NHS Trusts: Finances

Ben Bradshaw Excerpts

Monday 1st February 2016 Commons Chamber

[Mr Ben Bradshaw (Exeter) (Lab)]

Devon NHS had no deficit in 2010 when we had a Labour Government. It now has the worst deficit in England. What assurances can the Minister give my constituents in Exeter and those elsewhere in Devon that services and waiting times will not deteriorate even further?

[Ben Gummer]

I thank the right hon. Gentleman for his co-operation and help in trying to form the future of the NHS in Devon. This will work only if there is a cross-party effort, and the same is true of the national level. We have particular, urgent problems in Devon, and that means that the deficit will increase unless we take significant local action. That action needs to be led by local clinicians, and I am very glad that they are talking constructively. My job and that of the right hon. Gentleman is to provide support in the coming months so that we can have one plan that we can then implement.

William Mead: 111 Helpline

Ben Bradshaw Excerpts

Tuesday 26th January 2016 Commons Chamber

[Mr Hunt]

I am happy to undertake that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), will look urgently into whether such a campaign would be right. I can reassure my right hon. Friend that the package that we put together and announced last January did contain what most people felt was necessary, but we can always look at whether more needs to be done. I commend her for her campaigning on the issue of sepsis. On a more positive note, when the NHS has decided to tackle conditions such as MRSA and clostridium difficile, it has been very successful. In the past three years, the number of avoidable deaths from hospital-acquired harms—the four major ones—has nearly halved, so we can do this. We should be inspired by the successes that we have had to make sure that we are much, much better at tackling sepsis.

[Mr Ben Bradshaw (Exeter) (Lab)]

One reason why the number of calls to 111 has trebled is that people find it impossible to get to see their GP. As well as the shocking failings of this family’s GP, is it not the case that the Government were warned of the consequences of abolishing the popular and successful NHS Direct and of replacing it with a non-clinician led service? Will the Secretary of State look personally at the performance of 111 in the south-west, which has been bedevilled by failings ever since it was set up?

[Mr Hunt]

I gently say to the right hon. Gentleman that when 111 was set up it had the support of the Opposition. The shadow Health Secretary at the time looked at the risk register. The number of calls has increased dramatically partly because demand for NHS services has increased dramatically. That does not mean to say that there are not important things that need to be improved. We need to look honestly at what went wrong. The 111 service was one of the four areas where we should have done better. I am happy to look carefully at what is happening with 111 in the south-west. One improvement is that, in many areas, we are integrating the commissioning of 111 with the Ambulance Service, and that is something that happens in the south-west. On the whole, that has been a positive experience, but I know that there have been problems in the south-west, and I am happy to look further at them.

Oral Answers to Questions

Ben Bradshaw Excerpts

Tuesday 5th January 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. That system does not work for people who have to go to work, and we want to make it easier for people to book appointments online or using an app on their phone. We also want to make it easier for people living in rural areas such as his constituency of North Cornwall to have telehealth appointments where appropriate, so that they can see someone without actually having to go to the surgery.

[Mr Ben Bradshaw (Exeter) (Lab)]

Given the increasing difficulty that members of the public are having in getting an appointment with their GP quickly and at a time that is convenient to them, does the Secretary of State believe that his predecessor was wrong when, as one of his first acts, he scrapped Labour’s 48-hour GP access guarantee?

[Mr Hunt]

No I do not, because that had perverse consequences. When that target was in place, the number of people waiting to see a GP increased rather than decreased. In the last Parliament, the number of GPs went up by around 1,600—a 5% increase in the workforce—and we have plans to increase it by 13%, which would be one of the biggest-ever increases in the GP workforce in the history of the NHS, on the back of a strong economy.

Southern Health NHS Foundation Trust

Ben Bradshaw Excerpts

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

I can absolutely give that assurance to my hon. Friend’s constituents. I hope they will consider the tone of my earlier remarks and realise that we are not looking at this simply as an issue for Southern Health. Clearly, important changes must happen there and must happen quickly, and we will do everything we can to make sure that they happen. I also think, however, that there is a systemic issue in relation to the low reporting of avoidable and preventable deaths and harm, and the failure to develop a true learning culture in the NHS, which in the end is what doctors, nurses and patients all want and need.

[Mr Ben Bradshaw (Exeter) (Lab)]

I thank the Secretary of State for his statement and congratulate NHS England on what sounds like a very thorough report. I remind him that challenging the methodology was exactly the same first line of defence used by the now disgraced management at Mid Staffs hospital. Will he answer the specific question my hon. Friend the Member for Lewisham East (Heidi Alexander) asked as to when Ministers first knew about problems in the trust, which we hear go back to 2011, and what action they took as a result?

[Mr Hunt]

I thank the right hon. Gentleman for his comments. I hope I did address that by saying that the first time was when we realised there were issues around the tragic death of Connor Sparrowhawk. That is what started the process and led to the independent investigation. Because NHS England wanted it to be very thorough, that investigation went right back to 2011 and up to 2015. It looked at all unexpected deaths in that period, and at the reporting culture and lessons that had or had not been learned as a result. A lot of action has been taken. I can also reassure the right hon. Gentleman that during that period we have been implementing the recommendations of the Francis report, which has meant that throughout the NHS there is a much greater focus on, and transparency in, patient safety.

It is important to give the NHS credit. During the past three years, we have actually seen a 25% increase in the number of reported incidents. I think people are treating this much more seriously than in the past, but there is much more to do.

Mental Health

Ben Bradshaw Excerpts

Wednesday 9th December 2015 Commons Chamber

[Mr Ben Bradshaw (Exeter) (Lab)]

I am sorry to have to say, not for the first time in this House over the last few years, that in spite of all the warm reassurances from the Government that our mental health services are getting better, the experience of my constituents as users of the service, people who work in the service and those who manage the service is completely different.

It is extremely welcome that mental health has risen up the political agenda in recent years. I pay tribute to the many people outside and inside this House who, by speaking of their own experiences, have helped to achieve that. However, the higher public profile has not yet translated into delivery on the ground. In my area, the public are still experiencing services being cut and are still having to wait an unacceptably long time for talking therapies and other treatments.

In spite of the repeated warnings about the scandal of people being sent out of area in recent years and the assurances we have received, there was a 23% increase in the number of patients sent out of area last year, taking it up to more than 500. In Devon, which is one of the worst performing parts of the country, 45 patients were forced miles away from their friends and families.

I recently experienced that problem for myself, when the bright and previously happy teenage daughter of a close friend of the family had a crisis. While on the waiting list to receive treatment, her crisis escalated rapidly and she had to be admitted. There were no suitable beds at all in London, where she and her family live. She was first sent to Southampton, only for the unit there to be deemed unsuitable. She was then sent to Manchester.

[Paula Sherriff]

In my area of Kirklees, some children and adolescents wait up to two years for out-patient talking therapies. Does my right hon. Friend agree that that is appalling and completely unacceptable? Does he also agree that early intervention is very important to ensure that people do not suffer too much in later life?

[Mr Bradshaw]

My hon. Friend is absolutely right. As she clearly articulates, the picture on the ground is very different from the one that is so often painted by the Government.

The House may remember a case that caused headlines a couple of years ago when I raised it in another debate. A 16-year-old girl in Devon was kept in a police cell for two nights because no bed could be found for her anywhere in the country. Her case is not unusual. As we have heard in this debate, more than 6,000 people with mental illnesses were held in police cells last year.

[Marie Rimmer]

Does my right hon. Friend agree that the provision of tier 4 CAMHS beds is a national commissioning issue? Those beds are commissioned by NHS England, not by the CCGs. I think that that is a problem. The Government need to focus on the nationally commissioned beds. Many young people who have eating disorders get to the stage where they need such beds.

[Mr Bradshaw]

My hon. Friend is absolutely right. I hope that the Minister heard her intervention, because I will leave that bit out of my speech. I was going to raise the ongoing problem of the interface between mental health services for young people and adolescents and those for adults. A lot of people are falling through the gap.

There has been a lot of talk, including from the Government, about parity of esteem, but there is scant evidence of it on the ground at a local level. I ask the Minister to explain when he responds to the debate why, if the Government are serious about parity of esteem, NHS England has removed it from this year’s NHS mandate. That is the important document that the NHS publishes every year to tell local health services what they have to deliver. Why has parity of esteem been removed?

Why are the Government cutting so drastically the funding for public health, which delivers many preventive services, such as alcohol and drug treatments and psychological support for young people in schools, that stop people getting ill in the first place, saving money and lives?

As we have heard, after years of falling, the rate of male suicide is on the increase again. Suicide is the main cause of avoidable death among young males.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Would my right hon. Friend like to attend a meeting held by the all-party parliamentary group on suicide and self-harm prevention and the all-party mental health group, at which Dr Robert Colgate will address us on the subject of triaging? By that process, mental health nurses, social workers and GPs can triage a patient for whom they cannot get an immediate appointment and enable appropriate care plans to be put in place while they wait for the next-stage appointment. The meeting is on 29 January, and I hope that my right hon. Friend will join us.

[Mr Bradshaw]

I am sure that hon. Members will be grateful for that public invitation in spite of the pressure on their diaries from numerous all-party parliamentary groups.

Yesterday, the Health Select Committee was told that, whereas the vast majority of acute hospital trusts were expecting to run deficits this year—a big increase— the figure for mental health trusts was much lower. We might think that that is a good thing, but the reason that acute trusts are running such big deficits is that they are giving priority to ensuring safe care. So, if far fewer mental health trusts are running deficits, is that because they are simply cutting services? I should be grateful to hear the Minister’s view on the difference between the deficits being run by mental health trusts and those run being by general acute hospital trusts.

I shall close now, because many people want to speak in the debate. There is probably no one here or outside the House who has not been affected, or whose family has not been affected, by mental illness. We have been hearing warm words from the Government for several years about how things will improve. Indeed, we have heard today that they are improving, but that is not the experience of people on the ground. So I hope that, when the Minister responds, he will focus on action and delivery and not just on words.

[Several hon. Members rose—]

NHS Reform

Ben Bradshaw Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

I am more than happy to meet my hon. Friend to discuss those matters. Wythenshawe is an excellent hospital—I have been there—and it has provided a number of staff who have helped to turn round the standard of care at Tameside hospital, which has seen dramatic improvements. I recognise that Wythenshawe is an excellent hospital, and I am very happy to meet him to listen to his concerns.

[Mr Ben Bradshaw (Exeter) (Lab)]

How will the Secretary of State pay for his very laudable objective of seven-day working when he has lost control of NHS finances? Contrary to what he claimed about the situation in Devon, as things now stand our patient care is suffering, waiting times are rocketing and we are facing a £434 million deficit.

[Mr Hunt]

Let me tell the right hon. Gentleman why so many places are going into deficit. They have looked at the lessons of Mid Staffs and said, “We don’t want that to happen here.” That is why, in the past two and a half years, hospitals have employed 8,000 more nurses on hospital wards to deal with the scandal of short staffing that they faced and wanted to do something about. In the end, if it is not sustainable, it is not quality care, so we have to find smart ways to control deficits—not by reducing the staff and making care unsafe, but by making changes to process and through efficiencies, such as making sure that nurses do not spend too long filling out forms and can spend more time with patients. In terms of funding, I would just say that the only way to fund a strong NHS is to have a strong economy, and that is why the country voted in a Conservative Government in May.

NHS Success Regime

Ben Bradshaw Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

I thank my hon. Friend for her typically gracious welcome for the proposals. She understands why this matter requires a whole-system approach at local level. I can confirm that the NHS will be studying every single aspect of the local health economy and all that that entails.

[Mr Ben Bradshaw (Exeter) (Lab)]

Is it not disgraceful that in the health debate on the Gracious Speech two days ago the Secretary of State had nothing to say about the financial crisis affecting the NHS and refused to answer my questions about his plans for Devon, and that this announcement was made to the media yesterday with no details of how it is going to affect patient care or the quality of services in my area? The Minister is very keen on quoting Simon Stevens, but Mr Stevens told BBC Radio Devon this morning that this chaos was a direct result of the fragmentation following this Government’s reorganisation of the health service. When is the Minister going to admit that that reorganisation was a disaster, and when are the Government going to get a grip on the spiralling financial crisis in our NHS?

[Ben Gummer]

I heard the right hon. Gentleman’s comments during the debate on the Queen’s Speech, and I know that he has taken a keen and detailed interest in the problems in his local health economy. I know also that he has been very careful and keen to include local commissioners and those who understand what is happening on the ground. That is why I had hoped he would be pleased about the introduction of the success regime, which will build on the financial consultations and discussions that have been going on, will involve local commissioners and, importantly, will provide the back-up of national regulators and NHS England. I did not hear the comments of Simon Stevens on local radio but I did read his speech, in which he made the opposite point to the one that the right hon. Gentleman suggested. The reforms that were brought in, far from being as the right hon. Gentleman characterised them, have saved £1.5 billion in this year, in addition to the £5 billion previously—money that is being invested in care in his constituency.

Health and Social Care

Ben Bradshaw Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Ben Bradshaw (Exeter) (Lab)]

I congratulate the hon. Member for Central Ayrshire (Dr Whitford), who is the health spokesperson for the SNP, on an excellent maiden speech. I am sorry that the Secretary of State and the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), are not in their places because they are the Ministers who have a little bit of historical knowledge about the past couple of years in the NHS. I hope that the Under-Secretary of State for Health, the hon. Member for Ipswich (Ben Gummer), will relay the comments of other Members to them, so that the hon. Member for Battersea can respond to them fully at the end.

I want to stress how pleased I am that my right hon. Friend the Member for Leigh (Andy Burnham) spoke mainly about the deteriorating financial situation facing the NHS. To be perfectly honest, I was astonished that the Secretary of State had nothing at all to say about that. He cannot say that he and fellow Ministers have not been warned, because many MPs on both sides of the Chamber have been sounding alarm bells about this for some considerable time.

Last February the Government commissioned a series of reports on what they called the most financially challenged health economies in the country, of which Devon was one. Since then, nothing has happened: the Government have refused to publish those reports. I tabled a freedom of information request just before Dissolution asking where the consultants’ report was, and was told it could not be published because it would, in time, inform the making of decisions that would affect local NHS services in Devon. Why have we been waiting so long for action by this Government to address the financial situation, which in the meantime has got much, much worse?

Let me give some of the figures for my area. My local commissioning organisation, the Devon clinical commissioning group, announced last week that its deficit has risen to £40 million this year. My local hospital, the Royal Devon and Exeter hospital, which is one of the best performing and best managed hospitals in the country and which had never registered a deficit until the last two or three years, is now going to register a £20 million deficit this year; and Derriford hospital in Plymouth is looking at a deficit of £30 million. That is £90 million in deficits in just part of a county in part of our country. It is simply unsustainable for the Government to claim that there is no problem with NHS finances. The longer the Government delay action, the bigger the impact will be on services and on patient care.

The Minister may recall, because it received national publicity, that the response of my local CCG last autumn to the serious situation it faced was to announce a widespread programme of rationing and cuts. The measures, which hit the national headlines, included preventing anyone who was obese or who smoked from having any routine operation, and rationing cataract operations to one eye and hearing aids to one ear. That provoked such widespread condemnation, not only from the public in Devon, but from across the country and from all the professional organisations, that, following an Adjournment debate I had with the Under-Secretary of State for Health, the hon. Member for Battersea, the plans were dropped. However, the underlying financial situation has not been addressed, and it has got worse.

I was told by Health Ministers just before the election that there was a plan afoot—a success regime, which is a rather unfortunate way to describe a way to address a not-very-successful situation—but that nothing would be announced before the general election. How much longer do we have to wait for that so-called success regime, or some sort of action to remedy the Government’s failure, to be introduced? People in Devon and across the country want to know when action will be taken and delivered.

Members have said that the disastrous Lansley reforms have made the job of Health Ministers much more difficult. One of the reasons why we have been unable to grip the problem in Devon and elsewhere is that we now have so many different organisations in the NHS responsible for regulation and performance management. We have Monitor, responsible for foundation trusts; we have the NHS Trust Development Authority, responsible for non-foundation trusts; and then we have NHS England, responsible for CCGs. No one has gripped this problem: Ministers have not gripped it, the different bits of the NHS have not gripped it, and that is why it has got out of control.

I remember very well—I have the scars on my back—the time when we were in government and the finances got out of control. It happened for different reasons—we were increasing capacity in the NHS at such a rate that the NHS lost control of its spending. The situation now is much more serious, because spending has been so tight, so the impacts of the loss of control we are seeing in the NHS now are extremely serious cuts or the sort of rationing that my local CCG proposed last autumn, which Ministers rejected. I want the Minister who winds up the debate to give an assurance that the Government do not believe that that sort of model offers an answer to the financial crisis affecting many trusts and the NHS as a whole. I hope that Ministers will look carefully at the fragmented landscape of NHS management, performance management and regulation, which is preventing us from finding a solution to this problem.

Let me give one more example. We had cross-party support in Devon—I am pleased that the hon. Member for Totnes (Dr Wollaston) is still in her place—for the integration of community services in most of the county. They are currently delivered by North Devon district hospital, but everyone else, including Conservative Members such as the right hon. Member for East Devon (Mr Swire) and the hon. Members for Central Devon (Mel Stride) and for Tiverton and Honiton (Neil Parish), agree with me that it would make much more sense to integrate those services vertically in our parts of Devon. That has not happened, because the North Devon trust objected and Monitor launched an investigation, which is still dragging on, with no resolution reached.

We have lost months of time and millions of pounds, and we have not been able to get on with improving the integrated care that the Secretary of State and everyone with any sense in this Chamber has talked about during the course of this debate. Please, will the Under-Secretary of State for Health, the hon. Member for Ipswich, address the financial crisis that his Secretary of State failed even to mention in his opening remarks, and will he think carefully about the changes in delivery structures we need if the local health service is to deliver the improvements, the savings and the care that our public need?

--- Later in debate ---

[Jane Ellison]

No, I am sorry, I will not give way. As they have demonstrated today, the hon. Lady and many of her colleagues sought to weaponise the NHS in the last Parliament and they are seeking to do so again.

In return for NHS staff stepping up and working so tirelessly for their patients, the Conservatives have committed the money that the NHS says it needs. Two elections running, the Labour party failed to commit the money that the NHS says it needs. Until the Opposition do that and explain how they can deliver the strong economy that is needed to do it, they have no right to speak about this. It is only possible to deliver that if we have a strong economy and a long-term economic plan. Listening to the NHS, not running it down—that will continue to be our approach in this Parliament.

[Mr Bradshaw]

I regret that the Minister missed my speech, because she, like her right hon. Friend the Secretary of State, has so far failed to mention the elephant in the room: the record deficit facing the NHS. She knows about this, because we have debated it in this House; she knows exactly what I am talking about. What is she going to do about that deficit? When is she going to address it? When is she going to fulfil the promises she made to my constituents in Exeter and the population of Devon, which faces one of the worst deficits in the country? Without action, patient care and services will suffer.

[Jane Ellison]

I am sorry that I was not in the Chamber for the right hon. Gentleman’s speech. I was briefly attending a meeting of directors of public health, but I know he asked a specific question about the turnaround plan in his area. I believe it has been presented to the new governing body of Devon CCG, but I am happy to pick up the detail. As he says, we have debated the issue.

On the deficit in the NHS, my right hon. Friend the Secretary of State for Health responded in great detail in his opening address, but the thing about NHS finances that the Labour party never gets its head around is that, yes, they are under pressure, but one has to have a long-term plan for how to address that—plans for integration, out-of-hospital care and prevention. One has to be able to say—[Interruption.] The hon. Member for Denton and Reddish asks where the money will come from. That is a question the electorate asked the Labour party all the way through the election—that was the No. 1 question the electorate of this country asked the Labour party, and answer came there none.

I am proud of the work we have done in the past five years, in which the NHS has built capacity and improved the care it delivers. It is worth reiterating the facts that my right hon. Friend the Secretary of State gave at the beginning of the debate. The NHS is now performing more than 1 million more operations; it has 9,400 more doctors and 7,700 more nurses; it sees, treats and discharges more than 3,000 more people within four hours every single day. By the end of the last Parliament, public satisfaction with the NHS was up 5% and it was deemed the best performing health system in the world by the Commonwealth Fund.