Edward Argar
MP for Melton and Syston · Conservative · United Kingdom
“I will not keep the Committee long. I am very pleased to see the hon. and gallant Gentleman, the Minister, still in post, as this is a policy area that he has cared deeply about throughout his life. I share the broad support for the instrument expressed by the shadow Minister, my hon.”
“I appreciate it may be set out in the 2006 or 2025 primary parent legislation to these draft regulations, but if he can, I would be grateful for a little clarification. Finally, paragraph 10.1 of the explanatory memorandum refers to the legislation being continuously monitored.”
“I live in my patch and I know that there will be genuine local fury at the contempt this Government have shown for my constituents in approving a Leicester city land grab, which has cross-party opposition locally.”
“Lady was right to highlight in her remarks the importance of timely discharge from hospital as a key element of whether we can achieve that flow into hospital beds and have hospital bed capacity to allow an A&E department or emergency department to function.”
“That should not be a challenge; I suspect that that data is already extant in some part of the system. She is proposing a very moderate measure, which would pull all that together in one place, and allow it to be focused on and looked at in the round, rather than in disparate little penny packets of data.”
“Gentleman’s point, however, that with many of these things—both clinicians and coroners grapple with this—it is often complex to determine the actual most significant contributory factor. My hon.”
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“The clause will be vital in supporting the Government to deliver on a range of policies being developed as part of our obesity strategy, which includes commitments to consult on front-of-pack nutrition labelling and whether to mandate alcohol calorie labelling. The power will enable us to make improvements to food and drink information more effectively while retaining a level of scrutiny on any proposed changes. The clause can also help us to deliver on wider Government objectives, including options for the forthcoming food strategy White Paper, which sets Government ambitions and direction for food system transformation. I commend clause 127 to the Committee.”
“We want the ability to respond quickly to those changes and that changing evidence base as and when required. Retained EU regulation 1169/2011 sets requirements on labelling and food information in the UK. It was designed to apply to EU member states. Now that we have left the EU, primary legislation is required to modify the retained legislation. Clause 127 will help us to settle this issue by conferring powers on the Secretary of State in England, and Ministers in Scotland and Wales, to modify requirements on food labelling using regulations. The regulations made under this power will be subject to the affirmative procedure, which will ensure that any changes introduced are debated and actively approved before implementation.”
“I can reassure the Committee that I will be a little briefer than in my remarks on clause 125. Clause 127 amends the Food Safety Act 1990 to make provision for domestic legislation to modify retained EU regulation 1169/2011 concerning the labelling, marketing, presentation or advertising of food and the descriptions that may be applied to food. The current powers to amend the regulation are limited in scope. This power will afford the Government an additional necessary lever to introduce domestic changes that better suit and support consumer needs and priorities for food information. We know that consumers want transparency and clear information about the food and drink that they are buying, and such information can inform people’s choices. Scientific information and evidence on labelling and consumer needs continue to evolve.”
“I just want to give the shadow Minister the assurance he seeks that I believe that the powers under this clause would be used sparingly and proportionately. Question put and agreed to. Clause 127 accordingly ordered to stand part of the Bill. Clause 128 Fluoridation of water supplies”
“Clause 129 simply provides for the existing arrangements to be treated as if they were made under the new statutory regime for fluoridation. The clause also provides that all previous England fluoridation arrangements shall be treated as if they were entered into between the Secretary of State and the water undertaker. The Secretary of State has the power to modify the detail of these existing arrangements to give effect to this, provided he first seeks to agree the modifications with the water undertaker. I therefore commend these clauses to the Committee.”
“In September, the chief medical officers for England, Scotland, Wales and Northern Ireland made a joint statement confirming that water fluoridation is an effective public health intervention for improving the oral health of adults and children. Such schemes have been in operation for more than 60 years, and no credible evidence that they cause health harms has emerged. It is time we take action that will enable us to reduce the oral health inequalities across the country, and I commend clause 128 to the Committee. I turn briefly, and finally, to clause 129. We have a number of existing water fluoridation schemes across England that have been in place for decades. We want to ensure that those existing arrangements can be treated in the same way as any new schemes created using the powers in clause 128.”
“The clause also allows for the Secretary of State to make regulations that will enable the sharing of costs for fluoridation schemes with water undertakers and/or public sector bodies that may receive benefit from such schemes. However, before making any such regulations, the clause imposes a duty on the Secretary of State to consult. The clause also requires the Secretary of State to consult water undertakers on whether any proposal for new fluoridation schemes, or whether any termination or variation of an existing scheme, is operable and efficient prior to undertaking any public consultation, for which there will also continue to be a duty. The clause requires us to set out in regulations the process for consulting the public, for example on any new proposed schemes. That will ensure that those affected will continue to have a voice.”
“Under the Bill, any plans to cost share with public sector bodies would be subject to regulations on which there is a requirement to consult. A precedent has been set over the decades for the funding of water fluoridation schemes. We believe that, to move forward, it would be best to have the flexibility to work collaboratively across industry and the public sector to effect what could be the most significant improvements in oral health that we have seen to date. For those reasons, I ask the hon. Member for Nottingham North to consider not pressing the amendment to a Division. Clause 128 would transfer the power to initiate, vary or terminate water fluoridation schemes to the Secretary of State.”
“On amendment 151, we are taking powers in the Bill to remove the operational burden associated with bringing forward new schemes. Prior to 2013, both the NHS and local authorities had, at different times, responsibility for funding both revenue and the capital cost associated with fluoridation schemes. There are no current proposals for cost sharing, but given the cycle of legislation and the infrequency with which such opportunities present themselves, we have taken the decision to include such measures in the Bill. We have discussed the provisions with both NHS England and NHS Improvement and the Local Government Association, and I can assure the Committee that should we bring forward any plans to cost share in the future, we would seek to fully engage with relevant groups at the earliest opportunity.”
“We understand that some local authorities have begun the process to bring forward schemes, and we appreciate that they are passionate about their schemes and the benefits that they would bring to the populations they serve. I want to provide assurance that we share the ambition to expand schemes so that more of the population can benefit from water fluoridation, which we know is both safe and effective. Any plans to expand schemes will of course take into account oral health across the country as well as areas that have already began to progress schemes. We want to engage and listen to local areas so that together we can make the biggest impact on oral health improvement that we know fluoridation will provide. For those reasons, I ask the hon. Member for Nottingham North to consider withdrawing his amendment.”
“Transferring responsibility to central Government will allow us, for the first time, to move away from the limitations of local authority boundaries and to look more strategically across the country, to where oral health is the poorest. Subject to funding being agreed, we will be able to expand schemes across larger areas to make an impact on a bigger scale. We know it is less cost-efficient to operate schemes across individual local areas.Allowing local authorities to continue to bring forward schemes and to enter into arrangements with water companies separately would run counter to our ambitions to manage expansion at a higher level, again adding extra complexity, which we are eeking to remove.”
“We have seen no new water fluoridation schemes implemented for the past 40 years. Both major parties in the House must accept our responsibility for that. That is not a fault of the NHS or local government, but because responsibility in our view has sat fundamentally at the wrong level for driving forward such a health intervention. Local authorities currently have the responsibility to initiate new water fluoridation schemes or to propose that existing schemes are varied or terminated. We have heard their frustration with the overly burdensome and complex processes in place for initiation and variation of schemes. The steps we are proposing to take through the Bill are intended to make it simpler to expand schemes. We all share the same ambition.”
“As has been set out, tooth decay is a significant, yet largely preventable, public health problem. In 2019-20, more than 35,000 people aged 19 or under were admitted to hospital for the extraction of decaying teeth. In the same year, the cost of hospital admissions for tooth extractions among that age group was estimated to be £54.6 million. As we know, fluoride is a naturally occurring mineral found in water and some foods, and at the right levels it has been shown to reduce tooth decay. If five-year-olds in England with low levels of fluoride drank water containing at least 0.7 mg of fluoride per litre, the number experiencing decay would fall by 28% in the most deprived areas, and the number of hospital admissions for tooth extractions due to decay would reduce by up to 68%.”
“The hon. Gentleman is absolutely right in the points he makes about fluoridation and the parallels he draws with the vaccine. Although there have been times over the past 20 months when he and I, and our respective Front-Bench teams, have not necessarily agreed on every aspect of the response to the pandemic—that is appropriate, as the Opposition seek to challenge and question the Government—may I pay tribute to him and his colleagues in the shadow health team for what they have done to highlight the importance of the vaccine and to counter the misinformation that some have spread about it? I will speak to amendments 149 and 150 together, as the former is consequential on the latter. They would allow for local authorities to bring forward proposals for new fluoridation schemes and to enter into arrangements with water companies.”
“That of course comes on top of the work we are doing to strengthen the NHS workforce, who have performed so brilliantly throughout this crisis. All of this is vital if we are to help get our NHS back on track and ensure that no one is left waiting for vital tests or treatments and that we have the right buildings, equipment and systems so that our NHS is fit for the challenge ahead.”
“The House will have seen the announcement of £5.9 billion to tackle the NHS backlog of diagnostic tests and procedures and to support the delivery of millions more checks, scans and treatments for patients across the country. This includes £1.5 billion for increased bed capacity, equipment, new surgical hubs to tackle waiting times for elective surgeries and at least a total of 100 community diagnostic centres to help to clear backlogs of people waiting for clinical tests such as MRIs, ultrasounds and CT scans, as well as £2.1 billion of investment to modernise digital technology on the frontline. This is an historic package of investment that will support our aim of delivering around 30% more elective activity by 2024-25 compared with pre-pandemic levels.”
“Mr Speaker, I hope that you will recognise that I seek to be assiduous in my accountability to this House and in adhering to its protocols and forms, not least as a former member of the Procedure Committee. I can reassure you that what you said just now will have been heard not just by me but by colleagues in my Department and in Her Majesty’s Treasury. Just as we are determined to keep this country safe from covid-19, we also want to tackle the backlog that the virus has brought with it. We know that “business as usual” will not be enough, so we will do whatever it takes to ensure that people get the treatment they need as quickly as possible. In September, we announced plans to spend £8 billion to tackle the elective backlog over the next three years, in addition to the £2 billion this year.”
“She will have seen last month’s announcement of £12 billion of funding, a significant part of which will help to build that workforce, on top of the commitments we made at the last election and on which we are delivering.”
“Lady touched on the single most important element of our ability to tackle the pandemic and to respond to the consequences for the elective waiting list and, as I know she would, I put on record our thanks and gratitude to those staff. Radiologists and radiographers are the key people in this space, and since 2010 we have increased the clinical radiology workforce by 48% from 3,239 to 4,797 full-time-equivalent posts. The number of diagnostic radiographers is up by 33% since 2010. Does that mean we need to continue to do more? Of course it does, and she is right to highlight the need for continued investment in our workforce.”
“The hon. Lady is right that the waiting list is 5.7 million and growing. As she will have seen, the Secretary of State has made it clear that the number could grow to more than 13 million if all those who would normally have come forward in the previous year do come forward. That is exactly why we are taking these steps. Rather than expressing concern about the announcement, I would have thought she would welcome this investment, this new money, to help tackle those waiting lists. Of that 5.7 million, around 1.36 million—I may be slightly out—are waiting for diagnostic tests, which is why this is so crucial. The hon. Lady asks where the money is coming from. She tempts me, but I am afraid she will have to wait until Wednesday’s Budget for the Chancellor to set out how he is funding each of the announcements. The hon.”
“I am grateful to my hon. Friend, indeed my friend, and I understand and entirely appreciate where he is coming from. He is an assiduous parliamentarian and quite rightly, as Mr Speaker alluded to, he takes the role of this House extremely seriously, as do I. I suspect that what he says, just as what Mr Speaker said, has been heard loud and clear both in the Department of Health and Social Care and across the Government, including in the Treasury.”
“I alluded to the £12 billion that the Secretary of State announced back in September, a significant part of which will go to support the workforce in the delivery of elective recovery. On how community diagnostic centres and community diagnostic hubs will both be selected and operate, we are working closely with the NHS on exactly how to do that to ensure that the workforce are sufficient and that we do not impose burdens over and above those already imposed on them. I think that I have answered the right hon. Gentleman’s questions, but I am sure that his hon. Friends will come back if I have missed anything.”
“To take one example, we did exactly that by making an extra £110 million available to help support the maintenance of RAAC—reinforced autoclaved aerated concrete—plank hospitals around the country. On mental health, the right hon. Gentleman is right to talk about capital investment. In the context of those new hospitals, mental health facilities and hospitals are included. They have not been left out; they have got their share. The right hon. Gentleman also rightly talked about staff, which, as I said to the hon. Member for St Albans (Daisy Cooper), is a key point. We have seen significant increases in the number of doctors and nurses. He is right to highlight the need for continued increases in specialisms such as radiographers and radiologists. I highlighted the increases that we have seen, but we know just how valuable they are.”
“I am grateful to the right hon. Gentleman—my constituency neighbour—for his sensible and reasonable questions. I will endeavour to answer each of them in turn. On capital, he will know, not least because his local hospital—mine as well—is in that list to receive capital investment as part of the overall 40 new hospitals programme, that an initial £3.7 billion has been already allocated to the 40 hospitals that we are committed to delivering by 2030. That is investment not just in maintenance but in replacing old or outdated stock with new hospitals to minimise those longer-term maintenance bills. He is right that we must continue to support ongoing maintenance, as we have done.”
“My right hon. Friend will know that by far and away the overwhelming majority of that money was one-off spending to tackle the pandemic in its most acute phase. We will need to continue to spend some of that on therapeutics, vaccinations and similar. On other things, such as the significant increase in infrastructure and understanding that we have built in test and trace and in testing and diagnostic capacity, I am looking at how a long-term legacy can be born of that and how we can transition the learnings and infrastructure from that to continue to deliver for patients in more normal times.”
“The hon. Gentleman is absolutely right that the Secretary of State said that there would be Barnett consequentials. The details of those will be set out on Wednesday.”
“One of the single biggest things we can to do help with retention is to be flexible with our workforce—recognising, exactly as my right hon. Friend says, the need for flexibilities, not just for female members of our workforce but for all our workforce, as well as the need for additional staff to come through and help ease the burden.”
“I am grateful to my right hon. Friend. We have rightly set out what we are doing to increase numbers through recruitment, but as she says a key part is retaining the skilled and dedicated workforce. We need to recognise that there is not a separate workforce who have been dealing with the pandemic and who will now to be dealing with elective recovery—they are the same NHS workforce, who will all have been working very hard. We have to be sensitive to the fact that they need the time to recover physically and emotionally after the pandemic. That is what we are seeking to do. We are being realistic in setting expectations about how long it will take to clear the backlog. It is right that we do that with the public, because we must look after our workforce.”
“Is it possible with these new approaches to deal quickly with a large number of high-volume, low-complexity treatments that impact on quality of life? Equally, there are very complex treatments for which a month, a week or even a day longer can lead to more adverse clinical outcomes. It is right that we go for clinical prioritisation. Although I am keen that we should keep people informed and engaged as participants in the process, it is vital that we see this issue as clinically led.”
“The hon. Lady and I have spent many days in recent weeks sitting opposite each other in the Health and Care Bill Committee, and she knows of what she speaks given her background in the NHS. She is right about the validation of those lists and then the prioritisation, but although it is absolutely vital that we ensure that patients and those on the waiting lists are kept informed and included in the decisions and discussions about their care, her key point was about clinical decision making. In this context, the decision making and prioritisation must be clinically led. I have spoken with the Royal College of Surgeons and others of the royal colleges about how we approach the issue. We should look at a number of factors.”
“I always listen with great care to my right hon. Friend. He is right that we in this House, on behalf of taxpayers, provide the resources to the NHS and others to deliver the outcomes that we want for all of our constituents, but it is absolutely right that the NHS and others set out their plans for doing so, and that we hold the NHS to account for delivery against those plans. Ministers will draw up those plans in tandem with the NHS because, quite rightly, just as I will hold the NHS to account, I know that my right hon. Friend will hold me to account in this House. A key element of those plans for tackling the backlog must also be reform and innovation rather than simply more of the same.”
“As I said, it is very easy for people to say that X specialty was not working during the pandemic because that surgery was not happening, but you can bet your bottom dollar that the people involved were probably helping out—the anaesthetists and theatre nurses were—so we do need to address that point. I will be happy to see the hon. Gentleman.”
“That means more diagnostic capacity and more diagnostic capacity at an earlier stage, as some other countries have. I am quite happy to acknowledge that, under Governments of both political complexions, we could have done more, and that is why we are doing more now, and I say that to him gently. He talks about urgency; he is right. He also makes a very important point, which I tried to allude to in my earlier answer. If I did not land it clearly, I will attempt to do so now. He is absolutely right to highlight the risk of burn out and exhaustion, for want of a better way of putting it.”
“I know that the hon. Gentleman genuinely feels strongly about this issue. He and I discussed it in a recent debate in Westminster Hall, and I think I am due to meet him to discuss the 10 points that he flagged up then as genuinely practical suggestions to help improve both retention and recruitment in the NHS workforce. He knows that I am always happy to do that. Hopefully, my office will have been in touch with him. If it has not been in touch, it will be, because I want to have that conversation with him. On the hon. Gentleman’s key point, there are number of things. This is about not only tackling the urgent backlogs now, but building a system that is resilient for the future and that can actually tackle the broader challenges that we as a society face.”
“My hon. Friend is absolutely right, which is why part of this figure—£2.1 billion—is allocated for things such as ensuring that digital patient records and shared care records are rolled out across every trust. There has been an extensive roll-out, but there is more still to do.”
“I am grateful to the hon. Gentleman for welcoming the capital and for his tone. Quite rightly, he highlights the workforce point again. I go back to what I said to the hon. Member for St Albans (Daisy Cooper): on the basis of the figures that I have, since 2010, we have increased the clinical radiology workforce by 48% and the number of diagnostic radiographers is up by 33%. We continue to build on that. The hon. Gentleman is right about the long lead time, which is why it behoves me to say that the increase in numbers is a reflection not just of this Government, but of the previous Government’s investment in this space.”
“I entirely appreciate where my right hon. Friend is coming at this from. I hope that, in answering my right hon. Friend the Member for Forest of Dean (Mr Harper), I was clear that we hugely value the amazing work done by all our NHS workforce. This is about providing them with the money and resources they need to do the job, but also stimulating reform and innovation alongside that. The final point made by my right hon. Friend the Member for Epsom and Ewell (Chris Grayling) was about the calls by some for particular policy approaches to this winter by Her Majesty’s Government. He will have heard my response to that on various media outlets on Thursday morning.”
“My hon. Friend is coming back for a second bite of the cherry after Health and Social Care questions last week. I am well aware that there is significant housing development in his constituency and in many others. We need to ensure that the GP and broader health facilities follow that development, and do so in a way where the local health system can predict it and plan to deliver on that basis.”
“The hon. Lady knows that I have a huge amount of respect for her and her work in this House. She is absolutely right to highlight the need for parity of esteem not just to be a phrase, but to be made a reality in our constituencies and on our streets. That is why we have significantly increased funding for mental health not just in revenue terms, but in the capital terms about which we are speaking today—as I alluded to in response to the shadow Secretary of State, in terms of investing in eliminating mental health dormitories, but also in terms of new hospitals. I suspect that the hon. Lady was possibly alluding to child and adolescent mental health services. I am always happy to discuss that issue with her, as is the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan).”
“My hon. Friend asks a key question. I can reassure him that he will see that plan published in the coming weeks. I know that he will both study it carefully and hold me and the NHS to account on what is in it.”
“I am grateful to the hon. Gentleman. Everyone loves a trier in this place, particularly on behalf of their constituents. I have met him to discuss this, as he alludes to. I think I am overdue giving him an update letter on where we are. As he will be aware, we have had significant numbers of expressions of interest in the opportunity to be one of the next eight hospitals. We look forward to making an announcement on them in the spring of next year. I cannot say any more than that—but, as ever, he makes the point on behalf of his constituents.”
“My hon. Friend makes an interesting and important point. These will be new diagnostic hubs, but he alludes to a central point. For example, there could be a hub in the car park of an existing hospital where these services are delivered to allow it to deliver them in a covid-free environment, rather than having the same front door for A&E or similar. We are working through the exact detail of how these new hubs will be delivered, but we will be looking at how they can potentially fit with existing services.”
“The hon. Lady will know that, while her local clinical commissioning group—her local health system—may well be considering various options, it has not put any particular option forward to me in that context. I look forward to seeing her letter, but I am certainly happy to meet her if that pre-empts my reply.”
“We need to make sure that our NHS workforce, which is diverse in terms of its skills and background, is able to work where those skills are most effectively deployed to deliver the best outcomes for patients. My hon. Friend is absolutely right: where are there are administrative tasks, which I do not in any way denigrate, that are better performed by an administrator than a clinician, we should be looking to deliver that.”
“I am grateful to the hon. Gentleman —my hon. Friend—for his question. The Chancellor will set out the detail of Barnett consequentials in due course. The hon. Gentleman knows that I speak to Robin Swann, to whose work I pay tribute, at regular intervals—almost fortnightly—about a number of things. I have not yet discussed the detail of this matter with him, and it will be for him as a devolved Health Minister to make those decisions, but I will of course discuss it with him.”
“For a brief moment, I thought my hon. Friend was not going to mention the new hospital at Kettering. Yes, I am very happy to have that conversation with NHS England colleagues as I continue to discuss the new hospital in his constituency with them at regular intervals.”
“The hon. Lady is right to highlight that primary care and GP practices are often the front door for the vast majority of these people on the waiting lists, and I pay tribute to the hard work of GPs up and down the country over the past year and a half to two years. She will have seen the announcement a few weeks ago by my right hon. Friend the Secretary of State, in which he set out further support that would be made available to help GP practices.”
“We should make sure that general practice is an attractive career for newly qualified doctors wherever they are in the country. I suspect it will be for those individuals joining the profession to determine where they wish to practise, but I suspect my hon. Friend will do a very good job of explaining to them the joys of working in Rother Valley.”
“The hon. Lady asks a very important question. Patient safety, including in midwifery and births, is central to what we are about in this Government and in NHS England. That is one reason why we have seen more than 9,000 more nurses, midwives and health visitors recruited, but we need to continue to do more, and we will continue to do so.”
“As my hon. Friend alludes to, I met her and other hon. Friends from Cornwall last week to discuss this matter. I appreciate the pressures facing the NHS in Cornwall, particularly after the pressures it faced over the summer, when other parts of the system may have experienced slightly less pressure, because of all the holidaymakers who rightly go to visit Cornwall. I look forward to working with her further on this and thank the staff of the trust for what they are doing. We recognise the challenges, which is why we are providing this extra capital funding, including capital funding from previous pots, to her trust. I am happy to have a further meeting with her and her chief exec, if she feels that would be helpful.”