National Health Service Funding
Jeremy Hunt Excerpts(8 years ago)
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Jonathan Ashworth
In a few moments.
We have spotted the Secretary of State’s conjuring act because we have seen this Tory trick before—robbing Peter to pay Paul. The result of this trick is cuts and underfunding, more pressures flowing through to the frontline, and, as the NAO said,
“Financial stress…harming patient care”.
In all our constituencies we see ever-lengthening queues of the elderly and the sick waiting for treatment. Across the board, we see the worst performance data since records began.
Jonathan Ashworth
What world is the Secretary of State living in? Half a million patients have waited for four hours or more in A&E in the past three months—the worst performance for this time of year for more than a decade—and he says it is nonsense. Some 350,000 of our constituents are waiting longer than the promised time for elective treatment—some have been waiting more than a year—and he says it is nonsense. Delayed discharges from hospitals are at record levels, and he says it is nonsense. The number of people waiting for 12 hours or more on trolleys has increased by over 700% since 2011-12.
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move an amendment, to leave out from “House” to the end of the Question and add
“welcomes the Government’s investment, on the back of a strong economy, of significant additional funding and resources each year for the NHS during the 2015 Parliament; notes that this settlement was frontloaded at the specific request of the NHS in NHS England’s own plan to deliver an improved and more sustainable service, the Five Year Forward View; and further notes that the NHS will receive a real terms increase in funding in each year of the Spending Review period, while the Labour Party’s Manifesto at the last election committed to only an extra £2.5 billion a year by 2020, far less than the NHS requested.”.
As I did in last week’s debate on social care, I start by recognising the fantastic work done by NHS staff up and down the country. This autumn, I met a mental health nurse who told me how she had had to cope with the pressure of one of her patients throwing himself off a bridge the day after a consultation. I am sure that all Members have stories of the incredible dedication of NHS staff—not just people doing their jobs, but people putting their heart and soul into their work, staying late, going the extra mile, and sacrificing home time and holidays to be there for patients. As I did last week, I also recognise the 50,000 NHS staff from EU countries, including 26,000 low-paid staff, who do a brilliant job. Today we have heard concerns about funding, A&E—
Paul Farrelly (Newcastle-under-Lyme) (Lab)
Will the Secretary of State give way?
Mr Hunt
I will give way in a moment, but I just want to finish this sentence, if I may.
We have heard concerns about funding, A&E performance, waiting times and morale, and I want to answer them all. There are many pressures in the NHS, but I also want to recognise some successes, because one of the things that is most damaging to morale is not giving credit where it is due.
Paul Farrelly
Can the Secretary of State explain why he has made scores of redundancies in north Staffordshire? In my 15 years as an MP, I have never seen the local NHS in such a meltdown, with a scorched-earth policy of cuts and closures, and more to come with next year’s still-secret STP. When will the Government realise that pressures on social care and the NHS are such that those services are unsustainable without decent further funding and investment?
Mr Hunt
As the hon. Gentleman knows, those things would certainly be unsustainable if we had followed the Labour party’s investment plans at the time of the previous general election. If he wants to know what is happening to staff, let me tell him that in the period I have been Health Secretary, we have got 5,000 more doctors and 10,000 more nurses. That is what happens when we have a Government who are prepared to invest in the NHS.
The shadow Health Secretary talked about A&E—he is right to say that we are not hitting the target, and we are doing something about that—but he did not tell the House that, since Labour left office, we have recruited 1,200 more doctors for A&E departments, which is a 25% increase, including a more than 50% increase for consultants. Every day, we are seeing 2,500 more people within four hours.
Dr Rosena Allin-Khan (Tooting) (Lab)
Will the right hon. Gentleman give way?
Dr Allin-Khan
I am a junior doctor in A&E, of which the right hon. Gentleman speaks, and I can say that morale is at an absolute all-time low. We have a recruitment and retention crisis in A&E. We are losing all the fantastic staff whom we have been able to recruit because this Government are not recognising and accepting the fantastic workforce on our A&E frontline. All the doctors are leaving.
Mr Hunt
With respect, the hon. Lady might be on the wrong side of the House, because I started my speech by recognising the brilliant work done by doctors and nurses, something that the shadow Health Secretary conspicuously failed to do. Let us look at her own hospital: since 2010, St George’s has—[Interruption.] I do not know whether she is interested in hearing my response to her intervention. Since 2010, her hospital has had 884 more nurses and 240 more doctors, and her CCG had a £10 million funding increase this year.
Dr Allin-Khan
I thank the right hon. Gentleman for allowing me to speak again. I shall refer at length to St George’s hospital in my speech, but it is very unfair of him to bring it into this debate. It is because of this Government that St George’s hospital is operating at a £50 million deficit. It is because of this Government that we are now in special measures. It is—
Madam Deputy Speaker (Natascha Engel)
Order. The hon. Lady is hoping to catch the eye of the Chair later in the debate. As it is, there will be a five or four-minute time limit, so Members who intervene must do so very briefly and not very frequently. If they do not do so, I am afraid that they may not be called to speak.
Mr Hunt
The shadow Health Secretary also did not talk about cancer. In 2010, we had the lowest cancer survival rates in western Europe. Since then, we have referred for cancer tests 2,200 more people every day, and 100 more people are starting cancer treatment every day. The cancer charities say that this is saving 12,000 lives a year. On mental health, he did not mention the fact that we are treating 1,400 more people every day, with record dementia diagnosis rates.
Mr Jackson
Would not Opposition Members be a little more straightforward and honest about the wider context if they admitted the demographic challenge that this Government face, as they would have faced? The number of over-60s will increase by 50% in the next 15 years. Should they not also admit that the private finance initiative was an appalling millstone—£64 billion —to bequeath to this Government? That has had an impact on frontline care.
Mr Hunt
My hon. Friend is absolutely right to raise that point. People will be astonished to hear Labour Members wasting their time talking about a privatisation of the NHS that is not happening when they were responsible for PFI, the worst possible privatisation that has done such enormous damage.
Another point that the shadow Health Secretary did not mention was the quality and safety of care in our NHS that Labour left behind. The Francis report revealed massive problems—short staffing, a culture of denial and cover-ups—and they were not just at Mid Staffs but, as we now know, at Basildon, Morecambe Bay and many other trusts. Since we have been in office we have changed that. We have put 31 hospitals into special measures, which is more than 10% of hospitals across the entire NHS, and we have recruited record numbers of doctors and nurses.
I want to tell the House about one hospital that was put into special measures. Care was unsafe at Wexham Park in Slough—so much so that fewer than half the hospital staff were prepared to recommend the care provided there to their own friends and family—but it has gone from having six of its eight clinical areas rated as requiring improvement or inadequate, to having all eight of them rated as good or outstanding. It has come out of special measures, as have 15 hospitals in total, and we should all commend the staff who have worked incredibly hard to turn around those hospitals.
Jenny Chapman (Darlington) (Lab)
The right hon. Gentleman has the nerve to talk about the inheritance from a previous Administration, when what we inherited in 1997 was people dying on waiting lists of more than 18 months for heart operations.
Mr Hunt
I have often from this Dispatch Box been prepared to praise some of the achievements of the last Labour Government. They did bring down waiting times, but they did not focus on the quality and safety of care.
What we now know from the CQC’s new regime, which has just finished its first round of inspections, is that 56% of our hospitals are good or outstanding. One could say that it is disappointing to know that 44% of hospitals are not, but to those who would use that as a political weapon I say this: we are the only country in the world brave enough to set up an independent inspection regime, and if we want to have the safest, highest quality care, the first thing we need to know is where it is good and where we need to improve it. I thank the chief inspector of hospitals, Professor Sir Mike Richards, for his outstanding work in raising quality.
Joan Ryan
The right hon. Gentleman talks about the inspection regime, but I think I am right in saying that it was not something he and his Government introduced. The Care Quality Commission was introduced by a Labour Government, as far as I am aware. As I know from North Middlesex hospital, hospitals end up in special measures because they are underfunded and under-supported, and cannot get the doctors they need.
Mr Hunt
The right hon. Lady is right that the Care Quality Commission was set up by the last Labour Government, but it did not have independence from the Government in its inspection reports. When we legislated for that, Labour tried to vote it down. We got it through and changed the inspection system, and it is working extremely well.
I want to move on to the substance of the debate, which is about the funding of the NHS. I congratulate the hon. Member for Leicester South (Jonathan Ashworth) on his courage—indeed, his chutzpah—in confronting the issue of funding, despite inheriting a Labour policy to cut NHS funding by £5.5 billion a year by the end of the Parliament. He is right that there has never been greater financial pressure—we have had the financial crisis in 2008, the deficits and the growth in demand from the ageing population—but he must accept that that makes it all the more extraordinary that Labour wanted to cut the NHS budget in 2010 and to cut it from the current levels in 2015. I simply say that we could, as a Government, have chosen to cut NHS funding from this year’s level by £1.3 billion, as under Labour’s plans, but we would have had to lay off 11,000 doctors or 40,000 nurses.
Andy Burnham (Leigh) (Lab)
The problem with the Conservatives’ script is that they talk about NHS funding, but they completely neglect social care. There can be no debate about the fact they have cut social care every year for the last six years, taking support away from half a million older people, many of whom are now trapped in hospital beds. Greater Manchester says that it has a shortfall of about £80 million in social care; the figure is £1 billion nationally. Has the Secretary of State raised this issue with the Chancellor? Has he made an emergency bid for funding? Will there be more money for social care this year?
Mr Hunt
That is not the problem with our script; it is the problem with the right hon. Gentleman’s script, because as shadow Health Secretary he sanctioned a policy that would have given the NHS £1.3 billion less this year, and at the last election the then shadow Chancellor said he would give not a penny more to local authorities, whereas we are seeing social care funding go up by £600 million this year. More money is going into the NHS and the social care system under a Government who are committed to funding them both.
What is especially wrong with the argument made by the shadow Health Secretary, whom I welcome to his place for his first Opposition day debate, is his suggestion that the Government have not honoured their promises to the NHS. What did the independent commentators say at the time of last year’s spending review? Simon Stevens, whom he quoted, said
“our case for the NHS has been heard and actively supported.”
NHS Providers, which he quoted, said it was
“a good settlement for the NHS.”
The King’s Fund, which he quoted, said it was
“a good settlement for the NHS”.
In fact, because of the Government’s commitment to the NHS, we are spending 10% more on it as a proportion of GDP than the OECD average—that is more than Norway, Finland, Korea, Australia and New Zealand.
Sir Simon Burns
Does my right hon. Friend agree that without that investment since 2009-10 to last year there would not have been the 1.6 million more operations within the NHS that benefit all our constituents?
Mr Hunt
My right hon. Friend is right. I congratulate him, because he was part of the shadow Health team that persuaded the then shadow Chancellor and Leader of the Opposition that we needed to make that investment, thanks to which the NHS is doing 5,000 more operations every single day.
Michael Gove
My right hon. Friend has been very gracious in taking interventions from all sides, and also in citing independent voices. Has not the independent King’s Fund also pointed out that the sustainability and transformation plans that he is overseeing are the “best hope” of securing long-term improvement for both health and care in this country? Does he agree that the Opposition should pay rather more attention to those independent experts, rather than repeating their own press releases?
Mr Hunt
My right hon. Friend is right that just occasionally we should listen to experts—but only very occasionally. In the spirit of listening to experts, and as the Leader of the Opposition is here, I will tell my right hon. Friend something else the King’s Fund has said that he will agree with, which is that
“claims of mass privatisation were and are exaggerated.”
Let us not go chasing down rabbit holes.
The result of this Government’s commitment to the NHS is that real-terms spending per head has gone up by 4.6%, which is double the rate in Scotland and three times the rate in Wales. The hon. Member for Leicester South also mentioned the National Audit Office. He did not mention that the numbers quoted in the NAO report are last year’s figures. He chose not to mention this year’s numbers, which were published last week. They show that 40 fewer trusts are in deficit. Yes, a year ago, half of trusts were missing their financial plans, but now 86% are hitting those plans.
The latest figures, from Friday, show that the deficit will fall 73% from last year, and even lower than the year before. Why is that? It is because of a sustained effort by the NHS to tackle the problem. [Interruption.] The Opposition do not want to hear this, but the truth is that the NHS is gripping the very problem the shadow Health Secretary called a debate on. Agency spend, one of the biggest challenges, is on track to go down from £3.7 billion to less than £3 billion. The rates paid for agency nurses are down 18% on a year ago, and for locum doctors they are down 13%. Our procurement changes are on track to save half a billion pounds. The money we raise from international visitors is up three times, from £84 million to £289 million.
Keith Vaz (Leicester East) (Lab)
It is important that we focus not just on the level of spending but on where we spend the money. With long-term conditions such as diabetes, is it not essential to focus on preventive work, which in the long term will save the national health service a huge amount of money?
Richard Drax (South Dorset) (Con)
I congratulate my right hon. Friend on the calm and dignified way he is dealing with this debate, as compared with the Opposition. May I put in a plug for local community hospitals, not just in my constituency but right across the country, and how vital their retention is for good quality care in the future?
Helen Goodman
Since the Secretary of State thinks community hospitals are so important, will he guarantee that the Richardson in Barnard Castle will stay open?
Several hon. Members rose—
Mr Hunt
I will make some progress, but I will find time to give way to hon. Friends who I know want to come in.
I want to pick up on a particularly extraordinary comment made yesterday by the shadow Health Secretary. He said:
“aggressive efficiency targets have contributed to deficits”.
That is a curious thing to say, first because his own spending plans would have meant £5.5 billion more efficiencies. If he thinks our plans are aggressive, I just wonder how he would describe Labour’s approach. Secondly, I know we are all Corbynistas now, but basic economics suggests that efficiency plans do not increase deficits, but reduce deficits. That is what we need to do in the NHS, because we want the money to go to patient care.
There is another danger in the shadow Health Secretary’s argument, a trap that is very easy not just for him but for many commentators to fall into: the suggestion that this is a uniform problem across the NHS that it is powerless to grip without further Government intervention. The reality is that there is huge variation across the system. The deficits at good or outstanding trusts are five times less than the deficits at other trusts. If all trusts had the same financial performance as the good or outstanding ones, we would have a surplus of nearly half a billion pounds. Half the deficits are from just 22 trusts. We see this variation on a very specific level. For example, the amount paid for a pair of surgical gloves, which are very important to all hospitals, is £1.27 in some hospitals and just 50p in others. As for waiting lists, of 1,000 people who are waiting more than a year for their treatment, which is unacceptable, there is just one person from an outstanding trust who has been waiting that long. Some 93% are from trusts that require improvement or are inadequate. This is why we have a huge programme to support and improve those trusts and deal with the challenges they face.
Alex Chalk (Cheltenham) (Con)
On financial management, does the Secretary of State recognise that in Labour-run Wales agency staff spend has increased 60% in the past year? That compares with the tough measures taken in England to crack down on wasteful spending.
Andy Burnham
The Secretary of State is trying to blame hospitals for the deficit, but the point is that the spend on agency staff has ballooned in England over the past six years. The reason is that the Government, and their predecessor, cut nurse training places and left hospitals in the grip of private staffing agencies. It is therefore simply not fair of the Secretary of State to stand at the Dispatch Box and blame hospitals for a problem of the Government’s making.
Mr Hunt
I am not blaming hospitals. We are supporting hospitals to deal with the problem. The root cause of the problem, set out in the Francis report, was hospitals covering up bad problems. We said no to that and said that we were going to sort it out by having more nurses on our wards. That is why, in the four years that I have been Health Secretary, we have had 10,000 more nurses on our wards.
Simon Hoare (North Dorset) (Con)
Does my right hon. Friend agree that the public are finally starting to see through the usual Labour smokescreen that is high on rhetoric and low on alternative solutions, with very patchy and poor delivery when Labour is given the chance? My right hon. Friend’s approach to the health service—a quiet delivery of change and proper funding—is what the public are looking for.
Mr Hunt
It is noticeable that the two potential solutions we have heard have been from Opposition Back Benchers—the right hon. Member for Leicester East (Keith Vaz) and the former shadow Chief Whip, the right hon. Member for Doncaster Central (Dame Rosie Winterton)—and not from the Opposition Front Bench. My hon. Friend makes an important point.
The shadow Health Secretary is right to hold the Government to account for the funding of the NHS and the social care system, but it is a big mistake to distil all issues around the NHS into the simple issue of money. That subcontracts the responsibility for safe, high-quality care to politicians. If we are going to be the safest and the best quality system in the world, that has to be everyone’s job, everyone’s focus and everyone’s commitment—politicians, yes, but managers, doctors, nurses, porters, healthcare assistants and every single person working in NHS.
On the way forward, we first need to move to accountable care organisation models and the “Five Year Forward View”, including the STP process. The shadow Health Secretary called STPs “secret plans”, but in fact 28 of the 44 have been published and the rest will be published before Christmas. Many in the House, on both sides, objected to the Health and Social Care Act 2012 because they felt it did not do enough to support integrated care. Well, now we have a process that is bringing together the NHS and the social care system, acute trusts and primary care, at a local level. That is a big prize and we should support it, not try to make political capital out of it.
Robert Flello
In Stoke-on-Trent, the CCGs sit on the STP group. We have still not seen the report, but we have seen an executive summary. When the STP group suggests one thing, the CCG undermines it by closing community hospitals and cutting community beds. They are not working together; they are working against each other.
Mr Hunt
That is exactly what we need to sort out. We have the STP process to stop people doing their own thing, instead of having a co-ordinated, well-planned strategy. If we stick with this process, embrace innovation and technology and retain a relentless focus on safety and quality of care, in this Parliament we will see a million more people accessing mental health treatment every year; 5,000 more doctors working in general practice and a transformation of services through GPs; a new four-week cancer waiting time standard that will save 30,000 lives a year; more failing hospitals turned around; the weekend effect tackled; more doctors and nurses; and an NHS staying true to the promise made to patients in 1948 that safe, high-quality care would be there for everyone, regardless of income. That is what this Conservative Government will deliver, and I urge the House to support the amendment.
Several hon. Members rose—
Social Care
Jeremy Hunt Excerpts(8 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“welcomes the Government’s Spending Review settlement for health and social care, which ensures that the amount of money available to local authorities for adult social care services will rise significantly across the Parliament, and ensures that up to £3.5 billion more will be available by 2020; commends the work and dedication of those in the social care sector; and further welcomes the introduction by the Government of the social care precept which allows local authorities greater autonomy in making decisions about how they best meet their local communities’ needs for social care.”.
I too want to start by paying tribute all those working in the social care system; there are few jobs that are more important to our society. They work with some of the oldest and most vulnerable people in our society, many of whom have dementia. That is a growing population, with the number of over 90-year-olds having increased by more than a quarter. Life expectancy is up by a whole year since Labour left office. While I would like to claim credit for every Government achievement, that is a demographic change and no thanks to this Government. It also places huge pressure on the system. Every older person is a dad, a mum, a grandparent or a neighbour, and Members on both sides of the House, whatever our disagreements, want them to be treated with the utmost standards of dignity and respect.
Jack Dromey (Birmingham, Erdington) (Lab)
There are none so noble as those who care, and they include the Castle Vale carer I met who buys Easter eggs out of her own pocket to give out in her own time to those she cares for. Does the Secretary of State understand the despair being felt by carers who are told that they have only 15 minutes per visit, the despair being felt by those being cared for because they no longer have the contact they once had, or the despair being felt by the family and friends of those who built this country and who now deserve better in the twilight of their years?
Mr Hunt
I absolutely agree with the hon. Gentleman. It is the hallmark of a civilised society that we treat all older citizens with dignity and respect. I totally disapprove of 15-minute visits. I find it impossible to understand how anyone could really look after someone’s needs in a 15-minute visit. I hope that, like us, he is proud of the introduction of the national living wage, which is helping the people who do this very important work. It will help 900,000 people working in the social care system by paying all over-25s a minimum hourly rate of £7.20 from this April.
Paul Blomfield (Sheffield Central) (Lab)
The Secretary of State will know that Ministers have acknowledged that illegal non-payment of the national minimum wage is rife in the care sector. Does he agree that Her Majesty’s Revenue and Customs should publish the results of the investigations it launched two years ago into the six big providers? Where employers are found to be non-compliant in relation to an individual care worker, does he agree that HMRC should carry out a full investigation into that employer to see how widespread that non-compliance is?
Mr Hunt
We are absolutely determined to clamp down on employers who do not pay the national living wage. If the hon. Gentleman or any other hon. Member has any evidence at all of that happening, they should let HMRC know. HMRC has a policy of naming and shaming employers who do not do the right thing and rightly so.
Wes Streeting
It is welcome that the minimum wage will increase and that money will hopefully reach the workers we are discussing. Will the Secretary of State acknowledge, however, that the consequence of the increase is that the precept that local authorities charge residents for social care will be eaten up by the wage increase—even in local authorities such as the London Borough of Redbridge, of which I am still an elected member? What will he do to alleviate the very real financial burden on my local authority and others to ensure that everyone gets the quality of care they need?
Toby Perkins
The Secretary of State is being generous in giving way. He started his peroration by talking about the importance of care for the elderly and he is absolutely right about that. Does he agree that we are also talking about caring for people with learning and physical disabilities? The care debate is often entirely about the elderly, but it is much wider than that.
Mr Hunt
I will give way shortly, but I want to finish my point about the critical role played by care staff. In total, 1.5 million people work in the social care sector, and I want to mention one group in particular: the 90,000 who come from the EU. They do a brilliant job and we value their contribution to the sector.
If the House will forgive me, I want to share one story from early in my time as Health Secretary about an absolutely brilliant manager, who is Polish, of a dementia care home in Swiss Cottage. The people at the home had advanced dementia and many were unable to talk or move, so the atmosphere in the home was challenging to say the least. I asked the lady how she motivated her staff every day, and she said, “If I can get a resident to smile, they won’t remember it the next day, but I do, and I go home with a smile on my face.” The care that was being provided was, to be frank, completely remarkable. This is a moment for all of us to reaffirm what the Prime Minister said today at Prime Minister’s questions: we want these people to remain and we are confident and optimistic that we will be able to get them to remain.
Norman Lamb
I totally share the sentiment that EU workers are welcome in our country and that we must guarantee their future as soon as possible.
Does the Secretary of State ever feel that he is confronted by a pretty fundamental choice? He can either preside over a system that deteriorates with an increasing number of failures of care, which I know he cares passionately about, or he can be the politician in government who confronts that, who works with other parties and who comes up with a sustainable long-term solution. It is one or the other. I urge him to take the latter course.
Mr Hunt
I absolutely want to be someone in this role who confronts poor care and does everything possible to fight for the highest standards. That is exactly why I am doing this job. Poor care comes in different forms and, yes, funding is an issue. As the health and social care system goes through perhaps its most financially challenging period since the founding of the NHS, I particularly want to ensure that we protect the high standards that the right hon. Gentleman cares about.
Andy Burnham
I heard the Secretary of State’s earlier words about EU carers. I am sure that they were genuine, but words are not good enough for them. The longer the Government leave them in limbo, the greater the risk is that they will leave. Our national health service and our care system could not cope with losing all those staff, so what more is he doing? Is he petitioning the Prime Minister for a decision now that will give them leave to stay and properly respects their contribution to our society?
Mr Hunt
With respect to the right hon. Gentleman, with whom I have enjoyed many debates in this House, neither he nor I wanted the Brexit vote to happen, but now that it has, we have to cope with a very changed world. The Prime Minister said that she is confident of getting an early agreement. I hope that what we are saying in this House this afternoon will resonate with people and make them understand just how valued they are.
Several hon. Members rose—
Mr Hunt
I want to conclude the section about the role of social care staff.
Whatever disagreements we have in this afternoon’s debate, I want the message to go out loud and clear to all social care staff that Members from all parts of the House recognise the work that they do, and that they value it and support them to do that work better. That is part of the definition of a civilised society.
Helen Whately
On the point about the need for a long-term sustainable health and social care system, is it not the case that the Secretary of State is driving through work in devolution deals and sustainability and transformation plans, which aim to achieve exactly that—bringing together health and social care to create a much more sustainable system?
Mr Hunt
My hon. Friend is absolutely right. Although this afternoon’s debate is about the social care system, the sustainability and transformation plans are a critical part of the long-term solution for financial efficiency and for improving the quality of care.
I congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on introducing this debate, which is the first Opposition day debate that she has led. I also pay tribute to the fact that she has had a long-standing interest in these issues. She has asked me questions about the social care system on many occasions. She was particularly right to focus on the impact on the NHS, which is real, and on the impact on family carers, which is also real. She talked about Susan and about the impact on people who are finding that they are giving more hours of care than they were planning or are sometimes even able to give. That is something of which we must all be aware. She asked me to answer a direct question: do I recognise the scale and seriousness of the issues faced by the social care system? The answer is, yes, I do. I want to try to address, as comprehensively as I can, some of the substantive issues faced in the social care system.
Let me start by saying that, although today’s debate and the majority of the hon. Lady’s comments were around funding, the issue is not only about funding. The hon. Member for Chesterfield (Toby Perkins) mentioned that social care is not just about older people. In 2011, we had the shock of what was uncovered at Winterbourne View by a BBC “Panorama” programme. We have had a number of examples of horrific abuse at care homes. The Ash Court Care Home case in Kentish Town was one that came to light in 2012. The abuse there was filmed by a relative on a hidden camera. Those issues were primarily not about funding, but about cruelty—a strong word—that we have tolerated in our system. We have had some very significant policy responses since then, which are making a real difference. The first is that this Government, under the coalition, introduced the toughest system of care home inspection in the world.
We often talk in this House about the work of the chief inspector of hospitals, but I wish to pay tribute today to the work done by the chief inspector of adult social care, Andrea Sutcliffe, and her team. She has completed the inspection of nearly 90% of care homes and domiciliary care services. It is encouraging that, despite the pressures that we have been talking about this afternoon, 72% of the places that she inspected were good or outstanding. More importantly, the 28% that are not are the 28% that we know about and are therefore able to do something about.
I take issue with the way the shadow Health Minister presented her findings. She said that a quarter of the inadequate places were unable to improve following re-inspection. However, the reality is that more than three quarters of places that got an inadequate inspection did improve, which is a huge step forward from where we were a few years ago when we did not know where those places were and when there was no change happening at all.
John Woodcock (Barrow and Furness) (Lab/Co-op)
The Secretary of State is right to highlight the need to improve standards and the need for a rigorous inspection regime, but—taking on board what his former ministerial colleague, the right hon. Member for North Norfolk (Norman Lamb), said—does he accept that even if every single care home in the country reached the appropriate standard, there would still be a care crisis? There is not sufficient funding in the system to make it work. Will he agree to work with all parties to do what we should have done many years ago—before the general election in 2010, as he will recall—and get a grip on the issue and, as a country and as a House, try to sort it out?
Mr Hunt
I am more than happy to work with people of all parties to come to a sensible consensus. The one thing that unites all the major parties is a commitment to the NHS and social care system. With respect to the other issues, it is not just about rooting out poor care. It is also about something that the hon. Member for Worsley and Eccles South mentioned earlier—giving a career structure to people who work in the care system and giving them recognition. That is why in April last year we introduced the care certificate, which is based on achieving 15 standards. It is a voluntary system, but the CQC inspects against it, so there is a strong incentive for care providers to get their staff enrolled for the care certificate. I pay tribute to the work done by Camilla Cavendish, who did a lot of thinking and had a long-standing interest in this issue in her time as a journalist and at No. 10, and on whose proposals we are basing our work in this area.
Huw Merriman (Bexhill and Battle) (Con)
I am grateful that my right hon. Friend has mentioned the CQC and also touched on wages. When I met the south-east director of the CQC, it was clear that there is an issue of staff not being paid properly and then moving around the care home sector for a small amount of extra money, which is vital to them. Does my right hon. Friend agree that the living wage will stop that occurring and result in more people staying in jobs for longer?
Mr Hunt
That is a very important point. We have heard suggestions that the Government have been about words, not action, but the national living wage will do an enormous amount to help keep people in jobs for longer and help them to start to think about their jobs as a career, with potential progression into other parts of the health and care system, such as nursing. I commend my hon. Friend for the work that he does on this in Sussex.
Mr Betts
The Secretary of State said that the issues in social care were not only about funding, but it seems that funding is the only issue that he does not want to talk about. The Communities and Local Government Committee is taking evidence on social care. We have had evidence from local councils, including Conservative councils, council directors, unions, care providers in the private sector, care receivers, carers, academics and research institutions, all of whom say that there is a funding crisis in social care. Does the Secretary of State think he might just be wrong in being the only person to deny that such a funding crisis exists?
Mr Hunt
With great respect to the hon. Gentleman, I was coming on to talk about funding. I just wanted to make the point that the issue is not just about funding.
I respectfully disagree with some of the suggestions made by the shadow Health Minister in her comments earlier that this is essentially about party political choices, for the simple reason that at the last election, Labour promised less for social care and would have spent less than we are spending. I gently remind Opposition Members that Ed Balls as shadow Chancellor was absolutely explicit in 2015. He said that he would not reverse funding cuts to local government—indeed, he would have made further cuts. Under this Government, those cuts have started to be reversed. Spending on adult social care increased—[Interruption.] These are the facts. Spending on adult social care increased by around £600 million in the first year of the Parliament and is set to increase further because of the spending review, which will mean that up to an additional £3.5 billion can be spent during this Parliament.
Liz Kendall (Leicester West) (Lab)
I am afraid the Secretary of State is living in cloud cuckoo land. My council has to make £55 million of cuts on top of the £100 million it has already made. There is a funding crisis, and we will not solve it unless he admits there is a crisis. He cannot continue to be in denial, and we cannot have a Prime Minister who constantly says that the NHS and social care have the funding they need. We need cross-party agreement on this long-term issue, but, first, he has to acknowledge that there is a problem.
Mr Hunt
I have great respect for the hon. Lady, but Leicester Council actually increased its adult social care budget by 7%. Overall, there was an increase in the adult social care budget last year, and that was made possible by the new social care precept, which is being used by 144 out of 152 councils. That will raise £382 million this year and up to £2 billion a year by 2019-20.
Liz Kendall
My council has had to cut other vital local services to fulfil its statutory obligations. The social care precept will not even pay for the increase in the minimum wage—the council is going to have to move money from elsewhere. The Secretary of State is living in denial. You cannot solve a problem unless you admit there is one. People are willing to work across the House to deliver a long-term solution, but he has to admit that there is a problem.
Mr Hunt
With the greatest respect, I do not know whether the hon. Lady heard what I said just a few moments ago, but I answered very directly what the shadow Health Minister said. Do I recognise the scale and seriousness of the issues? Yes, I do, and I am coming on to explain what I think the solutions are. The point I am making is, yes, the budget—the amount spent on social care—was cut in the last Parliament, as a result of the very difficult economic situation we faced after the financial crisis in 2008, but it is starting to go up again in this Parliament. We need to look at what we can do to try to turn that into a sustainable improvement in the care received by all our constituents.
A crucial point was missing from the shadow Health Minister’s opening speech. There was a suggestion that the issues in social care are essentially caused entirely by decisions made by central Government. We need to salute the efforts made by councils of all colours to deal with the pressures in social care, because those are very tough. Middlesbrough Council, for example, increased its social care budget by 11%—it is the most improved council in England. My own council, Surrey, which is an affluent area, but has a large number of elderly people to look after, has battled enormous odds to expand provision.
However, the fact is that there is enormous variation in the way local authorities have responded to these challenges. If we look at the impact on the NHS, and at the delayed transfers of care that are attributable to social care, we can see that the best councils, such as Peterborough, Rutland, Newcastle and Torbay, have virtually no delays in hospital discharges attributable to social care. That can be compared with Birmingham, Manchester, Reading and Southampton where there are between 14 and 21 days of delayed transfers attributable to social care per 10,000 of population every working day. That is a difference of 20 times between the best and the worst councils, and we cannot say that there is a 20-times difference in funding between the best and the worst councils.
Mr Jim Cunningham (Coventry South) (Lab)
Members have alluded to the fact that local authority budgets are under the hammer at the moment. More importantly—I have raised this with the Secretary of State before—one of the big problems is having the social workers to get people a care package when they leave hospital to go home, and that creates bed blocking, so we are in a vicious circle. The last Labour Government looked at an offer from the then Conservative Opposition to get together and have a properly funded national care service. Why have we not looked at that?
Mr Hunt
The hon. Gentleman is absolutely right to say that the presence of social workers in hospitals is vital in discharging people, but I think he will be quite shocked to know that 50% of all the delayed transfers of care in the entire NHS happen in just 20 local authority areas. There are many places that are doing these things well, even in the current challenging financial circumstances, but there are others that, frankly, could do a lot better.
Overall, what we see is a picture where the best councils have expanded funding and provision. For example, last year, Windsor and Maidenhead increased its spend by 6.4%, and the number of people accessing long-term care is up by 8%. That was a Conservative council, but the Labour council in Doncaster also chose to increase its social care budget by 10%—nearly £8 million—and it is looking after nearly 7% more people.
This is not just about funding; it is also about the speed of health and social care integration and about local leadership. Where such leadership exists, important changes are happening even now. For example, in Cheshire East, dedicated workers are supporting people with early-stage dementia, saving more than £4,000 a year per client in social care costs while improving the service for patients. Milton Keynes is another good example: its innovative pilots have cut delayed days attributable to social care by nearly three quarters.
Others, regrettably, have chosen to cut funding and provision. There are many reasons for that, but the one thing that is difficult to explain to the public is why, at times of such challenge, local authority reserves have increased by nearly £10 billion since 2010. The hon. Member for Worsley and Eccles South made a fair point when she said that there has never been greater financial or operational pressure on all councils. Like the NHS, there is huge pressure, but unlike the NHS, it has not been possible to protect their budget since 2010.
What is the way forward in this very difficult situation? I think that it is a combination of the right financial decisions locally and recognition by local authorities and the NHS that they are part of the same team. That is why, as has been said, the sustainability and transformation plan process is so important.
It is easy to knock a process whereby local areas come together to have yet more meetings, which we are pretty good at doing in the NHS and social care system, and it is also easy to characterise those meetings as secret, but the fact is that people do not want to publish their plans until they are ready, and they will all be published by the end of this year. Many Members on both sides of the House criticised the Health and Social Care Act 2012 because they felt that it did not do enough to promote integrated care, but now we have a process to do that. That is massively important for the social care system, as this is the first time that local authorities are properly involved in NHS planning. Indeed, four of the STPs—namely those for Greater Manchester, Norfolk and Waveney, Nottinghamshire, and Birmingham and Solihull—are headed by local authority leads. On Monday, the head of operations at NHS England told me that there was not one STP meeting that he had been to where a local council was not represented. At the moment, it is a planning process and it needs to be delivered, but planning needs to happen collaboratively. It is a significant change for the NHS and social care system, but it is finally happening.
Robert Flello
So why is it that Stoke-on-Trent City Council tells me that no council officers or councillors have been involved in the Staffordshire STP? Given that it covers the whole of Staffordshire, the more deprived areas of Stoke-on-Trent and north Staffordshire will, in effect, subsidise south Staffordshire, because it has greater debts. Why cannot MPs have input into the plan? It is absolutely disgraceful.
Mr Hunt
Everyone will have input into the plan, but the hon. Gentleman might want to ask his council why it is complaining about pressures on the social care system when it has refused to use the social care precept and raise extra money, which could be desperately used for social care. That would make a real difference to his constituents.
Where councils and local NHS organisations are working together, we are seeing some real financial savings that are having a big impact. For example, Northumberland has saved £5 million through integrated services with Northumbria NHS Trust, and there has been a 12% reduction in demand for residential care as a result. In Oxfordshire, where the local authorities, clinical commissioning groups and trusts are all working together, discharge delays are down 40% in six months, and those due to social care have more than halved.
Karin Smyth
We are having an interesting tour of various councils around the country. I referred earlier to the fact that people have been let down after the 2015 Conservative manifesto, which promised them that they would be secure in their own homes. The proposal to that effect in the Care Act 2014 was postponed because so many councils put pressure on the Government to delay. The Public Accounts Committee has been told that the proposal will be introduced in April 2020. What work is happening in the Department to ensure that that proposal will come forward so that people will be secure in their own homes?
Mr Hunt
We are doing work, and I would simply say that we have also delivered on that promise because we have introduced the deferred payment scheme, which means that no one will need to sell their home because of social care costs.
I will wind up now, because I know that many hon. Members want to speak. When we have local authorities and the NHS working together, what is our objective from that process? We want a seamless transition for patients between the health and social care system. We want shared electronic health records so that patients are not asked the same questions time after time. We want a single assessment system so that people are not assessed twice by different organisations trying to get different results. We want to see the pooling of budgets, we want to get rid of delayed transfers of care, and we want multidisciplinary teams. Most importantly, we want there to be a single plan for every vulnerable person, to which everyone who is involved in their care adheres. Those are the objectives.
In the face of enormous pressure, the best solution for local authorities and local NHS organisations that are finding things challenging right now is not to slow down those vital changes, but to accelerate the pace of change, so that we eliminate waste and improve patient care at the same time. Councils that do so will have the full support of the Government. I urge the House to support the Government’s amendment.
Madam Deputy Speaker (Natascha Engel)
Before I call the next speaker, I will have to impose a seven-minute limit. I have to warn Members that the more interventions that are taken, the more that limit will have to come down.
Andy Burnham
I am very grateful to the hon. Gentleman for his intervention and the spirit in which he made it. He is absolutely right: that set everything back and meant that there was no possibility of a cross-party approach. There will have to be such an approach if we are to fix social care and, indeed, to give the NHS what it needs, because they will both need more funding during this Parliament. That is the real shame. I did not make my point about Andrew Lansley for political reasons; I just want people to understand what happened, so that the current generations of politicians might do something different.
The answers we have since had from the Government are wholly inadequate. We have heard today that the precept does not raise enough money, particularly for poorer councils. It is no answer; in fact, it just cynically devolves the responsibility for the whole issue to local government, even though councils did not create the problem. I still favour an all-in system. I will say it: I favour a system in which we ask older people to pay a set contribution, so that they have peace of mind in later life, with all their care costs covered.
Mr Jeremy Hunt
I am listening very carefully to the right hon. Gentleman. In the spirit of wanting to rise above party politics, will he agree that it was totally wrong of him to suggest at any stage in the last Parliament that the Government wanted to privatise the NHS, when we have never had the intention to do so? It was wholly irresponsible to scare the public about that.
Andy Burnham
In a week when Virgin Care is taking on a huge community care contract, I do not think the Secretary of State should be making that point—particularly the Secretary of State who privatised ambulance services in Greater Manchester. I honestly do not think we need to go there.
The point that I am making is about funding social care. The Conservatives claimed that we were introducing a new inheritance tax. Do people not understand that just 3.4% of estates in this country attract inheritance tax? Why is that? Because the vast majority of estates are whittled down by the costs of care—tens of thousands of pounds, or hundreds of thousands of pounds for some people. That is not fair and it is not sustainable. We must be able to do better.
I feel so strongly about this because I saw my grandmother go through the care system in England 20 years ago and, frankly, it was nowhere near good enough. I arrived here saying that I would do something about it. I tried to do something about it, but we have not got anywhere near a solution to the scale of the challenge. People will need to put party politics aside and find common ground. The point scoring and failure to grasp big issues have led to a situation where people have low regard for this place.
We are left with a malnourished, privatised care system in England that is sinking lower as we speak. A culture of slap-dash 15-minute visits is entrenched, in which staff do not get properly treated, trained or respected. Standards in care homes have slipped even further, and stories of neglect and abuse abound—we hear them all the time. Countless vulnerable people and their families still have to pay these cruel dementia taxes, which have risen under this Government, losing everything they have worked for and going into later life with everything on the roulette table: home, pension, savings—the lot. That is not the care system we should have in 2016 in this country. At what point are we going to say, “Enough is enough,” and actually do something about it?
Mr Jeremy Hunt
Just before my right hon. Friend wraps up, I want to put on record my thanks to him for his outstanding work in my Department, both in mental health and in social care, and for his real commitment to the voluntary organisations and the patients and service users in those areas.
Oral Answers to Questions
Jeremy Hunt Excerpts(8 years ago)
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Sir Henry Bellingham (North West Norfolk) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
In the past four years, 31 trusts have been put into special measures, more than one in 10 of all NHS trusts. Of those, 15 have now come out and I particularly congratulate the staff of Sherwood Forest, Wye Valley, and Norfolk and Suffolk trusts which have come out of special measures in the past month.
Sir Henry Bellingham
Does the Secretary of State agree that the sustainability and transformation plan for Norfolk and Waveney is a vital part of the Queen Elizabeth hospital’s future as it successfully moves out of special measures? Although there is overwhelming support for integrating health and social care, will he confirm that there will be full consultation with different patient groups on the STP?
Mr Hunt
I can absolutely give that assurance. Through my hon. Friend I congratulate the staff of King’s Lynn hospital who have turned things around there. It was a great privilege for me to visit it and see the work that they have done. My hon. Friend is right—the next step is to integrate the work done in acute hospitals with what happens in the community and the social care system. That is why the open and transparent STP process is so important.
Heidi Alexander (Lewisham East) (Lab)
I do listen carefully to the Health Secretary and sometimes I end up wondering what planet he is living on. There are as many trusts in special measures now as there are trusts that have come out of special measures. Just because different people in different places are experiencing poor care does not make the overall picture any better. When will the right hon. Gentleman accept that the overall amount of resource going into the system is simply inadequate if he wishes to provide high quality, timely care for all?
Mr Hunt
Let me tell the hon. Lady that what is different now is that we have a special measures regime. When Labour was in power, the problems were swept under the carpet and not dealt with. Now they are being dealt with because we want every NHS patient to have confidence that we will not have another Mid Staffs. That is why we are making very good progress. With respect to funding, may I respectfully tell her that had we followed her party’s spending plans, the NHS would have £1.3 billion less this year?
Mr Ben Bradshaw (Exeter) (Lab)
The Secretary of State will know that with depressing regularity the same hospitals come up on that list that he has just referred to. Sustainability and transformation plans provide the opportunity to address some of the unsustainable elements of local health economies, but only, as my hon. Friend the Member for Lewisham East (Heidi Alexander) says, if the money is there. With the health service facing its tightest financial settlement in its history, these plans are just not deliverable.
Mr Hunt
The right hon. Gentleman understands health extremely well, both from his ministerial position and from being on the Select Committee. If he looks at the hospitals going into special measures, he will see that we are beginning to succeed in moving hospitals out of special measures, but because we have an independent inspection regime, sometimes other ones go in. That is how it should be. That is what works very well in the education sector and is beginning to work well in driving up standards in health care as well.
To go back to my answer to the hon. Member for Lewisham East (Heidi Alexander), £1.3 billion more in the NHS this year compared with what would have been put into the NHS if Labour had won the last election means 30,000 nurses, 13,000 doctors or 200,000 hip replacements that we are able to do because of this Government’s funding of the NHS.
Peter Dowd (Bootle) (Lab)
The Secretary of State for Health (Mr Jeremy Hunt)
Because of the 2008 financial crisis, all political parties committed to reducing the proportion of GDP spent on health in 2010, but because this Government chose to protect the NHS, the proportion fell from 6.4% to 6.2%, a drop of just 0.2% of GDP.
Peter Dowd
While welcome, that creative response does not answer the question. The fall in GDP spent on health is worrying. To mitigate that fall, when can my constituency expect its share of the Brexit NHS bonus to be injected into its health economy, which would bring in £30 million a year?
Mr Stewart Jackson (Peterborough) (Con)
I thank the Secretary of State for taking time last week to visit the Peterborough City hospital and to praise the magnificent staff there, who are labouring under a £35 million annual private finance initiative millstone. Is the wider context not that we would have a lot more money to spend on front-line care if we did not have to deal with a poisonous legacy from Labour of £64 billion of appalling PFI contracts in the NHS?
Mr Hunt
My hon. Friend is absolutely right. I was incredibly impressed with the staff I met at Peterborough hospital—there was incredible commitment to patients and some fantastic work going on in the oncology and renal departments, which I visited. He is right: PFI was a disastrous mistake, saddling hospitals up and down the country with huge amounts of debt, which cannot now be put into front-line patient care. We are doing everything we can to sort that out and not repeat those mistakes.
David Tredinnick (Bosworth) (Con)
My right hon. Friend will be aware that the NHS spends only about £400 million a year on homeopathic medicine and treatments through the 400 doctors who have trained in homeopathy and are members of the faculty. If he wants to reduce antibiotic prescribing, may I suggest that he increases that budget, because there are very good scientific trials now showing that upper respiratory tract infections can be treated using homeopathic medicine? May I write to him about that?
Mr Hunt
May I commend my hon. Friend for his great persistence in flying the flag for homeopathic medicine? While we must always follow the science in the way we spend our money on medicines, as I know he agrees, he is right to highlight the threat of antibiotic resistance and the need to be open to every possible way of reducing it.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
Today I publish my first annual report as Chair of the Public Accounts Committee, in which I conclude that there is a sustainability crisis in the funding of the NHS. Surely the Secretary of State will agree—he has made some comments in the media that suggest he is becoming aware of this—that he will need to lobby the Chancellor for a better settlement in the autumn statement. Will he update the House on his negotiations?
Mr Hunt
I am sorry to disappoint the hon. Lady but I do not update the House on Government discussions which happen in the run-up to every Budget and autumn statement. What I would say to the hon. Lady is that I am not someone who believes that the financial pressures that undoubtedly exist in the NHS and social care system threaten the fundamental model of the NHS. What they remind us all of is that what we need in this country is a strong economy that will allow us to continue funding the NHS and social care systems as we cope with the pressures of an elderly population. That, for me, is the most important challenge—the economic challenge that will allow us to fund the NHS.
David T. C. Davies (Monmouth) (Con)
Will my right hon. Friend confirm that, under his tenure as the Minister, there has been a real-terms increase in spending on the NHS in England, unlike in Wales, where, over the last few years, we have seen real-terms cuts under the Labour party?
Mr Hunt
As ever, my hon. Friend speaks wisely. Thanks to this Government, health spending in England is up by 10.1% in cash terms—4.6% in real terms—since 2010. That is double the cash increase in Scotland and three times the cash increase in Wales. Other parties talk about funding the NHS, but Conservatives say that actions speak louder than words.
Jonathan Ashworth (Leicester South) (Lab)
But we have seen public health budgets cut and social care budgets cut, and I can now tell the House that the maintenance budgets have been cut. In fact, the backlog of high-risk maintenance facing the NHS has soared by 69% in the past year. In London alone, the high-risk backlog has grown by £338 million; across the country the figure is nearly £5 billion. NHS finances are so stretched that even the most urgent repairs are being left undone. Is this what the Secretary of State meant when he said that he is giving the NHS the money it asked for?
Mr Hunt
I know that the hon. Gentleman has only been shadow Health Secretary for a while, but may I ask him to cast his mind back to 2010, when the party that wanted to cut the NHS budget was not the Conservative party but Labour? In 2015, his party turned its back on the five year forward view and said it would increase funding not by £8 billion but by just £2.5 billion. It is not enough to found the NHS—you have got to fund it.
Mr Speaker
Order. These exchanges, not untypically, are taking far too long, and part of the reason for that is that the Secretary of State keeps dilating on the policies of the Labour party. If he does so again, I will sit him down straight away. [Interruption.] Order. There are a lot of colleagues who want to ask questions. We want to hear about Government policy, not that of the Opposition. I have said it, it is clear— please heed it.
Jonathan Ashworth
Thank you, Mr Speaker.
If everything is so rosy with the NHS’s finances, why did Simon Stevens say just a couple of weeks ago that
“2018-19 will be the most pressurised year for us, where we will actually have negative per-person NHS funding growth in England”—
in other words, that NHS spending per head will be falling? The number of patients waiting longer than four hours in A&Es has increased. The number of days lost to delayed discharge has increased. The number of people waiting more than 62 days to start cancer treatment following referral has increased. Should not the Secretary of State do his job and make sure that next week’s autumn statement delivers the money that the NHS urgently needs?
Mr Hunt
Unlike other parties in this House, we have been increasing funding for the NHS. Thanks to that, we are now funding the NHS in England at a 10% higher proportion of GDP than the OECD average, and we are in line with the western European average because of our commitment. These are difficult financial times and there is financial pressure, but this Government have been saying that despite that financial pressure we must make sure that the NHS continues to offer safe, high-quality care—and that is our focus.
Henry Smith (Crawley) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
Last month, I launched the safer maternity care action plan, which is part of our ambition to halve the rates of stillbirths, neonatal deaths, maternal deaths and brain injuries by 2030.
Henry Smith
I am grateful to my right hon. Friend for that answer. In 2001, the then Labour Government closed the maternity unit at Crawley hospital. Longer journeys to East Surrey hospital have been a safety concern. Will the Department look at reintroducing midwife services to Crawley hospital and GP surgeries in Crawley?
Jeff Smith (Manchester, Withington) (Lab)
Paul Blomfield (Sheffield Central) (Lab)
The Secretary of State for Health (Mr Jeremy Hunt)
I am pleased to report to the House something I was not sure I would ever be able to say: last week, the British Medical Association called off its industrial action and committed to working with the Government on the implementation of new contracts for junior doctors. This will make a significant contribution to our commitment to a safer, seven-day NHS, and the Government will work constructively with junior doctors to address their concerns, because they are a vital and valued part of our NHS.
Paul Blomfield
The South Yorkshire and Bassetlaw STP sets out some very positive ambitions, but it warns that there will be a financial shortfall for health and social care services in our area of £571 million by 2020-21. Those ambitions are unachievable unless the Government address the shortfall. What is the Secretary of State going to do about it?
Mr Hunt
We are working very carefully with all STP areas to make sure that their plans are balanced so that we can live within the extra funding we are putting into the NHS—an extra £10 billion—by 2020-21. We will look at that plan and do everything we can to help to make sure that it works out.
Andrew Selous (South West Bedfordshire) (Con)
Mr Hunt
I am happy to do that, and I would like to pass on my congratulations to Dr O’Toole, who obviously does a fantastic job for my hon. Friend’s constituents. We are investing significantly in general practice, with a 14% increase in real terms over this Parliament and our ambition to provide an extra 5,000 doctors working in general practice. This will mean that the need for locums will become much less and we can have much more continuity of care for patients.
Julie Cooper (Burnley) (Lab)
The Secretary of State and the Minister will be aware that Capita has wreaked havoc in GP surgeries across the land, placing extra pressures on already overstretched NHS staff, compromising patient safety and breaching confidentiality. Last week, I met a group of practice managers who told me that some patient records have been missing for months, while others have turned up apparently half-eaten by mice. Given that this contract was introduced to save the NHS money, will the Minister tell us how much it is costing to rectify the mess and what steps she is taking to compensate GPs for the expenses they have incurred as a result of ill-conceived and poorly implemented contracts?
Robert Neill (Bromley and Chislehurst) (Con)
Mr Jeremy Hunt
I thank my hon. Friend for bringing up that issue. Everyone recognises, on both sides of the House, that the health and social care sectors need to work together. That happens very well in some parts of the country, but not in others. I think all hon. Members have a job to make sure that people behave responsibly in their constituencies.
Chris Law (Dundee West) (SNP)
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
The number of nurses working in mental health has fallen by 15% since 2010, from 45,384 to 38,774. Why is that, and does the Secretary of State believe that it will achieve real parity of esteem for mental health in our country?
Mr Jeremy Hunt
What I can tell the hon. Lady—who, I know, rightly campaigns hard on mental health—is that we are treating 1,400 more people in our mental health services every day than we did in 2010, and we will be treating a million more people every year when we have implemented the taskforce report. We are investing more, and we are making good progress.
Matt Warman (Boston and Skegness) (Con)
Shared care allows GPs to provide complex prescriptions for drugs such as methotrexate, but in my constituency the Beacon surgery recently withdrew from those arrangements. Can the Secretary of State assure me that the Department will support not only patients who now face potentially longer round trips, but GPs themselves, so that they can continue to provide those vital services?
John Cryer (Leyton and Wanstead) (Lab)
Is the Minister satisfied that the National Institute for Health and Care Excellence procedures for the approval of anti-cancer drugs are sufficiently speedy, because the waiting times for approvals can be months or even years, and there is a widespread feeling that that is too slow?
Mr Jeremy Hunt
We have tried to speed this up with the cancer drugs fund, which helped 84,000 people in the last Parliament, but we always keep the NICE procedures under review and I take on board what the hon. Gentleman says.
Bob Blackman (Harrow East) (Con)
We recently had an excellent debate in Westminster Hall on the Government’s tobacco control strategy. When will they publish the new strategy, which was promised for publication this summer?
NHS Funding
Jeremy Hunt Excerpts(8 years ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Jonathan Ashworth (Leicester South) (Lab)
(Urgent Question): To ask the Secretary of State if he will make a statement on NHS funding.
The Secretary of State for Health (Mr Jeremy Hunt)
Compared with five years ago, the NHS is responsible for 1 million more over-75s. In five years’ time, there will be another 1 million over-75s. Our determination is to look after each and every NHS patient with the highest standards of safety and care, but there is no question but that the pressures of an ageing population make this uniquely challenging.
I welcome the chance to remind the House of this Government’s repeated commitment to supporting our NHS. The NHS budget has increased in real terms every year since 2010. NHS spending has increased as a proportion of total Government spending every year since 2010, and is 10.1% higher per head in real terms than when we came to office. The OECD says that our spending is 10% higher than the OECD average for developed countries. At 9.9% of GDP, it is about the same as that in other western European countries, for which the average is 9.8%.
Given the particularly challenging current circumstances, in 2014 the NHS stepped back and for the first time put together its own plan for the future. It was an excellent plan, based on the principle that because prevention is better than cure, we need to be much better at looking after people closer to or in their homes, instead of waiting until they need expensive hospital treatment. The plan asked for a minimum increase of £8 billion in NHS funding over five years. It asked for this to be front-loaded to allow the NHS to invest in new models of care up front.
Following last year’s spending review, I can confirm to the House that the NHS will in fact receive an increase of £10 billion in real terms over the six years since the “Five Year Forward View” was published. In cash terms, that will see the NHS budget increase from £98.1 billion in 2014-15 to £119.9 billion in 2020-21. That rise is highly significant at a time when public finances are severely constrained by the deficit that this Government regrettably inherited. Because the NHS’s particular priority was to front-load the settlement, £6 billion of the £10 billion increase comes before the end of the first two years of the spending review, including a £3.8 billion real-terms increase this year alone. That £3.8 billion represents a 52% larger increase in just one year than the Labour party was promising over the lifetime of this Parliament.
Jonathan Ashworth
This morning the Chair of the Health Committee and her colleagues on that Committee said that the Government’s NHS spending claims were “inaccurate” and “false”. The Opposition agree with that analysis. Ministers—and the Secretary of State has just done this again—tell us that they are investing £10 billion more in the NHS, but it has now been confirmed that that figure is
“not only incorrect but risks giving a false impression that the NHS is awash with cash.”
Is not the reality that the Government have cut adult social care, the public health budget and the NHS capital budget? Now we learn that the average amount we spend on healthcare for each person in this country will fall in 2018-19. Does that not raise serious questions about the claims that Ministers, and, indeed, Prime Ministers, have been making from that Dispatch Box? In fact, the only way the Government’s figures could be further discredited is if the Secretary of State slapped them on the side of a bus and got the Foreign Secretary to drive it.
Will the Secretary of State admit that the Government have not actually given the NHS the money it needed? Will he give us an accurate account of spending plans for the NHS? Will he tell us when the Chancellor is going to respond to the Health Committee’s letter, and what representations he himself is making to the Chancellor ahead of the autumn statement?
We have also learned today from Health Service Journal that one in three local areas intend to close or downgrade A&E departments within 18 months, one in five expect to close consultant-led maternity services, and more than half plan to close or downgrade community hospitals. Will the Secretary of State confirm whether those reports are accurate? How many A&E departments, maternity units and community hospitals does the Secretary of State expect to close or be downgraded within the next year and a half? Our constituents want those answers.
Before the last election, the Secretary of State told us he was “confident” about delivering the money the NHS needed. Today that confidence has been exposed as utterly misplaced. Tory promises are completely in tatters. Rather than defending the Prime Minister’s spin on the £10 billion figure, why does the Secretary of State not stand up for patients and staff, and deliver the funding that the NHS and our social care sector desperately need?
Mr Hunt
I start by welcoming the hon. Gentleman to his first urgent question in his new role. As I am a relative old timer in my role, I hope he will not mind me reminding him of some of the facts about health spending.
First, the hon. Gentleman said that the Government did not give the NHS what it asked for. Let me remind him that Simon Stevens, a former Labour special adviser—I know for new Labour, but he was none the less a Labour special adviser—said at the time of the spending review settlement last year that
“our case for the NHS has been heard and actively supported”
and that the settlement
“is a clear and highly welcome acceptance of our argument for frontloaded NHS investment. It will…kick start the NHS Five Year Forward View’s fundamental redesign of care.”
I will tell the hon. Gentleman who did not give the NHS what it asked for: the Labour party. At the last election, it refused to support the NHS—[Interruption.] I know this is uncomfortable for the new shadow Health Secretary, but the reality is that the party on whose platform he stood refused to support the NHS’s own plan for the future. As his question was about money, I will add that the Labour party also refused to fund it. The NHS wanted £8 billion; Labour’s promise was for additional funding of £2.5 billion—not £6 billion or £4 billion, but £2.5 billion, or less than one third of what the NHS said it needed. Even if we accept the numbers of the Chair of the Select Committee—and, as I will go on to explain, I do not—Labour was pledging over the course of the Parliament only around half of what this Government have delivered in the first year of the spending review.
The hon. Gentleman used other choice words, one of which was “spin”. I will tell him what creates the most misleading impression: a Labour party claiming to want more funding for the NHS when, in the areas where they run it, the opposite has happened. Indeed, in the first four years of the last Parliament, Labour cut NHS funding in Wales when it went up in England—[Interruption.] Yes, it did. Those are the official figures. That is in a context in which the Barnett formula gives the Government in Wales more than £700 more per head to spend on public services, so there is more money in the pot.
The hon. Gentleman talked about social care. May I remind him of what the shadow Chancellor at the time of the last election—Ed Balls, who is now sadly no longer of this parish—said? During the election campaign, he said of funding for local councils “not a penny more”. We are giving local councils £3.5 billion more during the course of this Parliament.
The hon. Gentleman talked about other cuts that he alleges will happen in A&E departments and other hospital services. I simply say to him that we have to make efficiency savings. I do not believe they will be on the scale he talked about, but how much worse would they have to be if the NHS got a third of the money it currently gets?
If the hon. Gentleman and his party think the NHS is underfunded, they need to accept that the policies that they advocated in the past two elections were wrong —they advocated spending less than the Conservatives. Until they are serious about changing their policy, no one will be serious about listening to their criticisms.
Dr Sarah Wollaston (Totnes) (Con)
I agree with the Secretary of State that prevention is better than cure, but he will know that achieving the aims of the five year forward view was dependent on a radical upgrade in public health and prevention. He will know that it was also dependent on adequate funding for adult social care. In addition, there are continuing raids on the NHS capital budget, and we need to put in place the kind of transformation that he and our sustainability and transformation partnerships wish to achieve.
Will the Secretary of State therefore confirm that he recognises the serious crisis in social care and the effect it is having on the NHS, and the effect that taking money from public health budgets is having? Although I accept that he does not agree with the Health Committee’s appraisal of the £10 billion figure, I am afraid I stick by those figures.
Mr Hunt
I have enormous respect for my hon. Friend. I respect her passion for the NHS, her knowledge of it and her background in it, so I will always listen carefully to anything she says. I hope she will understand that just as she speaks plainly today, I need to speak plainly back and say that I do not agree with the letter she wrote today, and I am afraid I do think that her calculations are wrong.
The use of the £10 billion figure was not, as she said in her letter, incorrect. The Government have never claimed that there was an extra £10 billion increase in the Department of Health budget. Indeed, the basis of that number has not even come from the Government; it has come from NHS England and its calculations as to what it needs to implement the forward view. As I told the Select Committee, I have always accepted that painful and difficult economies in central budgets will be needed to fund that plan. What NHS England asked for was money to implement the forward view. It asked for £8 billion over five years; in fact, it got £10 billion over six years, or £9 billion over five years—whichever one we take, it is either £1 billion or £2 billion more than the minimum it said it needed.
I think my hon. Friend quoted Simon Stevens as saying that NHS England had not got what it asked for. He was talking not about the request in the forward view, but in terms of the negotiations over the profile of the funding we have with the Treasury. The reason that the funding increases are so small in the second and third year of the Parliament is precisely that we listened to him when he said that he wanted the amount to be front- loaded. That is why we put £6 billion of the £10 billion up front in the first two years of the programme.
I fully accept that what happens in the social care system and in public health have a big impact on the NHS, but on social care we have introduced a precept for local authorities combined with an increase in the better care fund—[Interruption.] This is a precept, which 144 of 152 local authorities are taking advantage of. That means that a great number of them are increasing spending on social care. It will come on top of the deeper, faster integration of the health and social care systems that we know needs to happen.
On public health, I accept that difficult economies need to be made, but it is not just about public spending. This Government have a proud record of banning the display sale of tobacco, introducing standardised packaging for tobacco, introducing a sugary drinks tax and putting more money into school sports. There are lots of things that we can do on public health that make a big difference.
On capital, I agree with my hon. Friend about the pressure on the capital budget, but hospitals have a big opportunity to make use of the land they sit on, which they often do not use to its fullest extent, as a way to bridge that difficult gap.
Martyn Day (Linlithgow and East Falkirk) (SNP)
With some 80% of trusts in deficit and only 4% meeting accident and emergency targets, I am grateful to the Health Committee for flagging up the dire financial state of the NHS in England, as evidenced by its letter to the Chancellor. We learn from that document that the £10 billion figure is a bit of a fallacy. In Scotland, the SNP Government are committed to investing an additional £2 billion by 2021, but any reduction in new money for the NHS from the UK Government would have an impact on Barnett consequentials. Given that the UK Government have already slashed Scotland’s budget by 10% between 2010 and 2020, they need to be honest and transparent about what that reduction will mean for Scotland’s funding. With the Department of Health having accidentally not adjusted its books for an extra £417 million from national insurance contributions, and having broken its control total by £207 million, will the devolved Governments get any share of that additional £624 million?
Mr Hunt
Many people in Scotland will be somewhat surprised by the hon. Gentleman’s comments, because in the last Parliament spending on the NHS in England went up by 4%, whereas in Scotland it fell by 1%. The IFS confirmed that at the time of the independence referendum, saying:
“It seems that historically, at least, Scottish Governments in Holyrood have placed less priority on funding the NHS in Scotland…than governments in Westminster have for England”.
In this Parliament, the hon. Gentleman’s party has already lost a vote on NHS cuts in the Scottish Parliament and been criticised by Audit Scotland for its performance. When the SNP has the courage to increase NHS spending in Scotland by the amount we are increasing it in England, we will listen, but until then it should concentrate on looking after Scottish NHS patients in Scotland.
Several hon. Members rose—
Mr Philip Hollobone (Kettering) (Con)
People in Kettering appreciate plain speaking. Can the Health Secretary tell the House what the NHS budget was in 2014-15, what it will be in 2020-21 and what the difference is between the two numbers?
Norman Lamb (North Norfolk) (LD)
Is there not an urgent need to be straight with the British public about the resources we will need to maintain both the NHS and the care system, and to confront the fact that we will all have to pay a bit more to ensure that our loved ones get care when they need it?
Mr Hunt
When the right hon. Gentleman and I worked in government, we both campaigned hard on many occasions for more funding for the NHS, including mental health—a particular priority for both of us. The answer to his question is yes, and that is why we are putting in more money in this Parliament. My own view is that in future Parliaments we will need to continue to increase the amount of funding going in to the NHS. The only point I would make is that what funds the NHS is a strong economy, so we have to make sure that increases in NHS funding are sustainable and compatible with a strong economy. That is something that this Conservative Government have a very good track record of delivering.
Mrs Cheryl Gillan (Chesham and Amersham) (Con)
The plans to achieve savings from community pharmacies are causing a great deal of concern in my constituency. The patients group at the John Hampden surgery and residents in and around Prestwood believe that the plans may result in the closure of our excellent rural pharmacy in Prestwood. What reassurances can the Secretary of State give to my constituents today that no pharmacies will close that are more than a mile from any other pharmacy? Will he make sure that he takes into account the implications for GPs’ workloads when looking at pharmacies?
Mr Hunt
First, the people of Prestwood are lucky to have such an assiduous MP to campaign for their interests in Parliament today; indeed, my right hon. Friend always does so. I can give her that reassurance, because in the package of efficiencies we set out—it is right that we ask pharmacies to make efficiencies in the way they are run, just as we are asking the rest of the NHS to make efficiencies in the way it is run—we are protecting all pharmacies that are a mile or more from any other pharmacy. In that sense, we are absolutely determined to protect provision for her constituents and all our constituents who depend on rural pharmacies.
Tracy Brabin (Batley and Spen) (Lab)
If the Government had stood by their word and invested the promised £10 billion in the NHS, does the Secretary of State agree that the downgrade of Dewsbury A&E might not have been necessary?
Mr Hunt
First, may I welcome the hon. Lady to her place in this House? I am sure that she will make an extremely important contribution. Yes, she is filling very big boots, but, if I may say so, she has made a very good start.
On what happens with A&E departments, changes in the pattern of the services we provide have been a feature, both when the hon. Lady’s party has been in power and when my party has been in power, because the needs of the people who use the NHS also change. We therefore need to strike the right balance between reassuring people that services are provided near where they live, while ensuring that they receive the right care when they get there. For strokes, that does not always mean going to the nearest hospital, but somewhere with 24/7 stroke care and the greatest chance of saving the patient’s life. If the hon. Lady has concerns about Dewsbury hospital, I am very happy to talk to her further.
Michael Gove (Surrey Heath) (Con)
At a time when every Department, with the exception of the Department for International Development, has to reduce public expenditure, it seems a remarkable feat of political skill to have secured an increase for the NHS bigger than either the Home Office budget or that of the Ministry of Justice. Will the Secretary of State tell me whether there are parts of the United Kingdom where health expenditure is not rising as fast as in England? If there are, which political parties are in charge there?
Mr Hunt
I thank my right hon. Friend, whose passion and commitment to higher standards for the constituents he serves have inspired me in this job, just as I know they have inspired many others in the education field. There are indeed parts of the United Kingdom that allow us to make a very good comparison of the commitment to and funding of the NHS. In Wales, funding went down in the first four years of the previous Parliament. In Scotland, funding went down over the course of that Parliament. Both the Scottish National party and the Labour party like to talk about the NHS, but when it comes to writing the cheques, they are nowhere to be seen.
John Cryer (Leyton and Wanstead) (Lab)
Can the Secretary of State guarantee that every A&E department in north-east London, with a rapidly rising population, will remain open for the rest of this Parliament? If he cannot guarantee that, how many will close and which ones? What is his hit list?
Mr Hunt
What I can guarantee is that the decisions about the future of A&E departments will be taken locally by clinicians who have the best interests of their patients at heart. I think that the hon. Gentleman and I would be able to agree that these decisions are not best taken by Secretaries of State. It is much better that they are taken by people who do not have any party political axe to grind. Any decision to change service provision at an A&E has the opportunity, if it is so wished, to be reviewed by the Secretary of State when it goes through an independent process. That is exactly what would happen in north-east London, were the local community to wish it.
Andrew Stephenson (Pendle) (Con)
Under the previous Labour Government, Burnley general hospital lost its A&E department and a number of key services. Under the coalition Government, a new £9 million urgent care centre opened and just last week the trust submitted plans for a £15 million development of the hospital. Does that not perfectly demonstrate the unprecedented investment in the NHS since Labour left government?
Mr Hunt
It absolutely does. I much enjoyed visiting with my hon. Friend some health facilities in his constituency during the general election campaign. The difference between Conservative Members and Labour Members is that we recognise that every penny of the NHS budget has to come from a strong economy. We know that if we take that for granted, we end up having to cut the NHS budget, which is what has happened in Spain, Italy, Greece, Portugal and many other countries that have lost control of their national finances. That is something that Labour Members would do well to remember.
Mr Ben Bradshaw (Exeter) (Lab)
The Government have been well and truly found out on this issue. Rather than quote selectively from Simon Stevens, the head of the NHS, will the Secretary of State confirm that among the conditions that Mr Stevens put down to the Government as part of the five-year review was an increase in public health spending, not a 20% cut, and a policy of maintaining spending on social care? Will he also confirm—he was there in Simon Stevens’ presence before the Select Committee—that Mr Stevens made it quite clear that those conditions and others had not been met?
Mr Hunt
Actually, what Mr Stevens said—I was there—was that social care and, indeed, public health provision needed to be maintained. We are increasing the social care budget by £3.5 billion over this Parliament. Although I accept that difficult cuts are being made to the public health budget, we are doing other things that do not cost money to make sure that we continue to improve this country’s excellent record on public health.
Anna Soubry (Broxtowe) (Con)
We all want a well-funded NHS. I congratulate the Secretary of State on making sure that we now have record spending in England. Last night, the A&E department of the Queen’s medical centre was tweeting that it effectively could not cope. We all of course congratulate and thank the hard-working staff in A&E, but the problem was demand. Does my right hon. Friend agree that the NHS can do much more to improve the way it signposts people? It was urging people to go to the urgent care centre, which does stitching and mends broken bones, all of which was news for many people in Greater Nottingham.
Mr Hunt
My right hon. Friend is absolutely right. That, of course, is why all parts of the NHS in England are embarking on the sustainability and transformation programme, which is designed to do precisely what my right hon. Friend says—to find smart ways to reduce demand. That will include, for example, better use of pharmacies, better use of GPs, more mental health provision—[Interruption.] Opposition Members are shouting, but why were they not prepared to put the money into the NHS to help us implement these plans? There would be no sustainability and transformation plans on the thin gruel that they promised for the NHS at the last election.
Rob Marris (Wolverhampton South West) (Lab)
I was always against the private finance initiative. This Government have set up a £1.5 billion bail-out fund for PFI. I put it to the Secretary of State that that is to rewarding past profligacy and penalising frugal trusts such as the Royal Wolverhampton NHS Trust. When will the Secretary of State redress this imbalance, stop rewarding profligacy and reward frugality?
Mr Hunt
I am getting more and more impressed with the hon. Gentleman’s questions. Last time, he accused me of being a Corbynista, and today he is criticising me for profligacy, when the general tone of most Members seems to be that we are being rather too parsimonious with the NHS. I completely agree with him that private finance initiatives were an utter disgrace, leaving the NHS with over £70 billion-worth of debt by 2010. Unfortunately, there does not seem to be a strong correlation between shiny new buildings and good care for patients, as can be seen in a number of Care Quality Commission reports. We are doing everything we can to unwind that very difficult problem.
Several hon. Members rose—
Sir Desmond Swayne (New Forest West) (Con)
How much more would the Secretary of State have had to spend per year by 2021 if the Chancellor had taken the Labour party’s advice?
Mr Hunt
If the Chancellor had taken the Labour party’s advice, the NHS would have had £5.5 billion less to spend every single year. I just ask Members who are worried about their A&E departments, worried about mental health and worried about GP provision on which of those services the axe would have had to fall if we had followed Labour’s spending plans?
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Since the 2010 general election, we have lost over 1,500 mental health beds, there are 5,000 fewer mental health nurses and over 400 fewer doctors working in mental health. The pledge that the Secretary of State made at that Dispatch Box on 9 December—that every clinical commissioning group would increase its spend on mental health—lies in tatters. When will this Government’s rhetoric on equality for mental health be matched with adequate resources?
Mr Hunt
I will tell the hon. Lady when that rhetoric became reality. We now have the highest dementia diagnosis rates in the world, according to some estimates. We are treating three quarters of a million more people with talking therapies every year than we were in 2010. Every single day, we are treating 1,400 more mental health patients. By the end of this Parliament, because of our spending plans, we will be spending £1 billion more on mental health every single year, treating 1 million more people. I think that that is pretty good.
Andrew Selous (South West Bedfordshire) (Con)
Is not one way to help the NHS to deal with its financial pressures by focusing on improving quality and using proper data? Professor Tim Briggs’s report, “Getting it Right First Time” is already improving patient outcomes and saving the NHS money.
Mr Hunt
I thank my hon. Friend for bringing Professor Briggs to meet me. He is an extremely inspiring man. He has established that every time someone has an infection during an orthopaedic operation, it costs the NHS £100,000 to put it right, but that is happening 0.5% of the time in the case of some surgeons and 4% of the time in the case of others. Dealing with variation of that kind is a way not just to reduce costs, but to avoid enormous human heartache.
Kate Green (Stretford and Urmston) (Lab)
NHS managers in Greater Manchester have made it clear that the pressures on the NHS are a function of pressures on the social care system and that costs are rising because of increases in the national living wage and the need to fund overnight cover. What is the Secretary of State doing to address those financial pressures on social care, given that the precept does no more than scratch the surface?
Mr Hunt
I agree that there are real pressures, although I should add that many Members were worried about some of the poor working conditions of people in the social care system and that 900,000 people on low pay in the system will benefit from the introduction of the national living wage. However, I agree that leaving people parked in hospitals when they should be being looked after in the community is financial nonsense. What is happening in Greater Manchester is one of the most impressive examples of health and social care integration in the country, and that must be the long- term answer.
Tom Pursglove (Corby) (Con)
I am very proud of the Government’s funding record, but does my right hon. Friend agree that it is also crucial to make the right strategic decisions? For example, it was a Conservative-led Government with a Conservative Health Secretary who delivered the urgent care centre in Corby, which has transformed health opportunities in our area and taken pressure off our A&E.
Karin Smyth (Bristol South) (Lab)
Representatives of the Department of Health and NHS England have appeared before the Public Accounts Committee eight times so far this year. We have taken a detailed look at the Department’s accounts, following the Comptroller and Auditor General’s unprecedented explanatory note, and I am glad that the Health Committee has said that it will examine the issue further.
The Secretary of State said that prevention was better than cure. The “General Practice Forward View” refers to a £2.4 billion increase in investment by 2020. Can the Secretary of State assure us that that crucial investment in primary care will be protected and not used to plug hospital deficits?
Mr Hunt
It is a vitally important investment. The first speech that I made as Health Secretary after the last election was made to GPs, and I said then that we wanted to deliver an extra 5,000 doctors working in general practice. It is vital that we eliminate hospital deficits, but we are making good progress in doing so.
John Howell (Henley) (Con)
Does my right hon. Friend agree that, when it comes to funding the forward view, the treatment of patients in their homes is not principally about cost-cutting but is part of a radical change in health provision for the future on which clinicians agree?
Mr Hunt
Absolutely. The simple principle for those of us who are not doctors is that it is much cheaper to nip illnesses in the bud than to wait until they progress. Treating someone at stage 1 or 2 of cancer is not only cheaper for the NHS, but much more likely to lead to a full cure. That is the whole foundation of the strategic change that we are making in the NHS.
Ms Angela Eagle (Wallasey) (Lab)
My constituents who are watching these exchanges will think that the Secretary of State is living in a parallel universe. The sustainability and transformation programme in Merseyside is reputed to be tackling a £1 billion deficit. The way in which it has decided to tackle it in Wirral, in my area, is to draw up plans to close Clatterbridge, our cancer hospital, to close Arrowe Park, our acute hospital, to close the Countess of Chester hospital, and to create some new hospital in Ellesmere Port at some time in the future. No one believes the blather from this Secretary of State.
Mr Hunt
I do not recognise the plans the hon. Lady is talking about, but I say to her that we do need to change our service provision; we are dealing with many more older people, and her constituents need better care at home and in the community than they are currently getting. Any big changes will be subject to a proper consultation, and would indeed go before the Independent Reconfiguration Panel and if necessary end up on my desk. I also say to the hon. Lady that setting her face against all changes may be—
Richard Drax (South Dorset) (Con)
Does my right hon. Friend agree that patients get better in a cosy environment in community hospitals, and can he give me an assurance that he will love and maintain them for as long as he is in post?
Mr Hunt
I am sure that no one could do a better job of loving and maintaining community hospitals than my hon. Friend. Community hospitals have an important role to play. I have three excellent ones in my constituency. At best, they represent the change we need to see in the NHS, which is personalised care closer to home, but that does also mean that they sometimes need to change the way they deliver services within a building even if the NHS logo remains firmly on the outside of that building.
Emma Reynolds (Wolverhampton North East) (Lab)
I was proud to sign the cross-party letter to the Chancellor on NHS funding, in which we quote the Care Quality Commission saying that
“adult social care…is approaching a tipping point”
and that is having an impact on those who rely on it and on “the performance” of the NHS. Does the Secretary of State recognise that this Government’s cutting social care funding by over a third was a false economy, that there will still be a gap in social care funding even if all councils took up the precept and that, for as long as we have that, we will have hospital deficits and delays?
Mr Hunt
I do recognise the pressures in the social care system, but, in an era of very constrained national finances, funding for the social care system is going up by £3.5 billion a year by the end of this Parliament, which is a significant and important rise. I say to the hon. Lady that it is this Government who have set the CQC free to tell us the honest truth about the quality of care in our hospitals, GP surgeries and social care system, and it is because of that that we are able to have the kinds of questions and answers we are having today.
Helen Whately (Faversham and Mid Kent) (Con)
This Government have shown their commitment to the NHS, promising and delivering increases in funding, unlike the Opposition parties. My right hon. Friend recognises the connections between health and social care and is driving the integration of those two areas. May I urge him to continue looking at both the funding and performance of health and social care in the round?
Mr Hunt
I congratulate my hon. Friend on her excellent question. I absolutely agree with her, as someone who worked in healthcare before she came to this House, that it is vital to nurture the links between the health and social care systems if we are to deal with some of the issues that concern Members on both sides of the House. There are some very good examples of where this is working well, but it is not happening in as many places as it needs to, and we all must focus on that.
Daniel Zeichner (Cambridge) (Lab)
The Secretary of State was in Cambridge on Friday. Did he have an opportunity to notice that at Addenbrooke’s, the hospital that serves Cambridge, the number of over-85s coming into A&E has risen by almost 12% year on year, and on Friday there were 100 over-85s in that hospital who should have been out in the community? Does he agree that that is proof perfect of the failure of this Government’s policies on social care, which are the root cause of the problems in our NHS?
Mr Hunt
The hon. Gentleman is looking at the record of this Government: we have 1,200 more doctors in our A&E departments, who are treating within four hours 2,500 more people every single day. We are also putting more money into the NHS and into the social care system. Addenbrooke’s is a hospital under great pressure, but it is determined to co me out of special measures and do its best for patients, and I salute all the staff, whom I much enjoyed meeting there on Friday. The one thing they would not want is the NHS budget to be cut from current levels.
Robert Jenrick (Newark) (Con)
The Secretary of State knows that over 50% of the deficit at my local trust, Sherwood Forest Hospitals NHS Foundation Trust, and 25% of all its annual revenue goes on paying off its PFI premium. Will the Secretary of State take this opportunity to look again at my trust and others? Will he also remind the House which party left that toxic legacy for my constituents?
Mr Hunt
I am happy to remind the House, as my hon. Friend requests, that we inherited this situation from the Labour party in 2010. Despite that toxic legacy, the people working in the Sherwood Forest hospitals have done an incredible job of turning the trust around since it was put into special measures a few years ago. I commend them on their progress, which I hope will bear fruit and allow the trust to come out of special measures soon.
Mr Speaker
I would like to conclude these exchanges by 4.30 pm because there is other pressing business. If people take a long time, they are preventing their colleagues from contributing. I am sorry, but it is as simple as that.
Derek Twigg (Halton) (Lab)
Does the Secretary of State believe that there is a need for additional funding for adult social care over and above that which has been already allocated?
Mr Hunt
We are putting extra money into adult social care, and local authorities have the ability to increase their funding to adult social care through the new precept. In an ideal world, everyone would like more money to go into the NHS and social care system, but Government Members know that those systems are powered by a strong economy and that we can increase our budget only at a rate that the economy can afford. The past six years show that if we take care of the economy, we can increase the NHS and social care budget, and that is what we are doing.
Michael Fabricant (Lichfield) (Con)
Is it not the case that there will never be enough money to go into the NHS? Does the Secretary of State, like me, find the sanctimonious finger-wagging from the Opposition Front-Bench team utterly nauseating given that Carwyn Jones in Wales said that the Labour Government there would make an 8% cut to the NHS in Wales? That is the legacy of Labour.
Mr Hunt
That is absolutely the point. In Wales, people wait twice as long to have a hip replaced and the figure on A&E is about 10% lower than in England. The consequences for patients in Wales are horrific. That is why everyone watching today’s exchanges will take them with a big pinch of salt.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
The Health Committee has been quite clear that of the actual £4.5 billion being spent by the Government on increased funds—not the £8 billion or the £10 billion mentioned by the Secretary of State— £3.5 billion comes from cuts to public health and to education and training. The Secretary of State can come to the Dispatch Box and twist it all he likes, but he has been found out. Every health sector worker in this country has his number and knows him to a tee—we know exactly what he is doing.
Mr Hunt
I just do not agree with the hon. Gentleman. I stand by the numbers. I am afraid that, on this occasion, the Health Committee got its numbers wrong. The figure of £10 billion did not come from the Government; it was a figure that the NHS said that it needed. In fact, it needed less than £10 billion and we are delivering more than was asked for—something that the Labour party was not prepared to do.
Matt Warman (Boston and Skegness) (Con)
The Secretary of State has taken an interest in the rurality and sparsity that hospitals in Lincolnshire wrestle with. Will he confirm that it is because this Government are spending half a trillion pounds on the NHS over the course of this Parliament that workers and patients at Pilgrim hospital, for example, can be confident about the hospital’s future?
Mr Hunt
All NHS facilities in my hon. Friend’s constituency and across the country can be confident that the NHS has a bright future. In fact, if we are to deliver the NHS plan, more rural and remote places are precisely where we must pay most attention to keeping people healthy and well in their homes. That is why not only community hospitals, but GP surgeries and all the places upon which rural communities depend are a vital part of the NHS’s future.
Tristram Hunt (Stoke-on-Trent Central) (Lab)
I wrote to the Secretary of State over the summer because trollies were bumper to bumper in the corridors of Royal Stoke University hospital. This was not mid-winter but high summer. Since then, there have been more hospital bed closures in cottage hospitals, so I repeat my invitation and ask the Secretary of State to come to Stoke-on-Trent and see for himself the crisis in the funding settlement, which is hitting some of those with the most chronic health conditions.
Mr Hunt
I am happy to visit the hon. Gentleman’s local hospital, as I have been concerned about it for some time. I know that things have been particularly challenging there in the wake of what happened in neighbouring Mid Staffs, which has created its own pressures on the hospital. I also know that its staff work extremely hard in very challenging circumstances, so, yes, I will visit that hospital.
Edward Argar (Charnwood) (Con)
Does my right hon. Friend agree that achieving improvements in public health comes down not simply to the amount of money spent by the Government on it, but to a range of factors, including how it is spent, regulation, education and individuals’ choices?
Mr Hunt
I absolutely agree with that. This House should be very proud of the fact that, according to the UN, when it comes to public health this is the fifth healthiest country on the planet—after Iceland, Andorra, Singapore and Sweden, if my memory serves me correctly. That is a record we want to continue.
Mr Dennis Skinner (Bolsover) (Lab)
A lot of figures have been bandied about today. For the record, when Labour inherited office in 1997 the amount spent on the NHS was £33 billion, whereas by the time we left office in 2010, 13 years later, the figure had gone up to £100 billion. It is an easy figure to calculate: three times more in real terms. We can contrast that with this Secretary of State for Health, who is coming here today fiddling figures and shutting Bolsover hospital.
Maggie Throup (Erewash) (Con)
It is clear to me that the NHS cannot rely solely on the Government to achieve financial sustainability; nor should it be used by some as a political football. Does my right hon. Friend agree that there is a responsibility on all NHS stakeholders to work together to cut waste where it exists, and towards a long-term sustainable social care programme?
Mr Hunt
My hon. Friend is absolutely right about that, which is why we need to make difficult efficiency savings—around £22 billion during this Parliament. We made about £18 billion to £19 billion-worth of savings in the previous Parliament, so I think it is doable. It will not be easy, but she is right in what she says.
Wes Streeting (Ilford North) (Lab)
If things are as rosy as the Secretary of State is making out, why is the London Borough of Redbridge, where I am an elected Member, suffering from public health cuts and, even while charging the social care precept, is still barely able to cover the costs of wage increases, let alone improve the service? He should have been lobbying the Chief Secretary this afternoon, not painting this ridiculously unjustifiable rosy picture.
Mr Hunt
I do not think the hon. Gentleman was listening to my statement, which said clearly that the NHS is under unbelievable pressure. It does not really work for the Labour party to campaign for increases in the minimum wage, which we read about today, and then to criticise the increasing costs in the adult social care system caused by the national living wage that was introduced by this Government.
Jason McCartney (Colne Valley) (Con)
Will the Secretary of State look at splitting the Calderdale and Huddersfield NHS Foundation Trust, so that the disastrous PFI deal at Halifax, where we will pay £700 million for a hospital that cost £64 million, will stop dictating the closure and downgrading of services at Huddersfield?
Mr Hunt
I salute my hon. Friend for the campaign he is leading at the moment, standing up for his constituents. He is right to point to PFI as one of the principal causes, and we now have to find a way to deal with that issue in a way that improves and does not detract from the quality of care offered to the people he represents.
Andy Slaughter (Hammersmith) (Lab)
According to Sir Richard Sykes, the chair of Imperial College Healthcare NHS Trust, “the problem is funding”, we are “killing” NHS staff by making them work 18 hours a day, and it is not in a position to close any more accident and emergency facilities in north-west London because there is not the capacity to do so. How is the NHS in north-west London supposed to save £1.3 billion over the next four years, as its sustainability and transformation plan proposes?
Andy Slaughter
Give a serious answer to a serious question—you’re a buffoon! [Hon. Members: “Ooh!”]
Mrs Anne Main (St Albans) (Con)
It is regrettable that the Chair of the Select Committee, my hon. Friend the Member for Totnes (Dr Wollaston), has led this attack on a Government who are doing so much. Will my right hon. Friend tell me what more is being done to recoup the money that should have been clawed back from those who had health insurance and who should not have used our system?
Mr Hunt
My hon. Friend is right to point out that problem. For years, under the previous Government, there was a total resistance anywhere in the NHS to ensuring that the only people who received care free at the point of use were people paying for the NHS through the taxes that they or their families pay. That is something to which we will put a stop. There is much more work to be done. We have the second biggest aid budget in the world. That is the way that we help developing countries, but we cannot have an international health service.
Lilian Greenwood (Nottingham South) (Lab)
NHS trusts’ deficits are now the worst that they have ever been, with 85% of acute hospitals unable to balance their books. That situation will be made even worse as the falling value of the pound raises the cost of imported medicines and equipment. What assessment has the Secretary of State made of the extra funding needed to protect the NHS from the devaluation of sterling following the Brexit vote? What will he do to support trusts, such as Nottingham University Hospitals NHS Trust, which are already in deficit?
Mr Hunt
There are indeed a number of cost pressures in the NHS, but the NHS also has the advantage of being the single largest purchaser of healthcare products—equipment and medicine—in the world, and therefore we have huge scope to get better prices for those things than we currently get. We are supporting hospitals such as the one in the hon. Lady’s constituency by centralising procurement and bearing down on the cost of agency staff and locum staff. Given that pay accounts for more than 70% of the typical hospital trust, that will help.
Chris Davies (Brecon and Radnorshire) (Con)
Labour in my home area of Wales has cut the NHS by 8%. Can my right hon. Friend confirm to this House that he will never follow its example?
Mr Hunt
It is not just the money that Labour has cut. It has refused to set up an independent inspectorate of hospitals such as we did in England, which is the sure way of knowing that we never have a repeat of what happened at Mid Staffs. I urge the Welsh Government to think again about their approach to that.
Jenny Chapman (Darlington) (Lab)
Darlington’s A&E is among the one in three earmarked for closure or downgrading. In his opening response to what is an urgent question, not a statement, the Secretary of State said that he did not accept that figure of one in three. How many A&Es will be downgraded, or does he not know?
Mr Hunt
Those plans come up from local areas. The NHS is not projecting that we will have significant reductions in the need for emergency care over the next few years. What matters is that we make sure that, yes, people can get to an A&E near them, but that when they get there, they get the right expert care, and that is what local areas are working on.
Clive Efford (Eltham) (Lab)
In my constituency, a nurse-led practitioner service has been closed because of a lack of resources. Similarly, stroke rehab has been cut because of a lack of resources. Our A&Es are not meeting waiting times, and are now under threat because their orthopaedic services have been privatised and handed out to Circle, which may not contract back to their local healthcare trust, thereby undermining the capacity to maintain those A&Es. Does the Secretary of State accept responsibility for any of that?
Margaret Greenwood (Wirral West) (Lab)
I am particularly concerned that the Government are cutting supply in public health to create demand for a private healthcare market, which means that, like the United States, we will have a two-tier system. I was very concerned by the vague response that the Secretary of State gave to my hon. Friend the Member for Wallasey (Ms Eagle). Will he guarantee this afternoon that there will be no closures of Arrowe Park hospital, Clatterbridge hospital or the Countess of Chester?
Mr Hunt
With respect to local service provision, these things are decided locally. If the hon. Lady wants to dig up the old chestnut about the privatisation of the NHS, let me say that the outsourcing of services to the private sector increased much faster under her Government than under this Government. If we did have those malign motives for the NHS, increasing its budget by £10 billion over the course of this Parliament and increasing doctor training by one of the biggest increases in its history would be a strange way of going about it.
Accelerated Access Review
Jeremy Hunt Excerpts(8 years, 1 month ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
This morning Sir Hugh Taylor has published the final report of the accelerated access review (AAR). The AAR was tasked with making recommendations to the Government on reforms to accelerate access for NHS patients to innovative medicines, medical technologies, diagnostics and digital products. The report sets out a framework of recommendations to streamline and accelerate the pathway for new products from development to their use with patients and to enable widespread adoption across the NHS.
The Government welcome Sir Hugh’s final report and are grateful to him, Sir John Bell, the external champions and the external advisory group for their excellent work, which draws upon contributions from many individuals and organisations from patient groups, the NHS, industry, academia and clinicians. We are grateful for the important input that this review has had from NHS England NICE, the MHRA and NHS Improvement.
The report provides us with a strong basis to make the right decisions about how the health system can be adapted to meet the challenges of the future, attract inward investment, grow our thriving life sciences industry and use innovation to improve patient outcomes in the context of the financial pressures on the NHS. It will be important to implement this report in a way that is affordable for the NHS. The Government will now consider the proposals in detail with our partners and will provide a fuller response in due course.
The Government remain strongly committed to the life sciences and to building a long-term partnership with industry. It is determined to help the UK become the best place in the world to produce new drugs and products that can transform the health of patients, where the research, development, regulatory, commercialisation and investment infrastructure enable innovation to flourish and thrive while improving patient’s lives.
AAR Final Report (AAR final.pdf) can be viewed online at: http://www.parliament.uk/business/publications/ written-questions-answers-statements/written-statement/Commons/2016-10-24/HCWS209/.
[HCWS209]
Health Service Medical Supplies (Costs) Bill
Jeremy Hunt ExcerptsMonday 24th October 2016
(8 years, 1 month ago)
Commons ChamberRead Full debate Health Service Medical Supplies (Costs) Act 2017 View all Health Service Medical Supplies (Costs) Act 2017 Debates Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move, That the Bill be read a Second time.
This is a short and focused Bill which is vitally important not only for the NHS but for patients. NHS spending on medicines is second only to staffing costs. The Health and Social Care Information Centre—now NHS Digital—estimated that the NHS in England spent over £15.2 billion on medicines during 2015-16, a rise of nearly 20% since 2010-2011. With advances in science and our ageing population, those costs can only continue to grow.
Medicines are of course a vital part of patient care in the NHS, both in hospitals and in the community. Thanks to the research and development efforts of the life sciences industry—an industry which contributes £56 billion and tens of thousands of jobs to the UK economy every year—our understanding of diseases and the best way to treat them has improved dramatically over the past 20 years. Who would have thought for instance that UK work pioneering superconducting magnets would result in MRI scanners—scanners which would save hundreds of lives each year through the early detection of breast cancer—or that the remarkable research by our National Institute for Health Research into translational medicine would lead to scientific breakthroughs in areas such as gene therapy being taken from the lab to the clinic? In a six-year period this has led to 340 patents, generating over £80 million from intellectual property.
This Government are committed to ensuring that patients get access to innovative and cost-effective medicines as quickly as possible. I pay tribute to the work carried out by my hon. Friend the Member for Mid Norfolk (George Freeman), who worked tirelessly in government to promote the life sciences industry, and who established the accelerated access review to provide clear recommendations on how the Government, the NHS and the industry can work together to ensure patients benefit from transformative new products much more quickly. That review was published today and is an excellent document which challenges everyone in the medicines system to up their game.
Our mission is to continue our progress in ensuring patients get rapid access to life-changing and cost-effective medicines. However, we also need to ensure that we are getting the best value for the NHS, which is why we have brought this Bill before the House.
The purpose of the Bill is to clarify and modernise provisions to control the cost of health service medicines and to ensure sales and purchase information can be appropriately collected and disclosed. These provisions will align the statutory and voluntary cost control mechanisms currently in existence, allow the Government to control the cost of excessively priced unbranded generic medicines, and ensure we have comprehensive data with which to reimburse people who dispense medicines. Taken together, these measures will enable us to secure better value for money for the NHS from its spend on medicines.
James Cartlidge (South Suffolk) (Con)
I congratulate my right hon. Friend on this effort. I recently received a written answer saying that last year GPs spent £85 million prescribing paracetamol. A packet of 500 mg paracetamol costs 19p in Asda, and I wonder whether this Bill will enable us to look those costs and whether such prescribing is appropriate.
Mr Hunt
I am grateful to my hon. Friend for raising that issue. Although the measures he mentions are not directly covered in this Bill, he reminds the House that the business of getting value for money from our drugs business is everyone’s business throughout the NHS. There is a huge amount of prescribing of medicines that is not strictly necessary. Indeed, we had further evidence of that from the Academy of Medical Royal Colleges this morning. My hon. Friend makes an extremely important point: this Bill is part of the effort to get better value for money from our medicines budget, but initiatives such as the one he talks about are equally important.
Steve McCabe (Birmingham, Selly Oak) (Lab)
Further to that question, I can see how the Bill will deal with the issue of debranding, and that is very welcome, but I understand there are three other areas of concern. There is the question of price delay, which the Competition and Markets Authority has been looking at, and there are the problems of tying and bundling and so-called loyalty schemes, all of which act to inflate the cost of medicines to the NHS artificially. Will the Bill also deal with those areas?
Mr Hunt
It will deal with some of those concerns, and we will listen to all the concerns raised by hon. Members during the progress of the Bill. On the particular issue the hon. Gentleman raises, the CMA is already investigating the behaviour of pharmaceutical companies in certain situations, but it has become clear to us that there is a particularly unethical and unacceptable practice of drugs companies getting control of generic drugs for which they command a monopoly position and then hiking the prices. There was one product whose price increased by 12,000% between 2008 and 2016, and if the price had stayed the same as before the increase, the NHS would have spent £58 million less. The Government’s conclusion is that the simplest and quickest way to sort this out is through new legislation, but I will happily take the hon. Gentleman’s other concerns offline and look into them further.
John Glen (Salisbury) (Con)
I welcome the provisions of the Bill that will close a loophole and deal with terrible examples of where the NHS is in effect exploited, but can my right hon. Friend point to the future in light of the suggestion that the drugs bill will increase to £20 billion by 2020—a much more significant increase than can be afforded under the projected expenditure in the NHS? What bigger measures need to be put in place for us to deal substantively with that bigger problem?
Mr Hunt
My hon. Friend is right in that we see demand for NHS services, which includes treatment and drugs, increasing by a total of around £30 billion over the next five-year period, which is a huge amount and certainly more than we as a country can afford without changing practice. That is why we are implementing a very challenging series of efficiency reforms designed to make sure that we can afford to continue current levels of NHS service on the £10 billion increase this Government are putting in. Part of that is indeed measures such as those in this Bill to control the drugs bill. My hon. Friend is also right that going forward over the next 25, rather than five, years we will be seeing the bigger issue of the accelerating pace of innovation in science. That provides great opportunities for the NHS, but potentially great pressures for the budget, and I am sure we will continue to discuss those issues extensively in this House.
Dr Andrew Murrison (South West Wiltshire) (Con)
What assessment has my right hon. Friend made of the impact this Bill might have on the parallel trade in pharmaceuticals, which he will know has both costs and benefits for the NHS and for patient care?
Mr Hunt
My hon. Friend obviously knows about these matters in a great deal of detail and should be reassured that this Bill should prevent people who are part of the current voluntary pharmaceutical price regulation scheme—PPRS—from parallel-importing through European subsidiaries, which currently under single market rules we are not able to do anything about. That loophole will be closed.
The first element of the Bill relates to controls on the cost of branded medicines. For many years the Government have had both statutory and voluntary arrangements in place with the pharmaceuticals industry to limit the overall cost of medicines to the NHS. Companies can choose to join either the voluntary scheme or the statutory scheme. Each voluntary scheme typically lasts for five years before a new scheme is negotiated.
The current voluntary scheme is the 2014 PPRS. The objectives of that agreement include keeping the branded health service medicines bill within affordable limits while supporting the availability and use of effective and innovative medicines. For industry, the PPRS provides companies with the certainty and backing they need to flourish both in the UK and in the global markets.
The current PPRS operates by requiring participating companies to make a payment to the Department of Health of a percentage of their NHS sales revenue when total sales exceed an agreed amount. So far the PPRS has resulted in £1.24 billion of payments, all of which have been reinvested back into the health service for the benefit of patients.
Rob Marris (Wolverhampton South West) (Lab)
The early part of the Bill appears incredibly tortuous, because it relates to whether something is under the voluntary scheme or the statutory scheme and to switching back and forth between the two. Is that because we have a voluntary scheme which started in 2014 and will run until 2019, and the Government intend not to renew it? If the Government are minded to consider renewal in 2019, why have parallel schemes making the whole thing much more complex than it needed to be?
Mr Hunt
The hon. Gentleman makes an important point. It will be for this House and the Government to reflect prior to 2019 on whether it is worth carrying on with two schemes, which has been the arrangement for many years. Successive PPRS voluntary agreements have covered the vast majority of sales to the NHS and the statutory scheme has been a back-up for people who do not want to participate in the voluntary scheme. Recently, however, there has been an element of gaming the system whereby more and more firms have been moving from the voluntary scheme into the statutory scheme. The Bill will remove the incentives for them to switch between schemes and will make the benefits to the NHS essentially the same whichever scheme people choose. It will be for this House to reflect on and for the Government to consider whether the dual structure is right going forward.
Daniel Zeichner (Cambridge) (Lab)
The Secretary of State tells us that £1.24 billion has come back through the rebate, but many are puzzled about where that money has been spent. Can the Secretary of State tell us?
Mr Hunt
Absolutely. The money comes back to the Department of Health and is invested in the NHS. Indeed, it would be wonderful if it was more than £1.24 billion, because there is an awful lot of need on the NHS frontline right now; the funds are much needed. Our concern is that companies have been exploiting the differences between the voluntary and statutory schemes, particularly the loophole, which the Bill seeks to close, that if companies have drugs in both schemes, we are unable to regulate at all the prices of the drugs that would ordinarily fall under the statutory scheme. That is why the Bill is so important.
Kit Malthouse (North West Hampshire) (Con)
Notwithstanding the Bill’s objectives, which I can see are admirable, does the Secretary of State accept that hundreds of millions of pounds could be saved in the drugs budget if there was better analysis of NHS prescription patterns? I have called before for the appointment of analytical pharmacists to look at the balance between prescription efficacy and cost and at trying to increase the use of biosimilars. Some of that £1.24 billion could be invested in that greater analysis.
Mr Hunt
Yes. My hon. Friend makes an important point. The third part of the Bill will provide for much better data collection to allow that analysis to take place. We are also seeking to break down the barriers between the pharmacy sector and general practice. During this Parliament, we will be financing 2,000 additional pharmacists to work in general practice so that we can learn exactly those sorts of lessons.
Dr Sarah Wollaston (Totnes) (Con)
Further to that important point about biosimilars, and in welcoming this legislation and the opportunity to create savings for the NHS, will the Secretary of State also address the long-standing issues around Lucentis and Avastin? The hon. Member for Mid Norfolk (George Freeman) updated the House about the barriers in both domestic and European legislation that prevent the use of Avastin—it is not licensed for wet age-related macular degeneration—but the scale of savings could be so vast that there is a case for introducing measures in the Bill to allow for such issues to be addressed.
Mr Hunt
I am happy to look into that—some of my own constituents have been affected by that issue. I am not aware that there is scope to consider that important point in the Bill, but we should reflect on what we can do to deal with some of the anomalies in the drug licensing regime that lead to the unintended consequences that my hon. Friend talks about.
We have a statutory scheme for companies that are not in the PPRS that is based on a cut to the list price of products, rather than a payment mechanism on company sales. Since the introduction of the rebate mechanism in the PPRS, the volumes of drugs going through it have been lower than estimated. At the same time, the statutory scheme has delivered lower savings than predicted. The inequity between the two schemes has led to some companies making commercial decisions to divest products from the PPRS to the statutory scheme, further reducing the savings to the NHS.
Last year, the Government consulted on options to reform the statutory medicines pricing scheme by introducing a payment mechanism, in place of the statutory price cut, broadly similar to that which exists in the PPRS. Our clear intention was to put in place voluntary and statutory schemes that were broadly comparable in terms of savings. Of course, companies are free to decide which scheme to join and may move from one to the other depending on the other benefits they offer, but the savings to the NHS offered by both schemes should be broadly the same.
NHS respondents to the consultation supported our position, but the pharmaceutical industry queried whether the Government had the powers to introduce a statutory payment system. Following a review of our legislative powers, we concluded that amendments should be made to clarify the existing powers to make it clear that the Government do have the power to introduce a payment mechanism in the statutory scheme. The Bill does that by clarifying the provisions in the NHS Act 2006 to put it beyond doubt that the Government can introduce a payment mechanism in the statutory scheme. The Bill also amends the 2006 Act so that it contains essential provisions for enforcement action. Payments due under either a future voluntary or statutory scheme would be recoverable through the courts if necessary. That would include the power to recover payments due from any company that leaves one scheme to join the other.
The powers proposed in the Bill to control the cost of medicines are a modest addition to the powers already provided for in the 2006 Act to control the price of and profit associated with medicines used by the health service. The powers are necessary to ensure that the Government have the scope and flexibility to respond to changes in the commercial environment. The intended application of the powers will, of course, be set out in regulations. We will provide illustrative regulations to reassure the House that we will be fair and proportionate in exercising the powers.
Rob Marris
I voted for the 2006 Act, but I have to say to the Secretary of State that profit controls are pretty draconian, particularly for a Conservative Government. The Government appear to be extending them when we have historically dealt with what society refracted through this House as excessive profits through taxation, such as the windfall tax on banks and so on. The Secretary of State now proposes to extend profit controls to a major part of the economy, which would no doubt be loved by the Leader of Her Majesty’s Opposition. To a socialist such as me, a Conservative Secretary of State doing that seems a bit counterintuitive. Could he say a bit more about why he is extending profit controls?
Mr Hunt
Our march on to the centre ground carries on apace. [Laughter.] In response to the hon. Gentleman’s fascinating point, I gently reassure him that our approach will be fair and proportionate. This is not about bringing in wide profit controls. It is important to say that we recognise—our view is shared across the House—the pharmaceutical industry’s incredibly important role in medical advances, and we want Britain to be its European centre of operations post-Brexit. Many Members have campaigned about dementia and we hope that we can get a cure—it could happen in this country—and we recognise that profits are what fund the research that makes such remarkable changes possible.
It is important, however, that we are able to see what profits are being generated from a company’s choice between the PPRS scheme and the statutory scheme as a clue to whether the company is being fair to the NHS, which is funded by taxpayers. That is why the Bill’s measures strike the right balance.
Mark Field (Cities of London and Westminster) (Con)
I hope that not only the Opposition but Government Members are reassured by those comments in response to the hon. Member for Wolverhampton South West (Rob Marris). Will the Secretary of State take this opportunity to emphasise the great contribution that the pharmaceutical industry makes not only in this country but as a global player? As he says, the profit motive is important to ensuring the competition that allows for reform and the new drugs that will transform our lives and the lives of future generations.
Mr Hunt
I am happy to give that reassurance. As I said, this industry contributes £56 billion to the UK economy, with tens of thousands of jobs. When the Prime Minister talks about where she sees our competitive advantage, she talks, first, about financial services, and life sciences is the very next industry she mentions. I completely agree with right my hon. Friend about its incredible importance, not just to this country but to the future of humanity. That is why we seek in this Bill to establish a fair relationship between the NHS, which we have to represent as we are funding it through the tax system, and the pharmaceutical industry. It is also fair to say that there have been times when some pharmaceutical companies’ practices have been disappointing, and because we want to make sure that that does not happen and that we can continue with a harmonious and productive relationship we are proposing this Bill to the House.
Kevin Foster (Torbay) (Con)
We agree that this is not about profit controls—about having a fair return for investment made—but about tackling an emerging business model that could almost be seen as profiteering.
Mr Hunt
My hon. Friend is right about that. The nice way of putting it is that we are closing a loophole. If one were being less polite, one might say that it is a shame we are having to do that. None the less, it is important to do what we are proposing to the House.
We recognise that it has been some time since the Government consulted on the options, and I wish to reassure hon. Members and those companies in the statutory scheme that we will consult further on the implementation of a payment mechanism in the statutory scheme, including the level of the payment mechanism, before the regulations come into force. We estimate that 17 companies would be affected by the introduction of a payment mechanism, with the 166 companies that are currently members of the PPRS not being affected. Our proposals would save health services across the UK an estimated £90 million per year.
The second key element of this Bill amends the 2006 Act to strengthen the Government’s powers to set prices of medicines where companies charge unreasonably high prices for unbranded generic medicines. We rely on competition in the market to keep the prices of these drugs down. That generally works well and has, in combination with high levels of generic prescribing, led to significant savings. However, we are aware of some instances where there is no competition to keep prices down, and companies have raised their prices to what looks like an unreasonable and unjustifiable level. As highlighted by the investigation conducted by The Times earlier this year, there are companies that appear to have made it their business model to purchase off-patent medicines for which there are no competitor products. They then exploit a monopoly position to raise prices. We cannot allow this practice to continue unchallenged. My Department has been working closely with the Competition and Markets Authority to alert it to any cases where there may be market abuse and provide evidence to support this, but we also need to tackle it within our framework for controlling the cost of medicines and close the loophole of de-branding medicines. Although the Government’s existing powers allow us to control the price of any health service medicine, they do not allow controls to be placed on unbranded generic medicines where companies are members of the voluntary PPRS scheme. Today, most companies have a mixed portfolio of branded medicines and unbranded generic medicines. For that reason, all the manufacturers of the unbranded generic medicines mentioned in the investigation by The Times are able to use their PPRS membership to avoid government control of their prices.
It should be said that that practice is not widespread, but a handful of companies appear to be exploiting our freedom of pricing for unbranded generic medicines where there is no competition in the market, leaving the NHS with no choice but to purchase the medicine at grossly inflated prices or to transfer patients to other medicines that are not always suitable. Alongside the Government, many in the industry would also like to see this inappropriate behaviour stamped out.
Norman Lamb (North Norfolk) (LD)
I very much agree with the point that the Secretary of State has just made. He talked about collaboration with the CMA. Can he give any indication as to whether he expects action to be taken on abuse in the marketplace, given that a small number of companies have behaved appallingly?
Mr Hunt
I cannot give the right hon. Gentleman that indication because, as he will know, the CMA operates completely independently, and I therefore do not know what its findings are going to be. Of course, I would support any action that it recommended. I do, however, think that this Bill can give us some security in the House that if the CMA is unable to find evidence in the specific cases it has before it, we will be able to take action as a Government, provided the House is willing to support the Bill.
Mike Wood (Dudley South) (Con)
Has my right hon. Friend made any assessment of how the prices of the drugs quoted in the article in The Times compare with those paid in other health services and by healthcare providers in other western European countries?
Mr Hunt
We have made some assessments of those things, but, in essence, our concern is that, even without comparisons with what is happening in other countries, we are talking about totally unreasonable behaviour. I mentioned one example earlier, but I can give another of a medicine whose price increased by 3,600% between 2011 and 2016. I just do not think we can justify that. Given that we want to have strong, harmonious, positive relationships between the NHS and the pharmaceutical industry, we need to eliminate the possibility of that kind of behaviour happening in the future.
This Bill therefore amends the 2006 Act to allow the Government to control prices of these medicines, even when the manufacturer is a member of the voluntary PPRS scheme. We intend to use the power only where there is no competition in the market and companies are charging the NHS an unreasonably high price. We will engage with the industry representative body, which is also keen to address this practice, on how we will exercise this power.
The final element of the Bill will strengthen the Government’s powers to collect information on the costs of medicines, medical supplies and other related products from across the supply chain, from factory gate to those who supply medicines to patients. We currently collect information on the sale and purchases of medicines from various parts of the supply chain under a range of different arrangements and for a range of specific purposes. Some of these arrangements are voluntary, whereas others are statutory. The Bill will streamline the existing information requirements in the 2006 Act relating to controlling the cost of healthcare products. It will enable the Government to make regulations to require all those involved in the manufacture, distribution or supply of health service medicines, medical supplies or other related products to record, keep and provide on request information on sales and purchases. The use of this information would be for defined purposes: the reimbursement of community pharmacies and GPs, determining the value for money that the supply chain or products provide; and controlling the cost of medicines. This will enable the Government to put the current voluntary arrangements for data provision with manufacturers and wholesalers of unbranded generic medicines and manufactured specials on a statutory footing. As the arrangements are currently voluntary, they do not cover all products and companies, which limits the robustness of the reimbursement price setting mechanism.
A statutory footing for these data collections is important so that the Government can run a robust reimbursement system for community pharmacies. I know that some colleagues have raised concerns about the implications of our funding decisions for community pharmacies, and today I want to reassure the House that this Bill does not impact on those decisions, nor does it remove the requirement for consultation with the representative body of pharmacy contractors on their funding arrangements in the future. However, the information power will give us more data on which to base those discussions and decisions, rather than relying on data only available to us under voluntary schemes and arrangements. The information power would also enable the Government to obtain information from across the supply chain to assure themselves that the supply chain is, or parts of it are, delivering value for money for NHS patients and the taxpayer—we cannot do that with our existing fragmented data.
Mrs Flick Drummond (Portsmouth South) (Con)
In this regard, will my right hon. Friend be giving consideration to asking pharmacies that can prepare their own medicines—aqueous cream and things—as tremendous sums could be saved for the NHS? Will he be considering that in the overall scheme of getting information on the medicines they are providing?
Mr Hunt
The information we collect might make it possible for us more robustly to analyse issues such as the one my hon. Friend rightly brings to the House’s attention. Even if it does not, we should consider the issue, and I am happy to write to her to see whether we can make more progress in that area.
I also wish to reassure the House about the application of the information power to the medical technology industry. More than 99% of the companies supplying medical technologies to the NHS are small and medium-sized enterprises. Their products may be less high profile than the latest cancer medicine, but they are no less innovative or vital for patients. We have no interest in placing additional burdens on those companies.
The 2006 Act already provides powers for the Government to require suppliers of medical technologies to keep and provide information on almost any aspect of their business. This Bill will clarify and modernise those powers, and I am committed to exercising them in a way that is fair and proportionate to companies, to the NHS and to taxpayers who rightly demand value for money from the supply chain. Companies are currently required to hold information on their income and sales for six years for tax purposes. We will work closely with industry to ensure that the requirement to keep and record data does not significantly increase this burden.
My officials have already been in discussion with all parties across the supply chain—for both medicines and medical devices—about these powers to ensure that their implementation is robust but proportionate. We will provide illustrative regulations to aid debate on these provisions. I also want to reassure colleagues that, following Royal Assent, a full and open consultation will take place on the regulations specifying the information requirements.
I thank Ministers and their officials in the devolved Administrations for their constructive input and engagement with my Department on the Bill. Although many of its provisions are reserved in relation to Scotland and Wales, some information requirements that currently apply to England only could also apply in the territories of the devolved Administrations.
We intend to propose amendments to the Bill to reflect the agreement between the Government and the devolved Administrations, so that information from wholesalers and manufacturers can be collected by the Government for the whole of the UK and shared with the devolved Administrations. That avoids the burden created by each country collecting the same information.
The Welsh Government have also asked me to enable them to obtain information from pharmacies and dispensing GPs—a power that the Scottish Government and the Northern Ireland Executive already have. The Government will therefore propose an amendment to the Bill to amend the NHS (Wales) Act 2000 so that Welsh Ministers can obtain information from pharmacies and dispensing GPs.
Medicines are a vital part of the treatment provided by our NHS. Robust cost control and information requirements are key tools to ensuring that NHS spending on medicines across the UK continues to be affordable. They also help to deliver better value for taxpayers and to free up resources, thereby supporting access to services and treatments. This Bill will ensure that there is a more level playing field between our medicines pricing schemes while ensuring that the decisions made by the Government are based on more accurate and robust information about medicines’ costs. It will be fairer for industry, fairer for pharmacies, fairer for the NHS, fairer for patients and fairer for taxpayers, and I commend it to the House.
Healthcare Safety Investigations
Jeremy Hunt Excerpts(8 years, 1 month ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
“There is a culture within many parts of the NHS which deters staff from raising serious and sensitive concerns and which not infrequently has negative consequences for those brave enough to raise them”
(Sir Robert Francis QC, Freedom to Speak Up report - http://webarchive.nationalarchives.gov.uk/2015021815 0343/https:/freedomtospeakup.org.uk).
The NHS has an excellent track record in recruiting and developing the very best—the brightest, the most dedicated and the most caring. Our staff have a passion for providing the highest quality care that they can, and a commitment to continuously improving their knowledge and their skills. We must not forget that what staff learn through the experience of giving care is at least as valuable as what they are taught in the lecture theatre. Learning through experience is the key to improving the quality of people's care. This includes learning from mistakes.
We need to create the right conditions to enable staff to learn from their experiences, including their mistakes. All too often, they tell us that there is a culture of blaming, not learning. That is why the Government want to change the atmosphere in which NHS staff work.
There is a strong connection between ‘psychological safety’ and a culture of learning within an organisation. In a true culture of learning, staff can feel confident they will be treated fairly, and patients and families can be assured that errors and the causes of them will be fully explored. Creating and sustaining this broader culture of psychological safety and learning is down to leaders and managers in the system. For them to be able to do so, the Department of Health, as steward of the health system, needs to set the right conditions for such a culture to flourish.
Recent inquiries have illustrated that staff need to feel more confident that the information they give to safety investigations, which have the sole function of learning from errors, will not be used unfairly. That is why we are proposing to create a “safe space”—a statutory requirement that information generated as part of a safety investigation will be kept confidential and will not be shared outside the investigation’s boundaries, except in a number of limited circumstances.
This is used currently by the Air Accident Investigation Branch (AAIB), where investigators are able to offer this safe space to those they speak to, thanks to the robust statutory framework in which they work, arising from regulation-making powers in primary legislation. A key aspect of this statutory framework is the duty not to share information given in the course of an investigation with any other individual or body, unless (usually) there is a High Court order.
The proposal outlined in this consultation is to create a statutory prohibition on the disclosure of material obtained during certain health service investigations unless the High Court makes an order permitting disclosure, or in a limited number of other circumstances.
This broadly mirrors the regime followed in the area of air accidents investigations. It would allow the investigator to say to staff involved in incidents:
“This investigation is not to attribute blame. The information you give me as part of this investigation will not be passed on to those not involved in the investigation unless there is a High Court order, or if the information you provide demonstrates to me there is an active and ongoing threat to patient safety represented by the practice or actions of one or more individuals that requires action”.
The safe space approach is designed to improve patient safety standards over time, by enabling clinicians to discuss openly and honestly their experiences, including aspects of care that ought to be improved. These are valuable lessons that others can learn from, and will improve standards, potentially across the whole system. By concentrating on finding these more widely applicable lessons, safe space investigations will address themes rather than re-examine specific cases. But should the investigation uncover evidence of immediate risks to patient safety, criminal activity, serious misconduct or seriously deficient performance then the police or relevant professional regulator will be informed and will take the appropriate immediate action.
Creating a safe space is also a difficult balance to achieve—between reassuring staff that the information they give will not be passed on, while also reassuring patients and families that they have the full facts of their, or their loved one, care. We all want the standard of that care to get better and better each year. The purpose of this consultation is to seek the views of patients, the public and the professionals who work in the NHS about our proposed approach. In particular, we want to find out from them about what needs to be changed, added, or strengthened in order to achieve the learning not blaming culture that will underpin quality improvement in the NHS.
Attachments can be viewed online at: http://www.parliament. uk/business/publications.
[HCWS191]
Oral Answers to Questions
Jeremy Hunt Excerpts(8 years, 1 month ago)
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Sir Henry Bellingham (North West Norfolk) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
In the last four years, 29 trusts have been put into special measures; that is more than one in 10 of all NHS trusts. Of those, 12 have now come out, having demonstrated sustainable improvements in safety and quality of care. There are nearly 1,300 more doctors and 4,200 nurses working in trusts that have been put into special measures.
Sir Henry Bellingham
The Secretary of State will be aware because he visited it last year, that the Queen Elizabeth hospital in my constituency has come out of special measures. It has made excellent progress, not least by introducing Saturday lists for in-patients and putting in place numerous measures to transform the out-patients department. Will he join me in paying tribute to all staff of the hospital, particularly the chief executive, Dorothy Hosein, and the chairman, Edward Libbey, for the excellent progress that they have made?
Mr Hunt
I am very happy to do that, and I very much enjoyed my visit to the QE with my hon. Friend a couple of years ago. This is a very good example of how trusts can be transformed when they go into special measures. Since coming out of special measures, the QE has opened a state-of-the-art laparoscopic theatre, got a dedicated breast unit, and expanded its A&E. It has got 72 more nurses over the past few years. It is a good example to many other trusts in special measures, and it shows that that really can be a turning point, bringing about benefits for patients and staff.
Derek Twigg (Halton) (Lab)
The problem is that many trusts are still in a financial mess and have a deficit. If hospitals and the wider health service are to solve that, they need more funding, and councils, too, need funding for care. What is the Secretary of State doing to fight for more funding for his Department to ensure that we deal with those problems properly?
Mr Hunt
The hon. Gentleman will have noticed that in last year’s spending review the NHS got the biggest funding increase of any Government Department. We have committed to the NHS’s own plan, which asks for £10 billion more a year during the course of this Parliament in real terms. However, I do not disagree that there are still very real financial pressures in the NHS and particularly in the social care system. The trusts that are delivering the highest standards of care are those with the lowest deficits. Delivering unsafe care is one of the most expensive things people can do, which is why this is an important agenda.
Chris Green (Bolton West) (Con)
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
The Secretary of State will know that in my own area of Calderdale and Huddersfield there is a dreadful situation for the trust that has been caused by the behaviour of the clinical commissioning group and the way in which it procures. He has received a large petition from thousands of people in the Huddersfield area about the closure of the A&E. Will he look at that seriously and intervene, because the competence of local CCGs is not up to the mark?
Mr Hunt
I am well aware of that issue and have received a number of representations from hon. Members on both sides of the House. There is a mechanism by which these issues end up on my desk—they have to be referred by a local council’s overview and scrutiny committee and then I get an independent recommendation—but I will look at this carefully if that process is followed.
Mrs Maria Miller (Basingstoke) (Con)
To cope with rapid population increases in my constituency, Basingstoke has advanced plans to build a critical treatment hospital and cancer centre, with the support of more than three quarters of the population. Does my right hon. Friend expect sustainability and transformation plans to provide clear, timely direction on plans for this new model of care in the community?
Mr Hunt
I can absolutely reassure my right hon. Friend on that. One of the main purposes of STPs is to make sure that we deliver our cancer plan, which will introduce a maximum four-week wait between GP referral and ultimate diagnosis. If we get it right, that might result in around 30,000 lives a year being saved, so this is a big priority for every STP.
Colleen Fletcher (Coventry North East) (Lab)
The Secretary of State for Health (Mr Jeremy Hunt)
Tragically, suicide is now the biggest single cause of death in men under 50. There are 13 suicides every day, of which three quarters are men. I am currently reviewing our suicide strategy to make sure we leave no stone unturned in trying to reduce the totally unacceptable level of these tragedies.
Colleen Fletcher
Yesterday marked the launch of the mental health awareness and suicide prevention campaign called “It takes balls to talk” across Coventry and Warwickshire. The campaign is a public information programme targeted at male-dominated sporting venues, which aims to direct men to help and support when they need it to promote positive mental health and reduce the incidence of male suicide. With suicide being the single most common cause of death in men under 45, will the Secretary of State take the opportunity to welcome and support this important new campaign?
Mr Hunt
I am happy to do just that. I would like to thank the hon. Lady for bringing up this very important and difficult issue. We are making progress in reducing suicide rates, but we can do an awful lot better. The thing that troubles me most is that nearly three quarters of people who kill themselves have had no contact with specialist NHS mental health services in the previous year, even though in many cases we actually know who they are because, sadly, most of them have tried before. I am very happy to commend the “It takes balls to talk” campaign. She may want to put the campaign in touch with the national sport mental health charter, which is another scheme designed to use sport to try to boost the psychological wellbeing of men.
Helen Jones (Warrington North) (Lab)
A recent survey showed that one in four members of the emergency services experienced mental health problems, and that a number of them experienced suicidal thoughts. What is the Secretary of State doing to protect our vital paramedics and other ambulance staff, and to ensure that they get the support they need in dealing with absolutely appalling situations?
Mr Hunt
Again, I thank the hon. Lady for raising that. She will be pleased to know that the NHS has introduced a scheme, backed with funding, to encourage NHS trusts to look after the mental wellbeing of their own staff. I particularly want to pay tribute to the courage of people who work in the air ambulance service, because they see—day in, day out—some of the most difficult and distressing cases. They have to cope with the pressure of that when they take it home every day, and we all salute them.
Luke Hall (Thornbury and Yate) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
Last week, I announced plans to make the NHS self-sufficient in the supply of newly qualified doctors by the end of the next Parliament. We recognise the brilliant work that is done by the many outstanding overseas doctors who work in the NHS and have made it clear that, whether or not they are from the EU, we wish that work to continue post-Brexit. However, as the fifth largest economy in the world, Britain should be training all the doctors it needs. While there will always be beneficial exchanges of doctors and researchers between countries, we have a global obligation to train enough doctors for our own needs, otherwise the inevitable consequence will be to denude poorer countries of doctors whose skills are desperately needed.
Luke Hall
Thornbury health centre is crying out for redevelopment to cater for the growing local population. Will my right hon. Friend meet me, representatives of the health centre and NHS Property Services to see how we can take a co-ordinated approach that will move the health centre forward?
Mr Hunt
I can do better than that, because I have said that I am prepared to go to the health centre. I remember a very good visit to Thornbury community hospital during the general election campaign. I understand what those at the health centre are trying to do and they are absolutely right to be thinking about how they can improve out-of-hospital services.
Barbara Keeley (Worsley and Eccles South) (Lab)
Will the Secretary of State look into the creation of a sideways move for a chief executive of a trust that was criticised for failing to investigate patient deaths? Six weeks after the special recruitment exercise by Southern Health, Katrina Percy has resigned from her advisory role, with a substantial 12-month salary payoff that has been signed off by the Department of Health and the Treasury. The campaign group, Justice for LB, has called that “utterly disgraceful” and I agree. Will the Secretary of State investigate?
Mr Hunt
I agree with the hon. Lady that the way this case was handled was by no means satisfactory. The truth is that it took some time to establish precisely what had gone wrong at Southern Health. As this House knows, because we made a statement at the time—I think it was an urgent question, actually—there was a failure to investigate unexplained deaths. I do not think the NHS handled the matter as well as it should, but we now have much more transparency and we do not have a situation where people go on and get other jobs in the NHS, which happened so often in the past.
Dr Tania Mathias (Twickenham) (Con)
Mr Jeremy Hunt
I am very happy to do that. My hon. Friend is right to highlight the fact that the provision of mental health services to children is one of the biggest weak spots in NHS provision today. It is an area that we are putting a big focus on. I would be happy to talk to her about the situation in her constituency.
Danny Kinahan (South Antrim) (UUP)
Fiona Mactaggart (Slough) (Lab)
Mr Jeremy Hunt
The Conservative candidate in the Witney by-election will be saying very clearly that because of the extra funding from this Government we are aiming to have 5,000 more doctors working in general practice by the end of this Parliament, something that would not have been possible with the increase of less than half that amount promised by the Labour party.
Wendy Morton (Aldridge-Brownhills) (Con)
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
I listened very closely to the Secretary of State’s comments earlier on mental health. On 9 December he stood at that Dispatch Box and said that
“CCGs are committed to increasing the proportion of their funding that goes into mental health.”—[Official Report, 9 December 2015; Vol. 603, c. 1012.]
However, my research shows that 57% of clinical commissioning groups are reducing the proportion they spend on mental health—yet another broken promise. When will we have real equality from this Government for mental health?
Mr Jeremy Hunt
I will tell the hon. Lady what this Government have done. We have legislated for parity of esteem for mental health. We are treating 1,400 more people every single day for mental health conditions compared with six years ago. We have a new plan that will see 1 million more people treated every year by 2020, including a transformation of child and adolescent mental health services. That is possible because we are putting into the NHS extra money that her party refused to commit to.
Andrew Stephenson (Pendle) (Con)
Mr Hunt
My hon. Friend is absolutely right. I find it extraordinary that the Labour party said that our plan to train more doctors was “nonsense”. We currently have 800 doctors in the NHS from Sri Lanka, 600 from Nigeria, 400 from Sudan and 200 from Myanmar. They are doing a brilliant job and I want them to continue doing that job, but we have to ask ourselves whether it is ethical for us to continue to recruit doctors from much poorer countries that really need their skills.
Margaret Greenwood (Wirral West) (Lab)
I was alarmed to read at the weekend that NHS chiefs are warning that hospitals in England are on the brink of collapse. Is it the Government’s intention to cut the public supply of healthcare in order to create demand for a private healthcare system, or will they give the NHS the additional funds it needs?
Mr Hunt
Let me remind the hon. Lady that the party that introduced the most outsourcing to the private sector was her Labour Government under the previous Health Secretary, Alan Milburn. Our view is that we should be completely neutral as to whether local doctors decide to commission their care from the public sector or private sector. We want the best care for patients.
Lucy Allan (Telford) (Con)
Local health commissioners have concluded that Telford’s brand new women and children’s centre, which serves some of the most deprived populations in the country, should be closed and moved to a more affluent area where health is better than the national average. The commissioning process has lost the confidence of local people. Will the Secretary of State intervene and ensure that local health commissioners fulfil their legal duty to reduce health inequalities?
Mr Jeremy Hunt
I thank my hon. Friend for standing up for her constituents—it is absolutely right that she should do so. She would agree that that has to be a local matter led by commissioners locally, but she can be reassured that we are always watching what is happening to ensure that people follow due process, and that the results of any changes proposed benefit patients as intended. I will therefore watch very carefully what is happening in Telford and in Shropshire more broadly.
Mr Dennis Skinner (Bolsover) (Lab)
About half a dozen times in the last hour, the Secretary of State has bragged about the extra money he is putting in to the national health service, so why is Bolsover hospital, like many others that have been referred to in the past half hour, due to close? Why are neighbouring hospitals in countless constituencies in Derbyshire closing? Why does he not use some of that money to save the Derbyshire hospitals?
Mr Hunt
The extra money we are putting in to the NHS is going to better cancer care, better mental health care and better GP provision—it is going to all the things that Members on both sides of the House know matter. It will also mean that we can support our hospitals better. With our ageing population, we will continue to have great demand for hospital care, but the best way to relieve pressure on those hospitals is to invest in better out-of-hospital care, which has not been done for many years.
Mr Philip Hollobone (Kettering) (Con)
Kettering general hospital is treating a record number of patients with increasingly world-class treatments, yet despite being located in an area of rapid population growth, due to an historic anomaly, the funding for the local clinical commissioning groups is among the worst in the country in relative terms. What can Her Majesty’s Government do to correct that?
Mr Hunt
I am happy to look at that particular funding issue for my hon. Friend. I know that Kettering hospital is under a great deal of pressure. The one thing that it could do to relieve its financial pressures is to look at the number of agency and locum staff that it employs. As with many hospitals, there are big savings to be made in that respect in ways that improve rather than decrease the quality of clinical care.
Karin Smyth (Bristol South) (Lab)
The Secretary of State will be aware that the Public Accounts Committee has questioned both the Department of Health and NHS England on the parlous state of NHS accounts this year, following the comments by the Comptroller and Auditor General. It is clear that STPs are the only plan on the table. Will the Secretary of State make clear his support to the NHS to deliver the STPs in the teeth of opposition from his own Back Benchers? If he will not, what is plan B?
Mr Hunt
I do not recognise the picture the hon. Lady paints about opposition to STPs. We need to ensure we have good plans that will deliver better care for NHS patients by bringing together and integrating the health and social care system, and improving the quality of out-of-hospital plans. While we are in a period where those plans have not been published there will obviously be a degree of uncertainty, which we will do everything we can to alleviate, but she is right to say that these plans are very important for the future of the NHS. The process has our full support.
Kevin Foster (Torbay) (Con)
The Secretary of State will be aware of the concern in my constituency about the future of Paignton hospital, which prompted hundreds to turn up to a recent meeting. Does he agree with me that it is vital the clinical commissioning group, in publishing its plans, does not just publish what it will remove but the details of what it will replace them with?
Lilian Greenwood (Nottingham South) (Lab)
Two years ago, Nottingham University Hospitals NHS trust privatised support services, including cleaning, handing them over to Carillion in an effort to save money. Since then there have been shortages of equipment, shortages of staff and an appalling decline in standards of cleanliness. Will the Secretary of State condemn Carillion for putting patients at risk? When will he ensure that hospital services in Nottingham are properly funded?
Mr Jeremy Hunt
The decision on whether to outsource services must be a matter for local hospitals. I know that that hospital has been struggling with its deficit. I have been to visit the hospital myself and I know it has been trying very hard to improve clinical care. If the contract is not working and the quality is not right, I would expect the hospital to change it, but it must be its decision.
Several hon. Members rose—
Wachter Review
Jeremy Hunt Excerpts(8 years, 2 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today an independent review has been published which makes recommendations about how to support the effective implementation of IT systems in the health system in England.
In October 2015 I asked Professor Robert Wachter, a US clinician and authority on the issues and challenges of implementing IT and digital systems in healthcare, to undertake a review of implementation of IT in the NHS, with a particular focus on the introduction of electronic health records in the acute sector. It was to draw on recent experience in both England and the US and make recommendations on how to introduce such systems more effectively in the NHS. The review started in February this year and was supported by an advisory board drawn from digital healthcare experts in the US and UK, as well as a representative from Denmark.
The independent review has now been completed and the full report is attached and available at https://www.gov.uk/government/publications/using-information-technology-to-improve-the-nhs.
Healthcare, like other areas of life, needs to make effective use of technology to deliver services as efficiently and cost effectively as possible, while meeting the needs of patients and their expectations of a modern public service. If we are to deliver on our ambition to deliver the safest, most efficient healthcare possible for NHS patients we must make the most of these technologies, moving away from paper-based records to a system that provides every health care professional with the information they need, at the point of care, so that they can make safe, effective treatment decisions, and that provides patients with easy access to all the information they need to be active partners in managing their health and wellbeing.
Digital technology is increasingly in use in many parts of the NHS but there are still some organisations that have yet to embrace its use, and many more that have found the task of implementing systems very challenging. The result is that despite already making investments in digital technology, local NHS organisations are often not getting the expected benefits for patients, health care professionals or the system.
Professor Wachter’s review identified a number of critical factors for success and has made 10 recommendations that focus on:
The importance of clinical engagement and leadership to successful implementation.
The need to improve workforce capability in the use of technology in the delivery of care, in particular the need for more clinician-informaticists (clinicians with informatics expertise) to lead implementation of clinical IT systems, including for a National Chief Clinical Information Officer (CCIO).
A phased approach to funding and implementation that reflects the level of readiness and existing digital maturity of NHS Trusts with initial support for those Trusts which have already made good progress in digitising and are ready to go further, or which are demonstrably ready to make good progress.
Interoperability as a core characteristic of the system from the outset to support clinical care, innovation and research.
I am grateful to Professor Wachter and his advisory group for their work on this important area for the future development of a NHS that is sustainable and meets our expectations of a modern service.
Today I am also presenting plans to start to implement those recommendations with the announcement of:
The first Global Exemplars. These Trusts are judged to be the most advanced in the use of digital technology in England, and which we expect to move to become world leaders at an accelerated pace:
Each Global Exemplar will be supported via international partnerships and will be expected to share their learning and experience across the NHS to show how care can be enhanced across the whole health system using digital technologies. Each of these Trusts will be able to bid for up to £10 million of funding.
The creation of a group of National Exemplars. These Trusts, although not yet as advanced as our Global Exemplars, are ready to make good progress in implementing digital technology and each can bid for up to £5 million of funding.
A competition to find a UK university partner to set up a Digital Academy to provide improved workforce capability in use of technology in the delivery of care.
The first Global Exemplars will be:
City Hospitals Sunderland NHS Foundation Trust
Luton & Dunstable University Hospital NHS Trust
Oxford University Hospitals NHS Foundation Trust
Royal Free London NHS Foundation Trust
Royal Liverpool and Broadgreen University Hospitals NHS Trust
Salford Royal Hospitals NHS Trust
Taunton and Somerset NHS Foundation Trust
University Hospitals Birmingham NHS Foundation Trust
University Hospitals Bristol NHS Foundation Trust
University Hospitals Southampton NHS Foundation Trust
West Suffolk NHS Foundation Trust
Wirral University Teaching Hospital NHS Foundation Trust
NHS England has also already announced, in July, the appointment of Professor Keith McNeill as NHS Chief Clinical Information Officer. Professor McNeill will have a key role in providing national leadership for this important agenda that will increase the speed and scope of the NHS’s adoption of digital technologies to support the transformation needed to deliver NHS services fit for the future. He will act on behalf of the whole health and care system to provide strategic leadership, also chairing the National Information Board, and acting as commissioning ‘client’ for the relevant programmes being delivered by NHS Digital (previously known as the Health and Social Care Information Centre).
It can also be viewed online at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-09-07/HCWS134
[HCWS134]
Junior Doctors: Industrial Action
Jeremy Hunt Excerpts(8 years, 2 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I regret to inform the House that last week the British Medical Association announced that it was initiating further rounds of industrial action over the junior doctors contract. They involve a series of week-long all-out strikes between now and Christmas, which were scheduled to start next Monday, although this afternoon the BMA delayed the first strike until 5 October. That news is of course welcome, but we must not let it obscure the fact that the remaining planned industrial action is unprecedented in length and severity and will be damaging to patients, some of whose operations will have already been cancelled.
Many NHS organisations, including NHS England, NHS Providers, the NHS Confederation and NHS Improvement, have expressed concern about the potential impact on patient safety. Indeed, this morning the General Medical Council published its advice to doctors on the strike action. While recognising a doctor’s legal right to take industrial action, it urged all doctors in training to pause and consider the implications for patients, saying:
“Given the scale and repeated nature of what is proposed, we believe that, despite everyone’s best efforts, patients will suffer.”
Many others have also questioned whether escalating the strikes is a proportionate or reasonable response to a contract that the BMA junior doctors’ leader, Dr Ellen McCourt, personally negotiated and supported in May. She said then that the new contract was
“safer for our patients, safer for our junior doctors… and also fair.”
She said, with respect to junior doctors, that the contract
“really values their time, values them as part of the workforce, will really reduce the problem of recruitment and retention, emphasises that all doctors are equal, and has put together a really good package of things for equalities.”
We recognise that since those comments were made, the new contract has been rejected in a ballot of BMA members. However, it is deeply perplexing for patients, NHS leaders and, indeed, the Government that the reaction of the BMA leadership, which previously supported the contract, is now to initiate the most extreme strike action in NHS history, inflicting unprecedented misery on millions of patients up and down the country. We currently expect up to 100,000 elective operations to be cancelled and up to a million hospital appointments to be postponed, which will inevitably have an impact on our ability to hit the vital “18 weeks” performance standard.
Today I want to reassure the House that the Government and the NHS are working round the clock to make preparations for the strikes. All hospitals will be reviewing their rotas to ensure that critical services such as accident and emergency, critical care, neonatal services and maternity services are maintained. The priority of all NHS organisations is to ensure that patients have access to the healthcare they need and that the risks to patients are minimised, but the impact of such long strikes will severely test that. As with previous strikes, we cannot give an absolute guarantee that patients will be safe, but hospitals up and down the country will bust a gut to look after their patients in this unprecedented situation and communicate as soon as possible with people whose care is likely to be affected.
Turning to the long-term causes of the dispute, it is clear that for the BMA negotiators it has been largely about pay, but I recognise that for the majority of junior doctors there is a much broader range of concerns, including the way their training is structured, the ability to sustain family life during training periods, the gender pay gap and rota gaps. After the May agreement, we set up a structured process to look at all these concerns outside the contract and I intend that that work will continue.
Health Education England has been undertaking a range of work to allow couples to apply to train in the same area, to offer training placements for those with caring responsibilities close to their home, to introduce a new catch-up programme for doctors who take maternity leave or time off for other caring responsibilities, and to look at the particular concerns of doctors in their first year of foundation training. Today, HEE has set out further information for junior doctors about addressing these non-contractual concerns, and we are proceeding with the gender pay review that I mentioned in my last statement to the House on this issue.
We have also responded to specific concerns raised by the BMA. First, the BMA, NHS Employers and Health Education England have agreed changes to strengthen whistleblowing protections for junior doctors beyond the scope of existing legislation, so that junior doctors can take legal action against the HEE, in relation to whistleblowing, as if the HEE was their employer. Secondly, in direct response to the concerns raised by Dr McCourt over the role of the independent guardians of safe working hours, NHS Employers has written to all NHS chief executives to set out in considerable detail the expectations for the new guardian role. As of 2 September, 186 of 217 guardians had been appointed with the involvement of BMA representatives, with a further 15 interim arrangements in place, and it is expected that all will be appointed by the middle of this month.
Many junior doctors have expressed concern about rota gaps, and the new contract acknowledges and tackles this concern. The guardians of safe working hours will report to trust and foundation trust boards on the issue of rota gaps within junior doctor rotas. This will shine a light on the issue and it will be escalated, potentially to the Care Quality Commission and the General Medical Council, when serious issues are not addressed. I strongly urge all those considering taking industrial action to consider the progress being made in all these areas before making their final decision.
With respect to the broader debate about seven-day care, we recognise that many doctors have concerns about precisely what is meant by a seven-day NHS. As Sir David Dalton stated publicly last week, we offered to insert details of our seven-day plans in the May agreement, but this was rejected by the BMA, so it is very disappointing that it now says the need for more clarity over seven-day services is one of the reasons for the strike, but given that it has said that, I would like to repeat further reassurances on that front today.
First, while the changes to the junior doctors contract are cost-neutral—that is, the overall pay bill for the current cohort of junior doctors will not go up or down—our seven-day services policy is not cost-neutral, and will be funded out of the additional £10 billion provided to the NHS this Parliament. Secondly, while the pay bill for the current number of junior doctors will not increase, we do expect the overall pay bill to go up as we have committed to employing many more doctors to help to meet our commitment on seven-day services. That means that our plans are not predicated on simply stretching the existing workforce more thinly or diluting weekday cover.
Thirdly, we recognise that junior doctors already work very hard, including evenings and weekends, and while we do need to reduce weekend premium rates that make it difficult to deploy the correct levels of medical cover, we expect this policy to have greater implications for the working patterns of other workforce groups, including consultants and diagnostic staff. Finally, we have no policy to require all trusts to increase elective care at weekends. Our seven-day services policy is focused on meeting four clinical standards relating to urgent and emergency care, meaning that vulnerable patients on hospital wards at weekends will get checked more regularly in ward rounds by clinicians, and clinicians will be able to order important test results for their patients at weekends.
Despite these reassurances, there may remain honest differences of opinion on seven-day care, but the way to resolve them is through co-operation and dialogue, not confrontation and strikes which harm patients. To those who say these changes are demoralising the NHS workforce, I simply say that nothing is more demoralising or more polarising than a damaging strike. It is not too late to turn decisively away from the path of confrontation and to put patients first, and I urge everyone to consider how their own individual actions in the coming months will impact on people who desperately need the services of our NHS.
This Government will not waiver in our commitment to make the NHS the safest, highest-quality healthcare system in the world, and I commend this statement to the House.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The prospect of a rolling five-day strike by junior doctors was one of the utmost gravity. The junior doctors have suspended next week’s action, which is a step I believe the whole House welcomes, but the remaining programme of industrial action stays in place. If it eventually goes ahead, it will be the first such strike by junior doctors in the entire history of the national health service.
What the current situation shows is that there has been a complete breakdown in trust between junior doctors and the Government. The morale of junior doctors could not be lower, and that is not something for the Secretary of State to dismiss. But somehow the Secretary of State continues to take no responsibility for the current state of affairs—no responsibility for repeatedly arguing that the only problem was that doctors had “not read the contract”, no responsibility for the misleading use of statistics by claiming that thousands of patients were dying because of poor weekend care.
The president of the Royal College of Paediatrics and Child Health, Professor Neena Modi, said:
“despite concerns raised by senior officials, Jeremy Hunt persisted in using dubious evidence about the so-called ‘weekend effect’ to impose a damaging Junior Doctor contract under the bogus guise of patient safety”.
The Secretary of State still insists that the contract is about a seven-day NHS when we know now that his own officials were telling him that the NHS had too few staff and too little money to deliver what he was talking about.
The Secretary of State well knows that the public simply do not believe him in his attempt to demonise the junior doctors. Try as he might, he has failed to convince the public that somehow junior doctors are the “enemy within” or mere dupes of the BMA. Far from being manipulated, doctors voted emphatically against the new contract.
Everyone in this House will remember the 7/7 bombings and the No. 30 bus which exploded in Tavistock Square, a few yards from the headquarters of the British Medical Association. Everyone will remember the pictures of doctors, who had been in meetings and their offices, pouring out of the BMA building, heading for the 14 dead people and the 110 victims, without flinching or faltering, fulfilling their vocation of saving lives. These are the people that the Secretary of State seeks to vilify.
Today we know that the junior doctors—who, contrary to what the Secretary of State implied, have always made patient safety a top priority—have cancelled the action planned for next Monday, but if we are going to remove the threat of industrial action, there are questions that the Secretary of State has to answer. There are widespread reports of deficits and financial crises, so how can the NHS move to enhanced seven-day week working, even with the proposed £10 billion the Secretary of State mentioned in his statement, when there are not the resources to maintain the status quo?
I welcome the structural work going on outside the contract on issues such as work-life balance, the gender pay gap, the rota gaps, strengthening whistleblowing protections for junior doctors and, importantly, looking at the role of guardians of safe working hours, but the Secretary of State talked in his statement about confrontation: what could be more confrontational than seeking to impose a contract? Even at this late stage, I ask him to listen to the junior doctors’ leader, Dr Ellen McCourt, when she says:
“We have a simple ask of the Government: stop the imposition. If it agrees to do this, junior doctors will call off industrial action.”
The public are looking for the Secretary of State to try to meet the junior doctors: stop vilifying them, stop pretending they are the “enemy within”, and meet their reasonable demands.
Mr Hunt
I will respond to the hon. Lady’s comments, but she needs to be very clear to the House about the implications of Labour’s position on this. She has just said that she welcomes the suspension of next week’s industrial action, but that was not her position at the weekend. At the weekend, when the medical royal colleges, the General Medical Council and even The Observer criticised the proposed strike, what was she saying? She was saying that she would join them on the picket line—something her predecessor refused to do. The fact is that strikes cause harm, misery and despair for families up and down the country. When one of the most extreme members of the BMA junior doctors executive, Dr Yannis Gourtsoyannis, said that these strikes were
“the single most positive thing that has occurred within NHS politics in decades”,
what was Labour’s response? Did it condemn that? No. The shadow Chancellor actually invited him to advise Labour on policy. I just say this because—
Mr Speaker
We are always grateful to the hon. Member for Worthing West (Sir Peter Bottomley) for whatever counsel he might wish to proffer, even if it is done from a sedentary position.
Mr Hunt
Thank you, Mr Speaker.
The shadow Health Secretary needs to recognise that working people, the people her party claims to represent, need a seven-day NHS. The vulnerable people that Labour claims to represent get admitted to hospital at the weekends, and in industrial disputes patients should always matter more than politics. The next time she meets a constituent who has suffered because of not having a seven-day service or because their operation has been cancelled because of a strike, she and her colleagues should hang their heads in shame.
The hon. Lady has used some very strong words. She used words such as “vilifying” and “demonising” in relation to the junior doctor workforce, and that is a very serious thing to say. I challenge her to find a single piece of evidence that has come from me or anyone in the Government, and if she cannot do so, she needs to withdraw those comments and apologise to the House. The fact is that the single most demoralising thing for the NHS workforce is strikes, because they entrench and harden positions, which results in people getting very angry, and it becomes much harder to find consensus.
The hon. Lady also talked about the use of statistics. She does not have to listen to what I say—and I understand, given the sparring that goes on between us, that she might not want to—but we have had eight academic studies in the past five years that describe increased mortality rates for people admitted to hospitals at weekends. Her response to this, in a phrase she used in another context, was that there was “zero empirical evidence” for a weekend effect. I would caution her on this, because taking that approach to hard data is exactly what happened at Mid Staffs, where hard evidence was swept under the carpet year after year because it was politically inconvenient. This Government will not make that mistake.
Finally, the hon. Lady said that my civil servants had apparently advised me that this policy would not work. Not at all. What happens with every Government policy, as you would expect, is that smart civil servants kick the tyres of every aspect of the policy to enable us to understand the risks involved. She did not mention the fact that the same document to which she referred actually says that we are on track to deliver the four clinical seven-day standards to 20% of the country by next April. I think that her constituents will welcome that, even if she does not. These strikes are going to harm patients, damage the NHS and make it harder, not easier, to resolve the challenges facing junior doctors. Labour has chosen political opportunity today, but we will do the right thing for patients.
Mr Kenneth Clarke (Rushcliffe) (Con)
Does my right hon. Friend agree that it has been an indefensible anomaly for many years that the national health service so reduces its services at weekends when the patients it serves are vulnerable to urgent or emergency conditions and need the highest standards of care for chronic conditions on a seven-day basis? Will he continue to make what he has described as careful progress? Will he also make it clear that the seven-day service will not simply do routine work and that it will be introduced as resources and staffing allow in line with civilised conditions? Further, on the strange politics of the dispute that keeps coming back to haunt him, does he agree that while the BMA has always been one of our most militant trade unions and while the Labour party has been very left wing in its leadership before—most notably in the 1980s—it is almost inconceivable that at any time in the past such extreme militant action that threatens patients would have been supported by the BMA or the Labour party? They are now opposing a contract that union leaders praised as a sensible settlement, given the improvements that it offered, only two or three months ago.
Mr Hunt
As ever, my right hon. and learned Friend speaks incredibly wisely. Actually, his last comment goes to the nub of why this is totally extraordinary, unprecedented and completely unacceptable. It is true that the junior doctors have rejected the agreement that was reached in May in a ballot, and we have to accept that. There are all sorts of reasons why that might have happened, but the choice to escalate the industrial action and to call the worst strike in NHS history was made not by those junior doctors but by the BMA leaders. They made that decision about a contract that they themselves had described as being good and safer for doctors and patients only in May. How can they justify that? Is there not perhaps a desire to pick a very big fight?
We were making good progress over the summer in a whole series of dialogues in different areas to try to resolve some of the non-contractual issues that the junior doctors are worried about, but this action makes it virtually impossible to continue that progress, although we will try very hard to do so. My right hon. and learned Friend is absolutely right to say that this is completely unacceptable and damaging for patients. I am afraid that I am having to go through some of the very same battles that he had to go through when he was Health Secretary.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I know how difficult it will be for junior doctors to take part in the strikes that have been described, and I personally am really sad that we have come to this point. Does the Secretary of State recognise the anger and desperation among the junior doctors that have led us to this point? In my mailbag from junior doctors, two things stand out. One is that the threat of imposition was there right from the word go last summer, and it therefore felt like a threat rather than a negotiation. The other involves the misuse of numerical statistical data by translating it into a claim that it refers to avoidable deaths at weekends, even though there has been no evidence of avoidable deaths. The Secretary of State has not commissioned a review of cases that might show how many of those deaths were avoidable and whether a lack of junior doctors contributed to them. The real danger in the NHS at the moment is rota gaps. Doctors are being asked to do double shifts or to carry two pagers, which means that where there should be two doctors covering an area or a service, there is only one. That is a real, palpable danger right now.
The Secretary of State has said that he would employ extra junior doctors rather than spreading the same number more thinly, but where does he plan to get them from when we cannot even fill the existing posts? I welcome the focus on the four clinical standards that boil down to greater senior doctor review and access to diagnostics, but does he not think that we might have got further if we had started at that point last summer? He calls for a turn away from strikes and for getting around the table to co-operate and discuss these matters, so when is he going to meet the junior doctors to try to avert these strikes?
Mr Hunt
The hon. Lady is a doctor, and I would simply say to her, as I said to the shadow Health Secretary, that she needs to justify the claims that she constantly makes in this Chamber about a misuse of statistics. I have been very clear about when we can actually statistically say that a death is avoidable. The studies demonstrate clearly that a higher number of people are dying from weekend admissions than we would expect. What this Government will not do is sit and ignore those numbers, which are backed up in study after study. I think that we are doing the right thing, and as a doctor she should recognise that.
The hon. Lady has said time after time over the past year that the Government should lift the plans to impose the contract and get around the table and negotiate. She could today have given the Government credit for doing exactly that in May when we thought there was an opportunity to do a deal. We lifted the imposition of the contract and got around the table to negotiate a deal that turned out to be good for both sides. Having done that, the problem is that the same people with whom we negotiated the deal have decided to call the most extreme strike in NHS history, which is unacceptable.
Rota gaps are a real problem that we are trying to address by, first, ensuring that systems are in place for junior doctors to blow the whistle if they think that such gaps are unsafe for patients. That is why we have introduced guardians of safe working, and we are committed to that. Secondly, we want to ensure that there are people to fill those rota gaps by training more doctors. We are training 11,420 more doctors in this Parliament than in the previous and already have around 9,000 more doctors than in 2010. As a doctor, those are things that the hon. Lady should recognise.
Several hon. Members rose—
Dr Sarah Wollaston (Totnes) (Con)
I welcome the BMA’s suspension of next week’s damaging industrial action. It is clear from its statement that thousands of doctors had been in touch to say that they wanted to keep their patients safe. Doctors know that they cannot do so with full, rolling, five-day walkouts. Will the Secretary of State therefore join me in asking the BMA to ballot its members to hear their views before they proceed with the other proposed, damaging, five-day walkouts?
Mr Hunt
The BMA should talk to its members much more because, as far as I could tell, the consultation over the summer showed that only a minority actually wanted this extreme series of rolling one-week suspensions of labour that the BMA supported in the end. Most junior doctors are perplexed and worried about the situation and would love to find a solution. There was a bitter industrial dispute, but we actually started a process through which trust was being rebuilt on both sides. In a series of meetings, I met the junior doctors’ leader to talk through the areas of her greatest concern and we made progress in addressing two of those four outstanding areas. Building that trust means actually sitting around the table and talking, not having confrontational strikes. I think that that is what most junior doctors want.
Norman Lamb (North Norfolk) (LD)
I want to return to the critical issue of how we ensure safe cover during the week if we expect doctors to work more hours at weekends. The Secretary of State has repeated again today that he will employ more junior doctors, but what is the timescale? What will the net increase in doctors be this year, next year and in the rest of the Parliament?
Mr Hunt
I do not have figures to hand for exactly what the number will be this year—I will certainly let the right hon. Gentleman know—but around 11,500 extra doctors will be trained during the course of this Parliament.
As I said in the statement, it is important to recognise that the changes involve not only junior doctors. We need more weekend consultant cover—that is particularly important—and more people who are able to do the diagnostic tests. A whole range of people need to take part in the changes to improve standards of care at the weekends.
Michael Gove (Surrey Heath) (Con)
I congratulate my right hon. Friend on his reasonable yet resolute approach throughout the negotiations, which has been reflected in the fact that the leaders of so many royal colleges chose to criticise the decision to go on strike. The suspension of the strike action is therefore wholly welcome.
My right hon. Friend made the point that clinical standards will be improved as a direct result of the move towards a seven-day NHS. Will he enlighten the House about which particular types of patient in which circumstances will benefit as a result of his welcome drive to improve patient care?
Mr Hunt
I am happy to do that. Indeed, I am delighted to take a question from my right hon. Friend, because it is after someone has long departed an office that people actually appreciate that big, important changes were made, which was certainly the case from his tenure as Secretary of State for Education.
One of the clinical standards states that people admitted at weekends should be seen by a senior doctor—a consultant or an experienced junior doctor—within 14 hours. They will be seen by a doctor much sooner than that, but they should be seen within 14 hours by someone experienced enough to know whether there is something to worry about. That would happen in most places during the week, but it does not happen in many places over the weekend. Another standard relates to the most vulnerable patients who are at real risk of going downhill. This is not the clinical term, but doctors say that spotting people who are going downhill is one of the most important things. Such people should be checked at least twice a day by someone experienced enough.
Those are two of the four clinical standards that we want our constituents to be reassured are in place across the country. We think that that will make a big difference.
Heidi Alexander (Lewisham East) (Lab)
The Health Secretary will know that a worrying number of A&E and maternity departments were either closed or downgraded over the summer because they simply could not get the necessary number of junior doctors: Chorley, Ealing, Stafford—I could go on. If we are training more junior doctors, why do we still have that problem?
Mr Hunt
The pressures in the NHS mean that there is a need for more doctors for all sorts of reasons, and we do not have as many doctors as we need at the moment. That is why this Government are training more doctors and putting an extra £10 billion into the NHS. The manifesto that the hon. Lady stood on just over a year ago would not have put that sort of funding into the NHS and would have meant that we were unable to train that number of extra doctors. We are doing that, but it takes time and we need to ensure that services are safe while we are getting there.
Dr Andrew Murrison (South West Wiltshire) (Con)
I congratulate my right hon. Friend on his balanced and reasonable approach in the negotiations despite provocation from people who really should know better. Does he agree that there cannot have been a single occasion in the history of the NHS other than this in which the General Medical Council—the body responsible for professional standards—has effectively had to intervene to stop a strike? Will he also admit that we might have underscored the centrality of Sir Bruce Keogh’s four clinical standards a little more when introducing the notion of the seven-day NHS?
Mr Hunt
In response to my hon. Friend’s last point, we have been clear from the outset about what we mean by a seven-day NHS for hospital care, but a huge amount of misinformation has been put out. This time last year, for example, the BMA was telling many people that our plans were to cut pay by between 30% and 50%. That is why strikes are damaging. Positions get entrenched on both sides and misinformation sometimes gets out, as it has done, causing a lot of anxiety.
I agree with my hon. Friend about the GMC’s significant intervention. The medical regulator is completely independent of Government and has been clear that doctors have a responsibility not to take a decision under any circumstances that would lead to their patients being harmed.
Dr Rosena Allin-Khan (Tooting) (Lab)
As the Secretary of State knows, prior to taking up this office in June I was an emergency medicine junior doctor on the frontline of our NHS for the past 11 years. Today, doctors have listened and have halted strike action, putting patient safety first.
This is not the first time I have stood before the Secretary of State to say that I worry that the imposition of the contract does not put patient safety first. The Government can train all the extra doctors they want, but current junior doctors are leaving. The risk of having a contract imposed on them is causing them to move further afield to places such as Australia. I have always maintained that a safe seven-day NHS cannot be created with an overstretched five-day team and the rota gaps are proof of that. Doctors have listened today. Will the Secretary of State listen and please halt the imposition?
Mr Hunt
I thank the hon. Lady for what she did alongside many colleagues working in A&E departments over many years, but to call this an imposition is a mischaracterisation given what actually happened. The contract was not only agreed, but recommended and supported by the leaders of the BMA. Before she was elected, we had many discussions in the House about whether negotiations were possible and what I should do, and there were a range of different views. In the end, I listened—just as she has asked me to today—and sat down and negotiated a deal that was supported by the BMA’s leaders. That is why it is so incomprehensible that those same leaders—the people who represent her and her profession—have now called the most extreme strike in NHS history.
Sir Peter Bottomley (Worthing West) (Con)
I put it to my right hon. Friend that the choice for junior doctors or doctors in training is whether they have the old contract or the agreed contract. I have not yet had a letter from any of my doctors saying that they think the old contract is better for them, for the health service or for patients. May I therefore recommend that they sign up willingly to the new contract, that they start discussions with the BMA, and through the royal colleges, on what should happen in a few years’ time when the contract itself comes up for review and that they work to improve the non-contractual situation, which my right hon. Friend has provided a good lead on?
Mr Hunt
My hon. Friend is absolutely right on that. In May, the BMA leadership, with whom we were having a very open discussion, had satisfied themselves that on the concerns many junior doctors have about their working conditions, many of which I accept are wholly legitimate, we had done pretty much everything we could inside a contract and the work that needed to be done was on the extra-contractual things. I am talking about the way the training system works when people are being rotated to a different hospital every six months, the fact that some people were being sent to a different city from their partner and how bad that was for family life, and all sorts of other things that need to be sorted out. Ironically, since the introduction of the working time directive, things have got a lot worse for many people, although we do not want to go back to the excessive hours of before. Those were the things we were patiently working through, and the way that is done is through dialogue, not confrontation, which is why this action is such a step backwards.
Mr Dennis Skinner (Bolsover) (Lab)
Is it not a weakness of the Secretary of State’s argument that it is just conceivable that he is wrong about imposing a settlement on a seven-day week for the NHS? It takes two to cause a strike, which is why he should look at this proposal again. He is very airy-fairy about training these doctors for the future. He is not being clinically correct at all. He has heard from people who have recently worked there, so why does he not reassess this seven-day week, get around the table, stop imposing a settlement and come to a negotiated agreement?
Mr Hunt
With great respect to the hon. Gentleman, if I am wrong about this, so are the leaders of the BMA, because they said the contract that he says I should not impose was a good contract, safer for patients and for doctors, and good for the NHS, for equalities and for a range of things. The contract we are proceeding with is one that doctors’ leaders said was a good deal for junior doctors, so if we are going to resolve this, that is the contract we should proceed with.
Alistair Burt (North East Bedfordshire) (Con)
May I express my strong support for the Secretary of State, not only for the measured way in which he has handled today’s statement, but for the way in which he has conducted the negotiations, as shown by the 100-plus concessions that have been made to doctors’ negotiating positions over the past four years? Is not the inevitable logic of the BMA’s suspension of the strikes—I warmly welcome that—on the advice of other medical professionals that this should be applied in exactly the same way to the other strikes that have been called? The same logic would apply. Would it not be best for the BMA’s reputation to call off the rest of the strikes and to work with the Government on the other non-contractual areas that need to be dealt with, so that we can move forward from this, end this period of confrontation, get the health service that we all believe in and end some of this silly rhetoric coming from those who suggest that Conservative Members do not believe in the NHS?
Mr Hunt
I have a stunning new ministerial team, two of whom I am pleased to see here today, but I wish to take this moment to say how much I enjoyed working with my right hon. Friend last year. Then, as now, his advice and thoughts are very wise. The Government have made 107 concessions, and the BMA might like to think what signal it sends if that many concessions are made, an agreed deal is reached with the union leadership and the reaction then is for the most extreme strike in history to be called. What encouragement will that give to other Ministers to be moderate and reasonable in their negotiations with unions? The position being taken is preposterous and many other choices could have been made when dealing with losing the ballot, but he is right in what he says.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
A lack of workforce planning and weak financial management have led to staff shortages, which have been a major contributor to this dispute. The Department of Health accounts and NHS England accounts, which came out on 21 July, underlined that weakness in financial planning, with the Comptroller and Auditor General saying clearly that he had real concerns about the future sustainability of NHS funding. We have, however, heard the Secretary of State say again today that the £10 billion available is to solve the issue about the seven-day NHS, but we have also heard that money promised for many other things by the head of NHS England. Does the Secretary of State really have a plan for the financial sustainability of the NHS? If so, what is it?
Mr Hunt
We do and we are implementing it. I know that the hon. Lady has looked at this in great detail, and I simply say, in broad terms, that following the tragedy of what happened at Mid Staffs the NHS was very honest about how some of the poor care there was happening in other places and NHS trusts decided that they needed to have more staff in their hospital wards. The poor workforce planning that she talked about, which goes back many decades in the NHS, meant that the result was an explosion in the use of agency staff, the cost of which rose to more than £3.5 billion in the last financial year, which has put huge pressure on finances. The lesson that we must take away, not just for the junior doctors’ strike, but for financial sustainability, is that we need to be better at workforce planning and training up the number of doctors and nurses that we need.
Several hon. Members rose—
Dr Julian Lewis (New Forest East) (Con)
In other words, I am totally unqualified as a medical doctor. Therefore, may I ask a question about democratic mandates? I appreciate that, unlike a referendum, a general election does not give an entirely specific mandate on every proposal put forward, but will the Secretary of State take the opportunity to remind the House and the country of how central the proposal for a seven-day NHS was to the Conservative manifesto as far as his Department was concerned?
Mr Hunt
My right hon. Friend is right, as that was our only really substantive promise in terms of a commitment to the NHS at the last election. We are funding it and we have an absolute obligation to the British people to deliver on it. That is why in that short period after the last election I felt I had to be clear with the BMA that we were going to deliver on that manifesto promise. If the BMA had reflected on that, it might have perhaps behaved differently from how it did.
Diana Johnson (Kingston upon Hull North) (Lab)
In the light of the ongoing dispute and concerns about patient safety, has the Secretary of State given any consideration to the idea of compulsory independent arbitration, binding on both sides, to settle disputes where patient safety and public safety is in dispute? Will he look at that?
Michael Fabricant (Lichfield) (Con)
Last Thursday, I was at Queen’s hospital in Burton having a minor skin procedure—hence my black eye—where I met not just junior doctors and consultants, but patients. Let me tell my right hon. Friend how concerned they are about this series of strikes. They just do not understand it, as one junior doctor said to me—he may or may not have been in the minority. Dr Johann Malawana, the previous BMA representative for junior doctors, said that this was a “good deal” for junior doctors—I noted that down at the time. One point that was made to me was that this constant defence of BMA action by the Labour party and, in particular, by the Labour spokesman is regarded as being encouragement for these strikes, whether she means to do it or not. May I urge her to say, “Look, it is not good enough. It is not good enough for patients and it is not good enough for the NHS”?
Mr Hunt
My hon. Friend is absolutely right. All of us in this debate have one simple thing to consider: what is the right answer for the people we represent? They understand that there are financial constraints and that the NHS cannot do everything, but they do want us to strive to make it safer and better the whole time. It is a surprise and a disappointment that we do not hear more of that language from the Labour party.
Bill Wiggin (North Herefordshire) (Con)
My constituents who are patients do not want this strike, and I do not believe that my constituents who are doctors want this escalation in industrial action. If it is the case that only 4% of doctors support this escalation, should the BMA not again check its mandate?
Mr Hunt
It absolutely should. The BMA has been out of step with both the British public and its own members this week. My hon. Friend’s own hospital in Hereford—Hereford county hospital—is in special measures. It has a huge number of problems, which it is working really hard to sort out, and we are helping it to sort them out. Is that not what we should be focusing on in the NHS, rather than having to do contingency planning for these damaging strikes?
Alex Chalk (Cheltenham) (Con)
Does the Secretary of State agree that the actions of the BMA in warmly backing the contract in May only to condemn it in August and call for these extreme strikes have seriously damaged its credibility? On the issue of pay, which we know from the leaked WhatsApp messages is the only red line, can he confirm that no doctor working legal hours will be paid less?
Mr Hunt
Yes, I can absolutely confirm that. We have put in place pay protection to make that happen. My hon. Friend is right that this is very damaging for his constituents in Cheltenham. Given that there is so much pressure in the NHS, the junior doctors who are thinking of striking must ask themselves whether it is really going to help their organisation respond to those pressures if it has this enormous distraction—this incredible demoralisation that we get with these kinds of strikes.
Mike Wood (Dudley South) (Con)
Does my right hon. Friend share my disappointment that the BMA leader who co-authored the new contract and said that it was beneficial for our patients and for our junior doctors is now trying to whip up support for a series of strikes that every credible medical leader has said would be disproportionate and harmful to patients?
David Morris (Morecambe and Lunesdale) (Con)
The fact that these strikes are occurring and being called off is very serious, especially against the backdrop of this contract. One of my constituents, who is a doctor, the chairman of Doctors in Unite and the deputy chairman of the BMA, stated in the Sunday Times that this issue could be used to beat the Tories and make the country great again. Does my right hon. Friend agree that it is appalling that patients across the country are being used as pawns in the political game of “Corbynista-ism”?
Mr Hunt
I completely agree. I am afraid that this is where I am very, very disappointed with the Labour party. Thrilled though it might be to have so many supporters of the leader in the more extreme ranks of the BMA, it helps no one to try to use the NHS as a political pawn and to weaponise the NHS as it tried so destructively to do before the last election.
Mr Philip Hollobone (Kettering) (Con)
Kettering general hospital is under pressure on a number of fronts. Even if the industrial action does not take place, the threat of it diverts key personnel from their normal difficult task of contingency planning, filling rotas and making sure that patients stay as safe as possible. Does my right hon. Friend agree that even the threat of industrial action does huge harm to our hospitals and the NHS?
Mr Hunt
I am more than happy to agree with my hon. Friend. The staff at Kettering general hospital work extremely hard. I have been there, as he knows. It is a very busy hospital. One shudders to think what the impact would be if we removed a third of the doctor workforce in a hospital such as that.
Philip Davies (Shipley) (Con)
I was just reading an article from earlier in the year from The Guardian newspaper, which said that Saturday working is the major sticking point in the junior doctors’ dispute. Does the Secretary of State agree that any doctor who goes on strike over premium rates of pay on a Saturday, which most people in this country do not get when they work on a Saturday, should hang their heads in shame? Will he give a commitment that he will not make any further concessions, as he has already given far too many. Is it not time to look at whether we stop doctors from going on strike altogether in the NHS, as is the case with other emergency services?
Mr Speaker
It may be the first occasion upon which the hon. Member for Shipley (Philip Davies) has vouchsafed to the House that he is a Guardian reader.
Mr Hunt
I was nervous mentioning the fact that the Government have made 107 concessions when I saw that my hon. Friend might be in the Chamber because I knew that, for him, that would be 107 too many. His broader point is absolutely spot on. The working terms and conditions for Saturdays for junior doctors in this new contract are better than they are for nurses, police officers, fire officers and for those in many other parts of the economy. That is why I think it is a fair deal that everyone should recognise and welcome.
Kevin Foster (Torbay) (Con)
I know that the Secretary of State will agree that what sums up this dispute is that, under the existing contract unless the new one is brought in, we could be treated by a doctor working their 91st hour in a week. Does he agree that it is absolutely bizarre to see this level of strike action called when even the BMA’s own council was so divided over whether to support it?
Mr Hunt
That is absolutely right. What my hon. Friend is alluding to is the fact that, in the new contract, we are reducing the maximum hours that any doctor can be asked to work in any one week from 91 hours to 72 hours. There are all sorts of other safeguards that benefit safety. He is right. This should not be happening, and I urge the BMA to reconsider.
Richard Drax (South Dorset) (Con)
May I offer my support to my right hon. Friend. I have never heard him vilify the doctors, as he was accused of doing. That language was not appropriate in this debate. Is he aware—I have heard this from one chief executive—that hospitals have been told not to speak to the junior doctors to try to resolve the dispute within the hospitals and the foundation trusts themselves? If there has been such an instruction, does he agree that it will not help solve the dispute for the future?
Mr Hunt
I am very surprised to hear that. If my hon. Friend wants to pass me the details, I will happily look into it. On the ground, the management of hospitals are working very closely with not just junior doctors, but BMA representatives to try to do everything they can to keep patients safe if these strikes go ahead.
Mr Speaker
Order. I am most grateful to the Secretary of State and to colleagues. Proceedings Time for conclusion of proceedings First day New clauses, new schedules and amendments to clauses and schedules relating to corporation tax. Two hours after the commencement of proceedings on the motion for this Order. New clauses, new schedules and amendments to clauses and schedules relating to tax avoidance and evasion. Four hours after the commencement of proceedings on the motion for this Order. New clauses, new schedules and amendments to clauses relating to VAT on women’s sanitary products. Six hours after the commencement of proceedings on the motion for this Order. Second day New clauses, new schedules and amendments to clauses and schedules relating to capital gains tax. 4.30 pm New clauses, new schedules and amendments to clauses relating to insurance premium tax; remaining new clauses, new schedules and amendments to clauses and schedules; remaining proceedings on consideration. 6 pm
Finance Bill (Programme) (No. 2)
Ordered,
That the following provisions shall apply to the Finance Bill for the purpose of supplementing the Order of 11 April 2016 in the last Session of Parliament (Finance (No. 2) Bill: Programme)):
1. Paragraphs (11) and (12) of the Order shall be omitted.
2. Proceedings on Consideration shall be taken on the days shown in the following Table and in the order so shown.
3. The proceedings shall (so far as not previously concluded) be brought to a conclusion at the times specified in the second column of the Table.
4. Proceedings in Legislative Grand Committee and proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at 7 pm on the second day of proceedings on consideration.—(Jane Ellison.)