Maternity Services: East Kent

Caroline Johnson Excerpts

Thursday 13th February 2020 Commons Chamber

[Ms Dorries]

I fear that you will shout at me again, Mr Speaker, if I try to answer my hon. Friend’s question fully, because I agree with everything that she has said. Maternal deaths absolutely must become a never event, and we must focus on making pre-eclampsia and post-partum haemorrhage, which lead to such deaths, never events. I went to the first meeting of the APPG on baby loss and, as my hon. Friend knows, I am always happy to go and hear anything that anyone has to say about this issue that will help our work in trying to improve maternity standards[Official Report, 2 March 2020, Vol. 672, c. 4MC.].

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I should mention at the start of my question that I work as a consultant paediatrician, and that I look after babies and have attended a number of deliveries. I would like to thank the Minister for being so thorough, robust and dedicated in ensuring that this situation improves and that babies are safely delivered throughout the country. In my practice, I have noticed that all baby deaths and adverse outcomes are thoroughly investigated locally, but in my experience this tends to be done just locally. The lessons might be shared internally, but they are not being shared with other hospitals down the road, where the same mistake might be made. I welcome what she is doing, but can she reassure me that those lessons will be shared nationally, so that everyone can benefit from the lessons that are learned, and that such sharing will be widespread so that future tragedies are prevented? Can she also reassure me that, when she sets up the Healthcare Safety Investigation Branch process, its culture is such that doctors, nurses and midwives are able to give full and free answers, and that we get the balance between accountability and blame just right?

Wuhan Coronavirus

Caroline Johnson Excerpts

Tuesday 11th February 2020 Commons Chamber

[Matt Hancock]

The hon. Lady makes an important point, especially in relation to communicating through, for instance, the Department for Education and schools to make sure that schools get the reassurance that they need. I pay tribute to the way the hon. Lady has conducted herself, given the number of cases in her constituency, and the impact on local health services. We have taken action urgently where contact tracing has shown that it needs to be taken, and we will take that proportionate action. I am also very keen to be able to provide reassurances to people that we are taking the action that is needed and that the threat to the public remains moderate, even as we have seen the increase in numbers.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

In my local hospital, staff are being provided with specially fitted masks to ensure their safety when treating patients who may or may not have the coronavirus. Will the Secretary of State confirm that that is part of a wider package of ongoing policies and procedures in the NHS to keep our staff safe when treating these patients?

[Matt Hancock]

Yes, of course. Making sure that we have the equipment to keep our staff safe is a very important consideration—keeping medics safe is very important not only for them but for the public, because they provide such an important service.

NHS Funding Bill

Caroline Johnson Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

It seems to me that the NHS Funding Bill is really just the beginning. If the Government are serious about identifying specifically how much money they will commit to particular parts of the NHS budget, that is to be welcomed, and certainly any increase in any part of NHS spending is welcome. A 3.4% increase compared with what we have had during the very challenging period of the past three to four years is therefore very welcome. I believe that it actually is a floor, not a ceiling. I totally understand the interpretation, which I think is correct, of the money resolution, but that relates specifically to amendments to this Bill. My reading of the money resolution is that we can, in further Acts, expand and increase these amounts.

My real concern is trying to get to the bottom of how these figures have been arrived at. There has been an assumption that it is all about inflation and looking at comparative figures, but there are three pieces to this. What are the assumptions underlying the decisions that have come to these figures? What assumptions have been made about inflation, because Brexit has changed much since these figures were first arrived at? How are we looking at demand and need? Do the Government really understand what the unmet need is? Certainly, reports by the Public Accounts Committee indicate that the Government do not really have a grasp of that. That then leads me to question whether these are the right figures to do what everyone in this House wants, which is to meet the needs of all our citizens for good healthcare and, ultimately, good social care, which is not part of this Bill. I think the Government have missed a bit of an opportunity here. It would be helpful if they had set out how they will flex if the assumptions with regard to savings and efficiencies changed, if the inflation rate changed, or if demand changed. The bits missing from this Bill are a formula to calculate the increase and some honesty about the basis on which the Bill has been put together.

As we have heard, some specific promises have already been made in a five-year plan. We have said that mental health spending will go up by £2.3 billion, which is a 4.6% increase a year; that mental health spending for children and young people will grow faster as a part of that budget; and that there will be an increase in primary and community healthcare spend in the areas of highest health inequalities. But as yet we do not have any mechanism for an annual statement on exactly where we are on this spending. In addition to a formula that explains how we got to this magic figure, there should be an annual statement on these figures so that we can see how the 4.6% a year increase for mental health has actually been delivered and whether children and young people are actually getting the biggest chunk.

It has been said, quite rightly, that in this Bill we are looking at only part of our total health and care ecosystem. We must look at what we do about infrastructure—hospital—spending. The £2.8 billion hospital infrastructure promise in the spending review last year was very welcome, but, as the hon. Member for Central Ayrshire (Dr Whitford) pointed out, what about the repairs? With regard to the training budget, the spending review refers to a 3.4% increase. Is that really going to cover it? How are we going to measure whether it is actually spent? The hon. Lady referred to the 1% increase in public health grant. Can that really be enough? For me, what is really needed is an annual report on all health spending. The biggest challenges to getting this right—I am not the first and I will not be the last to say it in this Chamber—are stopping the slippage from revenue budgets to capital budgets and the slippage that will inevitably occur if social care is not properly funded. We absolutely have to fix the social care challenge, and this Bill is not enough, and cannot stand alone, in terms of solving these issues.

This Bill is welcome, but it is in many ways a missed opportunity. We need to see the total picture. We need to have proper accounting. We need to have proper visibility of the numbers so that we as a House can demonstrate clearly to the great British people that we are delivering on what we have promised and what they need.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Does my hon. Friend accept that the purpose of the Bill is not to set out the absolute detail of every single possible thing that could happen over the next few years, but simply to provide assurance to the NHS in England of the minimum funding that it could possibly receive, and the massive increase that we are giving it, so that it can continue to plan for the future?

[Anne Marie Morris]

My hon. Friend is absolutely right that we should provide a long-term plan and a long-term budget. However, if we are to be honest with the public and with ourselves, we need to measure what we are doing and be clear and accountable to the public that what we have said we will spend delivers the outcome we have promised.

This is about openness, transparency and accountability, and that is the missed opportunity. It may well be that this sum is right and that the savings that have been promised can be made to enable it to be adequate, but there is some serious doubt about that. Without openness, honesty and the figures being reported on each year, we cannot put our hand on our heart and say that we are doing what we promised the British people we would do. There is a saying that what gets measured gets done, so let us measure this. Let us get to the crux of this spending and prove to the British people either that we have got it right or, if not, that we have a formula to get it right so that we can do what is right. We need a plan to monitor the10-year plan, which is great in ambition but needs to be properly scrutinised and properly monitored so that not just the Government and the Conservative party can be held accountable, but all of us in this House can be held accountable, because it is for all of us to get this right. It is not just down to the Government: it is for all of us to ensure that we deliver what people, frankly, need and deserve, and what we have promised.

Health and Social Care

Caroline Johnson Excerpts

Thursday 16th January 2020 Commons Chamber

[Jonathan Ashworth]

No, because we do not think it would work—it is not feasible. It is not just the Committee in the Lords that says that—plenty of think-tanks have said it is not feasible as well.

There is broad consensus about the principle of better integration between health and social care. We have long argued for it, and now the Government have come round to arguing for it as well. The Government are proposing an NHS Bill along the lines of what Simon Stevens of NHS England has proposed. We long warned that the Health and Social Care Act 2012, which was introduced by Andrew Lansley and supported by sitting many of the Ministers on the Front Bench, would not lead to the levels of integration and co-ordination of care that was needed but to a fragmented mess.

We also long warned that the compulsory competitive tendering provisions of the Act would lead to more contracts being handed to the private sector. About £9 billion-worth of contracts were handed to the private sector, despite the Secretary of State telling us that there would be no privatisation on his watch. If his Bill gets rid of those compulsory competitive tendering provisions—the so-called section 75 regulations—we would welcome that, but we want competitive tendering to be abolished completely. We do not want clinical services privatised. We do not want clinical services outsourced, such as pathology labs in London, as is happening on the Secretary of State’s watch. We do not want tinkering in the Bill: we want the Health and Social Care Act binned so that we can restore a universal public national health service. [Interruption.] The Secretary of State says that it is universal. He is clearly not aware of the rationing that is going on across the country because of austerity and the privatisation of the NHS that is his policy.

As I indicated in the debate on the Gracious Address before the election, we will work constructively with Ministers to ensure the speedy passage of the health service safety investigations Bill. We will look to strengthen the independence of medical examiners. We call on the Government to do more to roll out medical examiners across NHS trusts. It is disappointing that so far only about 50% of trusts have medical examiners. These are absolutely vital to improving patient safety, because we know that things do go wrong in the delivery of care. We have all been shocked by the revelations at Shrewsbury and Telford Hospital NHS Trust. This is the worst ever maternity scandal, with clinical malpractice apparently allowed to continue unchecked since the ’70s. It is absolutely horrific and astonishing. I cannot imagine the grief that the families affected must have had to endure. Will the Secretary of State update the House on what is happening at Shrewsbury and Telford? I appreciate that there was an Adjournment debate on that matter last night, but I think the House would appreciate his offering us some reflections on what is happening at Shrewsbury and Telford. Will he also commit to reinstating the maternity training fund to help to improve maternity safety in our hospitals?

I am sure that the Secretary of State will agree, more broadly, that the delivery of safe care depends on adequate staffing levels as well, so would he support enshrining safe staffing levels in legislation? We are short of 44,000 nurses in England. Community nurses have been cut by 6,000 since 2010. Learning disability nurses are being cut. Mental health nurses have been cut by 10%. Health visitor numbers are down. School nurses have been cut. We have been warning for years about the detrimental impact on safe care of these staffing shortages. That is why, for example, we fought the Government on the abolition of the training bursary. We welcome the fact that Ministers are now bringing back a partial version of the bursary in the form of a maintenance grant, but why not bring back the whole bursary? Without bringing back the whole bursary, many are sceptical that the Secretary of State will deliver on his commitment for 50,000 new nurses, because as quickly as—[Interruption.] Well, he is rather stretching the definition of the word “new”. He gave the impression in the general election campaign that there were going to be 50,000 new nurses, but that soon unravelled, because when he went on the media it turned out that he was including in his figures 19,000 nurses who already work in the national health service. I of course have some sympathy—

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I am afraid that on this occasion I will not, because many Members want to make maiden speeches. There is nothing worse for a Member waiting to make a maiden speech than seeing the time ticking down because Front Benchers are taking lots of interventions.

[Jonathan Ashworth]

I will tell you who was talking rubbish, Mr Deputy Speaker: the Secretary of State when he said at the general election that he was delivering 50,000 extra nurses. That is why he avoided Piers Morgan during the election campaign. I do not know why the Secretary of State avoided Piers Morgan—he is a pussycat. I went on Piers Morgan’s show every week; why did the Secretary of State not go on?

I will give way once more, and then if Members will indulge me, I will not give way again, because a lot of Members want to make their maiden speeches in the debate.

[Dr Caroline Johnson]

I am grateful to the hon. Gentleman for giving way. He is using a lot of statistics and figures, and he talked about the definition of “more” and “new”. I want to ask him about the 44,000 vacancies that he talked about. Is it not right that when the Health Committee looked at that, it found that 38,000 of those places were actually occupied by nurses who work on the bank because they choose that working model?

[Jonathan Ashworth]

As the hon. Lady knows from her work on the frontline in the NHS, the problem is that bank and agency staffing have contributed to many of the deficits that our trusts are dealing with. That is one of the problems with the way in which the workforce have been managed by the Government.

The Secretary of State says that his figures include 19,000 existing nurses. I have some sympathy for him, because we have been raising the issue of retention in the NHS for some time. That is why we were so vigorous in opposing the public sector pay cap, of which he was a great champion for many years as a Tory Minister, and it is why we were pleased that the Government got rid of it, following pressure from those on the Labour Front Bench. It is a laudable aim to improve retention in the NHS, but it is not the same as recruiting new nurses.

The Secretary of State expects to recruit 12,500 nurses internationally, while at the same time imposing a tax on those nurses through the immigration health surcharge, increasing it to more than £600 per family member per year of a nurse’s working visa. Does he really expect to recruit 12,500 nurses internationally while imposing this nurses’ tax on them?

The Secretary of State will also know that we are desperately short of nurses in the field of mental health services. We welcome the commitment to reform the Mental Health Act 1983, and we will work constructively with him on that, but we have had enough warm words and rhetoric on mental health services. It is now time to deliver the parity of esteem that patients deserve. We have a shortage of mental health beds, which means that too many people are sent hundreds of miles across the country to receive care, away from their family and friends, often in poor-quality private providers.

The Secretary of State likes to boast of hospital upgrades, but anyone who has been in a mental health trust, works in one or has visited one, as I have, knows that the mental health estate is, frankly, some of the worst estate in the NHS. It is unsafe. Mental health patients deserve so much better, yet there is still no credible plan in anything he has said to modernise and replace the 1,000 beds in old-style dormitory wards in mental health trusts across the country. Children are being particularly let down, with increasing rationing of mental health services and more than 130,000 referrals to specialist services turned down despite children showing signs of eating disorders, self-harm and abuse. Matters have become so desperate that there are even reports of GPs advising children to exaggerate problems, because otherwise they will not get any help. This is the chaos of the underfunded system, and it leads to an increasing number of children and young people presenting at A&E in mental health crisis. A&E is no place for someone in mental health crisis. This is a disgrace, and our mental health services now need investment.

That brings me to A&E more generally. The Secretary of State will say that there is increased demand on our A&E, and that is true. There is increased demand on our A&E because mental health services have been pushed to the brink; because years of cuts to social care are pushing more and more people to A&E; because public health prevention budgets have been hammered by years of cuts under this Conservative Government; because GP numbers in our communities have been cut and people cannot get appointments; because walk-in centres have closed under the Tories; and because pharmacies were cut back. More broadly, it is because decisions by this Government—whether it is their decisions on housing and universal credit or their cuts to children’s services, with Sure Start centres closing—and rising levels of poverty mean that health inequalities are widening. It all adds up to more people presenting at A&E because of 10 years of Tory austerity.

What is the Tories’ answer to the worst A&E performance figures on record? It is to scrap the four-hour A&E target. Abolishing the target will not magic away the problems in A&E. It will not suddenly fix a system that saw 100,000 people waiting on trolleys last December. That is why the president of the Royal College of Emergency Medicine said yesterday:

“Rather than focus on ways around the target, we need to get back to the business of delivering on it”.

But Ministers cannot get back to the business of delivering the target, because they will soon ask the House to approve legislation that will legally bake in the underfunding of our NHS. The NHS underfunding Bill effectively caps NHS spending way below the level that experts say our NHS will need. The last Labour Government did not need legislation to signal their support of and commitment to the NHS. The last Labour Government got on and delivered record investment in our NHS. They delivered a 6% increase in investment into the NHS, and they delivered the lowest waiting lists and the highest satisfaction ratings on record—and we did not need the gimmick of a Bill to do it. We got on and delivered it.

The Secretary of State is proposing a Bill that fails to reverse the £850 million of cuts to public health prevention services. This is at a time of rising drug deaths, rising presentations at A&E for alcohol abuse, rising STI infections and rising obesity among children. He is asking us to approve a Bill that does not reverse the raids on capital budgets or deal with the £6.5 billion backlog of repairs facing our hospitals, which has left hospitals with sewage pipes bursting, ceilings falling in and lifts not working. He is proposing a Bill that does not give the NHS the 4% uplift annually that many experts say it needs. That is why Labour has tabled an amendment today to give the NHS a 4% uplift, and every Tory MP who believes in the NHS should support it. The Secretary of State is enshrining in law four more years of underfunding of our national health service and four more years of capped expenditure in our national health service, but it does not have to be that way.

I congratulate the Government on securing election. I congratulate the Secretary of State and all the Ministers who have been reappointed to the Front Bench, and I pay tribute to my former shadow Ministers who lost their seat, Paula Sherriff and Julie Cooper. We will hold the Secretary of State to account. We will test him on whether he delivers 40 new hospitals, 50,000 new nurses and 6,000 new GPs. We will test him on whether he drives waiting lists down, as the Prime Minister promised yesterday. Where the Secretary of State is right, we will work constructively with him. Where he is wrong, we will argue our case forcefully.

The Secretary of State was elected on a promise to fix the NHS. With 4.5 million people on the waiting lists, 2.5 million people waiting beyond four hours in A&E and 34,000 people waiting beyond two months for cancer treatment, our constituents now expect him to fix the NHS. He could start by giving the NHS the level of investment it needs, which is a 4% uplift. He could start by voting for our amendment in the Division Lobby tonight.

--- Later in debate ---

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is an honour to speak on a Queen’s Speech that has set out such a fantastic programme for government, and from a Conservative majority Government. As a consultant paediatrician, it is particularly special for me to be able to speak in a debate on health.

I want to talk about the importance of engineers. My daddy is very fond of telling me that engineers have saved more people’s lives than doctors have; it will perhaps not surprise Members to know that daddy is an engineer. To some extent he is right, because improvements in water, sanitation, investigatory tools such as CT and MRI, and ventilating machines have saved many lives. That is why I am really pleased that the Government are bringing forward the medicines and medical devices Bill: it is by investing in research and increasing the number of people in clinical trials, and investing in research and development generally—the Government are committed to increasing investment in R and D to 2.4% of GDP—that we will be able to improve people’s lives. This is not all about increasing the NHS budget, although I am also pleased to see that we are giving the NHS its biggest ever cash injection, at £33 billion by 2023.

In my last minute, I want to talk about diagnostic centres. Grantham Hospital is very important to me and to my constituents, and to the constituents of my new neighbour, my hon. Friend the Member for Grantham and Stamford (Gareth Davies). I was pleased that earlier this week we were able to meet the Health Secretary to talk about the hospital’s future—a positive and excellent future, in a growing town.

As a doctor, I have seen a progressive move towards greater centralisation, with services becoming increasingly remote from the people whom they serve. That makes sense for low-volume, high-complexity work, because it improves outcomes for the patients who need such treatment, but it does not make sense for high-volume, low-complexity work, which should be delivered closer to home. I was pleased to hear the Health Secretary say essentially just that in his speech earlier today, when he suggested that diagnostics and investigations would move closer to home, which would mean a positive future for Grantham Hospital and the people there.

However, my first priority—and, no doubt, that of my hon. Friend the Member for Grantham and Stamford —is to ensure that the hospital’s A&E department reopens as a 24-hour, round-the-clock service. That is no more than my constituents deserve.