Primary Care: North Essex

Bernard Jenkin Excerpts

Tuesday 14th March 2017 Westminster Hall

[Mr Carswell]

My hon. Friend, as so often, is absolutely spot on. His judgment is impeccable. The failure to provide people with the primary care they need when they need it means that more people then tend to go to A&E departments. The people who run the ambulance service tell me that that then causes a bottleneck in A&E, which has a knock-on effect on ambulance response times. Many of the problems we are grappling with are a consequence of the failure to provide accessible, customer-focused primary care where it is needed.

The consultation on the minor injuries unit and walk-in centre is irresponsible. I share the view that it would clearly be absurd to shut that facility. A lot of angst and worry could be addressed if the option was ruled out now, and I hope it is.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I am most grateful to the hon. Gentleman for inviting us to take part in his debate, and I commend him for securing it. We are now in the throes of the so-called sustainability and transformation plans, which are being constructed on the acknowledgment, confirmed by the Boston Consulting Group, that there has been underinvestment in primary care in Essex for 20 or 30 years. If the STPs are to address the demand on the primary care units and deal with the shortage of GP facilities, there has got to be a programme, supported by Ministers, of investment in primary care in Essex so that the GPs can do far more for their patients without sending them off to hospital.

[Mr Carswell]

The hon. Gentleman is absolutely spot on. This is a cumulative problem that has been allowed to get worse over decades—perhaps a generation or more. I am often struck by how some of the GP surgeries in my constituency are located in what started out as residential houses built in the 1930s. There has simply not been the investment that was needed over a long period of time. That is also part of the problem. To be fair to GPs, if we do not provide attractive surroundings and surgeries, people are not going to want to work in those 1930s houses. If anyone in the district council is listening, I urge them to take that into account when talking about new planning for the area. Some top-quality, first-rate surgeries in which GPs are happy to work would go some way to addressing the problem.

I am incredibly grateful to the Minister for coming along to respond, and to the hon. Members for Harwich and North Essex (Mr Jenkin) and for Colchester (Will Quince), who are committed to this issue and have done a lot of work for their constituents. I hope to hear from the Minister not only about how we can get more GPs in our area but about the reforms we need to change the way people obtain primary care, so that they are no longer supplicants standing in a queue to receive care on the system’s terms but valued patients who get the care they need when they need it.

--- Later in debate ---

[David Mowat]

My hon. Friend may be relieved to hear that Colchester general hospital is not in my portfolio, but I will speak to my ministerial colleagues about it being a pilot and write to him.

[Mr Jenkin]

A moment ago the Minister mentioned some extra money for primary care. Who is responsible for investing that money? Does it come from NHS England and not from the CCG? How do we influence how that money is spent, so that there is some accountability in the process?

[David Mowat]

All money goes into the health service through NHS England, which used to be called the NHS Commissioning Board. The money is then given to the CCGs around the country to spend. In terms of a funding formula and so on, there are some specific primary care initiatives, including infrastructure-based ones for new premises and things of that type, and specific ones, which I am about to talk about, such as recruiting more GPs. We absolutely need more GPs, not only in Essex but across the country, although we do need them in particular in parts of Essex. The responsibility for that lies with NHS England, through the CCG. It is the CCG that has the accountability—to answer the earlier question, “Who do we blame for this situation?”—and I want to make that quite clear.

As for what all that means, we have workforce issues in primary care, and the Government and NHS England are committed to having 5,000 more doctors working in primary care by 2020, which should mean more availability and vacant jobs in Clacton being filled. We are determined to meet that commitment with progress made this year, with more medical students going into GP training than has ever been the case before in the history of the NHS—just over 3,000 of them. The hon. Member for Clacton was right to talk about pharmacists, and we also need to make progress with them. We aim to have 2,000 pharmacists working in primary care by 2020, as well as 3,000 mental health therapists.

All of that matters, but in addition we have to allow people to work in a different way from how they have up to now, and some of that is happening across the CCG in Essex. Broadly speaking, however, we find that a GP hub of 30,000 to 40,000 patients enables more scale. That would let us employ physios, pharmacists, mental health therapists and, indeed, social workers—in terms of the relationship with hospitals and the transfer of patients—and to have longer opening hours. I therefore completely accept the hon. Gentleman’s points about working and being open on a Saturday. We are determined to achieve that by 2020, although we are starting from a difficult position in Essex, given the lack of GPs generally. Only by collaboration and working across practices will we make progress. The model of a single GP practice—and such practices still exist—is self-evidently not viable and does not allow us to do some of the things that we need to in primary care, such as employing pharmacists and other such disciplines.

Those are my general comments, but I completely agree that unless all that lands in Essex, it is just words. Judge and jury on it will be the extent to which we are successful in landing some of that stuff in Essex. To address the specific issues, I will now talk about a number of things that have gone on in the hon. Gentleman’s local CCG. Of the nine practices in Clacton, a number have been closed to new patients, as he said. I am informed that the East Lynne practice, the Ranworth practice and the St James practice all closed to new patients in 2015, but two of those are now completely opened. The other has temporarily closed again but is expected to reopen soon. On the statistic he cited at the start, my understanding is that only one practice in Clacton now has no immediate opening in its list. The CCG has worked hard on that.

There are clearly specific issues with getting people with a GP background to move into the area. The CCG has put in place a workforce plan to address matters of recruitment and retention of GPs principally, but also of pharmacists, nurses and allied health professionals. Again, the judging of that will be in something actually happening and the vacancies in Clacton being filled. The plan exists and is being managed, and I understand that the CCG expects to make progress with it.

The practices in the CCG have come together in three collaborative groups, covering about 80% of the total number of patients seen, although the patient who sees the same GPs from the same practice and goes to the same clinic might not realise that. GPs are working collaboratively in a way that should enable better leverage of their time—I return to that point made in connection with pharmacists. We have to get away from every patient’s principal contact in the primary care system having to be a GP, rather than other professionals who could help a great deal. For example, I was recently in a practice where a pharmacist was conducting a diabetes clinic. Diabetes clinics are routine, happening perhaps every month or so, with a set of standard questions to be asked, and there is absolutely no reason why they need to be conducted by a GP, as opposed to a pharmacist. That applies in Essex, too.

I draw the attention of hon. Members from Essex to a couple of grants lately given to practices in their area. A £46,000 resilience funding grant has gone to the Clacton GP Alliance and, in a specific effort, almost £400,000 of capital funding to three GP practices that are coming together I think in Clacton hospital. The CCG understands that the standard of premises and infrastructure in Clacton is generally weaker than in other parts of the country—certainly weaker than is needed to attract the sort of talent necessary.

I have a “jam tomorrow” point to make, but it is worth putting it on the record. There is a plan to have a medical school in Essex, in Chelmsford, I think in 2018. That will obviously help, because people who train as doctors in that part of Essex will be more likely to live there, enjoy living there and, in time, make their careers and lives there. We have found that to be so in other parts of the country; I hope it works for Essex.

In connection with the minor injuries and walk-in centres, I want to speak briefly about the consultation. Members have pointed out that it would be absolutely ridiculous if, by closing those centres or doing anything to affect patient flows, more patients were to go to Colchester hospital. That is self-evidently true, and the CCG believes so too. Interested Members will know that the consultation, which set out four options, has received more than 3,500 replies. In all fairness, I do not believe that the CCG was consulting in order to close; it was consulting because contracts were up, and it wanted to look at the options and how to do better. One view given to me was it was more confusing than it ought to be for patients to know where they ought to be.

I cannot say anything today about the outcome of the consultation, other than that the CCG board will consider the recommendations received in the 3,500 responses and the various other pressures that have been discussed today. Frankly, people in the CCG will also be listening to our debate today. I would be surprised if closure of the centres was top of the list, given the other pressures on GP practices, the hospital and so on. The decision will be made by the CCG at the board meeting on 30 May.

I will finish as I started, by saying that there is a problem with the number of GPs in Clacton and North Essex. The problem is understood and action is being taken that I hope does not all amount to “jam tomorrow”, to use the phrase of the hon. Member for Clacton. Although progress has been made in getting lists open and so on, clearly a lot more needs to be done. I am happy to continue to meet the hon. Gentleman in the months ahead if we are not making progress and getting things better.

Question put and agreed to.

Public Administration and Constitutional Affairs Committee

Bernard Jenkin Excerpts

Thursday 2nd February 2017 Commons Chamber

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I am grateful for the opportunity to present to the House the seventh report of PACAC this Session, “Will the NHS Never Learn?”, a follow-up to the Parliamentary and Health Service Ombudsman report on the NHS in England, “Learning from Mistakes”.

Over the past decade, written complaints regarding NHS services have doubled, from just over 95,000 in 2005-06 to more than 198,000 in 2015-16. Investigations into such complaints have frequently failed to identify the root causes of any mistakes that occurred. Even more frustrating is that they have failed to prevent the same mistakes from being repeated over and over again, despite multiple reports highlighting that as a critical issue from both the Parliamentary and Health Service Ombudsman and the Public Administration and Constitutional Affairs Committee, which I chair.

In its report “Learning from Mistakes”, which was published last year, the PHSO highlighted the fear of blame that is pervasive throughout the NHS. That fear drives defensive responses and inhibits open investigations, which in turn prevents NHS organisations from understanding what went wrong and why. That also undermines public trust and confidence, because the public can see that NHS organisations are failing to learn from mistakes—if they did, that would drive improvement. A combination of a reluctance on the part of citizens to express their concerns or to make complaints, and a defensiveness on the part of services to hear and address concerns, has been described by the PHSO herself, Dame Julie Mellor, as a “toxic cocktail” that is poisoning efforts to deliver excellent public services.

To further understand the issues and what more needs to be done to tackle them, PACAC recently undertook its inquiry, which followed up on the PHSO’s “Learning from Mistakes” report. In PACAC’s report, which was published earlier this week, we conclude that if the Department of Health is to achieve its policy of turning the NHS into a learning organisation, it must integrate its various initiatives to tackle the issue and come up with a long-term and co-ordinated strategy. That strategy must include a clear plan for building up local investigative capability, as the vast majority of investigations take place locally. We will hold the Secretary of State for Health accountable for delivering the plan.

PACAC’s report also considered the potential impact of the new healthcare safety investigation branch, which is in the process of being set up. The creation of HSIB, as it is known, originates from our recommendations as the Public Administration Committee in 2015. The Government accepted our recommendation, and HSIB is due to be launched in April. It will conduct investigations into the most serious clinical incidents, and is intended to offer a safe space to allow those involved in such incidents to speak openly and frankly about what happened. In so doing, it is hoped that HSIB will play a crucial role in transforming the expectation and culture in the NHS from one that is focused on blame to one that emphasises learning. It should be a key part, albeit only a part, of the wider strategy that we want the Government to adopt.

Unfortunately, there is still a long way to go if the Department of Health’s aim of turning the NHS into a learning organisation is to be achieved. Most importantly, HSIB is being asked to begin operations without the legislation necessary to secure its independence and ensure that the safe space for its investigations is indeed safe. That undermines the whole purpose of HSIB. It is essential that the Government introduce the necessary legislation as soon as possible.

To ensure that the learning produced from HSIB’s investigations leads to an improvement in standards, PACAC also reiterates its previous recommendations, made in our 2016 report, “PHSO review: Quality of NHS complaints investigations”, that the Government should stipulate in the HSIB legislation: first, that HSIB has the responsibility to set the national standards by which all clinical investigations are conducted; secondly, that local NHS providers are responsible for implementing those standards according to the serious incident framework; and, thirdly, that the Care Quality Commission should continue to be responsible, as the regulator, for assessing the quality of clinical investigations at local level according to those standards.

The purpose of complaints is not just the redress of grievances—which I must say is extremely unsatisfactory in the NHS anyway—although that is clearly important; complaints are a tool by which public services can learn and improve. When medical professionals are forced primarily to be concerned with avoiding liability and responsibility and are trapped in a culture of blame, there can be no learning. There is an acute need for the Government to follow through on their commitment to promote a culture in which staff feel able to speak out and in which the emphasis is placed on learning, not blame. I very much hope that they will implement PACAC’s recommendations as a step towards achieving that as soon as possible.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate my hon. Friend for his work, and that of his Committee, on producing the report. He is absolutely right about HSIB and the need to underpin it properly. The Government have said that they would cap litigation costs at £100,000. I think my hon. Friend would accept that there will always be litigation, even if we get a more satisfactory means of redressing grievance, in the way he has suggested. Does he think that that cap would be appropriate, particularly since motor costs, for example, are capped at that level? Would that mean that people with grievances would be properly compensated while, sadly, their lawyers would not be?

[Mr Jenkin]

I confess I am not sighted on the proposal to cap litigation costs, but people resort to litigation only because they feel that their complaints are not being heard and that the problems they have identified in the service are not being addressed. People resort to litigation because they do not feel they are being told the truth. We know from our surgeries that most people who complain come in and say, “I only want to make sure this doesn’t happen to somebody else. I don’t want compensation.” Nevertheless, because that public-spirited attitude to complaining is so often rebuffed in the health service, people resort to litigation because they feel there is a cover-up.

In other fields, such as aviation and marine investigations, where this kind of investigative process is already established and is designed to find the causes of accidents without blame, there is far less resort to litigation at the outset. That does not preclude litigation in the final analysis, but discovering the truth without blame is the first step towards reconciliation.

[Glyn Davies (Montgomeryshire) (Con)]

I, too, greatly welcome this report, as do my constituents. That may seem surprising to some of my colleagues, as, of course, my constituency is in Wales, but all my constituents use hospitals in England for elective care and specialist care, so this is as important to the people of Wales as it is to the people of England. I have also been involved in many of the complaints. Does the Chair of the Committee acknowledge that, in the debates that he has had and in any follow-up debate that he might have, the position of Welsh constituents is key, because, although they are in another Administration as far as health is concerned, they depend on hospitals in England for treatment?

[Mr Jenkin]

I am most grateful to my Welsh hon. Friend for his question. It gives me an opportunity to highlight not only my agreement with the point that he makes, but that this is just about healthcare safety investigations in England. By pursuing this policy to set up HSIB, the Government have embarked on a very, very major and significant reform, which the health services in Scotland, Wales and Northern Ireland are certainly watching. I can assure my hon. Friend that they are being watched all over the world. Different countries in different jurisdictions have tried using various bodies to deal with this question. I do not think that any country before England has embarked on a reform of this scale and nature that has the capacity to transform safety investigation in a health system. I very much hope that Wales, Scotland and Northern Ireland will either set up their own equivalent of HSIB, or employ HSIB as the pinnacle of their investigation system as well. This matter is not something that necessarily needs to be devolved any more than the Air Accidents Investigation Branch of the Department for Transport.

[Sir Peter Bottomley (Worthing West) (Con)]

Does the Chairman agree that each of us receives from our constituents many more golden letters about their treatment in the health service than letters of complaint? When there are complaints or questions, openness and responsiveness matter most, and most of our constituents are satisfied with that. HSIB will be for the pinnacle of the hardest cases, but most cases should be resolved locally by the GPs or the hospitals.

[Mr Jenkin]

I certainly agree that the vast majority of our constituents who experience the care of hospitals or GP practices are extremely grateful for the quality of care that they receive. However, we cannot underestimate how corrosive the blame culture has been throughout our health system. Crises such as those at Mid Staffordshire and at the Morecambe Bay maternity unit arise from the defensive culture that exists in the NHS. If we are to change that into a much more open and collaborative system of learning from mistakes, we need HSIB to set the tone throughout the entire organisation. It is not just about dealing with a few complaints, but about setting a whole new standard for a whole new profession in the NHS about how complaints and clinical incidents are investigated. I am most grateful to have the opportunity to present this report.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Labour welcomes this constructive report and thank all of those involved in producing it. It highlights some worrying statistics, including the fact that the most recent NHS staff survey found that 43% of staff thought that their organisations treat staff involved in near misses, errors and incidents fairly. Clearly, from the Chairman’s candid contribution today, there is a long way to go before we eradicate the culture of defensiveness that he has described. To give HSIB the strongest start, it was the clear view of the Committee, HSIB, the Expert Advisory Group, HSIB’s chief investigator and even the Minister himself that legislation is needed, but, as of today, no legislation has been forthcoming. Given that, does the Chair of the Committee agree that it might be better to delay implementation to allow time for legislation?

[Mr Jenkin]

I am most grateful to the hon. Gentleman for his question and for his support. I am also extremely grateful to my Committee for its work on this report.

I hesitate to lose the progress that we have made. We have approved the appointment of the chief investigator of HSIB, who spent 25 years as chief investigator of the Air Accidents Investigation Branch of the Department for Transport. He brings with him that wealth of experience and perspective about how this organisation should work. The answer is, as the hon. Gentleman suggests, for the Government to bring forward the legislation as quickly as possible. I know that efforts are being made in that direction, but perhaps the Minister will have something to tell us.

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

I wish to add my thanks to my hon. Friend and members of the Committee for their considered report. He has succinctly described to the House what more needs to be done systematically to transform the way in which the NHS learns from errors to improve patient safety. We support the main thrust of the Committee’s recommendations and will offer a detailed response to the report in due course. Like the Committee, we put this matter right at the top of our agenda to change the culture within the NHS, of which he has spoken so eloquently today.

We are committed to making our hospitals and GP surgeries the safest in the world, supported by the NHS as the world’s largest learning organisation. The only way in which we will achieve that is through a learning rather than a blame culture characterised by openness, honesty and candour; listening to patients, families and staff; finding and facing the truth; and learning from errors and failures in care.

As my hon. Friend has indicated, the Government have accepted the recommendation of PACAC’s predecessor Committee to establish an independent healthcare safety investigation service. The Healthcare Safety Investigation Branch will be up and running from April. I join him in welcoming the appointment of Keith Conradi, the former chief inspector of the Air Accidents Investigation Branch, who has a strong track record of delivering high-quality investigations in aviation.

The hon. Gentleman’s Committee has again called for HSIB to be statutorily independent, and we agree that it should be as independent as possible if it is to discharge its functions fully and effectively, and we would not rule out the option of legislation. His Committee has also raised, in this week’s report, various suggestions for HSIB and its potential role in setting standards. We will be responding to that formally in due course.

We are committed to ensuring that the NHS becomes an organisation that learns from its mistakes. In response to the Care Quality Commission’s report, “Learning, Accountability and Candour”, from April this year all NHS trusts will be required to publish how many deaths they could have avoided had care been better, along with the lessons that they have learned.

Before I pose my question, I should like to thank the Committee for its response to the Government’s recent consultation, “Providing a Safe Space in Healthcare Safety Investigations”, and we will be responding to it shortly.

Improvements in safety, incident handling and learning in the NHS will not happen overnight, but does my hon. Friend agree that the shared programme of work demonstrates a commitment, across the care system, to improve the way in which all serious patient safety incidents are viewed and treated, and is that not a crucial foundation for lasting change?

[Mr Jenkin]

I am most grateful to the Minister for his question and for the fact that he has personally appeared at the Dispatch Box today with his opposite number from Her Majesty’s Official Opposition. I know that his presence here underlines the commitment of the Secretary of State to this programme of change.

I very much welcome the shared programme of work to which my hon. Friend refers, but, in taking evidence for this particular report, we found that there was some dislocation between the various bodies involved in it. We conclude that it is only Ministers, and probably only the Secretary of State, who can draw this together to ensure that there is a coherent strategy and a plan, which is what we emphasise in this report.

Finally, my hon. Friend refers to legislation in passing, but I hope that valiant efforts are being made in that regard. Perhaps something can be included in Her Majesty’s Loyal Address later this year. I must point out that it is not just about statutorily underpinning the independence of HSIB, but the safe space to which he refers and on which he thanks the Committee for its contribution. The safe space has to be legislated for. Without legislation, there is no safe space. The AAIB, the Marine Accident Investigation Branch of the Department for Transport and equivalent bodies could not possibly function unless they can provide people with protection, so that those people can come and talk openly and off the record about what has happened. That has transformed the safety culture in other areas, and it is the transformation that we need in the health service. I leave with the Minister the word “legislation” echoing in his ears, and I very much look forward to making further progress with him on these matters.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The House is grateful to the Chair of the Public Administration and Constitutional Affairs Committee for bringing his report before the House this afternoon and for taking questions.

Land Registry

Bernard Jenkin Excerpts

Thursday 30th June 2016 Commons Chamber

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I will be as brief as I can, speaking in this debate as the Chair of the Public Administration and Constitutional Affairs Committee—the successor to the Public Administration Select Committee, which considered the question of open data in the previous Parliament and produced a report on the matter.

What is the Land Registry? It is a part of our critical national infrastructure. It is an absolutely fundamental function of any civilised state. It is how disputes are resolved. In the most war-torn parts of the world, there is a land registry in every country—even for every town. It has been in the lexicon of military doctrine since the days of empire that when a town is taken, the land registry is taken first so that the disputes that arise between different factions and families after control has been taken can be resolved. The first building that the Black Watch took in Basra when the British Army went into southern Iraq was the land registry. That is how fundamental a land registry is to any civilised state.

[Victoria Prentis (Banbury) (Con)]

My hon. Friend and I share different views on the European Union, but I wonder whether he remembers the chaos that ensued when the former East Germany was unified with West Germany. There was no proper land registry for East Germany, making it difficult to ascertain who owned many houses in places such as Potsdam.

[Mr Jenkin]

That is exactly the point. The former communist state had destroyed the old records to create a new order.

I have no objection in principle to privatisation, which has been a successful means of transforming large parts of the former public sector. Even the Labour party would have absolutely no intention of returning large parts of what is now in the private sector to the public sector.

Transforming the Land Registry into a modern, digitally-based service is crucial for making it more efficient and responsive to user needs. So far the digital transformation has been extremely slow. I have three main concerns about the present proposal. I hasten to add that I am speaking on my own behalf; this is not an agreed statement by my Committee. The Land Registry must continue to operate as an essential public service, the future owner of a privatised Land Registry must be committed to providing long-term stability, and the final deal, if there is one, must fulfil the Government’s own stated objectives for the use of open data.

In a submission to the Government’s consultation, I recommended that the quality of service provided to the public by the Land Registry must be prioritised above realising capital gains or transferring risk from the Government’s balance sheet. The primary concern must be to ensure that an accurate record of land use and ownership is maintained in public hands. The Land Registry’s core services should be protected from any real-terms price increases, and their quality must not suffer as a result of any transfer of operations to the private sector. The Land Registry is, and will remain, part of our critical national infrastructure. Its protection is crucial, and any public-private model or privatisation model must put in place safeguards to prevent the service being disrupted in the event of bankruptcy or commercial failure of any kind.

Our report in 2014 was based on evidence from leading figures in the world of data management and statistics, as well as from Ministers. Although the Committee did not look in detail at the privatisation of the Land Registry, we did look into the future use of the Government’s major datasets, of which the Land Registry is one. The final report made several recommendations for the use of Government data. In particular, we stressed the need to ensure that datasets are easy to access, easy to read and free to use.

On the specific subject of the Land Registry, the Committee concluded:

“A radical new approach is needed to the funding of Government open data. Charging for some data may occasionally be appropriate, but this should become the exception rather than the rule. A modest part of the cost to the public of statutory registrations should be earmarked for ensuring that the resultant data . . . can become open data.”

Data held by the Land Registry are one such example. If this model is adopted by the Government, they must not allow a new privatised entity to expect to make money from the selling of those data. The expectation must be that the data will be freely available.

In public policy terms, it is important to understand the value of open data to the economy as a whole. Research commissioned by the Open Data Institute found that public sector open data will provide more economic value every year, equivalent to as much as 0.5% of GDP, than data that users have to pay for. For example, we all use the Postcode Address File. That has been privatised, but what makes it of such value to us is that we can get on a website and get it free. How outrageous it would be if we had to pay for that.

Unfortunately, when the Royal Mail was sold, we transferred those data to the private sector and now big businesses have to pay to use those data. The result is that new forms of open source data will be created, which will gradually take over from the Postcode Address File. By transferring those data into the private sector as we have, we have undermined their value and created a cost to the productive sector of the economy for accessing them. In our conclusions, we stated that the sale of the Postcode Address File was the wrong decision. We concluded that such an asset should have been kept in public ownership, where it would be a national asset, free for businesses and individuals to use for the benefit of the wider economy.

If the Land Registry is privatised, the land register itself—the actual data—must stay in public ownership. It is crucial that the Government preserve for themselves a substantial degree of policy flexibility with regard to any agreement made with a privatised organisation, and if they decide that the public interest is best served by a change in data policy, they must remain free to effect this and to do so without excessive cost.

I am deeply concerned that the future owner of a privatised Land Registry must be committed to long-term stability and continuity. That depends on the character of the operator, if there is to be a private sector operator. The operator should understand that it may derive profit only from some kind of long-term yield for a long-term contract with the Government and be prepared to invest in the organisation to achieve this aim. An investor with a more venture capital-style approach, aiming to make a capital gain out of the development of the business and then on-sale, would be a completely inappropriate form of ownership.

[Mrs Moon]

Given all that the hon. Gentleman has said about the importance of the integrity of the Land Registry, why is it not appropriate to build that flexibility for entrepreneurship into the current Land Registry so that it can make the profit that is necessary for the investment and modernisation that are needed? Why do we have to take this risk?

[Mr Jenkin]

I shall come to that. It is a perfectly reasonable question.

The type of owner of the infrastructure might be like the banks automated clearing system, which is a company that is owned by the banks. It is just an operating company that the banks fund in order to provide them with a service. That is much more the kind of privatisation that I would find acceptable, rather than a company called Land Registry plc, with its own board of directors thinking about how to develop its business. It is a service and there is a function that it needs to provide.

The final proposal should include a full assessment of what has happened in other countries where such a service has been transferred to the private sector. Additionally, in any privatisation plan the Office for National Statistics should have the power to take over the collation and publication of Land Registry data, effectively getting a daily feed from all new records and publishing them free online. If the Government decide to proceed with some kind of privatisation of the operations, in two years’ time I expect to be calling the Department for Business, Innovation and Skills and UK Government Investments, which is overseeing the process, to discuss with my Committee what effect this movement has had on the publication of open data.

Finally, in answer to the hon. Member for Bridgend (Mrs Moon), I hope the Government will explore alternative means of doing that by keeping the Land Registry in the public sector. Let us face it: it is only silly Treasury rules that prevent very cheap public money from being put into this with public sector involvement, but keeping it in public ownership, in order to develop the customer-responsive and properly capitalised system that we want. My mind is open, provided the data remain in public hands. My mind is open, provided the arrangement is stable, but I would not rule out transferring the service to some mutual or some existing consortium of banks or insurance companies or even keeping it in the public sector.

Dietary Advice and Childhood Obesity Strategy

Bernard Jenkin Excerpts

Monday 23rd May 2016 Commons Chamber

[Mr Speaker]

I find it very hard to believe that the hon. Gentleman is in Brussels. [Interruption.] Order. Given that I have granted the hon. Gentleman’s application for an urgent question, it is a considerable discourtesy for him not to be here at once. He should have been in the Chamber. This must not happen again. The hon. Gentleman is a very serious and conscientious parliamentarian. If you put a question in, man—be here. Let us hear it. I am sorry to be annoyed, but I am annoyed, because the House’s interests are involved. This is not just about the hon. Gentleman; it is about all the other Members who have bothered to be here on time and about the interests of the House. The Minister was here well in time, which is good, and the shadow Minister has toddled in—the hon. Member for Wolverhampton South West (Rob Marris) beetled into the Chamber just in time. Let us hear from the hon. Member for Harwich and North Essex (Mr Jenkin).

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

Thank you, Mr Speaker. I accept your admonition with good grace.

NHS: Learning from Mistakes

Bernard Jenkin Excerpts

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

I contrast the tone of the hon. Lady’s response with that of the shadow Health Secretary. Although I by no means agree with everything she said, she does make some important points.

It is not the case that we have delayed the medical examiners scheme. In the previous Parliament, we had pilots so that we could understand exactly how the examiners would work. That is relevant to the hon. Lady’s other point about audit, with which I completely agree. One thing that medical examiners will be able to do is to look for unexpected or unexplained patterns in deaths. Obviously, the vast majority of deaths are routine, predictable and expected, but those examiners will be able, looking at audit tools, to identify where there are things to worry about, which is why this is an important next step.

With respect to whistleblowers, I will reflect on what the hon. Lady says. We are trying to eliminate the need for things ever to get to the point where someone has to become a whistleblower. We want to ensure that people are supported to speak out about mistakes they have seen or made and concerns that they have, and that they are confident that they will be listened to. We are publishing a table today about the quality of the reporting culture. Much of the raw data that allow us to rank trusts on the quality of reporting data come from the NHS staff survey, which asks staff how valued they think they are, and how safe and easy it is to raise concerns. That is why this is a big step forward.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my right hon. Friend for his statement and for taking forward so many of the recommendations that were made a year ago in the Public Administration Committee’s report on investigating clinical incidents in the NHS. I particularly thank him for implementing the creation of a safe space, which has been a controversial and difficult subject because some people think that this is about hiding stuff, when in fact it is about getting people to speak much more openly and freely. Will he say something about how that will be implemented without primary legislation?

[Mr Hunt]

I thank my hon. Friend for his question. He and I have talked many times and thought very hard about how we can learn lessons from the air industry. He is one of the people who came to me first to say that if we want to set up an equivalent to the air accidents investigation branch, we need to give people in the healthcare world the same legal protections that others have when they are speaking to that branch, and that is at heart of the statement that I have made to the House today.

The point about safe space is very, very important. This is not about people getting off scot free if they make a terrible mistake. There is no extra protection here for anyone who breaks the law, commits gross negligence or does something utterly irresponsible. Patients still have those protections. What they gain is the comfort that we will get to the truth and learn from mistakes much more quickly. Every single patient and bereaved family says that the most important thing is not money, but making sure that the system learns from what went wrong. We will ensure that we construct the safe space concept, and I do not rule out extending that beyond the investigations of the healthcare safety investigation branch.

End of Life Care

Bernard Jenkin Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I hardly feel worthy of catching your eye today, Mr Deputy Speaker, having not been in my place for a question earlier today. I apologise to you and to Mr Speaker for that. I was, in fact, preparing for this debate, as Chairman of my Select Committee. I commend my hon. Friend the Member for Totnes (Dr Wollaston), the Chair of the Health Select Committee, for her report and for securing time to debate end-of-life care on the Floor of the House.

I shall wantonly use this opportunity to promote one of the reports produced by my Select Committee, the then Public Administration Select Committee. I am not just talking about the report on dying with dignity, which followed a report by the Parliamentary and Health Service Ombudsman. That report underlines why my hon. Friend the Member for Totnes is absolutely on the right track in making her investigations.

We have urged the Government to recognise the shortcomings that exist in many of our health institutions. People are not recognised to be dying when they are dying, their symptoms are not addressed, and there is poor symptom control. People have watched loved ones dying in pain because of ineffective symptom management. As has been mentioned today, there has been poor communication. Professionals have failed to engage in open conversations with patients and family members. There have been inadequate out-of-hours services, and people have suffered because of difficulties in gaining access to palliative care out of hours. There has been poor care planning, and delays in diagnosis. And so it goes on.

What strikes me about so many of the accounts that we have heard this afternoon is the lack of learning, the sense of helplessness, the sense that this is just what happens in our health system. That is what drove my Committee, at the end of the last Parliament, to produce the report entitled “Investigating clinical incidents in the NHS”. Imagine what it would be like if we had an NHS in which, whenever something went wrong, there was a proper and open investigation, followed by learning from what had occurred—without blame—to prevent a repetition. So often, in debates such as this, we hear about the same things occurring again and again.

Our report revealed that

“there are 12,000 avoidable hospital deaths every year. More than 10,000 serious incidents are reported”

to the NHS, in England alone,

“out of a total of 1.4 million mostly low-harm or no-harm incidents annually. There were 338 recorded “never events” (such as wrong site surgery) during 2013-14”,

and there were 174,872 written complaints. The then latest estimate of clinical negligence liabilities on the NHS balance sheet was £26.1 billion. If we could get just 10% of that right, we would save millions of pounds. If we could avoid 10% of those incidents, we would save the NHS huge amounts of money.

We looked into the way in which other safety-critical industries dealt with safety management and incident investigation. The most notable is aviation, but similar considerations apply to marine accidents, accidents in the North sea oil industry, and the work of the Rail Accident Investigation Branch, which was set up after the Paddington rail crash. I learned a great deal when I was shadow Secretary of State for Transport at the time of that rail crash. For instance, I observed how hopeless it was that the safety regulator of the railway, the Health and Safety Executive, was responsible for investigating its own failings in the event of a rail accident.

The Committee concluded that what was needed was an independent clinical investigation service that would investigate untoward incidents in the health sector. It would have to have three key elements. First, it must provide a “safe space” in which clinicians, NHS managers, patients and patients’ families could discuss things without fear of recrimination or reprisals. Such a service does not currently exist in the health service. No one dares speak for fear of getting the blame. In aviation, it is quite normal for pilots to report each other and report themselves without fear or favour, because that safe space exists.

Secondly, the service

“must be independent of providers, commissioners and regulators”.

There is no such independent investigative capacity in the NHS. We have a higgledy-piggledy arrangement for investigating clinical incidents. It might be local, it might involve a regulator, but it ends up with the Secretary of State coming to the Dispatch Box and calling for a public inquiry. That is when we really know that it has all gone wrong. The Francis report was very much a jumping-off point for us.

The third requirement is that any such clinical incidents investigation service should have the power to publish reports and to disseminate its recommendations and learning. This should not be about blaming people; it should be about learning. I am very pleased that the Government accepted our recommendations and that they have set up an expert advisory group. The group has been holding discussions for many months on how to implement the proposals.

I am sad to say, however, that three things are still lacking from the Government’s proposals for what they are going to call the health safety investigation branch, which will operate in a clinical incident investigation capacity. The Government’s refusal to contemplate primary legislation on this matter means that there will be no safe space. Their refusal to create new public sector bodies outside the framework of the NHS will mean that the health safety improvement branch will be domiciled within NHS Improvement, which is one of the regulators from which it needs to be independent. And the Government’s refusal to contemplate primary legislation means, of course, that there will be no primary legislation.

I think the Minister understands these matters very well, but I have to say to him that if, having accepted our report, the Government go ahead and create the health safety investigation branch of the NHS on this basis, they will not be implementing our findings, which they say they have accepted. It is sad that we are going to lose the opportunity to do this, and I very much hope that the Government will continue to think about introducing at least a draft Bill that would enable us to work in the longer term towards the primary legislation that we need in order to set this up. That would transform lives, and the NHS, in a way that nothing else could do.

Junior Doctors Contracts

Bernard Jenkin Excerpts

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

The trouble with commissions is that they tend to take rather a long time to come up with their conclusions, and we need to sort out these problems now. That is why the Chancellor promised an extra £3.8 billion for the NHS next year, and why we said that we want 5,000 more GPs working in general practice, which will help out-of-hours services. We have a five-year plan that the NHS has the funding to implement, and that will transform out-of-hospital services. I hope that those developments will address the right hon. Gentleman’s concerns.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my right hon. Friend for his patience and resolution in bringing this matter to a conclusion. Does he share the real sadness that so many of us feel that these wonderful young people who come into the health service to be doctors with such high ideals are caught up in this terribly debilitating and damaging dispute? I ask him to reinforce his efforts to engage and speak directly with junior doctors and the medical profession as a whole and not allow the disruptive behaviour of the British Medical Association to destroy the relationship that we need to have with our doctors.

[Mr Hunt]

My hon. Friend is right. There was absolutely no reason to have this dispute, because the things that we are trying to sort out—seven-day care and safer care for patients—are what every doctor wants to happen. Indeed, they choose medicine as a profession from the highest of ethical motives, and we want to support them. I share his sadness that it has come to this, but given that the counter-party in the situation is not willing to budge, we have to take action to remove uncertainty and to do the right for patients and for doctors. I will certainly continue to engage. The new commission headed up by Professor Dame Sue Bailey will also look at wider issues of morale, which will make a big difference.

NHS Reform

Bernard Jenkin Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

The hon. Gentleman makes an important point. As part of what I said in my statement, we are looking at how we train doctors. My hon. Friend the Member for Weaver Vale (Graham Evans) talked about creating a learning culture, and the big change that we need to make is creating a culture in which people feel supported to speak out about any concerns or anything on which they think they can see a way of doing something better. They must not feel that that could threaten their career prospects. We do not have that culture in the NHS at the moment, but we need it if the NHS is to be the world’s largest learning organisation, as I argued in a speech this morning. I think staff are up for it, but it is a big change.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my right hon. Friend very much for his extraordinarily embracing response to the Public Administration Select Committee report on clinical incident investigation. We started less than a year ago with the germ of an idea, and it has turned into what amounts to a radical reform of safety investigation in the health service. That is a tribute to him and to the Committee’s witnesses, but it is a tribute to the health service itself that it has embraced the idea, which is a big change that I believe will be transformative.

May I pick up on the Secretary of State’s reluctance to provide special legislation for the immunity of those giving evidence to the new patient investigation body? Will he keep an open mind on the subject? If he wants that body to be truly independent and to have a special status, he should remember that the marine accident investigation branch and the air accidents investigation branch have specific legislation to provide for such immunity. Public interest disclosure protection must not be challenged by freedom of information requests, given that freedom of information has been extended into areas where we never imagined it would go. We have to be specific in legislation that that cannot happen in this instance.

[Mr Speaker]

Too long—I hope the answer will be somewhat briefer.