Steve Barclay
MP for North East Cambridgeshire · Conservative · United Kingdom
“I speak to my brief exchange earlier with the Minister. As the previous speaker, the hon. Member for Harpenden and Berkhamsted, said, the draft regulations are fairly benign and very welcome to help people who are struggling with their bills.”
“The issue is not the lack of will; the issue is the alignment between procurement, regulation and clinical leadership, particularly in the colleges, as well as the ability to scale innovation—it is not about having more ministerial pilots.”
“Just to localise it to my own constituency, the Cambridgeshire and Peterborough ICB alone paid out £14 million in redundancies last year. It merged with a number of other ICBs to form the Central East ICB, yet we know hear from the Government that it should align with metro mayors, which means going back to exactly what it was before: the…”
“My right hon. Friend is absolutely right: the Government are spending millions of pounds and there is no plan. The measure was announced without working that out, it came as a surprise to many within the system, and it has had a chilling effect on many decisions. That is not isolated.”
“I rise to speak to clause 1 on the abolition of NHS England and clause 6 on promoting innovation. What characterises the first of those is an announcement without any clear plan. That is what has driven the cost and confusion that a number of Members across the House have spoken about.”
“All this is around 18 months on from the actual announcement. The confusion seems to extend to the Government themselves, because they seem unable to answer pretty straightforward written parliamentary questions. Given the time limit, I will give just a few examples.”
The complete record
Every one of 4,327 lines we hold for Steve Barclay, in date order, each linked to its source. Free to read, in full, without an account. Page 19 of 87.
“My hon. Friend makes an important point, and I am happy to update the House, as we have already achieved 35% coverage. By the end of the month, we expect to have 399 operational mental health support teams, covering 3 million children and young people. We plan to go further, with over 500 such teams by spring 2024.”
“It is a huge opportunity. My right hon. Friend and I have discussed this matter outside the Chamber, and I met Ben Goldacre in the summer to discuss his fantastic work in the context of covid. It is absolutely right that, given the potential of artificial intelligence, there are huge opportunities in relation to health inequalities and allowing us to better target provision. I think my right hon. Friend would agree that we should do that through the prism of patient consent. One thing that we are trying to build into the NHS app is the ability to better empower the patient to decide what they wish to sign up to and what they would like their data shared with.”
“We are committed to a major conditions paper, not least because many people with cancer have multiple conditions; that is why it is important that we look at these issues in the round. With the Minister for Social Care, I had a very useful roundtable with key stakeholders, including the cancer charities. The key issue is that as part of our work on cancer checks, over 320,000 more people are receiving treatment for cancer compared with last year—that is around fifth higher—and we are expanding our capacity through the diagnostic centres, the surgical hubs and the expansion of the workforce. All of that fits within the strategy we have through the major conditions paper.”
“It is one on which people are still voting, with a decision of the NHS Staff Council due on 2 May. The largest union, Unison, has voted in favour of it, by a margin of 74% in favour. So we have agreed a process with the trade unions, which I am keen to respect, and we should now allow the other trade unions to complete their ballot, ahead of that NHS Staff Council meeting on 2 May.”
“I recognise that there are significant pressures on junior doctors, both from the period of the pandemic and from dealing with the backlogs that that has caused. I do want to see a deal that increases junior doctors’ pay and fixes many of the non-pay frustrations that they articulate. But the junior doctors committee co-chairs have still not indicated that they will move substantially from their 35% pay demand, which is not affordable and indeed is not supported by those on the Opposition Front Bench. Let me turn to the second part of the hon. Gentleman’s question and the steps we are taking to prevent further strike action in the NHS. We have negotiated a deal with the NHS Staff Council; it is an offer we arrived at together, through constructive and meaningful negotiations.”
“In the coming days, I will also update the House on the very significant progress that has been made on the successful action taken over recent months to clear significant numbers of 78-week waits, which resulted from the covid pandemic. It is regrettable that the British Medical Association junior doctors committee chose the period immediately after Easter in order to cause maximum disruption, extending its strike to 96 hours and asking its members not to inform hospitals as to whether they intended to strike, thus making contingency planning much more difficult. Let me put on record my huge thanks to all those NHS staff, including nurses and consultants, who stepped up to provide cover for patients last week.”
“I am grateful to the hon. Gentleman for his question. On its first part, we will not have firm figures on the number of patient appointments postponed until later today, because the NHS guidance has been to allow trusts a full working day to collate the data on those impacts. We do know from the previous three-day strike that 175,000 hospital appointments were disrupted and 28,000 staff were off. There is an initial estimate that 285,000 appointments and procedures would be rescheduled, but it is premature to set out the full impact of the junior doctors’ strike before we have that data. I am happy to commit to providing an update for the House in a written statement tomorrow.”
“We have always worked in good faith to end the disruption that these strikes have caused and we will continue to do so. None the less, it is right to respect the agreement that we have reached with the NHS Staff Council and to await its decision, which is due in the coming weeks.”
“It has chosen to pre-empt all that not only with the strikes that come before that decision of the NHS Staff Council, but by removing the derogations—the exemptions—that apply to key care, including emergency care, which is a risk to patient safety. Trade unions are continuing to vote on the deal. The deal on the table is both fair and reasonable, including just over £5,000 across last year and this year for nurses at the top of band 5. The deal has been accepted by the largest union in the NHS, including, as I have said, the shadow Health Secretary’s own trade union. It pays more in cash to Agenda for Change members than the deal on the table from the Labour Government in Wales. It is a deal that the majority of the NHS Staff Council, including the RCN’s own leadership, recommended to its members.”
“He says that he does not support the junior doctors in their ask of 35%, and neither does the leadership there. We need to see meaningful movement from the junior doctors, but I recognise that they have been under significant pay and workforce pressures, which is why we want to sit down with them. The bottom line is that the deal on the table is reasonable and fair. It means that just over £5,000 across last year and this year will be paid for a nurse at the top of band 5. The RCN recommended the deal to its members, but the deal was rejected by just under a third of its overall membership. It is hugely disappointing that the RCN has chosen not to wait for the other trade unions to complete their ballot and not to wait for the NHS Staff Council, of which it is a member, to meet to give its view on the deal.”
“The shadow Secretary of State seems to ignore the fact that we have negotiated a deal with the NHS Staff Council, and it is a deal that it has recommended to its members. Indeed, the largest health union has voted in favour of the deal—indeed it is his own health union that has voted in favour of it—and yet he seems to suggest that we should tear it up even though other trade unions are voting on the offer, and their leadership had recommended it. Secondly, the shadow Secretary of State says that we should sit down and negotiate. We have made an offer of 10.75% for last year, compared with the Labour Government in Wales, who have offered just 7.75%, which means that, in cash terms, the offer in England is higher than that put on the table by the Welsh Government, whom, I presume, he supports.”
“I agree; it is extremely surprising that the BMA has asked its members not to liaise with NHS managers as they put in place those contingency plans. I urge the BMA junior doctors committee to think of those colleagues who have to provide the cover for those strikes. I reaffirm my thanks to all those staff in the NHS who provided cover following the Easter period, but it puts more pressure on other NHS staff if the BMA junior doctors committee is not willing for its members to liaise with management on sensible contingency measures, as I urge them to do.”
“In part, that is why my door is open and I am keen to discuss with junior doctors the pressure they face not just on pay, but on non-pay issues. There is the issue of support for the number of doctors and the workforce plan we have committed to bring forward to boost recruitment, but other non-pay issues are also frequently raised by junior doctors, such as booking annual leave and rostering. I am keen to work constructively with junior doctors to address those, but for us to do so they need to move from an unrealistic and unaffordable 35%, which the Leader of the Opposition himself has recognised is an unreasonable position.”
“I very much agree with my hon. Friend that this is a fair and reasonable settlement. As I say, it is more than £5,000 at band 5, and the NHS Staff Council has recommended it. The majority of trade unions, including the RCN, recommended this deal to their membership. That is why we should respect the NHS Staff Council process, respect the ballot that is still live and allow those votes to continue.”
“We are keen to do the same with the junior doctors, but that has to be based on a reasonable opening position from them.”
“One of the concerns at the moment is the BMA rate card, which is significantly increasing the cost of providing the required cover for the strikes, and in turn taking money away from things NHS staff have raised with me, such as improving our tech offer, improving the NHS estate and the many other priorities on which money could be spent. I am keen, as I am sure the hon. Gentleman is, to bring down the cost of agency workers. That is why we have the commitment to the NHS workforce plan and why I am keen to sit down constructively with the junior doctors committee, in the same way that I did with the NHS Staff Council. After we reached our deal, the leader of those negotiations for the trade unions commented on the meaningful and constructive approach that we took with the Agenda for Change negotiations.”
“I agree with my hon. Friend. The fact that even the Labour party does not support 35%—the Leader of the Opposition himself says that is not affordable —indicates how out of step the junior doctors committee co-chairs are on what is realistic to get the balance right in bringing down inflation and on the wider economic pressures we face. We stand ready to engage constructively with the junior doctors committee but, as my hon. Friend says, that has to be on the basis of a meaningful opening position.”
“We have agreed an offer with the Agenda for Change staff council. That is something that the staff council and the majority of trade unions have recommended to their own members, and that the largest health union has voted in favour of. I think we should allow that ballot to take place; it reflects meaningful and constructive engagement. That was reflected in the fact that trade union leaders themselves recommended the deal to their members. I hope that, when we come to the 75th anniversary, we can celebrate that.”
“As ever, my right hon. Friend raises an extremely important point. As part of the negotiation with the AfC staff council, a number of non-pay issues were discussed. Job evaluation is one such issue. Likewise, for junior doctors, areas such as e-rostering are extremely important. I share his desire for investment in technology, and to look at the time spent by clinicians that could be spent by others in the skills mix or through better use of artificial intelligence technology and a better estates programme. That is why it is important that we continue to have that funding, as well as reaching the offer that we have with the AfC staff council.”
“These talks will not be reopened if members reject this pay offer.” The leadership of the RCN recommended the deal, as did the leaderships of the GMB and Unison. It is odd that the hon. Lady does not want to recognise that.”
“The odd thing is that the hon. Lady seems to be disagreeing with the trade union leadership, which is not her usual position. Unison described it as a “decisive outcome” when 74% of its members voted in favour of the deal. It is odd that she wants to deny the GMB and other trade unions the space to vote on what their leaders have recommended—the GMB leadership has also recommended the deal to its members. Even the RCN leadership recommended the deal to its members. As Pat Cullen herself said: “Negotiations work by compromise and agreement. We did not get everything and nor did the government. Ministers made improvements every day of those three weeks because we were able to say that returning to striking was the clear alternative. No union could enter negotiations and flatly say ‘no’ until you get everything you want.”
“My right hon. Friend is absolutely right to focus on patient safety and the duty that all involved have to safeguard it. Indeed, I have previously given the Royal College of Nursing’s leadership credit and praise for granting strike exemptions, known as derogations—notwithstanding our disputes, I was happy to recognise that on the record. Given that less than a third of the RCN’s total membership has voted against the deal, and that the RCN’s leadership recommended it, it is very odd that it has now hardened its position and removed those exemptions. I very much hope that it will reflect further on the matter in the coming days, because I think its previous stance of granting exemptions was right.”
“It perhaps will not surprise the House to hear that the hon. Gentleman disagrees with his party’s leader on that, because the Leader of the Opposition says: “I don’t think 35% is affordable”. The hon. Member for Leeds East (Richard Burgon) is also wrong on the quantum, because the cost would be £2 billion, not £1 billion as he says. [Interruption.] Well, that has never been how departmental budgets operate—not when his party was in power, and certainly not now. He is wrong on the amount and wrong on the policy.”
“My right hon. Friend makes an extremely important point. Patient safety should come first for all parties in this dispute. That is why I urge the Royal College of Nursing to wait for the NHS Staff Council decision on the offer. Voting is still ongoing, and it would be premature to announce strike action ahead of that decision.”
“On social care, which relates to the hon. Lady’s point about discharge, she will recall that in the autumn statement the Chancellor put additional funding into adult social care—funding of up to £7.5 billion over two years, which is the largest ever increase in funding for social care. Also, I announced at the Dispatch Box in early January a reprioritisation of funding in the Department—it was a £250-million package—in the light of urgent and emergency care pressure. That included funding to support greater discharge, to get more flow. I touched on the workforce plan earlier. We will publish it shortly; in the autumn statement, the Chancellor committed to doing so.”
“I do agree with my hon. Friend. If that demand were agreed to, it would mean some junior doctors receiving a pay rise of over £20,000. We need to find a balance, with a fair and reasonable settlement for NHS staff, recognising the huge pressure from the pandemic and the backlogs it has caused, while at the same time bringing inflation down, because that matters not just to NHS staff, but to all working people who are impacted by inflation.”
“As I have said, we need to see meaningful movement from the BMA. The 35% demand that it has set out is not affordable, which is a point that is recognised by most colleagues across the House—certainly, Opposition Front Benchers recognise it. We need to see significant movement from the BMA to be able to have constructive and meaningful engagement.”
“I very much agree with my hon. Friend, and he is right to highlight the wider issues that we want to discuss. The previous negotiation with the junior doctors included, for example, setting up a higher pay band, which has meant that there has been a cumulative increase of over 24% over four years. It included targeted action such as a £1,000 a year allowance for junior doctors who work less than full time, and targeted action around unsocial hours and weekend work. Those are the meaningful discussions that we want to enter into with junior doctors, but that has to be on the basis of a realistic and deliverable discussion, and 35% is not that.”
“The rather odd thing is that we have a larger cash offer on the table for 2022-23 than the Labour Government in Wales, and we have reduced our longest waits far more than they have in Wales. We have a deal that the trade union leaders themselves have recommended, that the majority of staff councils have recommended and that the largest health union has voted emphatically in support of. It is right that we allow time for that deal to go through, and we stand ready to have similar meaningful and constructive engagement with the junior doctors once they move from what is an unrealistic position.”
“In short, the position of the shadow Health Secretary seems to be to deny the vote of his own union, Unison, which voted 74% in favour; to not wait for the NHS staff council to reach its decision; and to unravel to some extent what has been meaningful and constructive engagement with the “Agenda for Change” staff council. My right hon. Friend is right to be confused about the Opposition’s actual position.”
“More widely in terms of elective recovery, we made progress in the summer on the two-year waits, in stark contrast to Wales, which was significantly above 50,000. We got it under 2,000 in the summer. I will update the House shortly on the 78-week waits. We are working through the key actions in our elective recovery plan as we deal with the consequences of the build-up from the pandemic.”
“The hon. Gentleman makes two important points. The workforce plan is critical, and I have referred to that already. He also raises the importance of early diagnosis of cancer, and he is absolutely right on that. He will have seen that the faster diagnosis standard was met in the latest operational performance data for February, which was extremely welcome news. There is obviously more still to do. That is why we are rolling out the programme of diagnostic centres and surgical hubs. We are redesigning patient pathways to streamline those journeys, and we are looking at variation in performance on such things as faecal immunochemical tests. There is a huge amount of work, but I hope he can see some progress in the latest figures.”
“I do share my hon. Friend’s concern. Full Fact has shown that the figure is inaccurate. It disregards higher pay later in the evenings and at weekends. It ignores the 20% that goes into pensions and that junior doctors, probably more than any other profession, have very quick pay and career progression. That is why, as part of our listening exercise, we made changes to pensions in the Budget. That was a reflection of the fact that senior doctors have often accumulated those pension pots, which is one of the other challenges we are dealing with. It is an indication of the career and pay progression that many junior doctors will see later in their careers.”
“Sometimes people take a pay hit when they go into an apprenticeship if they were at the top of their previous band. That is one of the things we agreed to work on with the staff council. Again, I am sure that an area of consensus in the House will be that apprenticeships offer great opportunities for people to progress, and we should not have a financial penalty when people pursue them.”
“The hon. Gentleman raises an important issue, and there is a lot more we can do around the skills mix in the NHS and ensuring that people operate at what is referred to as the top of their licence and make the maximum of the training they have. Often there are restrictions in place. We are looking at physician associates and medical examiners and at the role of pharmacists within primary care, as well as at how we get the right continuing professional development to train people, so that we get more of the career ladder from different roles. There is a lot that we are looking at, in the context of the workforce plan, around the right skills mix, the right training and job evaluation. That was one of the issues in my discussions with the staff council—for example, there was a particular focus on apprenticeships.”
“I share my hon. Friend’s concern. We have worked constructively with the Royal College of Nursing and, as I say, I was happy to put on the record my acknowledgment of the exemptions it had previously granted. I hope that between now and the end of the month, it will further reflect on the fact that the 48 hours of continuous strike action will happen without consultation with other staff council members and without waiting for the decision of other trade unions that are currently balloting. He will know that “Agenda for Change” is a deal that covers all the trade unions, not just the RCN in isolation, and I think it is right to wait for all the trade unions to vote and for the staff council to meet.”
“First, I thank my hon. Friend for her service and for the work she was doing on Friday. I join her in putting on the record my thanks to all those staff who did provide cover, as I said in my opening remarks. She is right to highlight the minimum service legislation, and we will obviously need to reflect on recent events in that context. She also points to the fact that the decision by the BMA junior doctors committee to advise members not to notify hospital management about whether they were striking obviously made it more likely that clinics would be cancelled, even when it then transpired that doctors could have provided cover. That is clearly regrettable and indicates the need for resolution, and we want to work constructively with the junior doctors on this.”
“The BMA’s junior doctors committee’s refusal to engage in conversations unless we commit to delivering a 35% pay increase is unacceptable at a time of considerable economic pressure and suggests a leadership that is adopting a militant position, rather than working constructively with the Government in the interests of patients. None the less, we remain determined to find a settlement that not only prevents further strike action but, equally, recognises the important work of junior doctors within the NHS, just as we have done with the “Agenda for Change” trade unions in their dispute. We will continue to work in good faith, in the interest of everyone who uses the NHS.”
“NHS England has stated that it will prioritise a number of areas, including emergency treatment, critical care, maternity care, neonatal care and trauma, but— [ Interruption. ] The hon. Gentleman asked the urgent question, so he might want to hear the answer. NHS England has been clear that it cannot fully mitigate the risk of patient harm at this time, which is concerning and disappointing. Patients should not have to face such disruption again, and I have invited the British Medical Association and the Hospital Consultants and Specialists Association to enter formal talks on pay, with the condition that they cancel strike action.”
“I am grateful to the hon. Member for Ilford North (Wes Streeting) for his question. I know that colleagues and constituents will be concerned about the planned 96-hour walkout organised by unions representing junior doctors. The hon. Gentleman asks about the impact, and we know that during the previous walkout by junior doctors earlier this month, 181,000 appointments had to be rescheduled. The disruption and risk will be far greater with this four-day walkout, not only because it lasts longer but because it coincides with extended public holidays and Ramadan, with knock-on effects on services before and after the strike action itself, and because a significant proportion of junior doctors will already be on planned absence due to the holiday period.”
“The Opposition are full of contradictions. The reality is that there is a position in terms of the— [Interruption.] The right hon. Member for Islington South and Finsbury (Emily Thornberry) chunters again. There is a position in terms of precondition. The shadow Secretary of State asked me to confirm at the Dispatch Box whether it was a precondition of the junior doctors. Ahead of the urgent question, I checked the minutes— [Interruption.]”
“It is why the Royal College of Nursing, Unison, the GMB and the Royal College of Midwives are all recommending the agreement that has been reached, covering more than 1 million staff across the NHS, to their members. The junior doctors have set a precondition on those talks which the hon. Gentleman does not agree —[Interruption.] That is a precondition. He does not seem to understand the terms the junior doctors —[Interruption.] He asked the question, he is getting the answer and the fact that it points to the contradiction in his own position is one that he seems to be having trouble with. Conservative Members are used to contradictions from those on the Opposition Front Bench. He supports the use of the independent sector, whereas his deputy does not. He wants to nationalise the GP estate, but his shadow Chancellor does not.”
“I have checked the minutes of the meeting and there was a list of conditions —a pay restoration of 35%, and a range of other factors that were put on the table— that were preconditions that the Government had to commit to. The point is that he has said in the media that he does not support those preconditions. He says that 35% is unaffordable, so what is his position? One minute he says that he supports the junior doctors and that they should not go on strike, yet the next minute he says that he does not actually support the precondition that the junior doctors have said is the requirement for them to enter into discussion. The reality is that the Government have taken a constructive and meaningful approach to trade union negotiations. That is why we have reached agreement with the “Agenda for Change” trade unions.”
“The urgent question was on the junior doctors —[Interruption.] I am sure I will quote —[Interruption.] There is a rare point of agreement between us. The hon. Gentleman is chuntering, but let me go through the list of things that he did raise pertaining to the junior doctors’ dispute. He said that the Government should get the junior doctors committee in for talks; we have done so—his third question made reference to the fact that we have. We have had the junior doctors in for discussions —[Interruptions.] I will run through the questions. The hon. Gentleman questions whether there are preconditions attached to those discussions.”
“The Opposition do not seem to like their question being answered. The shadow Secretary of State asked me to confirm the position, for the avoidance of doubt, at the Dispatch Box. That is exactly what I am doing. I have checked the minutes. I have spoken this morning with officials to confirm, before I made the statement to the House, that it was a precondition of the talks. We were told, in terms of the pay erosion of 26.1%, that that needed to be restored at 35%, alongside other things. The reality is that he does not support that. He is facing both ways, wanting to support the junior doctors, but not actually willing to support the pay that they are demanding.”
“I would draw an important distinction between a militant group that appears to have taken over the junior doctors committee and the vast majority of junior doctors who do a hugely important job within the NHS. We recognise in Government that they have faced considerable pressures from the pandemic, and we stand ready to work constructively with them. There are, on the other hand, some within the BMA junior doctors committee who appear to have a more political agenda. Indeed, I refer hon. Members to the statements of members of that committee, who have said that they want to move the BMA to more traditional trade union activity and to pursue a more overt political agenda.”
“First, there is absolutely no traducing going on. In my last answer, I praised the junior doctors and recognised the fact that they have faced huge pressure from the pandemic, which is why we stand ready to work with them. Some on the BMA junior doctors committee have a different agenda, but we stand ready to work very constructively with that committee. The hon. Gentleman suggested that I drop the precondition. It is not I who set the precondition; it is the junior doctors committee that did so. I remind the House that it includes restoration to 2008 levels of all elements of pay, not just basic pay; parking fees and exam fees; and “radical” reform of the Review Body on Doctors’ and Dentists’ Remuneration. It is the junior doctors committee that set those preconditions, not the Government.”
“I thank my hon. Friend for his question. Yes, the Department is working very closely with colleagues in NHS England and across the NHS to mitigate as best we can the impact of the junior doctors’ strike. He is right that we had meaningful and constructive talks with the staff council representing “Agenda for Change” staff. I am very pleased that, as a result of the constructive engagement we had, the NHS staff council was able to recommend that pay award to its members. He is right that that points to the constructive approach that we have taken. We stand ready to have that constructive engagement with junior doctors, recognising the real pressures that the profession has been under. We will mitigate as best we can, but, given the timing over the Easter period, obviously, there is a risk in terms of patient harm.”
“I think we can see what sort of impact it will have from the previous strike, which was over three days and impacted 181,049 appointments. We can see there will be a significant impact. On mitigations, as part of our electives recovery plan, we are doing a range of things, including expanding community diagnostic hubs and the fast-tracking of surgical hubs. The NHS is responding brilliantly with things such as super Saturdays, where teams process higher volumes of treatments, particularly in certain areas. We have the Getting It Right First Time programme, led by Sir Jim Mackey and Professor Tim Briggs, which is looking at how we embed best practice. Having hit the first interim milestone of our recovery plan in the summer, the two-year wait, we are now focused on the 78-week wait target and working our way through that.”
“I agree with my hon. Friend that we need to do both: we need to get inflation down, recognising that has an impact across the whole workforce, including for those working within the NHS itself, and we need to recognise the real pressure that junior doctors and others within the NHS have faced. That is why we stand ready to have meaningful and constructive talks with junior doctors, in exactly the same way as we have had with midwives, nurses and others within “Agenda for Change”. We must balance the wider issue of inflation and what is affordable to the economy against recognising the real pressures the NHS has faced and responding to that, including for junior doctors.”