Health Questions

14th November 2017

Philip Dunne answers MPs’ questions on his work at the Department for Health.

NHS Trusts: Subsidiary Companies

1. How many subsidiary companies have been set up by NHS trusts. [901807]

Local NHS organisations are responsible for deciding the most appropriate structures they need to deliver services to their patients within available resources. Commissioners and regulators are responsible for ensuring that NHS providers act in the best interests of patients and taxpayers. A theme of the 2015 review into performance variability across NHS hospitals, undertaken by the noble Lord Carter of Coles, sought to drive efficiency through sharing administrative functions across NHS bodies in an area. A number of trusts are creating the right structures to do so. NHS Improvement is aware of 39 subsidiaries consolidated within the accounts of foundation trusts as of 31 March 2017.

Does the Minister share my concern that NHS trusts in Yorkshire are now lining up to follow the example of Airedale NHS Foundation Trust, which recently, behind closed doors and as part of a VAT scam, set up a subsidiary company to run many of its activities, which will not only cost the Treasury in lost tax receipts, but mean that new staff, such as hospital porters, will no longer be on NHS terms and conditions?

I can reassure the hon. Gentleman that we have no interest in allowing NHS trusts to avoid their tax responsibilities. Guidance was sent to all trusts in September to ensure that any TUPE transfers of staff would remain subject to NHS pension rules and should not be done for tax avoidance purposes.

What role does the Minister see for the private and voluntary sectors in the provision of NHS services and delivery in the future?

There has been a continuing involvement of private provision of health services since the very origins of the NHS, when GP partnerships came in, as private businesses, to provide their services. Of course, competitive tendering to NHS contracts was introduced by the last Labour Government, and the rate of private provision under that Government grew faster than it has under this Government. According to the last figures, 7.7% of services were provided by the independent sector.

Where a foundation trust or other NHS provider sets up a wholly owned subsidiary within the public sector, would the Minister expect to see all those papers in the public domain?

As I said to the hon. Member for Keighley (John Grogan), the trust, which would consolidate subsidiaries in its accounts, would publish the accounts of subsidiaries as part of its consolidated accounts each year.

On Sunday, the Secretary of State said that

“good public services are the moral purpose of a strong capitalist economy”,

yet trusts are so strapped for cash that they are creating private companies to get around VAT laws. Not only does this take money away from the Exchequer, meaning that other parts of the NHS are effectively subsidising these trusts, but it also removes vital protections for staff, who will find that they no longer work for our national health service. Be in no doubt: this is another step down the road of privatisation. Will the Minister set out, therefore, what protections are in place to prevent any of these companies from being sold off in the future to the highest bidder?

I am afraid that the hon. Gentleman, for whom I have considerable respect, is trying, yet again, the tired old approach of weaponising the NHS by alleging privatisation—seeing privatisation fairies where there are not any. This is about responding to the review of Lord Carter—one of his hon. Friends in the other place, I remind him—into driving efficiency through the NHS, which I know he supports, and about finding the right structures to allow, for example, the back offices of different NHS bodies in an area to be combined. That requires a structure, and a number of foundation trusts are setting up subsidiaries to provide those services to each other.

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Leaving the EU: Health and Social Care

7. What recent assessment his Department has made of the effect of the UK leaving the EU on the health and social care sector. [901813]

20. What recent assessment his Department has made of the effect of the UK leaving the EU on the health and social care sector. [901826]

We are fully engaged with the highest level of Government work on Brexit. My right hon. Friend the Secretary of State is a member of the Cabinet Committee on Brexit, and he is engaged on all areas where Brexit may impact the health and social care sector. We are actively considering the Brexit implications for the UK on workforce, medicine and equipment regulation, reciprocal healthcare, life sciences, public health, research, trade and data.

Is the Minister aware of the latest figures released this month by the Nursing & Midwifery Council? The figures confirm a clear trend: an 11% increase in the number of UK-trained nurses and midwives leaving the register, alongside an 89% drop in those coming to work in the UK from Europe. Does the Minister agree with the chief executive of the Royal College of Nursing that

“These dramatic figures should set alarm bells ringing in Whitehall and every UK health department”?

It is the case that we have been reliant for much of the increase in clinicians in this country on doctors and nurses coming from the EU, so a reduction in that increase is something we are watching carefully. I gently say to the hon. Gentleman that the last figures we have show that, as of the end of June, there were 3,193 more clinicians working in the NHS in England than there were in June 2016.

Brexit may well result in a loss of both rights and funding for people with disabilities, so when will this Government release their full impact assessment of the medical and social care sector?

The hon. Gentleman is looking for answers about social care. The Under-Secretary of State for Health, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who has responsibility for social care, has made it clear that a paper will be published in due course. I am afraid that the hon. Gentleman will just have to be a bit more patient.

Earlier, my right hon. Friend the Secretary of State made a welcome statement about the contribution of EU citizens to the health and social care sector. Will the Minister kindly advise us on what is being done at a trust level to support overseas workers, both from the EU and elsewhere, to ensure that they feel welcome and are encouraged to stay here as long as possible?

I am grateful to my hon. Friend for giving me the opportunity to reaffirm the commitment of the NHS, from the centre right through to every organisation for which EU citizens are working, that these people are welcome here. My right hon. Friend the Secretary of State for Exiting the European Union yesterday made it very clear that we are looking to have a simple, straightforward and cheap means for those who are here at the point of departure to be able to register to stay here. We want to encourage all those who are working for our NHS, wherever they come from, to continue doing so.

During his visit to the hospital in April, the Minister will have seen that Kettering General has a long and proud record of recruiting medical staff from outside the EU, and in numbers. Is it not the case that the NHS has always recruited from outside the EU and will continue to do so after Brexit?

My hon. Friend is right to say that there has been a long-standing tradition of this country welcoming professionals from outside, through various waves of migration that go back several decades. It is important to point out to him that the Secretary of State announced a year ago a 25% increase in the number of doctors in training in this country and earlier this autumn a 25% increase in the number of nurses to be trained in this country, so that we become less reliant on overseas clinicians at a time of a shortage of some 2 million worldwide.

Being a member of the European Medicines Agency has allowed UK patients early access to new drugs, and it also plays a crucial role in quality control and safety monitoring, so what solution has the Department come up with to ensure not only timely access to new drugs after Brexit, but that any complications are spotted early?

As I indicated in response to the hon. Member for Glasgow South West (Chris Stephens), finding an appropriate relationship with the EMA post-Brexit is one of the core strands of work the Department is doing. As the hon. Lady will be aware, next Monday the other EU nations will vote to decide which country will host the new EMA. It is our intent, as we have made clear to the EU negotiators, to seek mutual recognition.

With the World Trade Organisation not having updated its drug list since 2010, all new drugs developed in the past seven years could incur tariffs. What contingency plans have been made to avoid shortages and increased costs in the event of a no-deal Brexit?

As the hon. Lady will be aware, we are looking for a relationship with the EU to ensure that we have tariff-free access to the single market, including for drugs and medicines, because the life sciences industry is such a critical element of our economy. Contingency plans are being put in place for a no deal. She will have to wait, as will the rest of us, to see whether or not that eventuality happens. Of course we do not want it to occur—it is not our intent.

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Sustainability and Transformation Partnerships

13. What the timetable is for sustainability and transformation partnerships to become accountable care systems. [901819]

There is no fixed timetable for sustainability and transformation partnerships to become accountable care systems. Evolution from an STP into one or more ACSs is dependent on an STP demonstrating that it is working in a locally integrated health system. Both commissioners and providers, in partnership with local authorities, will need to choose to assume collective responsibility for resource and public health, and the criteria for that were set out in NHS England’s next steps in the “Five Year Forward View”.

Last week, NHS doctors took out a judicial review against the Secretary of State’s plans to use secondary legislation to enable private companies to run big parts of the accountable care organisations. I think the Government understand that doctors, nurses, patients and the public want an NHS that is run for the public by the public using public funds. Ultimately, will the Minister ensure that we have time in this place for Members to discuss and scrutinise the ACOs, because they are a drastic change to our NHS?

I can honestly say that the best thing the hon. Gentleman can do to understand what STPs are really all about is talk to the recently appointed chair of the Norfolk and Waveney STP, which covers his local area. He will find that the former Labour Secretary of State, Patricia Hewitt, can give him very good advice.

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Topical Questions

T9. Rural communities, and towns such as Newark without an A&E, desperately need a high-performing ambulance service, yet East Midlands ambulance service, and services across the country, are generally missing their targets. This is not a new problem—it began with Labour’s disastrous regionalisation of ambulance services—but it needs to end, and improvement is required. What strategy do the Government have to improve response times for ambulance services in the east midlands and across the country?[901690]

I am aware that the performance of the east midlands ambulance service is not what local residents or we would like at present. The strategy that is being adopted is to introduce a new ambulance response programme, and EMAS has an ongoing consultation with staff on introducing new working models to bring that into effect.

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The south Cumbria area is one of the few places in England where patients who need even the least complex radiotherapy treatment must travel for longer than the maximum 45 minutes recommended by the National Radiotherapy Advisory Group. In NHS England’s consultation, which will close on 18 December, will the Secretary of State make sure that access to radiotherapy within 45 minutes is a key criterion in allocating resources so that Westmorland general can be given its much-needed satellite radiotherapy unit?

I am grateful to the hon. Gentleman for raising that point. We are absolutely aware of the need to have more radiographers and sonographers available to support facilities around the country, and we have currently some 200 radiographers in training. I would like him to write to me so that we can follow up the specific point he makes about south Cumbria.

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The NHS sustainability and transformation plan review in my region recently recommended that all acute services be maintained at North Devon District Hospital. That was a very welcome decision and a victory for the community. Will the Minister work with me and local NHS managers to ensure that the clinical need that has been identified can be fully met?

I share my hon. Friend’s ambition. I greatly enjoyed visiting his hospital in Barnstaple during the summer, and I have been impressed by the way in which the four trusts in Devon that provide acute services have decided to come together and provide a collaborative pool of, in particular, emergency department staff to ensure that each hospital is adequately covered and there is continuity of service. I think that is a model that we can adopt elsewhere.

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