Oral evidence: Work of the Secretary of State for Health and Social Care, HC 523

Oral evidence, 9 July 2019.

Witnesses

Matt Hancock and Sir Chris Wormald.

Chair

Good afternoon, Secretary of State, and welcome back permanent secretary Sir Chris Wormald to this accountability session. Let me start by asking you about NHS funding, and in particular how difficult it is going to be moving forward because we do not know when the spending review will be. On the issue of capital backlog, I am hearing a particular concern from providers of services about the backlog in critical maintenance repairs. Is that something you would like to comment on today?

Matt Hancock

It is something that is on my radar. There is clearly a need for a future capital settlement across the NHS. We have a capital budget for this year and we need to settle the capital budget for next year and onwards in the spending review, whether for new projects that we need, for upgrades, for projects to which we have already committed that are multi-year projects and for maintenance. They are all important. There is a critical piece of policy work that needs to be done to replace PFI. The cancellation of PFI at the last Budget was an entirely understandable policy decision by the Government. After all, the problems of PFI are something that anybody with a PFI hospital understands only too well. The consequences of that and what it is replaced with are something that needs to be landed in the spending review.

Chair

What impact assessment have you made yourself about the scale of the critical backlog? What impact is that having on things like waiting lists across the NHS?

Matt Hancock

A whole series of different categorisations of backlog are done at local level. Some of the maintenance work that is needed is of long standing and needs to be done but is not particularly immediately pressing. There is other maintenance work that needs to be done. We have a capital budget, much of which each year goes on maintenance. It is important when we present the case for the capital budget for next year onwards in the spending review that we take into account the need for maintenance, even though it is the less sexy end of capital budgets, as well as the need for new services and upgrades of existing facilities.

Chair

You say it is the less sexy end, but we are talking about high and significant risk. It is not just that buildings have fallen into a bit of disrepair.

Matt Hancock

That’s right.

Chair

There is high and significant risk.

Matt Hancock

For some.

Chair

It is over £3 billion of the backlog. The total backlog is much greater because, as you know, there have been a series of capital to revenue transfers over the past few years, so, in real terms, capital budgets have been falling. Hospital chief executives are deeply worried about the impact that is having. They need not only an ongoing budget for capital but somebody to address the very high-risk critical backlog of over £3 billion.

Matt Hancock

Yes, of course. As I say, the backlog is partly routine and partly time-critical. We have a capital budget this year, much of which goes to tackling the backlog. I will look for the figure while we are speaking.

Chair

The total backlog is £6 billion. That is not just what needs doing, moving forward.

Matt Hancock

The £6 billion is the total backlog. Each year, part of that is dealt with and new maintenance requirements come in. Part of our case to the spending review is that this needs to be dealt with alongside the expansion of facilities, whether that is new facilities or upgrades to existing facilities. My overall approach to the capital budget is that we need to deal with the maintenance backlog, but we also need to deliver improvements where they best improve service outcomes. I have not pushed particularly hard for lots of big shiny new hospitals. Often, investments in existing hospitals that make them work better—for instance, in Plymouth—are the best way to get value for money in terms of the service improvement that you get in return.

Sir Chris Wormald

Chairman, I think you said that capital budgets were falling. They are not, actually; they are going up. We spent about £4.6 billion on capital in 2015-16, and it is up to £5.9 billion in 2018-19. We do not deny, as the Secretary of State said, that there are a lot of pressures out there and that capital has been constrained while we have been in a period of austerity, but we have actually been investing more each year for the last few years. You mentioned capital revenue switches. They have been falling. They were £1.2 billion in 2016-17 and that fell to £500 million last year. We hope to move away from capital revenue switches after this year.

Chair

Are there further capital to revenue transfers?

Sir Chris Wormald

We have a capital revenue switch this year, which was planned and has been announced; it is in our estimates and all that. We hope that will be the last capital revenue switch we make. Capital revenue switches have fallen by £700 million over that period. At the same time, our capital expenditure—our total budget—went up by £600 million. The net effect of that is £1.3 billion more—

Chair

But can I bring you back to this? In 2010-11, the capital budget was 5% of overall spending and it has gone down to 4.2% of overall spending.

Sir Chris Wormald

Over that period, yes.

Matt Hancock

But over that period the overall spending has gone up significantly, more than offsetting that.

Sir Chris Wormald

As I say, we do not deny that capital has been constrained during the period.

Chair

It has been downgraded as part of what you were doing.

Sir Chris Wormald

We have been completely clear that, during the period of austerity, we emphasised frontline services in our spending. As the Secretary of State says, that went up and the capital position has been tight. However, we have been putting more into capital over the last few years. As the Secretary of State set out, these questions in future will become part of the spending review settlement.

Chair

To give you an example from my local hospital, they had three theatres out of action because of ventilation or extraction systems going down and needing major upgrades; it is currently two. That starts to have an impact on the day-to-day running of the hospital. Secretary of State, you mentioned that you want to prioritise the things that improve the efficiency of hospitals, but if your capital spending means that your hospitals are in such a poor state that they cannot function properly, do you accept that this is now having a major impact on the performance of hospitals around the country?

Matt Hancock

I am glad that one of the three theatres has been brought back into use. I absolutely accept that there is a £6 billion backlog and that the capital budgets have been going up over time, and that the future capital budgets need to be resolved in the spending review. It is a complicated picture because some of the capital expenditure is decided on in the Department, and some of it is decided on at local level by a foundation trust that is in financial balance without recourse to the Department. It all comes out of the same budget. Handling the capital budget is complicated, but at least it has been going in the right direction.

Chair

What is your best estimate of when we will actually see the spending review?

Matt Hancock

I do not know because it is a decision for the next Prime Minister, and we do not even know who that is going to be yet.

Chair

The other issue we have is what is going to happen to the HEE budget. You have your NHS people plan, but it is very difficult for people to make a people plan without knowing how much they are going to be able to spend on the workforce.

Matt Hancock

Up to a point. If I could answer that in two parts, there is a whole series of departmental budgets that need to be settled in the spending review: capital, public health, training, and of course social care. The HEE budget is only one part of the training budget because all NHS organisations need to consider the training needs of their staff. The system as set out in law has HEE separately managing training budgets from the institutions that employ people. We are bringing those together because, especially in hospitals, and in primary care to a lesser extent, it needs to be the hospitals that have the primary duty for training up the staff they need. Training budgets come both from HEE and from internal resources. More than that, the people plan is not just about headcount and the HEE budget, important as they are. It is much broader, about making the NHS a great place to work. I think a big fault in the past, to tell you the truth, is that, within the NHS, workforce planning has been about numbers and what I think of as tractor production figures, as opposed to thinking about people as the main asset of the NHS. To characterise the people plan as only about exactly what numbers we are going to need in 10 years’ time is a very narrow view of the much broader change of culture that we are trying to promote.

Chair

I do not take that view. One of the things that this Committee heard very loud and clear in our nursing workforce inquiry was the importance of continuing professional development budgets, and that is very much a core part of the HEE budget. Is that something you are—

Matt Hancock

Hold on. It is partly about the HEE budget and it is partly about the hospital budgets. If you are running a hospital and you are the chief people officer for a hospital—not all hospitals have chief people officers, and they should—of course you get some of the training budget from HEE. The big training budgets, especially for doctor training, go through HEE. Yes, some of your CPD can come from HEE, an external source, but you can do an awful lot of it on your own balance sheet. If you are running a hospital, the most important resource are your staff and you need to be training them up. Of course the people plan is about what we do with the HEE budget; hence we can only publish the final people plan after the spending review. There is a big culture change that needs to take place across the NHS, and which the best trusts already deliver and are brilliant at, which is not to regard your people as something that somebody else looks after but as an absolutely core resource to each hospital.

Chair

What is your position on nursing bursaries, and particularly having some flexibility for mature students and making sure that we get more students coming into particular key shortage specialties? Are you going to be making any changes there?

Matt Hancock

Yes, we are looking at some changes there to make sure that we have the right incentives, especially to go into the areas of nursing that are in particular shortage at the moment. There is an overall shortage. It is not as big as the vacancies figure, which is often the figure used, because an awful lot of vacancies are filled, for instance, through bank and agency. That is a different problem that also needs fixing. Nevertheless, there is a shortage overall, but the biggest shortage is in specific areas such as community nursing, and mental health nursing in particular. The biggest drop-off in applications after the introduction of the bursary was among mature students, as we have discussed before. We get the new figures on nursing degree applications later this week. I have not seen them yet. The last figures out, six months ago, showed a rise and showed that the number of applicants still exceeds the number of places. That implies that the biggest barrier to growing the nursing workforce is still in the number of training placements. Since the most urgent priority is to get more nurses, the best use of resources is in expanding the number of training places, given that we still have more applicants than training places. We want to take action on incentives to get people into the areas of particular shortage, but we also have to be clear-headed about where it is best to use the firepower we have.

Chair

Because there was not enough thought given to the training places as this started, you are looking at that now.

Matt Hancock

Very much so. Absolutely.

Chair

Johnny has a question about mental health and funding.

Johnny Mercer

Secretary of State, I am interested in funding disparities per area. The reports that have just come out on this talked about quite significant differences between certain areas of the UK. In the Surrey heartlands, it is only 10% of its budget—£124 per person. In South Yorkshire, it is £220 per head. I know that it can be a slightly misleading way of calculating spend, but how are you going to use the money that is coming down with the new settlement to level up and make sure that we move on from coming out with big policy announcements around money to looking and judging ourselves by how it actually feels to live in one of the communities where the mental health spend is significantly less than elsewhere?

Matt Hancock

That is a really important point. We are in the middle of fixing it, although it is by no means fixed. The way we are doing it is as follows. As you know, the long-term plan commits mental health services to receiving a £2.3 billion a year uplift by the end of the five-year period as a minimum. The way we ensure that happens is by having a rising minimum spend that will then be broken down at CCG level, or in due course at ICS level once they are a legal entity in each geography. That means that there will be a rising baseline minimum spend in a particular geography. Some areas are already above where that minimum spend will end up, but lots are not. They will be picked up through that. The trajectory in each geography is being worked out during this financial year and will come into force from April.

Johnny Mercer

The long-term plan is only one part of the picture. One of the things we have focused on in this Committee is a health in all policies approach to how we are going to tackle mental health. The single biggest factor in improving an individual’s mental health can often be a job, and that would be outside your Department. Will you be making a pitch for a comprehensive cross-Government approach to mental health? If so, how has that been received so far either in the Treasury or with any of the candidates who are looking to become Prime Minister?

Matt Hancock

There is a cross-Government committee on this. Jackie Doyle-Price leads on it within the Department. It is already happening in some areas, but there are other areas where there is much further to go. You said that it is not the Department’s remit to tackle mental ill health at work, but actually we now have a joint unit with DWP to look precisely at the health impacts of work, both what the NHS needs to do in order to help people get into work and what the incentives of the DWP policies are to help people get back into work. We have a joint team, and Amber and I put out a joint announcement on that a couple of weeks ago, as part of a wider DWP announcement. Likewise, we have made loads of progress with DFE on mental health support in schools, which has gone well. There has been real enthusiasm in those two areas. They are probably the two areas where we have made the most progress. Another area where I would like to see more progress is on links to the MOD and the mental health of veterans. Yesterday’s announcement by the Defence Secretary on broadening the statutory basis of the policy areas that the MOD is allowed to get into by law will really help. Until now, that has been entirely an NHS issue. There has been progress, but not as much as I would have liked. Now we will be able to do much more joint work, should the proposals that the Defence Secretary made go through.

Rosie Cooper

On the workforce, an area you mentioned that would be short of nurses is in community nursing and that sort of thing. I have two very quick questions. One is on the bullying at LCH. We have the Kirkup inquiry. I seek your assurance that that will be set up and up and running by the recess, so that we know we are good to go by then.

Matt Hancock

Yes. I have said it now, so we will make that happen. I am very keen to see that the new Kirkup report into the issues that you raise gets up and running fast, and also up and running on an independent basis, with the secretariat supporting Bill to do that work in the way he proposes.

Rosie Cooper

Excellent. I have a very short second question. Where are we up to with Kark?

Matt Hancock

Two of the proposals from the Kark review I accepted immediately. The rest were taken forward in the people plan. Several of them require legislation. At the moment, we are looking at a whole series of different legislative options, proposed both as consequences of the Kark review and through the NHS long-term plan itself. We are considering how to take those forward.

Rosie Cooper

Do you have a rough timescale?

Matt Hancock

In the autumn. The new legislative priorities have to await the new Prime Minister, but we are committed to having NHS legislation. There is a question over the scope of that legislation.

Chair

We come now to pensions.

Matt Hancock

I thought that might come up.

Andrew Selous

Secretary of State, could you tell us how serious you regard the pensions issue as far as hospital consultants and GPs are concerned?

Matt Hancock

I regard the issue as very serious. There is a significant problem that is an unintended consequence of a different tax change and its interaction with the NHS pension scheme. The problems for GPs and for consultants are quite different in policy terms. The interactions between the pensions tax regime and the NHS pension are very complicated, but I am absolutely determined to solve the problem.

Andrew Selous

Could you tell us about the level of engagement you are getting from the Treasury on this issue?

Matt Hancock

You will have seen yesterday that the Chief Secretary took the UQ on this—

Andrew Selous

Which I placed.

Matt Hancock

She made constructive comments in terms of making progress. I have spoken to the Chief Secretary since, so this is an urgent priority that we are taking forward.

Andrew Selous

When you say urgent, can you give us an indication of the rough timescale for doing something about it? From what I have seen, it is building up and the last thing we want is for it to come to a head over the summer as we go into the winter.

Matt Hancock

This has to be solved with a consultation first. I want to get the consultation paper out as soon as possible. We are putting the final touches on that consultation, and I met the BMA yesterday to discuss it. That was a constructive discussion. As you can see, the Treasury is engaged. After all, at its core this is a tax policy rather than a Health Department policy, but of course the biggest impact is in my area. We are committed to resolving it by the new financial year. I would strongly recommend that people who are affected by the lifetime allowance take no precipitate action on early retirement, because we are going to fix this problem. For people who are affected by the annual allowance, I understand the problem, but we still need to make sure that we find solutions urgently so that people can do the work they want to do and that the NHS needs them to do.

Andrew Selous

Can you give us an assurance that the consultation will be wider than just the 50:50 accrual proposal, which I understand the BMA do not think is sufficient to address the breadth of the problem?

Matt Hancock

The 50:50 proposal would go some way to solving some of the problems. The BMA makes a case that it does not solve all of the problems. I have heard that case. The consultation will include open questions as to how best to solve the problem. Everybody will be able to respond to the details that we put out, explaining how they think it best to solve the problem. We are just working on the final details of that, following a meeting with the BMA yesterday.

Andrew Selous

What would you say to the GP who is doing fewer sessions per week at the moment because of fear of breaching the annual allowance?

Matt Hancock

I would say that we are trying to fix the problem and we understand the interactions. We are going to try to fix it as soon as possible.

Chair

Some of this is not the Treasury. Some of it arises from difficulties that GPs have in actually finding out where they are with their pensions. One of my constituents was told that they would have to wait for three months to get a response. At the end of that period, when they chased it up, they were told that their pension records had not been updated by Primary Care Support England for three years and that they would have to wait a further three months once their records were updated. Isn’t there something you also need to do to sort out the speed with which people can get up-to-date information about where they are with their pensions?

Matt Hancock

If you write to me with that case, I will absolutely look into it. That is the first I have heard of that particular problem. I have heard lots of problems in this area, but I am very happy to look into that one.

Chair

I will get permission to forward the email to you. I have met a number of GPs over the last couple of weeks, and that seemed to strike a chord—the delays in finding out whether they have a liability at all in the future. Many young doctors simply do not want to take on extra hours because they do not know where that is going to wind them up.

Matt Hancock

In many, many cases, people raise concerns that are not fully founded. I have looked into a number of cases where the problem for an individual is not nearly as big as they worry. It is one of the reasons why I want to solve this as quickly as possible. I think we can give reassurance to quite a lot of people. For instance, I have seen cases where people said that they have been faced with a very large up-front total tax bill, but we have already changed the rules to ensure that people do not have to pay cash tax bills up front and instead can ensure that that is swallowed within a rising pension pot. There are a number of areas where people are understandably concerned because they have heard rumours, and the rumours are much worse than the reality. I will fix the substance, but I also want to provide people with the reassurance that in many cases doing extra work increases their total remuneration, and the problem is not nearly as big as is feared. I want to get the facts out there, both so that we can reassure people and so that people get up-to-date information as fast as possible about what the actual impact on their total pay is. That is only fair.

Andrew Selous

Secretary of State, what lessons have you learned from the failure of the 2016 GP forward view to get 5,000 extra GPs in primary care by 2020? We need to understand where we went wrong on that in order to arrive at a long-term plan.

Matt Hancock

Yes. Great question.

Andrew Selous

What have we learned from that to make sure that we do not fall into the same pitfalls?

Matt Hancock

The good news is that on the latest figures the number of GPs is rising, albeit only by 300. We have a long way further to go, but at least we are moving in the right direction. Looking back to the GP forward view and what happened afterwards, the No. 1 thing is that the focus was understandably on hiring new GPs, and that has been successful. There is a record number of GPs in training; it is three thousand four hundred and—

Sir Chris Wormald

Seventy-three.

Matt Hancock

Thank you. I do big picture and the permanent secretary does detail; it is a good team effort. There was a successful focus on new GPs. I think there was not enough focus on retention, both in people doing a full week’s work, full time, and in keeping people in general practice in the NHS. The NHS people plan focuses on training new staff, including new GPs, on recruiting from overseas and on retention. Hence why I reacted the way I did to the initial questions about the people plan; the retention piece is about far more than just the numbers coming through. It is about the overall culture and what it is like to work in the NHS, dealing with some of the pressures that many people feel under.

Andrew Selous

What do we need to do to encourage GPs to work more sessions? I think the average is about three and a half days a week. If it went to four and a half, it would make a massive difference up and down the country.

Matt Hancock

Yes.

Andrew Selous

Secondly, many GPs are retiring in their mid-50s when, ideally, we should be getting another 10 years or so work from them. What are we doing in those two areas?

Matt Hancock

Tackling early retirement is partly about financial incentives, and sorting out the lifetime allowance pension issue, for instance. It is partly about workload. It is the same answer for people who go from full time to part time. There is the annual allowance incentive problem and workload. If you are working and your list is longer than it has ever been, it is hard. I get that. It is hard. One of the solutions is not only getting more GPs—there is a virtuous circle if we can get that going more strongly—and getting them to the right places, but changing primary care so that GPs have more support. I was really struck a year ago to the day, when I became Health Secretary, by the fact that in primary care there is on average one nurse for every two GPs. In secondary care, there are two nurses for every doctor. They cannot both be right. My instinct, strongly shared by Simon Stevens, is that far more support from other health professionals around GPs also makes it better to be a GP. I do not want to put words into the mouth of the royal college, but Helen Stokes-Lampard is a wonderful woman and I think she probably broadly shares that view. There are examples around the world where the ratio is far higher than 2:1 other health professionals to a GP, where in a primary care system the GPs do the difficult cases where a lot of judgment is needed, and the full weight of their training can be brought to bear on a case, and nurse practitioners and other health professionals and nurses in GP practices can do an awful lot of the broader work. We are in the middle of a move to that structure. There is a long way still to go.

Andrew Selous

Do we have a target for the number of overseas GPs we are trying to recruit in the meantime to get the numbers up?

Matt Hancock

No, we do not have a target for the share between recruitment overseas and domestic training. We have an overall goal of 5,000 more than the 2015 baseline.

Andrew Selous

But we have not put a date on when we achieve that in the long-term plan, have we, unlike the GP 2016 forward view? Maybe you feel you have been burned by that experience, but it leaves me a little bit nervous that there is no date.

Matt Hancock

Why don’t I look to see if we can put a date on it in the final people plan that comes out? It will be dependent on the HEE budget. It is also dependent on how quickly we can fix the problems that are driving retention issues.

Andrew Selous

Personally, I feel it would be helpful from a motivational point of view within the Department if everyone knew that we were trying to get to a certain number by a certain time.

Matt Hancock

Yes. If I can explain where I came from on that, I arrived to find that we were missing the target. Indeed, we were going backwards. We were clearly not going to hit 5,000 by the original target date. I was very clear that we needed to keep the target, and we needed to do work on what date it was realistic to hit it by. I will take that away and look at putting it in the final people plan.

Andrew Selous

That is excellent; fantastic, thank you.

Sir Chris Wormald

I think you said that the five year forward view for GPs was a failure on the basis of the 5,000.

Andrew Selous

I didn’t say that today. I just said that you have not achieved the 5,000 target.

Sir Chris Wormald

There was an awful lot more in the five year forward view for GPs than just the figure, although of course that was very important. An awful lot of that thinking is there in the long-term plan and is going ahead. We are investing more in primary care and all those sorts of things. I would not want to leave the impression that that plan was entirely about the numbers. A lot of the thinking continues, as you have seen.

Matt Hancock

Before we leave primary care, I have some news that I can give you. As you know, we are forming GP services into primary care networks. I can report that there are now 1,259 primary care networks that include 99.7% of all GP practices. We will be getting that to 100% in the coming days and weeks.

Chair

We have not left general practice, as Paul has another question.

Dr Williams

Secretary of State, I would like to ask you a question about patients’ experience of general practice. An increasing proportion of patients say that their experience of booking an appointment is not satisfactory. People report to me that they make sometimes hundreds of telephone calls at 8.30 in the morning. When they eventually get through, they are told, “We’re sorry, you are going to have to call back and repeat the exercise tomorrow.” Sometimes, people say that they cannot get a GP appointment for six weeks. Three out of 10 people report a poor experience. Seven out of 10 people report a good or satisfactory experience. Clearly, it works in some places and does not work in others. What are you going to do to help the people for whom it is not working?

Matt Hancock

Clearly, part of the solution is expanding the service that is available, as we have just discussed—both GP numbers and wider personnel in primary care. I also think there is a technological solution. The standard phone system that is used is unsatisfactory. Even without going to the full use of technology and Skype for a GP appointment, which works very well for some people and which we are rolling out, the ability to book, whether by phone or online, could be much better. The very long waits to see a GP are nearly always to see a named GP. There are very few areas where the urgent need to see a GP has the same degree of problem. I too hear stories of people who have to phone over and over again. There are examples of new technology that allow for most people to go online and pick a GP appointment. You could take a bit longer and pick a named GP appointment with your named GP, or you could go for a sooner one with a GP or healthcare professional in that practice. Getting people culturally used to the idea that more often than not, when you go to the doctor, you do not see a doctor but a nurse or other health professional is a big culture change that we need to go through as a country. That frees up resources for the receptionists at the doctors to use the same system, but by answering the phone to people who cannot go online.

Dr Williams

I know all these things and you know all these things, and practices in which it is working know all these things as well, but what are you going to do to make sure that patients who happen to be registered with a practice that has decided not to take up those technologies are not disadvantaged?

Matt Hancock

This is where primary care networks can help. It is one of the examples of why we have gone to primary care networks. In an individual small GP practice, especially one under pressure, they often do not have the bandwidth to make that sort of improvement. You need quite a lot of communication with your patients and you need to improve the system and get the technology. You need to go through, essentially, what we could regard as a change management process. A primary care network gives us two advantages. First, there are only 1,259 of them. There will be a few more than that once we have finally completed it, but it is a tractable number, as opposed to the tens of thousands of GP practices. Secondly, a primary care network can go through the individual practices putting in place the new system with the support for people—both patients and staff—that is needed to get on to the new technology. I have seen this happen in some GP practices where there has been a massive problem in the past. They moved on to the new system. The patients were concerned, and the GPs did not want everybody complaining. Nearly always, within a short space of time, everybody is much happier with the new system driven by technology, but it takes sensitive handling to get from A to B.

Dr Williams

What is your ambition for this? When will you be satisfied and—

Matt Hancock

Never.

Dr Williams

What is the ambition? How will you know that you have been successful in helping to improve GP services?

Matt Hancock

If, in a year’s time, the proportion of people saying that there is a problem of access, and the means of access falls from around three in 10 to, say, half that figure, that would be a reasonable target. That may be a goal that you as a Committee might want to set me.

Chair

Looking at things like extended access and Sunday opening, what I am hearing from GPs is that that is taking away from the availability of an overstretched workforce to cover out-of-hours shifts and that quite often Sunday extended opening hours are not well filled. Do you think it is time to review the evidence about Sunday GP opening and some of the extended hours aspects? Net, have they actually been a good idea? Should we review it?

Matt Hancock

We have only just completed the roll-out, which happened ahead of time. I think we need to give it a little bit of time to bed in, but there will be a moment when we assess whether it has worked. It is part of the culture change, isn’t it?

Chair

But Sunday opening has been going on for a while. I am hearing that the take-up has not been high, but the real challenge is finding people to fill the out-of-hours shifts. In other words, GPs are doing shifts where there is low demand, whereas out of hours is struggling to fill shifts.

Matt Hancock

Chris is going to come in. My overall approach is that you have to follow the user need and what the patients want. This was done as a Government decision to ensure that it was available.

Chair

Don’t you think it is political though? It was a political decision to say, “We have seven-day opening.” It was not something that was needed but it had unintended consequences, so we should look at that.

Matt Hancock

We should look at how people actually use their GP services, and whether they concentrate just on their iPads, for instance. We need to make sure that we deliver care in the place that people want it at the times when people want it.

Chair

People need it to be available out of hours.

Matt Hancock

Absolutely.

Chair

But you cannot fill your out-of-hours shifts because you have an overstretched workforce.

Matt Hancock

I do not think it is necessarily automatic that there is a link from one to the other. I want to go away and think about that.

Sir Chris Wormald

I was going to say exactly that. NHS England looks at this quite carefully and has been discussing with local areas what is appropriate in different places. I have not had a conversation with them about it for a while; we said we needed to go away and get an update, but, from memory, it is quite different in different parts of the country as to whether or not the local population wants Sunday opening. I will go away and check, but I think they have been taking a reasonably flexible approach about the balance between weekends, evenings and Sundays depending on what local areas want. As I said, I have not had an update for a while, so I will go away and check, and we will come back to you on that.

Matt Hancock

There is an interaction with technology. First, people may choose to access GP or primary care services through technology at different times of the day and week than they would by shipping up at the surgery. One of the things we have found from the expansion of telemedicine availability in primary care is that the times when doctors want to work change. More people are willing to do evening work by telemedicine because they can do it from their own home.

Chair

We are going to come on to social care.

Mr Bradshaw

Secretary of State, in the 2017 general election, your party promised a Green Paper on long-term social care by the summer of 2017. Where is it?

Matt Hancock

It will not be published before the new Prime Minister is in place.

Mr Bradshaw

Why has it not been published in the last two years?

Matt Hancock

Because we have not been able to find a way through that would get the sort of cross-party support that is hugely helpful for projects like this. That has not been helped by the nature of the wider political debates that have been going on.

Mr Bradshaw

Hold on. You are blaming other parties. You are in Government. You have a majority on paper with the DUP. You had a manifesto commitment. What evidence do you have that it is other parties’ fault that you have not published the Green Paper?

Matt Hancock

For instance, we all lived through the 2017 experience of landing a social care policy in the middle of an election campaign. I thought the major parties had taken from that experience that we should try to resolve this in a way that was more collaborative. I think the work of your Committee and the Communities Committee, as I have said many times before, was an exemplar of how cross-party working can proceed. I observe that at the start of May my colleague, Damien Green, who was responsible for this area of policy when he was in Government, came forward with a proposal that was remarkably similar to your proposal, and it was attacked on the day by the shadow Chancellor as a tax on old people. It has proved difficult, and I regret that it has proved difficult, to build cross-party consensus more broadly than Select Committees.

Chair

It was broader than that.

Matt Hancock

I had hoped it was too.

Mr Bradshaw

You mentioned our report. The Lords have come out with a report. Two reports have been drafted following extensive consultation and evidence-gathering with MPs across the political spectrum. You are a Government of one party plus the DUP, yet you have not been able to agree to put a Green Paper out. A Green Paper is only a discussion document. Why don’t you just put it out so that we can talk about it? If Labour attacks it, you will have a field day because you will be able to say that the Labour party is being irresponsible. Why not just put it out there?

Matt Hancock

The Lords report is a case in point. The Lords report is also a cross-party report and it comes to a different conclusion from you.

Mr Bradshaw

But you are in Government. It is your job. You are the Minister. You are the Secretary of State and it is your job to come up with policy for everybody to consult on. Why don’t you just do it?

Matt Hancock

As I say, we are going to have to await the next Prime Minister before we can make progress on this. I wish we had been able to put something out. As with pensions and other similar very long-term issues, it is far better if it is done on a cross-party basis.

Dr Williams

On 28 March 2018, a letter to the Prime Minister from the Chair, signed by more than 90 MPs from across the parties, offered to work collaboratively on this issue. That offer was not taken up. Secretary of State, how can you say that it has been blocked because there has not been cross-party collaboration when a large group of cross-party MPs have offered the chance to work on it?

Matt Hancock

I have taken this up and had discussions with my opposite numbers and various people, and the Committee. I wish that we had been able to find cross-party agreement, but I have not been able to do that yet.

Mr Bradshaw

The Daily Express said last month that 77 people over 65 have died every day waiting for a social care package since you first announced it more than two years ago. In total, 64,000 people have died. Is that a statistic that you recognise?

Matt Hancock

I have not seen that statistic, but what I would say is that the long-term solutions to this are by their nature long term. We also need short-term solutions, which we have provided. The total budget available to spend on social care has gone up by 11% over the last three to four years. We have put in an extra £650 million this financial year, and £240 million in the last financial year, since I became Secretary of State a year ago. Of course, like so many people, I want to see a long-term solution, both so that we have a sustainably funded social care system into the future and so that we can remove some of the injustices in the system, like the fact that unlike any other area of Government policy people have to sell their home in order to pay for it. There are injustices in the rights that you have for Government support according to your condition, whether you have dementia or cancer, for instance. There is a whole series of injustices in this area that I would dearly love to see addressed, and there is the short-term funding problem. We have done better on the short-term funding problem with the provision of funding, albeit one year to the next—I stress that is a short-term solution—than we have with being able to bring forward proposals for the long term.

Mr Bradshaw

You talked about dementia. The Alzheimer’s Society said today that over the period we have been waiting patients have spent £15 billion of their own money on care. Is that a figure you recognise, and is it acceptable?

Matt Hancock

I saw that on the front page of the newspapers. In fact, one of the reasons I was a couple of minutes late was that I was with the Alzheimer’s Society at their presentation downstairs.

Mr Bradshaw

Purely coincidentally I am sure, the man you are backing to be the next Prime Minister has promised as his priority a tax cut for the richest 8% of the population, amounting to £8 billion annually. That is exactly the same figure that the Lords Committee, and indeed we, believe needs to go into social care to plug the gap. Which would be your priority?

Matt Hancock

He has also proposed solving the social care problem and made it clear that that will be a high priority for his Administration. We do not know for sure that Boris Johnson is going to win. I think he will, and I hope that he does. He has made the commitment to tackle social care as a very significant issue.

Mr Bradshaw

But government, as you know, is about priorities. Would your priority be to give £8 billion to the richest 8% of the population or to solve the social care crisis, as Health Secretary? That is your responsibility as Health Secretary.

Matt Hancock

I am absolutely clear that we need to reduce taxes when we can afford that, and I am delighted that Boris has made the clear pledge to tackle the problems in social care.

Mr Bradshaw

How is he going to do it?

Matt Hancock

He has put forward high-level proposals and I look forward to working—

Mr Bradshaw

How is he going to pay for it?

Matt Hancock

He has made a series of proposals during the campaign, as has Jeremy Hunt. As we know, there is fiscal firepower in the Treasury currently because the economy is growing strongly and employment is very high. A year ago, when I came in, one of the questions in my first evidence session was, “How are you going to pay for the £20 billion extra for the NHS?” The answer is that we have not had to put up taxes to pay for that because there are more people in work paying taxes rather than people paying more tax. The best way to fund strong public services is with a strong economy.

Chair

Can I add one section on the issue of sleep-in shifts, particularly for disabled adults who require overnight care? The issue has not been resolved. As you know, the advice is still being given that providers should continue to pay sleep-ins at the national minimum wage, but there has been no earmarked extra funding for that. A great deal of anxiety about payments is being caused to people who are in control of their own personal budgets. It is causing a huge amount of stress for severely disabled adults, and is putting providers at significant risk of collapse. The issue has not been resolved. We are waiting for the Supreme Court judgment in 2020, but providers are still being advised to continue paying without having any money earmarked. It is particularly an issue for young disabled adults.

Matt Hancock

The Court of Appeal judgment that was reached just under a year ago is that employers are not required to pay the national minimum wage for sleep-in shifts.

Chair

But they are being advised to continue to do so, so that they do not have a huge backlog liability if the Supreme Court judgment goes the other way.

Matt Hancock

As far as I understand it, there has been updated public guidance following the ruling. Of course, I have to be careful in what I say because this area is, as you mentioned, being appealed to the Supreme Court, who are set to hear the arguments on 12 and 13 February next year. That is the situation.

Chair

Can I clarify something? Learning Disability Voices wrote to me about this on 7 June. They say that they understand the Government’s position to be that providers should still continue to pay sleep-in shifts at the national minimum wage. Are you saying that is not the case?

Matt Hancock

We put out updated public guidance, and I will write to you with the full details of that guidance. I am being careful in what I say because the area is under judicial consideration.

Chair

It would be helpful if you could clarify it because, as I said, there is a great deal of concern that the issue has not been resolved. We have been backwards and forwards in correspondence on it, but if you could write to me again that would be very helpful.

Matt Hancock

I will write to you before the end of next week.

Chair

Thank you; that would be helpful. We come now to the issue of prevention. It is extraordinary that the prevention Green Paper was apparently on the grid for publication this week for No. 10 and it has been pulled at the last minute.

Matt Hancock

I wouldn’t believe everything you read in the newspapers.

Chair

Well, I think I believe that.

Matt Hancock

You may well believe it but—

Chair

It was from a very good source. Was it on the No. 10 grid for publication this week? Presumably, you would have known that.

Matt Hancock

Not as far as I know, no. Obviously, I have been doing a lot of work on it, but as far as I know it did not have a grid slot.

Chair

The publication has not actually been delayed. Is that what you are saying to me?

Matt Hancock

I was not aware of a set date for it to be published. In a way, that is process rather than substance.

Chair

I think there is a great deal of substance to discuss on this.

Dr Williams

I would like to ask about the soft drinks industry levy. As you rightly said in January, it has taken 90 million kg of sugar from drinks since it was introduced because companies reformulated their drinks to avoid the levy. You hailed it in January, but last week you backed a review into the soft drinks industry levy. Are you no longer convinced that the evidence shows that it is effective?

Matt Hancock

I am strongly supportive of following the evidence. In fact, last month I asked the CMO to conduct a review of the evidence around this, and I look forward to hearing what she has to say.

Dr Williams

What is the expert advice that you are currently getting about the impact of the soft drinks industry levy?

Matt Hancock

The facts on the ground have not changed. However, it is always best to base your judgments on the best available evidence. That is what I have always sought to do as a Minister, and I think evidence-based reviews are very valuable in formulating future Government policy. Hence, I had already asked the CMO to conduct such an evidence-based review.

Dr Williams

What was the remit of the review? Is it a review into the policy that has already been implemented, or is it a review looking at potential extension of the levy?

Matt Hancock

It is to gather evidence around the area covering both.

Dr Williams

The levy itself is up for review.

Matt Hancock

The question is whether we should gather evidence about the impact of the policy and any future policies associated with it. I think all policies like this should be based on the evidence. I am delighted that the CMO, who is one of the finest scientists of her generation, will be conducting that evidence-based review.

Dr Williams

The evidence is that it has taken a large amount of sugar out of people’s diets. There is not yet any evidence that that is being translated into a reduction of childhood obesity, but there is certainly less sugar being consumed. Do you see the case for extending it, given that less sugar is being consumed, perhaps to milk drinks?

Matt Hancock

The case for an extension was always due to be considered by the Government in 2020. When the so-called sugar tax was first introduced, we always said that we would look at it again in 2020. I commissioned the evidence base from the CMO in anticipation of that consideration being given next year.

Dr Williams

Would you like to see it extended?

Matt Hancock

I would like to see the evidence.

Dr Williams

If the evidence shows that it is reducing consumption, do you think that is a good thing?

Matt Hancock

Let’s see what the evidence says.

Dr Williams

What if the evidence showed that it is reducing consumption?

Matt Hancock

I do not want to prejudge what the evidence says. I want to look at the evidence.

Dr Williams

But we already have evidence that shows that. You are looking for the evidence review; that is reviewing existing evidence. There is already evidence in the public domain that shows it is reducing consumption. Do you think that is a good thing?

Mr Bradshaw

You highlighted a speech.

Matt Hancock

Yes, but having asked Sally to do this work, I do not want to prejudge it. I want to ensure that she can come to a full scientific basis.

Dr Williams

I am not asking you to prejudge it; I am asking—

Matt Hancock

But you are, because you are asking a conditional question—if this is the outcome.

Dr Williams

You are asking for an evidence review.

Matt Hancock

Yes.

Dr Williams

The evidence that is being reviewed is there. You have hailed it, and there are papers that have been written in The Lancet and the British Medical Journal that have looked at it. I am sure that you are getting expert advice on it.

Matt Hancock

I am.

Dr Williams

Do you think it is a good thing that consumption of sugar is reducing as a result of the soft drinks levy?

Matt Hancock

I am a massive fan of tackling obesity. I think that is incredibly important.

Dr Williams

That was not the question I asked. Is it a good thing that consumption—

Matt Hancock

You keep asking about the evidence. As I said, I asked Sally Davies to do an evidence-based review, and that is what I will be looking to.

Dr Williams

If the evidence-based review shows that it works, would you politically—this is a political question—support extending it, perhaps to other products, or perhaps increasing the level at which taxation applies so that we are taking more sugar out of people’s diets?

Matt Hancock

That is another of those conditional questions.

Dr Williams

It is a political question. These are political choices about—

Matt Hancock

No, it is a conditional question.

Dr Williams

These are choices about public health policy.

Matt Hancock

I look forward to looking at the evidence.

Andrew Selous

I want to broaden it to the obesity debate, if I may. A recent report by St Thomas’ Hospital’s charitable arm told us that only 5% of children in Paris are obese, but the figure for London is 22%. We are a bit of a European outlier. When you look across the channel, what lessons do you draw from what Europe does better in this area that you think we could usefully copy here for the UK?

Matt Hancock

This is really tricky territory. There is a whole series of cultural questions, in particular in terms of diet and the prevalence of home cooking. There are differences between different countries, essentially, in how people eat and the nutrition that we have.

Andrew Selous

Is there any intrinsic reason why the UK could not move towards a more European attitude to food? If you look at the prices of some foods, fresh food seems to be cheaper in Europe according to the recent Food Foundation report, whereas often in the UK processed food seems to be cheaper. There seems to be something odd going on with the pricing mechanism. I wondered whether anyone in the Department of Health was looking at that. We have seen success in Amsterdam in some areas. They are actually building on the reductions in childhood obesity there and looking at what some supermarkets are doing. They are trying to sell less unhealthy food to children. It seems to me that, if we want to be world-leading, we have to look at what other countries are doing well to learn from them.

Matt Hancock

I totally agree with you. There is such a lot of work to do. The recent evidence on the price impact of going for fresh and non-wrapped food compared with pre-prepared food I thought was incredibly striking. I think it was from Hugh Fearnley-Whittingstall, who has done some good work in the area. There are inQ419ternational comparisons, but the thing is that we have to start from where we are. We are so far behind some other countries that we have to do a whole lot of work even to catch up.

Sir Chris Wormald

We have some national examples. I am sure you have seen the case of Leeds, which had some success.

Andrew Selous

I have looked at some of the Leeds data.

Sir Chris Wormald

On your general point that we should look at what works, yes, of course we should. We look internationally at best practice from around the world. There is always a translation question, and quite frequently what works here already is better. The public health position internationally is quite mixed. We do very well by European standards on smoking—

Andrew Selous

I will stick to obesity for the moment, if I may.

Chair

I think there is a political question as well for the Secretary of State.

Andrew Selous

Can I come back to the actions proposed in chapter two of the childhood obesity plan? I am picking up a little bit of concern from the Obesity Health Alliance and others about the length of time of some of the consultations. Could you give us an update on when those consultations will be concluded and we can expect to see action on things like the 9 pm watershed, the multi-buy promotions and other areas like that?

Matt Hancock

I do not have an exact list in front of me, but I can come back to you.

Andrew Selous

That would be helpful.

Matt Hancock

Some of those are currently open, and some are closed but have only just closed and we are considering the responses. We need to take action in this space. We have set out a whole load of actions in chapter two, and we are taking that work forward.

Andrew Selous

While you are Secretary of State, you will ensure that there is no delay on sticking to the chapter two timetable on consultation and action following that.

Matt Hancock

Yes, there has been a huge amount of work.

Andrew Selous

The last area I would like to ask you about is calorie labelling. I will ask you the same question I asked Simon Stevens a week ago. Do you know how many calories you have eaten in the last 24 hours? Ballpark, are you able to tell us?

Matt Hancock

No.

Andrew Selous

Does that worry you, Secretary of State? As men, we are supposed to eat less than 2,500 a day and for women it is 2,000. It is almost impossible to find out if we are doing that, yet it is Public Health England guidance to us all. How are we supposed to stay within it if the labelling is so poor?

Matt Hancock

Part of the reason that I have not is that it is not just about labelling. It is also about how we live our lives. I try to eat in a way that keeps me reasonably healthy. It is a challenge that all of us face.

Andrew Selous

What is behind my question is that I am frustrated by the calorie labelling on what we buy when we go out.

Matt Hancock

Yes, absolutely.

Andrew Selous

It is one of the actions in the childhood obesity plan that out of home there will be calorie labelling. We are bringing it in for one part of the landscape, so I am really asking about when we go to supermarkets. Don’t you think there is a role for better information in GP surgeries, for example, as to how many calories are in the typical meals we Brits eat? Wouldn’t that be a help in terms of public education?

Matt Hancock

Yes. An important thing to consider is how that information is imparted. Sometimes it is there, but it is in tiny print on the back and you can hardly see it. There are other ways of imparting that sort of information that are better.

Mr Bradshaw

You rather dismissed the Chair’s questions about process, Secretary of State, but process is quite important. As Cancer UK pointed out this week, obesity is now the main cause of cancer. If the Green Paper is not delayed, when can we expect it?

Matt Hancock

Shortly. The question of what is on the Downing Street—

Mr Bradshaw

You said shortly about the social care Green Paper two years ago, or your predecessors did.

Matt Hancock

I do not think I did.

Mr Bradshaw

You are constantly saying shortly about Green Papers that then never appear. A lot of them just vanish, don’t they?

Matt Hancock

No.

Mr Bradshaw

What do you mean by shortly? Let’s be a bit more specific. We have had shortly before and it never happens.

Matt Hancock

I cannot be more specific because the date has not been agreed.

Mr Bradshaw

The outgoing public health Minister who resigned in March tells me that he did the write-around several weeks ago, before he left, so what is going on?

Matt Hancock

I am not going to get into internal processes. I do not know whether that is true or not.

Mr Bradshaw

He also told me that the write-around draft contained plans to extend the sugar tax to sugary milk drinks; to ban the sale of energy drinks to the under-16s; and a slew of other policies aimed at improving public health. It would be very disappointing if those did not emerge in the eventual Green Paper, wouldn’t it, because of what is going on with the current Tory leadership contest?

Matt Hancock

No. The public health Minister has been doing a brilliant job. She has been in post for a long time and she has been responsible for the final drafting of this Green Paper, not her predecessor.

Mr Bradshaw

Caroline Dinenage?

Matt Hancock

Seema Kennedy.

Mr Bradshaw

Do you think that the sugary drinks tax is regressive?

Matt Hancock

I have not seen analysis on that, and it is always worth looking at the evidence.

Mr Bradshaw

I beg your pardon? You are Health Secretary, but you have not looked at the evidence that caused your Government to introduce it in the first place, and that showed it was not regressive and that actually the people who most benefit from it are the least well-off.

Matt Hancock

It is a tax policy that has been in place for some time. I was not the Health Secretary when it was brought in. I have just asked for a review of the evidence.

Mr Bradshaw

But, given that there is a major public health crisis, you have not yourself studied the evidence that showed that the policy is not at all regressive.

Matt Hancock

The thing is, Mr Bradshaw, when I want to see the evidence, I get the very best people to assemble it, and then I do not prejudge the outcomes of that evidence.

Mr Bradshaw

Is it not rather strange that you have only asked for the evidence since your favourite contender for the Tory leadership made a boo-boo over this? You never asked for it before.

Matt Hancock

No, I did ask for it before, so that is nonsense.

Mr Bradshaw

Has Caroline Dinenage been reprimanded for calling what Boris Johnson said “Bollocks”?

Matt Hancock

No.

Johnny Mercer

Secretary of State, there are obviously two different lines of thought in politics around the sugar tax at the moment. For those who do not have the deep whirl of ideology and are just pragmatists and want to see childhood obesity decreasing and have been to places like Amsterdam to see where this has happened—I am genuinely asking you because I want to be able to say this to people—what would you say is the line in your mind between state intervention and a smaller state actually intervening on behalf of the most vulnerable people, who are at times exploited by very clever agents?

Matt Hancock

What I would say is that all taxes have behavioural consequences. Those of us on the centre right who think about the dynamic impact of taxes really understand that. For instance, some people make the argument that, as we reduced corporation tax, we increased corporation tax receipts because it led to an increase in economic activity. That is a classic centre right argument about the impact of taxes. It also works in other areas. There is evidence, for instance, that the anticipated static expectation of receipts from the sugar tax were £600 million, but the actual receipts were £253 million, which demonstrates a dynamic impact. The question you have as a policy maker is where do you want your dynamic impact to fall? Hence, it is so important to review the evidence and base your analysis on the evidence.

Johnny Mercer

Do we have any evidence from other cities that have a better record? You have heard that we are a bit of an outlier when it comes to childhood obesity.

Matt Hancock

There isn’t anywhere else that has done a sugar tax in the same way. There are other cities that have been successful. Chris mentioned Leeds. You mentioned Amsterdam, but nowhere has really tackled the problem. The countries that do well on obesity are ones where there is a big cultural difference. Nowhere has yet turned around a problem that has gone too far, so to speak.

Johnny Mercer

I know that people have gone pretty hard on you over this, but the reality is that both contenders to be the next Prime Minister have said that they will follow the evidence.

Matt Hancock

And care deeply about solving the problems of obesity. I think it is always worth waiting for the evidence.

Chair

You mentioned the dynamic impact of the tax. It has gone from £600 million to collecting £253 million.

Matt Hancock

They are the correct figures, yes.

Chair

Isn’t that the perfect tax? It drives reformulation and that is why you are collecting less. It has had the impact of making producers reformulate. Surely, that is very good evidence that it has had an effect. It depends what your end point is. Are you going to assess whether it is effective by whether or not it has in itself been the magic bullet in preventing childhood obesity, or are you are going to be saying that it is successful because it has reduced sugar consumption, which is the point my colleague Paul was trying to get at? If you are going to say, “We will scrap it because childhood obesity hasn’t changed,” surely that would be appalling, Secretary of State. It is not just about obesity; it is about things like the fact that the biggest cause of admission to hospital for children is to remove their rotten teeth. We are interested to hear from you what looks like success. What do you mean by evidence? What will be your end point?

Matt Hancock

I look forward to coming back and giving you a full assessment after we have seen the full scientific evidence from the CMO.

Chair

Is the end point for you going to be whether it reduces sugar? Is that a good end point, or is the end point going to be whether it has had an impact on obesity? What are you judging as success? Is it a proxy marker? What is your marker for success?

Matt Hancock

There is a problem that the biggest cause of admission to hospital among children is because of dental problems.

Chair

Removing rotten teeth.

Matt Hancock

Largely tooth decay. There is also a problem of obesity. Both of these need to be tackled. To say is it one or the other—

Chair

I am not saying one or the other.

Matt Hancock

Obviously it is both.

Chair

But if you are judging the end point and if you are going to say to us, “Well, we’ll scrap the sugary drinks levy if there hasn’t been a reduction in obesity,” that would be appalling.

Matt Hancock

No, I am proposing to follow the evidence.

Chair

That is what we are trying to ask you about. What evidence are you most interested in? Are you most interested in reduction of sugar or in some—

Matt Hancock

As I say, I am interested in both and I look forward to Sally’s report. We are going to look at all these things in the round. There is another point as well. For both the goals you mentioned, there are also other policies that can be brought to bear.

Chair

Yes, you have to do both. But the worrying thing is that, if there is a change in philosophy that says childhood obesity is all about making children run around a bit more and that we do not want to do anything that upsets industry, I am afraid we are in real difficulties. What people want to be clear on from you, Secretary of State, is where you feel all of this fits in. I want to quote to you for a minute from your vision for prevention, which was published in November, to great fanfare. You said: “There is a role for government to create the environment that makes healthy choices as easy as possible, and to address the conditions that lead to poor health. This could be through laws, regulations and incentives.” Are you still committed to the fact that sometimes laws, regulations and incentives have a place?

Matt Hancock

I am committed to that. I am committed to every word of that paper. Absolutely.

Chair

That is what I wanted to hear. We are not going to be saying that all of this is nanny state nonsense and it has all got to be swept out of the way because one of your colleagues does not like anything that looks like intervention.

Matt Hancock

We are going to be following the evidence, Sarah.

Chair

Well, that is very good. We shall be bringing you back to discuss that if you are still in your post.

Matt Hancock

Did I mention that we should follow the evidence?

Chair

Yes, I know, but we want to be clear about what you are going to be measuring. There is a philosophy that we are hearing from some of your colleagues that we do not have to care about things like this if they involve things that industry does not like.

Mr Bradshaw

You keep saying “follow the evidence,” but you have only started saying it since Boris Johnson made his remarks.

Matt Hancock

No, that is just not true.

Mr Bradshaw

You have been a Minister for longer than that. Was your evidence not evidence-based before the leadership campaign?

Matt Hancock

Dearie me. You cannot base your questions on things that are not true, Mr Bradshaw. I asked the CMO last month to undertake this review, and I am delighted that she is undertaking it. I keep being invited to prejudge the outcome of a review of one of the most brilliant scientists of our age, and I would rather let the evidence speak for itself.

Chair

If the CMO says, “Extend it because the evidence supports it,” will you be recommending that to your colleagues?

Matt Hancock

I will be waiting to see what she says.

Chair

I think we have gone as far as we can there. Paul, do you want to talk about the first 1,000 days?

Dr Williams

I do not have a specific question.

Chair

We will move on to Brexit.

Mr Bradshaw

Do you still agree with yourself on this, Secretary of State?

Matt Hancock

Yes.

Mr Bradshaw

Good, because on 2 June, you said in your interview with The Times—I think it was while you were still in the leadership race; I cannot remember—“No deal is not a policy option available to the next Prime Minister, whether they like it or not.” Do you still agree with your statement?

Matt Hancock

Since then, if you follow the evidence, you will see that there have been votes in the House of Commons.

Mr Bradshaw

For goodness’ sake, what a joke.

Matt Hancock

Since then, there has been a vote in the House of Commons, which I, frankly, expected the Government to lose, but which the Government won by 11 votes. You have to follow the evidence.

Mr Bradshaw

You now think that a no-deal Brexit is desirable, do you?

Matt Hancock

No, and I have never said that, but I think we need to prepare for it and always have.

Mr Bradshaw

You said it was not a policy option available to the next Prime Minister.

Matt Hancock

That was my judgment at the time. At that point, there was a vote in the Commons, which I think a lot of people expected the Government to lose, to make time available in the parliamentary timetable for legislative action to rule out no deal. The Government won that vote by 11 votes, so there you go.

Mr Bradshaw

You are talking about one vote, but there had been previous votes where MPs voted 400 to 160 against no deal, and there will be other opportunities to vote. You are basing your judgment now on a single vote in the Commons in the middle of the Conservative leadership campaign rather than what your best assessment of the judgment was when you were running to be leader of this country, in your interview with The Times on 2 June.

Matt Hancock

When the evidence changes, I consider that evidence, yes.

Mr Bradshaw

So it might change back again if Parliament votes to stop no deal. You might have to change your mind again.

Matt Hancock

I have always maintained the view that we need to prepare for no deal. I prepared the Department for no deal on 29 March, and I am preparing the Department and the overall health system for a no-deal exit on 31 October.

Mr Bradshaw

In spite of the fact that the British Medical Association believes that a no deal would have catastrophic consequences for the health and social care sector. Thanks to an FOI, because the NHS would not volunteer this information, trusts also talk about a catastrophic consequence or impact of a no-deal Brexit on the health and social care system.

Matt Hancock

I do not recognise that. I think that the plans we have put in place have allowed us to make the necessary preparations. You know our caveats around guarantees and how we rely on others to make preparations as well. For instance, the pharmaceutical industry did a great job in the run-up to 29 March. We are ramping up no-deal preparations again now, ahead of 31 October, and I am confident that the Department is doing everything appropriate for a no-deal exit then, should that happen. That is not my preferred outcome. It never has been, but it has always been something I think it is necessary to prepare for.

Mr Bradshaw

If you are still in this job as Health Secretary in October under a Prime Minister heading for no deal, you would be comfortable with that, would you?

Matt Hancock

I have always been clear that we need to prepare for a no-deal exit.

Mr Bradshaw

I am not talking about preparing. I am saying if it is about to happen, rather than having a referendum or—

Matt Hancock

It is not my preference, but, as in the run-up to 29 March, I am fully prepared to make the necessary preparations in advance and then do my duty to ensure that people get the medicines they need.

Mr Bradshaw

How are those preparations going, particularly when it comes to freight and shipping? They were not going too well previously, were they?

Matt Hancock

Preparations were in place ahead of 29 March and we have renewed those preparations for the new date.

Mr Bradshaw

What about the ferries? They did not exist, did they?

Matt Hancock

We got the ferry contracts that we needed to and the capacity that was necessary. As you might have seen, because it was published 10 days ago, we have made further preparations for 31 October.

Mr Bradshaw

And the warehousing and all your fridges.

Matt Hancock

We have renewed the contracts with refrigeration capacity to make sure that we have the plans in place. We learned a lot from doing that in the run-up to 29 March. We have renewed the contracts as appropriate.

Dr Williams

I want to ask about post-Brexit trade deals. Donald Trump has said that the NHS is freeloading from the United States because our drug prices are too low. Do you think that the NHS is freeloading off the United States?

Matt Hancock

No, I think we get a good deal for our drugs. As the largest single payer system in the world, we are able to negotiate well with global drugs companies. I am very proud of the drugs deals that we do because, while we always look to get drugs cheaper, and particularly for generics there is further work that we need to do, we strike a good deal.

Dr Williams

I agree with you. Your equivalent in the United States Administration, Alex Azar, said that the United States would “pressure” other countries through trade negotiations, “so that we”—the United States—“pay less, they pay more.”

Matt Hancock

That is the nature of trade negotiations.

Dr Williams

That is what Trump wants because apparently we are freeloaders. Won’t any trade deal with Trump mean our health service paying more?

Matt Hancock

No, because we will negotiate well. For instance, you might have noticed that Donald Trump first said that the NHS needed to be “on the table” in a trade deal, and then, after pressure from the Government, within 24 hours, reversed that position. Of course, we shall be robust.

Dr Williams

When we are talking about health services being on the table, it is pricing of drugs that is likely to be on the table. Can you absolutely guarantee here today that the NHS will not be paying more or will not be worse off as a result of a post-Brexit trade deal with Trump’s USA?