EU Working Time Directive (NHS)

Andrew Gwynne Excerpts

Thursday 26th April 2012 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

Thank you, Mr Howarth, for calling me to speak. It is a pleasure to serve under you.

I congratulate the hon. Member for Bristol North West (Charlotte Leslie), who opened the debate, and the Backbench Business Committee on granting the debate. In fact, I want to pay a particular compliment to her for the comprehensive way in which she opened the debate and put forward her case.

Clearly, the working hours of all health workers, and not just junior doctors, are incredibly important to our NHS and to the quality of care that patients receive. I am glad that we have had a chance to examine those issues in some detail today in this Backbench Business Committee debate.

It is concerning that there have been reports in the press, and indeed from Members in Westminster Hall today and on other occasions, that there are cases where locum health workers have charged extortionate amounts for short-term cover in the NHS, with the potential knock-on effect on the quality of care that patients receive. As a number of hon. Members, including the hon. Member for North Antrim (Ian Paisley), have said, that is a matter that is of particular concern, especially for small rural hospitals; that was a point that he made eloquently. It is an issue that I will explore in some detail later.

As we all know, the European working time directive is European Union legislation and it was enshrined in UK law as the Working Time Regulations 1998. Except for doctors in training and workers in certain excluded sectors, the directive has applied in full to most workers, including all employed doctors, since 1 October 1998. The directive imposed a general limit of 48 hours on the working week. However, it allowed member states to let individuals opt out of that limit if both an employer and an employee agreed. At the time of its introduction, the UK was the only country to take advantage of that measure and allow an individual opt-out. There are now 16 member states using total or sectoral opt-outs, as the hon. Member for South Northamptonshire (Andrea Leadsom) correctly stated.

Particular concerns arose in relation to the health and social care sector, and importantly in relation to the position of doctors, as well as junior doctors, who, since August 2004, were gradually brought within the provisions of the directive. From August 2004 to August 2009, junior doctors’ working hours gradually moved towards compliance with the 48-hour working week. Although junior doctors in some specialties could work a 52-hour week until 31 July 2011, most junior doctors have been subject to the average 48-hour working week since 1 August 2009 and all junior doctors have been subject to that limit since 31 July 2011.

Of course, there have been particular concerns in relation to the health sector, and importantly regarding the position of doctors and junior doctors, which have led to this debate today. Although the directive applies to other sectors as well, it has always had a particular effect on the NHS, given how night-time and weekend cover has been organised in most hospitals, as we heard from the hon. Member for Central Suffolk and North Ipswich (Dr Poulter).

I note what several Members have said, particularly in relation to training. My hon. Friend the Member for Vauxhall (Kate Hoey) commented on Guy’s and St Thomas’ hospital, which is nationally and internationally renowned. The previous Labour Government commissioned the independent chair, Professor Sir John Temple, on behalf of NHS Medical Education England, to examine the impact of compliance with the directive on the quality of training. The hon. Member for Totnes (Dr Wollaston), who speaks on such matters with a great deal of experience, specifically referred to that. Although Sir John Temple’s 2010 report concluded that quality medical training can be delivered within a 48-hour working week, it also highlighted some challenges to be addressed, including round-the-clock team working. Those concerns have been echoed during today’s debate.

Other issues relating to the working times of doctors and junior doctors also need to be addressed. As Sir John Temple’s report found, there were concerns about post-graduate medical training, the objective of which is to produce fully qualified specialists who are able to provide high-quality, safe patient care. Experience of delivering services is an integral part of a junior doctor’s training. “Time for Training” highlighted some of the difficulties created for trainees and the service, especially in providing out-of-hours and weekend emergency patient care. Again, a number of Members have spoken about that today.

Some small, practical changes by employers, such as improving handovers and team-working at night, more involvement of doctors in designing their own working patterns, less reliance on junior doctors and more involvement of consultants during out-of-hours periods, have led to positive results without the need for excessive working hours. Clearly, issues remain, and I do not say that we have it right. Such matters should always be kept under review.

As I have said, the directive raises issues for health services across Europe, and Members have raised a number of concerns today about the directive’s impact on the NHS in the United Kingdom. We should consider ways to resolve those issues and be ready to work constructively with the European Commission and other member states to seek suitable solutions fit for our country’s needs.

As we know, the Commission is re-examining the directive. That is an acknowledgement that, although the legislation will remain, member states have had a number of issues with its implementation.

[George Eustice (Camborne and Redruth) (Con)]

The hon. Gentleman will be aware that in 2008 the previous Labour Government attempted to make some changes to the working time directive. The European Commission started that process, but the European Parliament voted at that point to abolish altogether the opt-out on the 48-hour maximum working week. The previous Government quickly slammed the lid and ran away from any idea of reforming the working time directive. Does he think that that was a mistake and that the previous Government should have persevered with their original intention?

[Andrew Gwynne]

The previous Government were right to attempt to have the matter re-examined. Whether the previous Government’s acceptance of the ruling needs to be reconsidered is something we are discussing today. We have a new Government, of course, and they have a responsibility to take up such matters with European Union institutions, as I would expect a future Labour Government to have the same responsibility to pursue concerns raised by this Parliament. Of course, it is incumbent on the Government of the day to try to resolve such matters with EU institutions. I accept that, were there a Labour Government instead of the current coalition, it would be right for our Government—irrespective of which party is in control—to take up such matters with EU institutions.

[George Eustice]

Does that mean it is the Labour party’s policy in opposition to seek to reform the working time directive?

[Andrew Gwynne]

The Labour party’s position is to support much of what the working time directive has brought about. Some real issues have been raised by Members of all parties in today’s debate. I recognise a lot of the issues and concerns, and it is incumbent on the Government of the day to resolve such matters to best suit the needs of the member state—in our case, the needs of the NHS throughout the United Kingdom. We support the working time directive, however, and its positive achievements, which have not been touched on to a great extent in today’s debate. There have been some positives.

We therefore have reservations about changes to the European working time directive. High-quality, safe patient care and the maintenance of further enhancement of the quality of training and education for junior doctors are important. I note the issues raised today, and specific areas must be looked at. We heard concerns about the maintenance of training standards, but patient safety must be paramount, and we should co-operate with all interested parties to develop sensible, workable and achievable solutions to the problems. If we allow a relaxation of the European working time directive for junior doctors, the danger is that we run the risk of a gradual return to their working dangerously long hours. I urge the Government to tread carefully because as the hon. Member for Bristol North West said, to be fair, some aspects of the working time directive had laudable aims. As was echoed in a number of contributions today, we do not want to see a return to the dangerous working hours worked by some doctors in the past.

[Charlotte Leslie]

Does the hon. Gentleman acknowledge that even if we relax the working time directive, with its detriments to the NHS, doctors would still be bound by the new deal and the 56-hour week? I see no return to the bad old days while the new deal is in place, although I think it, too, needs looking at again.

[Andrew Gwynne]

I shall come on to the new deal shortly, but no one would want to go back to the past with tired doctors working excessive hours. Many Members recall the very real horror stories that surfaced from time to time, in particular through the 1980s and early 1990s, when it was not uncommon for junior doctors to be working a 100-hour week, as we have heard in the debate. The hon. Member for Totnes called on her personal experience and the hon. Member for Stafford (Jeremy Lefroy) called on his domestic experiences from the past to make some reasonable points about the stress and strain that the old ways of working placed on doctors. I was reassured by their comments that they did not want to see a return to those days.

An article in the BMJ, the British medical journal magazine, looking at the effects of the working time directive, suggested that it was hard to draw firm conclusions. It also found that reducing working hours to fewer than 80 a week had not adversely affected outcomes for patients or in postgraduate training in the USA, where similar restrictions were introduced. As we heard from my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), the systematic review found the same, and that cannot be discounted because it does not necessarily fit some arguments. I do, however, take full account of today’s anecdotal evidence from Members, although it might well be wise to look at the wider, long-term implications of relaxing some of the directive’s conditions.

If we go back a number of years, to the 1990s, the new deal tried to establish that full shift working should not exceed 56 hours. Through the 1990s, compliance with the new deal was poor, so a new contract was introduced in 2000. The implementation of the Working Time Regulations for employed doctors in the training grades has helped to protect doctors from working dangerously long hours, improving patient safety.

I accept, as we have heard from several hon. Members, that press reports of locum doctors costing hospitals and the NHS some quite extortionate amounts are concerning. Some reasonable points were made by the hon. Member for Central Suffolk and North Ipswich, who speaks with experience on these matters, about the clocking off and clocking on culture, which is certainly a concern. Clearly, questions must be raised about spending so much public money in these financially restricted times, and we need to know what will be the knock-on effect for the quality of patient care, especially if patients are continually seeing different doctors every time.

The Minister, in answer to the hon. Member for Kingswood (Chris Skidmore), mentioned the 11% drop in the use of locums since May 2010 and the increase in the number of doctors, which is welcome. I will just make the point that those extra doctors were trained and came through the system under the previous Labour Government. It would be churlish of the current Government not to recognise that as they take some political capital. May 2010 was not month zero; those doctors were coming through the system previous to that.

This debate has been a positive step. As we have heard, a number of issues surround health workers, especially junior doctors, and I agree that they should be further examined as we seek ways to resolve the problems. However, we should approach with some caution the idea of relaxing some of the directive’s conditions in relation to junior doctors as in the longer term it might cause more problems than it solves.

In closing, I refer to the opening comments of the hon. Member for Bristol North West in which she said that we all value the expertise and professionalism of NHS staff and that the aims of the working time directive were very reasonable. Long hours were dangerous for both doctor and patient and we do not want to return to those days. She is right. Although we recognise that there are issues to consider in relation to staffing implications and the cost to the NHS, we do not want to see the positives that have been secured disappear. I look forward to hearing from the Minister an indication of the current Government’s thinking on how to strike that important balance for those working in our medical and clinical professions in the NHS. I feel a bit like Daniel in the lion’s den. I urge the Minister to tread cautiously, and I mean that with all sincerity. Yes, there are some issues, but he really should resist the knee-jerk reaction of his party’s anti-EU wing, which is probably its mainstream. He needs to look holistically at the issues, the concerns and the benefits.

Mental Health Care (Hampshire)

Andrew Gwynne Excerpts

Wednesday 18th April 2012 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship as always, Dr McCrea, and to contribute to this important debate. I commend the hon. Member for New Forest East (Dr Lewis) for ensuring that this issue is raised in Parliament and for the comprehensive, forceful and eloquent case that he and his colleague, the hon. Member for Romsey and Southampton North (Caroline Nokes), made for protecting services in Hampshire. After contributions from his colleague from the not-quite-neighbouring county of Staffordshire, the hon. Member for Burton (Andrew Griffiths), and from Northern Ireland—the hon. Member for Strangford (Jim Shannon)—we are indeed a United Kingdom in making the case for adult acute mental health care beds.

Given the huge changes that are going on in the NHS, it is important that we do not forget those who are genuinely most in need. Mental health services and mental health provision have often been referred to as the Cinderella service. It is crucial that the provisions for those with mental health needs do not slip down the gaps in health care provision.

The hon. Member for New Forest East forcefully raised local concerns about the plans of the Southern Health NHS Foundation Trust, and he is right to do so. This debate is important, because statistically one in four of us will experience a mental health problem in our lifetime—an example of how we live our lives in the 21st century. Mental ill health will soon be the biggest burden on society, both economically and sociologically, costing some £105 billion a year. The World Health Organisation predicts that, by 2030, more people will be affected by depression than any other health problem.

The previous Labour Government made important progress on mental health, with the national service framework early on and the improving access to psychological therapies programme towards the end. But we must also look to the wider challenges of modern life. People are living longer, less stable, more stressful and isolated lives. It is clear that there is still a tendency not to talk openly about mental health. The stiff-upper-lip culture is ingrained in our society, at home, in our work places and, yes, even in Government and Parliament.

The challenges of 21st century living demand a rethink in our approach to mental health. We need to consider a number of issues. For people to get the support that they need from the NHS to live full and economically active lives, and if it is to be sustainable in the 21st century, mental health must move from the edges to the centre of the NHS. Also, we can no longer look at people’s physical health, social care and mental health as three separate systems. They must be part of one vision for a modern health care system. Changes in our public services will be successful only if matched by a wider change in attitudes towards mental health.

We need to pay attention to and look at the stigma surrounding mental health, because not only must people face the direct effects of depression but their problems can be compounded by the reactions of others. People do not feel able to admit to having a problem that could change their employment and prospects or lose them their friends. With most illnesses, people get a sympathetic shoulder to cry on, but with mental illness, they may get the cold shoulder. Even if people admit a problem, family and friends might not know how to advise them adequately. The public debate that has been so powerfully led by Stephen Fry, Frank Bruno and others is therefore tremendously important. It is essential that the excellent “Time to Change” campaign, led by Mind and Rethink and funded by the Department of Health, ultimately prevails.

The specific issue of today’s debate was put so eloquently by the hon. Member for New Forest East. I do not wish to stray into the politics of Hampshire’s health overview and scrutiny committee, nor into the internal politics of the local Conservative party—fun though that might be—but he made some important points. It would be helpful if the Minister clarified whether he has seen any meaningful assessment of how many mental health beds there should be in Hampshire. Of course, trusts all over the country have to make efficiency savings, but cutting front-line services and making efficiency savings are two very different things. So although I understand the need for referral from the health overview and scrutiny committee to the Minister, has he been able to analyse whether there is an adequate supply of beds for mental health patients throughout the county of Hampshire, particularly if required in an emergency admission? Is there adequate capacity? If so, has there been an assessment of future operations with the reduced beds available?

I ask those questions not least because the hon. Member for New Forest East made it clear that the statistics that he had obtained contradict the statistics that have been put forward by his local NHS trust and that are being used by the health overview and scrutiny committee. To move forward, we need certainty, clarity and confidence in those statistics, so that decisions made locally are based on sound statistics. We will see more instances of trusts forced to make difficult decisions. Indeed, we have heard what is happening in other parts of the country today. Such decisions will undoubtedly have real consequences for the care received by patients, not least because of the combined effect of the Nicholson challenge, set in train by the previous Government, and the huge top-down reorganisation pushed through by this Government under the Health and Social Care Act 2012.

Finally, mental health is an equality issue, and social progress in the 21st century depends on us waking up to that fact. Children from the poorest 20% of households are at a threefold greater risk of mental health problems than children from the most affluent 20% of households. We will only have a fairer and more equal society in this century if we work to change attitudes to mental health and to look at a whole-person approach to health care, so that the problems that we might all face at some point in our lives do not stop us from reaching our potential. Again, I commend the hon. Gentleman for putting his case for mental health in Hampshire so forcefully. I, too, look forward to the Minister’s response.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 27th March 2012 Commons Chamber

[Mr Burns]

Yes, my hon. Friend raises an important issue. We must ensure that every contact counts, and that there is greater working between GPs and patients to help to deal with what is a significant problem among certain sections of the community.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The first step that the Government should take is to start listening to doctors. Is it not the case that some senior GPs are now spending as little as one day a week seeing patients because they are too busy working on the Government’s massive NHS upheaval? It is costing the NHS up to £124,000 a year to replace each of those GPs with a locum. That is why the Department’s leaked transition risk register warns that GP leaders are not sufficiently developed to run consortia, and that they might be drawn into managerial processes that drive clinical behaviour, rather than the other way round. The risk rating for that is that it is likely to happen, with major consequences. When is the Minister going to get his head out of the sand and start listening?

[Mr Burns]

Well, that interesting rant bore little relation to the facts—[Interruption.] If the hon. Member for Copeland (Mr Reed) would just button it for a minute, he will get the answer. The answer is that we are constantly listening to GPs, nurses, consultants and others within the NHS health economy. As we showed during the progress of the Health and Social Care Bill, we listened and we accepted a number of recommendations from the Future Forum and from a number of others, which strengthened and improved the Bill. I have to say that the hon. Member for Denton and Reddish (Andrew Gwynne) just does not get it.

Veterans (Mental Health)

Andrew Gwynne Excerpts

Wednesday 7th March 2012 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

As always, it is a pleasure to see you in the Chair, Mr Dobbin. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this important and topical debate. We have heard the sad news today that six of our service personnel are missing and presumed dead in Afghanistan. It is a poignant reminder of the reality of serving in Her Majesty’s armed forces. Our thoughts and prayers are with the families at this time.

I note that we had a similar debate on this subject last year, proposed by my right hon. Friend the Member for Salford and Eccles (Hazel Blears). It explored many of the important issues surrounding the mental health of veterans. It is right that we should again take the opportunity to discuss the welfare of our serving personnel and veterans and the impact on their families. For veterans’ mental health, we need to look at the true picture of how people are affected after they have left service. Indeed, we should be paying as much attention to the issues that face service personnel and their families when they leave the armed service as when they are actually in service.

The UK’s armed services are among the best in the world, and we can rightly be proud of them. We owe them a great deal of gratitude for the work that they do in our name. The charity, Combat Stress, has shown that a significant minority of servicemen and women suffer from mental ill health as a result of their experiences. A study in May 2010 into personnel who had served in Iraq and Afghanistan showed a 4% prevalence of probable post-traumatic stress disorder. An estimated 180,000 troops have served in those two operations: if 4% develop PTSD, that equates to 7,200 more sufferers.

The study also highlighted a prevalence of 19.7% for common mental disorders, and 13% for alcohol misuse. We must look into ways in which we can deal with that and ensure that the right facilities and support are in place to diagnose and treat such conditions. Admittedly, improvements have been made in recent years. Mental health pilot schemes have improved support and treatment for personnel suffering from mental health problems.

In 2007, the Labour Government extended priority access to NHS services to all veterans whose medical conditions or injuries were suspected of being due to military service. Priority access had previously extended only to those claiming a war pension, and efforts were made to raise awareness of that. As has been mentioned in the debate, we now have the armed forces covenant enshrined in law, which I think all hon. Members welcome.

The interim report on the covenant summarises the Government’s approach, taking forward recommendations in the report by the hon. Member for South West Wiltshire (Dr Murrison), “Fighting Fit”, which I also welcome. I understand that the report’s recommendations were rolled out over the past year, many of which were introduced as pilot programmes to be reassessed after their initial trial periods. I would welcome an update from the Minister on the pilots and also an assurance that his Department has been promoting them among serving personnel and veterans’ communities.

Most Members will have met ex-service constituents who have been directly affected and heard about their experiences, some of which we have heard in the debate today. We should rightly recognise the important work done by organisations such as Combat Stress, which provides an invaluable service to veterans around the country. Its centres and outreach work allow veterans to get the help and support that they need in a specialised environment, along with other veterans who are going through similar experiences.

The Enemy Within campaign run by Combat Stress seeks to tackle the stigma that, unfortunately, as we have heard today, can be a barrier to people getting the support and help that they need. Currently, they have a caseload of more than 4,800 veterans, including 228 who have served in Afghanistan and 589 who served in Iraq. The majority are ex-Army: 83.5%. Their youngest veteran is just 20. The invaluable work of Combat Stress and other organisations, such as the Royal British Legion, is to be warmly welcomed, but the Government should also take on their fair share of the responsibility. It is important that we do not view the services offered by the voluntary and charitable sector as any sort of replacement. That work should complement, not replace, the services that the Government offer.

Indeed, as we already know, the charitable sector is facing an incredibly tough time at the moment. Even though organisations such as Combat Stress and the Royal British Legion have continued to have generous support from the public, we should not assume that those services will always exist and always have enough funding to run. The Government should decide which services they have a duty to provide and should fund them properly. The Government need not always be the vehicle to deliver those services, as we have heard, but they can fund experts such as Combat Stress and the Royal British Legion to do so on their behalf.

The Government should also consider how mental health services for veterans can be guaranteed, when their national health service reforms are creating so much uncertainty. I share the concerns of the hon. Member for Southport (John Pugh), although I am reassured by the Minister’s reply that a single commissioning body, the NHS Commissioning Board, will be responsible. I think that that is the right way forward.

Clearly, those in the armed forces are trained to do a tough job and rightly have to develop a tough mental attitude. This, of course, can mean that it can be harder for people coming out of the services to admit that they have a mental health problem, let alone talk about it. We should also take into account how long it can take people actually to get the support that they need. Combat Stress has suggested that the average length of time is 13 years. In some cases, it has taken veterans 40 years to seek out the help and support that they need. That is far too long, and we should do all that we can to shorten the time and to let people know that help is available for them now.

Combat Stress has also provided detailed evidence involving cases of individuals who have faced marriage break-up, unemployment, social isolation or substance abuse because they were unable to deal with their mental health problems. However, as with all mental health conditions, a great deal of stigma still surrounds it, which can make it much harder to talk about openly. Until we tackle that stigma, it will be difficult to make significant changes.

I appreciate that it is hard to establish the level of need without a tracking system. As we know, there is no record of how many veterans are being treated for mental health problems on the NHS. Clearly, if we cannot quantify the problem, it is difficult for the Government to quantify the true cost of treating mental illness among former members of the armed forces.

Nor should we overlook the impact of deployments on the mental health of our reservists, as has been mentioned. As we know, the Government’s Future Force 2020 plan showed that the role of reservists will increase significantly in the coming years, mirrored by reductions in the number of regular service personnel. It must make sense for the Government to ensure that support is in place for reservists prepared to take on those extra responsibilities.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

I commend my hon. Friend for his speech. Is there not a problem in the offing, given that the Army is being reduced to 82,000 soldiers and certain regiments are being disbanded? We need to know what the NHS Commissioning Board and the Department of Health are doing to aid those who will soon be former soldiers entering civilian life and to determine their mental health issues and what type of help the NHS can provide.

[Andrew Gwynne]

I absolutely agree that we must ensure that ex-service personnel are supported. I am sure that the Minister will respond to that in his closing remarks.

One recommendation in the report “Fighting Fit” stated that a veterans’ information service should be deployed 12 months after a person leaves the armed forces and that regulars and reservists should be followed up approximately 12 months after they leave. Will the Minister update us on how that is developing, and what plans the Government have for the future funding of the Combat Stress-led 24-hour support telephone line for veterans? Will the Department provide an evaluation of how the funding for “Fighting Fit” has been spent, what it has achieved and what will happen for future funding? What additional steps is the Department taking to raise public awareness of issues that relate to veterans’ mental health?

[Gemma Doyle (West Dunbartonshire) (Lab/Co-op)]

While my hon. Friend is on the subject of funding, is he, like me, keen to hear from the Minister whether he supports our call for a £1 million fund for research into legacy issues from Afghanistan and Iraq, with a focus on mental health? That could be paid for by a reduction in generals in the forces.

[Andrew Gwynne]

I am grateful to my hon. Friend. The Labour Front-Bench defence team has made that commitment, which is laudable. Redistributing part of the saving to serve veterans’ mental health shows that the issue is a priority for us.

This debate has provided us with the opportunity to explore the issue of our veterans’ mental health and welfare. I pay tribute to Combat Stress, the Royal British Legion and other groups that, along with many service organisations and charities, play an outstanding role in supporting the whole armed forces family, for which we should thank them. I congratulate the hon. Member for York Outer on securing the debate. We must ensure that our servicemen and women receive support after their tour of duty is finished. Surely, we as a nation owe them that.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Lansley]

Yes, indeed. I share my hon. Friend’s view about the importance of this publication. For the first time, we are publishing the data so that we are absolutely transparent about performance in this and other areas. It is wrong that there are primary care trusts that are failing to meet the nine standards of care that are set out. That is why we published the atlas of variation. By focusing on that variation and through the commissioners’ responsibility to meet the standards, not least in the publication of the quality standards, we will deliver improving standards across the country.

[Andrew Gwynne (Denton and Reddish) (Lab)]

But the Secretary of State must surely be aware that, for seven weeks running since the new year, the NHS has missed its target for 95% of patients to be seen within four hours at A and E. That is precisely what Labour warned would happen when this Government downgraded the waiting times standard. Is it not clear that he has lost control over waiting times while he focuses on the largest top-down reorganisation in the NHS’s history? That is why he is losing public trust on the NHS. He should focus on what matters to people and drop the Health and Social Care Bill.

[Mr Lansley]

Let me tell the hon. Gentleman that the average time that in-patients waited for treatment at the time of the last election was 8.4—[Interruption.] The hon. Gentleman asked a question and I am telling him the answer. The average time was 8.4 weeks. That has gone down to 7.7 weeks. For out-patients, the average waiting time was 4.3 weeks at the time of the election. That has gone down to 3.8 weeks. The number of patients waiting for more than 18 weeks at the time of the election was—

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 10th January 2012 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

Figures revealed to the Opposition under freedom of information procedures show that GPs will receive up to £115 an hour for commissioning health care services on top of their existing salary. It makes no sense at all to take GPs away from patient care to become part-time accountants. When the NHS needs every penny it can get, patients will be astounded to hear that the Government plan to pay GPs twice. This comes at a time when 48,000 nursing posts are being axed and £3.5 billion is being set aside for the Minister’s bureaucratic upheaval. Will he now accept that the NHS can ill afford for money to be wasted on a top-down reorganisation that few want? Is it not now time for him to scrap the Bill?

[Mr Burns]

It is nice that the hon. Gentleman got the mantra in at the end—I have been expecting it all through this Question Time. He is wrong; what is important and what this modernisation has at its heart is the need for GPs to commission care for patients, because GPs are best equipped to know the needs of their patients. That is the way forward. Also, we are cutting bureaucracy and administration by 45% so that we can reinvest that money in front-line services. We want to spend money on health care and on improving outcomes, not on managers and bureaucracy.

Organ Donation

Andrew Gwynne Excerpts

Wednesday 30th November 2011 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

Thank you, Mr. Crausby. It is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing this debate. I also pay tribute to the hon. Member for Chippenham (Duncan Hames) for his sterling effort in squeezing a whole speech into a minute and a half—he did very well.

The system of opt-in for organ donation has been the subject for debate for many years because of the serious shortage of organ donors and consequent waiting lists for transplant operations which has led to suggestions from a number of stakeholders that a review of the current approach to organ donation is long overdue. In the United Kingdom, the number of people awaiting transplant operations greatly exceeds the number of organs available. This shortage of organ donors means that some 400 patients, mainly those waiting for life-saving heart, liver or lung transplants, die each year before a suitable donor can be found. As we have heard during the course of this debate, the BMA, many transplant surgeons, patient groups and many hon. Members in both Houses would like the UK to adopt a system of presumed consent where it is assumed that an individual wishes to be a donor unless they have opted out by registering their objection to donation after death. I recognise that there are strong feelings on both sides of the debate, as we have heard today—not least those put so eloquently by the hon. Member for Montgomeryshire.

Hon. Members who have served in this House for some time will be aware that the former Health Secretary, my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson), asked the organ donation taskforce to assess the possible impact of a change to presumed consent and the acceptability of such a change for the United Kingdom. By doing this, the previous Government recognised the complexity of the issues and widely differing viewpoints surrounding systems of consent to organ donation.

We know that the taskforce examined the complex moral and medical issues around presumed consent, including giving the family of the deceased a final say on the donation of any organs. It also looked at the views of the public, health organisations and other clinical, ethical, legal and social issues raised by a wide range of stakeholders, while at the same time establishing a series of expert working groups to help gather the relevant evidence. The Minister will be aware that the resulting report, entitled “The Potential Impact of an Opt Out System for Organ Donation in the UK” was published in November 2008, recommending that the current system of opt-in be retained and the recommendations of the taskforce’s earlier report on organs for transplant, produced in January 2008, be implemented. However, in July 2007, the chief medical officer supported the idea of an opt-out system with proper safeguards and good public information. My right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) also called for a public debate on the issue of presumed consent when he was Prime Minister and did not rule out changing the law to an opt-out system.

So what would actually happen under a system of opting out? It proposes that every person living in the country in which it is introduced is deemed to have given their consent to organ donation unless they have specifically opted out by recording in writing their unwillingness to give organs. Supporters of the introduction of such a system in the United Kingdom believe that establishing an automatic right to take organs when the donor has not expressed wishes to the contrary would lead to a significant increase in the number of potential donors. They also conclude that the relatives of, or those close to, a person who has not expressed a wish to donate would be relieved of the burden of making that decision at such a traumatic time.

However, one fear with presumed consent is that people will not get round to registering an objection and the subsequent expectation that organ donation should take place could lead to unnecessary distress for relatives and widespread adverse publicity. Many transplant recipients add that a donated organ is more easily accepted because they know that it has been positively given by the deceased whereas presuming consent would turn donation into an action by default.

Other concerns surround the potential medical risks involved in removing organs without full discussion with relatives. Families are a valuable source of information about their loved one’s previous health and relatives are questioned as part of the screening process. If an individual does not register an objection, it is possible that their silence may indicate a lack of understanding rather than agreement with the policy. It is because of these concerns that, in the majority of countries operating an opt-out system, health care professionals still consult the family to establish consent.

While always looking closely at both the pros and cons of the system of presumed consent, there is recognition across the health care profession and more widely that there is a crisis which leads to tragic loss of life—in the UK, at least one patient a day dies waiting for a transplant.

The former chief medical officer, Sir Liam Donaldson, was an enthusiastic supporter of presumed consent. He told The Guardian in 2007:

“We have something of a crisis in this country. Every day at least one patient dies while on the transplant waiting list. There are something like 7,000 people on the waiting list at any one time. There is a shortage of organs in this country and the situation is getting worse.”

A team at the centre for reviews and dissemination at the university of York focused on 13 studies and found strong links between presumed consent and increased donation rates. One of the studies found that donation rates were 25% to 30% with presumed consent. However, researchers also said that it was unlikely that presumed consent alone accounted for all of the effect as one study found that the number of transplant centres had a greater effect than an opt-out system. Other factors that had an effect on donation rates were death from road traffic accidents, health spending, public awareness and religion.

Support for presumed consent in the UK, as we have already heard, has grown steadily since 2000 and, in a survey carried out in 2007, 64% of respondents were in favour of moving to presumed consent. The BMA’s own figures are even more favourable, showing that around 70% to 90% of the population would be willing to donate their organs after death.

As I said earlier, when my party was in government, the then Health Secretary asked the organ donation taskforce to make specific recommendations to improve the infrastructure within which donation takes place and, since those were made, improvements have been achieved, with a 28% increase in donation rates over three years. The changes proposed by the taskforce include a wide range of measures designed to make the offer of donation a standard part of the care provided to dying patients—in the words of the taskforce, to make donation a

“usual and not an unusual event”.

As we have heard today, the Minister will be aware that this issue is being pursued in Wales with the National Assembly for Wales and the Welsh Assembly Government recently publishing a White Paper on an organ donation Bill for Wales which suggests an opt-out system with safeguards. As we have heard today, the moral and ethical arguments continue. It is right that we have this debate and have it in the United Kingdom Parliament as well as in the Assembly and that we raise awareness of this issue and help to educate people.

I share the concerns expressed today about the insufficient organs donated in the United Kingdom. There is no doubt that we need more people to realise that organ donation saves lives. We know that, in future, organ shortages—particularly for kidneys—are likely to increase. I congratulate the hon. Member for Montgomeryshire on securing this important debate, thank all hon. Members for their contribution and look forward to hearing from the Minister how the Government propose to resolve the crisis, what their position is on a presumed consent system and what action the Department of Health is taking to carry forward the work done by the previous Government on this issue.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Lansley]

My hon. Friend will know that health care and social care support workers do responsible jobs and that the responsibility for them lies principally with their employers and the staff who supervise them. We made provision in the White Paper we published last December for a process of assured voluntary registration. What I announced and referred to a moment ago will give a code of conduct and standards that will form a basis for an assured voluntary registration scheme in future.

[Andrew Gwynne (Denton and Reddish) (Lab)]

One key care standard is the time that people have to wait for their treatment. Labour got waiting times down to an historic low, and we warned the Secretary of State what would happen if he relaxed the 18-week standard. Figures show that the number of patients waiting longer than 18 weeks is up by 43% and, despite the U-turn that the Government have made on the use of targets, is not the problem that they have been so fixated on their top-down reorganisation that they lost control of waiting lists? Surely it is time for them to drop the Health and Social Care Bill and focus on the things that really matter to the people using and working in the NHS.

[Mr Lansley]

I am sorry, but that was all completely synthetic anger on the hon. Gentleman’s part. The average time that patients have been waiting in the NHS for treatment continues to be between eight and nine weeks. It has been so ever since the last election. The operational standard under the previous Government and now for the 18-week waiting time is that at least 90% of patients who are admitted for treatment should be admitted and treated within 18 weeks, and 95% of outpatients. Both of those operational standards continue to be met. Last week I made it clear that whereas the previous Government abandoned people who went beyond 18 weeks—and there were 250,000 of them who went beyond 18 weeks—we will not abandon those forgotten patients. We will make sure that they, too, are brought into treatment as soon as possible.

King George Hospital

Andrew Gwynne Excerpts

Tuesday 8th November 2011 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

I welcome you to the Chair, Mr Brady, and congratulate my hon. Friend the Member for Ilford South (Mike Gapes) on securing this important debate on the issues facing his local hospitals. I know that he, my right hon. and hon. Friends, and other Members across the party divide have campaigned extensively for their local health services, and I commend them for it.

The Government are implementing a number of much wider changes in the health service—I will touch on those later—but my hon. Friend must be disappointed with the recent decisions made about the hospitals in his area and the health services used by his constituents. He and others have mentioned the recent Care Quality Commission report on the standard of care received by people under Barking, Havering and Redbridge University Hospitals NHS Trust. The report had immediate concerns in relation to maternity services, identified failings in emergency care and radiology, and demanded widespread improvement.

As Members have mentioned, Queen’s hospital had the most serious concerns, including poor clinical care, verbally abusive and unprofessional behaviour by staff towards patients and colleagues, and a lack of learning from maternal deaths and incidents. The report states:

“Despite some signs of improvement in recent months, patients remain at risk of poor care in this trust”.

It also notes that the trust addresses issues on a short-term basis, under instruction, rather than proactively looking for longer term solutions. The report also states:

“There is past and current evidence of poor leadership from some managers and a culture among some staff of poor attitude and a lack of care for patients, especially in maternity.”

That is of extreme concern, and those views have been reinforced in this debate. The report also confirmed that attempts to cut the financial deficit at Barking, Havering and Redbridge trust led to reductions in the quality of care.

About three hours after the CQC report was published, the Health Secretary made an announcement about King George hospital, which now looks set to lose its A and E and maternity units. We know that the Health Secretary backed the IRP’s proposal for services to be expanded at nearby Queen’s hospital in Romford. That raises the question why, when the report on King George hospital was presented to the Secretary of State on 22 July, it then sat on his desk for more than three months and he chose to release its conclusions and recommendations on the same day, three hours after the CQC report.

From articles in the Ilford Recorder, in the constituency of my hon. Friend the Member for Ilford South, I see that there is a great deal of concern and consternation about that decision. Indeed, my right hon. Friend the Member for Barking (Margaret Hodge) described the decision in the press as “sheer madness”, outlining how Queen’s hospital is already having difficulty dealing with existing pressures—an issue which she raised today. My hon. Friend the Member for Ilford South previously described the decision as a disaster and is quoted in the Ilford Recorder as saying that the decision on King George hospital showed an

“absolutely contemptuous attitude to local people’s wishes and concerns”.

The proposed changes will not take place until the Barking, Havering and Redbridge University Hospitals NHS Trust, which runs both sites, tackles the issues raised by the CQC. The Minister went into a little more detail about that in the debate. However, it is not just the disruption, but the uncertainty of local people, who will no longer have access to A and E and maternity services on their doorstep, that should be of concern to all hon. Members.

Yes, we need to acknowledge that reconfigurations are unpopular. We went through that a few years ago in Greater Manchester. Nevertheless, given public opposition and the views of the overview and scrutiny panel, local MPs and members of the local authorities across party, will the Minister say what account has been taken of the level of local opinion on the local health services by the IRP? My hon. Friend says that it was in its report, but what weight did the IRP and the Secretary of State give to that level of opinion?

[Mr Simon Burns]

May I help the shadow Minister? The consultations—not on the IRP level when it was doing its work, but on the proposals themselves—have, since 20 March 2010, had to fulfil the four conditions for reconfigurations set out by my right hon. Friend the Secretary of State, which include consulting local people within the health economy and local opinion.

[Andrew Gwynne]

I appreciate that, but we heard today that there is a great deal of concern across local authorities and the communities, and I would like to know what weight was given to their views.

[Margaret Hodge]

Does my hon. Friend agree that it appears that money has been the key factor in forming the decisions, and not the care of people? The views of bureaucrats have taken precedence over the views and experiences of local communities.

--- Later in debate ---

[Andrew Gwynne]

Absolutely. We recognise that reconfiguration is sometimes necessary in parts of the country for reasons of financial efficiency, safety and better health outcomes. However, people are rightly disappointed by the way in which the nature of the debate changed in the run-up to the general election. As hon. Members rightly said, the general election was fought with a pledge about hospital closures and reconfigurations that is not being met. Back in 2010, the now Prime Minister clearly promised a moratorium to stop closures. Indeed, in opposition both he and the Secretary of State toured the country making promises to overturn some very difficult reconfiguration decisions taken by the previous Labour Government. Yet, as we have seen, the moratorium has not materialised, and there is now evidence of major changes to hospital services across the country.

I do not want to stray too far from the subject, but it is worth remembering that the Prime Minister gave a firm pledge not to close services at Chase Farm hospital, but in September 2011 the Secretary of State accepted the recommendations of the IRP and approved the downgrading and closure of services at Chase Farm. Similarly, at the Fairfield maternity department near Bury, we were told on a visit by the now Secretary of State that the service would be kept open. We now know that the maternity department at Fairfield general hospital is scheduled to close in March 2012.

My hon. Friend the Member for Ilford South raised concerns about the ability of Queen’s hospital to improve when the NHS faces tough financial challenges in the years ahead. That is fair comment. At the general election, Labour promised to guarantee to maintain NHS front-line funding in real terms. In contrast, the Prime Minister offered real-terms increases. We can debate that another time, but I would suggest that that was just an electoral gimmick. The Treasury figures show that in 2009-10 health spending was £102,751 million in the last year of the Labour Government. In 2010-11, actual health spending was £101,985 million.

[Mr Simon Burns]

Will the hon. Gentleman be kind enough to tell hon. Members that the health spending figures for the financial year 2010-11 were set by his own Government, and that, for the lifetime of this Parliament and thereafter, we are increasing health spending in real terms, albeit a modest increase because of the financial mess we inherited, which needs to be sorted out?

[Andrew Gwynne]

I said that that was the actual health spend for the first year of this Government, which represents a real-terms cut of £766 million, according to Treasury figures. That includes the GDP deflator, which so excited the Minister during the Opposition day debate when my hon. Friend the Member for Leicester West (Liz Kendall) tried to raise this issue. That is the first cut in health spending for 14 years. Indeed, that is the first real-terms cut since the last year of the previous Conservative Government in 1996-97. The Government promised a real-terms increase in health spending; they have delivered a real-terms cut.

There are wider concerns about how the Health and Social Care Bill will impact on local health services. The extensive reorganisation of the NHS was not put forward by either party in government in their manifestos, or in the coalition agreement. Clearly, such a massive reorganisation will make it harder for the NHS to tackle the sorts of problems identified at Barking, Havering and Redbridge University Hospitals NHS Trust, and the wider issue of social care for older people by the CQC. The Prime Minister has clearly gone back on his promise on NHS reorganisation. The coalition agreement could not have been any clearer:

“We will stop the top-down reorganisations of the NHS”.

It is difficult to see how the coalition Government could have said that, when only weeks later they published a White Paper outlining the biggest reorganisation of the NHS since 1948. It is clear that such a change on this scale is the last thing that the NHS needs right now.

Returning to the more specific question about Barking, Havering and Redbridge trust and the future of King George hospital, given the CQC report and what hon. Members have said today, what consideration has the Minister given to the ability of Queen’s hospital to deal with the added pressures on its services when King George hospital closes its A and E and maternity services? On the face of it, no consideration has been given to the local support for keeping A and E and maternity services at King George hospital. If services are to be transferred—the Minister says within two years—does he recognise that people need certainty and that NHS staff need proper expectations to plan and manage those changes? If those time scales are not met, what plans are in place for NHS services in that part of London?

The concerns expressed by Members today are right and need to be addressed by the Minister. Also, the wider changes to the NHS will make it much harder to identify such failures in care in future and to deal with them effectively. That is why we are so against what the Government are doing to our national health service.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 18th October 2011 Commons Chamber

[Mr Lansley]

I am afraid that the hon. Gentleman is completely wrong about that. In procurement throughout the NHS, what we have had is fragmentation, and what we need is better co-ordination. That is precisely why, since the election, for example, we have instituted a consistent bar-coding system, allowing procurement throughout the NHS to be undertaken more effectively; and why under the quality, innovation, prevention and productivity programme, the improvement in procurement —reducing the costs of procurement—is intended to achieve those savings and more.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Labour is proud of its legacy, with more than 100 new hospitals built to replace the crumbling Victorian buildings that we inherited in 1997, and it is not just the National Audit Office that has blown a hole in the Secretary of State’s assertion that 22 hospital trusts are on the brink of financial collapse due to PFI. John Appleby of the King’s Fund said:

“The…pressures on hospitals are not to do with PFI but…the need to generate £20bn worth of productivity improvements.”

Is not the real issue that the Secretary of State has tied up the NHS in a distracting and wasteful reorganisation that will cost more money than it will save, and take money away from patient care?

[Mr Lansley]

I welcome the hon. Gentleman to the Opposition Front-Bench position. We are looking forward to the exchanges with him and his colleagues, including during questions today.

Twenty-two trusts have told us, in the course of our looking at where the impediments are to their financial sustainability for the future, that the nature of the PFI contracts entered into by the previous Government is a significant problem in this respect. It is absolutely right for the NHS to build hospitals, which is why we are, for example, building a new hospital at Whitehaven in the hon. Gentleman’s constituency. [Interruption.] I beg his pardon—in the constituency of the hon. Member for Copeland (Mr Reed); we are building so many new hospitals. The nature of the PFI projects we enter into must be to provide value for money and be sustainable in the future. That is something that the previous Government failed to achieve.