shaved off them at the moment are not discretionary, but essential parts of healthcare. We can all come up with wonderful figures to show why we need to invest in healthcare. By and large, public health investment saves money in the long term, but the potential for public health intervention prevention services to have a real impact on people’s lives is truly enormous.”
“I suspect that the Minister, who will answer the debate shortly, will have fallen off his stool when he read the King’s Fund report a little under a year ago, which essentially said the same thing—that public health appears to be on the right track in this country at the moment and that the changes introduced in the White Paper five years ago have largely been successful. However, there is absolutely no room for complacency, as I am sure the Minister will agree, particularly when we have healthcare indices on areas such as our rate of teenage pregnancy. Although it has improved, it remains among the very worst in Europe. We do just slightly better than Bulgaria, Romania and Slovakia. Nobody here would be satisfied with that, I hope, and while we have public health indices as disastrous as that, there is no room for complacency.”
“I imagine that these issues will be examined by the commission proposed by the right hon. Member for North Norfolk when it is set up. Let me finish with a few more small points about public health. Among my distinguished medical colleagues in this place, I believe I am the only one with a postgraduate qualification in public health and the only one who has done a job with a significant public health input. I have a bit of a soft spot for this discipline, and I hope I understand some of what it is about. “Healthy Lives, Healthy People” has, in my view, been a success. It has set public health on the right track, handing back to local government a function that it arguably should never have lost, and setting up Public Health England, which I think has done a good job on the whole.”
“That allows us to have a service that is at least sustainable, notwithstanding my fears for the future and the inadequacy of our plans at this point in time, and should take us through to the end of the decade and beyond at a time when local government funding is being cut. That means that the pressure on social services, which was not anticipated by Simon Stevens, applies, while we face further pressures on the public health budget, too. Together, those pressures will mean having a deficit by the end of the decade that will need to be addressed. Beyond that, looking to 2025 and even further as Kate Barker has done, we need to determine how to find the extra funds that she feels are necessary, notwithstanding the dispute about where the funds might come from.”
“Without a strong economy, talking about improving public services across the board—and particularly in the huge area of healthcare—is, frankly, pretty pointless. There will not be the resources to sustain what we have at the moment, let alone the 12% increase suggested by Kate Barker in her report. That is fundamental. I want to give credit to Ministers for sustaining the Stevens plan. We have heard some contributions today suggesting why that the plan might not turn out to be sufficient, but finding that sort of money at a time of austerity is a huge achievement, which should be acknowledged. I was proud to stand only a few months ago on a manifesto that supported the £8 billion spend.”
“The hon. Gentleman is absolutely right. It comes back to the issue of integrating health and social care. We have to say that some progress has been made in that respect. At this point in my contribution, let me make it clear—despite the fact that this is intended as a non-partisan initiative—that I feel very strongly that without a strong economy, we will not make any progress at all. Improvement requires the sort of economy to which we aspire—not one such as has been sustained in Greece, Spain and Portugal. If we look at those three countries, whose healthcare systems were not comparable to ours before their respective crises, we should note what has happened subsequently, as their Governments have struggled to control their economic situation by making huge cuts. We need to be very aware that we have avoided that in this country.”
“Does my hon. Friend agree that one solution might be to develop further the GPs with specialist interest model, which was started some years ago but, if we are honest, has never really found its place in our NHS?”
“I am grateful to the hon. Lady for giving way, particularly as I was not in at the very beginning of her remarks. It is most gracious of her. I have been listening carefully and she is making a powerful case. Then she came over all partisan. Does she not accept that fundamental to spending on healthcare, as with the rest of our public services, is a sound economy? Does she accept that this Government have had to make some extremely difficult choices in order to get that economy back on track?”