Food for schools, prisons and hospitals, or Public Sector Procurement of Food.
The White Paper for a Health and Care bill.
[The Covid epidemic in England has highlighted the low number of nurses and doctors on the one hand, and the high number of people in poor health on the other. The minister for Health, Matt Hancock, presented to Parliament a White Paper that seeks to address both ends of the question. This Paper seems to reverse some of the 2012 Health and Social Care reform, in particular the minister for health seems to be getting back ultimate responsibility for the health service, which should be a good thing. See his presentation below.
Improving the food in schools, hospitals, prisons and army barracks, other government agencies and local government care homes would be a start in improving the health of the nation, but is a near impossible task because of the ideological stance of the government.
The Environment, Food and Rural Affairs Committee met on 12 January this year to discuss just that. There are guidelines for food buying in the public sector: buy local, buy fresh food etc ; these guidelines are not enforced and the Parliamentary Under-Secretary of State for Farming, Fisheries and Food, Victoria Prentis, is not proposing to have them enforced: it is a matter of cajoling and persuading. As she says repeatedly, food is a private good in this country, it is bought and sold. And the cost is where public bodies can make savings. (You won’t read that last bit in the transcript which follows.)
It was not membership of the EU that stopped public bodies from buying British, WTO rules also forbids this. But ‘buying local’ is allowed, and it is a proxy for ‘Buying British’.]
Public Sector Procurement of Food
[the first question refers to the already existing Government buying standards; these are:
- Foods produced to higher sustainability standards
Food produced to higher environmental standards – for example fish from sustainable sources, seasonal fresh food, animal welfare and ethical trading considerations
- Foods procured and served to higher nutritional standards
Food with reduced salt, saturated fat and sugar and increased consumption of: Fibre, fish, fruit and vegetables
- Q99 Chair: I appreciate your co-operation in these matters. We will get stuck straight into the first question on procurement of food. Why are the Government buying standards for food and the balanced scorecard not mandatory across the whole public sector?
- Victoria Prentis: They are mandatory in most of the public sector in terms of hospitals and the Prison Service and all Government Departments and their agencies. The section they are not mandatory for is schools. It is fair to say that the same standards are embedded in the school standards. The GBSF and the balanced scorecard are great documents. We will refine them and continue to work on them, but they are documents that I am sure most of your members would wholeheartedly support. The real problem with them is not whether they are mandatory; it is whether they are actually enforced. My worry and what we have to seek to address in this space is that we have to encourage public services to abide by these standards. They are mandatory across much of the public sector at the moment, but that does not mean that they always happen.
Victoria Prentis: Seasonal food is broadly cheaper food, which is an important point to get out there. One of the things that we may talk about later is the rules. We will still be constrained by international buying rules and WHO rules on procurement. We will not be able to say, “You must buy British”, in terms, but we will be able to say, “You must buy local. You must buy seasonal. You must buy sustainably sourced. You must buy organic”, if that is what we want to say. Those are the ways that we will encourage the uptake of food from small and medium-sized British food producers.
Q102 Robbie Moore: Welcome, Minister. My question is about monitoring and compliance. How many public sector bodies comply with the Government buying standards for food, and how do the Government obtain such data?
Victoria Prentis: As I was saying earlier, this is the weak point. Our data is really not good enough. In fact, I am not even prepared to tell you the extent of public procurement spend because we have not had good information on that, probably ever and certainly not for at least 10 years. It would not mean much if I were to tell you the data we have.
In DEFRA we do an annual survey of Government Departments; some of the responses we get are excellent and some are not. This is the area we really need to focus on. This is where change can really happen. We need to work at how we enforce our good rules. We will undoubtedly do further work on these rules in the next 18 months, but they are already good and gold standard—the sort of things we all approve of. Enforcement is the key to this.
We are having a national conversation at the moment about enforcement of rules. With that, it is probably the case that advertising, encouraging and showcasing good practice is going to be what truthfully makes the difference. Otherwise we would have to pay for a whole new world of enforcement, which I do not see central Government appetite for. We can definitely do more within the system; we have to see what is going on, and I am sure that will take place, but most of this is nudging, encouraging, advertising and showing.
Q104 Mrs Murray: How will leaving the European Union allow the UK to change its domestic food procurement rules?
Victoria Prentis: That is a really good question, because the perception of many of us has been that we have been held back from saying, “Buy British”, by being a member of the European Union. We have of course been part of the EU’s state aid rules for a long time. Truthfully, we will still be bound by the WHO state aid rules, which are not all that different. Where leaving the EU really changes our perception is that we are now starting to focus—you know, because you and I discuss it regularly—on our agricultural policies and fish policies as an independent nation. Leaving the EU, regardless of how we all voted in the referendum, has given us oomph and confidence as a nation in our food supply in a way that has really changed the focus. While the rules will not be all that different, we are still going to have to say, “Buy local. Buy sustainable. Buy organic”, or however you want to say it. We will not be able to say, “Just buy British”, but there is now a real appetite—sorry to use the word—for this work, and a real sense of urgency within Government that we take this forward, which perhaps we have not had in the last few years.
Q105 Mrs Murray: Do you agree that EU rules did not stop us from sourcing more food locally and that the UK could have done more by using proxy quality measures such as seasonal?
Victoria Prentis: Yes, I completely agree. It is interesting to see what other EU countries do. The French equivalent of the Agriculture Act says that 50%, I think, of food in public canteens should be organic or local or produced to certain standards. It does not say anywhere, “You must buy French food”, but the net result is that this definitely favours French farmers. I am sure as a Committee you are already looking at that, but that is the sort of thing we need to be looking at. We do not need to put it in primary legislation, but we can build our own guidelines around that.
The Netherlands are also really interesting in the food space, not least because they have done a lot of work on obesity that seems to be working. Of their Government spend, 40% has to be either organic or have sustainable properties of some kind. In Italy, I think 40%—it is a lot—of the food in schools has to be organic. That would not work for us because our organic sector is very much smaller, but it is possibly an aspiration and something we could look at, going forward. It is really useful to look at what other countries do within the rules.
Victoria Prentis: […] You can definitely have me on record as saying that I will do everything I possibly can to encourage the public sector to buy more local, sustainable, seasonal food. What I will not do, because I am not terribly keen on breaking the law, is say, “We must buy British food”, but I am very happy that the result of saying, “We must buy local, sustainable and seasonal food”, will mean that many British businesses get a look in.
Q114 Dr Hudson: Thank you all for being before us today. I wanted to focus in on the Government buying standards scheme and the balanced scorecard, and really look at some of the exemptions. The GBS says that all food must be produced in a way that meets UK legislative standards for food production and animal welfare, or equivalent standards. It adds that if in any particular circumstances “this leads to a significant increase in costs which cannot be reasonably compensated for by savings elsewhere, the procuring authority shall agree with the catering contractor or supplier to depart from this requirement”. I want to explore that particular exemption. I am encouraged that you said the GBS and balanced scorecard are going to be looked at by Government, but how can an exemption that allows substandard food production and animal welfare on the grounds of cost be justified? I wanted your thoughts on that.
[Answer: it was only used by the MoD, for buying bacon and eggs in Europe for troops stationed there.}
Q115 Dr Hudson: Given that the use of this exemption is, as you said, the exception rather than the rule, if the use of this exemption is happening it should be noted and recorded. Could you tell us how frequently this exemption is or has been used?
Ananda Guha: I am not sure how often it has been used. I know it has been used in the past. It is properly audited because it is signed off by a senior official, presumably in the Ministry of Defence. As I say, I am not aware of instances where it has been used. We can ask the MoD and revert, but it is not something that is done on a regular basis. I would hazard—unfortunately it is just hazarding a guess—that it is not used at the moment.
However, as I said, the future probably lies with auditing bodies and assurance bodies, such as the scheme, but not exclusively, Food for Life Served Here, run by the Soil Association. We do not have an army of enforcement officers in DEFRA in this space and we never will, so it is important that we find other ways of ensuring what goes on.
Q137 Chair: Minister, it also goes back to this question. We can have the best rules in the world, but if we do not enforce them, we are just wasting rainforests of paper if we are not careful. As we improve the situation around what we are going to buy and how we are going to buy it, let us make sure that we can publish data at the end of each year as to what the public sector has bought. That would then make a difference because, once we saw what was happening, we could monitor it more closely. At the moment, we do not entirely know, sometimes until it is too late, what is happening. I am sorry to keep on about it, but it is the crux of the matter.
Rosie Duffield: How important is the future food framework pilot that is being run by Crown Commercial Services for increasing market access for SMEs? I am pretty keen that that includes Kent producers. When will the pilot begin? What are the Government doing to ensure that it is not unnecessarily delayed?
Just before we get on to the border questions, you were prisons Minister. When we had the prisons representative here, he was saying that, traditionally, there were many more farms within the prisons, which worked very well. Probably for financial reasons and others, they have been sold off. I would just ask you perhaps, although it is not your exact brief, whether DEFRA can help to see whether we can reinstate some of those prison farms. It would be good for rehabilitation of the prisoner and also produce some excellent food. It is just something that I would like to throw into the mix.
Future of Health and Care
House of Commons 11 February 2021
Mr Speaker, I come to the House today to set out our White Paper on the future of health and care. The past year has been the most challenging in the NHS’s proud 72-year history. The health and care system as a whole has risen in the face of great difficulties. Throughout, people have done incredible things and worked in novel and remarkable ways to deliver for patients, and we in this House salute them all—not just the nurse who may have had to care for two, three or four times as many patients as he would in normal times, and not just the surgeon who may have been called to treat patients beyond her normal specialism, but the managers across health and care who have come together in teams, as part of a health family, at local and national level; the public health experts, who have been needed more than ever before; and the local authority staff who have embraced change to deliver for their residents—and from all, a sense of teamwork that has been inspiring to see.
As a citizen, I care deeply for the whole health and care family, the values they stand for and the security they represent. They are there for us at the best of times, and they are there for us at the worst of times. As Health Secretary, I see it as my role sometimes to challenge but most of all to support the health and care family in their defining mission of improving the health of the nation and caring for those most in need.
I come before the House to present a White Paper based firmly on those values, which I believe are values that our whole nation holds dear. The White Paper is built on more than two years of work with the NHS, local councils and the public. At its heart, this White Paper enables greater integration, reduces bureaucracy and supports the way that the NHS and social care work when they work at their best—together. It strengthens accountability to this House and, crucially, it takes the lessons we have learned in this pandemic about how the system can rise to meet huge challenges and frames a legislative basis to support that effort. My job as Health Secretary is to make the system work for those who work in the system—to free up, to empower and to harness the mission-driven capability of team health and care. The goal of this White Paper is to allow that to happen.
Before turning to the core measures, I want to answer two questions that I know have been on people’s minds. First, are these changes needed? Even before the pandemic, it was clear that reform was needed to update the law, to improve how the NHS operates and to reduce bureaucracy. Local government and the NHS have told us that they want to work together to improve health outcomes for residents. Clinicians have told us that they want to do more than just treat conditions; they want to address the factors that determine people’s health and prevent illness in the first place. All parts of the system told us that they want to embrace modern technology, to innovate, to join up, to share data, to serve people and, ultimately, to be trusted to get on and do all that so that they can improve patient care and save lives. We have listened, and these changes reflect what our health and care family have been asking for, building on the NHS’s own long-term plan.
The second question is, why now, as we tackle the biggest public health emergency in modern history? The response to covid-19 has accelerated the pace of collaboration across health and social care, showing what we can do when we work together flexibly, adopting new technology focused on the needs of the patient and setting aside bureaucratic rules. The pandemic has also brought home the importance of preventing ill health in the first place by tackling obesity and taking steps such as fluoridation that will improve the health of the nation. The pandemic has made the changes in this White Paper more, not less, urgent, and it is our role in Parliament to make the legislative changes that are needed. There is no better time than now.
I turn to the measures in detail. The first set of measures promote integration between different parts of the health and care system and put the focus of health funding on the health of the population, not just the health of patients. Health and care have always been part of the same ecosystem. Given an ageing population with more complex needs, that has never been more true, and these proposals will make it easier for clinicians, carers and public health experts to achieve what they already work hard to do: operate seamlessly across health and care, without being split into artificial silos that keep them apart.
The new approach is based on the concept of population health. A statutory integrated care system will be responsible in each part of England for the funding to support the health of their area. They will not just provide for the treatments that are needed, but support people to stay healthy in the first place. In some parts of the country, ICSs are already showing the way, and they will be accountable for outcomes of the health of the population and be held to account by the Care Quality Commission. Our goal is to integrate decision-making at a local level between the NHS and local authorities as much as is practically possible, and ensure decisions about local health can be taken as locally as possible.
Next, we will use legislation to remove bureaucracy that makes sensible decision making harder, freeing up the system to innovate and to embrace technology as a better platform to support staff and patient care. Our proposals preserve the division between funding decisions and provision of care, which has been the cornerstone of efforts to ensure the best value for taxpayers for more than 30 years. However, we are setting out a more joined-up approach built on collaborative relationships, so that more strategic decisions can be taken to shape health and care for decades to come. At its heart, it is about population health, using the collective resources of the local system, the NHS, local authorities, the voluntary sector and others to improve the health of the area.
Finally, the White Paper will ensure a system that is accountable. Ministers have rightly always been accountable to this House for the performance of the NHS, and always will be. Clinical decisions should always be independent, but when the NHS is the public’s top domestic priority—over £140 billion of taxpayers’ money is spent on it each year—and when the quality of our healthcare matters to every single citizen and every one of our constituents, the NHS must be accountable to Ministers; Ministers accountable to Parliament; and Parliament accountable to the people we all serve. Medical matters are matters for Ministers. The White Paper provides a statutory basis for unified national leadership of the NHS, merging three bodies that legally oversee the NHS into one as NHS England. NHS England will have clinical and day-to-day operational independence, but the Secretary of State will be empowered to set direction for the NHS and intervene where necessary. This White Paper can give the public confidence that the system will truly work together to respond to their needs.
These legislative measures support reforms already under way in the NHS, and should be seen in the context of those broader reforms. They are by no means the full extent of our ambition for the nation’s health. As we continue to tackle this pandemic, we will also bring forward changes in social care, public health, and mental health services. We are committed to the reform of adult social care, and will bring forward proposals this year. The public health interventions outlined in this White Paper sit alongside our proposals to strengthen the public health system, including the creation of the National Institute for Health Protection, and last month we committed in our mental health White Paper to bringing forward legislation to update the Mental Health Act 1983 for the 21st century.
This landmark White Paper builds on what colleagues in health and care have told us, and we will continue that engagement in the weeks ahead, but it builds on more than that: it builds on this party’s commitment to the NHS from the very beginning. Eagle-eyed visitors to my office in Victoria Street will have noticed the portrait of Sir Henry Willink, who published from this Dispatch Box in 1944 the White Paper that set out plans for a National Health Service, which was later implemented by post-war Governments.
Throughout its proud 72-year history, successive Governments have believed in our health and social care system and strengthened it for their times. I believe the NHS is the finest health service in the world. I believe in the values that underpin it: that we all share responsibility for the health of one another. Its extraordinary feats this past year are unsurpassed even in its own proud history. Once again, we must support the NHS and the whole health and care system with a legislative framework that is fit for our times and fit for the future. We need a more integrated, more innovative and more responsive system, harnessing the best of modern technology and supporting the vocation and dedication of those who work in it. This White Paper is the next step in that noble endeavour, and I commend this statement to the House.