Dame Meg Hillier
MP for Hackney South and Shoreditch · Labour (Co-op) · United Kingdom
“On a point of order, Madam Deputy Speaker, I have huge respect for the Minister, but she has said that she will not take any interventions. She is a very good Minister, and I trust that she will answer in detail the points that have been raised in the House today; having discussions with her and the Government after the debate is too late…”
“My hon. Friend talks about who makes our laws, and she has talked in articles that she has written about the primacy of this place. If the Bill goes forward, is she willing to accept amendments?”
“I welcome my right hon. Friend to her place and thank her for that response, which demonstrates the complications of these schemes. I asked the National Audit Office to look into this, and yesterday the Public Accounts Committee published its report on compensation schemes, suggesting that a central body be established.”
“I am pleased by my right hon. Friend’s answer, but she is in a unique position across Government to ensure that we are protecting not only women, but those who are blind or have visual impairments, who really value this technology.”
“I welcome the Chancellor’s clampdown on speculation and leaks ahead of the Budget; it is certainly an important step he has taken. On the issue of certainty, the National Wealth Fund is a critical investor in crowding in private investment around the UK. I noted that he has changed the remit.”
“Further to the points made by my hon. Friend the Member for Bournemouth East (Tom Hayes), it is important that we talk here and that we have diplomacy, but what practical actions are the Foreign Office and the Ministry of Defence taking to ensure that there is a review of physical defence and security, so that we send a clear message to t…”
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“NHS Improvement is a welcome body for trying to encourage best practice, because there is regional variation. It is quite right that any body as large and expensive to taxpayers as the NHS looks to perform as efficiently as possible but, once again, we are seeing NHS Improvement mask what look like cuts. A 4% efficiency savings target is once again being imposed. It was imposed in the previous Parliament by the then Chancellor, the right hon. Member for Tatton (Mr Osborne), and was acknowledged by the head of NHS Improvement, Jim Mackey, as particularly challenging. Worryingly, the reality was that everyone in the system knew that the target was too challenging, but there is a real lack of a culture of whistleblowing and calling it out in the NHS. It is difficult for people to speak truth to power, as we see over and over again.”
“My hon. Friend puts a face on the real challenge faced by many trusts and commissioners: they are having to make choices about where to spend the money. Despite the pledges about parity of esteem, there is a squeeze on mental health funding nationally. The reality of the overall picture is that growing demand is outstripping the ability of the NHS to supply needs, which is having a direct impact on patients. There are now longer waiting times for GP appointments. I alert colleagues to the Public Accounts Committee’s hearing on GP services next week; any thoughts from hon. Members’ areas are welcome. People are waiting longer to see specialists, with the 16-week target being breached, and A&E targets are being breached too often. There is a real challenge.”
“I agree with the hon. Lady. My own hospital does the same, taking on healthcare assistants and bringing them up through the system. The challenge is: how many people will be put off without that bursary payment? We need a clear answer from the Minister about what analysis was done of the impact on the workforce of that change. The amount of money involved is relatively small compared with the challenges and problems of not being able to provide a health service if we do not have enough nurses.”
“I should mention that the Public Accounts Committee has also been working with the Procedure Committee to try to ensure that the House can discuss the financial details of estimates rather than just the general principles, although I have obviously strayed into those, too. Hopefully, we can base these debates on the figures we have spent so much time looking at in the Public Accounts Committee. It is unedifying for the public to hear anonymous briefings and public argument; that does not wash with them. We need to be on top of this issue so that we hold the Government’s feet to the fire and make sure that, every step of the way, they know we are watching the budget. We will not let you get away, Minister, with raiding the capital budget to fund the accounts this year.”
“The key thing, of course, is how that figure comes through the pipeline and how we fill the gap. While the Minister is on his feet at the end of the debate, it would be helpful if he said what analysis the Department of Health has done of the impact of Brexit and any changes it may herald for our NHS workforce, because a high percentage of them are from Europe. We are hearing the right sounds from the Government, but we have not yet had any action on securing the future of those European citizens currently resident in the UK. If the Minister is able to give us any comfort on that, it would be very welcome. I am heartened that so many Members are in the Chamber to discuss this important issue.”
“I hope that heralds a change of attitude in the Government that will see no more anonymous briefing and silly bickering, but a strong, concerted effort to make sure that we future-proof our NHS for us and our children and that it is the beacon to the world that we all believe it is.”
“That solid base of funding was important in a constituency such as mine, where, for all sorts of reasons—culture, language and convenience—people often find their local pharmacy more readily than they do their GP practice, and they find it very useful. The Minister therefore has questions to answer on that point as well. A cross-party group of us recently met the Prime Minister, and I was heartened that she at least acknowledged the need to look at the long-term issues around health and social care. She has made a pledge that her adviser at No. 10 Downing Street will meet a cross-party group of MPs to discuss this issue further.”
“The hon. Gentleman makes a good point, and I visited one of my local pharmacies only a few weeks ago and saw at first hand the work it does to help ease the pressure on GPs, where people are waiting a long time for appointments, and on A&E. The Minister has taken a keen interest in pharmacies, but there is nevertheless a cut to their base budget. While we are on that point, it is interesting to note that that base amount allowed them to have the certainty to employ a member of staff to conduct appointments directly with patients. If they rely just on the revenue income they get from selling products, they cannot be sure that they can maintain that salary every year.”
“Question deferred until tomorrow at Seven o’clock (Standing Order No. 54).”
“Last year, a series of one-off extraordinary measures allowed the accounts—just about—to balance, but today Members on both sides of the House have drawn attention to the movement of the departmental expenditure limit from the capital to the resource side of the budget. According to the estimate, the limit is projected to increase to £1.2 billion. An awful lot of money is being taken out of the long-term future of the NHS to pay for day-to-day problems. That is not sustainable, and it is a great shame that the Minister did not address it. I hope that the Government will view it as one symptom of the long-term challenges of funding. This sticking-plaster will not solve the problem, but I hope that we can move forward on a cross-party basis, despite the Minister’s final comments.”
“I was going to say that this had been a good-natured and thoughtful debate. It is a shame that a Minister who is usually thoughtful has resorted to seemingly blaming NHS England for the present situation. I think it important to be clear about the budgetary position: NHS England asked for a certain amount of money, which the Government have stretched over an extra year. Money that was meant to cover five years has actually covered six, and I think it important to put that on the record. Members of all parties have made it clear that there are long-term financial challenges to our health system, and that we must have a long-term national debate about how we are to fund a health service that is fit for the 21st century.”
“T7. Last year, hospital trusts were urged by Department of Health officials to raid their capital budgets to cover resource funding. Does the Secretary of State think that is a good way forward, and what instructions is he giving officials this year?”
“The National Audit Office estimates that the total Government spend on housing in the last financial year was £28 billion, but a staggering £20.9 billion of that total was spent on housing benefit. Is that not a demonstration that rents are too high and that even people in work cannot afford them? Did the Secretary of State give any consideration to reforming housing benefit when putting together the White Paper?”
“What about the woman who wrote to me recently—a Dutch woman with a British partner and British children, who has spent 20 years in this country but does not know her future? What about another woman who is worried that, because she is a freelancer, she will not be able to stay in the UK? Changing this issue would not require an amendment to the Bill; the Government could agree to it straight away. We should be very wary of turning on foreigners in our midst at this time. Instead, we should give them succour. The Government should do so in the next few days, allowing such citizens to stay and continue to contribute to our country and setting in train the process by which they have to do it. If we do not do so, we should look very closely at our tolerances in this country.”
“Overall, 3 million EU citizens live and work in the UK. Those people pay more in tax than they withdraw in benefits, and they contribute at least £2 billion annually to our economy. A recent poll by BMG showed that a majority of UK residents believed that EU citizens’ rights should be guaranteed, with 58% agreeing with that position, 28% disagreeing and 14% saying “don’t know”. My hon. and learned Friend the Member for Holborn and St Pancras (Keir Starmer) talked about the human misery that this is causing. I have had people ringing my office in tears because they are worried about their future. When I am on doorsteps talking to constituents, they cannot hold back their emotions, because they are fearful about what it will mean.”
“In 2015-16, nearly 11% of staff who joined the NHS were from European Union member states other than the UK. That has gone up from nearly 7% in 2012-13. That demonstrates that there is a big gap between our skills in this country and the skills and talents that we need to fill those jobs. Let us look at the tech sector. I am proud to represent Old Street and Shoreditch, which is home to a burgeoning tech sector. Approximately 184,200 EU nationals work in tech. There are already issues with visas in this sector, because it is such a modern and emerging global industry. Often, jobs do not have titles—they do not exactly exist, in official terms—and there are real issues about where we get that talent from. Cutting off overnight the stream of EU citizens, who may be asked to leave this country, is a real issue.”
“I suspect that we will see an explosion, at speed, of quangos. This is the same Government who wanted a bonfire of the quangos. In the short time that I have, I want to focus my comments on EU citizens resident in the UK. At the last census in 2011, around 10% of my constituents were born in other EU countries. That was the case for about 27,000 residents across the Borough of Hackney, and the percentage is similar across London as a whole, where 841,000 people were born in other EU countries. If we look at student numbers, we see that 31,000 students from the EU were accepted in 2016, up 22% from 2010. That is a significant bunch of people who are contributing to our economy. We cannot get figures for everywhere in our public services, but 5% of NHS staff UK-wide are from other EU countries.”
“There has been much talk of the Prime Minister’s speech—made not in this House, but elsewhere—but no White Paper and no detail. After seven months, it is really shocking that the Government can come to the House today and say so little. There is still no real guarantee of parliamentary oversight. Although there was a vote to leave, there is a lot more detail below that decision that the House has a constitutional role to play in delivering. There is no certainty for business, as we stand here, and businesses in my constituency are very concerned about their future. There has been not a word of succour for EU citizens resident in the UK, an issue I have raised with the Prime Minister. There has been no answer about how the many regulations that will need to be transposed into our law will be dealt with.”
“It is a pleasure to follow the right hon. and learned Member for Beaconsfield (Mr Grieve), who, as ever, made some cogent points about the importance of process. I completely agree with him that the Government must lay out a process by which this House can begin to have a say in the proceedings and on the final deal. I stand up today to talk with passion about the biggest constitutional change to this country in my lifetime and in several generations. I regret that I do not believe that we will reverse this decision, but I will not be supporting it. That is not because I do not recognise the result of the referendum. I cannot walk blindly through a Lobby to trigger a process without a shred of detail from the Government.”
“I agree with that position, but I believe the Government could go further and make a unilateral declaration. These people live in our midst, they are our friends and our neighbours, they work in our public services, they are contributing to our economy, and I believe that people who are exercising their treaty rights today should be allowed to stay. They have made their lives in this country with every expectation that that would be the permanent position, and I think it would be magnanimous of the Government to give way now.”
“Notwithstanding that many of us were disappointed with the result of the referendum, we recognise that the people have spoken. Nevertheless, it is not just for the Government to decide the detail; it is very important that this House gets a proper say. In response to the hon. Member for Wellingborough (Mr Bone) and other Members, the Leader of the House indicated that there will be ample opportunity for debate. Will he be more specific about how many days this House will get to debate and influence the Government’s thinking on how we progress the negotiations, so that businesses and our constituents who are very concerned have their views aired in this House, and we can reflect the views of the people about how this will go ahead?”
“Q13. In response to the right hon. Member for Broxtowe (Anna Soubry), the Prime Minister talked about her desire to give clarity around our exit from the EU. Many of my constituents are European citizens who are paying tax and bringing up their families here. What assurance can she give them about their future, particularly if they change employer or are freelancers?”
“For many in my constituency, home ownership is but a pipe dream, with more people renting privately than owning their own homes. What steps is the Minister considering to encourage private landlords at least to offer longer tenancies for these very many private renters in London and in Hackney South?”
“As the Minister will know, the Public Accounts Committee has looked in detail at this issue, and we were rather shocked to discover that the Government themselves are woeful at collecting money from EU citizens who use our hospitals and for whom the Government are then responsible for getting the money from their home Government. When will the Government get their act together to make sure that this money comes into our NHS?”
“More people in my constituency rent privately than own their own homes and for most of them ownership is a distant or impossible dream. Are the Government considering looking at the supply of private rented housing on longer tenures, perhaps with rent guarantees, and possibly using tax reliefs or other mechanisms the Treasury has in its armoury, to encourage landlords to provide those longer-term tenancies and better security for the many private rented sector tenants?”
“In my constituency, I can tell the extent of someone’s poverty by the state of their teeth, so not only is there the issue of decay, but this is about not having the money to be able to get the necessary treatment—perhaps cosmetic treatment—which can then lead to embarrassment and a loss of confidence.”
“I commend the Hackney Gazette , which has done a lot to highlight the conditions in temporary accommodation hostels in my borough and across London. We have the Homelessness Reduction Bill, which is passing through Parliament, but that is only part of the picture. Saying that councils must accept people who are homeless is fine, but unless we have the homes available to provide to those people at an affordable level, we will not solve this problem.”
“This has a huge impact, focused, yes, on the absolutely poorest, but also on people such as the woman I mentioned—people who have just hit a bit of a rocky patch in their life, where something has gone wrong and caused a spiral downwards towards homelessness. There are so many hidden households in my constituency —families living on the sofa in the living room. It could sometimes be a family of an adult and two children in that situation while another family is living in the bedroom. For various reasons, they do not qualify for council housing, or they are on the waiting list—a bit of a misnomer when people wait a lifetime for a council property. Sometimes they cannot afford, on their income, to rent privately and they have no other options. Temporary accommodation is now costing Hackney council about £35 million a year.”
“My constituent was of course very concerned, anxious and depressed about what was going to happen in her situation, and she is just one of many. This is the worst situation I have experienced in over 20 years as an elected member at local or national level. The stress of poor, uncertain and overcrowded housing has a huge impact on health. If someone is homeless, it increases by one and a half times the likelihood of their having a physical health problem, and it makes them 1.8% more likely to have a mental health problem, although it seems to me from my experience of speaking to people face to face that those figures are underestimates. Perhaps they mask the temporary housing problem, compared with the reality of what I am seeing.”
“She became ill and her rent went up, so she fell notionally into arrears while she was trying to find another home, as her rent was no longer covered because of the housing benefit cap. She tried to find somewhere in Hackney and the neighbouring six boroughs but could find nowhere, until eventually a landlord said he would take her in on benefits. However, because of the complexities in how housing benefit is allocated, he would not take her unless he had a guarantee a month before she moved in that she would be able to receive housing benefit. However, the system does not allow for that. As a result, a woman whose health was challenged anyway was suffering mental health issues through no fault of her own.”
“That is not a surprise, given increasing house prices and rents, and the impact of the benefit cap, which means that people cannot now rent a three or four-bedroom home on housing benefit anywhere in London or the south-east of England. I have people coming to see me now who even five years ago, and certainly 10 years ago, would not have come to me about their housing. They were managing okay, they were living in the private sector, they were paying their rent and they were working. Now, one woman who came to see me had lost her job because she had been ill. She had hoped to go back to work. She had a good job with professional prospects, although not a well-paid job.”
“I am determined that the Government are clearer in their outcomes, because in constituencies such as Taunton Deane—or perhaps not, as the hon. Member for Taunton Deane (Rebecca Pow) highlighted—the need might be for green space or other facilities that would improve or promote health. However, if we do not have a wider view of what we are doing with our public assets, there is a danger that we will just sell to the highest bidder and lose the chance for several generations, because once land is gone, it is gone. Finally on this issue, it is important to touch on the increasing challenge of homelessness, particularly in London and in my constituency. London households in temporary accommodation now account for around three in four of all such households in England.”
“Given the state of homelessness locally, if we could provide families with more good-quality homes on that site that were not overcrowded, we would do more for public health and health inequalities than a lot of the fiddling around we do over whether a service should be based here or there and all the treatment work we are doing. Departments are now taking account of other “strategic objectives”, as they put it, in land disposals, but that is still ill-defined. My Committee will continue to push on this matter because from the perspective of my constituency, where we have extraordinarily high house prices, if we can release land and provide homes for key workers, that would contribute to the outcomes of those Departments.”
“That is a sign of the failure of preventive work to tackle health inequalities at the right point. When it comes to joining up Government, we need to look not just at the silos in various parts of the health budget, but at ensuring a healthier wider society. Let us take, on the one hand, the land disposals that the Government are undertaking to provide public land to build new homes. My Committee has looked at that a great deal, although I will not divert the House today too much. In my area we have St Leonard’s hospital, the site of a former workhouse in Hackney. When the most recent reorganisation of the NHS took place in 2011, the site was moved to the central PropCo, the property company that the NHS holds centrally to manage its estate. We therefore no longer have local control of what to do on that site.”
“If we replicated that across just east London, just think what we could contribute to the NHS budget. About 1.3% of workdays a week are lost to sickness in London alone, which is lower than in many parts of the country. All these things contribute to our productivity gap and have a big effect, so if we are to do what the Chancellor said yesterday and ensure that our workers produce in four days what they now produce in five, we need workers who are well and can work until the increased retirement age that is demanded. It is quite shocking that the hon. Member for Glasgow East (Natalie McGarry) and other colleagues from Glasgow represent a city where people will die before the age at which they qualify for their state pension. There are certainly many people in my constituency who face that, although they are not the average.”
“The cost of treating illness and disease arising from health inequalities has been estimated at around £5.5 billion a year, and then there is the issue of cost shunting, which is a big concern. If we do not tackle these things, it will not just be individual patients or their families who suffer, or the taxpayer funding these services; there is a wider impact on society. Productivity losses are estimated at between £31 billion and £33 billion per annum. Lost taxes and higher welfare payments cost in the region of £28 billion to £32 billion per annum. To go back to what the hon. Member for Totnes said about smoking, if we tackle tobacco issues in my neighbouring borough of Newham alone, that would save about £61 million per annum. That would make a big contribution to the local health budget in east London.”
“A lot of pressure was put on finance directors of acute trusts in particular at the end of the last financial year. Many were encouraged, for example, to move capital funding into the resources side of their budget in order to balance the books—a short-term measure that can lead to underinvestment in facilities that, if invested in, can actually save money and improve the patient experience. This short-term, year-on-year, or even spending review period planning will not tackle health inequalities effectively. We need a longer-term approach. We need to prevent more ill health and treat fewer patients. As others have highlighted, the age of death is increasing—we have an ageing population—but the age of disability remains broadly similar. Public Health England released a report towards the end of 2015 highlighting some of these figures.”
“People knew that there would be a problem with the budget two or more years out from the crisis in the budget settlement in the last financial year, yet there is no openness in discussing how we spend money in the NHS, what we spend it on and what we focus on. That brings me to public health. Too often, public health budgets are raided to deal with day-to-day crises and money is taken out of NHS education. The plans for service transformation are not necessarily a bad thing, but the danger is, if they are done in the wrong climate and with the wrong tone, that they are seen as an excuse for cuts. They can be so much better for patients, especially if focused on preventive work and the more efficient spending of taxpayers’ money, but too often they will be driven by financial pressures.”
“He reiterated that point in a Committee hearing only a few weeks ago. I will not spend too long on the budget figures—the debate needs to move on—but I will touch briefly on the overall figures this year for acute trusts alone. From April to September, trusts overspent by £648 million and the deficit for the first six months forecast to the year end is £669 million. This trend was increased largely because of the decision in 2011 to allow for 4% efficiency savings across the NHS by the then Chancellor of the Exchequer. Everybody in the system knew that that was not realistic on a long-term basis.”
“Every pound saved is a pound to spend on something else. That is the key point. Every pound saved in the Department of Health budget can be spent on other things and ought to be spent on public health in particular. I will come on to that. As I have highlighted, there are many pressures on the NHS budget. With all these discussions and figures being bandied around, we need to take a closer look. In 2015-16, the Department’s budget was projected to have a £2.45 billion deficit. The measures used in the last financial year to balance the budget were extraordinary and one-offs and led to an unprecedented three-and-a-half-page explanatory note from the Comptroller and Auditor General alerting all of us, particularly the Department, to his concerns that those were not replicable, long term or sustainable.”
“Ministers have moved from the mantra, “We’ve injected an extra £10 billion”, to saying, “The NHS has been given what it asked for”, as though they were scolding a naughty child, and, “We will manage this within the NHS”, as the Chancellor said yesterday when I asked him why he had not considered the NHS budget in the autumn statement. In today’s Daily Mail there is an exhortation—this is quoting sources close to or in Government—that the NHS simply needs to manage its resources better and cannot endlessly be given more money. I am Chair of the Public Accounts Committee. This is taxpayers’ money. I do not think we should endlessly pour money into any Department without demanding quite a lot of it, and I am clear that there are always efficiencies to be found in a system so large and with such a large overall budget.”
“The Government are keen endlessly to remind us that they have injected £10 billion into the NHS over the six-year period to about 2016. At the same time, we see an ageing population, a large and increasing demand, including for specialised services, and a health service squeezed at each step of the journey. My Committee has heard evidence on general practice, specialised services such as diabetes and neurology, acute trusts and social care, all of which has shown the impact on the budget. That has all been caught up in what, sadly, has been a rather childish debate over headline figures and often very subtle changes in language from the Government about who is to blame.”
“To take diabetes as an example, 4.8% of the population is currently diabetic, but that is set to rise to 8.8% in the next few years. It is my role and the role of my Committee to look at funding. Specifically, our role is to look at the economy, effectiveness and efficiency with which the Government spend taxpayers’ money, so I will talk first about how we spend the money that is allocated to our health service and how that is key to tackling health inequalities. I will then turn to how we look at the impact of decisions, both in the health service and in other parts of Government, on health inequalities—what we in the Committee call “cost shunting”. NHS budget spending is in the region of £110 billion a year.”
“I join colleagues across the House in congratulating the hon. Member for Totnes (Dr Wollaston) and her Committee on their work in this area and on securing this debate. She brings a calm and clear knowledge to every health debate. We really do need a long-term vision in this area and I know that she, like me, wants to see that, whatever party is in government. I speak today both as an MP for a constituency with large gaps in health, wellbeing and life expectancy, which are very much determined by place of birth, early years experience and poverty, and as Chair of the Public Accounts Committee, which in this year alone has published 10 reports on the national health service, some of which shine a light on this debate. Our reports show the huge pressures on the national health budget and the huge increases in demand on that budget.”
“I add a plea from my local constituency perspective as well as from my national perspective as Chair of the Public Accounts Committee—tackling homelessness is a vital issue to tackling health inequalities.”
“Even three years ago, I used to say, “Hold on and hang on in there for six months, and we’ll find a home for you.” Nowadays, it is increasingly a year or 18 months. The woman went into hospital to give birth and had to come back, with her new-born baby, her toddler and her husband, to that one room in the hostel. The people living in that hostel are among the most vulnerable—not an ideal environment in which to bring children home. Many people with a lot of problems are crowded into one place, without the support they need. This is not, I am sure, what any Member wants to see. We must tackle the issue, because the health problems that that spins off for the next generation of children are immense.”
“It is going to take a generation to solve this housing problem, so although I welcome what the Government have done, much more could have been in their six years of office. I am pleased that we now have a Housing Minister who is a London MP and who understands London issues. We London Members often speak about housing here, and it is as though we are in a different world from others. However, we have this very big problem of homelessness, overcrowding and excessive use of temporary accommodation. Let me finish with a story that should never be true in our world. It is a story of a woman who was living with her toddler and her husband in a hostel because she was waiting to get some council housing.”
“The hon. Lady pre-empts my next point. I welcome the fact that the Government have begun to make some moves on housing, particularly taking away the “pay to stay” provisions. I am making sure that all my local housing associations are not going to buy into this on a voluntary basis—I hope they would not in London. The autumn statement freed up housing associations to use Government money for affordable housing as defined locally, rather than as set nationally. The idea that in my constituency affordable would be 80% of private rents is nonsense; it is well out of the range even of people who are well above the minimum wage. Most young people in Hackney share a home, because they could never afford to rent somewhere privately and they certainly cannot get on the housing ladder.”
“In a long statement, we had no mention of the national health service. After the first six months of this year, the deficit is £648 million for trusts alone, with a year-end deficit forecast of £669 million. Given the extraordinary measures to which the Department of Health had to go to balance its budget in the last financial year and given those projections, what is the Chancellor doing to ensure that our national health service has a sustainable future?”
“Today I publish my first annual report as Chair of the Public Accounts Committee, in which I conclude that there is a sustainability crisis in the funding of the NHS. Surely the Secretary of State will agree—he has made some comments in the media that suggest he is becoming aware of this—that he will need to lobby the Chancellor for a better settlement in the autumn statement. Will he update the House on his negotiations?”