Government Policy on Health

15:37:00

It is always nice to see the right hon. Gentleman, but I was expecting to see the actual Secretary of State respond to this question. Perhaps he is at a business meeting with health firms—

Order. May I ask the shadow Secretary of State just to pose the question? The Minister will respond, and then the shadow Secretary of State will get her two minutes after that.

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the involvement of people with no formal appointment in the development of Government policy on health. I apologise to the House, Madam Deputy Speaker. I am more used to answering, but believe you me, I am looking forward to the questions.

And I am committed to making sure that the right hon. Lady is there, asking the questions, for a very, very long time. Unlike our predecessors, this Government cannot get enough of experts. We work with a wide range of stakeholders in developing policy, because that goes to the heart of our approach to mission-driven government. But I think the shadow Secretary of State was referring specifically to the right honourable Alan Milburn, so let me address him specifically. I walked into the Department of Health and Social Care on 5 July to be confronted with the worst crisis in the history of the national health service: waiting lists at 7.6 million, more than a million patients a month waiting four weeks for a GP appointment —if they could get one at all—the junior doctors still in dispute and on strike, and dental deserts across huge parts of our country, where people cannot get an NHS dentist for love nor money. This Government are honest about the scale of the crisis and serious about fixing it, which means that we need the best available advice—it is all hands on deck to fix the mess that the previous Government left. If a single patient waited longer for treatment than they needed because I had failed to ask for the most expert advice around, I would consider that a betrayal of patients’ interests. I decide whom I hear from in meetings, I decide whose advice I seek, and I decide what to share with them. I also welcome challenge, alternative perspectives and experience. The right honourable Alan Milburn is a former Member of this House, a member of the Privy Council and a former Health Secretary. He does not have a pass to the Department and, at every departmental meeting he has attended, he has been present at the request of Ministers. During Alan’s time in office, he gave patients the choice over where they are treated and who treats them, as well as making sure that the NHS was properly transparent, so that all patients were able to make an informed choice—a basic right that we expect in all other walks of life, but which only the wealthy and well connected were able to exercise in healthcare until Alan changed it. He gave patients access to the fastest, most effective treatment available on NHS terms, so that faster treatment was no longer just for those who could afford private healthcare. He made the tough reforms that drove better performance across the NHS and, along with every other Labour Health Secretary, delivered the shortest waiting times and the highest patient satisfaction in the history of the NHS. That is his record and Labour’s record, and it is the kind of experience that I want around the table as we write the reform agenda that will lift the NHS out of the worst crisis in its history, get it back on its feet, and make it fit for the future once again.

I fear that the right hon. Gentleman is betraying his inexperience. It is a shame that he needs all that help and experience; the rest of us have just got on with the job. The Department of Health and Social Care manages incredibly sensitive information, ranging from the development of healthcare policy to the handling of market-sensitive information concerning vaccines and medication, and the rules regarding patient confidentiality. It has emerged that Mr Milburn, a former Labour politician, has received more than £8 million from his personal consultancy firm since 2016. He advises one of the largest providers of residential care for older people, and is apparently a senior adviser on health for a major consultancy firm. [Interruption.] A Member sitting opposite says, “So what?” Given the risk of conflicts of interest—that, rather than the right hon. Gentleman’s inexperience, is the point of this UQ—has Mr Milburn declared his business interests to the Department? Can the right hon. Gentleman reassure the House on how such conflicts are being managed, so that we can get a sense of the scale of this open-door policy and Mr Milburn’s access? Could the right hon. Gentleman tell us how many meetings Mr Milburn has attended? How many were with NHS England? How many were conducted without ministerial presence? What sensitive information has Mr Milburn been given access to? Does it include information concerning the sale of patient information to pharmaceutical companies? Has Mr Milburn seen internal DHSC or NHSE documents regarding the pricing of medicines and vaccinations, and other market-sensitive information? This is all information that comes across the right hon. Gentleman’s desk, and there is no formal record for understanding what Mr Milburn has seen. If the right hon. Gentleman uses, as he has done just now, the excuse that this is all okay because Mr Milburn is a former Secretary of State and a Privy Counsellor, could the right hon. Gentleman set out where in the ministerial code or the civil service code such an exemption exists for unrecorded access to information by members of the public? I hope the Secretary of State will also confirm his lists of other advisers, their commercial interests and any other members of the public attending meetings that are of a deeply sensitive nature, so that we get a sense of just how far this goes. This is just more evidence of cronyism at the heart of this new Labour Government. Following recent press reports that a Labour party worker had been parachuted into a civil service role in the Department through a closed recruitment process, will the Secretary of State finally come clean to the House and be transparent about who is running his Department and shaping policy for him?

The right hon. Lady wants to compare experience. It took me three weeks to agree a deal with junior doctors—she had not even met them since March—and in the two and a half years that I was the shadow Secretary of State for Health and Social Care, she was the fifth and among the worst. Does it not just tell us everything we need to know about the Conservatives’ priorities? She does not ask me what we are doing to cut waiting lists. She does not ask about the action we took to end strikes. She does not ask about the action that has been taken to hire a thousand GPs, who she left to graduate into unemployment. She has not asked me about the news on the front page of The Daily Telegraph that, on their watch, 50 years of health progress is in decline. And funnily enough, there was nothing on the news from The Observer this weekend that the NHS was hit harder than any other health service by the pandemic because it was uniquely exposed by a decade of Conservative neglect. Having broken the NHS, all they are interested in now is trying to tie this Government’s hands behand our back to stop us cleaning up their mess. What the right hon. Lady is implying in this question is that, as Health Secretary, she never sought the advice of people who did not work in her Department, which would explain quite a lot actually. I feel sorry for her, because when I need advice, I can call on any number of Labour Health Secretaries who helped deliver the shortest waiting times and the highest patient satisfaction in history. But she never had that luxury, because every single one of her Conservative predecessors left NHS waiting lists higher than where they found them—except, of course, for Thérèse Coffey, who was outlasted by a lettuce. In fact, it says a lot about the modern Conservative party’s anti-reform instincts that the right hon. Lady is so opposed to Alan Milburn. They used to hug him close when they were cosplaying as new Labour. Andrew Lansley even asked whether Alan Milburn would chair the new clinical commissioning board that his top-down reorganisation created, although Alan sensibly turned him down and labelled the reorganisation “the biggest car crash” in the history of the NHS, which just goes to prove that Alan Milburn has sound judgment and is worth listening to. But if the right hon. Lady wants to lead with her chin and talk cronyism, let us talk cronyism. Why do we not talk about Owen Paterson lobbying Health Ministers on behalf of Randox? The Conservatives care so much about cronyism that they welcomed Lord Cameron back with open arms following his paid lobbying for Greensill. For reasons of ongoing court cases, let us not even get into Baroness Mone and the £200 million contract for personal protective equipment. Where was the right hon. Lady during those sorry episodes? Cheering on that Government and presiding over a record of abysmal failure that has put them on the other side of the Chamber. This Government are having to rebuild not only the public services that the Conservatives broke and the public finances they raided, but the trust in politics that they destroyed. We will put politics back into the service of working people and rebuild all three. Clearly, we will have to do it without the support of the Conservative party’s one- nation tradition, who are not even running and have abandoned their flag. It is clear that the Conservatives have not learned a thing from the defeat they were subjected to on 4 July, and we will get on with the business of clearing up their mess.

On a point of order, Madam Deputy Speaker. The Secretary of State has obviously decided that attack is the best form of defence, but the operation of the House will collapse if he declines to answer any questions about a very serious matter of public concern. Can we seek your guidance, Madam Deputy Speaker, on whether he is conducting himself appropriately in the House? We are seeking transparency on a matter of probity, and he has a duty to answer the House, not least under the ministerial code.

The urgent question has just started, so there will be ample opportunity to continue to hold to account the Secretary of State, who no doubt believes that his answers are responding to the UQ. We have some time to go, so if Members bob, I will endeavour to ensure that they are called to do so.

The sheer brass neck of the Conservatives to turn up on the very day that Transparency International UK published its report showing that £15 billion of contracts were red-flagged during the covid epidemic—[Interruption.] I am not reading. Those contracts have been red-flagged and are worthy of further investigation, and £500 million of them were given to companies that had not even lasted 100 days. Should the Conservatives not have taken that into consideration before coming here with this urgent question?

I wholeheartedly agree with my hon. Friend. Frankly, every single contribution from the Opposition Dispatch Box should begin with a grovelling apology for the way they conducted themselves in government, but they will not apologise: they have learnt nothing and they show no humility. To my hon. Friend’s point, when it comes to covid corruption and crony contracts, the message from the Chancellor is clear. We want our money back and the covid commissioner is coming to get it.

I call the Liberal Democrat Front-Bench spokesperson, Sarah Olney.

The Liberal Democrats find it deeply ironic that the shadow Health Secretary has raised this question on the involvement of people with no formal appointment in the development of Government policy. Are they forgetting their record in government? Perhaps we should remind everyone that, under the Conservatives, it was their friends that benefited from large contracts to supply the Government during the covid pandemic. The result is that, just today, as the hon. Member for Eltham and Chislehurst (Clive Efford) has already highlighted, Transparency International UK has revealed multiple red flags in more than 130 covid contracts totalling over £15.3 billion. With the Conservatives out of power, we have the opportunity to clean up our politics, so will the Secretary of State update the House on whether the Prime Minister plans to appoint his own ethics adviser or whether Sir Laurie Magnus will remain in the post? Will the ethics adviser be empowered to initiate their own investigations and publish their own reports?

I am grateful to the hon. Member for her serious contribution. She is right to say that transparency matters. That is why meetings in my Department, and their attendees, will be published in the right and proper way on a quarterly basis. It is also right to draw a distinction between those areas of business and meetings in the Department that are about generating ideas and policy discussion, and those that are about taking Government decisions. It is right that people from outside government come into the Department for Health and Social Care, or any Department, to lend their expertise and share their views, and it is right that Ministers make decisions absent of those outsiders. That is the distinction I would draw. The hon. Member raises a specific point about the Prime Minister’s ethics adviser. This is a Prime Minister who does take ethics seriously and will not behave in the way that his Conservative predecessors did. As for individuals, that is a decision for the Prime Minister, but I will ensure that the hon. Member gets a more fulsome reply.

I have been a surgeon for 28 years. In the first 14 years, we had a Labour Government and we saw the waiting lists more or less disappear, such that by 2010, a patient coming to see me in the clinic would be offered an operation. In the second 14 years, we have seen record waiting lists. I welcome the advice of Mr Alan Milburn, one of the most successful Secretaries of State and one of the architects of the fall in the waiting lists, and I support the Secretary of State in this.

I am grateful to my hon. Friend and I am delighted to see him here, bringing his experience to the House, sharing it with the nation, standing up for his constituents and being part of the team that will do what the last Labour Government did, which was to ensure that our NHS is back on its feet and fit for the future.

Notwithstanding the Secretary of State’s bluster, he must appreciate that, given Mr Milburn’s involvement in the private healthcare sector, his direct access to the Secretary of State may have conferred a competitive advantage. What does the Secretary of State say to those companies who compete with Mr Milburn’s companies about the access that he has had to the Secretary of State? How can we in the House be reassured about the kind of information that Mr Milburn has been able to access and what, if any, advantage that might have conferred upon him?

With the way that Conservative Members are carrying on, and with the smears and innuendo they are applying, I am surprised that Alan Milburn is not paying them a marketing commission. The right hon. Gentleman makes out that Alan Milburn has come into the Department and is making all the decisions. If he were up to what they are suggesting, I could not think of better word-of-mouth publicity. There is a clear distinction between inviting people with a wide range of experience and perspectives into the Department to have policy debates and to generate ideas, and having meetings that are about transacting Government business. I can assure the right hon. Gentleman and the House that nothing commercially sensitive has been shared with Alan Milburn, and I am genuinely astonished that Conservative Members think it is inappropriate for a Secretary of State for Health and Social Care to seek views, input and advice from their predecessors. In fact, I wonder how one of my Conservative predecessors, who is coming in to see me soon, will feel about their objections.

In October 2023, when I phoned my NHS dentist to get an appointment for my children, the next available appointment was in June 2024. [Interruption.] When June 2024 rolled around, they cancelled the appointment. The next available appointment is April 2025. Given my right hon. Friend’s disgraceful inheritance, does he think the Conservative party should spend a little more time reflecting on its record and a little less time asking pointless questions?

I wholeheartedly agree with my hon. Friend. Let the record reflect that, when he was raising the crisis that is leaving people in Hartlepool without access to NHS dentistry, Conservative Members were shouting, “What about Alan Milburn?” That says everything about their priorities, everything about their lack of remorse and contrition, and everything about why they should stay in opposition for a very long time while we sort out the state of NHS dentistry in Hartlepool and across the country.

How legitimate is it for the House of Commons to ask about external people coming into Departments and potential conflicts of interest? In cases like Alan Milburn’s, or that of a former Conservative Secretary of State, how does the Department identify and manage conflicts of interest?

It is entirely legitimate to ask questions, and it is also entirely legitimate for Government Departments to invite people with a wide range of experience and insight to advise on policy debates and discussions. That happens all the time. Where do we draw the line? Do we have to send compliance forms to Cancer Research UK before it comes in to talk about how we tackle cancer? Do we have to send declaration of interest forms to patients who want to discuss awful cases they have experienced? Frankly, I find this pantomime astonishing. I am surprised that the shadow Secretary of State thinks this is such a priority that she should raise it on the Floor of the House rather than NHS waiting lists, ambulance response times, GP access or the state of social care. It is clear that the Conservatives have not learned why they are in opposition.

I congratulate my right hon. Friend on taking advice from his predecessors. As someone who worked as a senior civil servant in the Department under Alan Milburn, I would like to echo my right hon. Friend’s comments about what a fantastic Secretary of State he was and speak to his record in that position. I also worked as a civil servant under the coalition Government. Will the Secretary of State also be seeking advice from Andy Burnham who, as Secretary of State when Labour last left office, left record low waiting times and high public satisfaction?

My hon. Friend is absolutely right. How fortunate we are to be able to turn to every living former Labour Health Secretary, from Alan Milburn to Andy Burnham, and in every single one of those cases be able to draw on people whose record of delivery led to the shortest waiting times and the highest patient satisfaction in history. I can confirm to my hon. Friend that, both in opposition and in government, I have been talking to the Mayor of Greater Manchester. He is doing some brilliant work on prevention. I am really looking forward to working with all our metro mayors to tackle health inequalities across the country and to improve the integration of health and care services across the land.

I know it will be a novelty for the Secretary of State actually to answer a question during this urgent question, but maybe he will do the House a favour by answering this very simple question with a yes or no. He said that no pass was given to Alan Milburn, so will he guarantee that no confidential documents that could have been used for commercial purposes were accessed or left his Department? Will he take responsibility if any documents or data discussed at ministerial meetings with Alan Milburn leave the Department—yes or no?

Yes.

Fixing and getting our NHS back on its feet should be a national mission, and everybody should be able to play their part in that. Will the Secretary of State confirm whether any former Conservative Ministers have put themselves forward to try to fix the mess that the party now in opposition created over the last 14 years?

This is the extraordinary thing: notwithstanding the public job application of a former Conservative Secretary of State, which did not meet the bar, I have been approached by former Ministers in the Department of Health and Social Care who served in the Conservative Government who, in a spirit of public service, have wanted either to do work for the Labour Government on issues that they care about, or have sought to share their experiences—the highs or, indeed, the many lows—of being in government. That is a totally legitimate thing to do. I suspect that, if I rang round all my Labour predecessors, I would find that the Conservative Government tried desperately hard to get them to work for them, because, as I say, the challenge for Conservative Health Secretaries was that they did not have any successful Conservative predecessors to turn to.

I share the Secretary of State’s frustration and understanding of the brass neck of the Tories on this point and I do not doubt the expertise of Alan Milburn, but legitimate questions have been asked about conflicts of interest. What safeguards are being imposed or considered to address the appearance of conflicts of interest?

It is absolutely right that people appointed to roles in public life declare their conflicts of interest so that they can be assessed when taking decisions or exercising powers to ensure that they are doing so in a way that manages those conflicts of interest and no conflict arises. Alan Milburn does not, at this stage, have a role in the Department of Health and Social Care. Many people have come into the Department for meetings in the past eight weeks. We do not ask them all to declare their interests. I know there is more red tape now in health and social care than when we left office, but this Government want to reduce that not increase it.

The Conservative party appointed a party donor, Wol Kolade, who wants to change how the NHS is funded, to the board of NHS England. In January, the right hon. Member for Louth and Horncastle (Victoria Atkins) held a meeting with his private equity firm, Livingbridge, less than one month after he gave her party £50,000, so is it not the shadow Health Secretary who ought to be answering questions about cronyism?

It is not for me, thankfully, to answer for the shadow Secretary of State for Health and Social Care; it is just my responsibility to clean up her mess.

Will the Secretary of State please illuminate the House about any conflict of interest concerning the gentleman in question? Did he head into the ministerial floor or access the Department? Many of us want our constituents to access health services and GP appointments. Did the right honourable gentleman, who is the Secretary of State’s friend from the old days and with whom he has worked with previously, have a day pass or a departmental pass? Beyond the bluster, can the Secretary of State assure hon. Members that there is no conflict of interest?

My right honourable friend, Alan Milburn, does not have a role in the Department. He does not have a pass to the Department. I am asked whether he has accessed the ministerial floor. I do not know where the Conservatives held their meetings, but I tend to hold them in my office on the ministerial floor.

Across Cramlington and Killingworth, I have heard countless stories—heartbreaking stories—of residents’ experiences of the NHS. They talk about the staggering length of waiting lists, access to GPs and access to dentists. Does the Secretary of State agree that, rather than focusing on who he might have once had a conversation with, the Conservatives would do better supporting the Labour Government in cleaning up the mess they left behind, which my residents live with every single day?

My hon. Friend is absolutely right. It is because of the way that she champions her constituency and her community that she was sent to this place to stand up for their interests. It will not be lost on her constituents or anyone else in the country that, with our national health service in the state that it is in and with the appalling headlines that we have been reading in recent days, the Opposition have absolutely nothing to say about the responsibility that they bear for the crisis or what they would do to fix it. They have the wrong priorities, but, fortunately, the country has the right Government.

How many meetings has Alan Milburn had in the Department? Will the Secretary of State place a list of all those meetings in the House of Commons Library? Knowing that the former Secretary of State has extensive financial interests in healthcare, did the Secretary of State ask him to declare those interests and publish them?

First, my right honourable friend, Alan Milburn, does not have a role in the Department. Secondly, of course we will publish, in the routine way that we do, details of meetings held in the Department and who attended them. I gently suggest that if the hon. Member has not made his way there already, there are plenty more interesting things to read in the House of Commons Library.

I think Opposition Members may be making the mistake of judging this Government by their own standards. I wish to ask the Secretary of State this: after my constituents and many others have suffered from the economic disaster that was caused in part by dodgy covid contracts and VIP fast lanes, what will this Government do differently?

I am delighted to see my hon. Friend here representing Bishop Auckland. The people of his constituency will be struck by the fact that this afternoon the Conservative party has chosen to create a mountain out of a molehill about a former Health Secretary coming in to lend his advice and experience to a Labour Government. On covid corruption, my hon. Friend is absolutely right to be angry, as indeed the country is, too. That is why my right hon. Friend the Chancellor of the Exchequer has been very clear that, when it comes to cronyism and corruption in covid contracts, we want our money back and the covid corruption commissioner is coming to get it.

There is just one standard and it applies to whichever party is in power, and that should be respected. All this whataboutery relating to what may have gone on under a Conservative Government! Anyone who has done something wrong should be pursued. Anyone in authority should be accountable. It is the failure of accountability, a failure of recognition, by the right hon. Gentleman that lets down the House today. Can he confirm to the House that Alan Milburn did not have access to official sensitive papers? Anyone who visits a Minister—they come in all the time—sits on one side of the table and the official sensitive documents are on the other side. Can he confirm that Alan Milburn did not have access that no other visitor would have?

In the meetings that I asked my right honourable friend to attend—I need to make sure that I get this absolutely right—I tend to think that I saw him on the other side of the table in the corner. I cannot guarantee that he sat at that point in every single one of the meetings, but he certainly was not sitting next to me. With regard to the papers for the meetings that he attended, they were discussion papers about the challenges facing health and social care. They were not Government decision papers or recommendations for Ministers. There is a distinction between those two things. I decide who attends meetings in the Department, and, when it comes to wide-ranging policy discussions, I decide what reading material people receive.

The Conservative party famously said that they had “had enough of experts”, and look at where that got us—the longest NHS waiting list in history. I am pleased that my right hon. Friend rejects that approach emphatically. In the spirit of listening to professionals who are trying to make a difference, I ask him and his team to consider visiting Hertfordshire, where the community trust is working on a hospital at home scheme. The scheme is making a huge difference to patients at the end of their life, who need to be supported, cared for and monitored. This is an important part of easing the burden on our NHS with which we have been left.

I would be delighted for either myself or one of my ministerial colleagues to take my hon. Friend up on that offer. What a refreshing change from so many of the contributions that we have had this afternoon from the Opposition. Of course we want to learn from people with experience and expertise in getting it right on the NHS and social care. Many of those people are outside Government. Many of them have valuable experience in other parts of the public sector, in our public services, in the voluntary sector and in the private sector—or indeed experience as patients, users or carers in our health and social care service. Our message as a Government is clear: when it comes to fixing the crisis in health and social care created by the Conservatives, we cannot get enough of experts, and we are looking forward to mobilising the country in pursuit of our mission, so that we can deliver an NHS that our country can once again be proud of.

Given the potential for commercial advantage to Alan Milburn, will the Secretary of State publish all the papers that Alan Milburn was able to read? If the Secretary of State gave them on Privy Council terms, as he seems to be saying, will he at least give them to any Privy Counsellor who wants them?

Given the state of the Opposition, I bet they would love to see what policy discussion papers we are putting forward in the Department of Health and Social Care. The hon. Gentleman is right: papers have been shared with my right honourable friend on Privy Council terms. The Opposition will, in time, be able to judge the fruits of the labour, in terms of my decisions and the decisions of this Government when it comes to fixing the mess that they created.

I welcome the decision of the Secretary of State to seek wisdom from experts across the health and care system in order to build a better NHS. Is he aware of the virtual hospital system that has been used at West Hertfordshire Teaching Hospitals NHS Trust Watford site, developed during covid in order to treat more people in a better setting?

I am grateful to my hon. Friend for his question. We know that the NHS is broken, and is going through the worst crisis in history. We will shortly hear from the noble Lord Darzi about the outcome of his investigation into the true state of our national health service, but against that bleak backdrop of political failure are stories across the country of triumph against the odds, and of some outstanding public servants doing extraordinary things, showing what the future of our health and care services could look like with a Government on their side. I am pleased that such a Government is here—this Labour Government—and I would be delighted to hear more about my hon. Friend’s constituency.

I wish the Secretary of State all the best in his new role, and in the task that he has taken on. With great respect to my Conservative colleagues, the downfall of the Tory Government was due in part to the fact that people did not trust the background politics behind closed doors. I want the Government to succeed, as do most people in this House. Stability and direction are much needed, but that can happen only with openness, transparency and a desire to put nation before party. How can the Secretary of State assure us that this Government will do things differently, and that policy will be proposed by those with know-how, and passed with scrutiny in this place, not simply due to pressure from lobby groups?

I strongly agree with the hon. Member. In the short time that I have been in post, I have been delighted to have had virtual meetings with the current Northern Ireland Minister of Health, as well as with his predecessor, the hon. Member for South Antrim (Robin Swann), who now sits over there on the Opposition Benches—I am delighted to see him in his place. Ministerial meetings attended by third parties are declared in our quarterly transparency publication. People will want to lobby and influence Government, and Members of Parliament, all the time. Members of Parliament regularly receive correspondence—let alone the deluge of advice that we receive in government. The important thing is that Ministers take decisions on the basis of the best possible advice available, that they weigh up carefully the evidence and arguments in a fair and proper way, and that advisers may advise but Ministers ultimately decide. This Government are aware of the deep crisis in trust in our politics. That is why, on his very first day, the Prime Minister talked outside Downing Street about restoring Government to service. It is why it should be no surprise whatsoever that many people who have given outstanding public service to this country, such as my right honourable friend Alan Milburn—and the same is true of Patricia Hewitt, Alan Johnson, my noble Friend Lord Reed, the Mayor of Greater Manchester and many more—want to roll up their sleeves and help the Government. They can see the state that the Conservative party left our country in, and are willing once again to roll their sleeves up to get our country back on its feet, turn the situation around and ensure that everyone in our country can look forward to the future with optimism and hope after 14 years of abysmal failure.

That is the end of the urgent question. I thank all Members who participated. In reference to the Secretary of State earlier, the privilege of choosing UQs is down to the Chair and is based on merit and the urgency of the point being raised.