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Tag: Karin Smyth

  • Karin Smyth – 2016 Parliamentary Question to the Department of Health

    Karin Smyth – 2016 Parliamentary Question to the Department of Health

    The below Parliamentary question was asked by Karin Smyth on 2016-01-04.

    To ask the Secretary of State for Health, when his Department plans to make a decision on whether to refer for consideration by NICE PRRNT treatment for pancreatic cancers.

    George Freeman

    The National Institute for Health and Care Excellence (NICE) has recently consulted stakeholders on the suitability of Lutetium-177 Dotatate – a type of peptide receptor radionuclide therapy (PRRT) – for treating unresectable, somatostatin receptor-positive gastroentero-pancreatic neuroendocrine tumours without disease progression for referral to its technology appraisal work programme. A decision on its referral to NICE will be taken shortly.

  • Karin Smyth – 2022 Speech on the NHS Workforce

    Karin Smyth – 2022 Speech on the NHS Workforce

    The speech made by Karin Smyth, the Labour MP for Bristol South, in the House of Commons on 6 December 2022.

    In 1948, at the dawn of the NHS, we were around 50,000 nurses short. By the 1960s, 40% of junior doctors were from India, Bangladesh, Pakistan and Sri Lanka. Thousands came from the Caribbean. It is estimated that by the 1970s, 12% of British nurses were Irish nationals, my own family among them. My Aunt Margaret Carter came to Stockport and my cousin Maureen McNulty came to Leeds. Britain welcomed them; they were not invaders. We trained them, we gave them accommodation, we offered them prospects. In the three decades I have worked in the NHS, the hundreds of nurses I have worked with remember their first job. They remember being greeted and welcomed. They remember their new belts. They remember it with great pride. We welcomed them nationally and, crucially, we welcomed them locally. We supported them with accommodation, transport and decent prospects.

    In January 2019, the then Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), made a statement about the long-term plan and the recommendations. Like the Secretary of State today, he talked about the largest increase in health spending. What he failed to admit, as did the Secretary of State today, was that we had witnessed a decade of the lowest growth the NHS had ever had. In particular, it badly hit public health, capital spending—why we have a £10 billion backlog on maintenance—and workforce education and training. Even if we skirt over the suppression of Exercise Cygnus and pandemic planning, we entered the pandemic unprepared. That is why we had rushed, ad hoc, WhatsApp-panicked procurement processes—about which we will hear much more later today. That is why 2020 was so bad.

    Members do not have to take my word for it. In June 2019, following that earlier statement, Baroness Harding and Sir David Behan, chair of Health Education England, gave evidence to the Health and Social Care Committee. I recommend that hon. Members read it. I totally agreed with Baroness Harding that the way we solve the workforce crisis is all about staff retention. It is all about people feeling that their careers were not being developed and that they did not have an opportunity to get on. At the time, retention rates were higher in any other profession. It was also noted that if we had kept at 2012 retention levels, we would have had 16,000 more nurses in 2019 than we had at the time. That is the problem.

    There are solutions and we have heard some of them today, but they are a mix of the national and the local. At national level, we need to welcome people. We will always need overseas recruitment, but upwards of 80% of NHS staff are homegrown. We need to incentivise retention—it is cheaper, it is quicker, it is the smart thing to do. The reasons for loss of staff are well known. The Government need to revisit the Augar review. They need to notice what has happened with the loss of bursaries. We need to involve further and higher education in that retention work.

    We also need to look at regional solutions. The Lansley Act, the Health and Social Care Act 2012, destroyed the regional architecture but there is still a role, still some semblance of a network, possibly grouping ICSs—we talked about that today—where NHS England could have a role without the performance stick. The emergency planning architecture, which was ignored at the beginning of the pandemic but still exists in some places and did rise to the challenge, linking local authorities and public health, could offer a skeleton of a service to co-operative supportive networks above trust and ICS level. But eventually everything is local. Just as we welcome people nationally and have national support structures to retain staff, we absolutely have to do things locally. We need to look at housing, transport, progression and, as has been said, pay and retention.

    I am not particularly interested in the large figures that have been bandied around today, including the millions of people on waiting lists and the 165,000 social care vacancies; I want to know what is happening in Bristol. I want to know what is happening to GP waiting times in Whitchurch, Bedminster and Bishopsworth. I want to know the vacancy rates at the Bristol Royal Infirmary and Southmead Hospital. When I asked the Secretary of State about the vacancy rate in North East Cambridgeshire, obviously, he could not answer, because none of us in this House can answer that question. As MPs, we should know the scale of the problem in our constituencies and, frankly, we do not. We need to know and to communicate to local people what the problem is. We need to help with the local situation and priorities, and we have to build our way out of it.

    There are no easy solutions, but there is a path. Sadly, the Government have not even started on that path. If we are to keep spending ever more of our country’s wealth on the NHS and care system—as we will, although it would help if we had grown the economy more in the last 10 years—local people must have a say in that. They have to understand the trade-offs and, crucially, be able to hold someone to account locally for the parlous state of our waiting lists.

  • Karin Smyth – 2022 Speech on the International Day for the Elimination of Violence Against Women

    Karin Smyth – 2022 Speech on the International Day for the Elimination of Violence Against Women

    The speech made by Karin Smyth, the Labour MP for Bristol South, in the House of Commons on 1 December 2022.

    I beg to move,

    That this House has considered the International Day for the Elimination of Violence Against Women.

    It is a pleasure to see you in the Chair, Ms Elliott. I thank the Backbench Business Committee and the hon. Member for Thurrock (Jackie Doyle-Price) for their support in securing this important debate.

    This year, the UN’s 16 days of activism fall at the same time as the FIFA men’s World cup. FIFA decided to hold the competition in a country where women remain tied to their male guardian and need his permission for key life decisions on matters including work and travel. We also meet against the backdrop of war in Europe. As is all too familiar across the globe, women are being targeted through sexual violence. Thousands of women have been transported hundreds of miles from home and forced to build a life for themselves and their families in other countries. Our thoughts and solidarity are with them.

    In the UK, we are in a cost of living crisis and in the grip of an epidemic of appalling violence committed by men against women and girls. Those two facts are inextricably linked. The epidemic includes violence at home, violence in the playground, violence in the workplace, violence on the walk home from school, violence online and across social media, and violence brought to life through the grotesque barrage of freely available extreme pornography on every corner of the internet. The violence can be short, sharp and brutal; sexual and degrading; insidious and coercive; hidden behind closed doors or hiding in plain sight—it is everywhere.

    Our collective unwillingness to speak honestly about this epidemic is perhaps driven by the same thing that compounds the horrors visited on countless women and girls: shame. Unlike those women and girls, we should be ashamed—ashamed that women feel unsafe on our streets, ashamed that girls are unable to enjoy the same freedoms and experiences as boys, and ashamed that many of our public bodies are haemorrhaging trust as institutional misogyny blinds them to their basic safe- guarding obligations.

    The facts speak for themselves. The number of women murder victims is at a 15-year high—I repeat, a 15-year high. Rape prosecutions and convictions are at a historic low, and countless women victims are abandoning their trials due to delays that this Government created—delays in the Crown court are at a record high.

    Yet the collective response has remained essentially unchanged for generations. Instead of investing in things that would help prevent males from developing into perpetrators and improve women’s economic circumstances —education, policing, criminal justice and large-scale societal change around care—we focus on the result of that inequality, and women and girls remain reliant on “that chat”. “Don’t walk down the lane on the way home; stick to the main street.” “Keep your headphones off.” “Keep hold of your phone when you get off the bus and keep your house keys poking between your fingers.” “Don’t wear high heels. If possible, wear a big coat.” “Don’t go for a run tonight; it’s too dark.” “Stick the bins out in the morning.” “Oh, and if anything does happen, it will be your fault.” Women have to second-guess their safety on a daily basis.

    Although I say the facts speak for themselves, that is only because women have fought hard to ensure the accurate reporting and gathering of sex data. A woman is killed every three days. I commend Karen Ingala Smith and her work documenting the facts through Counting Dead Women, which is a phenomenal project. Data shows that domestic violence, already endemic across Britain, skyrocketed during the pandemic. There were 260,000 domestic abuse offences between March and June 2020 alone. Research by UN Women UK found that 71% of women in the UK have experienced sexual harassment in a public place, rising to 86% of 18 to 24-year-olds. In the first lockdown, a fifth of women and girls aged 14 to 21 were catcalled, followed, groped, flashed or upskirted, rising to 51% during the summer.

    Let us look at the causes. In Bristol, the 2020 mayoral commission on domestic abuse, along with the joint strategic needs assessment, reported the variation in domestic-related abuse and crime across my city, from 7.1 per 1,000 in Redland to 79.9 per 1,000 in Hartcliffe and Withywood in my Bristol South constituency. Analysis in the UK and internationally has consistently found vulnerability to domestic violence to be associated with low income, economic strain and benefit receipt.

    Earlier this month, the chief executive officers and directors of the End Violence Against Women Coalition joined more than 80 other organisations to warn that the cost of living crisis is having a devastating impact on women, putting them at greater risk of violence and abuse. It is a sobering report. Many women face the choice of staying in an abusive situation or experiencing financial hardship or destitution. Relocation to safety, disruption to employment, and access to legal advice all come with a hefty price tag. These circumstances are only worsening in the cost of living crisis, as women are dominant in low-pay, insecure work in the public sector, care, retail and hospitality. All those sectors are being squeezed, putting more and more women and children at risk of harm, destitution or even death.

    At exactly the same time as demand for support to escape abuse is increasing, already overstretched specialist services have been confronted with rising bills to operate their life-saving services. Frontline organisations, such as refuges, are facing steep energy bills, and staff are covering the cost of service users from their own pockets, including feeding women who have not eaten for days.

    I hope that the Minister has been listening carefully—I thank him for that—but we have had enough of listening. We do not want any more time for “that chat”. We need to raise women’s economic status up the political agenda in all our political parties. We need to help women to access paid work at decent pay levels, with access to affordable childcare. We need to ensure that benefits are made in such a way as to ensure that women do not become dependent on their male partners. We need to ensure that women are not penalised for non-contribution as a result of caring. We need to ensure that the issue of financial abuse as part of abusive behaviour is recognised in the Government’s strategy to address violence against women and girls.

    There are some first steps that would help. It would be helpful if the Minister would agree to implement some of the following: put a rape and domestic abuse specialist in the police force in England and Wales; overhaul the police standards system, including vetting, training and misconduct, to ensure that victims get the best possible service and support from the police; bring in a domestic abusers register, which would allow authorities to track perpetrators and prevent them causing harm to more women; and set up specialist rape courts, which would end the traumatisation of victims by the system. Let us make the UK a beacon of progress.

    Alongside that, we need a recommitment to the importance of empirical data as fact. Data must be accurately compiled and accurately sex disaggregated in order to fully understand the impact of all crimes on women and girls. To tackle endemic sexism and sex-based violence, we must count sex, just as it is vital to combat discrimination against other groups. The need to accurately record separate and additional data is obvious. The offending patterns of men and of women show the highest differential of all, so we need to monitor the sex of the victims and perpetrators of all crimes.

    My hon. Friend the Member for Gower (Tonia Antoniazzi) stated recently in this place that at least six regional police forces now record suspects’ sex on the basis of gender identity, following the advice of the National Police Chiefs’ Council. Data based only on self-identified gender is not accurate data on which to build a violence against women and girls strategy, or to effectively plan services that support all victims and target all perpetrators, whatever their sex and however they identify. I could not agree with my hon. Friend more. Data is key to protecting women and girls from violence, and I hope the Minister can confirm the need for sex to be recorded by police forces in England and Wales.

    We talk often in this place of equality. We often celebrate the very presence of women and girls in sporting teams, on boards, in leadership roles or in politics as an end point. It is not. For as long as every woman and girl lives in a society that remains in itself so unequal, and presents such dangers, we should perhaps pause and reflect.

    Margaret Ferrier (Rutherglen and Hamilton West) (Ind)

    Earlier this year, the UK ratified the gold standard set by the Istanbul convention, but it has decided to opt out of article 59, which protects migrant women. Does the hon. Member agree that this defeats the point of the convention? There should be equal protection for all women, and this creates a hostile and discriminatory environment for some of the most vulnerable women in the UK.

    Karin Smyth

    The hon. Member makes an excellent point; I agree. I am sure that the Minister, or my hon. Friend the Member for West Ham (Ms Brown), will address it later from the Front Benches.

    As we reflect, let us remember that the great feminist writer and thinker, Chimamanda Ngozi Adichie, once said:

    “Your feminist premise should be: I matter. I matter equally. Not ‘if only.’ Not ‘as long as.’ I matter equally. Full stop.”

    Let us hope that, when we gather again next year, not only have the statistics become slightly less depressing and the Government response slightly less dispiriting, but we have taken some steps, however small, toward empowering every woman and girl to believe that they have a right to live a life where they matter equally—full stop.

  • Karin Smyth – 2015 Parliamentary Question to the Department of Health

    Karin Smyth – 2015 Parliamentary Question to the Department of Health

    The below Parliamentary question was asked by Karin Smyth on 2015-10-20.

    To ask the Secretary of State for Health, what information Health Education England holds on the number and proportion of doctors who completed their foundation training and are (a) not working in the NHS and (b) working abroad in the latest period for which figures are available.

    Ben Gummer

    Health Education England does not hold this information.

  • Karin Smyth – 2015 Parliamentary Question to the Department of Health

    Karin Smyth – 2015 Parliamentary Question to the Department of Health

    The below Parliamentary question was asked by Karin Smyth on 2015-10-20.

    To ask the Secretary of State for Health, what estimate he has made of the number of additional (a) nurses and (b) doctors required to deliver seven-day working in the NHS.

    Ben Gummer

    It will be for local providers and their Local Education and Training Boards to develop workforce plans for delivering seven day services in hospitals which will make the best use of staff skills and expertise. Current levels of service provision at weekends currently vary between hospitals. There may be additional staff needed, including doctors, and the Department is working with NHS England and Health Education England to make sure we have the workforce we need, including looking at new working patterns and roles such as physician associates.

  • Karin Smyth – 2022 Speech on the Northern Ireland Protocol Bill

    Karin Smyth – 2022 Speech on the Northern Ireland Protocol Bill

    The speech made by Karin Smyth, the Labour MP for Bristol South, in the House of Commons on 27 June 2022.

    Thank you, Madam Deputy Speaker. I will see how we go.

    Exactly six years ago today, following the Brexit referendum, we had a statement in this House from the then Prime Minister, and more than two hours of questions took place. I believe I was the only non-Northern Ireland Member of Parliament to raise the issue of the Northern Ireland border. Specifically, I referenced my own family who live on both sides of that border. My family are from Cavan and some of my family now live in Fermanagh. I spend a lot of time there crossing the border. It has always been personal to me. I witnessed and saw the benefit of the removal of the physical infrastructure throughout the 1990s. However, throughout most of the last six years—Members who were not here at the time have referenced it—Northern Ireland has received very little attention. It has always been an inconvenience to the Brexiteers, who have never really articulated a solution to the conundrum of the unique circumstances on the island of Ireland. Too many hon. Members on both sides of the House do not know or understand the history.

    Clearly, among the European Research Group or somewhere, a briefing pack is circulating that starts at 1800 with the Act of Union, moves swiftly on to 1998, and finds us here today. It would well behove many hon. Members to walk along the corridor to the Library and check the Hansard from this place throughout the 19th and 20th century. It would behove Conservative Members to understand the arguments between Disraeli and Gladstone about that “coming storm” from the west, because it is different now from it was throughout those times. Careless words spoken in this place throughout those two centuries have an impact across Ireland—in the Republic and in Northern Ireland.

    Peace and stability must always guide us—we all want that—but nothing in the Bill does anything to bring peace and stability to Northern Ireland. It gives no power to people in Northern Ireland, but all the power to singular Ministers in this Government. The Foreign Secretary told us today that she has had no agreement from the parties that they will go back to Stormont, and the powers given to the UK Government Minister are complete and unfettered with no accountability.

    A key part of the Belfast/Good Friday agreement, which no one seems to want to mention but which has always been important for bringing peace and stability across communities, is the mutual interest and mutual respect between the UK and Irish Governments for the two communities that exist in Northern Ireland. The Conservative party does not like it, but Ireland remains a member state and is that mutual interest. When people talk casually about the EU being the enemy, they really mean that Ireland remains an enemy. For the Brexiteers, there has always been one solution to the problem of Northern Ireland, which is for the Irish to leave the European Union.

    Brexit has never been about the UK leaving; it has always been about the destruction of the European Union. The solution for the Brexiteers—for the ERG that now controls the Conservative party—is for Ireland to leave, but that is not going to happen. Ireland has been successful in the European Union, which has transformed society and the lives of people there. That is the realpolitik. The unique circumstances on the island of Ireland have not changed. Somehow, we need to remind the Conservative party and other hon. Members of that place.

    With the dual regulatory system, Northern Ireland is on the cusp of either great prosperity or economic failure. It is our duty to decide on which of those paths we want to support people there. We could choose the investment that awaits—being the fulcrum between the EU and the United Kingdom is potentially exciting for business and prosperity in Northern Ireland—or we could chose stagnation, indecision, fighting in the courts, and debates about the niceties of legal arguments and international treaties of the last 200 years, which would frighten off the investment that is crucial for prosperity and security.

    It is not just personal now for me. The instability that breaking an international agreement causes definitely has an impact on businesses and people in my Bristol South constituency. Our international reputation as a safe place to do business, our stability and our rules-based economy are being totally trashed and shredded by the Government.

    In my remaining minute, I will alert hon. Members to the inquiry of the Public Administration and Constitutional Affairs Committee, of which I am a member, into international treaties. We have heard from Lord Frost and last week we heard from Professor Bartels from the University of Cambridge. When asked about the state of necessity, Professor Bartels said that

    “you resort to a defence of necessity when it is necessary, in other words you don’t have anything else.”

    The ultimate test of legislation is whether it will work, and it is clear that this will not work. It is a distraction—a distraction from the psychodrama within the Conservative party, and the Prime Minister—and it is truly shameful.

  • Karin Smyth – 2022 Speech on the Resignation of Lord Geidt

    Karin Smyth – 2022 Speech on the Resignation of Lord Geidt

    The speech made by Karin Smyth, the Labour MP for Bristol South, in the House of Commons on 21 June 2022.

    It is a pleasure to follow the hon. Member for Hazel Grove (Mr Wragg), the Chair of the Public Administration and Constitutional Affairs Committee, of which I am one of the so-called illustrious members and very pleased to be a part.

    Only two weeks ago, I spoke in another debate about the importance of standards in political life and how important they are to my constituents. At that time, the Government were trying to move us on, and that has not worked terribly well, but the issues that we are talking about today are important and do matter to our constituents. I said then, as a member of the Committee, that not many members of the public knew about our work—the long hours of deliberation, reports and inquiries, and how we had a certain Lord Geidt coming before us shortly. I ended up by saying that because of how our constitution now works and how the Government have behaved, all roads lead back to the chap at the top of the structure. The culture emanates from there, including the non-attendance before Select Committees, the late publication of documents, and the many other examples that were outlined in that debate—so here we are again.

    As well as reviewing the evidence that Lord Geidt gave to the Committee last week, it is worth reviewing his post-appointment hearing evidence taken on Thursday 13 May 2021, his name at that point having been alighted on by the Prime Minister following the resignation of his predecessor. In that session, we explored the lessons from Sir Alex Allan’s resignation and the issue of independence and advice. In response to questioning led by my colleague and friend, in this regard, the hon. Member for Thurrock (Jackie Doyle-Price)—she is in her place—who asked about recognising that we all have a view on and understand what is good and bad behaviour and what is constitutionally appropriate, Lord Geidt said:

    “As I have heard other people say recently, good behaviour is a very difficult thing to legislate for. I join those who suggest that it really needs leaders—of course, the Prime Minister, Parliament and civil servants—to set the necessary example. I hope very much that the work that I do in this role, which is described as “adviser”, will be in the service of advising the office of Prime Minister in the furtherance of that behaviour, taking the Ministerial Code as its point of reference. I agree with you that rules are absolutely not sufficient to stimulate good behaviour.”

    We fast-forward to earlier this year and the warnings that Lord Geidt was then moved to give, in the strongest terms he possibly could, in the introduction to his annual report. Before our session last week, on 14 June, I was not sure which Lord Geidt would be before us. Were we to get the one who appeared before us in May 2021, believing, as a chap of the system, I think it would be fair to say, that the system had worked, that his predecessor’s resignation showed that it worked, that updates to his terms of reference gave the independence that was necessary, and that leaders, crucially from the top, set the necessary example; or were we to get the one who was the author of the annual report? Following a fairly intense session of questioning on a number of different issues in the inquiry, we clearly found out just the very next day which Lord Geidt we now had.

    Our post-appointment session in May 2021 focused on the issue of wallpaper. Our last session was about a number of things, including the legal advice on the breaking of international agreements. That really is quite a leap, isn’t it, in only a year? I asked particularly about the leaking of legal advice on the breaking of the Northern Ireland protocol. We know that that advice has been leaked. We know that it is a serious breach of the code. We know that this has a profound impact on the UK’s constitution and domestic politics as well as on our international standing. We know that the legal advice is disputed. We know that the doctrine of necessity is extreme. We heard again this morning from experts on international law quite how unusual the new doctrine of necessity that we now have in the protocol is.

    In a series of questions, which I am going to refer to, I asked Lord Geidt about where this advice had been leaked from—essentially, whether it was from the Prime Minister or from the Attorney General. I asked him whether he had been asked to investigate that situation. I said that

    “we do have a recent leak with regard to the legal advice on the Northern Ireland protocol”,

    and asked him whether that constituted “a relevant example” for him to investigate. Lord Geidt said:

    “It may well do. You will recall that my new powers are squeaky new and I have not either been asked to or, indeed, pressed my own interest in giving advice in that example.”

    I asked Lord Geidt if the Prime Minister

    “has not asked you to investigate why that legal advice was leaked”.

    Lord Geidt said, “No, he had not.” I asked if the Attorney General was asked how the advice had been leaked? He asked me, “Have I asked?” I said yes, and he said, “No, I have not.” I said:

    “But your new powers do allow you to ask”

    the Attorney General. Lord Geidt responded:

    “I think that my new powers would allow me, unrestricted, to ask questions of the entirety of Government and others.”

    I said:

    “You raised the issue of the leak”—

    he had done that earlier—

    “The leak is clearly very serious… I would suggest it breaches the ministerial code, point 2.13. Would you agree?”

    Lord Geidt said:

    “I have not formed any advice and I have not brought an inquiry to bear on the situation.”

    I then asked if he thought it breached the ministerial code. He said:

    “Again, I would want to ensure that I could consider that fully before reaching a determination. By the way, as you know, the determination is then only advice to the Prime Minister.”

    I asked:

    “Have you looked at reaching a determination before?”

    and he said, “In this case, no.” We would seem to have been going round in circles.

    Part of that emanated from some correspondence from the shadow Attorney General, my right hon. Friend the Member for Islington South and Finsbury (Emily Thornberry). She had written to Lord Geidt to ask for advice, and he said he had responded to her, but that had not been received at the time. She has now received an answer, and again we are somewhat going round in circles. Lord Geidt responded to her finally, saying: “In the event of an allegation of unauthorised disclosure of information by persons unknown, it is open to the Government to commission an internal leak investigation where the Government in the circumstances considers it is appropriate, but that would be a matter for the Government to take forward and would not, at least in the first instance, be a matter for the independent adviser.”

    We are left on a circuitous route of trying to understand where a very serious leak has occurred. It is a clear breach of the ministerial code that seems to be no one’s job to investigate or move forward. That is simply one example of the very many outstanding breaches of the code now lurking behind the doors of Downing Street. Where do we now go? Ideally, we would like to return to decency in politics. This motion provides an interim solution. As I said when I intervened earlier, it is up to other hon. Members in this place to come forward with other solutions if they do not think this solution is suitable. The Government are being given a window, should they wish to take it, to do something decent.

    Our Committee, as the Chair has outlined, has a long list of current inquiries and a future work programme. We are not particularly looking for extra work, and this is clearly a matter for the Government under our constitution. However, I know that Parliament takes this seriously, and Parliament can and will step up. We will find a way through this to bring decency back into our politics. Again, at the end of these very long days, our commitment is essentially to our constituents. This is being taken seriously by a number of Members of the once great Conservative party. Our commitment remains on the Opposition Benches, and we will continue to pursue bringing back good standards of government, despite what the Prime Minister wishes to happen.

  • Karin Smyth – 2022 Speech on Standards in Public Life

    Karin Smyth – 2022 Speech on Standards in Public Life

    The speech made by Karin Smyth, the Labour MP for Bristol South, in the House of Commons on 7 June 2022.

    It is a pleasure to follow my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders), who is absolutely right that rules matter. I agree with him, the right hon. Member for Orkney and Shetland (Mr Carmichael) and the hon. Member for Gordon (Richard Thomson) that it is disappointing that there are not more Government Members speaking this afternoon, because this really matters to our constituents. Last night, Ministers were quick to say in the media, “Move on; no one cares,” but that is simply not true. No Government Members are here because they also know that this matters.

    I have been contacted by several constituents about standards in public life. They think that the Prime Minister has breached their trust, and many think that his actions have been beyond sickening and disgusting. I share their anger about his wilful disregard of the ministerial code and the standards that we expect from our Prime Minister, and about the erosion of public trust in this institution and politics in general.

    I serve as a member of the Public Administration and Constitutional Affairs Committee. I do not think that many among the public know much about that Committee or what it actually does, but as Members know well, Select Committees of the House are important bodies. They work well and have long been charged with the scrutiny of Government. We all sit in Committees rooms, off the Committee corridor, week after week, hearing in detail from expert witnesses and, often, members of the public about what is going on in the corridors of power. It is slow, deliberate work that often does not yield headlines.

    PACAC continues to run a series of inquiries on propriety and ethics in the aftermath of the Greensill scandal—remember that one? In this debate, we have all resurrected scandals and issues that some of us might have forgotten. It seems incredible that it is only a few months since we had to go through the Owen Paterson debacle. We are conducting a number of inquiries, as well as having one-off regular sessions with leaders of what we can call the post-Nolan landscape bodies.

    This is a useful, timely debate in many ways, but in other ways, our Committee wishes that it had come in another few weeks, because we will hear again from the chair of the Advisory Committee on Business Appointments in the coming weeks. We will have Lord Geidt, the Cabinet Secretary and the head of propriety and ethics coming before us. We also recently heard from the former independent adviser, Sir Alex Allan, who resigned, and his predecessor. All that evidence is on the website, and all the transcripts are available. Without putting too much pressure on our Clerks and advisers, we will be reporting, as a result of those deliberations, on the general issue of propriety and ethics later in the summer.

    I hope that the Government will heed our work and perhaps use the opportunity of this shameful episode in our country’s history to start working with the Committee more proactively to ensure that the highest standards are pursued. I also hope that the Government will use the great willingness of the leaders of the organisations that I mentioned, and of many Members here from across the House, to try to rescue public trust and pursue higher standards. It is now obvious that the whole edifice of what we might call the post-Nolan framework—reliance on the “good chaps” theory—collapses when the chap at the top and the chaps supporting him do not do the right thing.

    We are at an extraordinary juncture of our parliamentary democracy. Lord Evans’s response to the Government agreed with Lord Geidt’s report that there was a “low level of ambition”. The report has been quoted a couple of times today, but for hon. Members who have not read it, it really is worth reading in full. Lord Geidt writes about the ministerial code and the work he was asked to do; without impugning him too much, I think he would pass the test for a “good chap” in terms of how he came into the post.

    Lord Geidt describes what would be acceptable in normal circumstances, but goes on to say:

    “The circumstances of the period covered by my report, however, have been far from normal. For much of the year, the conduct of the Prime Minister himself has potentially been subject to consideration against the requirements of the Code. Accordingly, and whether unfairly or not, an impression has developed that the Prime Minister may be unwilling to have his own conduct judged against the Code’s obligations.”

    He describes the

    “test for the credibility of these new arrangements”.

    He writes:

    “It may be especially difficult to inspire that trust in the Ministerial Code if any Prime Minister, whose code it is, declines to refer to it.”

    He mentions the fixed penalty notice issued to the Prime Minister, requesting that the Prime Minister

    “respond accordingly, setting out his case in public”

    as to why he does not think that it

    “might have constituted a breach of the overarching duty within the Ministerial Code”.

    It is quite an extraordinary introduction to the annual report. In the circumstances of Lord Geidt’s appointment, it is really the strongest reference he could make to what he thinks is occurring.

    The new introduction to the ministerial code, which hon. Members have referred to, essentially rejects the idea of anyone being held to account except by having a general election. Obviously the Opposition would welcome a general election at any point; I love elections, and we have had quite a lot of them. It is right that we are held to account by our constituents, but it matters to our constituents that the Opposition come here and hold the Government to account day by day, in Select Committees and with questions, including questions in response to ministerial statements. Constituents do not expect to have to hold the Government to account themselves every few months or, as has been the case, every couple of years when they think that the Government are not upholding the highest standards. That is why we need to rely on statements made at the Dispatch Box having the authority that the country expects. The new introduction gives us another insight, should we need one, into the mind and attitude of the Prime Minister, the Conservative party and this Government. That is why it was so disappointing, and why last night was so disappointing.

    There was a lot of discussion about whether Sue Gray’s report would be independent. Let us stop a moment, stand back and think again about how some of what she reported, as a serving civil servant, was so shocking. She writes that

    “events should not have been allowed to happen”

    but that some of the more junior members of staff felt that what happened was okay because the

    “senior leadership at the centre, both political and official”

    essentially allowed it to happen. As she says, they

    “must bear responsibility for this culture.”

    Because of how our constitution now works and how the Government have behaved, all roads lead back to the chap at the top. The culture emanates from there, including non-attendance before Select Committees, late publication of documents and the many other examples that have been outlined today. However, my assurance to my constituents and the wider public is that the willingness we have shown in this place, in this debate and elsewhere, shows that we do love our country and our democracy. We think it can be better than it is at the moment. We will continue to work across Parliament, in Select Committees and in all our different ways to assure our constituents that the integrity, accountability and respect that need to exist in this place will exist again—with or without this Prime Minister.

  • Karin Smyth – 2020 Speech on the Domestic Abuse Bill

    Karin Smyth – 2020 Speech on the Domestic Abuse Bill

    Below is the text of the speech made by Karin Smyth, the Labour MP for Bristol South, in the House of Commons on 28 April 2020.

    I, too, welcome this long overdue Bill and many of its provisions. Since becoming the Member for Bristol South in 2015, the impact of domestic violence has been one of the most heartbreaking and dominant parts of my casework. My surgeries have been filled with women, mainly in their 20s, with children, who have been desperate to remain part of their community and have had family support but who have been seeking refuge from their perpetrator. The impact is wide, and when in recent discussions with headteachers and local police we have been trying to identify behavioural problems locally, we have often come back to a background of young men experiencing violence at home and then repeating it.

    This Bill is crucial for many of my constituents, because our area has some of the highest rates in the city. In 2018-19, police figures for Bristol showed more ​than 10,000 domestic violence and abuse incidents, but there is a shocking disparity between levels of violence across the city. A 2017 report on women’s health showed that the rate of domestic violence against women in some wards in my constituency was double the national average. There has been a problem for some time, and one that I raised with the UN rapporteur on human rights in 2018. In some of our communities it is embedded, normalised and long-term, and often not discussed. A significant part of the problem is that cases are not reported, which presents huge difficulties for people supporting the victims. Some 14% of the population in one of our wards think that abuse is a private matter—compared with a figure of 7% across Bristol as a whole. Sometimes a reluctance to speak out against abuse is related to the amount of time it has been going on. A report by the south-west rape crisis centre partnership entitled “The chilling silence” identified sexual abuse among older women in particular, and often not much publicity is given to those women. I would like to see that issue addressed in this Bill.

    In February, I held a surgery especially for women who had come through domestic violence—they were largely on the other side—and I asked them what services they would like to see changed. I am grateful to them for sharing their experiences and being brave. Most of the suggested changes centred on the justice system, but many related to mental health support once a victim has managed to flee their abuse, because the trauma does not end when someone leaves. I heard many examples of how the state apparatus is then used to manipulate the victim from a distance; for example, childcare arrangements and child maintenance payments can all add to the psychological trauma once someone has left.

    I wish to focus my comments on part 4 of the Bill. Bristol City Council is doing some excellent work in this area, alongside some brilliant partner organisations, but I am deeply concerned that the duty placed on local authorities to support and protect victims is not sustainable without the Government providing the necessary funding. After the past 10 years of cuts locally, this is an unrealistic ask, and funding must accompany duty and responsibility. Housing is also key. Having enough accessible and appropriate housing to accommodate victims quickly is essential, but far too often I have seen women and their children forced to move out of local areas, away from support networks and their families, while the perpetrator remains in the house. Where it is safe and appropriate to effect change, I hope that measures will be taken forward in this Bill.

    The Justice Secretary, in his opening remarks, identified a complex landscape locally, and the role of local authorities and police and crime commissioners. He said that the new commissioner would seek to understand that. I hope that she works closely with those in Bristol, as people there are doing a remarkable job. I wish to highlight the work being done by Avon and Somerset police, and I pay tribute to the police and crime commissioner, Sue Mountstevens, who over eight years has led tremendous work in this area, working with voluntary organisations.

    The police could not do such work without our excellent voluntary sector’s work with victims. The sector is coming particularly to the fore at this time, doing tremendous work to support women locally. However, if the Government are really serious about making an impact, they should support the call from my hon. Friend the Member for Torfaen (Nick Thomas-Symonds) ​for a duty to provide funding for this work, and particularly to ensure that good, quality-assured perpetrator programmes are in place.

  • Karin Smyth – 2020 Speech on VAT Rules and Hospital Improvement

    Below is the text of the speech made by Karin Smyth, the Labour MP for Bristol South, in the House of Commons on 9 January 2020.

    It is a pleasure to see you in the Chair for this debate, Madam Deputy Speaker.

    I am pleased to have been granted this debate at a significant time in Parliament, following this evening’s votes. I hope to shed some light on how complicated VAT rules, which have evolved over time in the NHS, are now creating incentives for trusts to behave contrary to the Government’s objectives, in particular those relating to capital investment and the implementation of the long-term plan.

    I am pleased to see the Minister for Health here to answer the debate. My expertise in the finer aspects of taxation policy and its operation is fairly limited, and I do not believe that he is a tax expert either, but before I came to this place I spent most of my professional life as an NHS manager so I know a lot about planning and delivering health services, including new hospitals. The Minister has clear policy objectives as the Government work to implement the NHS plan, which is predicated on place-based commissioning and improved capital infrastructure. I believe that, as the Minister for Health, he has an obligation to support NHS leaders by providing greater clarity on how the rules operate. Indeed, the Office of Tax Simplification agrees with me that this is a problem, with its 2017 report recording frustration

    “about a number of cases where the VAT position was unclear…with HMRC and government tendering departments having differing interpretations.”

    It noted that

    “VAT liabilities should be clearly outlined during the tendering process for public services and contracts.”

    The Government also appear to agree, and the spring statement announced a policy paper, although it was vague on details. The announcement was for:

    “A policy paper exploring a potential reform to VAT refund rules for central government, with the aim of reducing administrative burdens and improving public sector productivity.”

    The 2019 OTS update noted that that spring statement had involved a commitment to

    “a policy paper on VAT Simplification and the public sector”.

    It is essential to raise this issue now, because as we move towards implementing the NHS Plan we all need to understand exactly how the Government will allocate the necessary funding for hospital improvements and other infrastructure projects. The potential of VAT savings will increasingly become a major consideration for trusts up and down the country. Capital investment is always to be welcomed and it is long overdue. Whether we think we will have 40 or six new hospitals, my sympathies are with the finance directors and managers in trusts who are faced with the task of maximising these investments, and managing the competing interests of recruiting and retaining staff, developing integrated local health systems and securing local public trust in their plans. It is my belief that the underlying problem here is that the priorities of Her Majesty’s Revenue and Customs and the Department of Health and Social Care are not in alignment.​

    The problem manifests itself in a number of ways. First, a decade of underinvestment in our health service has led to NHS trusts desperately trying to recover whatever finances might be possible. Some of the VAT rules and debates go back decades. I hope the Minister does not rise to say that the last Labour Government used rules to involve the private sector and are responsible for some of this, and I respond by saying that it all started under Margaret Thatcher’s outsourcing, and we simply do not help anyone. I hope we can be more helpful than that. That was the last comment I had back, so I am just stemming that off at the pass.

    The real explosion in this issue came from the direction of the coalition Government and the creation of contracted-out services regulations. The HMRC manual “VAT Government and Public Bodies”, from 2012, states:

    “Government departments and health authorities have been encouraged to contract out services to the private sector which would have traditionally been performed in-house”—

    over many decades.—

    “It is recognised that many of these services would be subject to VAT and where they were acquired for ‘non-business’ purposes, the non-reclaimable VAT could act as a disincentive to contracting-out.”

    That was then the policy of the Government. The manual continues:

    “It was therefore decided to compensate government departments and health authorities by a direct refund mechanism, which is provided for in section 41(3) of the VAT Act 1994. Under this provision, the Treasury issues a Direction, commonly known as the ‘Contracting Out Direction’ which lists both the government departments and health authorities that are eligible to claim refunds of VAT, and the services on which VAT can be refunded.”

    For lay people, myself included, that in essence means that under these regulations full VAT could be recovered on the cost of a managed service which provided premises that could be used for delivering healthcare. Of course, the private sector was pleased, as it meant it could now, as it saw it, compete on a level playing field with the public sector. But really we should view any tax breaks or loopholes with extreme suspicion, as they lead to reduced revenue for the Exchequer. There should always be a compelling public interest for any tax breaks or loopholes. After this direction and as austerity has bitten, more and more complex arrangements have been set up.

    Following the OTS 2017 report, I am sure many in the accounting departments across the public sector were relieved to hear last year’s spring statement, when the then Chancellor announced a consultation on VAT in the public sector. This could mean a potential reform to VAT refund rules to reduce administration and improve public sector productivity. However, concerningly, the language of the spring statement, and the background to it, appear to suggest a widening of VAT refunds for those engaged in services—that, again, is reducing the amount of VAT paid by public sector contractors back to the Treasury. I am worried that the Treasury are going to make the situation worse.

    My good colleague in the other place, Lord Hunt, followed up on the whereabouts of the review in October, when he asked for an update on the review’s progress. He was told by the Earl of Courtown to expect a policy paper for public consultation “in the coming months”. I know we have all been busy, but the world awaits and it ​would be helpful if the Minister provided the House with an update on that review, either tonight or in writing afterwards.

    The area of VAT avoidance that has attracted a great deal of attention, and that myself and many colleagues—including my hon. Friend the Member for Blaydon (Liz Twist)—visited the Treasury to talk about last year, is the establishment of wholly owned companies in NHS trusts. Such companies can be seen up and down the country, from Northumberland to Yeovil. They vary greatly between those that try to remain part of the NHS and those that position themselves as separate corporate businesses only loosely connected to patients and the public. Most are set up to deliver a full range of facilities management services—including cleaning, catering, porters and security—and then charge the parent trust for this managed service on a private finance initiative-style unitary fee basis.

    We have heard that, to avoid charges of tax avoidance, which created a degree of media discussion, the new arrangements are supposed to be better from a service-delivery point of view. Ostensibly, they are solving problems with estates and facilities management and how staff are managed, but there is no evidence of that. In every case, almost all the benefits, some of which are considerable financial benefits for the trust, appear to come from tax changes, not service improvements. Many of the schemes have resulted in thousands of NHS staff being taken out of the NHS and transferred against their will into wholly owned subsidiaries. This increases fragmentation, and there are examples of companies falling out with their parent trust. There are also arguments about which organisation is responsible for what and who pays.

    Far worse is that in some cases the use of a separate company is used to undermine national agreements on terms and conditions. Around 50 such proposals have been progressed or are in the pipeline, and it is highly worrying that they were advanced in secret, without consultation with patients or the workforce involved. When freedom of information requests were made for access to the business cases that sought to justify the changes, trade unions and others were denied access, with claims that the information was commercial and confidential.

    Just this week, The Pharmaceutical Journal reported that 34% of trusts had outsourced their pharmacy service to a commercial firm and 16% have created wholly owned subsidiaries. The practice is now widespread. Despite that, the recent examples at the Bradford Trust and the Frimley Health Trust have been vigorously opposed, particularly by Unison, and it appears that both proposed schemes have been stopped. That is good news for thousands of low-paid staff who wish to remain NHS employees.

    Thanks to the considerable pressure put on NHS Improvement, trusts must now in effect ask for permission before they create a subsidiary company, although far from being a device to prevent the practice, the seeking of permission appears more like a scheme to embellish some badly written business cases so that the changes can go ahead with a veneer of justification. Under some pressure, that process is being reviewed.​

    Although in the short term it appears that individual trusts will gain through tax advantages offered by the wholly owned companies, other trusts will not, and it means less VAT for the Treasury. But the Treasury seems unconcerned about the lost income. The practice is not a strategic, collaborative or positive solution to the problems that trusts face, and it is not about better employment. The NHS has agreed national terms and conditions for a good reason: because overall it works. All these schemes try to undermine the national agreements and offer staff less favourable terms to save money.

    Having two-tier workforces is not a good way to progress. A few years ago, I made that point successfully in my own area of Bristol. The North Bristol NHS Trust, which was at the time under considerable financial pressure, was considering adopting a wholly owned company but, following local discussions, including with Unison, it recognised that in the local, highly competitive market for staff, at a time when the trust needed to start to collaborate on service development, it needed not to outsource. The creation of a second and third-tier workforce made no sense operationally and gave the wrong messages to staff and the public about valuing the all-important workforce across the entire Bristol health economy, so the trust did not do it.

    As I touched on in my opening remarks, the controversy over VAT and how it applies in the NHS is relevant to infrastructure investment, because the temptation for the trusts set to benefit from the new capital—I accept that there is new capital, and that is good—will be to avoid paying VAT to reduce significantly the direct ongoing costs. That is why it is so important that the Government give careful consideration to how the investment is going to be made.

    I believe the choices made by the Government on this issue will reflect how well they understand both the importance of the NHS estate itself, as part of the health ecosystem, and the direction of the long-term plan. I cannot emphasise enough—and I do think hon. Members understand this—that capital is not a technical, dry subject, but is crucial to the delivery of quality health care. It is not a burden on the system. It is time for us all to show we understand that we need a joined-up strategy and proper investment.

    The thing I kept at the forefront of my mind as an NHS manger, and do so now as a local representative, is that the health service is wholly funded by the taxpayer, and the public have a great attachment to people and place when engaging with healthcare. Buildings are so much more than a pile of bricks of which to sweat the assets, or empty vessels to lease for maximum return. Buildings really are a physical manifestation of local people’s love for and connection to their local health service. Local people are not over-concerned with how services are developed, but they do not expect their health service to behave in such a way as to constantly try to exploit tax loopholes or penalise staff.

    For 15 years or so I have been a supporter of the concept of place-based commissioning, by which I mean local collaboration across the public sector, making good use of the publicly owned estate to deliver quality health services and maximising the value of the taxpayer’s pound. Place-based commissioning has been the direction of travel for some time. It was knocked off course by ​the Health and Social Care Act 2012, but there is hope of getting it back on track once the long-term plan is in place.

    I understand that the setting up of a subsidiary might make sense in the short term for individual trusts, but it makes no sense for the wider health economy or the whole NHS. We must move from a competitive, short-term, market-driven approach at a micro level to a collaborative approach focused on overall gains. The logic of the VAT exploitation and WOCs practice is based on the old idea of trusts having autonomy, behaving like businesses and competing, but this is out of date and directly at odds with the NHS plan, which is built around place-based solutions like sustainability and transformation partnerships and integrated care schemes. On the contrary, the fundamental principle underpinning these initiatives and the Government’s own strategy is much greater collaboration across the system, which absolutely includes the use of buildings and any capital investment.

    Another example of what those running the health service are trying to grapple with is GP commissioning and the new primary care networks. One of my last jobs before coming to this place was running a GP commissioning group, so I understand how difficult it is to get practices to work together and align their businesses. Last summer the NHS published a document called “The Primary Care Network Contract DES and VAT”, referring to the way in which the health service funds these proposals. The document sought to give guidance about VAT in the new primary care networks. The author goes to some pains to set out over several pages what NHS England “expects” will be the best approach—and then comes the following caveat:

    “Although we anticipate the VAT treatment to follow the above analysis it is not straightforward. Practices should note that HM Revenue & Customs has not agreed the position described in this document and that they are the authority responsible for agreeing, administering and collecting VAT.”

    If the Government and NHS England are publishing guidance on how to set up these new organisations without really knowing how HMRC is going to treat them, how on earth can we expect people in the frontline to develop good services?

    Let me mention another issue, which is local to my constituents and which I have been working on for some time: GP employment status. For the last five years, HMRC has been reviewing the employment status of GPs who provide NHS out-of-hours services, which are now called integrated urgent care services. During this period, demand for GP services has risen and the need identified by NHS England for a substantial—that is, 5,000-plus—increase in the number of GPs has not yet been met with whole-time equivalent resourcing. Based on arrangements in place since the formation of the NHS, GPs have continued to work on a self-employed basis, and this remains the desired option for many of them. This has been the subject of some political debate over a number of years, but it is the position as people understand it.

    BrisDoc is a local GP organisation based in my constituency that provides urgent care services to the NHS. It has been faced with five years of uncertainty regarding its workforce because HMRC does not accept the legitimacy of independent GPs working on a self-employed basis, even though this correctly reflects the way services are contracted based on professional and ​legal advice. How they are funded is a separate debate, but if HMRC changed GPs’ status, it would increase the risk that GPs would not be willing to work and would increase the cost to the NHS. Both of these have a negative impact on NHS services, reducing GP capacity at a time when we need more, and costing more, which will ultimately lead to a greater cost for the Treasury.

    The priority has to be on patient safety and care, and the provider, BrisDoc, has continued to fight for this focus in order to maintain the best possible level of GP availability. However, HMRC states that its focus is simply on “employment status” and not any wider implications of any change, whereas NHS England indicates that it cannot get involved with determining employment status for GPs, who are an essential part of the NHS workforce. This leaves BrisDoc vulnerable to financial and workforce loss while doing everything possible to maintain the service. Its plea, and my plea on behalf of my constituents, is this: can the overall strategy for the GP workforce be reviewed to ensure that the key priorities and objectives are aligned with regard to any change in employment status? It is unacceptable nonsense for it to spend five years between the two Government Departments. Will the Minister be willing to meet me and BrisDoc to better understand the problem?

    I hope that I have impressed on the Minister not only the preposterous nature of this VAT problem but how critical it is that we sort this loophole out now through proper consultation with the NHS and an urgent publication of the VAT review. Finance directors in particular need the support to make decisions that align with the strategic vision of the long-term plan, not that are at odds with it. To do this, the guidance from HMRC and the policies of the Department of Health and Social Care must be joined up. If the Government are, as they have indicated, supportive of the strategic direction of the NHS plan, then this must mean supporting local health economies to flourish through the collaborative partnerships integral to STPs and integrated care systems. They simply cannot work if trusts, and other delivery partners, are in competition with each other.

    After a decade of fairly imprudent underinvestment and failing policy, we really are at a crossroads, and we need to get this right. If we can level the playing field for all trusts through proper funding, and consistent, sensible VAT rules that do not divert time and effort from the objectives of the trusts to serve their local patient population, we could have every reason to be positive about the potential of local place-based commissioning for success.