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.”
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“Under the existing arrangement, 40% of tier 2 visas were actually going to the NHS, but we have none the less lifted the cap. I pay tribute to my hon. Friend’s campaigning on behalf of South Dorset. He is always assiduous in speaking to Ministers and raising concerns on his constituents’ behalf. We are repurposing services, but we are moving beds to where there will be better support, and these are some of the changes that will deliver an NHS fit for the future. I am happy to continue discussions with him so that we ensure the NHS continues to serve his constituents with first-class care. Question put and agreed to.”
“I mentioned the “Agenda for Change” pay award, under which the pay of a healthcare assistant will go up by 26%, or nearly £4,000, over the next three years. A nurse with between three and four years’ experience will receive a 25% increase, which is more than £6,000 over three years, and a band 6 paramedic with between three and four years’ experience will have a £4,000 rise over three years. Again, as my hon. Friend mentioned, that recognises the hugely valuable contribution that staff make to the NHS. I touched on the fact that we are looking at specific areas in which we recognise that there are issues and referred to the postgraduate golden hellos as a way of targeting recruitment. I have also said that we have lifted the cap on tier 2 visas.”
“The removal of the bursary scheme has allowed us to offer more people the opportunity to become a nurse, rather than fewer, as was the case under the bursary. I do not want to choke off the opportunity for someone who aspires to be a nurse, but we should recognise that people want to progress at different stages of their lives. That is why the right option for some is to be a nursing associate. Some people may want to stay as a nursing associate, some may want to progress to being a nurse, and some may want to do a nursing degree apprenticeship. It is important that we offer the flexibility that people increasingly want in society so that they can pursue their careers at different rates and at different times. The Government have taken a whole range of measures.”
“The problem with the bursary scheme was that it involved a cap on the number of places, so a massive number of people who wanted to be nurses were rejected and denied the life chance of being a nurse. The removal of the cap has allowed us to increase the number by 25%—an additional 5,000 places. That is 5,000 people who will have the opportunity to train as a nurse who did not have such an opportunity under the bursary scheme. It is also means that while they are training as a nurse, they will have a higher maintenance grant through the Student Loans Company than they did previously under the bursary system. I appreciate the concerns raised about the bursary, but this Government are all for giving people the opportunity to progress, life chances and the opportunity to increase their skills.”
“Indeed, the four CCGs in Derbyshire have already identified £39 million of savings, against our target which is 3% of their overall budgets. Significant progress has therefore been made to meet the challenge set by NHS England.”
“It is a pleasure to serve once again under your chairmanship, Sir Christopher. I congratulate the hon. Member for High Peak (Ruth George) on securing this important debate. She has effectively put on record her concerns about the financial challenge faced by the Derbyshire CCGs. The hon. Lady is right to recognise that the Government are committing more money to the NHS. That is why the Prime Minister has announced a funding increase of, on average, 3.4% each year to 2023-24. The NHS budget will therefore increase by more than £20 billion a year compared with today. Alongside that, it is also right for NHS England, the independent organisation that allocates funding, to question the efficiency of CCGs, in particular by comparison with other CCGs, looking for what efficiencies can be found.”
“I was just about to come on to the voluntary sector, because that is where the hon. Lady’s speech started, but in her remarks she talked about the four CCGs coming together as part of the “efficiencies of scale”—her precise phrase—so I shall come back to the voluntary sector later.”
“There seems to be a slight contradiction in the hon. Gentleman’s argument. He is arguing that, on the one hand, the financial position was strong in 2016—I remind him simply that the Lansley reforms were in 2012—and, on the other hand, that the issue is with the Lansley reforms.”
“In which case, I refer to the remarks of the hon. Member for High Peak, who did say that the CCGs’ position was strong in 2016. The hon. Gentleman is therefore seeking to disagree with his hon. Friend rather than with me.”
“The CCGs will have those discussions with local stakeholders. It is important to be clear that before taking any final funding decisions on services through the voluntary and communities sector, that further round of engagement and consultation with the local communities, local authorities, patients, GPs and other stakeholders will take place.”
“Friend the Member for Erewash (Maggie Throup) has been an extremely strong champion of the benefits and importance of the programme in Erewash in her interactions with ministerial colleagues. The CCGs have introduced a range of financial measures to improve their financial position, including development of an efficiency strategy and a move to joint leadership arrangements, to which the hon. Member for High Peak referred. Closer functional working across the four CCGs in Derbyshire will help, but so will the additional capital that is being sought and innovation to work more efficiently through programmes such as vanguard. On the voluntary sector, which was the meat of the hon. Lady’s remarks, it is important to stress that decisions have not been taken and that a consultation process is under way.”
“Lady did not mention this, but it is pertinent that there is funding to Derbyshire in other forms: for example, the £12.5 million that has recently been provided for the four CCGs to spend on increasing theatre capacity at the Royal Derby Hospital. Again, that is part of enabling the CCGs to drive efficiencies. Some £40 million of sustainability and transformation partnership capital bids are yet to be approved. There are additional funding bids in the Department, NHS Improvement and NHS England as part of driving those efficiencies that the CCGs are being asked to deliver. Alongside that is the vanguard programme—the CCGs agreed a business case in January 2018 to spend £1.1 million to continue to fund significant elements of the Wellbeing Erewash programme. My hon.”
“One of the benefits of the hon. Lady calling this debate is that it allows Members from across the House to put on record their support for voluntary services as part of looking at the legitimate question of where the efficiencies from economies of scale can be identified across the CCGs. The Government are allocating more funding to the NHS, but they are looking at areas that are above their target allocation to ask, “Where are the inefficiencies and how do we spend that?” As part of asking taxpayers to contribute £20 billion more a year to the NHS, it is right that we ask how effectively that money is spent and that we ensure that we drive efficiencies. The hon.”
“He correctly identified that there is a cross-party consensus and indeed concern that the value for money of those services should not be the first line of call when seeking efficiencies. As part of that discussion, the CCG has confirmed that, having looked into this, three of the voluntary services will be protected. The south Derbyshire, Chesterfield and north Derbyshire Cruse Bereavement Care and the Stroke Association support services will be protected. The hon. Lady made a point about the value for money of night services costing £34,000, which within a £51 million target is a very small sum, and the New Mills where she cited the £2.26 per hour. That is exactly the discussion that the CCG is having. It is unhelpful to scare local people ahead of those consultations, because those decisions have not been taken.”
“My hon. Friend is absolutely right. I was coming on to address the allocations for the four CCGs, which I am told by NHS England are above where NHS England independently sets the target. To be precise, according to NHS England, in the case of the Derbyshire CCGs, North Derbyshire is 6.2% above its target allocation, while Erewash is 2.31%, Hardwick 1.92% and Southern Derbyshire 0.25% above the target. My hon. Friend is absolutely right that it is about how effectively the money is spent. He is also right that, within that search for efficiencies, alongside the additional £20 billion of funding that the Government have allocated, we need to address the point that the hon. Lady correctly raised about the value for money of many of the voluntary services.”
“To some extent, that is already happening in the form of the £45 million of the deficit that is being absorbed by NHS England, but part of the NHS England consultation is assessing where the CCGs are against their target allocation—it is part of the consideration of the £40 million of capital bids for Derbyshire and part of the £12.5 million that was secured for the improvements at Derby county. It is also part of other issues in the NHS such as length of stay—43% of patients in acute hospitals do not clinically need to be there and would be better served in the community, which is where those value for money assessments need to play a part.”
“That is why it is right that we have a discussion about the voluntary sector without scaring people that decisions have been taken, when services such as the three I mentioned have already been protected and I am told that no decisions have been taken on the other voluntary’s services. We are committed to spending more on the NHS in Derbyshire. That is the clear commitment the Prime Minister made. The CCG has made significant progress on delivering efficiencies against its 3% target, but we are building an NHS fit for the future, which includes ensuring that we give more money to Derbyshire. As part of the 10-year plan being devised by NHS England and NHS Improvement, Derbyshire will receive its fair share of that additional funding. Question put and agreed to.”
“Patients benefit from structured care in their homes or in an adult care-led facility—that model is supported by clinicians. We need to differentiate legitimate questions from NHS England in an area that is receiving more than its target allocation and where there are opportunities for efficiency, while taking on board the concerns raised by my hon. Friend the for Amber Valley about the transition as the additional Government funding comes, and while allowing the NHS in Derbyshire to change. Just as the additional funding to Derby will unlock efficiencies, so will the vanguard programme and other local initiatives on, for example, dementia care to deliver an NHS that is fit for the future. It needs to evolve but is also needs to take the community with it.”
“Again, local clinical decisions are taken by the CCGs, which is the correct approach. This goes to the heart of the point raised by my hon. Friend the Member for North East Derbyshire. Driving efficiency as part of spending more on the NHS is not about not having any change. Indeed, the hon. Lady previously expressed concerns about the specialist dementia inpatient beds in her constituency. Again, those are specific commissioning decisions—it is inappropriate for a Minister to comment on specific decisions—but, although I understand her concerns in relation to the number of specialist dementia inpatient beds, I am assured that the model implemented in Derbyshire reflects the changing needs and approaches to providing health and care for dementia patients.”
“The Government are undertaking a wide range of analysis in support of our EU exit negotiations and preparations. Our overall programme of work is comprehensive, thorough and continuously updated.”
“We will remain committed to attracting the brightest and best. The hon. Lady says that her area is “beleaguered”; I remind her that the Kent and Medway sustainability and transformation partnership received £101.2 million more than it received in the previous year.”
“My hon. Friend has raised an extremely important point. The Home Secretary recently announced a settlement scheme to enable those staff from the European economic area to remain. However, it is also important for us not to scare EU nationals, and to point out that there are now 4,500 more non-UK EU nationals working in the NHS than there were two years ago, at the time of the referendum. There is often a sense that there are fewer, but that is not the case.”
“I would have expected the hon. Lady to welcome the additional funds that have been announced—not just the £2 billion for social care, but the extra £20.5 billion a year, in real terms, that will be delivered through the long-term funding settlement. Instead of criticising that funding, the hon. Lady should welcome the Government’s commitment to increasing funds for the NHS and ensuring that it remains fit for the future.”
“My hon. Friend is right to draw the House’s attention to the fact that there are a number of benefits from leaving the EU, not just in terms of the dividend to which he refers, but in terms of flexibility, for example in— [Interruption.] Labour Members do not seem to want to hear about the opportunities: opportunities on life sciences for example, in terms of getting medicines through in shorter timescales; opportunities on immigration; opportunities on professional qualifications; opportunities even on food labelling. It is important that we take those opportunities, as my hon. Friend says.”
“As the hon. Lady will be aware, we accepted the amendment, and it is our intention to work as closely as possible on that as part of taking that forward— [Interruption.] To correct the— [Interruption.]”
“This is a near instantaneous correction, Mr Speaker, to recognise that what I should have clarified is that, following the vote in the House, it is our intention to work as closely as possible with that, and we recognise the point the hon. Lady makes.”
“There are a number of things that can be taken advantage of. We can use the flexibilities we have in terms of assessments with shorter timescales so that we can prioritise UK drugs that are bespoke to the UK market. There will be opportunities as part of this, as well as our working closely with European colleagues.”
“My right hon. Friend raises an important point about ensuring that procedures are done in the right place at the right cost, but primarily in a way that is best for the patient. I am happy to meet her to discuss the specifics of that and to see whether a change can be made.”
“I am happy to discuss with my hon. Friend how we provide support. Addressing the fact that 43% of patients in acutes do not actually clinically need to be in hospital is a key objective of the long-term plan to ensure that we get the right community services and relieve pressure from acutes.”
“Friend will join me in paying tribute to the outgoing Secretary of State, who is now Foreign Secretary, who made patient safety a central tenet of his time in the Department and, as part of that, spoke up for whistleblowers and for the value they offer to the NHS.”
“In particular, he raised a very concerning allegation regarding a constituent who had collapsed before 10 pm outside the urgent treatment centre. He is right that that centre should be open until 10 pm, so clearly that is a specific issue that I will be keen to explore with him. My right hon. Friend raised concerns as to whether his constituents who have whistleblown have in practice been gagged. As you are probably aware, Madam Deputy Speaker, as a member of the Public Accounts Committee, I spent a considerable amount of time and effort on that issue. In response to concerns raised by the PAC during that time, in 2013, the Government introduced guidance that banned gagging orders and a legal duty of candour. As this is the first time I have been at the Dispatch Box since the ministerial reshuffle, I am sure my right hon.”
“I commend my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) for bringing the important matter of NHS accountability before the House. No one who heard his remarks can doubt for one minute his passion both for the NHS and for ensuring that the services it provides meet the needs of his constituents. He is right in this month, when we mark the 70th anniversary of the NHS, to emphasise that the NHS belongs to the people—not to any specific party or group, but to the constituents it serves. My right hon. Friend made a number of specific allegations. Having been a Minister, he will appreciate that, having brought those issues before the House in the way he has, it is difficult for me to comment on some of the specific points, but I commit to follow up with him after the debate on some of those issues.”
“Friend expressed concern that service changes are “all in the hands of bureaucrats” and I must take slight issue with that.”
“I am grateful to my right hon. Friend for recognising that in the House. I think that is widely shared across the NHS. It is right that the Government are bringing forward the draft Bill to place the Healthcare Safety Investigation Branch on a legal footing. Indeed, trusts should disclose any pay settlements to NHS Improvement. Therefore, on the concern to which my right hon. Friend brought the House’s attention—whether whistleblowers have been gagged and, if so, whether that has been induced through financial payment—both those breach the Government’s guidelines and they would need to be reported to NHS Improvement. If he is able to share any specific allegations after this debate, I will be keen to explore them. My right hon.”
“Well, I must take issue with that point. First, my right hon. Friend is well aware that the Government have four tests that apply to service change that ensure the voice of patients is heard and in particular that service reconfigurations are clinically led and done at a local level. I draw attention to the work that Professor Tim Briggs and Professor Tim Evans are doing through the “Get it right first time” initiative, which is all about driving through change to service provision through the leadership of national clinicians working with local clinicians in order to get that service buy-in.”
“I suspect that that is why, at local level, the change was made. I appreciate that it was initially done on patient safety grounds, with the consultation following, as we explored previously.”
“I shall just unbundle two separate points from my right hon. Friend’s remarks. First, his point that these changes are all in the hands of the bureaucrats collides with the Government’s own position, which is that there are four tests. What he is drawing out is not whether the guidance is there as a protection but whether it is being implemented operationally, and that obviously needs to be looked at on a case-by-case basis. Secondly, he and I debated this issue in some detail in an Adjournment debate in March, when this specific point was explored more fully. The urgent care centre in question saw an average of seven patients between midnight and 8 am, and an average of four between 10 pm and midnight. So in the period between 10 pm and the centre reopening at 8 am, an average of 11 patients were being seen.”
“These are senior, complex, challenging roles that need to attract talented individuals. At the same time, those salaries and that remuneration need to be balanced with the wider values of the NHS. There is a live discussion about what the right level of remuneration is to attract talent while not being out of step with the NHS values that both sides of the House recognise. I turn now to my right hon. Friend’s point about the new hospital site and capital investment in the STP area. He will be aware that the same STP currently has a significant new build proposal at Harlow. My right hon. Friend the Member for Harlow (Robert Halfon) is assiduous in championing that proposal, and I met with the chief executive of that trust—”
“Member for Coventry South (Mr Cunningham) have raised similar issues. It is right that the views of constituency Members should be taken on board as part of any consultation, because Members of Parliament interact with a wide spectrum of their electorate and they are obviously well placed to feed into such consultations. As a Minister, that is something I take very seriously, and working on the cross-party basis, I am always keen to hear from colleagues when concerns arise. That goes back to my right hon. Friend’s point about trust. Issues in terms of pay need to be balanced. On the one hand, we need to recognise the complexity of senior leadership roles. We are dealing with hospital trusts that often have budgets running into the hundreds of millions of pounds.”
“The clinical commissioning group also expects the service to expand to include a greater skill mix of other professionals such as pharmacists, emergency care practitioners and community nursing staff, and to provide access to mental health services. This is not a static situation. Some improvements have been made, but I absolutely take on board the concerns that my right hon. Friend has raised. My right hon. Friend has raised concerns about the hiring of leadership positions, particularly two chief executive roles. He will be aware that this point was also raised by the hon. Member for Blackpool South (Gordon Marsden) in respect of the chair of Blackpool Victoria Hospital in an Adjournment debate only last week. I also note that the right hon. Member for Warley (John Spellar) and the hon.”
“As I have said, we did explore these issues in some detail in March, and I absolutely respect the conviction with which my right hon. Friend is championing the interests of his constituents. In the spirit of balance, I draw my right hon. Friend’s attention to the fact that a number of enhancements have also been made, including the introduction of a number of bookable appointments through NHS 111, which includes a clinical assessment service to ensure that patients’ needs are medically assessed; the addition of near patient testing for some conditions, reducing waiting times and reducing the need for patients to attend Watford Hospital; and an improved IT system meaning that medical staff will be able to access patient records if they give their consent.”
“Friend’s remarks—they must be taken forward with clinical leadership and in a way that delivers trust. I am happy to continue to engage with my right hon. Friend’s specific allegations on a case-by-case basis.”
“I beg to differ from my right hon. Friend on that, because this gets to the crux of the issue. The NHS must evolve. It has to move with technology and with the skills mix. Alongside the significant funding injection that the Prime Minister announced at the Royal Free Hospital, the NHS must also deliver productivity. At the specialist level, such as oncology or neuroscience, we often have populations of 3 million that need to be treated. Look at the footprint of the Christie NHS Foundation Trust, for example. If we look at the other end, we need to deliver more care in the home and not have acute trusts soaking up so much investment. We need dynamic reconfigurations without acute trusts being the sole focus of our attention. We need service changes but—this goes to the core of my right hon.”
“Again, I am happy to consider that issue. I have been up to visit the United Lincolnshire Hospitals NHS Trust and have met the chief executive and the leadership team, so I am aware of the issues, which are partly due to geography. However, we are straying slightly away from Hemel Hempstead. As I said, I am happy to engage with my right hon. Friend the Member for Hemel Hempstead on his specific allegations. It is important that service changes are done at the local level with clinical leadership in a way that builds trust, and I will continue to engage with him in the weeks and months ahead. Question put and agreed to.”
“NHS England has been working with the Avon local medical committee, practices, NHS Property Services and the Bristol, North Somerset and South Gloucestershire clinical commissioning group and has facilitated negotiations between GP practices and NHS Property Services on reviewing the levels of rent and service charges invoiced to GP practices, to ensure that there is transparency on them. However, as the hon. Lady will be aware, rent and business costs incurred by practices are reimbursed to GPs under the premises cost directions, and GPs should be compensated for any rent changes through that route. The Department has provided an additional £127 million to the NHS England mandate, with effect from the 2016-17 financial year, to fund the increased costs in the NHS of this policy change.”
“Two thirds of NHS costs are in the workforce, so driving workforce productivity is a key objective. I am sure the hon. Lady will agree that the workforce being consolidated in one office enables a degree of productivity and efficiency that would be harder to achieve if they were disparate across five areas. The hon. Lady mentioned the impact of the rent adjustment on Bristol. Some 15 GP practices in and around the city of Bristol occupy NHS Property Services sites.”
“These are big budgets, so we need to attract people of the right ability; it is a false economy to save a relatively small sum on lower salaries for people who then make incorrect decisions that waste much larger sums. At the same time, salaries should reflect the values of the NHS and should not be out of step with others in the NHS. There is a cross-party debate on that, and I am interested in the hon. Lady’s points about it. The hon. Lady also raised NHS Property Services’ new offices. My understanding is that the previous model was highly inefficient. It had five different properties, so the move to Gresham Street was a consolidation of those five properties into one. That drives productivity, which is a key issue that we need to unlock within the workforce.”
“On balance, as we look forward to the long-term plan and pick up on some issues that the hon. Lady quite rightly highlighted, it is also important to recognise that the old system often allowed estates to be utilised inefficiently. Having truer market rents has actually enabled more transparency and driven efficiencies, with savings then able to be reinvested into the service. The hon. Lady also mentioned salaries and bonuses, which again are part of a wider question. On the one hand, these are big businesses and their leaderships compete in a competitive market. There is a wider debate within Parliament on the right value to assign to senior salaries in the public sector in order to attract talent.”
“The previous model had the inherent conflict that the primary care trusts were both the landlord and commissioner of the property, and therefore the use of the estate was quite opaque. As a result, we did not get transparency on the true cost of the estate, meaning that inefficiencies were not being flushed out and estates were not being utilised in the most effective way. One driver of NHS Property Services applying market rents has been the need to encourage better utilisation of the estate by being more transparent on the actual costs. I point out to the hon. Lady that there has been significant progress as a consequence. Some £200 million in capital receipts has been unlocked, 500 capital investment construction projects are being launched each year and running costs have been reduced by £120 million.”
“The issue is that, if NHS England provided that service, the additional market rent costs would have been reimbursed, but because it is provided by the county council they are not. However, as she recognised, there has been progress in recent weeks, thanks in part to her work. I am happy to take forward a discussion on that offline if that would be helpful, because I recognise that it is an important service and that we need to ensure that, where market rents are applied, it is not counterproductive to those services. However, that should not get in the way of the wider point. The hon. Lady suggested that the new approach is a backwards step. I simply point out that there has actually been significant progress by NHS Property Services.”