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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“Member for Ellesmere Port and Neston raised the replacing of nurses, and he is absolutely right that it would be a concern if that were the intent behind the draft order. He will be aware that the CQC has oversight of staffing models, and that it will therefore be for trusts to discuss with the CQC how they will satisfy the necessary models. Members referred to the harrowing report that Bishop Jones published today. I recently went up to Liverpool Community Health NHS Trust, on which the Kirkup report contained some shocking revelations, highlighted, as the hon. Gentleman knows, through the tenacious campaign of the hon. Member for West Lancashire (Rosie Cooper). We have also seen what happened at Morecambe, after the tireless work of James Titcombe following the death of his baby, Joshua, and at Mid Staffordshire.”
“I am grateful to the hon. Gentleman for his support for the role of nursing associates. He raised several important issues, which I will address. Let me first respond to the point that the hon. Member for Huddersfield raised about the Royal College of Nursing. Under the heading “Our position”, the RCN has said in a briefing note: “We support the introduction of the nursing associate…role and the plans to regulate it.” It goes on to raise several points, some of which the hon. Gentleman gave good visibility to. I hope that gives the general tenor of the RCN’s support for the role, although that support is not unqualified and it has some questions—I do not want to mischaracterise its support. I hope that addresses that issue. The hon.”
“Again, just as it is a ladder for his constituents, it is a pathway through which European staff could potentially enter the NHS. [ Interruption. ] My memory was correct: the NMC has consulted on applying a fee of £120. The hon. Member for Ellesmere Port and Neston mentioned the guidance. The Department is working with arm’s length bodies, NHS Employers, healthcare environment inspectorates and the regulators—the NMC and the CQC—to develop guidance. That will obviously need to be in place before the first tranche of nursing associates come out of their training in January ’19. I also note his point on panels. It is a perfectly fair observation, and I take it on board.”
“From memory, the fee is the same as for a nurse in the NMC, which is £120, although I am sure that my colleagues will correct me if my memory is misplaced on that. That is a flat rate applied by the NMC across the board. The hon. Member for Huddersfield and the Opposition Front Bencher also raised the issue of overseas staff. This will be a new role, and the Prime Minister’s announcement on tier 2 visas applies to existing roles, such as doctors and nurses, whereas this role is not currently in place. However, the opening of the nursing associate part of the register will provide a new registration route for overseas nursing staff whose competence and qualifications fall short of those of a registered nurse, providing that they can demonstrate that they meet the same high standards expected of a nursing associate trained in England.”
“It is important that we increase the number of people able to access roles in the NHS, and this is a valuable pathway to enable that. I commend the draft order to the Committee. Question put and agreed to. Resolved, That the Committee has considered the draft Nursing and Midwifery (Amendment) Order 2018.”
“I see exactly the point that the hon. Gentleman raises. The NMC is consulting on that, and I think that consultation should be allowed to run its course, but I am sure that his points will have been heard by those undertaking it. Agency spend was raised. Again, that is an area of considerable focus within the Department. It is part of the transformation that the Prime Minister signalled with the investment announced on Monday, and there is a lot of work on, for example, e-rostering and how to give staff greater predictability and flexibility, and how we can use technology to facilitate that, because that also has an impact on retention rates. I hope I have addressed the hon. Gentleman’s points. I am grateful for his and the Opposition’s support for the new role.”
“NHS England, NHS Improvement and Health Education England are working with trusts on a range of recruitment, retention and return-to-practice programmes to ensure that the required workforce are in place to deliver safe and effective services.”
“I fear that the hon. Gentleman wrote his question before yesterday’s announcement. I thought that he might have started by welcoming the additional £2 billion of investment that Scotland’s NHS will be receiving. We are making historic investment in recruitment, which is why we are opening five new medical schools in England, training 1,500 new medical doctors, taking initiatives such as on apprenticeships and opening new pathways into clinical roles.”
“My hon. Friend is right to draw attention both to the Home Office’s welcome announcement on tier 2 visas and to the work on the workforce strategy, in which he played a key role. It will ensure that we have the right workforce for the NHS for the next 10 years.”
“The right hon. Gentleman, as a former Minister of State, will not want to choose selectively from the data on European economic area recruitment into the NHS. He will know full well that there are 3,200 more NHS staff from the EU since the referendum, which shows that people are still coming. If he has an issue with the Brexit dividend, perhaps, as my right hon. Friend the Secretary of State pointed out yesterday, he will raise that with his party leader, who sees that there is a Brexit dividend.”
“My hon. Friend rightly points to the key issue of how we bring down the £2.5 billion of agency spend. That goes to the heart of the Prime Minister’s announcement yesterday. Up-front investment in our workforce will allow us to reduce that agency cost.”
“The two do go together because the mental health workforce is a key component of the NHS workforce. I am sure that the hon. Gentleman will welcome the extra £1 billion by 2020 that the Prime Minister announced yesterday, as well as the Government’s prioritisation of mental health, which for too long has been seen as a Cinderella service within the NHS.”
“The hon. Lady will be well aware that there are 14,000 more nurses in the NHS than five years ago, but she is right to point to the wider issue of long-term workforce planning. That is why she will be aware that Audit Scotland criticised NHS Scotland for its lack of long-term workforce planning.”
“The hon. Lady’s supplementary question really reinforces the answer that I gave a moment ago: the essence of why we need a long-term plan is so that we anticipate these issues. We are addressing that through the Green Paper on social care, and that is part of the investment that the Prime Minister announced yesterday.”
“I am grateful that the shadow Secretary of State has drawn attention to public health because the Government have been making significant progress in that area. We have the lowest ever number of teenagers smoking and the lowest ever teenage pregnancy rate. Binge drinking is down and we are addressing child obesity with the sugar tax, which is among a number of measures that the Government have been bringing forward. We are making progress on public health and the hon. Gentleman is right to draw that to the attention of the House.”
“Once again—as we heard yesterday—there is no welcome for the announcement of additional funding for the NHS. Opposition Front Benchers are playing politics and talking down our NHS. The Prime Minister has set out a long-term vision to improve standards and raise mental health, which Labour Back Benchers highlighted. The hon. Gentleman should come to the House and welcome that investment in our NHS.”
“Community first responders play a valuable role in helping ambulance services. Support includes ongoing training, necessary medical equipment and occupational health support.”
“I am very happy to join my hon. Friend in congratulating Stuart McLellan, Ross Nelson and the volunteers that play such a key role. I know that my hon. Friend the Member for Brigg and Goole (Andrew Percy) also performs this service in his constituency. I have spoken to him about it and I know that it plays a very valuable role.”
“The workforce strategy we are bringing forward will include investment and an expansion in the number of medical schools— five new medical schools—alongside those 1,500 new doctor places.”
“I am grateful for my hon. Friend’s support on tier 2 visas. She will be aware that clinicians who reach the £1 million lifetime allowance limit can expect a pension of about £44,000, payable at age 60, increasing with inflation, plus a tax-free lump sum of about £132,000. Although these are ultimately issues for the Treasury, it is important that we ensure that tax allowances, two thirds of which go to higher-rate taxpayers, are fair to other taxpayers.”
“I very much enjoyed visiting the trust with my hon. Friend. As he will be aware from our discussion during that visit a process for capital bids is under way. As my right hon. Friend the Secretary of State set out, the date for that is mid-July and I look forward to seeing the bid from my hon. Friend’s trust.”
“My right hon. Friend is right to champion this, as he did through the recent Adjournment debate, when he set out the case in more detail. We recognise, as we did at the last Health questions and in the Adjournment debate, that there are significant issues with the local hospital, and that is why it is working very actively on its bid for capital funding.”
“Friend has assiduously raised in the House and has done so, rightly, again today. I reaffirm, as I said to him when we last debated this matter on 8 May, that we recognise that the Princess Alexandra hospital estate is in a poor condition. That is why the bid that I expect in mid-July is timely. I look forward to the bid addressing the transformation challenge. It is part of the Government’s wider £3.5 billion commitment to the NHS estates until 2022-23. I know my right hon. Friend will support his local STP in the transformation the system needs. I look forward to continuing to work with him as part of the plans to ensure the NHS is fit for the future in Harlow and in the surrounding region. Question put and agreed to.”
“Based on quarter 1 to quarter 3 data, it has so far offered 10 apprenticeships, against a public sector target for the trust of 72, with a half a million pound apprenticeship levy to be allocated. There is therefore scope for the trust to continue its efforts on apprenticeships as part of that wider agenda. I know my right hon. Friend will continue to champion that agenda. In conclusion, what is recognisable from the presence of my hon. Friends the Members for Saffron Walden, for Broxbourne and for Hertford and Stortford, as well as the constituency interests of other Members in the Chamber, is that this scheme is not just about Harlow but about the wider health care needs of the region. It is one that the Secretary of State has taken a close personal interest in, visiting on more than one occasion. It is one that my right hon.”
“I want to pick up on a comment my right hon. Friend made about the workforce. While capital is key to the redevelopment of the Harlow estate, it has to sit alongside wider workforce planning. The long-term nature of workforce planning has sometimes meant that there has perhaps been insufficient focus on this area. That is why the Government are bringing forward, through Health Education England, a workforce strategy this summer to look specifically at how we better plan for our workforce. I know that, particularly through his chairmanship of the Education Committee, my right hon. Friend champions a cause that is close to both our hearts: apprenticeships and how we better use them within the workforce. I am keen that he continues to work with the trust to expand the number of apprenticeships on offer.”
“I look forward to hearing about the trust’s updated plans for how it intends to transform the way care is provided to patients through integration with community and primary care, rather than just re-provide capital assets. Schemes are required to demonstrate affordable revenue assumptions and value for money, and to fully consider disposing of surplus assets to part-fund their developments. My right hon. Friend asked about timing. Given the challenges that the trust faces, I appreciate that it is a key issue for his constituents. An announcement will be made in the autumn on the next round of STP capital allocations, and I will continue our regular dialogue with him as that progresses. Bids are due by mid-July; I know the trust is fully aware of that timescale and I expect it is working closely to it.”
“He is correct to identify the opportunities that both schemes bring for a wider NHS career as part of the investment the Government are making—not just in Harlow but in the healthcare of the region, reflected by the support of colleagues in the House. Alongside those two schemes, the same STP, Hertfordshire and West Essex, also put in a bid for more than £600 million of capital funding in the same bidding round of autumn 2017 for the redevelopment of the West Hertfordshire Hospitals NHS Trust Watford site. That is a signal of the amount of capital the Government are putting in and the need for the local plans to reflect the competing bids around the country as part of that appraisal. There have been other capital schemes, such as the £2 million to which my right hon. Friend referred, given to improve emergency capacity for the winter.”
“The trust submitted a bid in autumn 2017 for STP capital for its integrated healthcare campus scheme, which was intended to replace the existing Princess Alexandra Hospital estate. The trust’s capital bid at that time asked for between £500 million and £600 million. That was not considered sustainable; the bidding process feedback asked the trust to revise its capital plans to a more realistic level. It is also worth reminding the House, and this is partly a tribute to the success of my right hon. Friend’s campaigning for Harlow, that that sits alongside the many millions of pounds secured for the public health campus, which is due to open in phases from 2021.”
“Friend referred to the application from the Princess Alexandra, and he will be well aware that the strategic outline case was put forward in July 2017 with the support of the local authority, outlining the various options that had been considered. The strategic outline case concluded that the best option was to build a new hospital, potentially as part of a broader health campus on a new site. The trust secured local support from the clinical commissioning groups and the sustainability and transformation partners for that strategic outline case, which has been through the necessary local healthcare governance procedures. I am pleased that plans for the new hospital and health campus are supported so strongly by local NHS stakeholders.”
“I also recognise that, as my right hon. Friend said, Princess Alexandra Hospital does face problems with the condition of its estate and buildings; he and I have discussed the issue during oral questions, and the Secretary of State has also recognised the point. NHS Improvement has advised that the condition of the hospital is not currently fit for purpose. It is right that plans are made to improve the estate and that those plans should be locally driven. As my right hon. Friend will be aware, the Government fully support the upgrading of the NHS estate to bring the NHS further into the 21st century. That is why we have committed £3.5 billion of additional capital funding in the 2017 autumn Budget to support the most ambitious programme of investment in buildings and technology that the NHS has seen to date. My right hon.”
“Friends the Members for Saffron Walden (Mrs Badenoch), for Broxbourne (Mr Walker) and for Hertford and Stortford (Mr Prisk), who are all here signalling their support for this important capital programme. I join my right hon. Friend in paying tribute to Nancy Fontaine, the chief nurse and deputy chief executive. She has played an important, transformative role at the Princess Alexandra over the past few years and may now, I understand, be moving to a new post. She has played a key role in taking the Princess Alexandra out of special measures—a distinction achieved in March this year. The trust improved its overall CQC rating, having been rated good in the effective and caring domains. That is a tribute to Nancy Fontaine, the senior leadership team and the entire staff of the hospital, who have worked so hard.”
“I pay tribute to my right hon. Friend the Member for Harlow (Robert Halfon). He raises the important issue of the future of the Princess Alexandra Hospital in Harlow, and is quite right to draw the attention of the House to it once again. As he said, he has raised this in a previous Adjournment debate, through multiple questions and in meetings with Ministers, including me, and he has secured visits from my right hon. Friend the Secretary of State and from my predecessor, my hon. Friend the Member for Ludlow (Mr Dunne). The strength of my right hon. Friend’s campaign is further reinforced by the number of colleagues here this evening. Dare I say, Madam Deputy Speaker, that I am sure the constituents of Epping Forest take a great interest in Harlow’s future hospital; this issue concerns you as well as my hon.”
“4MC.] The reality is that this Government are investing more in our NHS and delivering more outcomes for patients. Some 2,500 more patients a day are seen within the four-hour A&E target. We are training more dentists. The hon. Members for Lincoln and for Canterbury (Rosie Duffield) failed to mention the extra medical training places offered in their constituencies as part of the Government’s investment. The Conservatives have run the NHS for the majority of its 70 years. This Government are investing in our NHS and treating more people in it. This Government will ensure that the NHS remains fit for the future.”
“Member for Oldham East and Saddleworth (Debbie Abrahams) that there has been a slow and steady erosion of the NHS as a provider, even though the facts show a zero increase in the private sector share of NHS spending. My hon. Friend the Member for Bexhill and Battle (Huw Merriman) highlighted the fact that private sector involvement was embraced, sought and progressed by the Blair Government. That rewriting of history was further underlined by the Labour Members’ PFI amnesia. As my right hon. Friend the Secretary of State pointed out, the NHS has £80 billion of PFI contracts and a £200 billion a year spend on PFI. Labour Members mentioned Carillion—12 of the 13 Carillion contracts for service management were entered into under the Labour Government. [Official Report, 11 June 2018, Vol. 642, c.”
“Friends the Members for Lewes (Maria Caulfield) and for Faversham and Mid Kent (Helen Whately) pointed out, there was a rewriting of history. The Labour Government before 2010 embraced the private sector. As illustrated in Wrexham, contracts in Wales are given to the private sector when Labour is in office. Labour Members say one thing in opposition and do something else in office. We have seen the contradiction today. Labour Members say that they dislike accountable care organisations and that they are a form of privatisation. It might surprise colleagues to learn that the Mayor of Greater Manchester, the former Labour Secretary of State for Health, is seeking to pilot an ACO because he recognises the benefits of integration. The House heard misleading statements today. We were told by the hon.”
“Member for Stockton South (Dr Williams) said that sometimes it should be enabled. That point was conceded in the Chamber today by Labour Front Benchers, and in numerous media interviews, including on the “Victoria Derbyshire” show. They seem confused about whether they welcome the use of the private sector. The confusion extended to the remarks of the hon. Member for Blaydon (Liz Twist). She said that Gateshead trust is very good, yet she seems to ignore the fact that the legislation on subsidiaries was passed under a Labour Government. The staff survey for that trust shows that the subsidiary has a satisfaction rate that is 15% higher than it was in the NHS as a whole. Because of her ideology, she seemed to suggest that her constituents working within that trust, which is 100% owned by the NHS, are wrong. As my hon.”
“Friend the Member for Torbay (Kevin Foster) pointed out, that is perhaps why so few Labour Members wanted to address the motion. As my hon. Friend the Member for Cheltenham (Alex Chalk) said, the motion contradicts both legislation passed by the Labour Government in the form of the Freedom of Information Act, and numerous statements made by senior Labour politicians such as the former Foreign Secretary and Member for Blackburn in his evidence to the Chilcot inquiry. Instead, there was a mix of confusion and division among Opposition Members. The hon. Member for Lincoln (Karen Lee), who is not in her place and did not stay for the speech of the hon. Member for Bristol South (Karin Smyth), said that there is no logic to the use of the private sector, but in a well-informed and measured speech the hon.”
“The Government oppose the motion. There is no complaint from the Chair of the Health and Social Care Committee, my hon. Friend the Member for Totnes (Dr Wollaston), about papers sought and not provided. Indeed, there are no papers, according to the evidence that the Secretary of State read out at the start of the debate, which was provided to him by officials. There is no logic to the motion when, as several Members pointed out, there has been no increase in the share of NHS spending on the private sector over the past year. As my hon. Friend the Member for Corby (Tom Pursglove) in particular highlighted, the rate of increase has been slower under this Government than it was under previous Governments. As my hon.”
“Currently, the data is incomplete and will not truly reflect the usage of hand gel. We are exploring how to improve that data. The hon. Member for Central Ayrshire commented that transparency on what is being done and on variance in performance around infection rates is a key driver of prevention.”
“We all recognise the impact, not just on patient safety, but on the cost of infections and unnecessary deaths. We are actively looking at the issue of technology. The hon. Member for Strangford also asked if we could publish more. To pick up on the remarks of the hon. Member for Central Ayrshire on the way information is published in NHS Scotland, dialogues are already taking place. I am happy to ask officials to ensure that, as part of the collaboration that is already under way in NHS Improvement with colleagues in the Scotland and England NHS, we look at best practice to ensure that we are working with and maximising the learning from both sets of NHS. Public Health England has carried out some initial analysis of the available data to determine the suitability of the data available for publishing.”
“I recognise the limits of direct observation and how behavioural change may respond to those. That is why the Government are actively looking at the extent to which technology can facilitate this area. We have carried out an initial assessment; indeed, the NHS Improvement director of infection prevention and control, Dr Ruth May, and her team recently visited the Royal Wolverhampton NHS Trust, which has been trialling an electronic monitoring system to make an initial assessment of that. Their feedback is that the system is reliant on existing technology, and that many IT systems would not be able to support that. A number of practical issues need to be addressed before one would have a roll-out of technology. I reassure the House that Dr May and her team are actively looking at that issue.”
“Public Health England has been raising awareness, and NHS Improvement has begun a number of initiatives, such as its NHS provider bulletin and a hand hygiene theme in its executive masterclass. Other ways of raising awareness include the Royal College of Nursing’s glove awareness week. As the hon. Member for Central Ayrshire said, that it is all about taking practice from guidance or files and embedding that into the DNA, the culture and the way people operate, who include visiting relatives and staff at all levels, including doctors as well as nursing staff. A number of hon. Members, including my hon. Friend the Member for Amber Valley (Nigel Mills), raised technology and what more we can do. One theme of the debate was whether the Government are doing enough to drive forward the use of technology.”
“Friend the Member for North East Derbyshire (Lee Rowley) said, and that is reflected in our surgeries, because it impacts on the lives of those we represent. There is therefore a great deal of common cause. The debate is timely because it was World Hand Hygiene Day on 5 May, which is an initiative that the World Health Organisation started in 2010 to remind us all, including patients and family members, to practise good hand hygiene, to help reduce the spread of infections. The hon. Member for Strangford was right to challenge the Government to reinvigorate our approach to hand hygiene. A number of initiatives are under way in Government to address exactly the points that he raised.”
“As always, Mr Howarth, it is a pleasure to serve under your chairmanship. I join the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), in congratulating the hon. Member for Strangford (Jim Shannon) on securing the debate, which provides an opportunity for the House to emphasise the importance of raising standards of infection prevention and control in the NHS. He was kind to pay tribute to the Secretary of State for his work on patient safety, and on putting that front and centre in his priorities. As the hon. Members for Ellesmere Port and Neston and for Central Ayrshire (Dr Whitford) acknowledged, that is a point on which the House is united in a common cause. How we reduce infections is of real importance to our constituents, as my hon.”
“We will continue to embed hand hygiene practice and promote awareness of it in the NHS, not just through World Hand Hygiene Day but through debates such as this one.”
“As several Members recognised, hand hygiene plays a key role in infection prevention and control, in supporting patient safety and in our efforts to address antimicrobial resistance. Considerable progress has been made—MRSA has more than halved and C. difficile has reduced by just under half since 2010—but, as the hon. Member for Central Ayrshire rightly said, E. coli remains a key area for renewed focus. We have successfully slowed its growth, but we now need to reduce it significantly. Part of the challenge is that a lot of it occurs outside the hospital setting, in the community. I look forward to working with colleagues from across the House on this shared objective in an area where shared practice, from both England and Scotland, can help. We can learn from each other and from Members’ experiences in their constituencies.”
“Indeed, just recently, on 25 April, NHS Improvement issued a national early warning score 2 patient safety alert to support providers to adopt the revised NEWS2 to detect deterioration in adult patients, including better identification of patients likely to have sepsis. My colleague the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), hosted and gave a speech at the launch of Health Education England’s paediatric sepsis e-learning package, which, again, is about raising awareness at an early stage. That training package was informed by clinicians and by parents whose children sadly passed away from sepsis, so we can learn from those tragic events and ensure that warning signs are better picked up at an earlier stage.”
“The most recent data, which is for the third quarter of 2017-18, shows that emergency department assessment for sepsis has increased from 52% to 92%, and in-patient assessment has increased from 62% to 84% since April 2016. Considerable progress has been made, which reflects the renewed focus across the NHS, in England and Scotland, on the time-critical nature of sepsis treatment, but we know there is more to do, which is why a new cross-system action plan was launched in September 2017. That plan outlines a range of activities to ensure that the NHS is on the highest possible alert to tackle that devastating condition.”
“We are working extensively with stakeholders, including the royal colleges, academia and the research community, industry and our expert advisory groups, to inform our next steps. Several colleagues, including the hon. Member for Ellesmere Port and Neston, mentioned sepsis. We have made significant progress since our focus to improve sepsis practices increased in January 2015. There is new NICE guidance and a new national CQUIN measure to incentivise providers to improve the identification and timely treatment of sepsis. The hon. Member for Central Ayrshire was absolutely right about the time-critical nature of that treatment. That work is already delivering change.”
“Through that, we have incentivised hospitals to improve their sepsis care. Independent CQC inspections have focused on E. coli rates in hospitals and in the community. In addition, we have appointed a national infection prevention lead to ensure a sustained focus at national level, improved training and information sharing, so that NHS staff can cut infection rates and, through the National Institute for Health and Care Excellence’s 2017 guidelines, highlight standard principles and advice on good hygiene. Considerable progress is being made. Data published in 2017 suggests that four in 10 of all E. coli blood infections cannot be treated with commonly used antibiotics. Infection prevention and control is a key element of tackling antimicrobial resistance, and hand hygiene plays an important part in that.”