Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 26th November 2013 Commons Chamber

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

2. What steps he is taking to ensure that compassionate care is at the heart of the NHS.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Last week, we published a full response to the Mid-Staffs public inquiry and set out our ambition to transform the quality of compassionate care in the NHS. We have already put in place a robust new inspection regime and measures to make it easier for doctors and nurses to speak out when they are concerned about standards of care or safety.

[Alec Shelbrooke]

Compassionate care goes right through from surgeons to GPs. Will my right hon. Friend comment on evidence that epileptic women of child-bearing age are not being shown the compassion necessary during pregnancy from their GPs or neurologists and are not having the risks of taking their epilepsy medication outlined to them? To date, such medication has caused more than 20,000 birth defects.

[Mr Hunt]

I thank my hon. Friend for highlighting this important issue. The Medicines and Healthcare products Regulatory Agency regularly reviews the evidence relating to anti-epileptic drug use, particularly sodium valproate products, and we check what information is available to doctors so that it can be passed on to patients. I am concerned about the issue my hon. Friend raises, so I have asked NHS England’s national director of patient safety, Dr Mike Durkin, to look into it carefully and get back to me.

[Nick Smith (Blaenau Gwent) (Lab)]

New York has raised the age for buying tobacco products to 21. As a public health care policy, has the Department considered that matter?

[Mr Hunt]

As the hon. Gentleman will know, we are constantly reviewing all policies that could reduce tobacco use among young people. Smoking is the No. 1 killer, so dealing with it would be the best way of reducing this country’s premature mortality rates, which are far too high.

[Jonathan Lord (Woking) (Con)]

23. Does the Secretary of State agree that transparency is critical in improving hospital standards and that, following the Government’s latest measures in response to the Francis report, the health cover-ups by the previous Government will never be allowed to happen again?

[Mr Hunt]

The Labour party does not like to hear this, but the reality is that micro-managing the NHS through top-down targets failed to deal with the problems of compassionate care. My hon. Friend is absolutely right that the best way to deal with this is through total transparency, so that when we are sure there is a problem, the public find out about it quickly and it is dealt with quickly.

[Jim Shannon (Strangford) (DUP)]

Compassionate care must be central to the NHS. The Health Minister in Northern Ireland has launched “Quality 2020”, a strategy that is intended to improve care in Northern Ireland. What discussions has the Secretary of State had with the Northern Ireland Assembly and the Health Minister about this issue?

[Mr Hunt]

We are in close touch with all the devolved Administrations about the changes that we are making in the NHS in England, and, interestingly, we are experiencing different levels of engagement. We have had very good discussions with the Northern Ireland Health Minister about some of the changes, but those in Wales are still refusing to commission a Keogh report on excess deaths, which I think shows that Labour in Wales has not learnt the lessons of transparency.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

3. What steps he is taking to train and retain more accident and emergency health specialists in the UK.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I have asked Health Education England to consider how we can improve the structure and skill mix of the emergency medicine work force to deal with long-standing shortages in staff at both consultant and trainee levels. Along with the Emergency Medicine Taskforce, we are considering a number of options, such as increasing the non-doctor work force and the number of emergency nurse practitioners.

[Mr Sheerman]

Just what is going on in medical education in this country? We train doctors, but some never work as doctors, and others move abroad. Calderdale and Huddersfield NHS Foundation Trust has advertised and advertised again, but it cannot recruit accident and emergency staff. It certainly cannot recruit any who have been trained in this country, or who have been trained in paediatrics. What is going wrong with medical education here?

[Mr Hunt]

The hon. Gentleman has raised some important issues. We do face big challenges. We have increased the number of doctors in the NHS by 6,600 over the last three years, but it is still very difficult to attract as many people as we need to disciplines such as A and E.

I know that Calderdale and Huddersfield NHS Foundation Trust is especially concerned about A and E staffing. I had a very good meeting with representatives of the College of Emergency Medicine last week to discuss A and E consultants’ terms and conditions and, in particular, their antisocial working hours. We are giving the matter close consideration, but I agree with the hon. Gentleman that we need to do better in this regard.

[Mr Philip Hollobone (Kettering) (Con)]

While it is important to recruit and retain more A and E specialists, part of the problem is that a third of the patients who are dealt with in A and E departments could receive better treatment closer to their homes. What can the Secretary of State do to encourage that?

[Mr Hunt]

My hon. Friend is absolutely right. One of the biggest mistakes made in health care over the past decade was the introduction of the disastrous changes in the GP contract in 2004, which broke the personal link between GPs and their patients. Hard-pressed A and E departments, including the one at Kettering hospital, say that one of the things that will make the biggest difference to them is the provision of a named GP for the over-75s, so that they know that someone is responsible for those people when they are not in hospital.

[Fiona Mactaggart (Slough) (Lab)]

Is it not the chaotic and overstretched nature of many A and E departments that makes A and E an unattractive discipline for people to work in? Ever since the closure of the A and E department at Wycombe general hospital in my constituency, Wexham Park hospital has been unable to cope. What will the Secretary of State do about that?

[Mr Hunt]

We have gained more than 600 additional A and E doctors over the last three years, so the numbers are rising. However, the best thing that we can do for A and E staff is to give them a sense that we are addressing the long-term challenges that they face. The issues of integration with social care and delayed discharges are being addressed through the health and social care integration transformation fund, but we must also ensure that there are better primary care alternatives. The named GP for the over-75s will make a big difference in that regard.

[Margot James (Stourbridge) (Con)]

My local hospital, Russells Hall, is experiencing considerable difficulty in recruiting A and E consultants. Would not a good alternative approach be to train more paramedics to serve on ambulances and provide more effective and robust triage at emergency centres, so that patients can be redirected when necessary?

[Mr Hunt]

As ever, my hon. Friend speaks very wisely about this subject. In his review of A and E services, which was published a couple of weeks ago, Professor Keogh said that paramedics could deal with 50% of 999 calls on the spot, without taking people to hospital. I think that there is a big role for ambulance services that are prepared to upskill. It is also important for us to ensure that they have the necessary information. One of the main changes that we intend to make next year will ensure that they have access to the GP records of the people whom they pick up, so that they can give those people the care that they need in their own homes.

[Mr Jamie Reed (Copeland) (Lab)]

The president of the College of Emergency Medicine has said that the Government’s reorganisation has made A and E recruitment worse; the chief executive of the NHS Confederation has said that A and E pressures have been compounded by three years of structural reforms; yesterday, we learnt that the number of nurses choosing to leave their profession had jumped by more than one quarter under this Government; and the Health Secretary himself admits he is worried by the fall in nurse numbers on this Prime Minister’s watch. I hope he listens carefully so that he can answer precisely: will he today give the House a guarantee that every A and E in the country will have enough nurses this winter?

[Mr Hunt]

Will the hon. Gentleman think about what he has said? He said he was against a reorganisation that got rid of 8,000 managers and put 6,600 doctors on to the front line. That is why we are doing nearly a million more operations every year and why waiting times for longer waits are shorter than they were under Labour. We are recruiting more doctors because we are putting money into the front line.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

It takes seven years to train a doctor, but, for whatever reason, the new GP contract is looking to end seniority pay in six years. Is my right hon. Friend not concerned that that will lead to a mass retirement of doctors at the end of that six-year period in 2020?

[Mr Hunt]

We have to make the GP profession attractive to younger GPs as well. The money we save from getting rid of seniority pay will go back into practices, but it should not be given to people just for length of service; it should be related to quality of service too, which will make the GP profession much more attractive.

[Rosie Cooper (West Lancashire) (Lab)]

5. What recent assessment he has made of ambulance handover times at accident and emergency departments.

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[Nick de Bois (Enfield North) (Con)]

17. What progress his Department has made on improving out-of-hospital care for frail elderly people.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Improving the quality of out-of-hospital care is the biggest strategic long-term change that we need to make in the NHS. It will help to make the NHS sustainable. Reforming the GP contract is the first step, but we also need to make major progress on integrating the health and social care systems.

[Mark Menzies]

I welcome the Government’s announcement of named GPs for older people. What does the Secretary of State envisage that will mean for my older constituents?

[Mr Hunt]

My hon. Friend is not the only person to welcome that change. After months of telling the House that this was nothing to do with the A and E problems, the shadow Health Secretary said on the “Today” programme that he welcomed the change and that it would make a difference to A and E. So I welcome the return of the prodigal son with great pride and pleasure. For my hon. Friend’s constituents, this will mean that there will be someone in the NHS who is responsible for ensuring that they get the care package that they need. That is incredibly important, because when people are discharged from hospitals, the hospitals worry about whose care they will be under. This change will provide that crucial link and make a real difference.

[Sir Tony Baldry]

Does my right hon. Friend agree that the 2004 GP contract did enormous damage to the relationship between GPs and their patients, and that the recent changes agreed with GPs should ensure much more proactive care of our most vulnerable constituents and ease pressure on A and E departments?

[Mr Hunt]

I agree with my hon. Friend, and I am pleased that the shadow Health Secretary also agrees with him in welcoming the reversal of that disastrous contract. The personal relationship between doctor and patient is at the heart of what the NHS stands for, and at the heart of that is a responsibility to ensure that people get the care they need. That is what we need to get back, and I think that the change will make a big difference to my hon. Friend’s constituents.

[Nick de Bois]

Enfield CCG is working closely with Enfield council to try to deliver integrated health and social care, particularly for the elderly and the frail. Noting our higher-than-average elderly age demographic in the borough, will the Secretary of State take steps to ensure that those efforts are supported with extra funding?

[Mr Hunt]

My hon. Friend knows that the funding arrangements are decided independently of the Government, by NHS England, which will make its decision at a board meeting before Christmas. He is absolutely right to suggest that the funding formula should reflect not only social deprivation but the age profile of constituents, because the oldest people are of course the heaviest users of the NHS.

[Liz Kendall (Leicester West) (Lab)]

The Health Secretary claims that he wants the NHS to be the best in the world at looking after the elderly. Nice rhetoric, but the reality is that we now have the highest-ever number of elderly people trapped in hospitals because they cannot get the health and social care they need at home. We now have the equivalent of five hospitals full of elderly people who do not want to be there, and that is costing the taxpayer £20 million a month. Is not the truth that care of the elderly is getting worse, not better, on his watch?

[Mr Hunt]

The truth is that the previous Government had 13 years to integrate the health and social care systems, but they failed. We are doing that, and we are also providing named GPs to the most vulnerable people, so that, hopefully, they do not have to go to hospital in the first place. That is doing a lot more for older people than the hon. Lady’s Government ever did.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my right hon. Friend agree that successive Governments over 30 years have talked about the importance of joining up the different bits of the health care system and joining that up with social care? Is not the difference between this Government and their predecessors that, through health and wellbeing boards, the integrated care fund, named GPs and the pioneers programme that he has announced, this Government are actually doing it, rather than just talking about it?

[Mr Hunt]

I have to pay tribute to my right hon. Friend, because he has been talking about the integration of health and social care for a lot longer than I have, and he is absolutely right. I would add to his list one other really important thing we are doing: we are making sure that whatever part of the system someone is in, doctors can access their GP medical record—with their permission—because that information is vital in showing their allergies, medical history and previous admissions. Breaking down the barriers that prevent that from happening is one of the things that has not been picked up but is in the GP contract.

[Graham Evans (Weaver Vale) (Con)]

7. What steps his Department has taken to ease the short and long-term impact of winter pressures on NHS services.

[The Secretary of State for Health (Mr Jeremy Hunt)]

In the short term, a record £400 million has been assigned to help the NHS cope with winter pressures this winter, with £250 million announced in August—much earlier than before. For the long term, we will provide better out-of-hospital care for the frail elderly, by restoring the link between GPs and older patients, and looking to integrate the health and social care systems.

[Graham Evans]

Will my right hon. Friend join me in praising the outstanding work of Age UK and, in particular, Age UK Cheshire, which serves my constituency? It is raising older people’s awareness of seasonal impacts on health and offering support to prevent unnecessary pressures on the health service.

[Mr Hunt]

I am delighted to do that. As these are the last Health questions before Christmas, all of us would want to pay tribute to the voluntary organisations that do an extraordinary job of making sure that vulnerable older people do not get lonely over the Christmas period. It is heroic what they do—when we are with our families, they are looking after other people—and we should salute them all.

[Valerie Vaz (Walsall South) (Lab)]

22. One way to ease the pressure on the NHS is by not handing the £2.2 billion underspend back to the Treasury. Will the Secretary of State consider using it for the NHS?

[Mr Hunt]

I wish the hon. Lady had been as diligent in asking that question of Labour Ministers, who also handed back underspends to the Treasury when they were in power.

[Steve Baker (Wycombe) (Con)]

Along with county colleagues, I wrote to the Secretary of State on this subject, because Buckinghamshire Healthcare NHS Trust is relatively underfunded compared with the rest of the country and it is in special measures following the Keogh review. Further to the answer that he gave to the earlier question, when can we expect the NHS England funding settlement to reflect more equitably the age of the public?

[Mr Hunt]

I commend my hon. Friend for the campaigning he does for high standards in his local trust. That has not been easy because, as he says, there have been a lot of problems there, although I hope he thinks that we are beginning to turn a corner. The decision on the funding allocations will be made by NHS England before Christmas, and the things that he says will, of course, be taken into account.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Yesterday we learned that the number of people suffering from hypothermia has soared by almost 40% on this Government’s watch. This morning the Office for National Statistics revealed that the number of older and vulnerable people who died unnecessarily last winter jumped by 29%. For every person who tragically loses their life over the winter months, eight more are admitted to hospital, putting huge strains on our crisis-ridden accident and emergency services. Will the Secretary of State please tell us what he is going to do about it?

[Mr Hunt]

I do not think I have yet answered a question across the Dispatch Box from the hon. Lady, so I welcome her to her post. I just say that she should be careful what she chooses to turn into a political football, because hypothermia admissions, as Public Health England said in August, are very closely linked to the number of cold days over a winter and the length of that winter. We had a particularly difficult winter last year, but the number of winter deaths was nearly 20% higher under the previous Government, when the right hon. Member for Leigh (Andy Burnham) was Health Secretary.

[Mrs Mary Glindon (North Tyneside) (Lab)]

8. What assessment he has made of the effects of social care budget changes on attendances at accident and emergency departments.

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[Simon Danczuk (Rochdale) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I need to correct the record. In the House on 30 October, I said that it took 21 minutes longer for the average person to be seen in A and E under the previous Government—a figure that was repeated by the Prime Minister in Prime Minister’s questions. My Department made a statistical mistake: it turns out that under Labour, the average person took not 21 but 44 minutes longer to be seen. I apologise for underestimating the improvements made under this Government.

[Simon Danczuk]

When people have mental health problems, waiting too long for talking therapies can lead to poor recovery, relationships falling apart, and job loss. What progress has the Minister made in establishing and delivering maximum waiting times for talking therapies?

[Mr Hunt]

The hon. Gentleman is absolutely right: this is a big priority for the Government. We are a big fan of talking therapies. We have taken huge strides in improving take-up, but there is still a long way to go, and we are looking at introducing access standards, so that there is a maximum time beyond which no one has to wait.

[John Pugh (Southport) (LD)]

T3. What measurable progress is being made in improving data sharing, not just between hospitals and general practitioners, but between the NHS and social services, to avoid bureaucracy and additional cost?

[Mr Hunt]

My hon. Friend has taken a great interest in this topic, and he is absolutely right to do so, because if we are to give integrated, joined-up care, in which people deal with NHS professionals who know about them, their medical history, their allergies and all the other important things, it is vital that, if they give their consent, their medical record can be accessed. That needs to be from GP surgery to hospital to social care system. Under the named GP policy that we have announced, there is a big opportunity for care homes to access GP records and keep them updated daily, so that GPs are kept in daily contact with how some of the most vulnerable people are doing.

[Andy Burnham (Leigh) (Lab)]

Today I want to put to the Secretary of State new evidence that the A and E crisis is deepening, and having a serious knock-on effect on ambulance services. Information from police forces reveals that cases in which police cars have to ferry patients to A and E are far more widespread than people realise; in some areas, it happens on a daily basis. One ambulance service is now using retained firefighters to attend calls, and—this is how bad things have got—another ambulance service has seen a 350% increase in the number of 999 calls attended by taxis. Does the Secretary of State think that it is ever acceptable that when a patient dials 999, a taxi turns up?

[Mr Hunt]

I am afraid that that is utterly irresponsible. We are hitting our A and E target, and we are hitting our ambulance standard. When the right hon. Gentleman was Health Secretary he missed the ambulance standard for October, November, December and January. He is trying to talk up a crisis that is not happening. He should think about people on the front line and, just for once, put patients before politics.

[Andy Burnham]

The country will have heard the complacency from the Secretary of State. He needs to explain why he spent Friday afternoon making panicked phone calls to hospitals up and down the country that were missing their A and E target. He did not condemn the use of taxis, which is unacceptable but is happening on his watch because ambulances are trapped at A and E, unable to hand over patients. That means that 999 response times have got worse and large swathes of the country, right now, are without adequate ambulance cover. Is it not time that the Secretary of State was honest with the public and admitted the scale of the crisis facing the NHS this winter, and took action now to prevent it from engulfing other emergency services?

[Mr Hunt]

We will take no lessons in complacency from the party that did so little to sort out excess deaths in hospitals such as Mid Staffordshire, Morecambe bay, Basildon and Colchester, and many other hospitals. The truth is that, compared with when he was Health Secretary, we see nearly 2,000 more people every single day within the four-hour standard. We are doing much, much better: we have more A and E doctors, and the NHS is doing extremely well. I know that for him it is always politics first and patients second but, for once, he should be responsible and think about the people on the front line.

[Neil Carmichael (Stroud) (Con)]

T4. In contrast to the previous Government’s lack of focus, what have this Government done about hospital infection control, with particular reference to data management systems?

[Rosie Cooper (West Lancashire) (Lab)]

T2. Following Francis and Keogh, and in creating a more open and accountable NHS, will the Secretary of State, in the spirit of total transparency that he favours, order foundation trusts to publish all their board papers, have exactly the same publishing requirements as non-FTs, and hold all their board meetings in public?

[Mr Jeremy Hunt]

I absolutely encourage that transparency. In fairness, the hon. Lady will accept that this Government have done more to improve transparency in the NHS than any Government have ever done. I would encourage all FTs to be transparent about their board meetings, but they are independent organisations, and we have learned—[Interruption.] Well, this was legislation that her Government introduced, and we have learned that it is important to give people autonomy and independence, because they deliver a better service for patients.

[Dr Julian Huppert (Cambridge) (LD)]

T6. Cambridgeshire and Peterborough clinical commissioning group receives one of the lowest amounts of funding per head in the country. The Government’s own fair shares formula, which takes account of factors such as population, age and deprivation, says that we should have £46.5 million more each year. I know that it is not his decision, but does the Minister think that the new formula should be implemented?

[Caroline Lucas (Brighton, Pavilion) (Green)]

T5. The last time I asked the Secretary of State about the £30 million-worth of cuts forced on hospitals in Brighton and Sussex, he said that it was all down to local discretion. Does he admit that behind his rhetoric about protecting the NHS budget there still lies a real 4% cut to the centrally dictated national tariff? Does he acknowledge, therefore, that hard-working nurses and doctors have to do more with less money while patients suffer? Will he reverse those cuts?

[Mr Jeremy Hunt]

Can I explain to the hon. Lady that the reason for the 4% efficiency savings is that, although we protected the budget in real terms, demand for NHS services has gone up by 4% year in, year out, so we need to find those efficiencies? Within that, it is incredibly important that we do not make false economies in relation to the number of nursing staff, which is why last week’s announcement on our response to the Francis report will make a big difference, and we have already begun to see more nurses.

[Jonathan Evans (Cardiff North) (Con)]

T7. Given the more than 30% increase in the past five years in the cost to the NHS of prescribing stoma appliances, what action is the Minister taking to promote training for stoma patients in alternative management techniques, such as colostomy irrigation?

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[John Healey (Wentworth and Dearne) (Lab)]

The European Union has just agreed a trade deal with Canada that excludes health care, so will the Secretary of State ensure that the proposed EU trade and investment agreement with the US also excludes health care?

[Mr Jeremy Hunt]

We are looking at that very closely. We are big supporters of having a free trade deal between the EU and the US, but we do not want to do anything that would affect the fundamental principles, values and practices of the NHS.

[Stuart Andrew (Pudsey) (Con)]

The new review into children’s heart units feels very different, and I am pleased that everything is on the table. However, I was concerned to learn that the task and finish group has decided to meet in private. Given the group’s importance in decision making, and remembering the experience of the Safe and Sustainable review, does my hon. Friend agree that, in the interests of openness and confidence, the group should meet in public?

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[Karen Lumley (Redditch) (Con)]

In the past two weeks I have had to visit accident and emergency units in Redditch and in north Wales, unfortunately with members of my family. Although health is a devolved matter in Wales, will my right hon. Friend the Secretary of State invite his counterpart in Wales to spend some time at the great A and E unit in Redditch to see for himself the stark differences between the two services?

[Mr Jeremy Hunt]

I would be delighted to do so. He will see the impact of not cutting the NHS by 8%, which is what Labour has done in Wales, which means that in this country we are hitting our A and E targets and in Wales they have not hit them since 2009.

[Mr Speaker]

I am sorry to disappoint colleagues, but we must move on. Demand usually outstrips supply.

Medical Innovation (No. 2) Bill

Jeremy Hunt Excerpts

Friday 22nd November 2013 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Medical innovation has been vital to the dramatic rise in life expectancy of the last century. This country has a proud heritage of medical innovation from Alexander Fleming and the discovery of penicillin to Sir Peter Mansfield’s enabling of magnetic resonance imaging.

The Government should do whatever is needed to remove barriers that prevent innovation which can save and improve lives. We must create a climate where clinical pioneers have the freedom to make breakthroughs in treatment.

The Medical Innovation (No. 2) Bill, sponsored by my hon. Friend the Member for Northampton North (Michael Ellis), and the comparable Bill introduced by my noble Friend Lord Saatchi in the other place, correctly identify the threat of litigation as one such barrier. Their hope is that legislation to clarify when medical innovation is responsible will reduce the risks of clinical negligence claims. Their argument is that with this threat diminished, doctors will be confident to innovate appropriately and responsibly. This innovation could lead to major breakthroughs, such as a cure for cancer.

Their cause is a noble one, which has my wholehearted support. My noble Friend Lord Saatchi, in particular, is a great example of a parliamentarian motivated by conscience.

It is precisely because this issue is so important, because it affects us all, that we need a full and open consultation. A consultation that gets the views of patients on the right balance between innovation and safeguards. A consultation that hears from clinicians on the problems they face in innovating and how to overcome them. We are grateful to my hon. Friend the Member for Northampton North and my noble Friend Lord Saatchi for their own work to understand and address these issues.

So the Government commit today to carrying out a full consultation, working with my noble Friend Lord Saatchi and my hon. Friend the Member for Northampton North. This will draw on the wide engagement and discussions that they have already carried out with the public, patients and the legal and medical professions. Such a consultation will enable an open debate on medical innovation, as well as highlighting its vital importance. The Government expect to launch this consultation in January 2014 and to respond by May 2014.

My second commitment is that the Government will seek to legislate at the earliest opportunity, subject to the results of the consultation.

We all owe a debt to my hon. Friend the Member for Northampton North and my noble Friend Lord Saatchi for the great effort they have already expended on this issue. The Government will work closely with them to bring this to a satisfactory conclusion.

Health

Jeremy Hunt Excerpts

Friday 22nd November 2013 Ministerial Corrections

The following is an extract from the oral statement given to the House by the Secretary of State for Health, the right hon. Member for South West Surrey (Mr Hunt) on the Mid Staffordshire NHS Foundation Trust on 19 November 2013.

[The Secretary of State for Health (Mr Jeremy Hunt)]

It is impossible to deliver safe care without safe staffing levels. All hospitals will be required to monitor their staffing levels on a ward-by-ward basis, analysing precisely how many shifts meet safe staffing guidelines. By the end of this year, this will be done using models independently approved by the National Institute for Health and Care Excellence. No hospital will be able to conceal unsafe staffing from the public because from next June all that data, both at ward and hospital level, will be published alongside other safety data on a new NHS safety website, triggering CQC action if there is cause for concern.

[Official Report, 19 November 2013, Vol. 570, c. 1096.]

Letter of correction from Jeremy Hunt:

An error has been identified in the oral statement given on 19 November 2013.

The correct statement should have been:

[The Secretary of State for Health (Mr Jeremy Hunt)]

It is impossible to deliver safe care without safe staffing levels. All hospitals will be required to monitor their staffing levels on a ward-by-ward basis, analysing precisely how many shifts meet safe staffing guidelines. By the end of next year, this will be done using models independently approved by the National Institute for Health and Care Excellence. No hospital will be able to conceal unsafe staffing from the public because from next June all that data, both at ward and hospital level, will be published alongside other safety data on a new NHS safety website, triggering CQC action if there is cause for concern.

Mid Staffordshire NHS Foundation Trust

Jeremy Hunt Excerpts

Tuesday 19th November 2013 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, Mr Speaker, I would like to make a statement about the Government’s response to the Mid Staffordshire NHS Foundation Trust public inquiry.

Let me start by paying tribute to the men and women of courage, without whom this darkest episode in the history of the NHS would never have come to light. I am talking about people such as Julie Bailey and members of Cure the NHS, who stood outside the Department of Health in all weathers because no one would meet them to hear about the inhumane care given to their loved ones; brave whistleblowers such as Mid Staffs nurse Helene Donnelly; and campaigners who suffered tragedies elsewhere such as James Titcombe, who never gave up the fight after losing his son Joshua at Morecambe Bay. They suffered greatly for their selfless determination to ensure that their personal losses were not in vain. All of us in the House are humbled today to stand in the giant shadow of their bravery.

Robert Francis and his team also deserve huge credit. Their diligence and thoughtfulness led to an outstanding reform, which will transform our NHS for the better. Finally, let me pay tribute to all NHS front-line staff for whom reading about these events in the media has been immensely distressing. We owe it to them to make sure that poor care is never again allowed to take root and survive unchallenged in our NHS.

Since our initial response to the inquiry in March, much has happened. Thirteen hospitals have been put into special measures as part of a tough new failure regime. Those hospitals, where poor care had been allowed to persist, are now being turned around, and I thank the Keogh inquiry team for its painstaking work in that area. Independent Ofsted-style ratings of hospitals are under way, led by Professor Sir Mike Richards, the new chief inspector of hospitals. The first 18 trusts are currently being inspected, with quality of care and safety paramount. We have appointed new chief inspectors of adult social care and general practice, whose robust inspections of care homes, domiciliary care and surgeries start next year, and surgical survival rates for 10 major specialties have been published by individual surgeons, making the NHS a world-leader in transparency.

Today the Government are publishing our further response to the inquiry, as well as our response to the Select Committee on Health’s report on the inquiry. Both responses have been laid before Parliament.

The NHS is a moral being or it is nothing. It was set up 65 years ago with the noble ideal that no one should ever be prevented by background or finance from accessing the best care. That is why it remains the most loved British institution, and rightly so. But each and every case of poor care betrays those worthy aims. I do not simply want to prevent another Mid Staffs. I want our NHS to be a beacon across the world for not just its equity but its excellence. I want it to offer the safest, most compassionate and most effective care available anywhere. I believe that it can, but only if there is a profound transformation of the culture in the NHS.

The inquiry shows the devastating effects of overly defensive responses: hurting families, suppressing the truth and preventing lessons from being learned. Failure cannot be addressed when it is covered up, so today I am announcing new measures to promote a culture of openness and transparency. From 2014, every organisation registered with the Care Quality Commission will have a statutory duty of candour. Patients must be told promptly about any avoidable harm, but there will be a statutory requirement to notify any harm that has led to avoidable death or serious injury.

We will consult on whether hospitals that are found not to have been open and transparent with patients or families at the earliest reasonable opportunity should risk having their indemnity from litigation awards reduced or removed by the NHS Litigation Authority. The signal must go out loud and clear from hospital boards and chief executives to all clinicians: if in doubt, report an incident and tell the patient. The professional regulators have agreed to place a new, strengthened professional duty of candour on all doctors and nurses. Failing to inform a patient, not reporting avoidable harm or obstructing someone else seeking to do so will be subject to sanctions, including being struck off.

Inspired by the airline industry, the duty will cover “near misses”—occasions when mistakes were made that could have led to harm and from which we need to learn. Conversely, prompt reporting may be considered as a mitigating factor in a professional conduct hearing. That is not about penalising staff for making mistakes; it is about enabling them to learn from them. The NHS will adopt a culture of learning, as recommended by Don Berwick and his expert committee, and I thank them for their seminal report.

A culture of openness also means learning from complaints. In line with the recommendations of the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart’s excellent review, all patients will be able to access independent help in making their complaint, with clear signs in every ward explaining how to do so. The chief inspector of hospitals will inspect complaints handling to establish whether trusts are genuinely seeking to understand and learn from them; every quarter, trusts will publish the number of complaints received and lessons learned; and the health service ombudsman will dramatically increase the number of cases she looks at in detail.

[Official Report, 22 November 2013, Vol. 570, c. 12-14MC.]It is impossible to deliver safe care without safe staffing levels. All hospitals will be required to monitor their staffing levels on a ward-by-ward basis, analysing precisely how many shifts meet safe staffing guidelines. By the end of this year, this will be done using models independently approved by the National Institute for Health and Care Excellence. No hospital will be able to conceal unsafe staffing from the public because from next June all that data, both at ward and hospital level, will be published alongside other safety data on a new NHS safety website, triggering CQC action if there is cause for concern.

Things are already changing for the better and I am pleased to report that trusts are planning to recruit an additional 3,700 nurses compared with a year ago, but we need to go further to train and motivate staff, particularly the health care assistants and social care support workers who perform so much vital care. Health care assistants and social care support workers will be required to have a new care certificate to ensure that no one is ever asked to perform personal care without adequate training, whether in hospitals or care homes. The title “nursing assistants” will be used widely in hospitals, and paths to nursing careers will be improved. I thank Camilla Cavendish for her excellent work in this area.

We also need to broaden the talent pool going into NHS management positions, in particular by attracting more clinicians and those with good external experience. We have introduced a fast-track leadership programme, sending 50 people a year to a world-leading business school followed by time shadowing top NHS chief executives.

Robert Francis correctly highlighted the failure of regulatory systems to identify quickly what happened at Mid Staffs. Subsequently it has become clear that Ministers put pressure on regulators that may have led them to tone down news about poor care. That is totally unacceptable, so we will strengthen the statutory independence surrounding reports into care quality. The chief inspector will be the nation’s whistleblower-in-chief and nothing must ever be allowed to stand in his way.

The CQC can prosecute when fundamental standards are breached and trusts put into special measures will have a strictly limited time to get their house in order before administration is considered. Foundation trusts in special measures will have their autonomy suspended and action will be taken to ensure that they quickly improve. No trust will be able to progress to foundation status unless it is rated good or outstanding.

Proper accountability must be at the heart of the NHS. I have therefore accepted Professor Berwick’s recommendation of legal sanctions for those found guilty of wilful neglect or ill treatment. There will be a new criminal offence for care providers that supply or publish false or misleading information and a new fit and proper persons test will enable the CQC to bar unfit directors from boards.

Finally, every hospital patient should have the names of a responsible consultant and nurse above their bed. Starting with over-75s from next April, there will be a named accountable clinician for out-of-hospital care for vulnerable older people.

One of the most chilling accounts in the Francis report came from Mid Staffs employees who considered the care they saw to be “normal”. Cruelty became normal in our NHS and no one noticed. The Francis report made 290 recommendations. I accept the principles behind all of them, and wherever possible have adopted the practical solutions suggested by the inquiry. Robert Francis has welcomed today’s announcement as a carefully considered and thorough response to his recommendations, which he says will contribute greatly towards a new culture of caring and making our hospitals safer places for their patients.

Today’s measures are a blueprint for restoring trust in the NHS, reinforcing professional pride in NHS front-line staff and above all giving confidence to patients that after Mid Staffs the NHS has listened, the NHS has learned and the NHS will not rest until it is delivering the safest, most effective and most compassionate care anywhere in the world. I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

What happened at Mid Staffs was a betrayal of the NHS and its values. The previous Government rightly apologised, but now is the time to back our words with action. That is why, although I welcome much of what the Secretary of State has just said, it is my job to press him on where we feel he could have gone further and to question why, of the 290 Francis recommendations, 86 are not being implemented in full.

First, let me, too, pay tribute to my right hon. Friend the Member for Cynon Valley (Ann Clwyd), Professor Tricia Hart, Professor Sir Bruce Keogh, Camilla Cavendish, Professor Don Berwick and, of course, Robert Francis. Between them, they have given us proposals that will help to prevent a repeat but, more importantly, as the Secretary of State said, change the whole of the NHS for the better.

Both Francis reports found three primary and fundamental causes of what went wrong: a failure to listen to patients; a lack of properly trained staff; and a dysfunctional culture. I shall take each of those issues in turn.

First, I am sure the Secretary of State agrees with me that patients and their families must always, as Francis recommends, be the first priority for the NHS. That principle unites this House and it must also unite the NHS. Is not Robert Francis right to recommend that the NHS constitution, and the ethos it sets out, should be required reading for all NHS staff? I congratulate the right hon. Gentleman on agreeing to implement the Clywd review in full and change the way the NHS handles complaints.

Secondly, on the issue of staffing numbers and training, the first Francis report found that Mid Staffs made dangerous cuts to front-line staffing over a short period. I welcome the Government’s new focus on this issue, but is it not the case that nurse-patient ratios across the NHS have got significantly worse in the past three years, with 5,890 fewer nurses, more older patients in hospital and bed occupancy running at record levels? It is encouraging that the NHS has plans to recruit more nurses this year, and is introducing more monitoring. The Secretary of State says “things are already changing for the better”, but is he aware that Monitor has warned that trusts are planning major nurse redundancies in the 2014-16 period, far outweighing any increases this year? Will he intervene now to stop that? Further, can he explain why he stopped short of requiring safe staffing levels? Is he further aware that nurse training places have been severely cut in recent years and trusts are being forced to recruit overseas?

Alongside nursing, more action is needed to raise standards across the caring work force. As Robert Francis has said, it is unacceptable that the security guard at the door of the hospital is more regulated, and subject to professional sanctions, than the health care assistant attending to an elderly patient. The development of the care certificate as proposed by Camilla Cavendish is a step forward, but will it not work only alongside a register of those who hold it and an ability to remove it if they fall short? Was not Robert Francis right to recommend a system of regulation for health care assistants and, going forward, will the Government reconsider their decision to rule this out? Overall, although there is progress on staffing today, it does not go far enough and we will continue to challenge the Government on it.

Thirdly, on culture change, Francis’s central proposal is a new duty of candour on organisations and individuals. Extending the duty to organisations is a step forward, but patient groups are disappointed today that it will cover only the most serious incidents. Can the right hon. Gentleman say why it has not been extended to all incidents of harm? Further, it is not clear how an organisational duty alone will help individuals challenge an organisation where there is a dysfunctional culture. Is it not the case that an individual duty as proposed by Francis is essential? This point comes over clearly from the evidence given to Francis from a senior, soon to be retired consultant. He said:

“I took the path of least resistance . . . here were also veiled threats at the time, that I should not rock the boat at my stage in life.”

It is only when an individual is both required to speak out, and protected in doing so, that this House can say it has done enough to safeguard patients.

The duty of openness and transparency should apply equally to all organisations providing NHS services including, as Francis rightly recommends, contractors providing outsourced services. Given that this Government are bringing into the NHS more outside providers, patients will need reassurance that we do not have an uneven playing field where private providers face less scrutiny. So will the Secretary of State extend the duty of candour to all health care organisations, as Francis proposed? His amendments to the Care Bill do not make that clear. And should not he now commit to extending freedom of information law to any provider of NHS services?

On openness, Francis made a direct call on the Government to set an example to the rest of the NHS. He said that

“risk assessments should be made public, and debated publicly, before a proposal for any major structural change to the healthcare system is accepted.”

Given that the Government claim today to be accepting this, should they not show now that they mean what they say by finally publishing the risk register on the current reorganisation of the NHS?

Finally, on openness, the NHS would be more accountable to families with a proper system of death certification. The House will remember that this was a recommendation of the Dame Janet Smith inquiry into the Shipman murders. The report today says that the Francis recommendations on this are not accepted in full. If we fail to act now, might people be justified in thinking that this House has not learned the lessons of tragedies that have gone before? If the Secretary of State brings forward proposals, we will work with him on a cross-party basis to implement them.

In conclusion, I do not believe that cruelty has become normal in the NHS, but there is a much deeper question for us all and that is how, in the century of the ageing society, we do a better job of caring for older people. We should not accept the situation where, as Cavendish says, people are paid less than the national minimum wage. Should we not all set much higher ambitions for the care of older people and, in so doing, learn the most fundamental lesson of all from what happened at Mid Staffs?

[Mr Hunt]

Let me take the right hon. Gentleman’s points in turn. First, he will know, because this is what happened after the Bristol inquiry and the Shipman inquiry under the previous Government, that Governments do not always accept every single recommendation. What I have said today is that we accept all the principles behind every single one of Robert Francis’s recommendations. We are implementing 204 in full, and in respect of the 86 that we are not implementing exactly as he said, we are doing everything we can to make sure that we implement the spirit behind them, but we need to make sure that everything we do is workable in practice. Francis himself has said that it is a “carefully considered” response that is a “comprehensive collection of measures”.

On staffing numbers, which is an essential part of what we have to consider, if the right hon. Gentleman looks at the nursing hours per bed, he will find that they have gone up since 2010, not down. We recognise the crucial importance of front-line staff, which is why I gently say to him that we made some reforms to the NHS that meant that there are 5,500 more doctors on the front line and 8,000 fewer managers. What we also need is more nurses. That is why it is so encouraging that in response to what Robert Francis has said and the recognition throughout the NHS of the importance of compassionate care, we are getting a reaction from NHS trusts—not as a result of a direct ministerial decision, but because trusts themselves are recognising the importance of compassionate care. We think that is a very encouraging sign.

With respect to whether staffing levels should be mandatory, we agree that there are minimum recommended staffing levels, but they are not the same for every ward in every hospital. The minimum level might be one in six for an acute medical unit, one in four for a general medical unit, and one on one for intensive care. We took extensive advice on whether it would be appropriate to set a national minimum mandatory number. Not only is the chief nurse and leading nurses from across the country against this; the King’s Fund and the British Medical Association are against it. The BMA said something today in a statement which I never thought I would read in my lifetime—it said that the “Government is right” on this issue.

The right hon. Gentleman also opposed mandatory staffing levels back in 2011, although it is fair to say that in the House his position on this has changed. The important thing is that we allow local discretion to make sure that nursing levels are adequate, and that where they are not, that is exposed quickly so that there is no repetition of what happened at Mid Staffs.

On the regulation of health care assistants, every health care assistant will have to have a care certificate. Effectively, there will be a database which allows employers to check whether someone has such a certificate. That is a kind of register. The other reason for people talking about the regulation of health care assistants is that they want to make sure that if someone fails in their duty of care, they are not able to appear somewhere else in the country. That is why we have a vetting and barring scheme to make sure that that does not happen.

On the individual duty of candour, let us be clear: we want total candour about all avoidable harm, at every stage that it happens, anywhere in the NHS. We decided after much discussion that extending the statutory duty of candour to individual front-line clinicians would be likely to create a huge amount of bureaucracy and damage the culture of openness that we are trying to create, because everyone would constantly be worried about whether or not they were breaking the law. We decided that the right way to achieve the objective is through a professional duty of candour, which is much stronger than the current professional duty states. Critically—this is a key change—we decided to make sure that, just as airline pilots have protection if they speak out, if front-line NHS employees speak out, they too will get protection if there is a professional conduct case, and that openness at an early stage will be treated as a mitigating factor. That is really important in terms of changing the culture.

Finally, we absolutely do need to resolve the issue of death certificates. It is important that we have an independent view to certify deaths. It is a question of finding a practical way to make sure that we do that, but we very much accept the spirit of what Robert Francis said.

Today I hope that we will find a way forward on all the problems that Robert Francis addressed in his response and that we have been thinking hard about. I urge the shadow Secretary of State to join Government Members in saying that this is a moment when the NHS can once again reach forward and aim to be the very best in the world, because the kind of measures that we are talking about are not happening anywhere else, and that is something of which we can all be very proud.

[Jeremy Lefroy (Stafford) (Con)]

I thank my right hon. Friend the Secretary of State for his statement and commitment. A culture of compassionate and safe care for all in the NHS must be the legacy of the Francis inquiry. It is the least that those who suffered from dreadful neglect, and their loved ones who campaigned for justice, deserve. Staff throughout Mid Staffordshire trust have made firm strides since then in improving that culture with clear results in patient care, but will my right hon. Friend be the patients champion and ensure that the NHS puts patients first and foremost?

[Mr Hunt]

That is the central change in culture that we need throughout the NHS. I pay tribute to my hon. Friend in particular, because he has had a more difficult challenge with respect to his local hospital than any hon. Member. He has campaigned for the people who use that hospital and for the staff there with great integrity and courage, which I commend.

I have never believed that there is a conflict or a choice between putting NHS staff first and putting the patient first. I have never met a doctor or nurse who does not want to put the patient first. The trouble is that we have created structures and incentives that make it difficult for front-line staff to do what they joined the NHS to do, which is to care for patients with dignity, compassion and respect. That is what we are trying to do in the changes today.

[Ann Clwyd (Cynon Valley) (Lab)]

I am grateful for the kind words about the report from the Secretary of State and from my right hon. Friend the shadow Secretary of State. If I may plug our report for a moment, “A Review of the NHS Hospitals Complaints System: Putting Patients Back in the Picture” is available. I have not yet gone through the tick-list of all the things that we asked for, but I shall be doing that. The Secretary of State has agreed that we can monitor the progress that Sir Mike Richards makes in putting complaints and the treatment of complaints at the top of his list when he visits hospitals around in the country.

May I press the Secretary of State on one point? He said in his statement that “all patients will be able to access independent help in making their complaint”. How exactly will that be done and how will it be resourced? I am grateful to the many thousands of people who wrote to me during the course of the review who complained about similar experiences to mine on the lack of care and compassion. That applies not just to nurses, but throughout the NHS from top to bottom. I hope that this will address some of the many complaints from Stafford and elsewhere.

[Mr Hunt]

I congratulate the right hon. Lady on the extremely good report that she produced. I hope she will not find herself in a position of wanting to complain to me about the way in which I have implemented her report on complaints, because we intend to take it extremely seriously. She knows that I basically accept everything she said in it, although we will have to work carefully on the implementation of some things to make sure we get them right. She highlights one of the most fundamental problems. Probably the biggest problem is that some hospitals treat their complaints procedure as a process rather than something that they can learn from. Every NHS patient whom I have met who has had problems only ever says the same thing. They just want to know that the NHS will learn from what has gone wrong. That is all that they are interested in.

The point that the right hon. Lady makes is a very important one. People do sometimes feel that it is them against the system, and taking on a big establishment that might be well funded and is not really interested in hearing what they have to say is a very lonely process. It is vital that everyone who wants it can get independent support. One thing that we will be requiring is a sign, prominently displayed in every ward of every hospital, telling people, first, how they can make a complaint, and secondly, how if they want it they can get independent help and support. That could be a very good role for the new healthwatch organisations, but it may not be them in all cases, so most importantly, we will insist that people everywhere can access that independent help.

[Mr William Cash (Stone) (Con)]

Did my right hon. Friend hear my constituent, Debra Hazeldine, this morning on the “Today” programme, with a harrowing description of the way in which her mother was let down and died in Stafford hospital? I agreed with everything she said. Does he acknowledge that, although my right hon. Friend the Prime Minister listened, after correspondence and meetings with him, to my repeated calls and motions for the setting up of an inquiry under the Inquiries Act 2005, which the Prime Minister set up and which has led to a complete shake-up, not only of Mid Staffs but the entire health service, successive Labour Secretaries of State in the last Government disgracefully and repeatedly refused to agree to such an inquiry, and that but for our determined campaign with Cure the NHS, and in particular Julie Bailey, Debra Hazeldine and Ken Lownds and his campaign for zero harm, the 2005 Act inquiry would never have taken place and the Francis report would never have been produced, with all its beneficial consequences, in the Secretary of State’s hands, for the NHS in the national interest? When will the debate take place on this report on the Floor of the House in Government time?

--- Later in debate ---

[Mr Hunt]

I did not hear Deb Hazeldine this morning, but I have met her on a number of occasions, and she is an extraordinary, powerful advocate for the changes that we need to make in the NHS. I have had discussions with my right hon. Friend the Leader of the House about the possibility of debating this on the Floor of the House, and I would very much welcome the opportunity to do so. My right hon. Friend deserves great credit for the fact that he was one of the earliest people to push for a full inquiry. I hope that the shadow Secretary of State will now accept that it was wrong not to have a public inquiry—it was blocked so many times by the Labour party—because we have learned so much from what Robert Francis has been able to say, and the NHS will be the better for it. Great credit should go to my predecessor, who is sitting here now, who took the decision to have that public inquiry.

[Frank Dobson (Holborn and St Pancras) (Lab)]

Does the Secretary of State not agree that the horrors of Mid Staffs were taking place at the same time that wonderful first-class care, from both a clinical and compassionate point of view, was available in many hospitals throughout the country? Is he confident that the measures that he is putting forward now will ensure that the worst performing hospitals will raise their standards to those of the best?

[Mr Hunt]

We have to wait and see, but we have put in place a radical, tough new Ofsted-style inspection regime. The point of that regime is not just to identify hospitals where care is unsafe, but to identify outstanding hospitals, so that hospitals in difficulty have hospitals from which they can learn, and we create a culture, just as we have in schools, where failing schools learn from outstanding schools and have a pathway to improvement. That will make a big difference. As the right hon. Gentleman knows, we now have 13 hospitals in special measures, and I am sure there will be more as the inspection process gets under way. But we will also have the great hospitals that we can learn from, which will mean that this can be a positive process for the NHS.

[Mr Stephen Dorrell (Charnwood) (Con)]

I commend my right hon. Friend for the thoughtful and thorough way in which he has conducted the reaction to the publication of the Francis inquiry. Does he agree that the most chilling finding of Francis was that professional people whose focus should have been on the needs of their patients found themselves, in Francis’s words, “doing the system’s business”? Is not the central driver of my right hon. Friend’s recommendations to ensure that never again shall we have closed institutions in a closed system where that is possible, and that the key way forward is to throw sunlight into institutions that have too often been unchallenged?

[Mr Hunt]

My right hon. Friend, as so often, speaks wisely. This is probably the boldest step towards transparency taken by any health care system anywhere in the world. We will see if he is right, but I think that he is, because sunlight is the best disinfectant. It means that problems are sorted out much more quickly, but it is sometimes an uncomfortable process. It is really important that we as a country understand that exposing poor care in one place does not mean that there is poor care everywhere and that, in fact, exposing it is the quickest way to sort it out.

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

We need total candour with regard to avoidable deaths. The only way to determine that is through an independent review of medical case notes by neutral clinicians. That exercise took place at Stafford. Will the Secretary of State remind us of the result?

[Mr Hunt]

I do not have the results in front of me, but I am happy to supply them. I want to take up the right hon. Gentleman’s point about avoidable deaths, because one of the changes we want to make today is to avoid the temptation, when there is an avoidable death, for people on the front line to say that it was unavoidable. We are trying to create the structures that make it easy for people to speak out if they think that a death was avoidable and to ensure that they are encouraged to do so.

[Paul Burstow (Sutton and Cheam) (LD)]

I very much welcome the introduction of a statutory duty of candour, which the Minister of State, my hon. Friend the Member for North Norfolk (Norman Lamb), wrote into our 2010 manifesto. May I ask the Secretary of State about his plans to prosecute if the fundamental standards are breached, which is an important step with regard to corporate criminal accountability? In drafting those standards, will he ensure that advice is sought from the Director of Public Prosecutions, the Health and Safety Executive and others to ensure that the wording is clear and fit for purpose so that when a prosecution takes place there is no hiding behind the language in those fundamental standards?

[Mr Hunt]

We will absolutely do that. We are in the process of a very big consultation to ensure that we get the definitions of the fundamental standards absolutely right, but we also want to try to create a culture that means we do not get to that point in the first place. One of the problems we had with the current system is that the definition of success for a hospital tended to be about meeting waiting time targets and financial balance, rather than caring for patients properly. We want to re-engineer the system through the new inspection regime so that a hospital cannot be good or outstanding unless it is delivering good or outstanding care.

[Joan Walley (Stoke-on-Trent North) (Lab)]

What happened at Mid Staffordshire must never be allowed to happen again, but given that safe staffing levels will depend on adequate resources, can the Secretary of State give an assurance that there will be a debate in the House in Government time on the successor arrangements for Mid Staffordshire and for the University Hospital of North Staffordshire?

[Mr Hunt]

As the hon. Lady knows, we are going through a process at the moment and the trust special administrator is drawing up detailed plans, so it is premature to say what will happen, but we will of course keep the House well informed and there will be plenty of opportunities for her to question me, or anyone else she wants to question, about any decisions that are eventually made.

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the Secretary of State’s statement, which will help health professionals to get on with their jobs and improve openness and transparency across the NHS. I particularly welcome his recognition of the important role played by the 1.3 million health care assistants across health and social care. In implementing the vetting and barring scheme, will he ensure that individuals looking after people at home or in outside institutions can access that list to ensure that they have health care assistants who comply with the fundamental standards?

[Mr Hunt]

That is a very good point. I will take it away and look at whether that will be possible, because there is a powerful logic behind making that happen. As my hon. Friend has mentioned health care assistants, I would like to highlight the brilliant work they do, along with so many NHS staff. It has been a very challenging year for them to read about these examples of poor care, which are as shocking to them as they are to us. I agree that now is the time to get behind the people on the front line, who really want to change the culture for the better.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I, too, welcome the Secretary of State’s statement and the observations made by my right hon. Friend the shadow Secretary of State, but my constituents will be concerned about the impact of whatever the trust special administrator decides is right for Mid Staffordshire on the university hospital and the care they will receive there. Whether as a result of pressures from Cannock Chase or other areas, there is the risk that work will go to the university hospital but that it will not be fully recompensed for what is needed and that—this is a terrible thing to talk about in these terms—the profitable work that would otherwise cross-subsidise that might well go to other areas. Will the Secretary of State look carefully at ensuring that the university hospital is not penalised as a result?

[Mr Hunt]

We want to ensure that no hospitals are penalised and that we end up with a solution for the whole local health economy that is sustainable for the long term. The comfort that I think the hon. Gentleman can draw from today’s announcement is that, as a result of the openness and transparency and the rigorous independent inspections that will be happening at all the hospitals his constituents use, poor care, where it exists, will come to the surface and be dealt with much more quickly.

[David Tredinnick (Bosworth) (Con)]

The improved transparency and increased accountability will do much to right the wrongs of the past. When will the health care certificates for nursing assistants be introduced, and has my right hon. Friend considered giving hospital managers discretion to appoint individual nurses to the under-75s?

[Mr Hunt]

We are looking at improving care for people in all age groups, but we started the focus on the over-75s because they are the most vulnerable older people. Implementation of the care certificate is a very big change that will apply to several hundred thousand people, so it will not be an immediate process, but we want to get on with it. I think that it will give them a big boost and more professional confidence. We also want to improve the pathway into nursing, which is why we will be encouraging use of the phrase “nursing assistants”, rather than “health care assistants.”

[Valerie Vaz (Walsall South) (Lab)]

The College of Emergency Medicine has consistently called for an increase in emergency doctors, because there has been a 50% shortfall over the past three years. What plans has the Secretary of State to address that concern?

[Mr Hunt]

I met the College of Emergency Medicine yesterday to discuss those issues, among others. We have 300 more doctors working in our A and E departments than we did three years ago, but the hon. Lady is absolutely right that we need more, because 1 million more people a year are going through A and E than there were in 2010. Part of the challenge is to make A and E a more attractive profession for doctors. They might work long shifts and antisocial hours, which can make it unattractive. We need to find a way of dealing with that.

[Andrew Bridgen (North West Leicestershire) (Con)]

Frank and Janet Robinson’s son John died in 2006 as a result of failings at Stafford hospital. They are my constituents. The inquest into his death lasted only 90 minutes and called only two witnesses. After much campaigning and lobbying by his parents, a second inquest has been granted. It will call 12 witnesses, many of whom were available to the original coroner, and is scheduled to last four days. Does my right hon. Friend agree that had the original coroner’s report into John’s death been more thorough, many avoidable deaths at Stafford and across the NHS could have been prevented?

[Mr Hunt]

I agree with my hon. Friend. I hope that he will be encouraged by today’s announcement, because if in such a situation, which was an appalling tragedy, a trust is found not to have been open and transparent about something serious that has gone wrong, the fact that it risks becoming financially liable for any award made will be a major disincentive to trying to cover things up. That is a profound change, so I hope that it will comfort John’s parents to know that the kind of culture they had to fight so hard against will not be allowed to continue.

[Hazel Blears (Salford and Eccles) (Lab)]

The Secretary of State is right to highlight the need for fundamental culture change, but it is still the case that some of the most vulnerable people in our hospitals today—those with dementia—stay longer and are more likely to be readmitted and more of them die. My local hospital, Salford Royal, has recently implemented the Royal College of Nursing’s system called the triangle of care, which fully involves patients, carers and their families in the care of those with dementia. Will the Secretary of State take steps to ensure that that kind of system is implemented across the NHS?

[Mr Hunt]

I absolutely want to encourage that. I know that the right hon. Lady has campaigned a great deal on the needs of people with dementia, and I share her desire to do much better for them. Salford Royal is one of the best hospitals in the country and we should always learn from what it does, but 25% of people in hospitals now have dementia. The tragedy of what happened at Mid Staffs and of many of the stories of poor care in other hospitals that we read about is that very often they involve people with dementia, because they are the kinds of people who have been deprioritised when hospital managements have decided, for example, that they want to cut nursing inappropriately. We absolutely have to change that culture. There is now a very good system at several hospitals. People with dementia, in particular, must be helped to eat and drink at meal times. Many of us have been shocked by the stories of full trays of food being taken away because someone is unable to eat unaided. That, in particular, we need to stamp right out.

[Margot James (Stourbridge) (Con)]

The Cavendish review found too many instances of health care assistants being badly treated and managed by nurses. Health care assistants, now to be called nursing assistants, are on the front line of very many patient experiences. Will my right hon. Friend assure the House that other measures, in addition to the very welcome new certificate for nursing assistants, will provide the extra support to those staff that is obviously needed?

[Mr Hunt]

It is really important that we value the work of some of the lowest-paid people in hospitals who are carrying out some of the most important personal care for patients. They need to be managed properly, fairly and decently, given how important that work is. We need to ensure that nurses have the right attitude to the health care assistants who are working for them—as, most of the time, they absolutely do. That is why earlier in the year we proposed changes that we are piloting, so that before getting funding for a nursing degree, people had to spend time, potentially up to a year, on the front line as health care assistants. That will allow them to experience just how important that work is and then perhaps appreciate it a bit more.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

The Secretary of State has spoken about staffing levels, which will be of the greatest interest to patients and their families. He said that the situation will vary across wards and that there would be local discretion, with failings being exposed. When those failings are exposed, how will corrective treatment occur? Who will be responsible for ensuring that the corrections and changes are actually made?

[Mr Hunt]

We have set up a new inspection regime with a new chief inspector of hospitals under the Care Quality Commission. The CQC will look at the figures that are published every month on a trust-by-trust basis, alongside other safety data such as MRSA rates, bedsore rates, numbers of complaints, and other information that is crucial to its decisions. It is then its absolute duty and responsibility to swoop quickly if it thinks there is any cause for concern.

[Mr Aidan Burley (Cannock Chase) (Con)]

We now know that poor care was allowed to continue at Mid Staffs because staff were simply too afraid to speak out and, if they did, they were ignored or, worse, their careers were threatened. The high death rates at Stafford hospital were not taken seriously enough at the time and were merely explained away rather than used as an alarm signal that should have triggered further investigations. There was clearly a culture of fear among NHS staff, many of whom witnessed the appalling care of my constituents. Will my right hon. Friend make it his legacy to instil a culture of candour and openness in the NHS whereby concerns are acted on and high standardised mortality ratios are no longer brushed under the carpet to protect the NHS’s reputation but are instead properly investigated so that patient safety finally comes first?

[Mr Hunt]

My hon. Friend is absolutely right. These problems of high mortality rates date back very many years, and nothing, or too little, was done to sort them out. We must therefore make sure that we have a system where that cannot happen. Concealing poor care does not protect the reputation of the NHS, because in the end it gets out and destroys public confidence. I hope his constituents will feel that today’s announcements will create a new culture of openness and transparency that gives them confidence, so that if these awful things were ever to happen again—we hope they do not—we would find out quickly and action would be taken.

[Mr Kevin Barron (Rother Valley) (Lab)]

Having spent nine years as a lay member of the General Medical Council and five years chairing the Health Committee, I have heard little this afternoon that is likely to change the culture inside the national health service. May I refer the Secretary of State to the report on patient safety that the Committee produced in the previous Parliament? We considered the idea of having a statutory ombudsman to whom people could complain and who would have the power to investigate, even anonymously, instead of this situation in which doctors, particularly young doctors working in hospitals, dare not complain about what senior doctors are doing because of the attack on their career structure. We really must get some independence into this. We can have good words, we can talk about candour, and we can wish a lot of things, but changing the culture of the NHS is not done by statements or by legislation in this House; it is done by working inside the NHS. I am afraid that at the moment the system works against changing the culture owing to career structures and everything else. We need some independence in all this so that people can really learn how to change. New Zealand would be a good example to look at.

[Mr Hunt]

All I can say to the right hon. Gentleman is that Robert Francis himself stated this morning that we have announced a comprehensive collection of measures that

“will contribute greatly towards a new culture”

in the NHS. He is persuaded that this will make a very big difference.

Independence is a vital part of this change, so what are we doing to create it? For the first time, we will have an independent chief inspector of hospitals who goes anywhere he likes in the system to try to root out poor care. That person will be the nation’s whistleblower-in-chief, and their job will be to find out about these things inside hospitals. We are creating a culture in which it is in the interests of hospitals and doctors to be open and transparent, and that is another significant change. I do not want to underestimate the scale of the challenge we face, but I think most people would say that in the past 12 months we have seen one of the most fundamental attempts to change the culture of the NHS in its 65-year history.

[Fiona Bruce (Congleton) (Con)]

An essential part of being a medical professional is to exhibit a compassionate and caring approach whatever one’s circumstances, as indeed most NHS staff do. What new measures will offer patients assurances that this will be a priority in future?

[Mr Hunt]

The biggest assurance that patients will have is that the definition of success as regards how the system views a hospital will be the same as patients’ definition of success. They want to go somewhere that treats them promptly and safely and with decent, compassionate care. That has not been how the system has judged the success of a hospital or its chief executive or board. That is why it is such a profound change to have a new chief inspector and Ofsted-style ratings. I think this will make a big difference, but I do not want to underestimate how big a challenge it is and how long a process it will be fully to make the transformation we need.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Secretary of State will be aware of people’s disappointment that there is still no proper system of regulation for health care assistants. Does he understand that many members of the public feel that one of the problems with general standards of care in the health service may have been the push—under a Labour Government—for an all-graduate nursing profession? There is a strongly held view among members of the public that that has led to elevating taking exams and inputting data on a computer over providing basic levels of care, which is what they really value in a nurse.

[Hon. Members]

Hear, hear.

[Mr Hunt]

Never has the hon. Lady spoken with so much support from this side of the House—I do not wish to destroy her credibility with her own party! She points to something that the public feel very strongly about and that is an issue in some parts of the nursing profession. We looked carefully at whether we should remove the requirement for graduate qualifications and decided that nurses are now asked to do a great deal more than they were 20, 30 or 40 years ago in, for example, giving people medication and the clinical procedures they are asked to be involved in. We need to make sure that there is the right culture in nursing. That is why I proposed—it was very controversial at the time, although I think it has been quite broadly accepted now—that before becoming a nurse people should spend some time, potentially up to a year, on the front line as a health care assistant to make sure that those going into nursing had the right values and recognised that giving this personal care is a fundamental part of what being a nurse should always be about.

[Dr Julian Lewis (New Forest East) (Con)]

Will the package of reforms and the greater accountability put into effect as a result of the Mid Staffs tragedy have any bearing on other areas such as the all-too-prevalent cases of people being injured or even dying as a result of hospital-acquired infections?

[Mr Hunt]

Absolutely, because this is a package designed to deal with all avoidable harm, and hospital-acquired infections are an avoidable harm. It is designed not only to have much more transparency on the levels of harm in our hospitals, but to make sure that there is a culture of openness so that when people spot things that are going wrong, it is in their interests and in those of their hospital that they speak out. The changes are likely to result in—my hon. Friend will be the first to notice this—an increase in the amount of reported harm over the next few months. That will not be a bad thing, because it will mean that hospitals will be reporting harm that up until now they have not reported. We should welcome the fact that that will then mean that this harm will be addressed.

[Sammy Wilson (East Antrim) (DUP)]

Although health is devolved to the Northern Ireland Assembly, the culture and its consequences identified by the Francis report can nevertheless occur in the health service anywhere in the United Kingdom. What plans does the Secretary of State have to share the lessons learned and actions taken with the Health Minister in Northern Ireland and, indeed, with all the other devolved Administrations?

[Mr Hunt]

I am very happy to share any of the lessons we have learned, but I do so from a position of humility, because we still have to address very serious challenges in our NHS in England. It will take us time to sort them out. I am happy to work with any devolved Administrations. Indeed, I would like to work with other countries across the world, because the challenge of how to deliver high-quality, compassionate health care when resources are tight and with an ageing population is one that all countries face.

[Andrew George (St Ives) (LD)]

The Government’s position on the publication at ward level of safe registered nurse staffing levels is a welcome step in the right direction. My right hon. Friend will be aware that I have consistently argued for safe registered nurse-to-patient ratios at ward level, and no manner of enhancements of culture and leadership can ever be used to mask the risk to patients if there are not enough nurses on the ward. Is he aware that some trusts are conflating trained care assistants with registered nurses, and will he reassure me that, in enumerating the number of registered nurses on wards, trusts cannot conflate trained care assistants, welcome though they are, with registered nurses?

[Mr Hunt]

My hon. Friend makes a very important point, because in an era of transparency we depend on honesty from the people supplying the information being used. It is not always possible independently to audit every single piece of information. What we have said today is that deliberately supplying false or misleading information will be a criminal offence, which is a much tougher sanction than anything else we are saying today. We think that the most important thing is to establish a culture in which people tell the truth and speak out if there is a problem, because then something can be done about it.

[Jenny Chapman (Darlington) (Lab)]

There is a great deal to welcome in the Secretary of State’s statement, not least with regard to transparency and complaints. I welcome in particular the comments on staffing, although, obviously, we used to have more nurses than we have now. Will the Secretary of State look at the vetting and barring service, because my understanding is that use of the service and referrals to it have been declining over the past couple of years?

[Mr Hunt]

I have concerns about how much that service is used. My particular concern is not so much whether employers are checking before they employ someone, but whether they are informing the service that an employee should be referred to it for delivering inappropriate care. That is something that we will look at.

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

I remind my right hon. Friend that the Public Administration Committee is conducting an inquiry into complaint-handling across the public service and that Essex recently had an instance of failure at our local hospital, where complaints were not properly handled. How does my right hon. Friend intend to deliver on his statement that “all patients will be able to access independent help in making their complaint”? May I suggest to him that, rather than setting up a new structure or body, perhaps the ombudsman is the right body to help facilitate those complaints, because it would create a one-stop shop for them?

[Mr Hunt]

We have avoided setting up a new structure or body in our response to the recommendations made by the right hon. Member for Cynon Valley. As for how we will make sure that this happens, I agree with my hon. Friend that the ombudsman is the final port of call if someone is not satisfied with the way in which their complaint has been treated. That is incredibly important, and the ombudsman has herself agreed that she will handle vastly more complaints and go into detail a lot more than she does at present, which is welcome. Prior to that stage, however, lots of people feel that complaining directly to the trust, which has to be the first step, is a very daunting and difficult process and that they want independent help. That is why we have said that it will be an absolute requirement for trusts to show people how they can access that independent help and, indeed, to be prepared to make the finance available so that they get that help. There will also have to be signs on every ward telling people exactly how to do that.

[Mr George Mudie (Leeds East) (Lab)]

The Secretary of State will agree that the ethos and culture of any organisation start at the top. Over the past three decades, the boards have moved towards being composed more of practitioners and businesses than of consumers and patients. Will he consider putting an independent voice, or independent voices, on the boards so that the complaints go to a board that will listen to and debate them? Will he also consider advising trust boards to set up a formal structure up to board level so that complaints can arrive there, be seen and discussed?

[Mr Hunt]

The hon. Gentleman is right that reporting back about complaints to board level is a fundamental thing that should happen at every trust. We also need to make sure that all trusts are putting patients first; they will not be able to get a good inspection result from the chief inspector of hospitals unless they do so. The hon. Gentleman will know that the new structure of foundation trusts is designed to make sure that FTs are run for the benefit of their patients by the large number of members who are effectively the governing body of FTs. The hon. Gentleman is also right to say that this is not happening everywhere, and that is why today’s changes will, I hope, make a big difference.

[Mr Brian Binley (Northampton South) (Con)]

My A and E department has seen a massive 30% increase in patient throughput in recent years and a concerning 16% in recent months. Furthermore, 100 people who do not need medical care are taking up beds. I have recently organised meetings between local government leaders and the chief executive officers of our hospitals to explore other ways of dealing with these problems. Will the Secretary of State accept that more can be done in this respect, and will he tell us what he can do to further that approach?

[Mr Hunt]

My hon. Friend is absolutely right to focus on those pressures. We have been thinking about this very hard. Over the summer we announced £250 million to be distributed to the 53 A and E economies where the most difficulty is being experienced in meeting high standards for the public, and we are doing more. We are talking to the College of Emergency Medicine. Anything that my hon. Friend can do at a local level will be greatly appreciated. This is going to be a difficult winter and we need to stand full square behind our front-line staff.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Secretary of State just said that Salford Royal hospital is one of the best hospitals in the country and we should learn from what it does. What it does is support minimum safe staffing levels for patients and then publish the actual-versus-planned staffing levels on the wards every day. Staffing levels published on websites is a little step forward, but it is not enough. Why do we not learn from what Salford Royal does? I do not think that patients and their families are interested in what the staffing levels were a month ago; they are interested in what they are today.

[Mr Hunt]

We have based our recommendation today precisely on what Salford Royal does. It uses the kind of model to ensure minimum recommended staffing levels on every ward that we want every hospital to use. We say that we want those data published monthly, but that is a minimum. Salford Royal publishes them every day, which is very impressive. Given that most hospitals are not using tools anything like as sophisticated as that, it will be a big step up for most hospitals to do that. We want to do it. What is significant about our announcement is that we want to assemble those data for every trust in the country so that they can be compared on a monthly basis and so that people can know how many wards and how many shifts are being safely staffed at their local hospital compared with neighbouring hospitals.

[Rehman Chishti (Gillingham and Rainham) (Con)]

The Secretary of State will know that Medway Maritime hospital in my constituency had the seventh worst mortality rate in 2005 and 2006, yet nothing was done until he put the hospital into special measures. It is now linked with the outstanding Frimley Park hospital, sharing good practice and turning things around, so that my constituents can get good care, while inspections are also on their way. He said that if hospitals do not turn things around in the short term, they will be put into administration, but what does “short term” mean—is it a year or six months?

[Mr Hunt]

Our intention is that the maximum period when a hospital is put into special measures should never be longer than a year. After that, if it is not making significant progress, there is the possibility of it being put into administration. The reason for that, precisely as my hon. Friend said, is that we cannot let poor standards and poor care persist over a long period. I am pleased about the progress made at Medway Maritime in recent months; Frimley Park, which is my local hospital, delivers truly outstanding care. He is absolutely right to say that it should never have taken so long to get to the heart of the problem.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Secretary of State said that it is impossible to deliver safe care without a safe staffing level, which of course depends on resources. Under the coalition’s new funding formula, Hull NHS is due to lose £28 million, and it will not get any money for the A and E winter pressures that are bound to happen. How does he think that that will help safe staffing levels in Hull?

[Mr Hunt]

The funding formula is decided independently, and no final decision has been made. The decision will be made by NHS England, which I know is looking at that at the moment. It has to decide equitably across the whole country, based on need, population, social deprivation and other factors. Like the hon. Lady, I am waiting to see what it decides.

[David Mowat (Warrington South) (Con)]

Some 14% of the entire NHS budget goes on complaints relating to injury compensation. Of that, a third or £4 billion per year goes to lawyers. That diversion of cash away from the front line to lawyers makes it much harder to get the staffing levels that Francis envisaged. Will the Secretary of State address that as part of the wider issue?

[Mr Hunt]

My hon. Friend is right that it is absolutely shocking that we spend more than £1 billion a year on litigation claims in the NHS. The only long-term way of reducing that bill is to improve the safety record of the NHS, so that we do not have the terrible incidents that lead to high claims. The only way to do that is through openness and transparency, which is why today’s measures will make a big difference.

[Nick Smith (Blaenau Gwent) (Lab)]

I welcome the proposal on legal sanctions for those found guilty of wilful neglect. In south Wales, police Operation Jasmine has looked at the alleged abuse of elders in care homes. I understand the difficulties, but will today’s announcement help us to hold to account those responsible for corporate neglect in private sector care homes?

[Mr Hunt]

Absolutely. The Minister of State, Department of Health, who has responsibility for care services, has been very focused on making sure that there is proper corporate accountability. Today, we have announced the new fit and proper persons test that will apply to all organisations delivering care to make sure that directors of companies responsible for care homes and domiciliary services in which poor care happens are properly held to account. That is vital, because there should be no hiding place for people who send signals to their staff that lead to our reading the horror stories that, sadly, we have read.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

To my mind, the issue is about patients having confidence in their local hospital. What can we do to ensure that patients in my constituency have a better understanding of how Derriford hospital is performing and whether it is improving?

[Mr Hunt]

This is the heart of the change that we are making this year. My hon. Friend and I know exactly how well all the schools in our constituencies are doing, because there are transparent, independent Ofsted ratings, but we do not know how well our local hospitals are doing. We need an expert to go in and look at hospitals and then tell us, in language that non-clinicians can understand, just how well they are doing, as well as what needs to change when they are not doing well. We will get that with the new chief inspector of hospitals.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

I was struck by the Secretary of State saying that cruelty became normal in the NHS. I do not agree with him and I do not think that the public believe that cruelty has become the norm in the NHS. Most people join the NHS as a calling or a public duty: they believe in kindness and the importance of care.

It seems to me that one of the reasons for cruelty—and it does happen—is the stress of under-staffing. I understand that, as a result of the report, the Secretary of State will publish safe staffing levels ward by ward, but that he will not enforce them. The question that the public want answered is why. How can he, as Secretary of State, be happy to know that wards up and down the country are under-staffed and unsafe, and that he is not doing anything about it?

[Mr Hunt]

We have had a very bipartisan discussion this afternoon, so I am slightly disappointed that the hon. Lady is twisting my words. I did not say that cruelty became the norm everywhere in the NHS; I said that in places such as Mid Staffs cruelty became normal. If she reads the Francis report, she will find that that is the case.

Trying to duck or run away from that fact is what got us into a great deal of trouble, because we did not deal with the issues in Mid Staffs nearly as quickly as we should have done. On staffing levels, we are doing something that did not happen before. When her Government were in power, we did not know where staffing was unsafe, but now we will know and can do something about it.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

Will my right hon. Friend confirm that never again will Ministers duck their responsibility to be open and transparent in the reporting of failures, as they perhaps were in relation to Mid Staffs and potentially were in relation to Basildon hospital before 2010?

[Mr Hunt]

My hon. Friend is absolutely right. It is incredibly important that Ministers never, whether deliberately or inadvertently, give a signal to the system that they do not want poor care to be highlighted as quickly as possible. I am afraid that there is evidence that, whether or not former Ministers intended this, it was interpreted that the emergence of bad news stories would be met with a great deal of ministerial disapproval, and that did enormous damage.

[Mr Marcus Jones (Nuneaton) (Con)]

Out of Francis has come Keogh, which is leading to seven-day working and more doctors and nurses on the wards at George Eliot hospital. Increasing staffing numbers is important in our NHS, but does my right hon. Friend agree that having the right ratio of staff to suit the needs of individual patients is equally if not more important?

[Mr Hunt]

That is absolutely vital. I have been to the A and E department in George Eliot hospital, and reports I have heard say that morale is really turning a corner. I want to back the staff: it is incredibly difficult to work in a hospital that has been put into special measures, knowing that everything is not as it should be. They now have a sense that a corner is being turned and that the problems that they have long worried about are finally being addressed, particularly because of the link with University Hospitals Birmingham, which is one of the best in the country.

I agree with my hon. Friend that safe staffing is one of the measures that matters. George Eliot hospital has some pretty antiquated IT systems that mean staff spend much longer than they should filling out forms, rather than spending time with patients.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

Will my right hon. Friend give more details about how we can stop bad leaders and bad providers from working in the NHS? Will he confirm that that change will extend to ambulance trusts as well as to hospitals?

[Mr Hunt]

The change will absolutely extend to ambulance trusts. I know that my hon. Friend has had experience of poor leadership of ambulance trusts in her area. It will apply to all organisations registered with the Care Quality Commission. There will be a fit and proper persons test, because where people are responsible for poor care, we do not want them to pop up somewhere else in the system.

[Guy Opperman (Hexham) (Con)]

There has always been a professional duty on medical professionals to advise patients when errors occur; yet we know that that has not always happened. Although all hon. Members welcome the greater candour, transparency and protection in relation to whistleblowers that this Government are proposing through the fit and proper persons test, does the Secretary of State agree that true culture change will not happen unless the views of junior doctors, the staff generally in all hospitals and everyone in the NHS are made as important as the views of those at the very top?

[Mr Hunt]

My hon. Friend is absolutely right. True culture change is incredibly difficult to achieve unless we get behind the people on the front line and get them to want to change the culture. That is the insight in the report that Professor Berwick delivered in August. That is why today’s response is about backing front-line staff to deliver the care that they want to deliver and to be open when they are worried, and about supporting them in what is a very challenging period for the NHS. If we do not back them to do the right thing, then no matter what happens at the top, we will not see change on the front line.

[Mr Philip Hollobone (Kettering) (Con)]

I am sure that my constituents will welcome what the Secretary of State has said about transparency and openness, especially with respect to Kettering general hospital. When somebody goes into hospital, they want to have confidence that they will be treated efficiently and with a great deal of care. They get that confidence not just from statistics on the number of nurses or clinicians on a ward, but from the experiences that they hear about from friends and relatives who have been treated at the same hospital. They also get confidence from hearing examples of where things have gone wrong—some things will always go wrong—and that the complaints have been handled quickly and efficiently, and have not been dragged out. Does my right hon. Friend agree that hospitals should provide examples of good care that has gone right to give local people the confidence that their local hospital is doing the very best for them and that, when things do go wrong, people will put their hands up, admit it and deal with it quickly and efficiently?

[Mr Hunt]

Absolutely. It is a sign of great confidence when a hospital is open about things that have gone wrong. When I meet the top chief executives who are running the best hospitals in the country, I am always struck by how willing they are to be open about the problems that they have had. It is often in the less well-performing hospitals that the management feel less confident and willing to talk about the problems. That culture is really important. I hope that today is a step in the right direction.

[Mr Peter Bone (Wellingborough) (Con)]

I thank the Secretary of State for coming to the House and making such a detailed statement. I served under the previous Chairman of the Select Committee on Health, the right hon. Member for Rother Valley (Mr Barron), during the inquiry into patient safety. The Secretary of State has a point. The problem at the moment is that people make a complaint after something goes terribly wrong, but the complaints system is deliberately long, drawn-out and delayed. One never actually reaches the ombudsman. If we are to have a change in culture, we have to stop the managements of hospitals delaying the complaints system deliberately.

[Mr Hunt]

I totally agree with my hon. Friend. That is why I hope that what we have announced today will bring about a transformation in the way in which hospitals manage complaints. Some excellent work has been done to help us do that. The heart of the matter is that hospitals should be really interested in the complaints that they receive, because that will enable them to understand where they are not delivering good care and what they can do to put it right. That does not happen everywhere. Too often, the complaints system is treated as a process, in effect, to fob people off, rather than to get to the heart of what people are talking about. We absolutely need to change that.

NHS England (Mandate)

Jeremy Hunt Excerpts

Tuesday 12th November 2013 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today the Government have laid before Parliament the refreshed mandate to NHS England for 2014-15. The refreshed mandate will come into effect from 1 April 2014 and was developed following public consultation which ran from 5 July to 27 September.

The mandate sets an ambitious agenda to transform patient care and we expect NHS England to demonstrate significant progress against all the objectives by March 2015. To provide stability and enable the NHS to plan ahead, we have carried forward all existing 24 objectives. The Government have kept changes to an essential minimum to ensure the refreshed mandate remains strategic, outcomes-focused and affordable within NHS England’s budget, which is also set out in the mandate for 2014-15.

Where the Government have introduced changes, these focus on the priorities that will support the successful transformation of health and care services to meet the needs of an ageing population and the increasing prevalence of long-term physical and mental health conditions:

the vulnerable older people’s plan as a means for improving the health of the whole population and to provide excellent care for older people;

the addition of one new objective in relation to the system wide response to the Francis inquiry recommendations; and

taking forward actions to deliver a service that values mental and physical health equally.

The Government have included further ambitions on a limited number of areas to deliver the quality of care and treatment people need and expect. These areas are: reducing avoidable premature mortality; supporting people with dementia; improving patient experience—friends and family test; and making better use of resources.

The mandate also reflects the work being taken forward by NHS England to improve integrated care; addressing the failings witnessed at Winterbourne View private hospital; supporting a fair playing field for providers; improving outcomes for children and young people; and supporting innovation to improve patient care.

While the mandate sets out our vision over the long term, we also need to tackle immediate pressures. The Government previously announced their plans to handle pressures on A and E this winter and the allocation of £250 million funding to NHS England for distribution to the areas that need it most. The additional allocation requires an increase to the revenue budget for NHS England for 2013-14, and a revision to the current mandate will be laid before Parliament shortly reflecting this uplift in the budget only.

Alongside the mandate for 2014-15, we have published the Government’s response to the consultation and a refreshed version of the NHS outcomes framework 2014-15. Similar to the approach taken with the mandate, we have kept changes to the NHS outcomes framework to an essential minimum.

Copies of all these documents have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Urgent and Emergency Care Review

Jeremy Hunt Excerpts

Tuesday 12th November 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will update the House on Professor Sir Bruce Keogh’s urgent and emergency care review following this morning’s briefing to the media.

[The Secretary of State for Health (Mr Jeremy Hunt)]

In January this year, the board of NHS England launched a review of urgent and emergency care in England. Urgent and emergency care covers a range of areas, including accident and emergency departments, NHS 111 centres and other emergency telephone services, ambulances, minor injury units, and urgent care centres. The review is being led by Professor Sir Bruce Keogh, NHS England’s medical director. A report on phase 1 of the review is being published tomorrow, and it is embargoed until then. [Interruption.] This is an NHS England report, and NHS England is an independent body, accountable to me through the mandate. The report that will be published tomorrow is a preliminary one, setting out initial thinking. [Interruption.]

[Mr Speaker]

Order. There are highly charged feelings on this matter, but the Secretary of State has been asked a question, and his reply must be heard.

[Mr Hunt]

I should underline the fact that this morning’s briefing was under embargo, an embargo which, to my knowledge, has been respected. The final version will be published in the new year.

Sir Bruce has said that he will outline initial proposals and recommendations for the future of urgent and emergency care services in England, which have been informed by an engagement exercise that took place between June and August this year. There will be further consultation on the proposals through a number of channels, including commissioning guidance and demonstrator sites. Another progress report will be produced in the spring of 2014.

Decisions on changing services are made at a local level by commissioners and providers, in consultation with all interested parties. That is exactly as it should be, as only then can the system be responsive to local needs. It is vital to ensure that both urgent and emergency care and the wider health and care system remain sustainable and readily understandable to patients. A and E performance levels have largely been maintained, thanks to the expertise and dedication of NHS staff. A and E departments see 95% of patients within four hours, and the figure has not dropped below the 95% target since the end of April. However, urgent and emergency care is falling behind the public’s needs and expectations.

The number of people going to A and E departments has risen historically, not least because of an ageing population. A million more people are coming through the doors than in 2010. Winter inevitably challenges the system further, which is why we are supporting the most under-pressure A and Es with an additional £250 million. Planning has started earlier than ever this year, and the NHS has been extremely focused on preparing for additional pressure.

We will look at Sir Bruce’s report extremely carefully. Reform of the urgent and emergency care system may take years to complete, but that does not mean that it is not achievable. We are exceptionally fortunate in this country to have in the NHS one of the world’s great institutions. NHS staff are working tirelessly to ensure that the care that people need will continue to be available to them, wherever and whenever they need it.

[Andy Burnham]

Rarely has this House been treated to a more disrespectful and complacent reply. There are new reports today of 12,000 patients spending 12 hours or more on trolleys in A and E. A and E is in crisis according to the College of Emergency Medicine, and this is before the winter has even started. People are increasingly asking, “Where are the Government and what are they doing about it?” So far all they have heard is, “Crisis? What crisis?” But behind the scenes it is a different story. Such is the panic in Whitehall, the Prime Minister has apparently taken personal charge and this morning the media were given a private briefing on a major review of emergency care. What is going on and why is the Secretary of State running scared, blaming NHS England and trying to keep this House in the dark? It should not be for us to drag the Secretary of State here to give Members information already passed to journalists.

Let me remind the House what the Secretary of State said at Health questions in July. He said that Bruce Keogh’s review

“will report this autumn, precisely so that we can make sure we learn any lessons we need to learn for this winter”.—[Official Report, 13 July 2013; Vol. 566, c. 902.]

To hear him now, it was all about the long term. Let me ask him: what are those lessons, and what immediate action is he now taking ahead of winter?

Weekend briefings suggested Sir Bruce emphasises alternatives to A and E, such as walk-in centres and 111, but Monitor reported yesterday that one in four walk-in centres have been closed and others are today under threat of closure. We need a clear answer. Will the Secretary of State stop further closures of walk-in centres? Does he now accept that his 111 helpline is flawed, and will he put nurses back on the end of the phone, rather than call handlers? And what of the recruitment crisis in A and E? There is a shortage of senior A and E doctors and, according to the Royal College of Nursing, 20,000 too few nurses. Will the Secretary of State give a clear commitment to bring all A and Es back up to safe staffing levels?

Last week, a complacent Prime Minister stood there, told us everything was fine, and even claimed that the average waiting time in A and E had gone down to 50 minutes, but that is not true. I have here a written reply from the public health Minister telling us it has gone up to over two and half hours. When are the Government going to show this House and the country some respect, cut the spin, and give us the real picture about a crisis that is happening right now?

[Mr Hunt]

Mr Speaker, I will tell the right hon. Gentleman what complacency is: it is refusing to have a public inquiry into Mid Staffs, where staff in A and E departments were bullied and harassed when they tried to speak out. He did not think it was worth having a public inquiry into the poor care that his Government swept under the carpet and which we are doing something about. There is one figure that he refused to mention: the A and E performance figures published last week of 96.4%—hitting the target, higher than the previous week, higher than this time last year. That sums it up: in a good week he wants to run down the performance of hard-working staff whereas this Government are backing them.

Why are we having an A and E review? It is to clear up the mess and confusion caused by 13 years of Labour mismanagement of our emergency services. The right hon. Gentleman talks about walk-in centres. Why were they introduced? Because of the disastrous mistake over the GP contract. The brave thing for his Government to have done would have been to admit they got that wrong and reverse it, but they did not. They introduced a whole new raft of services, which confused the public: A and E, walk-in centres, GP surgeries, telephone helplines. Tomorrow we will sort out those problems. Yes there are difficult decisions, but they are decisions his Government ducked and left the public exposed as a result.

Before the right hon. Gentleman runs down our A and E services, let me just gently remind him that he talked about a recruitment crisis, but we have 300 more A and E consultants than when he was Health Secretary, we have nearly 2,000 more people—[Interruption.] I am sorry that this is difficult for those on the Opposition Front Bench to listen to. We have nearly 2,000 more people being seen within four hours every single day than when the right hon. Gentleman was Health Secretary —that is some 700,000 more people every year. We have more hospital doctors, more hospital nurses, more treatments and fewer long waits than when he was Health Secretary, and he should celebrate that improvement in our NHS’s performance, instead of trying to run down the people on the front line.

I will tell the right hon. Gentleman something else we are doing. We are tackling the long-term causes of pressure in A and E that his Government absolutely failed to do: not just the GP contract but also the integration of the health and social care system, the lack of which means that hospitals are not able to discharge people from their beds on time, causing huge pressure. Today, the shadow Health Secretary has shown his true colours. The man whose Government made so many wrong decisions about A and E is exposed as trying to make political capital while this Government sort out his mess.

[David Tredinnick (Bosworth) (Con)]

How many extra lives does my right hon. Friend expect to save through consolidating the A and E facilities in London, by having a smaller number of hospitals with more doctors? Does he expect to replicate that across England?

[Mr Hunt]

My hon. Friend is absolutely right. The changes we announced in north-west London will save hundreds of lives, by using principles that we will hear more of from Sir Bruce tomorrow. In particular, we are putting 800 extra people into out-of-hospital care, which will help the frail elderly, many of whom should never go to A and E—it is the most confusing place that someone with advanced dementia can go. If we can treat them at home, it is better for them and for our hard-working A and E departments.

[Mr Ben Bradshaw (Exeter) (Lab)]

May I assure the Secretary of State that the people of Exeter are not confused about their walk-in centres, but appreciate them and have been using them in ever-increasing numbers? These centres are now under threat, so will he at least admit that closing NHS walk-in centres and scrapping Labour’s GP access targets has been a dreadful mistake?

[Mr Hunt]

Perhaps the right hon. Gentleman might like to hear what the British Medical Association said yesterday about walk-in centres. The BMA is not known for its support of Government policies, but it said that urgent care centres

“were often opened in places with little patient demand…The result has been a lot of money being spent on these facilities with some now closing because commissioners have found there is not sufficient demand”.

That is the problem we are sorting out.

[Paul Burstow (Sutton and Cheam) (LD)]

One long-term cause of pressures in our A and E departments is the lack of parity of esteem between physical and mental health. Does the Secretary of State agree that it is unacceptable that two thirds of people experiencing a mental health crisis do not get access within four hours to a psychiatric assessment? Was it not a failure of the previous Government not to set access standards for people with mental health problems? Is it not time, as the mandate does today, to deliver just that?

[Mr Hunt]

My right hon. Friend is absolutely right about that. We do need parity of esteem between mental and physical health. The situation puts particular pressure on A and E departments, including the one closest to this House, at St Thomas’s hospital, where people said that the biggest single worry they have and the biggest single thing that makes it difficult for them to meet their targets is the lack of quick access to psychiatric services. We are looking at this matter and he is right to highlight it.

[Mr Kevin Barron (Rother Valley) (Lab)]

The Minister said that changes taking place in urgent and emergency care are done locally for local need. What does he think of the following statement made by Sir David Nicholson last week before the Select Committee on Health? He said:

“We are bogged down in a morass of competition law…we have competition lawyers all over the place telling us what to do, which is causing enormous difficulty.”

Does the Secretary of State not agree that the Government were warned about that when they brought in the Health and Social Care Act 2012? They were told that competition law was going to create chaos in the NHS, and it is doing exactly that.

[Mr Hunt]

I think the right hon. Gentleman will find that some of the competition law powers that are being used and are causing Sir David worry were actually from the Enterprise Act 2002, which we are now looking at to see whether we can sort it out.

[Mr Henry Bellingham (North West Norfolk) (Con)]

Is the Secretary of State aware that hospitals in Norfolk have recently made it clear to MPs that one of the key drivers of a big increase in people going to A and E is the fact that many people are not going to their doctor? Does he agree that it is essential that the GP contract of 2004 is rewritten so that doctors provide that 24/7 cover? When will he be able to sit down with the BMA and make real progress to right a serious mistake that the Opposition made?

[Mr Hunt]

My hon. Friend speaks wisely. The most senior A and E doctor in the country, Professor Keith Willett, said that he thought that between 15% and 30% of the people attending A and E could be looked after in the community. This is a root cause of pressure. I am afraid that the Labour party needs to show some humility before it starts whipping up public concern about problems that it had a very big part in making. I am in the process of discussions with the BMA, and I hope my hon. Friend will not have to wait too long for some good news.

[Glenda Jackson (Hampstead and Kilburn) (Lab)]

Will the Keogh review genuinely examine the lack of parity in respect of those who are physically ill and those who are mentally ill? We are already suffering from a crisis in emergency mental health beds in London and we are seeing an increasing use of A and E departments for those who are mentally ill. Surely we should be looking at an increase in walk-in centres for the mentally ill, which have proven to be remarkably effective in helping those on the brink of a serious fall.

[Mr Hunt]

The hon. Lady is absolutely right that the urgent emergency care we offer to people with mental health problems is not up to scratch and needs to be a great deal better. Different solutions will be appropriate in different parts of the country, but often going to a normal A and E is not the right approach. We need to consider whether, when people have such conditions, there can be better access to people who know them, their medical history and their condition and who are in a position to advise them in a way that means they do not end up doing what I have seen happening time and again in A and Es, where people end up as frequent fliers, going again and again to an A and E just because there is nowhere else to go. That is one thing that we are trying to sort out tomorrow.

[David Rutley (Macclesfield) (Con)]

We have heard a lot today about NHS A and E services in England. Will my right hon. Friend tell the House whether there are any lessons to be learned from A and E services in Labour-run Wales?

[Mr Hunt]

Wales has not met its A and E target since 2009 because the Welsh Government followed the advice of the shadow Health Secretary and cut the NHS budget by 8%.

[Mr Dennis Skinner (Bolsover) (Lab)]

This Government have been in power for three and a half years. They could have chosen to remedy some of the continuing problems in the health service, but what did they do? They decided to reorganise it from top to bottom. Is there any wonder there is a crisis this winter? Instead of closing A and Es and walk-in centres, why does the Secretary of State not walk away? It would give him more time to count his money.

[Mr Hunt]

Let me tell the hon. Gentleman that thanks to the reorganisation that he is so bitterly against, we have 5,500 more doctors on the front line and 8,000 fewer managers. We would not be managing to hit our A and E target today if we had not taken the difficult decisions that the Leader of the House took when he was doing my job.

[Glyn Davies (Montgomeryshire) (Con)]

Geography dictates that my Montgomeryshire constituents depend on A and E services in hospitals in England. Will my right hon. Friend reassure us that devolution will not be allowed to create a health care iron curtain between England and Wales, and will he ensure that decisions on A and E services in Shropshire take account of the interests of my constituents?

[Mr Hunt]

We will absolutely ensure that there is no iron curtain, but I must say that the increasing number of people coming from Labour-run Wales to seek treatment in England is an indication that people are voting with their feet because they know where the NHS is being better run.

[Heidi Alexander (Lewisham East) (Lab)]

On repeated occasions in this place, the Health Secretary has claimed to be saving A and Es when his proposals would remove intensive care units in many hospitals and allow blue-light ambulances to go sailing past their doors. Will the Health Secretary tell me what his definition of an A and E is?

[Mr Hunt]

That is exactly what tomorrow’s report is designed to clarify. It is not for me—[Interruption.] Let me say very straightforwardly—[Interruption.]

[Mr Speaker]

Order. I can scarcely hear the Secretary of State’s answers, and I want to hear them. Let us hear the response.

[Mr Hunt]

Thank you, Mr Speaker.

The hon. Member for Lewisham East (Heidi Alexander) will know that her constituents have some of the best stroke survival rates in England because we reduced the number of hospitals in London offering stroke services from 32 to eight. I am not going to stand in the way of those changes if they save lives.

[Jeremy Lefroy (Stafford) (Con)]

I very much look forward to the review, which is urgent. Given that accident and emergency departments do not operate in isolation, will the Secretary of State assure me that the review will consider the whole system, including support services, critical care units and the availability of specialist consultants—particularly those in paediatrics—who need to be available for an A and E to function effectively?

[Mr Hunt]

No one has campaigned more assiduously than my hon. Friend for his local hospital, despite the incredible tragedies and difficulties that it has been through and the pressures that has created for the people of Stafford. He is absolutely right: if we are going to solve the problem, we must consider the system holistically and consider how different A and E departments can specialise services. We need much more of a hub-and-spoke system, rather than one where every A and E has to offer exactly the same menu of services. If we do that, we will save more lives and that has to be the right thing to do.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

Following Monitor’s report yesterday on the closure of walk-in centres, is it not the case that at the heart of the Government’s NHS reforms is a massive shift in power from the consumers—the patients—to the producers of services? When the Government’s slogan is, in effect, “All power to the producers”, it is not surprising that services have been reorganised in a way that does not benefit patients. May I suggest that instead of sticking up for the BMA, the Secretary of State starts to stick up for patients?

[Mr Hunt]

After what happened at Mid Staffs, we will not take any lessons on sticking up for patients—none whatsoever. We are taking the power out of the hands of the managers in PCTs and SHAs and putting it into the hands of doctors on the front line who are seeing patients every day. That is the best thing we can possibly do.

[Bob Stewart (Beckenham) (Con)]

My constituents tell me that they much prefer to go to their doctor than to any other centre. Will the Secretary of State try to get more doctors involved in out-of-hours care?

[Mr Hunt]

That is the tragedy of what happened in 2004, when the personal link between doctor and patient was broken because the previous Government abolished named GPs for every patient. My hon. Friend speaks very wisely, as that is exactly what most members of the public want—they want to be able to get in and see their own GP quickly and easily. That is at the heart of the problem that tomorrow’s review of A and E will seek to address.

[Caroline Lucas (Brighton, Pavilion) (Green)]

Notwithstanding the brilliant local work of nurses and doctors, hospitals like those in the Brighton and Sussex University Hospitals NHS Trust face real challenges, including bed shortages and people having to wait for many hours for tests such as X-rays and so on. Sometimes, people wait in A and E for 12 hours for a bed. Does that not demonstrate how reckless and dangerous it is for the Secretary of State’s Department to impose cuts of £30 million on that hospital trust this year and next year, and will he reconsider?

[Mr Hunt]

Let me gently remind the hon. Lady that we have protected the NHS budget—we took a very difficult decision—but how the NHS budget is spent in local areas is a matter for local discretion. It is challenging for all hospitals, because if we are to address the long-term stability of the NHS we need to spend more money out of hospitals, which means finding efficiency savings in hospitals. We do not want to duck those challenges, which is why we are having the review that will be published tomorrow.

[Angie Bray (Ealing Central and Acton) (Con)]

My right hon. Friend will be aware that there are concerns about whether blue-light ambulance services will continue to define what an A and E is. Does he agree that for some years now victims of stroke, trauma and other serious problems have not necessarily gone to their local A and E but to specialist hospitals, and that that has been the reason behind the excellent improvement in outcomes?

--- Later in debate ---

[Mr Hunt]

My hon. Friend speaks extremely wisely. We have talked about stroke, so let me give another example, which is trauma. We have cut mortality rates by 20% as the result of a strategy to specialise trauma care. Those are the difficult decisions that the Government believe that we should not duck and that we need to face up to. If I may say so, when the Opposition were in power, they took a slightly wiser approach to the issue than the party political posturing we are getting today.

[Graham Jones (Hyndburn) (Lab)]

The Secretary of State earlier quoted the suggestion that GP walk-in centres were in the wrong places, where there was little demand. Last year, 33,000 people used the under-threat Accrington Victoria hospital walk-in centre, and now there is deep anger with the Conservative party. Will he explain how 36,000 people going to overstretched Royal Blackburn hospital A and E will help the situation there?

[Mr Hunt]

The hon. Gentleman makes my point for me extremely eloquently. Under the previous Government, we had a top-down, ham-fisted policy of opening walk-in centres everywhere as a sticking plaster solution to the disasters with their GP contract. Sometimes they were valuable services, sometimes they were not. We are clearing up the mess, but sometimes, when those centres are useful and important for the public, we will keep them.

[Martin Horwood (Cheltenham) (LD)]

The origins of the recruitment crisis in A and E obviously predate this Government. Will Sir Bruce Keogh’s review highlight the local trusts, like that in Gloucestershire, which appear to have significantly worse recruitment and retention records than neighbouring trusts and have used it as a rationale for downgrading services—such as, in this case, those at Cheltenham general hospital?

[Mr Hunt]

I hope that it will. I hope that it will give clarity about the long-term future for A and E departments, which has been a difficult issue for this Government and for the previous Government. What people want is stability, and they want to know that there is a Government who are prepared to face up to difficult decisions. They want to know that they have a future, and I hope that tomorrow’s review is the first step towards providing that security.

[Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)]

Is the Secretary of State aware that the A and E crisis is creating a huge backlog in specialist procedures, and will Sir Bruce Keogh’s review take that into account?

[Mr Hunt]

The number of people waiting more than a year for an operation has gone down from 18,000, when the hon. Gentleman’s Government were in power, to fewer than 1,000 now. We have reduced long waits at a time of great pressure on the NHS, so I do not recognise the hon. Gentleman’s figures at all, I am afraid.

[Mr Lee Scott (Ilford North) (Con)]

My right hon. Friend will have seen the disastrous reports that have come in about Barking, Havering and Redbridge University Hospitals NHS Trust, with some of the most alarming things including a report of a baby being put in a stationery cupboard. I am sure that, as he said in a recent debate, he will conduct a full review of King George hospital. Can that be done urgently, as we are now in a very serious situation?

[Mr Hunt]

I pay tribute to my hon. Friend for raising both publicly and privately his concerns about the hospital provision that his constituents face. We shall of course make sure that there is a proper review before any service changes are made. I hope that he will be reassured by the big change that happened this year with the introduction of an independent chief inspector of hospitals, who is going round the country rooting out poor care, not sweeping it under the carpet, as happened so often under the Labour Government.

[Derek Twigg (Halton) (Lab)]

Does the Secretary of State regret the loss of 6,000 nursing jobs since the last election?

[Mr Hunt]

The number of hospital nurses has gone up since the election, and as a result of the changes in the Francis report—the hon. Gentleman’s party refused to have a public inquiry many, many times—I hope that the NHS will recruit many more nurses.

[Mr Philip Hollobone (Kettering) (Con)]

The three Members for north Northamptonshire— the hon. Member for Corby (Andy Sawford), my hon. Friend the Member for Wellingborough (Mr Bone) and I—have come together on a cross-party basis, and are working with local clinical commissioning groups and Kettering general hospital to try to attract more investment to our local A and E because of the increase in the local population. May I share with the Secretary of State the fact that all agree that up to a third of attendees at A and E could be better treated closer to home, particularly in excellent urgent care centres such as that in Corby?

[Mr Hunt]

My hon. Friend speaks extremely wisely. He invited me to visit Kettering hospital, and I saw for myself that it was a very, very busy hospital. In the end, if we just stick with the current model we will reach bursting point, which is why we need to look at new models. That is why tomorrow’s review is important, and part of that—in fact, the bulk of the work in tomorrow’s review—is about how we transform out-of-hospital care, which is the big strategic change that we need to make in our NHS, and on which I am afraid the previous Government made so little progress.

[Nic Dakin (Scunthorpe) (Lab)]

Tomorrow’s review is supposed to deal with issues to do with this winter. Will the Secretary of State give the House an assurance that there will be no crisis of A and E on his watch this winter?

[Mr Hunt]

A and E departments are under huge pressure. We are seeing about 1 million more people every year than three years ago, and we have done more this year than has ever been done in NHS history to help to prepare the NHS for winter, including giving £250 million to 53 local health economies where the pressures are greatest. We continue to monitor the situation very, very closely to give more support where we can.

[Alex Cunningham (Stockton North) (Lab)]

The crisis in nurse vacancies and recruitment highlighted today by the Royal College of Nursing affects the North Tees and Hartlepool NHS Foundation Trust, which tells me that it has been forced to recruit trained nurses from the Philippines, as there are insufficient UK nurses available. What is the Secretary of State doing to address that particular part of his failure?

[Mr Hunt]

I have to gently say to the hon. Gentleman that recruiting nurses from the Philippines did not happen for the first time under this Government. One reason why those nurse vacancies have gone up is that the Government decided to conduct a public inquiry into what happened at Mid Staffs. The system reacts to that by wanting to hire more nurses, and I think that he should welcome that, not criticise it.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The report by the Health Select Committee on the A and E crisis found that only 16% of hospitals had the right level of consultant cover in A and E. Yesterday, we learned that half the vacancies for senior A and E doctors are unfilled, as doctors move to work overseas. The issue of staffing in A and E has been understood for the past three and half years, and there have been repeated warnings and reports. What has the Secretary of State done to address it and make sure that A and E wards have sufficient staff cover?

[Mr Hunt]

Recruiting 300 more A and E consultants than when the hon. Lady’s Government were in power.

[Jenny Chapman (Darlington) (Lab)]

What has the Secretary of State got to say about the fact that in my area, compared with four years ago, it is harder to get a GP appointment. We no longer have NHS Direct, and cuts in adult social care mean that patients are not making room for other patients to go to A and E. The person raising that with me is the chief superintendant of Darlington police, who is fed up with his officers being held up by taking patients to A and E, as those patients would otherwise wait more than an hour for an ambulance?

[Mr Hunt]

The hon. Lady makes some important points, and I congratulate her on being the first Opposition Member to raise the fact that it has become harder and harder to get an appointment with a GP. [Interruption.] I know that it is hard to accept, but it is a fundamental problem, and a challenge facing our A and E departments that the Government are determined to sort out.

[Jim Shannon (Strangford) (DUP)]

Before tomorrow’s report on the urgent and emergency care review, may I tell the House that in Northern Ireland, we treat urgent referrals by direction to the doctor on call and linking up with the chemist. Emergency referrals are done through hospitals, showing good practice and delivery. Is the Secretary of State prepared to contact the Northern Ireland Assembly and the Minister responsible to see how best practice works?

[Mr Hunt]

I am in regular contact with the Northern Ireland Minister for Health, Social Services and Public Safety about good practice in Northern Ireland, and I am delighted to hear that they are doing some good things in urgent and emergency care. We should be open to all good practice, not just in our country but all over the world.

[Mr Andy Slaughter (Hammersmith) (Lab)]

The Secretary of State may have seen the report in The Sunday Times at the weekend about the dispute between the medical director for London, who said that 20% to 30% of blue-light A and Es should close, and Sir Bruce Keogh, who said that less than that should close. Disgracefully, the Secretary of State has not told us what is in Sir Bruce Keogh’s report, but we know that it is below that figure, so why did he announce to the House two weeks ago that four out of nine—45%—of blue-light A and Es in west London would close, pre-empting the Keogh review?

[Mr Hunt]

Because it is going to save the lives of the hon. Gentleman’s constituents; it will mean that 800 more people are employed in out-of-hospital care; it will mean three brand-new hospitals for the benefit of his constituents; it will mean seven-day working; and it will mean seven-day opening of GP surgeries. That is why.

[Kevin Brennan (Cardiff West) (Lab)]

On reflection, does the Secretary of State regret the fact that he described people who felt ill enough to have to go to A and E on a number of occasions as “frequent flyers”? And would he like to apologise?

[Mr Hunt]

I am sorry, that is a completely ridiculous thing to say. I was using the phrase to talk about people who have to go back to the NHS time and again. The whole purpose of the reforms is to make sure that we give a better service to people who regularly use the NHS, and he should understand perfectly well what I was talking about.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

What discussions has the Secretary of State had with his colleagues across government about the need for urgent additional investment in social care? Surely he appreciates that the savage cuts to local authority social care budgets have only added to the pressure on accident and emergency units.

[Mr Hunt]

I find it a little difficult to take a lesson from the right hon. Gentleman, as his Government cut social care funding per head when they were in power and when the economy was in much better shape than it has been since the financial collapse that they caused. If he looks at what we announced this summer, he will know that the Chancellor announced an extra £2 billion of support for the NHS budget going into social care to deal with precisely the problems that he raised.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

Last week, the Secretary of State assured—[Interruption.]

[Mr Sharma]

Last week the Secretary of State assured me that A and E at Ealing hospital is safe, but since then we have heard very confusing and contradictory statements in the local area. First, will the Secretary of State reassure us today that the A and E department at Ealing hospital is safe in the future? Secondly, will he meet me and my colleagues from the west London area—I have written to him—to discuss our concerns and so that we can express our feelings?

[Mr Hunt]

I am always happy to meet colleagues if they have concerns about what is happening in their constituency, but I absolutely stand by what I said. There will remain an A and E at Ealing. That was the decision that I made because I wanted to give clarity, but I also said that the shape and size of that A and E may change in accordance with the announcement that is being made tomorrow by Sir Bruce Keogh. I hope that will give the hon. Gentleman further clarity and further certainty to reassure his constituents.

[Bill Esterson (Sefton Central) (Lab)]

The Secretary of State has already acknowledged that keeping people in their own home is one important way to relieve the pressure on A and E. I do not understand why, if he wants to make a real difference, he will not reinvest the NHS underspend to make up for the cuts in local government and put it into social care.

[Mr Hunt]

We have put in an additional £2 billion—that makes a total of £3.8 billion being invested to support the social care budget. That is significant because it is recurring expenditure. We have shown our commitment by continuing to support the social care system through this Parliament. The trouble with underspends is that they depend on how many resources we have in any particular year. It is therefore much harder to invest off the back of them.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Secretary of State has spoken about the importance of continuing care from one’s own GP to limit admissions to A and E, yet in Hackney, when GPs tried to take over and run the out-of-hours service, the commissioners were paralysed by the fear of legal challenge and, rather than putting patients’ interests first, put the rich lawyers’ interests first.

[Mr Hunt]

If I may say so, it was the Government whom the hon. Lady supported who removed the responsibility for out-of-hours care from GPs. I welcome and want to help any GPs who want to take it back.

[Steve Rotheram (Liverpool, Walton) (Lab)]

This Secretary of State has been forced to answer more urgent questions in the House than even the Prime Minister about Mrs Bone. When will he stop blaming others about the mess he has made of our NHS, take some responsibility for the top-down reorganisation and get on with the job that he has been over-promoted to do?

[Mr Hunt]

Let me tell the hon. Gentleman how well the NHS is doing. If one listens to the rhetoric from the Opposition Benches, one could completely underestimate the hard work of people on the front line. There are 800,000 more operations being carried out every year in the NHS than ever happened under Labour. At the same time, long waits for operations have gone down. I think that is something to be proud of.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

The response that the public health Minister gave to my written question showed that ambulance response times have increased over the past two years in 11 out of 12 trusts in England. Why is this happening?

[Mr Hunt]

Just as there is more pressure on A and E departments, there is also more pressure on ambulance services. We are treating that as very much part of how we support accident and emergency services over the coming period. There are particular pressures in the London area, the east of England and the east midlands, and we are doing everything we can to put those problems right.

[Helen Jones (Warrington North) (Lab)]

The Secretary of State referred to the Chancellor’s recent announcement about money for social care, yet this is only a tiny fraction of what the Government have already taken out of the social care budget through their 30% cuts to councils. Did he not realise the impact that that would have on A and E, or did he just not care about it?

[Mr Hunt]

I am very conscious of the pressure that having to sort out Labour’s deficit is creating on all Government Departments, but the Opposition cannot have it both ways. They cannot say that they are in favour of fiscal responsibility and then complain about every single cut. The difficult decision that this Government took was to protect the NHS budget. That is something that the Opposition did not agree with. They wanted to cut the budget from its current levels.

Changes to Health Services in London

Jeremy Hunt Excerpts

Wednesday 30th October 2013 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, Mr Speaker, I would like to make a statement on the “Shaping a healthier future” programme, a locally led review of NHS services across north-west London.

The NHS is one of the greatest institutions in the world. Ensuring that it is sustainable and that it serves the best interests of patients sometimes means taking tough decisions. The population of north-west London is growing and will reach approximately 2.15 million by 2018. About 300,000 people have a long-term condition. However, there is great variation in the quality of acute care. In 2011, there was a 10% higher mortality rate at weekends for emergency admissions, and the number of hospital re-admissions differs considerably across the area. The Independent Reconfiguration Panel expressed concerns that the status quo in north-west London was neither sustainable nor desirable, and might not even be stable.

In order to address these challenges, the NHS in London started the “Shaping a healthier future” programme in 2009. It proposed significant changes to services, including centralising accident and emergency services at five rather than nine hospitals; 24/7 urgent care centres at all nine hospitals; 24/7 consultant cover in all obstetric wards; a brand new trauma hospital at St Mary’s hospital, Paddington; brand new custom-built local hospitals at Ealing and Charing Cross; seven-day access to GP surgeries throughout north-west London; the creation of over 800 additional posts to improve out-of-hospital care, including a named, accountable clinician for all vulnerable and elderly patients with fully integrated provision by the health and social care systems; and increased investment in mental health and psychiatric liaison services.

These changes represent the most ambitious plans to transform care put forward by any NHS local area to date. They are forward-thinking and address many of the most pressing issues facing the NHS, including seven-day working, improved hospital safety and proactive out-of-hospital and GP services. The improvements in emergency care alone should save about 130 lives per annum and the transformation in out-of-hospital care many more, giving north-west London probably the best out-of-hospital care anywhere in the country.

The plans are supported by all eight clinical commissioning groups, the medical directors of all nine local NHS trusts, and all local councils except Ealing. It was as a result of a referral to me by Ealing council on 19 March 2013 that I asked the Independent Reconfiguration Panel to conduct a full review.

The panel submitted its comprehensive report to me on 13 September 2013 and I have considered it in detail alongside the referral from Ealing. I am today placing a copy of the panel’s report in the Library, alongside the strong letters of support for the changes that I received from all local CCGs and medical directors. The panel says that “Shaping a healthier future” provides

“the way forward for the future and that the proposals for change will enable the provision of safe, sustainable and accessible services.”

Today I have accepted the panel’s advice in full and it will be published on the panel’s website.

The panel also says that while the changes to A and E at Central Middlesex and Hammersmith hospitals should be implemented as soon as practicable, further work is required before a final decision can be made about the range of services to be provided from the Ealing and Charing Cross hospital sites.

Because the process to date has already taken four years, causing considerable and understandable local concern, I have today decided it is time to end the uncertainty. Therefore, while I accept the need for further work, as the IRP suggests, I have decided that the outcome should be that Ealing and Charing Cross hospitals should continue to offer an A and E service, even if it is a different shape or size from that currently offered.

Any changes implemented as part of “Shaping a healthier future” should be implemented by local commissioners following proper public engagement and in line with the emerging principles of the Keogh review of accident and emergency services.

I have today written to the chair and vice-chair of the health and adult social services standing scrutiny panel of the London borough of Ealing council, the chair of the IRP Lord Bernie Ribeiro, the chief executive of NHS England and local MPs, informing them of my decision.

These much-needed changes will put patients at the centre of their local NHS, with more accessible, 24/7 front-line care at home, in GP surgeries, in hospitals and in the community. More money will be spent on front-line care, which focuses on the patient. Less will be wasted on duplication and under-performing services.

Let me be clear that, in the joint words of the medical directors at hospitals affected, there is a

“very high level of clinical support for this programme across NW London”.

Local services will be designed by clinicians and local residents and will be based on the specific needs of the population.

None of these changes will take place until NHS England is convinced that the necessary increases in capacity in north-west London’s hospitals and primary and community services have taken place.

I want to put on the record my thanks to the IRP for its thorough advice. As the medical directors of all the local hospitals concerned said in their letter to me, these changes will

“save many lives each year and significantly improve patients care and experience of the NHS.”

When local doctors tell me that that is the prize, I will not duck a difficult decision.

I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

People at home will have listened carefully to what the Secretary of State has just said, and they will have one simple question in their mind: why is this man trying to close so many A and Es when we are in the middle of an A and E crisis? At least seven A and Es across the capital are under threat, at a time when all London A and Es are working flat out and are full to capacity. As we stand here, thousands of people are waiting to be seen, stuck on trolleys or held in the back of ambulances that are queuing outside A and E. When the A and Es we have are struggling to cope, how on earth can it be safe to close or downgrade so many?

That brings me to what I see as the major flaw in what the Secretary of State has announced. These plans have been in development for four years, as he said. Four years ago, A and E was not in the crisis that it faces today. The reality on the ground in London has changed. In 2013, A and Es in London have been getting worse and worse and worse. Across London, 200,000 people have waited in A and E for longer than four hours in the past 12 months. Here is the statistic that should make people stop and think: taking all its major A and E units together, London has missed the Government’s A and E target in 48 of the last 52 weeks.

Any further changes to this fragile and overburdened system must proceed with the utmost caution. Will the Secretary of State give me a categorical assurance that he personally gave in-depth consideration to the latest evidence of the pressure on London A and Es and to the changed reality that 2013 has brought before making his decision? I understand how tough such decisions are. Sometimes, difficult changes need to be made, as I found when I reorganised stroke services in London before the last election. When he does the right thing, based on a clear clinical case that lives will be saved, we will support him, as we did on children’s heart surgery. The problem with the closure programme, as managers admitted to Members of the House at the outset, is that it is primarily about saving money, not saving lives.

Even though the Secretary of State has made some minor concessions today, he is still performing pretty brutal surgery on west London’s NHS. It is the single biggest hospital closure programme the NHS has ever seen. Has he considered the impact of the changes on people in those communities who are on low incomes? They will face much greater costs and journey times in getting to hospital.

Will the Secretary of State be straight with us on the much-loved Charing Cross and Ealing hospitals? I listened carefully to what he said. What is the “further work” that he referred to? He spoke of their A and Es being of a different size and shape. Is that not spin for saying that the units will be downgraded and become urgent care centres? Alternatively, is he giving those units a permanent reprieve today? If he cannot answer those questions directly, local people in those areas will take what he has said as weasel words.

The Secretary of State said that there will be investment in communities before the changes go ahead. He said that to the hon. Member for Enfield North (Nick de Bois) in respect of Chase Farm hospital, but he is closing that unit next month. What guarantee do people have that he will follow through on this promise, when he broke the promise that he made to his hon. Friend?

The Secretary of State has made a statement on London health services. People will not have missed the fact that he has failed to mention Lewisham hospital and what happened at the Court of Appeal yesterday. Is that not a staggering omission? The victory that was won by the people of Lewisham will give hope to people who are disappointed by today’s announcement.

The humiliation of the Secretary of State in court again raises major questions about his judgment and his ability to manage such important decisions. In the summer, we explicitly warned him to accept the first court ruling. Instead, he ploughed on, throwing around taxpayers’ money in a cavalier fashion, to protect his pride and defend the indefensible. I have a simple question: how much has he spent on appealing that decision? When he decided to appeal, did the official legal advice from the Government recommend an appeal or did he overrule it? Will he confirm today to this House and to the people of Lewisham that there will be no further appeal against the court’s ruling? Will he give the people of Lewisham and the staff who work at Lewisham hospital a commitment that their A and E and maternity services will be protected? Finally, will he apologise to the people of Lewisham for the unnecessary distress and worry he has put them through?

It will not have escaped people’s notice that the Secretary of State is trying to put powers through the House quite soon to grab further powers for himself and drive through financial closures of A and Es without proper consultation, so that in effect he can do what he tried to do to Lewisham to every community in England. That will send a chill wind through those communities that fear to lose their A and Es, and that is why we will oppose those powers when they are considered by the House.

In conclusion, the Government have come a long way since the Prime Minister stood outside Chase Farm hospital days after the last general election and promised a moratorium on all hospital changes. Local people in west London will not have forgotten the Prime Minister standing outside Ealing and Central Middlesex hospitals and promising the same. People are seeing through a Prime Minister whose broken promises on the NHS are catching up with him. Has it ever been clearer than it is today that people simply cannot trust the Tories with the NHS?

[Mr Hunt]

I am afraid the right hon. Gentleman is sounding more and more desperate. Today the Government have taken a difficult decision that will improve services for patients. It was a moment for him to show that he understood the challenges facing the NHS, but that was not to be. He said that we should not proceed with the changes given winter pressures on A and Es, but he should read the document. The proposals are for more emergency care doctors, more critical care doctors, and more psychiatric liaison support that helps A and E departments, and they are supported by the medical directors of all nine trusts affected. He said that if evidence can be produced to show that the proposals will save lives, Labour will support them. What more evidence does he want? He should be shouting from the rooftops to support the proposals, but instead he is putting politics before patients.

The right hon. Gentleman mentioned A and E performance, and I am happy to tell him about that. On average a person now waits 50 minutes in A and E before they are seen; when he was Health Secretary it was 71 minutes. The number of patients seen in less than four hours every day is 57,000—nearly 2,000 more than when the right hon. Gentleman was Health Secretary. Our hospitals are performing extremely well under a great deal of pressure because we are taking difficult decisions of the kind that we are talking about today.

The right hon. Gentleman also talked about hospital closures. Again, he should read the proposals: a brand new trauma centre at St Mary’s hospital in Paddington; two brand new elective care centres at Ealing and Charing Cross; seven-day NHS care that will save lives; 24/7 obstetric care; 16 paediatric care centres. Those are big improvements in hospital care—[Interruption.] I will come on to Lewisham. I am acting to end uncertainty because I made the decision today that whatever the outcome of further discussions that the Independent Reconfiguration Panel recommends, there will remain an A and E at Ealing and Charing Cross. That is the best thing I can do for those residents.

The right hon. Gentleman mentioned Lewisham, but let us remember that the problem started because his Government saddled South London Healthcare NHS Trust with £150 million in private finance initiative costs. I judged that the right thing for patients was to sort out a problem that was diverting £1 million every week from the front line. Yes it is difficult, but I would rather lose a battle with the courts trying to do the right thing for patients than not try at all.

Finally, these are difficult decisions, but the party that really has NHS interests at heart is the one that is prepared to grip those decisions. We are gripping the problems in A and E, and in terms of hospital reconfigurations. That is why the NHS is safe in our hands and not safe in those of the Labour party.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my right hon. Friend agree that we tackle health inequalities, and improve health outcomes and access to accident and emergency departments, by facing up to the need to make difficult decisions to change the way care is delivered to keep it up to date? Does he further agree that today we have seen a Government who are prepared to face those challenges, and an Opposition spokesman who has demonstrated a determination to duck them? Who cares about the NHS?

[Mr Hunt]

I thank my right hon. Friend for that comment. He is right that this is about facing up to difficult decisions. One aspect of the proposals that is so exciting for people who want a transformation in services is that they involve employing 800 additional people for out-of-hospital care. The real way we will reduce pressure on A and E units is by ensuring that people, particularly the frail and elderly, are looked after better at home. That is what we must do. We must recognise that, fundamentally, the problems will not be solved by trying to pour in money in the way that it has always been poured in. We must rethink the model. This is a positive and ambitious programme. If the shadow Secretary of State were in my shoes, he would speak differently of the proposals, because they represent the way forward for the kind of integrated care he normally champions.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

Let me remind the Secretary of State that the High Court ruled that his actions in trying to remove services from Lewisham hospital to save a separate failing trust were illegal. He then lost the appeal. Will he now stop throwing good public money after bad, leave Lewisham hospital alone, and learn to respect the views of the people who work in our hospital and those who use its services?

[Mr Hunt]

I respect those views and the right hon. Lady for her campaigning. I understand why the people of Lewisham were unhappy about those changes but, as Health Secretary, I had to take a decision in the interests of all patients in south London. That was the first time the powers—the trust special administrator powers—were used. My interpretation was different from the courts, but I respect them as the final arbiter of what the law means. However, when we have to make difficult decisions about turning round failing hospitals—south London has some of the most serious problems in the country—it is important that the local NHS can take a wider health economy view of what changes are necessary. As I have said, I will respect what the Court has decided, but it is important that I continue to battle for the right thing for patients.

[Nick de Bois (Enfield North) (Con)]

The Secretary of State, his predecessor and the Prime Minister are well aware of my continued opposition to the decision to downgrade Chase Farm. However, today, will he join me in condemning the shadow Secretary of State, who has said that Chase Farm is closing? It is not closing. Against my wishes, there is a proposal to downgrade the A and E unit. The hypocrisy and politicking is worse because the previous Labour Government initiated the process and authorised the downgrade in the first place.

[Mr Hunt]

My hon. Friend speaks wisely. It is disappointing that we are not having a more intelligent debate. When Labour was in power, it closed or downgraded 12 A and E units in 13 years. The then Government realised that there were problems. He is right that they started the problem in Chase Farm. That is why, when we are facing such difficult decisions, it is important to have a responsible debate. I accept that MPs have views on their constituencies, but we have to start looking above the parapet to the wider interests of patients. That is a difficult thing to do, but I would have hoped for more leadership from the shadow Secretary of State, who used to be Health Secretary.

[Mr Andy Slaughter (Hammersmith) (Lab)]

The Secretary of State is destroying services in four great London hospitals, two of which are in my constituency, in the biggest closure programme in the history of the NHS. Why is he closing A and Es in two of the most deprived communities in London—Brent and White City—and why, rather than certainty, is he installing chaos into Ealing and Charing Cross hospitals? What is happening to the 500 beds at Charing Cross? What is happening to the best stroke unit in the country? What does he mean by A and Es that are different in size and shape? When will he answer those questions? This is a cheap political fix. How can anyone have confidence in the Secretary of State—

[Mr Speaker]

Order. We understand the general drift of the observations—[Interruption.] Order. I understand how strongly the hon. Gentleman feels, but he should really ask one question. The Secretary of State is a man of dexterity and no doubt will meet the hon. Gentleman’s needs as he sees fit.

[Mr Hunt]

Thank you, Mr Speaker. I will. The hon. Gentleman does no credit to himself or his party with such hyperbole. Let me remind him that the leaders of the clinical commissioning groups, including the ones in his area, which are there to look after his constituents, have said that

“delivering the Shaping a Healthier Future recommendations in full will save many lives each year and significantly improve patients’ care and experience of the NHS.”

That is what the doctors are saying, which is what I want to follow.

[Bob Blackman (Harrow East) (Con)]

At the Central Middlesex hospital, we have well qualified doctors and nurses waiting for patients to arrive but, at the same time, we have long queues at Northwick Park hospital. That makes no sense. Will my right hon. Friend assure me that any reduced resources at Central Middlesex hospital will be transferred in full to Northwick Park so that patients can be seen far more quickly and in a far better manner?

[Mr Hunt]

I assure my hon. Friend that the resources taken out of some acute services will be used to give better, safer and more high-quality services to his constituents. Northwick Park is one of the best examples of that. Stroke services in the north-west London area were centralised in Charing Cross and Northwick Park. As a result of those changes, which were introduced by the right hon. Member for Leigh (Andy Burnham), stroke mortality rates in London have halved. That is a very good example of why it makes sense to centralise certain more specialist and complex services if we are to get the best results for patients.

[Mr Andrew Love (Edmonton) (Lab/Co-op)]

The Secretary of State talked about putting politics before patients, but I remind him that the Prime Minister, when he was Leader of the Opposition, went to Chase Farm to say that the Conservatives would stop all configurations. That simply has not happened, but yet the Secretary of State continues to have a role. Patients and local residents are firmly opposed to the reconfiguration at that hospital and he will end up in court very soon over the matter. There is still time for him to reconsider that decision.

[Mr Hunt]

We did not agree with how the previous Government went about reconfigurations. I have announced a better way of achieving them, with better public and clinical support. My predecessor as Health Secretary paused on reconfigurations because he wanted to introduce a better structure, including the four tests, one of which was the need for local clinical support, and another of which was the need for effective public engagement. That is why we are in a better place today than we were with the previous Government’s reconfigurations.

[Sarah Teather (Brent Central) (LD)]

My constituents in Brent will be very disappointed with the Secretary of State’s announcement of the A and E closure at Central Middlesex hospital. However, given that the hospital trust began moving acute services out to Northwick Park hospital many years before the process began, they will probably not be surprised. Does he agree that there is an urgent need for health managers to work closely with Transport for London to ensure good transport links for my constituents in Harlesden to get to Northwick Park? It is currently extremely difficult to do so. Will he write to health managers to express that view?

--- Later in debate ---

[Mr Hunt]

The hon. Lady makes an important point. I accept that there will be changes in transport arrangements. I am happy to work with her and to talk to TfL about how improvements can be made in respect of the changes I have announced today.

I hope that the hon. Lady talks to her constituents about the positive aspects of the proposals. Hers will be the first part of the country in which all GP surgeries are open seven days a week—at least, there will be seven-day access to GP surgeries throughout her constituency and north-west London. North-west London will be the first part of the country where we have full seven-day working and we eliminate the fact that mortality rates are 10% higher if people are admitted in an emergency at the weekend. The positive aspects of the proposals will mean that her constituents find that they get better, safer care and live for longer.

[John McDonnell (Hayes and Harlington) (Lab)]

I represent wards with some of the highest morbidity and lowest life expectancy in north-west London. Clinical support for reform and restructuring was based on adequate funding during the period. Hillingdon clinical commissioning group has written to the Secretary of State to express its concern about the current funding formula, which could undermine service delivery unless there are additional resources. Will he meet representatives from the CCG and Hillingdon hospital, which he has denied additional winter money this year, to talk about the long-term future of our health economy?

[Mr Hunt]

Hillingdon CCG supports the changes because it recognises the profound impact they could have in addressing health inequalities. I know that that is precisely what concerns the hon. Gentleman. His constituents will be big beneficiaries of the changes we are announcing today. The funding formula is an extremely difficult issue. We have decided to depoliticise it by making it a matter for NHS England—it is decided at arm’s length from politicians because we believe it is very important that things are decided on the basis of an independent formula.

[Sir John Randall (Uxbridge and South Ruislip) (Con)]

I thank my right hon. Friend for his statement. We in Hillingdon are very pleased for our near neighbours in Ealing and in Charing Cross for this reprieve—rather than stay of execution—and it will take pressure off our residents. I echo the words of the hon. Member for Hayes and Harlington (John McDonnell), however, about the pressures we are facing in Hillingdon. Perhaps we could have a meeting with my right hon. Friend to discuss some of these issues, including the funding formula and the winter pressures.

[Mr Hunt]

It is the first time I have responded to a question from my right hon. Friend, so I shall take the opportunity to congratulate him on his knighthood. I am more than happy to meet him and his neighbour as long as they understand that the funding formula is not in my gift—it is decided by an independent body. As for the winter pressures money, the allocation was not decided by Ministers: it was decided by the people who are responsible for making sure that we head off winter pressures. They decided to concentrate resources in the third of the country where the problems were most severe, and that is how that selection was made.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The whole House knows that all the medical directors in the hospitals involved in north-west London support the reconfiguration. Does the Secretary of State really understand the importance of bringing ordinary people with him? Londoners are especially cautious about these reconfigurations because of the historic problems with access to GPs and the many excluded communities for whom A and E is their primary care, and because these institutions are often major employers in their area and people identify with them. Does he realise that unless he brings ordinary people and patients with him on these reconfigurations, Londoners will continue to fight them and, as in the case of Lewisham, they will continue to win?

[Mr Hunt]

Apart from the very last sentence, I actually agree with what the hon. Lady says. It is important to carry the public with us in these reconfigurations. Governments of both parties have struggled to do that in these difficult reconfigurations, which is why the new structures that we have introduced will put doctors in the front line to argue for changes. It is not just the medical directors of trusts supporting them, but the CCG leaders, who are all local GPs, making that case. That is why there is much stronger support for these changes. All the elected representatives on the local councils, apart from Ealing, supported these changes, and that is a very big change from what we have seen previously. I agree with the hon. Lady: we need to do more work and it is very important to carry people with us.

[Angie Bray (Ealing Central and Acton) (Con)]

It is fair to say that today’s announcement leaves my constituents in a much better place than they were over a year ago when we set out to save our four local A and Es. Obviously, there is disappointment about the loss of the A and Es at Hammersmith and Central Middlesex, but huge relief that the bigger A and Es at Ealing and Charing Cross will be saved. My right hon. Friend says, rightly, that it will be for the local CCGs to take responsibility for the future of these A and Es. Can he give us a little more detail on how he sees the services being delivered and improved by the CCGs, and can he reconfirm that the A and Es at Ealing and Charing Cross will be saved as A and Es?

[Mr Hunt]

I can absolutely confirm that A and Es will remain at Charing Cross and Ealing hospitals, thanks in no small part to the remarkable campaigning that my hon. Friend has done for her constituents, both in public and in private. I commend her for that. The process that has to happen is clearly set out in what the IRP says and in my reply. There must be full consultation. There will be changes to the way in which services are provided, but they will be changes made in the interests of patients. Whatever those changes are, A and Es will remain at those two hospitals.

[Heidi Alexander (Lewisham East) (Lab)]

It is a bit rich for the Secretary of State to accuse the Opposition of being desperate when he has been told by the court not once, but twice that he acted unlawfully in relation to Lewisham. The Secretary of State’s amendment to the Care Bill would enable him to do to other hospitals what the courts said yesterday he could not do in south London. Will he admit that under those changes no hospital would be safe, and that in fact he wants to inflict the blatant injustice that he tried to inflict on Lewisham on hospitals not only across London, but up and down the country?

[Mr Hunt]

I understand why the hon. Lady is rightly representing the concerns of her constituents, but she must also understand that I have to look at their interests as patients, as well as at the interests of the broader south London population. It is important to make that amendment to the Care Bill because hospitals are not islands on their own. We have a very interconnected health economy, and what happens in Lewisham has a direct impact on what happens in Woolwich and vice versa. If we are to turn around failing hospitals quickly—something that the last Government sadly did not do—we need to have the ability to look at the whole health economy, not at problems in isolation.

[Mr Lee Scott (Ilford North) (Con)]

Will my right hon. Friend look again at Barking, Havering and Redbridge trust? As he knows, the difficulties that Queen’s hospital has had simply meant that, in its own admission, it would not be able to cope without an A and E at King George hospital for many years to come.

[Mr Hunt]

I commend my hon. Friend for raising this issue with me consistently. I know his very real concern is to make sure that when those changes are made they do not have an adverse impact on his constituents. I will go back and make absolutely certain that no changes will be made until it is certain that they are clinically safe.

[Jim Dowd (Lewisham West and Penge) (Lab)]

Why does the Secretary of State find it so difficult to realise that he is not above the law? Both the Court of Appeal and the High Court have made it plain that his flagrant disregard for the law in trying to destroy Lewisham hospital cannot stand. Why does he not have the decency to abandon his proposals; apologise to the people of Lewisham and the staff and users of Lewisham hospital; and share his humiliation with the Leader of the House, the previous Secretary of State, who launched this illegal programme in the first place?

[Mr Hunt]

There is no humiliation in doing the right thing for patients, and I will always do that. Sometimes it is difficult and we have battles with the courts, but no one is above the law. I have said that I respect the judgment made by the court yesterday, and that is what I shall do.

[Mr David Burrowes (Enfield, Southgate) (Con)]

Are there not three lessons to learn from the Secretary of State’s statement and the response from the shadow Secretary of State? First, we should listen to the opinions of local doctors. Secondly, delay puts at risk patient safety. Thirdly, we should not play politics. For Enfield, is it not the case that we should recognise that local doctors have united to say that we need to get on and implement changes, because delay would put at risk patient safety this winter, not least at our new, expanded North Middlesex hospital in Enfield? The future of Chase Farm is secure, but it could also be put at risk if we do not allow the implementation of good changes. We should not play politics, but Enfield council is doing so by trying to challenge the changes.

--- Later in debate ---

[Mr Hunt]

As so often, my hon. Friend speaks wisely. It is very important that in all this we do the right thing for patients. My view on all these big changes is that once we have decided what to do, it should be done as quickly as possible, but within the bounds of what is clinically safe. It is very important that safeguards are in place and I would always follow the advice of local doctors as to the right moment to proceed with an important change in safety.

[Stephen Timms (East Ham) (Lab)]

Will the Secretary of State commit to doing better against the four-hour A and E waiting target in London in the future? Will he put on the record today his acknowledgement of the value of the contribution being made by those A and E units—too few at the moment—that are doing well against that target at the moment?

[Mr Hunt]

There are a number of hospitals that are doing extremely well, and we are doing everything we can to support those that are in difficulty. I absolutely recognise how hard front-line NHS staff are working: we are working with them in an incredibly detailed way on a hospital-by-hospital basis, not just in London but across the country, to see what additional support we can give to people as we go through a difficult winter. We have already announced £250 million of support for the third of trusts in the greatest difficulty, and we are looking at what other, non-financial means we can use to support other trusts. The search continues, because we recognise how challenging winters are for the NHS under this Government as under previous ones.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

Given the difficult legacy of the financial arrangements in London and south-east London in particular, and the Court of Appeal judgment yesterday, will the Secretary of State give an assurance that in future decisions will have the support of GPs in the areas affected; will not put at risk other viable and successful parts of the London health family; and will not suddenly impose new management structures and create huge disruption—for example, at King’s College hospital, Guy’s hospital and St Thomas’s hospital—as London health partners appear to be suggesting?

[Mr Hunt]

I certainly agree with two of the three points. I do not think it is credible to say that we will not make any changes to the NHS, even if they are in the interests of patients, unless there is unanimous support from local GPs. The reality is that that would always be difficult to achieve. We would end up with paralysis, which would be against the interests of patients. However, I do think that GPs should be in the driving seat and be the advocates of these changes, and we should listen to them above all people on whether to proceed with the changes. The whole purpose of the Government’s reforms to the NHS is to create less bureaucracy not more, so I would be concerned if there was any suggestion that more was being created.

We must always ensure that changes do not have an adverse impact on successful neighbouring areas. However, we need to encourage all areas to work together, because we have an interconnected health economy, particularly in London.

--- Later in debate ---

[Mr Speaker]

Order. The hon. Gentleman has had his say and we are grateful to him.

[Mr Hunt]

I am disappointed that the hon. Gentleman is disappointed. I am interested to know what his definition of “totally ignored” means, because we have decided that we will not close Ealing A and E, and that is a big decision. With respect to how his constituents feel, I completely understand that many people will be nervous about any changes. I hope he will become a big advocate of these changes, because his constituents will be among the first in the country to have seven-day access to GPs and a seven-day NHS, which means there will not be a higher mortality rate for admission to hospitals at the weekends and that there will be 24/7 consultant obstetric cover for people who need it when giving birth. They are big and important changes that will benefit his constituents.

[Mr Speaker]

Order. I should just say to the House, almost as a courtesy, that I am prioritising London Members. However, non-London Members should take heart. If they exercise their knee muscles they may have an opportunity in due course.

[Paul Burstow (Sutton and Cheam) (LD)]

The hon. Member for Hackney North and Stoke Newington (Ms Abbott) was absolutely spot on in her question to the Secretary of State, not least with regard to variability and accessibility of GP services. A few months ago, I asked him whether he would make it a requirement for plans to expand out-of-hospital care to be in place before hospital changes occur. Can I take it from his statement that it is his intention that, when recommendations from the Independent Reconfiguration Panel are before him, he will require plans to build capability for community health services and primary care services to be in place before they go ahead?

[Mr Hunt]

The right hon. Gentleman campaigns assiduously for his constituents. I recognise that there are worries about potential changes in his constituency, an issue he often raises. Yes, we must ensure, if there are transitions or changes, that proper plans are in place to ensure they can be made safely. If he reads the report, he will derive a great deal of comfort from the stress the IRP puts on the necessity of having proper alternative provision in place before any changes are made.

[Ms Karen Buck (Westminster North) (Lab)]

The Secretary of State’s statement has left us even less clear than we were on the implications for hospital services for Westminster residents. Frankly, that is quite an achievement. Planned non-emergency hospital services have already moved away from St Mary’s Paddington to pre-empt the closure programmes that he is now telling us will not happen. That was done on the basis that St Mary’s would become the premier emergency hospital for west London, so where does that leave the provision of additional emergency services? Will that leave my constituents having to travel to Hammersmith, Ealing and Central Middlesex hospitals for their treatment, something the local authority was not even consulted on? Many GPs did not even know where their patients were being treated.

[Mr Hunt]

I hope that I have provided clarity by saying that there will remain an A and E at Ealing and Charing Cross, and that I support what the report says, which is that there should be five major A and E centres, of which St Mary’s Paddington will probably become the most pre-eminent trauma centre in the country. This is a big step for the hon. Lady’s constituents who use St Mary’s, and I think that they will be pleased with what I have said today.

[Mary Macleod (Brentford and Isleworth) (Con)]

I congratulate the Health Secretary on his important announcement regarding the A and Es at Charing Cross and Ealing. My constituents in Chiswick will feel reassured about the ongoing service at Charing Cross, and I thank him for that. Does he agree it is important that at the centre of any decision he makes about health care are improved patient care and saving lives across London?

[Mr Hunt]

My hon. Friend is absolutely right. When the dust settles on these decisions—there is rightly so much local passion, concern and uncertainty relating to hospitals, such as Charing Cross, which has a great tradition—what people will notice is whether their local NHS services are getting better. I am afraid that one of the legacies from the previous Government was the abolition of named GPs in 2004 and a sense that it has become more difficult to access one’s local GP. The proposals mean that her constituents will be some of the first in the country to have seven-day GP services, a big step forward that her constituents will welcome.

[Jeremy Corbyn (Islington North) (Lab)]

Will the Secretary of State give me an assurance, following the huge debate that took place over the future of the A and E department of the Whittington hospital—and, by extension, the neighbouring Royal Free hospital—that its future is secure and that he will not try to reconfigure services once again in north London? Does he recognise that during that debate, my right hon. Friend the Member for Leigh (Andy Burnham), who was then Secretary of State, intervened to assure the future of the Whittington A and E department? I would like the same assurance from the Secretary of State, if that is possible.

--- Later in debate ---

[Mr Hunt]

I think the best reassurance I can give the hon. Gentleman is that, unlike when the Labour party was in power, the Secretary of State does not sit behind his desk planning reconfigurations in every part of the country. This is a locally driven process. We have put in place safeguards to ensure that, where there is a reconfiguration proposal from a local NHS, it meets certain criteria. It has to be supported by local GPs and there has to be proper engagement with the public. If his constituents are worried, I hope they will take heart from the thoroughness of the process that has happened today. It is the right process and a good process, and it will lead to better outcomes for the people involved.

[Mr Brian Binley (Northampton South) (Con)]

My own general hospital, in keeping with many throughout the country, has come in for unfair criticism owing to the increasing pressures exerted on its A and E department. What does the Secretary of State think has caused those pressures, and will he reassure my constituents by telling us what he is doing to help relieve A and E departments?

[Mr Hunt]

My hon. Friend is right to draw attention to the pressures. I am sure that most A and E departments, including his own one in Northampton, would say that the biggest single cause has been the increase in the frail elderly population and the inadequacy of the care those people receive outside hospital. We are trying to put that right by having named, accountable GPs responsible for out-of-hospital care, reversing the historic mistake made in 2004, when that personal link between GP and patient was abolished.

[Barry Gardiner (Brent North) (Lab)]

This decision is devastating for my constituents. The Secretary of State will know that in the last winter period, Northwick Park hospital and Central Middlesex hospital, which comprise the North West London Hospitals Trust, were the worst-performing hospitals when it came to meeting A and E targets not only in London, but in the country. The trust scored 81.03%. That is an appalling record. What he has done today, by announcing the almost immediate closure of Central Middlesex, can only make that much worse. The College of Emergency Medicine has said that his reconfigured hospitals should have at least 16 consultants in their emergency departments, but his decision will give them 10—and that is not for major trauma centres. Will he elaborate on what he will do to bring the number of consultants up to the level required by the college?

[Mr Hunt]

Has the hon. Gentleman, who is so against these proposals, not noticed the proposals for more emergency care doctors, more critical care doctors and more psychiatric liaison support for A and E departments, which will reduce pressure on A and Es and mean that people admitted through A and Es for emergency care will not have a 10% higher chance of mortality if they are admitted at weekends? His constituents will be among the first to benefit from that. I would caution him, therefore, against saying that this is devastating for his constituents. We were reminded in Prime Minister’s questions earlier of how Labour suffered from predicting massive job losses, when in fact there was an increase in jobs. This announcement is good news for the hon. Gentleman’s constituents, and he should welcome it.

[Sir Tony Baldry (Banbury) (Con)]

Does my right hon. Friend agree that, difficult though it may be, all NHS trusts will have to live within their budgets, because, with both Front Benches effectively having agreed public spending limits for several years to come, the amount of money that can be spent on the NHS will be finite whoever is in government?

[Mr Hunt]

My hon. Friend speaks wisely. Let us bear in mind the challenges facing north-west London, which are similar to those across the country, including in Oxfordshire. In the next two decades, its population is predicted to increase by 7%, and life expectancy has risen by three years in the last decade alone. Furthermore, the uncertainty over public finances means that the trust cannot bank on substantial increases in the NHS budget, so it has to do the responsible thing and look for better, smarter, more efficient ways to use that money to help more people. It has been brave and bold in doing this, and I think that many other parts of the country will take heart from what has happened today and come forward with equally bold plans.

[Stephen Pound (Ealing North) (Lab)]

Your House, Mr Speaker, is being made dizzy this afternoon by the surfeit of spin we are suffering. We are being asked to believe that this benevolent Government are partly motivated by a desire to end uncertainty. The death sentence ends the uncertainty of life, but it is not necessarily something I would recommend. Will the Secretary of State please provide a little information about what exactly a different shape and size A and E department looks like? The people of Ealing deserve to be told precisely what it means, otherwise they will think the worst.

[Mr Hunt]

I hope the hon. Gentleman will be pleased that today the death sentence on A and E at Ealing has been not just reprieved, but cancelled; it will keep its A and E. The definition of A and E is not something that politicians decide. We said in the statement that what the A and Es at Ealing and Charing Cross contain must be consistent with Professor Sir Bruce Keogh’s review of A and E services across the country, which they will be, and that any changes made in service provision must have full consultation with his constituents, which will happen. On the basis of an IRP report that simply says, “More work needs to be done,” I cannot answer all his questions, but I hope I can give him greater certainty than he had this morning that there will be an A and E for his constituents in Ealing.

[Dr Sarah Wollaston (Totnes) (Con)]

Clinically led, evidence-based changes to services save lives. That is straightforward and clear. It is also clear that we have to make these changes happen if we are to live within our means and the health service budget. How are we going to make reconfigurations such as this one more straightforward, because the cost and time are unacceptable? Likewise with mergers, how are we going to streamline this process?

[Mr Hunt]

My hon. Friend speaks wisely. It concerns me, as it does her, that these processes take so long. When it comes to changes in A and E and maternity services, exhaustive public consultation is necessary, because they cause such great public concern, but we also need to deal with these issues in a much more timely way, particularly when it involves sorting out the problems of failing hospitals. I agree with her, therefore, and I am looking at what can be done to speed up all these processes, while retaining the appropriate consultation with the public.

[Lisa Nandy (Wigan) (Lab)]

Does the Secretary of State have any idea of the concern he is causing up and down the country? In Wigan, we value our 24-hour A and E service; we do not want it downgraded, and we do not want it closed. Will he clarify his proposal for the future of Ealing A and E? Is he proposing a type 1 service? Also, will he give me a cast-iron guarantee that any future decision about our local hospital will be made on the basis of people’s lives, not cost?

[Mr Hunt]

I can assure the hon. Lady that decisions about the future of A and Es will be based on what is best for patients and on what will save lives and get the best outcomes—that will apply in her constituency, as it will in mine and every other constituency—but that will sometimes mean a difficult decision if we have a change that doctors strongly support, but about which members of the public are anxious. I have said that services at Ealing will change, but that there will be proper public consultation and that at the end of the process there will still be an A and E. The recommendation from the process was that the A and E should close, but I said, “No, I think there should be an A and E at the end of the process.” I am injecting that much certainty, therefore, but I am not going to micro-manage the local NHS by saying precisely what those services should be.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

It is not only A and E units in London that are under pressure; Derriford hospital’s A and E unit is also under pressure, because of our night-time economy. Is my right hon. Friend willing to meet me and potentially representatives from the English Pharmacy Board and my own Devon pharmacists to discuss how they can help to relieve some of the pressure on A and E units, especially down in Devon?

[Mr Hunt]

I would be more than happy to meet my hon. Friend and his local pharmacists. There is a lot that pharmacists can do. One change we are making that could make a big difference, where proper protections are in place for patients, is allowing pharmacists to access GP records so that they can give people the correct medicines, know about people’s allergies and things like that. There are lots of other things as well, though, and I look forward to the discussion.

[Grahame M. Morris (Easington) (Lab)]

The statement has broader implications beyond London, although I accept that colleagues from Islington and Ealing want to ensure they have their A and E facilities. On smaller A and E facilities outside London, however, the Secretary of State said there would be no political fixes, yet when he announced additional moneys to deal with winter pressures on 53 NHS trusts, there were none in the north-east of England. What assurance can he give my constituents that hospitals in the north-east will have sufficient resources to meet the demands placed on them in winter?

--- Later in debate ---

[Mr Hunt]

The decision on where to allocate the extra help was based on where the need was greatest, and it was taken not by Ministers, but on the basis of recommendations from people working in the NHS and dealing with these problems. They chose the 53 local health economies where they thought the pressures were greatest. The fact that nowhere in the north-east was selected indicates that A and E performance is better in the north-east of England than in other parts of the country.

[Steve Rotheram (Liverpool, Walton) (Lab)]

When the Secretary of State is not leading the smear campaign against my right hon. Friend the Member for Leigh (Andy Burnham), he is continually being dragged into the Chamber to react to events that he should be in control of. When will he finally get a grip on the problems in our A and Es across the country?

[Mr Hunt]

I completely reject what the hon. Gentleman says. There are 1.2 million more people using A and E every year than there were under the last Government, yet people are waiting for a shorter time, with more people being seen within the four-hour target. But we are doing something else. We are addressing the long-term problems of A and E, including the patent failures of the last Government over the GP contract, social care integration and the working time directive. All those things have made the pressures worse, but we are sorting them out.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

12. What recent progress he has made on improving the performance of hospital trusts placed in special measures.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Significant progress has been made at all 11 trusts placed in special measures in July, including changing the chair or chief executive officer and recruiting more nurses in every single one them and partnering each of them with a high-performing hospital so that they can make rapid progress in turning things around.

[Martin Vickers]

I thank the Secretary of State for his reply. He will be aware of my constituents’ concerns about services at Diana, Princess of Wales hospital in Grimsby. There are doubts about the future of the stroke unit and high mortality rates, and there are also problems with the East Midlands ambulance service. Will the Secretary of State give an assurance that he is satisfied that progress is being made at the hospital?

[Mr Hunt]

I think good progress is being made and I commend my hon. Friend for his campaigning on the issue. The trust concerned has introduced better privacy for patients, hired 154 nurses since the Keogh report and introduced electronic vital signs reporting at the bedside—all because we are being transparent and open about problems in the NHS and not sweeping them under the carpet.

[Andrew Bridgen]

Burton hospital, which serves part of my constituency, was one of the 11 hospitals placed in special measures following the Keogh report. Will my right hon. Friend assure my constituents that the improvements needed in those hospitals will be carried out in a culture of openness and transparency rather than one of opaqueness and cover-up, which so unfortunately typified the way in which the previous Government ran the NHS?

[Mr Hunt]

I know that my hon. Friend takes a very close interest in what happens at his hospital and I think that progress is being made in turning it around. What will be of concern to my hon. Friend is that, as far back as 2005-6, Burton’s mortality rate was 30% higher than the national average—it was even higher than that at Mid Staffs—and yet the problem was not sorted out. We are sorting it out.

[John Stevenson]

As the Secretary of State is aware, North Cumbria trust is in special measures. We have on our doorstep a potential solution to our problems, namely Northumbria trust. Will the Secretary of State give me an assurance that everything possible will be done to get North Cumbria out of special measures at the earliest opportunity and, much more importantly, that every support will be given to Northumbria in is acquisition of North Cumbria?

[Mr Hunt]

I can give my hon. Friend both assurances because Northumbria has been doing a huge amount to help North Cumbria turn itself around, including installing its patient experience systems to ensure that patients are treated with the dignity and respect that they deserve. The problems have been around since 2007 and he can tell his constituents that we are finally turning them around.

[Stephen Metcalfe]

As my right hon. Friend will be aware, Basildon university hospital in my constituency is one of the 11 hospitals that were placed in special measures following the failure of the previous Government to act on the information that they had. Will he tell the House what support the new management team, in whom I have great confidence, are receiving and when my constituents can expect to see sustained, long-term improvements?

[Mr Hunt]

I reassure my hon. Friend that the trust has hired 257 more nurses since the problems emerged this year, has better A and E processes, and has been partnered with the Royal Free in London to help it make even more progress. He will be as shocked as I am that when the Care Quality Commission identified problems at that hospital the last Government sat on the report for six months. That cannot be acceptable.

[John Healey (Wentworth and Dearne) (Lab)]

How can NHS patients and staff have any confidence in decisions about their local services when they are taken by the Competition Commission on the overriding grounds of what is best for a competitive market and not what is best for patients? Will he learn from the failure of the merger between the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and the Poole Hospital NHS Foundation Trust, and take merger off the table as an option for Rotherham hospital?

[Mr Hunt]

May I reassure the right hon. Gentleman that the competition authorities make their decisions based on what is in the best interests of patients and do not hold competition as an overriding ideology? He is right that we need to work closely with those authorities to ensure that they have the expertise to take decisions in the right way and with trusts to ensure that they have the expertise to ensure that they do not stumble when they go through those processes.

[Jenny Chapman (Darlington) (Lab)]

How can the public have confidence in their health service when police officers are taking patients who are sick and injured to A and E because ambulances are backed up outside A and E and take longer than an hour to arrive?

[Mr Hunt]

I will tell the hon. Lady why the public can have confidence in their health service: compared with three years ago, on broadly the same budget, the NHS is doing 800,000 more operations year in, year out; MRSA rates have halved; and the number of people who wait for a year or longer for operations has gone down from 18,000 to fewer than 400.

[Clive Efford (Eltham) (Lab)]

Will the Secretary of State explain why we have had a summer crisis in A and E? We are all used to the emergency services being overwhelmed in winter. Given the crisis that we have had, what will he do to assist the NHS in averting a winter crisis this year, rather than just blaming everybody else?

[Mr Hunt]

The figures for September, the last month of the summer, were 95.8% in England and 90.6% in Wales. It was not coalition-controlled England that had a summer A and E crisis, but Labour-controlled Wales.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Secretary of State for Health is clearly not adequately monitoring performance. If he was, he would be aware that serious problems remain across the accident and emergency departments of the trusts that were placed in special measures by Professor Sir Bruce Keogh. On his watch, the A and E performance at eight of the 11 trusts has got worse since Keogh reported, including at my hospital in Tameside. The A and E performance has got substantially worse at East Lancashire Hospitals NHS Trust, where the number of patients waiting for more than four hours has doubled since Keogh reported, and at Medway NHS Trust, where the figure has quadrupled. When will he stop all the grandstanding, cut the spin and get a grip on his A and E crisis?

[Mr Hunt]

I hope that the hon. Gentleman will be pleased that something is happening under this Government that did not happen under the Labour Government: we are putting those hospitals into special measures and sorting out the problems, including the long-term problems with A and E such as the GP contract—a disaster that was imposed on this country by the Labour Government.

[Andrew George (St Ives) (LD)]

6. What the current (a) highest, (b) lowest and (c) mean average registered nurse-to-patient ratio is on acute hospital wards.

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[Alun Cairns (Vale of Glamorgan) (Con)]

10. What steps his Department is taking to promote a culture of openness and transparency across the NHS.

[The Secretary of State for Health (Mr Jeremy Hunt)]

We need to change the culture of the NHS so that where there are problems with care or safety, people feel able to speak out. The Government have banned gagging clauses, they are introducing a statutory duty of candour, and they have for the first time published surgery outcomes for 10 specialties by consultant.

[Alun Cairns]

I commend the Secretary of State for his transparency agenda, which has uncovered previously untold horrors. What more can he do to ensure that in future no Minister can ever cover up failure in the NHS?

[Mr Hunt]

I know this is difficult territory for the Labour party, but the most important thing is for regulators to feel that they can speak out about poor care without fear or favour. I am afraid that did not happen under the previous Government, so let me just—

[Mr Speaker]

Order. I told the Secretary of State privately before, and I say it publicly now, that if he intends to devote part of his answer to talking about what happened under the previous Government, he can abandon that plan now and resume his seat. I suggest he resumes his seat.

[Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)]

As part of this openness and transparency, will the Government improve their relations with the police and prison services, so that we can have a clearer idea of why people with mental illnesses are spending time in police cells or being sent to prison?

[Mr Hunt]

I am pleased to tell the right hon. Gentleman that we are working closely with the police to try to ensure that some of the people held in police cells are given much faster access to mental health services. That includes a street triage pilot, which has had early and promising results.

[Charlotte Leslie (Bristol North West) (Con)]

I was informed this morning that the chair of the NHS property board has resigned. That follows the revelation last week, through parliamentary questions I asked, that the board has been raiding its capital allocation to subsidise its own revenue funding. In the interests of transparency, will the Secretary of State undertake to review and publish the recruitment and employment procedure of executive and non-executive members of the board—including civil servant Peter Coates who created the board, which oversees £3 billion-worth of assets—and conduct careful audit and scrutiny of the board’s accounts and minutes?

[Mr Hunt]

Obviously, the suggestions my hon. Friend makes are extremely serious. If she lets me have a copy of all the things she is directly concerned about, I will look into it with the greatest priority.

[Mr Jamie Reed (Copeland) (Lab)]

With regard to openness and transparency, the Secretary of State’s failure to extend the Freedom of Information Act to private providers delivering NHS services is fostering a culture of secrecy. As he forces clinical commissioning groups to tender more services to the private sector, and if he truly believes in openness and the independence of health regulators, will he follow the clear advice from Monitor and extend FOI legislation to private providers, or is he content to allow them to continue to withhold information from patients?

[Mr Hunt]

When it comes to transparency about care, there should be an absolute level playing field between private providers and NHS providers. To answer the hon. Gentleman’s question on regulators, what this Government are going to do, Mr Speaker, is ensure that the Care Quality Commission has statutory independence so that no Government can ever try to interfere with the processes of reporting poor care.

[Mrs Linda Riordan (Halifax) (Lab/Co-op)]

11. Whether he plans to close all or part of Calderdale Royal hospital’s accident and emergency ward.

--- Later in debate ---

[The Secretary of State for Health (Mr Jeremy Hunt)]

While always paying regard to the superb job done by most doctors, we should allow no hiding place for doctors who endanger patients’ lives by irresponsible or careless behaviour, which is why we have asked the Law Commission to come up with proposals to speed up General Medical Council investigations. We are also considering a new criminal offence of wilful neglect, as recommended by Professor Don Berwick.

[Priti Patel]

The cancer diagnosis of my constituent, Mrs Julia Wild, was delayed by nine months because of a mistake by the initial doctor at her first assessment. For four years, she has been fighting for an apology, for transparency and for the doctor to acknowledge what went wrong with her case. What can Mrs Wild, and other patients in the NHS who have had similar experiences, do to ensure that their complaints are taken seriously, that these life-changing mistakes are acknowledged and that the individuals responsible are held to account?

[Mr Hunt]

My hon. Friend speaks extremely well and I fully understand her concern about Mrs Julia Wild and the care she received. I cannot second-guess the clinical judgment of the GMC, but I agree that Mrs Wild is owed an apology. If the local NHS will not give it, I will give it now. We should have spotted the advanced lobular cancer and I apologise to her that we did not.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

On Friday I visited Cruddas Park surgery in my constituency to see the fantastic work that doctors and staff are doing in the face of huge levels of unmet need, health inequalities and rising mental health issues. If we hold doctors to account for their mistakes, is it not right that they should be able to hold Ministers to account for taking millions of pounds out of their funding and then telling my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) that it was nothing to do with him?

[Mr Hunt]

Doctors should be able to hold Ministers to account, as should the public. That is why they will be pleased to know that we protected the NHS budget, and did not follow the advice of the right hon. Member for Leigh (Andy Burnham), who wanted it cut from its current levels.

[Mr Crispin Blunt (Reigate) (Con)]

While we are always of course keen to hold doctors to account for their mistakes, I trust that we will be equally keen to reward them for examples of really good practice, such as those my right hon. Friend will see on Thursday when he makes his very welcome visit to the East Surrey hospital. I commend to him the work of Dr Ben Mearns and his emergency and acute team, who demonstrate good practice and also make it transparent to the rest of the national health service.

[Mr Hunt]

I am greatly looking forward to visiting my hon. Friend’s hospital on Thursday and going out on the front line. I agree that we need to celebrate success. This has been a difficult year for the NHS as we have learned to be much more transparent about problems when they exist, but one of the advantages of having a chief inspector is that his team will be able to identify and recognise outstanding practice, so that everyone will understand that, as well as some of the problems that get more attention, brilliant things are happening throughout our NHS.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Is the Secretary of State comfortable with a surgeon such as Ian Paterson flitting between the NHS and the private sector, making the same blunders in both but being subject to different levels of accountability and his victims having access to different levels of redress?

[Mr Hunt]

As I said in response to an earlier question, the responsibility to be transparent about care should apply equally in the public and the private sector. Obviously, in the public sector we have more levers, because we are purchasing care and we can impose more conditions than it is possible to do in the private sector. The most important thing is to have a culture in which such problems come to light quickly when they happen, so that they are dealt with and not repeated.

[Mr John Baron (Basildon and Billericay) (Con)]

15. For what reasons the publication of data on one-year and five-year survival rates for all cancers within the Clinical Commissioning Group Outcomes Indicator Set has been deferred until March 2014.

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[Steve Baker (Wycombe) (Con)]

16. What steps he is taking to ensure that the NHS becomes a more patient-led organisation.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The big shift we need to make is to turn the NHS into a patient-led organisation. Two measures that will help that are: independent inspections by a new chief inspector that put the patient experience at their heart; and asking every NHS in-patient if they would recommend their treatment to a friend or member of their family.

[Steve Baker]

I am encouraged by that answer. Long ago, the medical establishment was held to account by what were essentially patient-led co-operatives, and today more and more voices are asking for more patient engagement. Will the Secretary of State consider a paper brought forward by Civitas and Anton Howes calling for the incremental implementation of patient-led commissioning to close this gap?

[Mr Hunt]

No one campaigns harder than my hon. Friend on the issue of putting patients first in his constituency and throughout the NHS. CCGs have a legal obligation to involve patients in decisions about services and about them personally. The ideas in the paper he mentions are interesting, and I respect them, but given that we have brand-new commissioners and inspectors going out this year, I think we should see how the current reforms work first.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today we published a report demonstrating that the NHS could recover as much as £500 million from better systems to monitor and track those who should be paying for the NHS treatment and introducing new charges to certain categories of people currently exempt. This is a significant sum of money that could fund 4,000 doctors, and far from being xenophobic, as some in the Opposition have alleged, the Government believe it is right that overseas visitors who do not pay for the NHS through the tax system should make a fair contribution through charges.

[Annette Brooke]

Poole hospital, which is much loved locally and has excellent care ratings, has a financial problem relating to tariffs that must be addressed. The £5 million spent on putting a failed case for a merger between Bournemouth and Poole hospitals to the Competition Commission raises questions about processes and openness with the public. I hope the Secretary of State can make some comments today, but will he meet me and other local MPs to discuss all these issues in greater detail?

[Mr Hunt]

I am happy to do so. I want to make it clear to my hon. Friend that I am keen to ensure we have a structure inside the NHS that makes it easy for high-performing hospitals that want to work more closely together and share services to do so, if it is in the interests of patients. We need to do more work in this area.

[Andy Burnham (Leigh) (Lab)]

The Secretary of State has been in post for a year, and in that time we have got used to his style: everything is always someone else’s fault, be it lazy GPs, uncaring nurses or the last Government. And today we see more diversion tactics—now immigration is to blame. But there is an inconvenient truth that gets clearer day by day and which he cannot spin away: A and E is getting worse and worse and worse on his watch. We have had ambulance queues, a treatment tent in a car park and now police cars doubling as ambulances, with a patient dying on the backseat. The NHS stands on the brink of a dangerous winter. Will he today set out in detail what he personally is doing to avert a crisis?

[Mr Hunt]

I welcome the right hon. Gentleman back to his place. It is a great pleasure to see him there, even if it is not entirely what the Labour leader wanted.

If the right hon. Gentleman is shocked that I breached the A and E target for one quarter last year, he will want to make a full apology for the fact that he breached it for two quarters when he was Health Secretary.

[Andy Burnham]

This complacent spin is no good to the NHS. If he wants to compare records, let us do that. Under me, 98 per cent. of people were seen within four hours; under him, over 1 million people in the last year waited more than four hours in A and E—not only a winter crisis, but the first summer A and E crisis in living memory. Today it gets worse. New figures this morning show a further 450 nursing jobs have been cut, taking the total close to 6,000 under this Government. But what were they doing last night? They were voting in the Lords against safe staffing levels. Will he now listen to the experts, stop the job cuts and take immediate action to ensure that all A and Es have enough staff to provide safe care this winter?

[Mr Hunt]

We will listen to no one on the Opposition Benches when it comes to safe care for patients in the NHS. They presided over a system where whistleblowers were bullied, patients were ignored and regulators felt leaned on if they tried to speak out about poor care. That is a record to be ashamed of.

[Mark Pawsey (Rugby) (Con)]

T5. There is evidence that a nutritional meal can be a real aid to the recovery of patients, yet the Campaign for Better Hospital Food found that 82,000 hospital meals are thrown in the bin every single day. Will the Minister update the House on the steps being taken to ensure that patients receive a hot balanced meal, served at an appropriate time?

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[Toby Perkins (Chesterfield) (Lab)]

T4. My constituent Jemma Hill is 25 and suffers from chronic hip pain, for which a specialist has recommended hip arthroscopy surgery. However, she has now been told that her local clinical commissioning group does not fund such treatment. Does it not make a mockery of GP-led commissioning when a CCG will not fund the treatment recommended by a specialist to whom the GP referred my constituent in the first place?

[Mr Hunt]

I am very happy to look into that matter, because it sounds like a very deserving case. I will look into the details carefully if the hon. Gentleman gives me the relevant information.

[Jason McCartney (Colne Valley) (Con)]

T8. Does the Secretary of State agree that we need to learn from the mistakes of the Safe and Sustainable review of children’s heart surgery services and improve the forthcoming review in two ways? First, we should make the process a lot more transparent. Secondly, areas such as neo-natal, paediatric and adult intensive care unit services and transport and retrieval services should fall within the scope of the new review.

--- Later in debate ---

[John Glen (Salisbury) (Con)]

T10. Dr Elizabeth Stanger, a highly respected Salisbury GP, recently questioned me about the sustainability of providing multiple treatments for complex medical problems for several generations of the same family of foreign nationals. I welcome today’s announcement, and ask the Minister to reassure me that the mechanism to recover the funds will ensure that the money goes back to the clinical commissioning group so that it can provide a benefit locally.

[Mr Hunt]

I absolutely can reassure my hon. Friend about that. The point about the new, improved system for recovering charges is that we want the money to go back to the people providing the services so that they will be able to resource them better. This is not the diversionary tactic that some have accused us this morning of introducing; £500 million could have a huge impact on the NHS front line and allow his GPs to do a much better job.

[Kate Green (Stretford and Urmston) (Lab)]

This evening, the joint health overview and scrutiny committee for Trafford and Manchester will meet to consider whether the preconditions for the reconfiguration of services in Trafford, including those set down by the Secretary of State, have been met. I understand that the NHS area team has already confirmed that it believes the conditions have been fulfilled, but will the Secretary of State tell me what would happen if, as seems possible, the scrutiny committee were to take a different view tonight and decide that not all the conditions had been met?

[Mr Hunt]

We will obviously respect the legal processes, but if the scrutiny committee were to take such a view tonight, we would certainly look very closely at its concerns and ensure that we had satisfied ourselves on them before proceeding.

[Duncan Hames (Chippenham) (LD)]

A written answer from the former Minister, my hon. Friend the Member for Broxtowe (Anna Soubry), to my recent parliamentary question has on this subject revealed that people living in the south-west of England are three times as likely to contract Lyme disease as those in the rest of the country, yet I have a constituent doing what he calls drug runs to the rest of Europe to access the medicines necessary to tackle his symptoms. Will the Minister meet me to discuss how we can ensure the continuing availability of treatments for Lyme disease on the NHS?

--- Later in debate ---

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

When the Secretary of State meets the chairman of NHS England to discuss future priorities for NHS spending, will he ensure a fair deal for rural areas by ensuring that they reflect rurality, sparsity and the number of elderly patients and that we keep the minimum income guarantee for rural GP practices?

[Mr Hunt]

I can reassure my hon. Friend, as I am meeting some Yorkshire GPs later this week who have concerns about that very issue. The most important thing about the difficult issue of the funding formula is that it should be fair. That is why under the new legislation we have given the decision to an independent body so that it is taken at arm’s length from Ministers and so that it strikes the right balance between the issues of rurality, age and social deprivation.

[Hazel Blears (Salford and Eccles) (Lab)]

The NHS, with its massive purchasing power, can make a real difference to local areas through jobs and through supply chains. Some hospital trusts are enthusiastically implementing the Public Services (Social Value) Act 2012, including Barts and King’s. Will the Minister ensure that his new procurement strategy recognises the importance of social value?

[Tim Loughton (East Worthing and Shoreham) (Con)]

The Secretary of State knows Worthing hospital well; he has rolled his sleeves up there. When I went there a few weeks ago, I was told that the average age of patients in the hospital, stripping out maternity, is 85, yet we have qualified for no winter pressures money and we have a diminishing number of community hospital beds. Will he look into this anomaly, as he well knows the specific pressures we have on the south coast?

[Mr Hunt]

I understand my hon. Friend’s concerns and I know that there is a large elderly population in Worthing. I thought it was an excellent hospital with a fantastic atmosphere when I went and did part of a shift there. The winter pressures money went to the third of A and E departments that are struggling the most, so it is probably a compliment to his hospital that it did not receive it. We felt that with limited funds we had to concentrate resources where they were going to have the most impact. I hope that he understands why we had to make that difficult decision.

[Joan Walley (Stoke-on-Trent North) (Lab)]

This week, the report of the trust special administrator in respect of Stafford hospital is being presented to Monitor. Given that the preferred option is that the University Hospital of North Staffordshire should in some way take over, will the Secretary of State urgently meet all Members of Parliament for the north Staffordshire area to ensure that health care in north Staffordshire, where we already have a deficit of £31 million with an extra £18 million set to come over, will not be destabilised?

[Mr Hunt]

We are acutely aware of those concerns. In any reconfiguration, and particularly in this one, we want to ensure that there is no instability in the local health economy. We have given the trust special administrator a little longer to come up with a plan for Stafford hospital to try to secure local agreement, so I have not had a recommendation yet and I am going to wait and see what he says.

[Several hon. Members]

rose—

Jimmy Savile (Investigations Update)

Jeremy Hunt Excerpts

Monday 14th October 2013 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I wish to provide an update on progress with the Jimmy Savile investigations relating to national health service institutions.

There are currently three main investigations under way—Broadmoor, Stoke Mandeville and Leeds General Infirmary. Kate Lampard is providing independent scrutiny of the quality and rigour of these three investigations on behalf of the Department of Health. There are also investigations taking place at a further 10 trusts.

The Metropolitan Police Service, working with Kate Lampard, has established there was further relevant information regarding Jimmy Savile. The Department of Health asked the Metropolitan Police Service, through an agreed information-sharing process, to review information it held to ascertain if it included material related to health and care settings.

This review is still ongoing. We understand the material includes information about hospitals where investigations are already under way, and reference to other hospitals. Once this review is complete, the information will be passed on to the relevant trusts or investigations as quickly as possible. I will then issue another written statement, including the names of any other hospitals involved.

Although all 13 investigations are currently on track, this additional material means that the timetable will be affected. It is vital that the final NHS investigation reports are thorough and complete, and reflect all the evidence about Jimmy Savile’s pattern of offending. The final reports of all the investigations will now aim to be completed by June 2014, with publication sooner if that is possible.

Information Sharing (Caldicott Review)

Jeremy Hunt Excerpts

Thursday 12th September 2013 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today I am publishing the Government’s response to Dame Fiona Caldicott’s review of information sharing. This review was recommended by the Future Forum on information which reported in January 2012.

I am grateful to Dame Fiona and her panel and to the many people who provided valuable input into her review. Building on the wealth of experience, viewpoints and insights gained through the review and the preceding NHS Future Forum’s work, this document sets out the overall ambition and actions to transform how our health and our care services use and share information to the benefit of patients and service users.

For citizens, patients and users of care services, this response sets out how a new approach to information sharing across health and care can support more joined up, safer, better care for us. Dame Fiona’s review and our response look at actions for clinicians and other care professionals, managers, commissioners, councillors, researchers, and many others.

There are four key themes in the response:

patient and citizen rights—they should have confidence in how their information is handled through knowing how it is used and shared and how to object and through having access to their electronic care records;

improving sharing for direct care—appropriate and legal data sharing to drive integrated, joined-up, person-centred and safer care for people (where information governance rules have, in the past, been seen as a barrier);

improving sharing for other purposes—the importance of information for research, commissioning and public health and improving practice in this area, recognising this can only be done effectively if people are given a say in how information about them is used; and

better protection for information boards and other leadership groups will take responsibility for good information practices in their organisations, professionals will be consistent in the rules they apply and front-line staff will have improved training and education on information sharing and confidential information.

In summary, this response sets out the overall ambition and the early actions that will enable better information sharing to support our health and our care services to meet our needs and expectations, for now and the future.

“Information: To share or not to share? The Information Governance Review” and “Information: To Share or not to share, Government Response to the Caldicott Review” have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.