Adult Community Services

Darren Jones Excerpts

Wednesday 26th June 2019 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

I beg to move,

That this House has considered re-procurement of adult community services by Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group.

It is a pleasure to serve under your chairmanship, Mr Gapes. I am pleased that this important subject has been selected for debate. Although they cannot be present, my hon. Friends the Members for Bristol West (Thangam Debbonaire), for Bristol East (Kerry McCarthy) and for Bristol North West (Darren Jones) fully support my comments. This is an important issue for the people of Bristol South, and it is a local example of the debate on the legacy of the Health and Social Care Act 2012 and of the invidious position that local managers are being put in to understand the procurement rules.

Hon. Members know that I speak frequently about accountability and the opaque way in which many parts of the NHS operate. We seem to have lost sight of the fact that, however individual bodies are constituted, our health services are public services that are paid for by taxpayers—our constituents. I have also repeatedly said that if we keep asking people to pay more for our health services, they must have a greater say in the way that those services are run, particularly when they are being changed.

I have spoken before of my concern about the attitude of my local clinical commissioning group in Bristol, North Somerset and South Gloucestershire to the openness and transparency of its work, especially on the reprocurement of adult community services. The lengths to which the CCG, supported by NHS Improvement, has gone to hide, cover up and obfuscate are nothing short of a scandal. Most infuriatingly, the whole protracted cloak-and-dagger exercise has been entirely unnecessary, because a far less onerous and costly approach could have been used instead. The reprocurement is the wrong approach at the wrong time to developing community services, and runs counter to the direction of travel being set, in theory, by the new NHS 10-year plan.

Before I review the shortcomings of the reprocurement in greater detail, I will remind hon. Members why it matters. Away from the jargon, acronyms, terse letters and confidentiality agreements, thousands of people across Bristol, North Somerset and South Gloucestershire simply want to know what is happening to their local health services.

My constituent Clive got in touch just over a year ago to tell me about the great work being done at the Healthy Together leg clinic at the Withywood Centre, which provides intervention and treatment for the leg ulcers of patients in south Bristol. It is exactly the sort of joined-up, innovative and integrated community provision that Ministers tell us they want to see—a true partnership between Bristol Community Health, local GP practices and Age UK in Bristol, which come together across different sites to deliver gold-standard patient care that promotes faster and longer-lasting wound healing. The clinic also provides a social setting where patients feel more supported and are encouraged to feel more in control of their condition. There is time for people to care.

The service has transformed countless lives in my constituency and has been nominated for a national award. As I saw first hand when I visited the clinic earlier this month, it is an exemplar of the sort of collaborative provision that the new adult community services contract could and should expand on. Such collaboration takes years to yield results and very much responds to the local needs of the particular community.

The people who are providing the service, however, do not know for how long they will be able to continue, because the CCG will not tell them. The patients do not know for how long they will be able to access that life-changing service, because the CCG will not tell them. As the local MP, I cannot lobby, engage or reassure people, despite asking repeatedly for a peek behind the self-imposed reprocurement iron curtain, because—hon. Members will have guessed it—the CCG will not tell me.

Interestingly, another consequence of the process, which I do not have time to really go into, is the destabilising impact on the voluntary sector. Age UK will have to wait, cap in hand, to see which successful bidder secures the primary contract and how it then decides to sub-contract the provision. The same goes for all voluntary organisations involved in this sort of service provision. It would be bad enough if the Healthy Together clinic were a one-off —the only service caught up in a closed-shop procurement mess—but it is not. In truth, every adult community service is in the same position, which is simply not good enough.

Despite a year of making speeches in this place, asking questions of Ministers, doing time-consuming research and making countless phone calls to offices, neither the CCG locally nor NHS Improvement nationally will engage with me beyond continually asserting that they had no choice but to go down this route. That is a prime example of what the Health and Social Care Committee referred to in its recent report, which said that the

“problems stem not only from the procurement rules themselves, but also from people’s interpretation of these rules and their difficulty in understanding what is permissible within the rules.”

In place of answers, I am forced to restate the litany of my constituents’ questions and concerns that have essentially gone unanswered. First, there is a fundamental lack of clarity surrounding the reprocurement and an abject failure to link it to any broader NHS strategies. I am not the only one who is concerned about the process. I have been spoken to privately by many consultants, nurses, and other staff throughout the healthcare system; I am grateful to them for contacting me.

At no point has the CCG properly defined a needs assessment in the request for proposals. Moreover, at no point has it made the business case for change—the most basic starting point for any such process. Staggeringly, there is no service baseline, so we do not know what services exist. By extension, there are no defined outcomes, so bidders are being asked to make proposals. That is not what commissioning is meant to be about.

Although Ministers continue to trumpet the importance of the sustainability and transformation plans, there is no sense of alignment with those plans, the NHS long-term plan or the emerging integrated care systems. Similarly absent is any indication of integration with local councils on social care or public health, which we all acknowledge are the key issues facing our constituents.

Secondly, there are concerns about the chosen procurement process, because any number of much less onerous and costly approaches were possible. As ever, however, accurately assessing the process is near impossible because of the vice-like secrecy that the CCG has used throughout. What is certain is that we do not know how much it is costing the CCG or the bidders, which include the current not-for-profit community service providers. That means that we do not know how much it is costing us, the taxpayers.

I worked in the national health service for many years, and I have some experience of procurement in the organisation, but I have struggled to understand properly the process through which the procurement has been undertaken. To illustrate, the CCG’s description of the chosen process, in its own words from its own document—bear with me, Mr Gapes, because I did not write it—says:

“The procurement is being undertaken using a process developed by the CCG which has similarities to a competitive process with negotiation. For the avoidance of doubt, the CCG is not running the process strictly in accordance with any specific procedure set out in the Regulations so reserves the right to depart from that form of procedure at any point. This Request for Proposals sets out the procurement process the CCG plans to use for this particular Contract. The inclusion of particular stages, the use of terminology and any other indication shall not be taken to mean that the CCG intends to hold itself bound by the full scope of the Regulations.”

What does that mean? I think it means that the process is as clear as mud, carried out behind a wall of secrecy, but with a disclaimer that enables the CCG to do what it wants without our knowledge. Although we cannot access the process details, what we know does not bode well.

There are myriad loose ends and errors throughout the process. Taken together, they form a significant body of concerning issues. Of course, I would never have known about them—most people do not—if I had not scoured 300 pages of detail and 100 clarification questions asked by bidders. In fairness, I doubt the CCG was expecting anybody outside the process, including the local MP, to do so, but I read them all because I like detail and I think it is important to know what is going on. A lot of the gaps and oversights concerned me.

There seem to have been incorrect working assessments about bed numbers at South Bristol Community Hospital; gaps relating to workforce numbers and staff who have been TUPE-ed; and a number of misunderstandings and examples of where the CCG lacked knowledge about current contracts, rental payments and void space. There is also missing information about assets, and the bidders were apparently expected to carry out the due diligence. That not only places a huge burden on providers, but runs the risk that the entire process will collapse if it is not carried out correctly, as has happened elsewhere. It is worth highlighting that the National Audit Office investigation into the collapse of the UnitingCare Partnership contract in Cambridgeshire and Peterborough found that bidders

“faced significant difficulties in pricing their bids accurately due to limitations in the available data”.

The evidence I have seen in the documentation suggests that that is now happening.

We should all be very worried about that, because failed procurements in Staffordshire for cancer services and end-of-life care, and in Cambridge and Peterborough, had similar procurement processes to the one chosen by Bristol, North Somerset and South Gloucestershire CCG. In each case, there was a secretive process, a complex procurement methodology and a failure to engage. Together, they cost taxpayers millions, and they all failed. Instead of learning lessons, NHS Improvement and the CCG seem intent on repeating the mistakes.

[Darren Jones (Bristol North West) (Lab)]

I congratulate my hon. Friend on securing this important debate. Does she agree that the complexity of the procurement process and the difficulty that she—an expert in this area—is experiencing means that patients who rely on these services and workers in not-for-profit organisations, who deserve to know what the process means and what the outcomes will be for them, find it impossible to take part as important stakeholders?

[Karin Smyth]

Absolutely—I completely agree. That is why I will continue to speak up on behalf of my constituents; I know I have my hon. Friend’s support.

Predictably, I would like to finish where I began, on the issue of secrecy and a lack of transparency. As I have highlighted, this absurd behind-closed-doors approach has bedevilled the reprocurement from the off. If this is such a great change to community services, why are we not trumpeting it? Reprocurement was first referred to in governing body papers in May 2018, but other than that there has been virtually nothing. There was no official announcement, no media blitz, no news stories or television news clips, no leaflets in local GP surgeries or South Bristol Community Hospital to enable local people to have their say on the plans—nothing. Although there has been talk of consultation, it seems that only 20 people from south Bristol took part. In fairness, there were some nods to engagement, and surveys were completed by 196 people. There was an engagement planning workshop with patients, carers and the voluntary sector, but because it is a contracting process, they were asked to sign a confidentiality agreement.

There is no evidence that even that limited feedback has been listened to or acted on. The workshop was merely an illustration to bidders of what stakeholders might want to identify when community services are planned and delivered. Tellingly, in documents from January, the CCG stipulated:

“Formal public consultation is not required as part of the procurement as no ‘significant variation’ to services is planned at this stage”.

Why is it being done if there is no significant variation to services?

All the documentation—approximately 300 pages in total—is hidden behind a portal, including more confidentiality agreements. The whole process appears so desperate to avoid the merest hint of engagement that it screams, “We’ve got something to hide!” It is utterly self-defeating, and serves no one well—not patients, bidders, the CCG or the community at large.

The CCG says that it is seeking a consistent service across all three areas and both acute trusts. Two of the CCGs and one of the trusts have been in deficit for years, and at various times in the past few years they have been on NHS Improvement’s naughty step. The deficits are now being shared across the whole community. The jam is being spread more thinly and differently from how it was spread before. The process is being embarked on to help spread the already struggling and inadequate level of service more thinly. Those service providers are spending money that should be spent on services on a process that I believe will inevitably reduce community services in Bristol.

I have great respect for the Minister, but I have no confidence that the Government will be able to make any difference to the local position. I hope that she takes note of the variability in how the rules are interpreted locally, as the Health and Social Care Committee noted in its response to the legislative proposals for the NHS long-term plan. Other commentators are saying the same. I hope the Minister will reflect on this local example. Will she explain directly or through her officials why, when I wrote to the Secretary of State about this originally, I got a reply from NHS Improvement? NHS Improvement is the provider regulator; this is a commissioning issue.

I believe that the Government should rapidly respond to the proposals to remove the requirement for competition under the section 75 regulations. There is no reason to wait; they need to get on with it. This saga shows that the lack of investment in NHS services remains a problem. Why not just build capacity rather than go through these expensive tendering processes with providers outside the NHS? I actually support the place-based approach to service provision in the NHS plan, but I object to the fact that this reprocurement goes counter to that plan.

At the very least, on behalf of local people, I would like the Minister to support my calls to see the proposals before contracts are signed for the next 10 years. We need a local plan and collaboration with the local authority that meets our health and social needs. I want a guarantee that people in south Bristol will not be worse off. Currently, no one can give me that.

NHS 10-Year Plan

Darren Jones Excerpts

Tuesday 19th February 2019 Commons Chamber

[Jonathan Ashworth]

The hon. Gentleman makes an important point. There are elements of the long-term plan that we welcome, including the access targets for mental health. We also welcome the commitment to save 400,000 lives, although there is no detail in the plan about how those lives are going to be saved. We welcome the rolling out of early cancer diagnostic and testing centres—after all, it is a policy that I announced in the 2017 general election campaign. We welcome the roll-out of alcohol care teams in hospitals—a policy that I announced at the Labour party conference last year. We welcome the commitments on perinatal mental health—again, a policy that we announced previously. We welcome the commitment for preferential funding allocated to mental health services—another policy that the Labour Opposition previously announced—but we will need to study the details carefully, as the hon. Member for Oxford West and Abingdon (Layla Moran) said.

The points about mental health from the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) were well made, because currently three in four children with a diagnosable mental health condition do not get access to the support they need. Child and adolescent mental health services are turning away more than a quarter of the children referred to them for treatment by parents, GPs, teachers and others. That is quite disgraceful, so I hope the extra investment in mental health services reaches the frontline quickly, and I hope that in summing up the debate the Minister will give us more details about when we can expect to see progress on that front.

[Darren Jones (Bristol North West) (Lab)]

Does my hon. Friend agree that for hospitals such as Southmead Hospital in my constituency, which is one of the largest hospitals in Europe, frontline delivery requires a workforce that is able to meet the demand? Does he therefore agree with the comments from the King’s Fund, which says that the Government not only failed the test on the workforce but did not even turn up for the exam?

[Jonathan Ashworth]

My hon. Friend makes a good point, and I will come on to discuss the workforce in a few moments. First, let me pick up the point made by my hon. Friend the Member for Sheffield, Heeley (Louise Haigh).

There is recognition in the plan that widening health inequalities are becoming a more important issue, which we need to confront. There is much in the document about widening health inequalities. After years of austerity, with poverty rates increasing and child poverty at 4.1 million, we now see life expectancy in this country stalling for the first time in a hundred years, and actually going backward in the poorest parts of the country. Child mortality rates for children born into the most deprived of circumstances have increased. The truth is that poorer people get sick quicker and die earlier. For me, as a socialist and a Labour politician, that is shameful. We should be creating conditions in which people live longer, healthier, happier lives, which is why we need to end austerity across the board. The focus on health inequalities is therefore welcome, and that includes the stark recognition that inequalities are costing the NHS £4.8 billion a year in admissions—a remarkable figure.

Appropriate ME Treatment

Darren Jones Excerpts

Thursday 24th January 2019 Commons Chamber

[Darren Jones (Bristol North West) (Lab)]

Given the very short period available, I will not be able to do justice to Karen, Carolyn, Nathalie, Anna, Emma or many of my other constituents by telling their stories today. Like my hon. Friend the Member for Ealing North (Stephen Pound), I tell my constituents and all those watching, “The House has heard you and your stories, and understands your plight.” The will of the House will make that very clear to those on the Government Front Bench.

It is clear from the stories we have heard today what a devastating and complex disease this is. When I was a young undergraduate in human bioscience, studying immunology, I heard this referred to in the labs as “Multiple Excuses”, and that was not so long ago. There is clear evidence that much more work is needed on the biomedical and biological processes behind this complex and devastating disease.

I am a member of the Science and Technology Committee, and we have recently completed an inquiry into research integrity. We have some concerns about reporting and transparency, especially in clinical trials. This goes to the concerns of many ME sufferers about what research is being done and how it is being done. Further to our Select Committee inquiry, I hope that the Minister will say what he will do to provide transparency in prospective registration, to deal with positive bias in journals—researchers are incentivised to find positive answers, as opposed to proving negatives, which is sometimes just as important—and perhaps to change the culture of that environment.

Lastly, on the delivery of care, about which we have heard from many hon. Members, the research must be recognised in the NICE guidelines, which lead to the delivery of care for many sufferers—children and adults—and to some of these heartbreaking situations. In my final 10 seconds, I pay tribute to the hon. Member for Glasgow North West (Carol Monaghan), a colleague on the Science and Technology Committee. I was pleased to support her application for this debate, and I hope the Government will respond in the significant way that is needed.

Autism and Learning Disability Training: Healthcare Professionals

Darren Jones Excerpts

Monday 22nd October 2018 Westminster Hall

[Darren Jones (Bristol North West) (Lab)]

I rise as the Member of Parliament for Bristol North West, which contains Southmead Hospital: it was part of Oliver’s story, from which lessons need to be learned. Does the hon. Lady agree that the important point here is that we evidently have strong cross-party consensus; that we must now focus our efforts not just on debate and consultation but on achieving real change in the health service and our public services generally and right across our country; and that today’s debate gives us the impetus to do that?

[Wera Hobhouse]

I thank the hon. Gentleman for his intervention. I have said at another occasion today that the word “Parliament” comes from the French word “parler”, which means to talk, but we are also here to take action, so we must stop talking and take action. The issue of mandatory training is something that we can fix or determine here, and I very much hope that the Government will take that on board.

The urgent need for better training on autism and learning disability and the complications of the condition could not be shown more starkly than by the failings in Oliver’s case. In February, the charity Mencap launched the “Treat me well” campaign, which is aimed at transforming how the NHS treats people with a learning disability in hospital. In particular, women with a learning disability suffer disproportionately from health inequalities. We have heard the statistics today; they die on average 29 years before women in the general population, and men with a learning disability die on average 23 years before those in the general male population. That cannot be overlooked. We have also heard these figures today, but that does not matter—it will do no harm to repeat them: a YouGov survey conducted in 2017 found that nearly one quarter of the health professionals surveyed had never attended any training on learning disability, and two thirds wanted to have more training, so what are we waiting for?

Any illness or disorder that is either misdiagnosed or diagnosed late leads to far greater problems down the line. Early intervention depends on early diagnosis, and early diagnosis on training of those who come into contact with the sufferers. We are calling today for better training of healthcare professionals, which is an obvious start, but why not go even further? Let us look at the settings to which young people are exposed from an early age—namely, nurseries and schools. Given that ASD is so widespread, nursery nurses and teachers should receive at least some basic training to recognise the early warning signs. Far too little is being done. In my constituency of Bath, we have an autism board, but it rarely meets and has not even set up a work plan yet. Clearly, none of this is good enough.

ASD and learning disabilities can be successfully treated to give sufferers a full life. The earlier we diagnose the problem, the better the outcome. Many people with ASD also suffer from mental health problems, often as a consequence of not being diagnosed early enough. Let us end this tragedy. I fully support the recommendations that have been made, and I hope that we have the cross-party consensus to really do something quickly.

NHS Pay

Darren Jones Excerpts

Wednesday 13th September 2017 Commons Chamber

[Helen Whately (Faversham and Mid Kent) (Con)]

It is a pleasure to speak in this debate. I will not try to compete with my right hon. Friend the Member for Broxtowe (Anna Soubry), but one reason why I am speaking today—and why I often speak on healthcare matters in this place—is that I, too, come from a family of doctors and nurses who work in the NHS. It was wanting to make the NHS better that first got me involved in politics, and I care very deeply about our national health service.

I welcome the Government’s decision to lift the pay cap, and to do it in a responsible way, but it has served a purpose. Back in 2010, the pay cap was necessary. Indeed, there was a pay cap in the Labour party’s 2010 manifesto as well. Labour also recognised that a level of pay restraint was necessary because of the financial situation in which the country found itself. Pay restraint was urgently needed, because wages are a significant driver of costs in the NHS and the wider public sector, and the public finances were running totally out of control. The pay cap was part of the restoration of financial discipline, of confidence in our economy and of growth, which we are now enjoying. Thanks to that growth, millions more people are now in work.

It is right to lift the pay cap now, but it must be done with caution because this country still has a sizeable deficit and increasing levels of debt. We are still paying off large amounts of debt interest. We therefore have to be responsible in the way we make commitments on public sector spending. I am very concerned about Labour’s plans for the pay increases that they would be willing to fund. They seem to involve an open promise and a potentially bottomless pit. Labour Members will not tell us how much the pay increases would be, but we know that the proposals in their manifesto would have cost between £6 billion and £9 billion extra. It was not clear where that money was to come from. Time and again, we heard that it would come from corporation tax, but we know that when we put up corporation tax we reduce the tax take, so that policy would not have funded the increases. I am concerned that Labour Members are making an irresponsible promise that they would not be able to deliver, were they in a position to try.

I welcome the more responsible approach taken by this Government. It will not involve a blanket pay rise; rather, it will draw on the guidance of the next pay review body for the health service and make pay rises where they are most necessary. In my constituency in the south-east, for example, I am aware that the high cost of living affects the people on the lowest pay in the public sector, and I hope that they will be recognised in the pay review. We should definitely draw on the expertise of that body when making proposals for public sector pay, rather than just trying to score debating points and get the right headlines.

In my experience of about a decade working in many parts of the NHS, including hospitals, and as an MP, I have spoken to people working in the NHS and found that pay is rarely, if ever, the No. 1 concern. The issues that come up much more frequently include having time to care—

[Darren Jones (Bristol North West) (Lab)]

I thank the hon. Lady for allowing me to intervene. She clearly wishes to champion nurses and their selfless desire to serve the public, but does she acknowledge that nurses in my constituency have to visit a food bank after a long shift at the hospital? Should not their selflessness in wanting to serve the public be recognised by their being paid what they deserve so that they can fund their families and their livelihoods?

[Helen Whately]

I genuinely believe that all members of the public sector should be paid a fair amount, and that is exactly what the pay review body will report on in its next report.

I was making the important point that pay has not been the No. 1 issue among nurses and other healthcare professionals when I have asked them what worries them most. Instead, they mentioned having time to care; being part of a stable team rather than having a high turnover of staff and lots of temporary staff; being listened to by the people they work with, particularly the senior people in the institution; and being valued. Being valued is not all to do with pay; it is much more to do with the way they are treated. In fact, I remember very well talking to one nurse whose line manager had not talked to her since the previous appraisal. To me, that is an extraordinary way of not valuing a member of staff; everyone should have regular conversations with their manager about how they are progressing.

Part of the problem in some NHS institutions is, therefore, in my view, not good enough management practices. If they were improved, we would have a much better environment for staff to work in, and I would very much like to see more attention paid to creating the right environment for healthcare workers, as well as ensuring that there is a fair and sensible pay settlement.