NHS and Social Care Funding

Baroness Chapman of Darlington Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jenny Chapman (Darlington) (Lab)]

It is a pleasure to follow the hon. Member for Telford (Lucy Allan). I have not heard her speak before, and I look forward to hearing many more speeches from her in the future, but I completely disagree with her implication that we are letting ourselves, the House and our constituents down by standing up and championing health services in our constituencies. It is an essential part of our work and the reason many of us sought election to this place, particularly those such as my hon. Friend the Member for Tooting (Dr Allin-Khan), who has such relevant experience of this subject and made a tremendous speech. I listened with great interest to what she had to say, and I think that Ministers ought to be doing the same.

We have had a lot of debate about whether the NHS is in crisis and whether it is a humanitarian crisis, an ordinary crisis or a winter crisis. I looked the word up and found that a crisis is “a period of intense difficulty or danger”, which strikes me as a good description of where the NHS is today. Intense difficulty is what I am seeing in my local hospital, and it is what my constituents are coming to tell me about.

I have been an MP for nearly seven years, and I keep track of the topics people come to talk to me about in my local surgeries. I am sure many of us do that; it is not hard to do. Someone comes to see me every week either about an experience at the hospital or, more often still, because of an experience in adult social care. That is not something that has occurred suddenly over the last few weeks; it has been growing over time. I would say that the crisis we are witnessing today has been long predicted and is something that we have all felt happening over time.

The Government have chosen—they made a decision—not to act to prevent the worsening of the crisis, which is why there is such anger on the Opposition Benches. When a quarter of patients wait longer than four hours in A&E, that is a crisis. I do not really care whether they are there with an minor ailment or a more serious one, because four hours is too long to wait. The fact that people are there with minor ailments is a very clear demonstration of the problems that exist elsewhere in the system.

When people cannot get a GP appointment they sometimes phone 111, and, more often than not, they will be directed to A&E. I think we need a selection of services available at a central point, whereby if people need a GP, they can see a GP; if they need a practice nurse, they can see a practice nurse; and if they need to be admitted, they can be admitted.

[Victoria Atkins]

In an effort to reassure her colleagues, I want to ask a genuine question—one that I would have asked the hon. Member for Tooting (Dr Allin-Khan). What impact does the hon. Lady believe the 2004 GP contract has had on out-of-hours care? This seems to be the nub of many of the issues discussed this afternoon.

[Jenny Chapman]

The GP contract was changed in 2004, but I did not notice the sort of issues that we face today until far more recently. I am not a scientist or a doctor, but I understand cause and effect, and it does not ring true to say that something that happened six years prior to the change in government can be blamed for something that is happening six years after the change in government. I am not saying that there were no consequences, but I believe that ample opportunity has been provided to put measures in place that would have prevented us from being where we are now.

The hon. Lady’s intervention leads me nicely to my next point, which is about the Secretary of State. I had not intended to speak today, but I was so frustrated listening to him on the “Today” programme, trying to blame anybody but himself, that I decided to do so. He has a pattern. The first thing he does is blame the Labour Government, who were in government until 2010. His party has been in government since then, but he will blame Labour for anything he possibly can. He will find something that happened, perhaps at a particular trust and say that that is why something has gone wrong today. If that does not work and cannot be evidenced, he will say, “Well, that particular trust is a basket case. It is the trust’s fault or the fault of the local managers and local clinicians who have not organised themselves right.”

If that does not work, he will then blame the public, and tell them that they are going to the wrong place, accessing their care in a way that he does not think they should. He might call them “frequent flyers” or point to a problem that is the public’s fault. He will say, “They do not look after themselves properly; it is clearly their fault.” If that does not work, he will blame the local council, and I think that is the worst thing that I have heard him do—blame the local authority.

My local authority has prioritised adult social care, but the pressures are not going away. They are going to get worse and more difficult to manage—and it is running out of things to cut. It is closing our central library in Darlington and making other hideous cuts, and I do not know where the next round will come from.

[Robert Courts (Witney) (Con)]

I am sure the hon. Lady agrees that it is incumbent on us all to discuss the future of our NHS and our healthcare services responsibly. Does she not accept that when the Secretary of State is talking about where people go for their services, it is not a question of blame? We ought to move away from that blame culture. However, there is a benefit in trying to educate people. If their illnesses are not best served by A&E departments and are best served elsewhere, they ought to realise that they should go elsewhere. That would help us all. It would help the people who are seeking the services, and it would help the people who are providing them.

[Jenny Chapman]

Yes indeed, so why does the hon. Gentleman not say that to his right hon. Friend the Secretary of State? He is the one who is blaming people, not me. I should welcome a programme that involved explaining to people and making it easier for members of the public, including me, to decide where we should go when we need assistance.

One solution that the Government have come up with seems to involve watering down the four-hour target, although, interestingly, not even Conservative Members seem to be able to agree on—or explain—what change will be made, or even whether there will be a change. Their other solution is to close A&E departments, and, as part of the STP, the A&E department at Darlington memorial hospital is one of those that may be downgraded or closed. I do not think the local community will accept that. Part of our purpose in doing our job is to give a voice to local communities, but, so far, our local community has been completely shut out of the STP process. We would not have even known what was contained in the plan had it not been leaked by Hartlepool Borough Council on its website. That is a shocking way in which to conduct a dialogue with a local community.

In parallel with the STP process is the Better Health programme, which started about three years ago and which operates in the region that contains my constituency. I was shocked to discover from responses to parliamentary questions that local health managers had spent £4.6 million that could and should have been spent on frontline health services for my constituents on a consultation on whether or not to downgrade A&E. I could have spent that money a great deal better, and I could also have told those health managers what the local population thinks about the proposal. They are very angry and upset about it, and it is right for us to express such anger, disappointment, outrage and fears for safety in the House.

Many Members have spoken about their families and relatives today. My hon. Friends the Member for Chesterfield (Toby Perkins) and for Workington (Sue Hayman) spoke about their fathers. My dad died in 1994. He had had a heart condition. He was 48, and I was 20. Since then, I have taken a keen interest in cardiac health and services for people with heart disease. I was shocked to find that, before 1997, it was not uncommon for people to die while waiting for heart treatment and that people would often wait 18 months. The Labour Government changed that: we made it a matter of weeks, and we saved countless lives as a consequence.

When people say that the Labour party did not do a good job with the NHS, and when Conservative Members try to imply that we have a fake, dewy-eyed, sentimental attachment to the NHS, they are completely wrong to do so. We will fight for the NHS. We created it, but we also did a good job running it in government. We saved lives, cut waiting times and introduced targets, and that made a difference. It made things better for patients. We will never stop making that case, in the House and outside.

[Several hon. Members rose—]

National Health Service Funding

Baroness Chapman of Darlington Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right to raise that point. People will be astonished to hear Labour Members wasting their time talking about a privatisation of the NHS that is not happening when they were responsible for PFI, the worst possible privatisation that has done such enormous damage.

Another point that the shadow Health Secretary did not mention was the quality and safety of care in our NHS that Labour left behind. The Francis report revealed massive problems—short staffing, a culture of denial and cover-ups—and they were not just at Mid Staffs but, as we now know, at Basildon, Morecambe Bay and many other trusts. Since we have been in office we have changed that. We have put 31 hospitals into special measures, which is more than 10% of hospitals across the entire NHS, and we have recruited record numbers of doctors and nurses.

I want to tell the House about one hospital that was put into special measures. Care was unsafe at Wexham Park in Slough—so much so that fewer than half the hospital staff were prepared to recommend the care provided there to their own friends and family—but it has gone from having six of its eight clinical areas rated as requiring improvement or inadequate, to having all eight of them rated as good or outstanding. It has come out of special measures, as have 15 hospitals in total, and we should all commend the staff who have worked incredibly hard to turn around those hospitals.

[Jenny Chapman (Darlington) (Lab)]

The right hon. Gentleman has the nerve to talk about the inheritance from a previous Administration, when what we inherited in 1997 was people dying on waiting lists of more than 18 months for heart operations.

[Mr Hunt]

I have often from this Dispatch Box been prepared to praise some of the achievements of the last Labour Government. They did bring down waiting times, but they did not focus on the quality and safety of care.

What we now know from the CQC’s new regime, which has just finished its first round of inspections, is that 56% of our hospitals are good or outstanding. One could say that it is disappointing to know that 44% of hospitals are not, but to those who would use that as a political weapon I say this: we are the only country in the world brave enough to set up an independent inspection regime, and if we want to have the safest, highest quality care, the first thing we need to know is where it is good and where we need to improve it. I thank the chief inspector of hospitals, Professor Sir Mike Richards, for his outstanding work in raising quality.

--- Later in debate ---

[Jenny Chapman (Darlington) (Lab)]

It is a pleasure to follow the hon. Member for South West Wiltshire (Dr Murrison), whose points about hypothecation were particularly interesting.

Long-suspected proposals to downgrade Darlington Memorial hospital were confirmed by the leak of the STP by Hartlepool Borough Council. I am grateful to the council for allowing the document to enter the public domain. Darlington Memorial serves not only the town of Darlington, with its population of about 100,000, but communities living far into the Durham and the Yorkshire dales—Barnard Castle, Northallerton and beyond. Darlington is also the closest major town to Catterick garrison, the largest army base in Europe, which is set to expand yet further. Nearby hospitals have already been downgraded in recent years, with changes to emergency cover at Bishop Auckland hospital and to maternity services at the Friarage hospital in Northallerton. When those changes were made, in the face of enormous local opposition, residents were assured that services at the next nearest hospital, Darlington Memorial, would be safe.

Darlington Memorial is special to me, perhaps even more so than it is to many of my constituents—I make no apologies for that. Both my parents were nurses, and we lived in nurses’ accommodation at Darlington hospital for a while when I was eight or nine. My dad died at that hospital, as did my grandmother. My two sons were born there, and have made regular and at times unexpected use of its services ever since.

I do accept that, for some specialist services, there is a benefit to centralisation. I absolutely support clinically driven decision making. When cardiac services were moved from Darlington to Middlesbrough, it did not lead to a campaign—it was the right choice for patients, it improved outcomes and I supported it. However, major trauma is already located at James Cook University hospital in Middlesbrough, and the argument now is about centralising services that do not have problems in their outcomes. There is also no clinical gain for patients through such a change, which makes the proposal just wrong.

Another concern relates to the amount that has been spent on so-called engagement activity with the local community to explain the downgrading plans to residents and find out what they think about them. Answers to written parliamentary questions show that £4.6 million has been spent on such activities so far. That is a disgrace, and those responsible should be held to account, as they have wasted public money and are now misleading the public about the fact that there is absolutely nothing to show for that.

In recent months, a campaign to save Darlington hospital has been growing. People from SOS Darlington have been out campaigning in the town centre, knocking on doors, and holding coffee mornings, and they have done it all for free. They have managed to engage 6,000 people. They are doing a better job of engaging the public and they are doing it for absolutely nothing. There is no clinical case for downgrading services at Darlington hospital. Everyone involved knows that, which is why so much time and money is being spent on making up ways to persuade patients that it is a good idea.

The STP’s description of my constituents as “passive recipients of care” is not helping. The trouble is that the nirvana that the STP tries to support is not achievable without massive—as yet unquantified—amounts of up-front spending.

I admit that my attachment to my local hospital goes beyond the utilitarian, but I understand enough about how this process is unravelling to know that staff at Darlington Memorial hospital and their patients—my constituents—deserve an awful lot better.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am very pleased to be able to close what the hon. Member for Ellesmere Port and Neston (Justin Madders) described as an interesting debate. I would describe it as an occasionally high-pitched debate, to which a number of Members made constructive contributions. I must say to the hon. Gentleman that those constructive contributions came from the hon. Member for Central Ayrshire (Dr Whitford), who made a characteristically impressive speech, and from Back Benchers on my side of the House, whose contributions, I might add, outnumbered those from Back-Bench Labour Members by four to three—or one third—although this was an Opposition day debate. Where are the Labour supporters for the motion, I ask the hon. Gentleman? We shall have to see whether they turn up to vote; they certainly were not prepared to turn up to speak.

The funding of the NHS is clearly a subject that is close to the hearts of most Members in the Chamber, precisely because it, along with the contribution of all who work in the NHS—to whom I pay tribute, as did the Secretary of State, but as the hon. Member for Ellesmere Port and Neston failed to do—is what keeps the NHS going. The Government are committed to the NHS, and committed to ensuring that it is free at the point of use.

[Jenny Chapman]

On a point of order, Mr Deputy Speaker. Is it in order for the Minister to imply that there was a lack of interest among Labour Members, given that the speaking time limit was cut to four minutes, and then—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. It has been put on the record, and it is a matter of public record, but I will say that speeches were made by nine Opposition Members and eight Government Members. Speeches were made by six Labour Members and eight Conservatives. That may help the House, and may prevent any further arguments.

NHS Funding

Baroness Chapman of Darlington Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

It is not just the money that Labour has cut. It has refused to set up an independent inspectorate of hospitals such as we did in England, which is the sure way of knowing that we never have a repeat of what happened at Mid Staffs. I urge the Welsh Government to think again about their approach to that.

[Jenny Chapman (Darlington) (Lab)]

Darlington’s A&E is among the one in three earmarked for closure or downgrading. In his opening response to what is an urgent question, not a statement, the Secretary of State said that he did not accept that figure of one in three. How many A&Es will be downgraded, or does he not know?

[Mr Hunt]

Those plans come up from local areas. The NHS is not projecting that we will have significant reductions in the need for emergency care over the next few years. What matters is that we make sure that, yes, people can get to an A&E near them, but that when they get there, they get the right expert care, and that is what local areas are working on.

Junior Doctors Contracts

Baroness Chapman of Darlington Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

Yes, there are some hospitals that have managed to eliminate the difference between weekend and weekday mortality under the current contracts, but there are only a few. Having talked more widely with the medical profession, it is clear that we need a sustained national effort—contract reform is part of that effort—if we are to promise uniformly across the NHS that we will provide every patient with the same high-quality care, every day of the week. Part of that is having a modern contract for junior doctors that deals with the anomalies that they themselves recognise in the current contract; that is why this is the moment for wider reforms.

[Jenny Chapman (Darlington) (Lab)]

This is clearly a fight that the Secretary of State went looking for because he expected to put himself on the side of the patients. The trouble is that it has not worked out like that, because the patients, such as my hon. Friend the Member for Ilford South (Mike Gapes), use these services and know that junior doctors are in work at the weekend; it is some other procedures that are sometimes not available. Their feelings now will be fear and anxiety that they, their children or their elderly relatives will get sick, fall or need help on strike day. They will be seriously, seriously worried about that. Does the Secretary of State take any responsibility for the situation that he has caused?

[Mr Hunt]

On the contrary, I take full responsibility for delivering a safer NHS for patients. That is my job. If the hon. Lady wants to talk about patients, perhaps she might listen to the comments of one of the most famous patient safety campaigners in the country, James Titcombe, who tragically lost his son because of mistakes made at Morecambe Bay. He said that there has been

“much progress towards a safer NHS in recent years”,

but that there is

“much more to do to reverse the cover-up culture that flourished under Labour.”

William Mead: 111 Helpline

Baroness Chapman of Darlington Excerpts

Tuesday 26th January 2016 Commons Chamber

[Mr Hunt]

I can reassure the hon. Gentleman that we are looking at all these things. As with the issue of the prescribing of antibiotics raised by my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), of course we want GPs to avoid inappropriate referrals to secondary care, but it is vital that where a referral is needed, it happens. We see this not just in cases of sepsis, but in cases of cancer. It is vital that we get better at catching cancers earlier if there is to be a successful outcome to the treatment, so the hon. Gentleman is absolutely right. That will be looked at.

[Jenny Chapman (Darlington) (Lab)]

I commend the shadow Secretary of State on securing this urgent question. Earlier, the Secretary of State said that he felt that people had confidence in 111 because of the high call volumes, and that those had increased. I do not think that is the case. Confidence in 111 is shaky at best and this case could well shatter that confidence even further, unlike the confidence that we all felt in NHS Direct when we had young children. What is he going to do to make sure that as well as listening to the people whom he has mentioned already, he involves patients in determining what they need in 111 to give them back the confidence that we need them to have in order to avoid some of the pressure on the rest of the service?

[Mr Hunt]

The hon. Lady is right about the importance of involving patients when such tragedies occur, and I said in my response to the urgent question how grateful I was to the Mead family for their co-operation. One of the things the report identifies as important is earlier involvement and more listening to parents and families in such situations. I caution the hon. Lady against a blanket dismissal of the service offered by 111. There are many clinicians and call-handlers who work extremely hard and who deal with about a million calls a month, and the vast majority of those cases have satisfactory outcomes. But does that mean that there are not significant improvements that we need to make to that service? No, it does not. Of course there are things that need to be done better and we must learn the lessons from this terrible report.

Oral Answers to Questions

Baroness Chapman of Darlington Excerpts

Tuesday 5th January 2016 Commons Chamber

[George Freeman]

My hon. Friend makes an excellent point. The key is, of course, more funding and more integration, but crucially more local leadership too, and we are actively making it easier through the devolution programme for local authorities and local health leaders to plan the integrated services that are appropriate for their area. Not all areas are the same.

[Jenny Chapman (Darlington) (Lab)]

17. Having listened to what the Minister has to say, people in my constituency will be disbelieving. The number of days that patients are stuck in hospital, not because they are sick but because there is nowhere to move them, has doubled under his Government. He has to acknowledge that that is due to the neglect of local government and adult social care specifically.

[George Freeman]

It is true that in different areas there are different pressures. In my own area of Norfolk there are pressures. Let me remind the hon. Lady that A&E spending has gone up dramatically over the past decade, from £900 million in 2001 to £2.4 billion. The early evidence from the better care fund, which we launched only this year to tackle this very issue, is 85,000 fewer delayed transfers, 12,000 more older people at home within three months of discharge, and nearly 3,000 people supported to live independently. Through more funding, greater freedoms and local devolution, we are supporting health leaders and council leaders to bring together health and care.

Cities and Local Government Devolution Bill [Lords]

Baroness Chapman of Darlington Excerpts

Monday 7th December 2015 Commons Chamber

[Mr Allen]

I can barely believe that my hon. Friend would be anything other than consensual. In recent weeks he has perhaps been known as being on the provisional wing of the Labour party, but his innate character is that of seeking consensus. I agree very strongly, as I always do, with my constituency neighbour. I hope colleagues throughout the UK adopt a similar view and take us forward on this issue.

[Jenny Chapman (Darlington) (Lab)]

Is my hon. Friend concerned that there are absent voices from the consensus thus far, in the shape of the public, who are not always involved or even aware that these kinds of deals are going ahead? I realise it is difficult, but do their voices not need to be captured somehow, too?

[Mr Allen]

To an extent, their voices have to be captured by those who seek elected office, whether in this House or in the locality. Devolution is just one part of a broader democratic settlement. It is essential that it is not just the great and the good who are involved. As I outline in new clauses 1 to 4, there has to be the most tremendous unprecedented outreach. A citizens convention must go way beyond even what we saw in Scotland, either in the referendum campaign or in its own citizens convention, and use all the modern techniques of social media, technology and electronic polling, so that people can feel ownership. My hon. Friend is absolutely right that unless we build that in, and unless people feel that a proper debate has been had, the process could be stressed and fractured when people feel that the right thing has not been done. I would argue, therefore, as with new clauses 1 to 4, that we will need a broad-based exercise involving an unprecedented level of public participation in order to settle our democracy not just for the next four years but so that it holds for 100 years after that. That cannot be done on the back of us alone making these decisions.

Madam Deputy Speaker, I seek your advice on a matter of order, although I do not know if I am entitled to do so in the middle of a speech. There are amendments on health. Should we talk about those matters now or wait for a natural break?

Oral Answers to Questions

Baroness Chapman of Darlington Excerpts

Tuesday 13th October 2015 Commons Chamber

[Ben Gummer]

The core purpose of the Vanguard programme is to ensure that we get local solutions to local healthcare problems. Only by making sure that we release the potential of local healthcare staff and providers, doctors and nurses, do we get the solutions we require rather than things being determined from Whitehall, as was the wont of previous Administrations that we will not follow.

[Jenny Chapman (Darlington) (Lab)]

I can think of few things more frightening than being in labour and being turned away from a maternity unit that someone has visited, become familiar with, and got to know the staff. Over a third of units closed their doors to women in labour last year. What is the Minister going to do about this, and why does he think it has been happening?

Patient Safety

Baroness Chapman of Darlington Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

It certainly does, and that is another area where it would be refreshing to have a bit more openness from the Labour party. We can afford 8,000 more doctors and 4,000 more nurses in our NHS than when Labour was in power because we got rid of primary care trusts and strategic health authorities, and 20,000 administrative jobs that were not on the front line—a change that Labour opposed bitterly every step of the way. Labour Members must say what would happen to those doctors and nurses if we repealed the Health and Social Care Act 2012, as they have publicly committed to do.

[Jenny Chapman (Darlington) (Lab)]

If the Secretary of States wants some kind of TripAdvisor-style scheme for the NHS that is fine; it may improve safety and it may help patient choice. However, a woman who has fallen to the bottom of her stairs and is waiting hours for an ambulance does not have a choice. That is happening now and it was not happening five or six years ago. What is he going to do about that?

[Mr Hunt]

First, I will ensure that throughout the system when we have failures in care we are completely transparent about them and do not seek to brush them under the carpet. That is a very important change. Secondly, yes there is pressure on ambulance services, just as there is pressure in most parts of the NHS now, but under this Government our ambulance service is taking 1,000 more people every day on emergency journeys. We should credit it with doing a very good job in difficult circumstances.

Oral Answers to Questions

Baroness Chapman of Darlington Excerpts

Tuesday 1st April 2014 Commons Chamber

[Jenny Chapman (Darlington) (Lab)]

Who is responsible for the disgraceful increase in the numbers of people across the country waiting hours in pain and indignity for an ambulance?

[Mr Jeremy Hunt]

We have 1.2 million more people going to A and Es every year. The ambulance service has, on the whole, been doing a good job, but there have been areas where there are problems. We need to change our attitude towards the capabilities of ambulance services, particularly the ability of paramedics to treat people on the spot, and we are driving through that change.