As a general principle, I believe that individuals should have as much control as possible over their own lives. This leads me to be broadly supportive of a change in the law to allow assisted dying for those who are terminally ill and mentally competent. We must be incredibly careful to ensure that any change in the law does not encourage anybody to make the decision to end their life. New or amended legislation should only allow those who are already determined to end their lives to do so without their loved ones having to endure difficult legal processes afterwards.
This is an incredibly difficult issue and the case studies which many constituents have highlighted are deeply saddening. However, I completely understand why other people feel equally strongly against assisted dying and their views are to be respected. It is good that these sorts of issues are almost always considered to be 'issues of conscience' when Parliament votes on them and so MPs are free from political constraints in deciding their views. Assisted dying is regularly considered by Parliament and I am sure that this Parliament will be no exception.
Arthritis and Covid-19
I know that arthritis can be an incredibly painful and debilitating condition, and we do need to ensure that people with arthritis are getting the treatment they need as the NHS begins to return to normal. I would like to set out some of the steps the Government is taking to make sure that happens.
The NHS is being provided with an additional £33.9 billion by 2023/24; this is the largest, longest funding settlement in the history of the NHS. This landmark investment to help secure the long term future of our NHS is extremely welcome, and I hope you agree it demonstrates the Government’s commitment to properly funding our NHS and public services: health is the Government's top priority.
Alongside this, the NHS was asked to undertake a clinical review of standards relating to waiting times. This must be clinically led to enable best, and safest, delivery of care for patients. I understand that NHS England has now prepared proposals, covering waiting times across the service, including elective procedures, mental health, cancer, and A&E. I understand that the recommendations following this review have been deferred as part of the NHS response to the Covid-19 pandemic, which is understandable. I will be sure to study these in due course.
I know that, while it has been important to postpone some NHS activities to protect individuals and enable resources to be used as efficiently as possible, my colleagues in the Department of Health and Social Care, as well as NHS Staff, are determined to restart elective procedures as soon as it is safe to do so. The exact pace of this restoration is determined by local circumstances, according to local need and demand, and according to the number of coronavirus cases being dealt with by the hospital. I have been in regular contact with the Northern Devon Healthcare Trust about this and other issues.
Fix Dementia Care
Thank you for contacting me about adult social care.
I believe we must all receive dignified care in old age. With an ageing population, this is one of the biggest challenges our country faces. I support the Government’s commitment to making sure that the most vulnerable in society gain the support they need. Whilst it is important to note that more than 4 of every 5 people in care receive care from good and outstanding organisations, it is clear that more needs to be done to tackle this serious challenge – crucially by securing a long term funding solution. I am delighted that the Prime Minister has spoken of his determination to tackle this, stating in his first speech as Prime Minister that “we will fix the crisis in social care once and for all with a clear plan we have prepared, to give every older person the dignity and security they deserve”.
The Government is currently producing a Social Care Green Paper, which will consider a range of proposals to improve social care, as well as funding options to ensure our social care system is able to meet the needs of our ageing society and is placed on a sustainable footing for the long term. Since 2015 local authorities have had greater flexibility over the use of the council tax social care precept, so they can choose to raise extra money, as well as retain savings from the New Homes Bonus, totalling £240 million.
In the Spending Round in September, an extra £1.5 billion was made available to councils for adult social care services. This funding should be viewed as a significant down payment as we move towards a long term funding solution.
Money alone will not fix the problem and reform is needed to encourage high standards across the whole country. It is vital for us to consider ways of better joining up health and care services, and I am encouraged by the use of the Better Care Fund to assist local government and the NHS with the implementation of integrated health and care services.
Shielding and Blood Cancer
It is crucial that those at most risk in our society are protected in order to safeguard their own health and prevent the NHS from being overwhelmed. I am also greatly saddened to hear of financial difficulties at this time. No one following Government instruction, should be penalised for their efforts.
I do not wish to see anyone put at any risk as the lockdown is eased. I have been reassured by colleagues in Government that they are following the best medical advice for getting people back to work. I strongly encourage employers who employ people with blood cancers to utilise the Coronavirus Job Retention Scheme (CJRS) for as long as possible until the safety of such employees can be guaranteed. As I am sure you are aware, the CJRS has been extended until October and it should be used where necessary. I would also like to take this opportunity to remind employers that they have a legal responsibility to ensure their employees and other people on the premises are protected.
Cancer Treatment and Coronavirus
When people start treatment for cancer, their medical team works with them to balance the risks and benefits of treatment before agreeing a plan. As a result of the pandemic, it may be that doctors consider the risks of certain treatments, particularly those that weaken the immune system, to be much greater than normal. They will take into consideration how urgent your treatment is: in some cases, delaying treatment might not make a big difference to the outcome. Patients with cancer visit hospitals regularly, but for those who are particularly vulnerable, this may have been more risky than usual at the height of the pandemic as it may result in exposure to the virus. As a member of the Radiotherapy APPG I did raise concerns about access to cancer treatment during the pandemic directly with the Minister responsible.
The Secretary of State for Health and Social Care announced the restoration of NHS services on 27th April, starting with the most urgent, like cancer care and mental health support. The NHS is open for business, and anyone who needs care and treatment should continue to access it as and when they need it, especially when delays could impose both an immediate and a long term risk to health. I know that continuation of cancer services is absolutely vital in many cases, which is why I welcome that restarting cancer care in a safe manner has been a priority for the NHS and for the Government. I welcome also that, due to covid-19, the 21 cancer alliances in England have established hubs to ensure dedicated cancer care away from hospitals dealing with the virus.
Any changes to treatment protocol to ensure patients are treated safely should be carried out in full consultation with patients, to ensure that they fully understand the reasoning behind any changes made in line with guidance from clinical experts. If you have concerns about your own situation, I would strongly encourage you to speak to your medical team to discuss your options.
As a member of the Department for Work and Pensions Select Committee, I am particularly conscious of the invaluable contribution made by carers, and how our society could not function without their work. I recognise the vital contribution made by the multitude of different carers: residential, domiciliary, paid, unpaid. Many carers spend a significant proportion of their life providing support to family members, friends and neighbours. I agree completely that carers must receive the right support to help them carry out their caring roles. A tenth of adults in the UK provide unpaid care for a friend or family member, and these people should be supported in the invaluable work they do.
That is why a cross-Government National Carers Strategy was introduced to look at what more can be done to support existing and future carers. After a lengthy consultation with carers, the Government announced a two-year programme of support. This includes support for young carers, effective action to help carers balancing their caring and employment responsibilities, and ensuring that health and social care services are responsive to their needs.
The Government is continuing to support the implementation of improved rights for carers, enshrined in the Care Act 2014. I welcome the fact that benefits to support vulnerable and disabled people, including Carer’s Allowance, are exempt from the freeze on working-age benefits. I am also glad to note that the Department of Health and Social Care will continue to lead a programme of targeted work to support carers.
This year, Carers' Week has fallen during the coronavirus pandemic, a time which has highlighted the invaluable work carried out by carers, both paid and unpaid. I am pleased the Government has fulfilled its commitment to offer tests to all adult care homes for over-65s for their residents and staff. At the beginning of June, a new Social Care Sector Covid-19 Support Taskforce, chaired by David Pearson, was also announced. It will work to tackle and control the transmission of the virus in social care. I will continue to work with the Government throughout this difficult time in particular to ensure that carers are able to access the support that they need.
Thank you again for taking the time to contact me.
NHS Testing (Opposition Day debate - 24/06/20)
I am aware that a number of people have raised the issue of the Opposition Day Motion yesterday, which proposed a weekly testing programme for NHS and social care staff. To be clear, I am not against regular testing of NHS staff. However, the Opposition Day Motion is not what the Chief Medical Officer has recommended, and the Government is following his advice.
Professor Chris Whitty has recommended a fortnightly testing programme which can be more frequent if the local or national epidemiological conditions demand, e.g. if there is a local outbreak or if national levels of transmission rise. NHS England and NHS Improvement have written to NHS Trusts across the country to ensure this is implemented. Testing is continuing to be prioritised for NHS staff who have symptoms to ensure that they can continue to work if they do not have Covid-19.
I was present for this debate and I spoke about the hard work of all those at North Devon District Hospital, in our social care sector, and at Public Health Devon. I listened carefully to all the contributions made during the debate and I was not entirely sure that the Shadow Secretary of State for Health was clear about the content of his motion. The motion asked for a weekly testing programme, whilst in his speech he only asked for weekly testing ‘if necessary’. Weekly testing ‘if necessary’ is completely consistent with the Government’s position.
It is also worth highlighting the fact that the Government’s amendment to the Opposition Day Motion passed without a vote, meaning the opposition did not oppose it.
Abortion (Northern Ireland) (No. 2) Regulations 2020
I voted in favour of the above legislation on 17th June, and I want to explain why I made that decision to those constituents who contacted me.
This vote was about standardising the legislation on abortion across the whole of the United Kingdom. I agree that the Northern Ireland Assembly should be allowed to have its say, but the origin of the duty for the UK Government to legislate on this issue stems from the Assembly not having sat for several years. Legislation was therefore passed in July of last year which aimed to standardise abortion law but which stated that if the Assembly were restored by a set date, the law would not change. The Assembly failed to come to an agreement which led to its restoration, and so the Government are under a legal obligation to act.
In fulfilling its obligation, the Government has sought to mirror provisions under the Abortion Act 1967, and a consultation was held on the proposed framework. Whilst the Northern Ireland Assembly did vote against this change, it did so during a plenary session and so the vote had no bearing on the legislation. The Government’s legal duty to legislate therefore remains. However, the Assembly is free to amend the regulations so long as those amendments are compliant with the 1979 CEDAW Treaty.
Abortion (Cleft Lip, Cleft Palate, and Clubfoot) Bill
The approach to abortion in Great Britain is set out in the Abortion Act 1967, which states that two doctors must certify that, in their opinion, a request for an abortion meets at least one and the same ground laid out in the Act. These grounds include “risk to the life of the pregnant woman”, and “substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped”.
There is guidance for doctors on how to comply with the Act has been issued, which stipulates that registered medical practitioners should be able to show how they have considered the particular facts and circumstances of a case when forming their opinion. Full details can be found online at www.gov.uk/government/publications/guidance-for-doctors-on-compliance-with-the-abortion-act. Not every pregnancy goes to plan and foetal abnormalities of varying degree of severity occur. Women need support and information to reach an informed decision about how to proceed. Health professionals must adopt a supportive and non-judgemental approach regardless of whether the decision is to terminate or continue the pregnancy.
Before making a decision about my position on this Bill, I am waiting to see the full text of the proposed legislation. I will then consider whether it is something I can support.
Prison Safety and Coronavirus (plus Julian Assange)
I welcome the collaborative approach taken by Public Health England (PHE) and Her Majesty's Prison and Probation Service (HMPPS). This is essential to ensure the implementation of measures to keep prisoners and prison staff safe, protect the NHS and enable the continued operation of the prison estate.
Early data emerging indicates that explosive outbreaks of Coronavirus are not being seen across the prison estate and PHE modelling suggests that the measures introduced are demonstrating that jails are successfully limiting deaths and the transmission of the virus within the estate. I understand that this has been driven by a combination of increased social distancing, reduced transfers of prisoners between prisons and acting within individual prisons to reduce infection. This has reduced the Reproduction Number (or R) to 1 or below. However, until a vaccine or effective treatment has been found, the risk of large outbreaks remains. Ministers will of course continue to review and closely monitor the prison estate.
I understand many constituents have concerns regarding court cases as the outbreak continues. Courts provide a vital public service and justice must be delivered wherever possible. I welcome the fact that Her Majesty's Courts and Tribunals Service have increased the capacity for telephone and video hearings to allow for remote hearings where appropriate. The decision to hold a hearing by telephone or video is for the judge, panel or magistrate, taking into account the needs of the parties, including their ability to access and use the right technology.
Some constituents have contacted me about this topic and how it relates to the safety of Julian Assange. It would not be appropriate for me to comment on an individual case, but the above measures are in place to ensure the safety of all in the UK’s prisons.
Trade Bill NHS Campaign
The Trade Bill is an important piece of legislation which has a number of functions.
First, the UK has been working to reach continuity agreements with countries who we currently trade with through EU trade deals. The Trade Bill will enable these continuity agreements to be embedded into UK law so that the agreements can be fully implemented. In addition, in leaving the EU, the UK will be acceding to the World Trade Organisation’s Agreement on Government Procurement (GPA) in its own right. The Bill’s provisions will make sure the UK can implement procurement obligations under the Agreement, ensuring continued access to £1.3 trillion per year of global procurement opportunities for UK businesses. As an independent member of the GPA, the UK will be free to decide what procurement is covered under the agreement. Ministers have made clear that the UK’s GPA coverage does not and will not apply to the procurement of UK health services.
The Bill will also facilitate the creation of a new Trade Remedies Authority (TRA), to deliver a new UK trade remedies framework, which among other things will include protections for UK businesses from unfair trade practices or unforeseen import surges.
It is important to make clear that the Trade Bill is a continuity Bill, and its functions are largely distinct from the Government’s future trade agreements programme. Indeed, the Bill cannot be used to implement new free trade agreements with countries such as the US. The Bill simply enables the 40 free trade agreements that the EU had signed with third countries before the UK exited to be transitioned. Separate work on the future trade agreements programme is of course also pressing ahead, with negotiations already underway with the US, and soon to begin with Japan.
With specific regard to a UK-US free trade agreement (FTA), I believe that as our economy recovers from the challenges posed by COVID-19, we need to be negotiating enhanced trade ties rather than putting up barriers. I am reassured by my Ministerial colleagues’ commitment not to compromise the UK’s high animal welfare, environmental, food safety and food import standards in any future FTA, including one with the US. Ministers do not want to compromise the UK’s domestic welfare production standards either. I want to be clear that the NHS will also be protected in any future trade agreement, including one with the US. The price the NHS pays for drugs will not be on the table, and nor will the services the NHS provides.
It is important to make the distinction between the Trade Bill and the Government’s future trade agreements programme. The process of negotiating future trade deals is not primarily a matter for the Trade Bill. However, I want to reassure you that there will be opportunities for both the public and Parliament to consider, contribute to and scrutinise negotiations for future free trade agreements. Public consultations will run ahead of all negotiations, and a number have already taken place, including for negotiations with the US, Japan, Australia and New Zealand. Ministers have also committed to provide Parliamentarians, UK citizens and businesses with access to the information they need on trade negotiations.
I agree that our children’s services need proper financial support. I am pleased that in the 2019 Spending Review the then Chancellor made an additional £1 billion available to help local authorities meet rising demand for both children and adult social care. I also welcome that £84 million has been allocated over a period of five years to assist up to 20 local authorities to enhance their social care services, ensuring that they are able to engage more effectively with those who need support the most.
That said, I recognise that there needs to be a longer-term solution to ensure sustainable funding for children’s social services, and to ensure that funding is fairly distributed across the country. I welcome the conclusion of the review into the support available for children in need, which looked at what makes a difference to the educational outcomes of children in need and what works in practice to improve those outcomes. I am assured that the findings of the review will be acted on to inform and improve policy.
I hope this has provided a measure of reassurance. I will continue to closely monitor funding levels for children’s social services.
Northern Ireland Abortion
I appreciate the strength of feeling about the issue of abortion and I welcome the balanced and sensitive approach the Government has taken. As the Northern Ireland Executive was not restored by 21 October 2019, it remained the UK Government’s legal obligation under section 9 of the Northern Ireland (Executive Formation etc) Act 2019 to bring forward the framework to provide lawful access to abortion services in Northern Ireland by 31 March 2020.
Following a consultation, the Government has now brought forward the new framework. I believe it delivers abortion reform for Northern Ireland consistent with the United Nations Committee on the Elimination of Discrimination Against Women Report recommendations.
The new framework does provide clarity and certainty for medical professionals and also ensures the health and safety of women and girls in Northern Ireland. I have attended a briefing from the Northern Ireland Minister who has explained why this legislation is worded differently to the legislation in the rest of the UK, which is now over 50 years old. The Minister has also met with the Northern Ireland Health Minister as the implementation and commissioning of abortion services will be a matter for the NI Health and Social Care Board to take forward. Further information about the reforms can be found on the Northern Ireland Office website.
Welfare of Care Workers
I want to first express my gratitude to care workers for the incredible way in which they are doing a very difficult job. We all owe keyworkers a debt of gratitude and I agree that we must recognise their efforts appropriately.
Once we have beaten Coronavirus, we will all have to reassess the way we do things and ensure that the social care sector is put on a stable footing for the foreseeable future. The Government is committed to cross-party talks on the future of social care, and these talks will be wide-ranging and include issues such as pay.
In the meantime, I have been working to ensure that care homes have the Personal Protective Equipment (PPE) they need. The distribution of PPE is a challenge of huge proportions and any care home having difficulties can contact me and I will do my best to resolve them. The Government is doing everything it can and I am in constant contact with Ministers to ensure that PPE gets where it needs to be. Devon has sufficient supplies of PPE and I am working to make sure it stays that way. There is a new national PPE helpline available to those who need PPE here: 0191 283 6543 or email email@example.com . Anyone having difficulties can also use this facility set up by a local company, Applegate: https://www.applegate.co.uk/covid19
If you know of somewhere still struggling to get PPE, please do email me and I will escalate it and ensure that this is delivered as soon as possible. The Government is doing everything it can to get supplies to the right places but it is an enormous challenge.
Young People’s Mental Health
It is incredibly important to protect and support the health of children and young people in our society; approximately 10 per cent of 5 to 16 year olds have a clinically diagnosable mental health problem.
Between 2015 and 2020, an additional £1.4 billion has been invested to transform children and young people’s mental health. This aims to help an additional 70,000 children and young people to access NHS specialist services a year by 2020/21. Schools and colleges will also be incentivised to train designated leaders for their pupils’ mental health, and introduce new mental health teams, both of which will ease pressure on NHS mental health services.
In addition, the NHS is on track to deliver new waiting time standards for eating disorder services by 2020/21. Four fifths of children and young people with an eating disorder now receive treatment within one week in urgent cases and four weeks in non-urgent cases. Extra investment will enable maintained delivery of the 95 per cent standard beyond 2020/21.
I know in North Devon, the waiting lists for mental health support are often too long, and I have been working with the Department of Health and our local NHS to try and improve the situation. I will put the event on 30th March in my diary and make every effort to attend.
NHS Waiting Times
The NHS was asked to undertake a clinical review of standards relating to waiting times. I think it is important that any decision to alter the targets for waiting times in A&E must be NHS-led. Accordingly, the NHS has undertaken a clinical review of standards relating to waiting times, and has now prepared proposals covering waiting times across the whole of the health service. This includes waiting times for joint replacement waiting times, something many constituents have contacted me about.
The Government will now carefully consider the proposals before taking any next steps, and in the meantime will continue to hold the NHS to account on its existing standards.
In the meantime, the Government is investing to reduce existing waiting times which I know are too long in many different areas of the NHS. This investment includes an extra 50,000 nurses and 6,000 GPs, which should go a long way to improving the situation. As far as North Devon is concerned, we have always had recruitment issues due to our relative isolation, and I am working with our NHS Trust to find solutions.
Protests Outside Abortion Clinics
This country has a proud history of allowing free speech but the right to peaceful protest does not extend to harassment or threatening behaviour. The law already provides protection against harassment and intimidation, and the police have a range of powers to manage protests. Like all members of the public, protesters are subject to the law and suspected criminal offences must be robustly investigated and dealt with by the police.
Following concerns about the tactics of protestors outside some abortion clinics, a review was instigated by Government in 2018. This review revealed that anti-abortion demonstrations take place outside a minority of facilities. In 2017 for example, 363 hospitals and clinics in England and Wales carried out abortions. Of those, 36 hospitals and clinics experienced anti-abortion demonstrations. With this in mind, the Government decided that introducing national buffer zones would not be an appropriate response given the experiences of the majority of hospitals and clinics.
That said, while I do not want to see peaceful protest curbed, it is completely unacceptable that anyone should feel harassed or intimidated simply for exercising their legal right to healthcare advice and treatment. The decision to have an abortion is already an incredibly personal one, without women being further pressured by aggressive protesters.
NHS & Trade Deals
Under this Government, the NHS will always remain free at the point of use and in public ownership. I would not support anything which meant the privatisation of the NHS or additional costs on healthcare for those who need it.
Free trade is a driver of economic growth which can raise incomes, create jobs, and lift people out of poverty, which is why I am glad that outside of the EU the UK will be able to strike new trade agreements with countries across the globe. That said, more trade should not come at the expense of the high levels of quality and protection enjoyed in our country.
The UK will continue to ensure that the NHS is protected in all trade agreements it is party to. Outside of the EU, rigorous protections for our NHS will be maintained and included in any future trade agreement which the UK negotiates.
Northern Ireland Abortion
I am pleased that the Government recognises the sensitivity of this issue and the range of views expressed by people on all sides of the debate. It is a highly sensitive issue, regardless of where your view lies and one where it is important that the matter is considered with due care and sensitivity.
The Government is working towards the laying of regulations for a new legal framework for the provision of abortion services in Northern Ireland, as required by the 2019 Act. The new framework will be in force by 31 March 2020.
To help inform the shape of the legislation that is introduced, a consultation was held. This has now closed, and the Government is due to publish its response shortly. I very much welcome the Government’s commitment to ensure that the health and safety of women and girls, and clarity and certainty for the medical profession, are at the forefront of their considerations.
To ensure early diagnosis of eye disease, it is important that people are encouraged to get their eyes tested on a regular basis. Clinical advice states that most people should get their eyes tested every two years. Free NHS eye tests are available for those diagnosed with diabetes or glaucoma and those aged 60 or over. This helps to encourage people at particular risk of developing eye disease to have their condition checked regularly. The latest figures show around a 10% increase in the number of eye tests since 2010 so some progress is being made.
I also welcome the broad range of support available for those diagnosed with visual impairments. Many hospitals have Eye Clinic Liaison Officers, or similar early intervention support staff, who provide the practical support which patients need following their diagnosis, including advice on how to deal with their sight loss and maintain their independence.
I will liaise with the Health Secretary about this issue to make sure that North Devon is able to deliver the service that people with sight problems deserve and expect.
Immigration Health Surcharge
I believe that overseas visitors should be able to access our NHS as long as they make a fair contribution, just as the British taxpayer does. The NHS is a national - not an international - health service and I commend the Government’s determination to stamp out misuse of the system to ensure it remains free at the point of need in this country.
After a review of the evidence, the annual surcharge will now cost £400 per annum, with a discounted rate of £300pa for students (and their dependants) and Youth Mobility Scheme applicants. The proposed amount is still below full average cost recovery level, which is calculated as £470. The UK must protect its reputation as a great place to live, work and study, and increasing the IHS still offers access to far more comprehensive services at a lower cost than some of our main competitor countries.
The IHS applies to those living in the UK temporarily. Those with indefinite leave to remain and vulnerable groups, including asylum seekers and refugees, are exempt from the charge. It is only right that people who come to the UK for more than six months should contribute to the running of the NHS.
People for whom the IHS applies work in a broad range of jobs fulfilling important jobs in the public and private sectors, jobs that keep the country running. I believe that the IHS should be applied equally, to all non-EEA residents who are in the country temporarily. All residents will benefit from the £220 million funding for the NHS that this fund will provide. The answer is not therefore to exempt nurses from the charge, but to increase their pay; and this is happening.
This charge was brought in to ensure that temporary users of the NHS from outside the EEA are making a fair contribution to the functioning of our national asset, regardless of their employment status. Although some temporary migrants will be paying tax and National Insurance contributions, they will not have made the same financial contribution to the NHS which most UK nationals and permanent residents have made, or will make, over the course of their working lives. It is therefore fair to require them to make an up-front and proportionate contribution to the NHS.