Junior Doctors’ Contracts
Jeremy Hunt Excerpts(9 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 commitment to delivering seven-day hospital services and saving lives by combating the weekend effect; notes the British Medical Association’s (BMA) decision to walk away from negotiations to reform a contract which all sides acknowledge is not fit for purpose; further notes the Government’s proposed introduction of new contractual limits which protect staff from working unsafe hours and the commitment that average junior doctors’ pay will not fall; and calls on the BMA to put patient care first, to choose talks over strikes, and to return to negotiations.”.
I warmly welcome the hon. Member for Lewisham East (Heidi Alexander) to her post at her first Opposition day debate.
One Saturday in April 2006 a 20-year-old man called John Moore-Robinson was out mountain biking with his friends in Cannock Chase when he fell off his bike and the handlebars hit his stomach. His friends dialled 999 and he was rushed to hospital. Although the paramedic who took him to hospital thought he had life-threatening internal bleeding, instead of being treated he was left for 50 minutes, apart from a brief examination. Then he was told he had bruised ribs and sent home. In fact, he had a ruptured spleen and tragically died later that Saturday night.
Tragedies happen in any healthcare system, and despite such stories I am fiercely proud of our NHS and the brilliant care given by our doctors and nurses seven days a week. The hon. Lady was right to thank each and every one of them. Anyone who uses such stories to denigrate the NHS should remember that last year the Commonwealth fund rated us the best healthcare system of 11 major countries—better than France, Germany, Australia or the US—and rated our A and E departments —[Interruption.] It was the Opposition who called this debate, so they might want to listen to some of the arguments. This is a very important issue about the lives of NHS patients, and I am saying that the tragedies and the problems we have should not be used to denigrate the NHS or our A and E departments.
Part of being the best in the world is being honest about where we need to improve, and the fact remains that in our hospitals today we have around three times less medical cover at weekends. In our manifesto in May this Government committed to a truly seven-day NHS so that we prevent a repeat of the tragedy that happened to John Moore-Robinson.
Ms Gisela Stuart
The Secretary of State is absolutely right that we need to address the fact that there seems to be less cover at the weekends. He is trying to circle that square without expanding the number of doctors and the services. He is thinning the service on Monday to Friday to bring more cover to the weekends. That does not solve the problem.
Mr Hunt
I am happy to deal with that. We went into the election in May saying that on the back of a strong economy we were prepared to commit £10 billion extra to the NHS in real terms over the course of this Parliament. That was £5.5 billion more than the hon. Lady’s party was prepared to commit. In the last Parliament, when the increase in NHS spend was half that amount, we increased the number of doctors by 9,000, so we are increasing the number of doctors, but as we do so we need to ensure that we give the right care to patients.
I want to give a word of caution to the shadow Secretary of State. The tragedy of John Moore-Robinson, the gentleman I have mentioned, happened not only on a Saturday, but at Mid Staffs. The last time the House discussed the difference between excess and avoidable deaths was under a Labour Government, when they tried to brush the problems at Mid Staffs under the carpet, saying that we should not take the figures on excess deaths too seriously because they were a statistical construct and different from avoidable deaths. I would have hoped that the Labour party learned the lessons of Mid Staffs and would not make the same mistakes again. [Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The hon. Member for Islington South and Finsbury (Emily Thornberry) may shake her head, but I expect voices in the Chamber to be a little quieter. I want to hear the Secretary of State, and I think all our constituents do. I understand that you might not agree.
Mr Hunt
Let us look at some of the facts. What is the most important thing for people admitted to hospital at the weekend? It is that they are seen quickly by a consultant. Currently, across all key specialties, in only 10% of our hospitals are patients seen by a consultant within 14 hours of being admitted at the weekend. Only 10% of hospitals provide vital diagnostic services seven days a week. Clinical standards provide that patients should be reviewed twice a day by consultants in high-dependency areas but, at weekends, that happens in only one in 20 of our hospitals across all key services.
Helen Whately (Faversham and Mid Kent) (Con)
Is the Secretary of State shocked, as I am, that the shadow Health Secretary seemed to say that the NHS should continue as it is, and that she appears to deny the weekend effect, which means that people are dying unnecessarily?
Mr Hunt
Yes, I am shocked. I am really shocked about the suggestion that there is a difference between what is right for patients and what is right for doctors. The shadow Secretary of State spent a lot of time talking about morale. The worst possible thing for doctors’ morale is their being unable to give their patients the care they want to give.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
Does the Secretary of State not see anything perverse in making the case for a seven-day NHS—he has repeatedly done so—while drawing up a junior doctor contract that financially penalises doctors who already work evenings and weekends? How can that make any sense?
Mr Hunt
The contract will not do that. The contract we are proposing will give more reward to people who work the most antisocial hours. I will explain the details of that later.
The shadow Secretary of State talked about academic studies, so let us look at what the academic studies on the weekend effect say. The Freemantle study, published in the British Medical Journal, which is owned, incidentally, by the British Medical Association, said in September that the mortality rate for those admitted to hospital on a Sunday is 15% higher than for those admitted on a Wednesday. It said the weekend effect equated to 11,000 excess deaths. Let us be clear about what that means. It does not mean that every one of those 11,000 deaths is avoidable or preventable—it would be wrong to suggest that. It means that there are 11,000 more deaths than we would expect if mortality rates were the same as they are on a Tuesday, Wednesday or Thursday. Professor Sir Bruce Keogh, the NHS England medical director, called it
“an avoidable ‘weekend effect’ which if addressed could save lives.”
It is not just one study. In the past five years, we have had six independent reviews. Another study in the British Medical Journal, by Ruiz et al, states:
“Emergency patients in the English, US and Dutch hospitals showed significant higher adjusted odds of deaths…on Saturdays and Sundays compared with a Monday admission.”
The Academy of Medical Royal Colleges—the body that represents all the royal colleges—said in 2012 that deficiencies in weekend care were most likely linked to the absence of skilled and empowered senior staff and the lack of seven-day diagnostic services.
Norman Lamb
During my travels across the country, I recently spoke with the chief executive and the chair of an acute trust. They said that they have no difficulty at all with junior doctors and ensuring that there is cover at weekends; their problem is with consultants—and the Secretary of State has just made that point. Has he not chosen the wrong target?
Mr Hunt
Chief executives of trusts and NHS employers have been very clear that this is about reform of contracts for both consultants and junior doctors, because the reduction in medical cover at weekends happens with both the consultant and the junior doctor workforces. Also, as I will go on to say, it puts huge pressure on junior doctors at the time when they do not have senior support and the ability to learn from it, and that is exactly what we want to sort out.
Junior doctors are not to blame for the weekend effect. The situation would actually be far worse without them, because they perform the lion’s share of medical evening, night and weekend work. In many ways, they are the backbone of our hospitals. However, the BMJ study this year showed that there is evidence that junior doctors felt clinically exposed at weekends, and nothing could be more demotivating for a doctor than not being able to give the standard of care they want for a patient.
Mary Creagh (Wakefield) (Lab)
The right hon. Gentleman has prayed in aid the weekend effect and quoted Sir Bruce Keogh, his own NHS medical director. Is he aware that Professor Keogh has also said that
“it is not possible to ascertain the extent to which these excess deaths may be preventable; to assume they are avoidable would be rash and misleading”?
Mr Hunt
Yes, and I agree with that, but it would be equally rash and misleading to say there are no avoidable deaths. Professor Keogh was saying that lives could be saved if we tackled this. All these studies are saying that 15% more people die than we would expect if we had the same level of cover at weekends as we have during the week. Therefore, as he says, the moral case for action is unanswerable.
Jeremy Lefroy (Stafford) (Con)
The hospital to which my right hon. Friend referred earlier is in my constituency. The accident and emergency department has improved hugely over the past few years—well over 95% of patients are seen within four hours—and one reason for that is that it has consultant cover all the time. It is not open 24/7—we want it to be—but for the 14 hours a day that it is open, it has consultant cover all the time.
Mr Hunt
I am going to make some progress before taking any further interventions.
The question for a Government and for a Health Secretary is this: when we are faced with this overwhelming evidence—six studies in five years—should we take action or ignore it? We are taking action. That is why in July I announced that we will be changing the contracts for both consultants and junior doctors as part of a package of measures to eliminate the weekend effect. If we believe in the NHS, and if we want it to be there for everyone, whatever their background or circumstances, we must be able to offer every NHS patient the promise of the same high-quality care, whichever day of the week they need it.
Let me set out for the House what I have proposed. We announced ambitious plans to roll out seven-day services across the country, with better weekend staffing across medical, diagnostic and support services in hospitals, as well as better integration with social care and seven-day GP access. That will reach a quarter of the population by March 2017, and the whole country by 2020. For consultants, we proposed an end to the right to opt out of weekend working, replacing it with a maximum obligation to work one weekend in four. To its credit, the BMA’s consultants committee has agreed to negotiate on that.
For junior doctors, we proposed to reduce the high overtime and weekend rates, which prevent hospitals from rostering enough staff at weekend, and increase basic pay to compensate. We have made a commitment that the pay bill as a whole would not be reduced, and today I can confirm that not a single junior doctor working within the legal limits for hours will have their pay cut, because this is about patient care, not saving money. Incidentally, I made it clear to the BMA at the beginning of September that that was a possible outcome of negotiations, in an attempt to encourage it to return to the negotiating table. Rather than negotiating, it chose to wind up its own members and create a huge amount of unnecessary anger.
Mark Spencer (Sherwood) (Con)
Given the Secretary of State’s assurance, is there any reason why the BMA should not come back to the table and negotiate with him to solve this problem so that patients are safer at weekends?
Emily Thornberry
Is the right hon. Gentleman going to continue with his plan to change the rules so that trusts that insist on doctors working unsafe hours can no longer be fined for doing so? It will help if he can assure us that those rules will continue and trusts will be fined if they break them.
Mr Hunt
They are not fines; they are perverse incentives to doctors to work unsafe hours. We want to go one better than that. We propose to stop hospitals requiring doctors to work five nights in a row or six long days in a row, and to bring down the maximum number of hours that hospitals can ask a doctor to work in any one week. On top of that, we have imposed the toughest hospital regime of any country anywhere in the world that comes down very hard on hospitals that are not providing safe care.
Norman Lamb
I want to ensure that I fully understand the commitment that the Secretary of State gave about not a single doctor losing out. I think he said that that is “provided they are working within maximum legal hours”. Does that mean people working up to 48 hours, which is the maximum working week under the working time directive? What about doctors who have opted out of that and are working 60 or 70 hours? Could they lose out?
Mr Hunt
It applies to all doctors working within the legal limit. If they opted out of the working time directive, it would apply up to 56 hours. For people who are working more than the legal limits, even after opting out, the right answer is to stop them working those extra hours because it is not safe for patients. But yes, that is the commitment to people even if they have opted out.
Mr Hunt
I am going to make some progress, if I may.
As well as reducing the maximum hours a doctor can be asked to work from 91 to 72 in any week—a significant reduction—and banning hospitals from requiring doctors to work five nights in a row or six long days in a row, as hospitals can currently make them do, we propose to ban the routine use of fixed leave arrangements that mean that some doctors have to give up to three months’ notice before taking leave, meaning that they miss out on vital family or personal occasions.
We did not, and do not, seek to impose a new contract; rather, we invited the BMA to negotiate a new contract so that we could end up with a solution that was right for doctors and right for patients. However, because we had recently won an election in which a seven-day NHS was a manifesto commitment, we said that having tried to negotiate this unsuccessfully for two and a half years, we would ask trusts to introduce new contracts if we were unable to succeed in negotiations.
Lady Hermon
I have a specific point about Northern Ireland. Of course, health is devolved to the Northern Ireland Assembly, but I can assure the Health Secretary that junior doctors in Northern Ireland are absolutely furious about the proposed changes to their contracts. It would help if he could confirm that he is in regular direct dialogue with the Health Minister in the Stormont Assembly, Simon Hamilton MLA. I ask him not to reply that officials talk to each other regularly, because “Minister to Minister” is what I would like to hear.
Mr Hunt
We do have regular dialogue. I suggest that the reason doctors in Northern Ireland might be angry is that they have been listening to misinformation about what the Government in England are proposing, which has, very disappointingly, made doctors all over the UK very angry. I hope that the assurances I am giving, which I gave to the BMA last month and the month before, face to face and in letters, will encourage the hon. Lady to report to the doctors she mentions that the right thing for the BMA to do is to come and talk to the Government. Regrettably, the BMA’s junior doctors committee has refused to negotiate since last June. Instead, it put up a pay calculator on its website that scared many doctors by falsely suggesting that their pay could be cut by between 30% and 50%. It has now taken that pay calculator down, but the damage to morale as a result of it continues.
Rachael Maskell (York Central) (Lab/Co-op)
Will the Secretary of State give way?
Mr Hunt
I will make some progress. Some people say that this is a battle between the interests of patients and those of doctors, but that is profoundly wrong. Doctors who are happy and supported in their jobs provide better care to patients, and the link between a motivated workforce and high-quality care is proven in many studies, as well as in hospitals such as that in Northumbria, where staff have become the greatest advocates for seven-day services since their introduction. Our proposed new system is intended to provide better support to doctors who work weekends, and make seven-day diagnostics more widely available across the NHS.
Simon Hoare
Given the clarity with which my right hon. Friend has addressed the principal concerns of junior doctors, does he expect the BMA’s junior doctors Committee to change its stance, come to the Department and restart negotiations, or will it continue to stall?
Rachael Maskell
This debate is reminiscent of 12 months ago and the “Agenda for Change”, when the Government refusal to negotiate with 1 million NHS staff caused industrial action and a strike. The same thing seems to be happening again. Will the Secretary of State take the shackles off the negotiations and enable the professionals to put their case on the table? Will he listen to them and let them lead negotiations?
Mr Hunt
That is exactly what I would like to happen, but it can happen only if members of the BMA walk through my office door—it is open—and sit down and start negotiating, which they have refused to do since last June. Just as it is wrong to pit doctors against patients, it is also wrong for the Labour party to pit the Government against doctors. In the previous Parliament, Labour wanted to cut the NHS budget, but we protected it. In May’s election we promised £5.5 billion more for the NHS than Labour did, and in the last Parliament a Conservative-led Government delivered 9,000 more doctors to the NHS, 1 million more operations a year, and 600,000 more people were referred for urgent suspected cancer every year.
Because we are not stopping at that, and because we are passionate that the NHS should offer the highest standards of care available anywhere in the world, the Government have also been honest about the problems facing the NHS. Two hundred avoidable deaths every week is too many—it is the equivalent of a plane crash every week. Nor is it acceptable that twice a week we operate on the wrong part of someone’s body, or allow other “never events” to happen. In many of those areas the NHS is performing at or better than international norms, but that does not make such things any more acceptable. We want the NHS to be the first healthcare system in the world to adopt standards of safety that are considered normal in the airline, nuclear or oil industries.
Rehman Chishti
The Secretary of State said that we are open to problems being highlighted. May I thank him for what he did by putting hospitals into special measures? Medway Maritime hospital had the seventh highest mortality rate in 2005, yet nothing was done. Support is now being given to that hospital to turn it around. We are highlighting problems, but we are also introducing measures to fix those problems.
Mr Hunt
I thank my hon. Friend for his consistent support for his local hospital. It has had many troubles, but it is beginning to show signs of turning a corner. If we want to turn things around, we must first be honest about the problem.
I welcome the shadow Health Secretary to her place. Her predecessor tried to minimise the care problems that took place under a previous Labour Government, and he described our attempts to put them right as trying to “run down the NHS”. I hope that she does not do the same. Labour used to be the party that stood up for ordinary men and women; it cared enough about them to set up the NHS, so that no one had to worry about getting good medical care, whatever their circumstances. People need to know that they can depend on our NHS seven days a week. Instead of making mischief about a flawed doctors contract that was introduced by a Labour Government in 2000, the hon. Lady should stand with us as we sort out this problem. Be the party not of the unions but of the patients who depend on high quality care, day in, day out. Professor Bruce Keogh talked about the moral and professional case for concerted action. Surely in that context, she might reconsider this rather ill-judged attempt to make party political capital out of a very real problem.
Everyone who cares about the NHS should want the same thing. The hon. Lady should tell the BMA to get around the negotiating table, something she conspicuously failed to do. In doing so she would stand alongside the many independent voices calling on the BMA to return to the table and discuss a solution with the Government—the Royal College of Surgeons, the Royal College of Physicians, NHS providers and the Academy of Medical Royal Colleges. If she does not do that, the British people will draw their own conclusion about which party is backing the NHS with the resources it needs, which party is supporting hospitals to become safer at the weekends, and which party is standing four-square behind doctors and nurses in their ambition to deliver high quality standards of care for patients. There is only one party that can be trusted, one true party of the NHS, and that is the Conservative party.
Mr Deputy Speaker (Mr Lindsay Hoyle)
There will be a four-minute limit on Back Bench speeches.
Dr Whitford
I totally agree. I also agree with the Secretary of State about patient safety. There is no one in the profession who does not want a seven-day emergency service that is strong and responsive to the needs of unwell patients, but we keep moving from people who are ill to routine services. He has said we must not call them avoidable, yet he just referred to 200 avoidable deaths a week, which is exactly what Bruce Keogh described as “rash and misleading”, and people object to that. There are no excess deaths at the weekend; the issue is with people admitted at the weekend, usually for radiology or investigation. Scotland has been moving on this for the last decade, by working with the profession, not pulling out the pin and throwing a grenade.
Mr Jeremy Hunt
For the sake of clarity, the 200 avoidable deaths are not about the weekend effect specifically, but come from the Hogan and Black analysis, which found that 3.6% of hospital deaths in England had at least a 50% greater chance of having been avoidable, which is separate from the weekend effect—the higher mortality rate among people admitted at weekends. None the less, where there are avoidable deaths—where death rates look higher than they should be—we have an obligation to do something.
Dr Whitford
I agree that it is important to investigate, but it is also important to understand the cause of the problem. A lot of the problem at Mid Staffs was the ratio of registered nurses to patients. That was echoed by Bray in his review of 103 stroke units, which showed that additional consultant ward rounds at weekends had no impact on death rates, while a better ratio of registered nurses reduced them by a third. We need to know the problem before spending billions trying to solve the wrong thing.
Andrew Gwynne
I do not have time to give way, I am afraid.
I echo those sentiments of sincere thanks, but we have heard of junior doctors who already work weekends, already work nights, already work holidays and give their all for their patients. Despite all this, the junior doctors now face a situation that has left them feeling deflated, demoralised and devalued.
Patient safety has been a key theme of today’s debate. Some Members have valiantly leapt to the Health Secretary’s defence, but those voices have been far outnumbered by Members who are deeply concerned that this contract is unsafe for doctors and unsafe for patients.
Members have argued that the removal of the financial penalties that apply to hospitals that force junior doctors to work unsafe hours risks taking us back to the bad old days of overworked doctors, too exhausted to deliver safe care. The BMA says this safeguard, which is built into the current contract, has played an important role in bringing dangerous working hours down. Removing this financial disincentive to overworked junior doctors is extremely alarming, especially at a time when junior doctors are already coming under an enormous amount of pressure and strain. If the Health Secretary would just listen, he would hear junior doctors shouting loudly and clearly that they cannot give any more.
Many Members highlighted the protests and marches that have taken place throughout the country in recent weeks. We had only to catch a glimpse of the placards that were waved as thousands of junior doctors marched against the contract to understand that those doctors now fear for their own health and well-being. I was struck by one banner which read, “I could be your doctor tomorrow, or I could be the patient”, and those doctors’ concerns have been echoed by many Members today. How can the Secretary of State possibly say that he is acting in the interests of patient safety if the very people who work in the NHS say he is putting safety at risk?
Another argument that has been advanced today is that the contract is necessary to ensure that our NHS works seven days a week. Not only does that argument do a huge disservice to our NHS staff who already provide care seven days a week and 24 hours a day, and reveal just how out of touch some Conservative Members are with the realities of working on the frontline in our NHS, but it is wholly inaccurate. If this junior doctor contract were imposed in its current form, it would have the opposite effect, as many independent clinical voices have warned.
It is a bitter irony that the problems that the new junior doctor contract was supposed to be trying to address when it was originally proposed back in 2012—the need to introduce better pay and work-life balance—are the very problems that will be made worse should the contract go ahead in its current form. In letters to the Secretary of State, the presidents of a number of royal colleges and faculties have made it very clear that they share those concerns, but he presumably thinks that they too have been misled.
The Secretary of State said that he did not intend to cut the pay of any junior doctor, but his sums simply do not add up, and everyone can see through the spin. No one with a GCSE in maths can believe that no doctor will be worse off as a result of the new contract. Let the right hon. Gentleman come to the Dispatch Box in the minute that I have left, and answer this question. To what percentage of junior doctors currently working within the legal limits will what the Secretary of State has said today apply? Is it 50%? Less than a quarter? What is it?
Andrew Gwynne
In that case, I ask the Secretary of State to explain this. If the pay envelope is not increasing, and if the pay is not being reduced, how can these sums add up? They just do not add up, and I suggest that he go back to night school and learn some basic arithmetic.
We know that the BMA has been conciliatory today: it has offered to speak to the Secretary of State again. I ask him, please, let us take this down a notch. Let us get him talking to junior doctors again. The simple fact is that these are the junior doctors who work in our A & E; these are the junior doctors who work in every department of every hospital on the frontline. They come in early and leave late, they already provide care for seven days a week, 24 hours a day, and they deserve a lot better than this Government.
Oral Answers to Questions
Jeremy Hunt Excerpts(9 years, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mike Wood (Dudley South) (Con)
6. What plans his Department has to increase capacity in general practice and primary care.
The Secretary of State for Health (Mr Jeremy Hunt)
It is a pleasure to be back, Mr Speaker. By 2020, we will increase the primary and community care workforce by at least 10,000, including an estimated 5,000 doctors working in general practice, as well as more practice nurses, district nurses and pharmacists.
Suella Fernandes
Fareham community hospital is an example of Labour’s expensive PFI gone wrong. At a cost of £28 million, it remains underused, half-built and subject to complex governance structures. What will my right hon. Friend do to enable better use of this facility to allow provision for minor injuries, a GP practice and more primary care?
Mr Hunt
My hon. Friend is right, regrettably, that the PFI projects under the previous Labour Government created a lot of unsustainable debt. I know her local clinical commissioning group is meeting GP practices and working with community health partnerships to see if they can progress the idea she is campaigning for. I hope to visit her in the near future to discuss it myself.
Mike Wood
Will my right hon. Friend join me in welcoming the £2.7 million in vanguard funding given to Dudley to provide primary care services out in the community? This will not only improve the level of clinical and social services provided to people in Dudley South, but relieve pressures on Russells Hall hospital.
Mr Hunt
I welcome my hon. Friend to his post. I am not sure I have had a question from him before. I know quite a bit about the Dudley vanguard programme, because I shared a taxi to Manchester station with the entire Dudley team. They told me, at close quarters, about their exciting plans. What really struck me was how they are talking to different bits of the health and social care system in a way that has never happened before. It is really exciting and I think it really will be in the vanguard of what can happen in the NHS.
Helen Jones (Warrington North) (Lab)
Many people in my constituency are struggling to see a GP from Monday to Friday. Warrington has fewer GPs than it had in 2010, despite a rise in population. The number of unfilled GP vacancies quadrupled under the previous Government. How does the Secretary of State expect to produce a seven-day service when he cannot properly staff the service from Monday to Friday?
Mr Hunt
I shall tell the hon. Lady how I expect to do it. We are, in fact, making very good progress. By March next year, a third of the country will be able to access routine GP appointments at evenings and weekends. We do need more GPs. I agree with her that it takes too long to get a GP appointment, but we are doing something about it. That is why we have announced plans to recruit an estimated 5,000 more GPs. That will be a 15% increase in the number of GPs, the biggest increase in the history of the NHS.
John Cryer (Leyton and Wanstead) (Lab)
It is widely known that there is a serious lack of doctors who want to go into general practice. At the same time, the Secretary of State is guilty of an abject failure to engage with the British Medical Association in negotiations on junior doctors’ practices. On that basis, how the hell can he promise to increase general practice?
Mr Hunt
Just look at our track record in the previous Parliament: we increased the number of GPs by 1,700—a 5% increase. We are, on the back of a strong economy, putting in funding that will make it possible to increase that number even more. The hon. Gentleman talks about the BMA. I simply say that the people refusing to negotiate are not the Government, but the BMA.
Several hon. Members rose—
Dr Andrew Murrison (South West Wiltshire) (Con)
Unfortunately, every time I open a page of my local newspaper these days I am met with the beaming face of yet another general practitioner in his mid-50s who has decided to throw in his hand after many, many years of serving his community. These doctors are best placed to manage patients in primary care and ensure that they do not have to go to secondary care or A&E. What analysis has my right hon. Friend made of the reasons these experienced professionals are leaving the profession prematurely, and what will his reforms do to stem the tide?
Mr Hunt
My hon. Friend makes a very important point. We have done extensive analysis, because of our commitment to transform the role of general practice, of the issues. They include too much bureaucracy and form-filling, which means that doctors do not spend enough time with patients, and a sense that successive Governments have not invested in general practice and primary care. That is exactly what we seek to turn around with the “Five Year Forward View”.
Ms Margaret Ritchie (South Down) (SDLP)
What discussions have taken place with the devolved Administrations regarding the introduction of the new GP contract, particularly the junior doctor contract, given the exodus of junior doctors to Australia?
Mr Hunt
We also have Australian paramedics working in the UK, particularly London, so that traffic goes both ways, but, as the hon. Lady will know, health is a devolved matter, and people follow their own paths. For England, we are determined to eliminate the weekend effect. Every year, there are 11,000 excess deaths as a result of inadequate cover at weekends, and we do not want that to continue.
Ruth Cadbury (Brentford and Isleworth) (Lab)
2. How much additional investment there will be in children and young people’s mental health services in 2015-16.
Chris Philp (Croydon South) (Con)
3. What progress his Department has made in delivering seven-day-a-week NHS services.
The Secretary of State for Health (Mr Jeremy Hunt)
Eighteen million patients will benefit from seven-day GP appointments by March next year, and seven-day hospital services will reach a quarter of the country by then.
Chris Philp
In my borough of Croydon, the clinical commissioning group is currently consulting on the possibility of having three seven-day-a-week, 12-hour-a-day combined minor injury and GP centres, with one at Purley hospital in my constituency. Can the Secretary of State confirm whether any additional funding is available from central Government to facilitate this seven-day-a-week service?
Mr Hunt
Yes, I can. I should have said that seven-day hospital services will be available to a quarter of the country by March 2017. We are putting an extra £10 billion into the NHS in the course of this Parliament, which will help in the roll-out of seven-day services—I hope in Croydon, as well. I commend my hon. Friend for his efforts in that respect.
Alison McGovern (Wirral South) (Lab)
I met a large group of junior doctors in my constituency on Friday, and we talked a lot about seven-day working. They asked me to put two things straight with the Health Secretary: first, the vast majority of junior doctors are already working seven days a week; and, secondly, on their contract, it was not terms and conditions that they were worried about, as I thought they were, but safety. In respect of those new contracts for junior doctors, what assessment has the Secretary of State’s Government made about patient safety?
Mr Hunt
I am very happy to do that, and to correct some of the misleading impressions given by the BMA about what the changes are. The changes are about patient safety. They are about the fact that someone is 15% more likely to die if admitted on a Sunday than on a Wednesday because we do not have as many doctors in our hospitals at the weekends as we have mid-week. I want to give better support to the doctors who work weekends by making sure that they have more of their colleagues and more consultants there, as well as proper safeguards, which I do not believe we have at the moment. I will be getting that message out, and I hope that the hon. Lady will, too, when she next meets her junior doctors.
Sir Simon Burns (Chelmsford) (Con)
I urge my right hon. Friend to continue on his drive to improve patient safety and to reduce avoidable harm in our NHS because that is crucial for patients and the professions.
Mr Hunt
I thank my right hon. Friend for his question, and for the interest that he showed in these issues when he was a Minister.
The reality is that about we have about 200 avoidable deaths every week in our hospitals. It is the same in other countries—this is not just an NHS issue—but it is a global scandal in healthcare, and I want England and our NHS to be the first to put it right. I think that that is consistent with NHS values, and consistent with what doctors and nurses all want.
Heidi Alexander (Lewisham East) (Lab)
It is good of the Secretary of State to join us today. If he had been here yesterday to discuss the small issue of the £2 billion NHS deficit, he would have heard me say that I hoped we could have a mature and constructive relationship.
As has already been said, junior doctors are key to the delivery of a seven-day NHS. The Secretary of State said recently:
“I don’t want to see any junior doctor have their pay cut.”
Can he now guarantee that no junior doctor will be paid less as a result of his proposed new contract? Yes or no?
Mr Hunt
I welcome the hon. Lady to her post. I hope that, just occasionally, we might agree on some things, although I suspect that today may not be one of those occasions.
Let me be absolutely clear about the commitment that we have made to junior doctors. We will not cut the junior doctor pay bill, but what we do need to change are the excessive overtime rates that are paid at weekends. They give hospitals a disincentive to roster as many doctors as they need at weekends, and that leads to those 11,000 excessive deaths. Let me gently say that that was a change to the doctors’ contracts made in 2003, so for members of the Labour party to say that this is nothing to do with them is not accurate, and they should help us to sort out the problem.
Heidi Alexander
I think it is fair to say that junior doctors will make up their own minds about that response.
Last week I received an e-mail about a seriously ill woman who had needed to be admitted to hospital over the weekend, but had stayed at home for two days because of recent interviews given by the Department of Health that had made her think
“that the NHS was not staffed at weekends.”
Her doctor went on to say:
“This delayed her operation, put her life in danger and ultimately will have cost the NHS more”.
Does the Secretary of State feel any responsibility for that?
Mr Hunt
Let me give the hon. Lady the facts. According to an independent study conducted by The BMJ, there are 11,000 excess deaths because we do not staff our hospitals properly at weekends. I think it is my job, and the Government’s job, to deal with that, and to stand up for patients.
The hon. Lady talked about being constructive. There is something constructive that she can do, which is to join the Royal College of Surgeons, the Royal College of Physicians and the Royal College of Nursing, and urge members of the British Medical Association not to strike but to negotiate, which is the sensible, constructive thing to do. Will the hon. Lady tell them to do that?
Mr Peter Bone (Wellingborough) (Con)
The question is about the seven-day NHS, but there is no point in our having a seven-day NHS if it is not an NHS across the country. I have a constituent with advanced prostate cancer who, as his oncologist says, needs docetaxel chemotherapy. In fact, all east midlands oncologists say that it is needed, but it is not provided by the NHS in my constituency, although it is provided in Birmingham. If we are to have a seven-day NHS, we need treatment across the board. Will the Secretary of State step in and do something about this?
Mr Hunt
I will look into the individual case that my hon. Friend has raised, but I think patients recognise that sometimes they need to travel further for the most specialist care, and can receive better care if they do so. However, the way in which what we are doing will help my hon. Friend’s constituents, and other people with cancer, is not just about consultants and junior doctors working at the weekends; it is about seven-day diagnostic tests, which will enable us to get the answers back much more quickly and catch cancers earlier.
Catherine West (Hornsey and Wood Green) (Lab)
4. What progress his Department has made in introducing a cap on care costs.
Tulip Siddiq (Hampstead and Kilburn) (Lab)
17. What additional financial support he is making available to the NHS to help it deal with winter pressures.
The Secretary of State for Health (Mr Jeremy Hunt)
Some £400 million in resilience money has been invested in the NHS for this winter. Learning from previous years, we have put this money into the NHS baseline for 2015-16 so that the NHS can plan effectively at an earlier stage.
Liz McInnes
I thank the Secretary of State for his response. In my constituency we have an excellent and much-used facility—a walk-in centre in Middleton town centre—which is now threatened with closure. Will he support our campaign to keep it open? Does he agree that its closure would create more A&E attendances and increase winter pressures on our acute services?
Mr Hunt
I welcome the question and understand the hon. Lady’s concerns about the changes. She will understand that we do not direct these changes centrally and they are decided locally. One of the things we have to try to do is deal with the confusion a lot of people have at a local level as to what they should do when they have, for instance, a child with fever at the weekends and whether they require a GP, an urgent care centre or an A&E department. I would ask all CCGs to be very careful to make sure they sort out that confusion so NHS patients know exactly what they should do.
Tulip Siddiq
The Royal Free hospital in my constituency is at the cutting edge of medical research and is currently treating Ebola patient Pauline Cafferkey. I am sure the Secretary of State will join me in wishing her a speedy recovery, yet the hospital faced considerable winter pressures last year. Will the Secretary of State work with the fantastic nurses and doctors at the Royal Free to ensure these winter pressures do not happen again this year?
Mr Hunt
I thank the hon. Lady for her excellent question. I know that the whole House is thinking of Pauline Cafferkey and her family and that it is proud that, under Dr Mike Jacobs and his team, she is getting the most outstanding care that it is possible to get anywhere in the world. We all wish her a speedy recovery. With respect to winter pressures, I know that the Royal Free had a difficult winter but I also know that it has a very good management team and made heroic efforts. I know that the whole team of doctors and nurses will do an excellent job, and we will want to support them in any way we can.
David Tredinnick (Bosworth) (Con)
As part of my right hon. Friend’s plans for dealing with winter pressures, will he look at making greater use of the 63,000 practitioners on the Professional Standards Authority’s 17 accredited registers covering 25 occupations? Has he found time yet to read the authority’s report, “Accredited Registers—Ensuring that health and care practitioners are competent and safe”?
Mr Philip Hollobone (Kettering) (Con)
Kettering general hospital, the local clinical commissioning group and the Government are all agreed that the best way to help the NHS in north Northamptonshire to cope with pressures all year round, including in the winter, would be to develop a £30 million urgent care hub at Kettering general hospital. That project is with Monitor. What can the Secretary of State do to encourage Monitor to speed up its deliberations?
Mr Hunt
Once again, I thank my hon. Friend for his persistent campaigning on behalf of Kettering general hospital. It is a very busy hospital under a great deal of pressure, and I know that people work very hard there. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who has responsibility for hospitals, met campaigners from Kettering recently to discuss this issue, and I will bring the matter up with Monitor as well.
Dr Philippa Whitford (Central Ayrshire) (SNP)
The Department of Health’s own figures show a dramatic change, from a £500 million surplus to a £100 million deficit in 2013, following the introduction of the Health and Social Care Act 2012. That deficit moved to £800 million last year and we have heard in the past week that it stood at more than £900 million from the first quarter of this year. Does the Secretary of State recognise that this situation has been exacerbated by the outsourcing and fragmentation of the NHS, which involves spending money on shareholder profits and tendering bureaucracy, rather than on patients?
Mr Hunt
I do not. That Act meant that we reduced the number of managers and administrators in the NHS in England by 19,000, saving the NHS £1.5 billion a year. The reason for the deficits that the hon. Lady talks about is that, around the same time, we had the Francis report on Mid Staffs, and hospitals in England were absolutely determined to end the scandal of short-staffing. However, agency staffing is not a sustainable way of doing that, which is why we are taking measures today to change that.
Dr Whitford
The Francis report recognised the problems of nursing levels. As hospitals will not be able to use agency staff or immigrant staff, how does the Secretary of State suggest they tackle the nursing ratios in hospitals?
Mr Hunt
If the hon. Lady looks at what has happened with permanent full-time nursing staff, she will see that the numbers have gone up in our hospitals by 8,000 over the past two years, so there are alternatives. We need to do more to help the NHS in this respect, and I will be announcing something about that shortly.
Paul Maynard (Blackpool North and Cleveleys) (Con)
10. What plans he has to review renewal arrangements for the issuing of NHS medical exemption certificates.
Chris Skidmore (Kingswood) (Con)
16. What steps his Department has taken to improve transparency in the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
Last year I launched My NHS, where patients can see how safe their local hospital is and many other things. From next May, there will be overall information on the quality of mental health and cancer care.
Chris Skidmore
Does the Secretary of State share my view that driving up standards in the NHS is better achieved through a culture whereby providers can learn from their peers? For example the excellent maternity department at my local Cossham hospital recently received an outstanding rating from the Care Quality Commission. That is better than the old ways of doing things through targets driven by Whitehall.
Mr Hunt
I agree, and I congratulate the doctors and nurses working in the Cossham maternity unit. Southmead hospital in Bristol has some of the best maternity survival rates in Europe, so there is a lot of very good practice. The way to get the word out is through transparency of outcomes, not endless new targets, so my hon. Friend is absolutely right.
Paula Sherriff (Dewsbury) (Lab)
T2. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
I would like to make a statement on measures the Government are taking to help NHS organisations tackle the deficits by reducing the cost of agency staff. Building on previously announced controls, from the end of November we will introduce maximum shift rates for all clinical staff employed through agencies, which will gradually decrease over time as the measures take effect and demand for agency staff reduces. In addition, we will work with each trust to limit or reduce the overall agency spend. Exceptional breaches of the limits will require advance agreement. Taken together, these measures are expected to improve patient care and reduce NHS agency staff spend by £1 billion over three years. The chief inspector of hospitals has confirmed that he believes this is the right thing to do.
Paula Sherriff
Like many Members across this House, I have been inundated with letters and emails from junior doctors who feel completely undervalued and undermined by the actions of this Government, so much so that thousands of them are leaving the UK. This weekend over 2,000 medics and students wrote to the Secretary of State, condemning him for his proposed unfair and unsafe changes to the junior doctors contract. What further evidence does he need to see that he has lost the confidence of the future leaders of the NHS, and does he think he can win it back?
Mr Hunt
Yes, I do. Let us be clear: this is about patient safety, about which every single doctor and nurse in the NHS is passionate. The problem is that the doctors whom the hon. Lady has met have been misled by their own union. This is not about cutting the pay bill for junior doctors, as the BMA has suggested. This is about safer care at weekends, reducing unsafe hours and doing the right thing for patients, and that is the right thing for doctors as well.
Martin Vickers (Cleethorpes) (Con)
T4. It emerged earlier this month that North East Lincolnshire CCG was operating a primary care incentive scheme intended to reduce outpatient referrals. Understandably, this has met with a hostile reception from my constituents, who fear it may affect decisions on their care. Will Ministers look into this scheme and either offer some reassurance or instruct the CCG to reconsider?
Andrew Gwynne (Denton and Reddish) (Lab)
Last week senior officials at Monitor reported being leaned on by the Department of Health to suppress the publication of financial figures ahead of the Conservative party conference. This week the Health Secretary has been accused of vetoing the release of impartial independent reports on measures that could reduce our consumption of sugar. Does he not understand that leadership on transparency must come from the very top? Will he now commit to practising what he preaches on NHS transparency and release this report immediately?
Mr Jeremy Hunt
I will take no lessons on transparency from the Opposition. Professor Sir Brian Jarman said that the Department of Health under Labour was a “denial machine” when it came to the problems of Mid Staffs. We have made the NHS more transparent than ever before, and we will continue to practise transparency.
Mr Steve Baker (Wycombe) (Con)
T6. What progress has been made towards the implementation of the Keogh review of urgent and emergency care?
Mr Hunt
We are making good progress and we expect to make a substantive announcement on that before the end of the year. That will be about improving the standard and the quality of care in A and E departments, which I know my hon. Friend has a great interest in, and removing the confusion that people feel about what precisely the NHS offer is in their area. It is looking good and I hope to have something to announce to the House before too long.
Teresa Pearce (Erith and Thamesmead) (Lab)
T3. A recent whistleblower revealed that the 111 helpline is in meltdown and at least two babies have died after staff failed to recommend treatment that may have saved them. Two weeks ago my own three-week-old premature granddaughter was very ill. Her parents called 111 and were promised that the duty doctor would call. He did not. They waited the whole long night and the next morning took her to A and E, and she was diagnosed with meningitis. What exactly is the Minister doing to fix the crisis in the 111 service?
Mr Hunt
This is a very serious issue and I will happily look into it personally to make sure that a full investigation is taking place into the incident the hon. Lady mentions, which clearly should not have happened. The 111 service has been an improvement on what we had before. It has taken nearly three times as many calls as the service it replaced, and around a quarter of those are referred to a clinician, but it is clearly not perfect, given the hon. Lady’s story, so I will look into the case that she raised.
David T. C. Davies (Monmouth) (Con)
T9. Patients in England wait 18 weeks for an operation, but in Wales, where Labour has run the NHS for the past 16 years, they wait 26 weeks. Does that not prove that only the Conservative party can be trusted to run the national health service?
Andrea Jenkyns (Morley and Outwood) (Con)
To continue on the same theme—hopefully I am coming in at the right time, Mr Speaker—I chair the all-party group on patient safety, in collaboration with the Patients Association. We are about to look into hospital infections, and in Parliament in November I will launch a hand washing campaign. What is the Department of Health doing to promote infection control outside hospital settings?
Mr Jeremy Hunt
I thank my hon. Friend for her great interest in this issue and for the campaigning she did before entering Parliament, which I know stemmed from personal tragedy. This is an incredibly important issue. We face a crisis in global healthcare as a result of anti-microbial resistance, which means the current generation of antibiotics is no longer as effective as it needs to be. Proper hygiene in hospitals is therefore vital, and we have a lot of plans that I will be happy to share with her.
Owen Thompson (Midlothian) (SNP)
T7. What measures is the Secretary of State putting in place to recruit and retain GPs? Given that he has indicated recruiting 5,000, where does he plan to find them?
Dr Sarah Wollaston (Totnes) (Con)
Delayed publication of evidence is as damaging as non-publication, which is why we rightly expect clinicians, researchers and managers to publish their evidence and data in a timely and transparent manner. It is a matter of great regret to the Health Committee that we started our inquiry today without access to the detailed and impartial review of the evidence that we need to make a contribution to this inquiry. Will the Secretary of State please set out when he will publish it?
Mr Jeremy Hunt
I agree with my hon. Friend about the importance of transparency and publishing in a timely manner. I will look again at the planned publication date for the report she wants to see, which will be published so that Parliament can debate it properly. The normal practice is for advice to Ministers to be published at the same time as policy decisions are made, as happened with the Chantler review and the Francis report.
Caroline Flint (Don Valley) (Lab)
T8. The Royal College of Nursing reports that it is becoming clear that for the first time since the early 2000s there is a critical shortage of registered nurses in the UK. Both the UK and global nursing labour markets are changing, and our increasing reliance on alternative sources is not sustainable. In 2014, 37,645 students across the UK were turned away from nursing courses. Is it not time the Minister admitted that the situation is not good enough and that the Government need drastically to scale up those places to reduce dependency on overseas nursing staff?
David Mowat (Warrington South) (Con)
Last year the NHS paid £300 million to claimants’ lawyers. Indeed, for small and medium claims, the lawyers made two to three times as much as the claimants themselves. Is there more we can do to stop this abusive behaviour?
Mr Jeremy Hunt
There certainly is. We spend £1.3 billion every year on litigation claims—money that could be used to look after patients on the front line. The way to avoid spending that money is to have safer care, and that is why it is so important that we have a seven-day service.
Patricia Gibson (North Ayrshire and Arran) (SNP)
T10. As the Secretary of State will know, the Scottish Government are once again in the vanguard in introducing crucial legislation—the Smoking Prohibition (Children in Motor Vehicles) (Scotland) Bill, which will eradicate more than 60,000 journeys per week where children are exposed to dangerous second-hand smoke. Will he advise on what plans are in place for the rest of the UK to follow Scotland’s example?
Mr Jeremy Hunt
The hon. Lady is absolutely right; we need more midwives. We recruited more midwives in the previous Parliament, and we do need to expand maternity provision as we have a growing birth rate. I am happy to look at the problems in her area. However, we also have a maternity review coming up early next year, led by Baroness Cumberlege, that will help us to address this problem sustainably.
Philip Davies (Shipley) (Con)
What health problems are caused by first-cousin marriages, and how much does dealing with those problems cost the NHS each year?
NHS England
Jeremy Hunt Excerpts(9 years, 4 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today, I am laying before Parliament my annual assessment of the NHS Commissioning Board (known as NHS England) for 2014-15. The NHS Commissioning Board Annual Report & Accounts 2014-15 were also laid (HC109). Together these documents show an improving picture of performance, both in terms of delivering the Government’s mandate and more widely as an organisation. Copies of both documents will be available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
NHS England’s annual report sets out the progress that has been made in the last year in delivering the Government’s mandate as well as acting to reduce health inequalities, improve quality and encourage greater public and patient involvement in the health service. I am encouraged by its focus on improving efficiency and delivery across the health service and its plans to tackle those areas where improvement is required.
My annual assessment recognises the progress that NHS England has made, I have been impressed by the way in which NHS England has worked with organisations across the health system to develop the NHS Five Year Forward View. We are committed to this vision for a better NHS, which has generated consensus across the health system about how care needs to change to meet patients’ needs.
The assessment also sets out my expectations of NHS England for the year ahead. In particular we want to see the NHS make further progress on achieving parity of esteem for mental health and to address winter pressures including restoring and sustaining performance all year round against access standards. We also want to see NHS England strengthen commissioning assurance as well as working with the health system to deliver the productivity and efficiency savings identified within the NHS Five Year Forward View.
Overall NHS England has made good progress during 2014-15. We will continue to work closely with NHS England to address the significant challenges ahead that will require NHS England to work with organisations across the health system to deliver the new care models, along with the productivity and efficiency savings articulated in the NHS Five Year Forward View.
[HCWS165]
NHS Modernisation
Jeremy Hunt Excerpts(9 years, 4 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
The health and care reforms came into operation on 1 April 2013. They reshaped the NHS to give patients a stronger voice and give doctors, nurses and elected councillors more power to decide how best to use local resources to significantly improve services and patients’ health.
The National Audit Office subsequently reported that the transition to the reformed health system was successfully implemented and the savings in administration costs would far outweigh the implementation costs.
The Department of Health originally forecast the total cost of transition to be £1.5 billion. On publication of the Department’s annual report and accounts for 2014-15, I can today announce that the actual costs to 31 March 2015 are £1.38 billion, and total costs are forecast to be under £1.43 billion. The costs to 31 March 2015 comprises:
£473 million on staff redundancies;
£75 million on IT for the new organisations;
£88 million on estates costs of closing bodies and setting up new organisations;
£29 million on internal Departmental costs (e.g. programme management);
£323 million on setting up clinical commissioning groups (excluding items above); and
£395 million on other costs of closing bodies (e.g. PCTs) and setting up new organisations.
The Department of Health also originally forecast that between 2010-11 and 2014-15 the reforms would save the NHS £4.5 billion in lower administration costs, as well as a further £1.5 billion a year thereafter. I can today also announce that actual savings were far greater, in cash terms at £6.9 billion over this period, including £2 billion in 2014-15—and in 2010-11 prices comparable to the impact assessment £6.5 billion, including £1.8 billion in 2014-15. This means the Government have successfully achieved their aim to reduce NHS bureaucracy costs by a third.
By removing excessive layers of bureaucracy, the NHS has significantly reduced the number of managers it employs. For example, the reduction of central administrative staff by 18,000 since 2010 has helped the NHS to increase the number of professionally qualified clinical staff by over 23,500, including over 8,500 more nurses and over 9,000 more doctors. These extra clinicians are treating record numbers of patients. For example, compared to 2012-2013, in 2014-2015 the NHS admitted 600,000 more patients to hospital, saw 3.4 million more outpatients, and did 2.2 million more diagnostic tests.
[HCWS161]
NHS Remuneration: Doctors and Dentists
Jeremy Hunt Excerpts(9 years, 4 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I am responding on behalf of my right hon. Friend the Prime Minister to the seven-day services reports of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) and the NHS Pay Review Body (NHSPRB). The reports have been laid before Parliament (CM9107 and CM9108). Copies of the reports are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
This Government are committed to creating a seven-day health service fit for the 21st century with patients receiving the hospital care they need seven days a week by 2020. Patients expect and should receive high-quality, safe care every single day. It is simply wrong that mortality rates are higher for patients admitted to hospital at the weekend than during the week. 6,000 lives are lost needlessly, each year, as a result, making this manifesto commitment a clinical priority and a moral cause.
Last year, I asked the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) and the NHS Pay Review Body (NHS PRB) for their observations on how contract reform for directly employed NHS staff in England might be required to support the delivery of seven-day services.
The DDRB was asked to make observations on proposals for reforming the consultant contract to better facilitate the delivery of healthcare services seven days a week, taking account of proposals for pay progression to be linked to responsibility and patient care, and for reforming clinical excellence awards. It was also asked to make recommendations on a new contract for doctors and dentists in training, including a new system of pay progression.
Similarly, the NHS PRB was asked to make observations on the barriers and enablers of seven-day services within national employment contracts for staff employed under the agenda for change pay framework—AfC which applies to non-medical staff—with particular reference to the impact of premium pay rates for working unsocial hours, incremental pay progression and any transitional arrangements.
I am grateful to the chairs and members of the review bodies for producing these reports.
The case for seven-day services
I am pleased that all those who responded to the PRBs’ calls for evidence accept the compelling case and support the vision for seven-day services with its primary aim of putting patients first and reducing mortality rates at the weekends.
How seven-day services are delivered on the ground must be informed by the clinical needs of local communities; one size cannot fit all. Some trusts are already delivering services across seven days as the PRBs observed, but this is by no means universal. The DDRB said,
“We also investigated the position in healthcare systems elsewhere in the world and it is our understanding that outside of accident and emergency services most international public healthcare systems are not providing a comprehensive twenty-four hour, seven-day service. We therefore conclude that the proposed new NHS arrangements would be trailblazing within healthcare systems.”
The NHS PRB concluded that the agenda for change pay system was not a barrier to the delivery of seven-day services and that more work should be undertaken to understand in more detail how services might be delivered in the future, the workforce implications and transitional arrangements. They also observed that the right of consultants to opt out of non-emergency work in the evenings and at weekends is a contractual barrier to the delivery of seven-day services and the DDRB also observed that,
“the role of consultant presence at weekends to make a difference to patient outcomes is accepted.”
It was noted that this is a contractual protection which is enjoyed by no other NHS professionals or by any other areas of the public sector workforce. DDRB said,
“In our view, the current ‘opt-out’ clause in the consultant contract is not an appropriate provision in an NHS which aspires to continue to improve patient care with genuinely seven-day services, and on that basis, we endorse the case for its removal from the contract.”
The PRBs’ views on the proposals
The independent DDRB concluded that the key principles proposed by the Government and NHS Employers are reasonable—to improve patient outcomes across the week and to reward greater responsibility and professional competence. They acknowledged the case for changing the contract for doctors and dentists in training (juniors) and concluded that the proposals made are fair, and that removal of the consultant opt-out clause is,
“an opportunity to smooth the transition between the junior doctor grade, which is routinely rostered for weekend working, and the consultant grade, which can choose whether to be rostered or not.”
They found that the core principles for reforming the consultant contract look right; that the proposals should be viewed as a total package of reform across the two contracts; and that there is scope for progressing some elements of consultant reform at different speeds, including early removal of the consultant opt-out. The DDRB endorsed changes to the antiquated approach for time served mainly annual incremental progression in both contracts.
I am particularly pleased that the NHS PRB agreed that contract reform should work for staff and patients and that any reform of the system of premium pay for working unsocial hours should not be done in isolation, but as part of a wider package of reform.
The NHS PRB observed that premium pay rates may not be out of line with comparator industries, but that there is a case for some adjustment to unsocial hours pay, for example, extending plain time working further into the evenings—from 7/8pm currently to 10pm—and noted the move, in some sectors, to plain time working on Saturdays. The DDRB suggested that the night window for juniors and consultants should start at 10pm.
The DDRB supported the proposed approach to the pay package for juniors; while it noted that the rates for unsocial hours and other elements were for the parties to agree, it also noted that total pay for juniors compares favourably with comparator groups and that, given the cost-neutral pre-condition for negotiations, that position will continue. It acknowledged the proposal to undertake further modelling on unsocial hours rates for consultants, while noting that some other professionals working across seven days do not receive any such payments but are expected to work any necessary additional hours as part of professional salary arrangements.
The DDRB recommended a common definition should be applied across all NHS groups, or a rationale for not doing so should be provided. The NHSPRB recommended that this be considered as part of a wider review of AfC, including reform of incremental pay progression so that there is a much stronger link between pay and performance.
We agree with the DDRB that contractual safeguards are necessary. These formed a core part of the proposals for consultants and juniors.
Supported by good staff engagement strategies, it is the overall employment offer, not just pay, that helps the NHS to attract and keep the staff it needs.
The DDRB also said,
“We support the continuation of national CEAs, and given the separation of local CEAs (to be reformed as performance pay, or payments for excellence), that the value of national CEAs will need further consideration.”
Next steps
Given the priority placed on seven-day services by medical leaders and patient groups, I was hugely disappointed that the BMA union walked away from negotiations at such a late stage last October when proposals had been developed. The DDRB has stated that its recommendations and observations,
“provide a roadmap on what could and should be achievable in the interests of everyone with a true stake in the NHS.”
We have lost a year in which we could have been moving towards changes that are in the interests of patients, doctors and the NHS. We cannot afford any more delays.
That is why I am now asking the British Medical Association (BMA) to engage with us rapidly over the summer and to tell me, by mid-September, whether they will work with us, without delay, to introduce modernised professional contracts for engagement and for training, focused on outcomes, on the basis of the recommendations and observations in DDRB’s report.
While we remain prepared to discuss a staged approach to changes for consultants, as recommended by the DDRB, we would be seeking immediate removal of the consultant opt-out, early implementation of new terms for new consultants from April 20160—moving existing consultants across by 2017—and the introduction of a new juniors’ contract from the August 2016 intake. We will also introduce a new performance pay scheme, replacing the outdated local clinical excellence awards so that we reward those doctors who are making the greatest contribution to patient care—the DDRB recommends that these be termed “awards for achieving excellence”. I will consult on removal of the current local scheme in the autumn, alongside proposals for a reformed national clinical excellence award scheme based on the recommendations previously made by the DDRB. We will be mindful of the importance of recognising those doctors who have national leadership roles in the NHS and the substantial contribution made by clinical academics.
The case for change, in the interests of all, is made. We would prefer to agree changes in partnership, as recommended by the DDRB and acknowledging its observation of the need to build mutual trust and confidence; but we will take forward change, in the absence of a negotiated agreement.
The NHSPRB said that the areas of agreement between the parties,
“should provide a positive basis for future discussions and progress on the expansion of seven-day services.”
I welcomed the agreement of the NHS trade unions earlier in the year to enter into talks on contract reform. The NHS trade unions have already agreed to a timetable seeing change beginning to be implemented from April 2016. I am now inviting the AfC trade unions to enter into formal negotiations with NHS employers, to that timetable, to agree a balanced package of affordable proposals for reform.
These reforms need to enable trusts to recruit, retain and motivate the staff they need to deliver high-quality safe care over seven days. All trusts must make the very best use of their pay bill, making every penny work for patients. I know most trusts prefer to use national pay frameworks provided they are affordable and fit for purpose. I recognise that, if national contracts cannot be reformed, it is likely that employers will feel that they need to use the employment freedoms they already have to take contract change forward.
In addition, my right hon. Friend the Chancellor of the Exchequer has made clear in the Budget that the Government will continue to examine pay reforms and modernise the terms and conditions of public sector workers. This will include a renewed focus on reforming progression pay, and considering legislation where necessary to achieve the Government’s objectives.
I therefore want these negotiations to build on the 2013 agreement on AfC pay progression and remove virtually automatic annual incremental progression from the NHS pay system—as is also proposed for consultants and junior doctors. Pay progression must be related to performance rather than time in the job and those who make the greatest contribution should see that rewarded in the pay system.
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NHS Leadership
Jeremy Hunt Excerpts(9 years, 4 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I have published today “Learning not blaming” (CM9113), which sets out the Government’s position on the freedom to speak up consultation, the Public Administration Select Committee report “Investigating Clinical Incidents in the NHS”, and Dr Bill Kirkup’s independent report on the Morecambe Bay investigation; and, in a separate document, Lord Rose’s report on NHS leadership.
The three reports cover distinct areas, and the accompanying document addresses the points and recommendations raised in each report. The “freedom to speak up” review by Sir Robert Francis QC, focused on whistle blowing; the Public Administration Select Committee report “Investigating Clinical Incidents in the NHS”; and, the investigation into university hospitals Morecambe Bay NHS Foundation Trust, conducted by Dr Bill Kirkup CBE. There are, however, some themes common to each report, including the importance of:
openness, honesty and candour;
listening to patients, families and staff;
finding and facing the truth;
learning from errors and failures in care;
people and professionalism.
In considering points made in these reports, the Government have been guided by the need to build on the work we and the NHS have done in recent years to improve the way in which the NHS treats patients and families, by developing capabilities locally to respond to patients’ and families’ concerns and to exercise proper oversight of care quality.
In recognition of this, the NHS’s own Five Year Forward View emphasises the need for care to be both safe and sustainable over the long term. For each of the reports, we therefore propose specific actions to address the immediate issues they raise, and in doing so make clear that the NHS must develop an improved approach to patient safety and complaints. Our response therefore sets out a strong expectation that we want nothing less than a renewed culture that values learning, not blaming; compassion, not defensiveness; and putting patients and families before systems and institutions.
In summary, we will:
put in place freedom to speak up guardians in each trust to build up capability and capacity locally, at the frontline of service provision;
ensure that every local NHS provider provides training in raising and listening to concerns;
remove the Nursing and Midwifery Council’s current responsibility and accountability for statutory supervision of midwives in the United Kingdom. (The NMC will of course remain responsible for the regulation of midwifery, but the supervision of midwives will be brought into line with the arrangements for other clinical professions);
review the professional codes of doctors, nurses and midwives and ensure that the right incentives are in place to encourage people to report openly, and to learn from mistakes;
set up a new patient safety investigation function to be fully operational from 1 April 2016—the independent patient safety investigation service. An expert advisory group will convene shortly in order to develop the structure, governance and operating model of this new service.
Freedom to Speak Up
The Government have consulted on a package of measures to implement the principles and actions set out in Sir Robert Francis QC’s report. In light of the consultation responses, I can now announce that the role of independent national officer will be hosted by the Care Quality Commission, who intend to have them in place by December 2015. I can also announce that freedom to speak up guardians will be appointed in all NHS Trusts, to build up capability and capacity locally, at the frontline of service provision, following guidance published by the independent national officer.
Robert’s report also called for training on raising and hearing concerns in every local NHS provider organisation. The relevant national bodies will now be working on a package that would include the following content:
the inclusion of content on raising concerns in induction training for all staff;
the inclusion of good practice regarding the raising of concerns for healthcare professionals as part of their professional codes, followed up through continuing professional development;
the regular use of reflective practice, through for example team meetings or Schwartz rounds, to review particular examples when concerns have been raised or not raised and how this might be improved in future;
the inclusion of content on raising concerns in other specific packages of training that NHS workers are expected to undertake or which NHS employers have included in annual training priorities; and
the inclusion of content on raising concerns in initial education and training undertaken by those learning to become healthcare professionals. This is already being considered and developed by health education England.
Morecambe Bay investigation
The Government have accepted all the recommendations of this report.
The recommendation for an independent patient safety investigation service is explained in more detail in our response to the Public Administration Select Committee report.
We will use secondary legislation to remove the Nursing And Midwifery Council’s current responsibility and accountability for statutory supervision of midwives in the United Kingdom. The NMC will of course remain responsible for the regulation of midwifery, but the supervision of midwives will be brought into line with the arrangements for other clinical professions. This will improve the local oversight and accountability for midwifery. Existing arrangements will remain in place until alternative arrangements are introduced.
In addition, I have asked Professor Sir Bruce Keogh to review the professional codes for all regulated staff in the NHS and to ensure that the right incentives are in place to encourage reporting and learning from mistakes, and prevent covering up.
In response to recommendations 25 and 42 in the report, I am proposing to review the regulations that set out statutory requirements for notifications to the Care Quality Commission and Monitor during 2015-16 with the intention of addressing Dr Kirkup’s recommendation that trust boards should openly report the findings of any reviews of care to relevant external bodies.
We would also like to extend this to the commissioning of any such reviews. We will consult on any changes.
In response to recommendation 20, NHS England has established a national review of maternity services, independently chaired by Baroness Cumberlege. It is anticipated that the review will publish proposals on safe and efficient models of maternity care at the end of the year. The review will pay particular attention to the challenges of achieving this objective in more geographically isolated areas.
Public Administration Select Committee report
We accept the recommendations of this report.
Our response sets out the Government’s decision to set up a new independent patient safety investigation service, to be operational from 1 April 2016. IPSIS will operate independently and it will be brought under the single leadership of Monitor and the NHS Trust Development Authority.
We have also set up an expert advisory group to advise on the scope, governance and operating model of this new service. The membership of this group includes:
Dr Mike Durkin, National Director for Patient Safety
Keith Conradi, Chief Inspector of the Air Accidents Investigations Branch
James Titcombe OBE, Morecambe Bay campaigner and currently working as a patient safety adviser to CQC
Prof Jonathan Montgomery, Professor of Healthcare Law at University College London
Julian Brookes, advisor on clinical governance for the Morecambe Bay Investigation, deputy chief operating officer Public Health England
Carl Macrae, Independent Quality Improvement Expert
Prof Martin Marshall CBE, Professor of Healthcare Improvement at University College London
Dame Eileen Sills DBE, Chief Nurse and Director of Patient Experience, Guy’s and St Thomas’ NHS Trust
Dr Bill Kirkup CBE, Chairman of the Morecambe Bay Investigation
Kate Lampard CBE, barrister and NHS strategic health authority chairman who provided oversight on the NHS’s Savile investigations.
PASC also recommended that, “draft legislation should be published for scrutiny early in the next Parliament” as part of the establishment of this new function. We will ask the expert group to consider whether the work of the independent patient safety investigation service would benefit from having any legal powers to fulfil its duties effectively.
I am confident that the new service will help to transform the state of patient safety.
Rose
I have today also published the report of Lord Rose’s review of National Health Service (NHS) leadership, “Better leadership for tomorrow”. A copy can be found online at: http://www.parliament.uk/writtenstatements. This is an important report making recommendations for the creation of a single NHS vision, improving training, performance management, reducing bureaucracy and improving management support.
I asked Lord Rose early in 2014 to consider what might be done to attract and develop talent from inside and outside the health sector into leading positions in the NHS and to recommend how strong leadership in hospital trusts might help transform the way things get done. Following the publication of the NHS’s Five Year Forward View, I requested him to extend his remit to consider how best to equip clinical commissioning groups to deliver the vision outlined within that report.
I welcome Lord Rose’s report and his 19 recommendations, all of which I have accepted in principle.
I am announcing today that the Government accept fully the recommendation to transfer responsibility for the NHS leadership academy from NHS England to health education England (HEE).
The Government also accept the need to do more to manage talent in the NHS and I can announce today that talent management for our brightest and best will become a formal responsibility for the single leadership of Monitor and the NHS Trust Development Authority.
My Department will work with the health and care system to develop plans to implement each of the other recommendations to the extent possible, subject to an assessment of proportionality, cost-effectiveness and affordability.
[HCWS113]
NHS Reform
Jeremy Hunt Excerpts(9 years, 4 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I would like to make a statement on measures to improve the safety culture in the NHS and further strengthen its transition to a modern, patient-centric healthcare system. The failings at Mid Staffs, detailed in the Francis report, were not isolated local failures. Facing up to widespread problems with the safety and quality of NHS care and learning the appropriate lessons has been a mission that the Government and the NHS have shared, with a common belief that the best way to deal with problems is to face up to them rather than wish that they did not exist.
Measures taken in the last Parliament include: introducing the toughest independent inspection regime in the world; more transparency on performance and outcomes than any other major healthcare system; new fundamental standards; a duty of candour; and the excellent recommendations by Sir Robert Francis QC. But because the change we need is essentially cultural, a long journey remains ahead. The Department of Health was described during the Mid Staffs era as a “denial machine”. We therefore have much work to do if we are to complete the transformation of the NHS from a closed system to an open one, from one where staff are bullied to one where they are supported, and from one where patients are not ignored but listened to.
Today I am announcing some important new steps, including: our official response to Sir Robert Francis’s second report, “Freedom to Speak Up”; our response to the Public Administration Select Committee report “Investigating clinical incidents in the NHS”; and our response to the Morecambe Bay investigation. I am also publishing Lord Rose’s report into leadership in the NHS—a key part of the way in which we will prevent tragedies such as these from happening again. I would like to thank everyone involved in writing those reports for their excellent work.
In his report “Freedom to Speak Up”, Sir Robert Francis QC made a number of recommendations to support this cultural change. All NHS trusts will appoint someone whose job is to be there when front-line doctors and nurses need someone to turn to with concerns about patient care that they do not feel able to raise with their immediate line manager. We will also appoint an independent national officer, located at the Care Quality Commission, to make sure that all trusts have proper processes in place to listen to the concerns of staff before they feel the need to become whistleblowers. Other changes will include providing information about raising concerns as part of the training for healthcare professionals and part of the curriculum for medical students, and placing a greater focus on learning from reflective practice in staff development.
Dr Bill Kirkup’s report into Morecambe Bay brought home to the House that there can be no greater pain than when a parent loses a child and then finds that pain compounded when medical mistakes are covered up. We will accept all the recommendations in this report, including removing the Nursing and Midwifery Council’s current responsibility and accountability for statutory supervision of midwives in the United Kingdom, and bringing the regulation of midwives into line with the arrangements for other regulated professions.
Likewise, we agree with the vast majority of the recommendations of the excellent PASC report into clinical incident investigations. In particular, we will set up a new independent patient safety investigation service by April 2016, based on the success of the “no blame” approach used by the air accidents investigation branch in the airline industry. It will be housed at Monitor/Trust Development Authority, which have the important responsibility of promulgating a learning culture throughout the NHS. Monitor/TDA will operate under the name “NHS Improvement”, and Ed Smith, currently a non-executive board member of NHS England, will become the new chair, with a brief to appoint a new chief executive by the end of September.
For NHS managers, Lord Rose’s report, “Better leadership for tomorrow”, makes vital recommendations to join up the support offered to NHS managers, to improve training and performance management, and reduce bureaucracy. He extended his remit to cover the work of clinical commissioning groups, which play a key role in the NHS, and today I am accepting all 19 of his recommendations in principle, including moving responsibility for the NHS leadership academy from NHS England to Health Education England.
These are important recommendations, which, in the end, all share one common thread: that the most powerful people in our NHS should not be politicians, managers or even doctors and nurses, but the patients who use it. Using the power of intelligent transparency and new technology, we now have the opportunity to put behind us a service where you get what you are given and move to a modern NHS where what is right for the service is always what is right for the patient.
A litmus test of that is our approach to weekend services. About 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals. Someone is 15% more likely to die if they are admitted on a Sunday than if they are admitted on a Wednesday. That is unacceptable to doctors as well as patients. In 2003-04, the then Government gave GPs and consultants the right to opt out of out-of-hours and weekend work, at the same time as offering significant pay increases. The result was a Monday-to-Friday culture in many parts of the NHS, with catastrophic consequences for patient safety.
In our manifesto this year, the Conservative party pledged to put that right as a clinical and moral priority. I am today publishing the observations on seven-day contract reform for directly employed NHS staff in England by the Review Body on Doctors and Dentists Remuneration—the DDRB—and the NHS Pay Review Body. They observe that some trusts are already delivering services across seven days, but this is far from universal. According to the DDRB, a major barrier to wider implementation is the contractual right of consultants to opt out of non-emergency work in the evenings and at weekends, which reduces weekend cover by senior clinical decision makers and puts the sickest patients at unacceptable risk. The DDRB recommends the early removal of the consultant weekend opt-out, so today I am announcing that we intend to negotiate the removal of the consultant opt-out and early implementation of revised terms for new consultants from April 2016. There will now be six weeks to work with British Medical Association union negotiators before a September decision point. We hope to find a negotiated solution but are prepared to impose a new contract if necessary. To further ensure a patient-focused pay system, we will also introduce a new performance pay scheme, replacing the outdated local clinical excellence awards, to reward those doctors making the greatest contribution to patient care.
I am also announcing other measures today to make the NHS more responsive to patients. Those include making sure patients are told about Care Quality Commission quality ratings as well as waiting times before they are referred to hospitals, so that they can make an informed decision about the best place to receive their care. NHS England will also develop plans to expand control to patients over decisions made in maternity, end-of-life care and long-term condition management, which I will report in more detail subsequently to the House. Finally, because the role of technology is so important in strengthening patient power, we must ensure that no NHS patient is left behind in the digital health revolution. I have therefore asked Martha Lane Fox, the former Government digital champion, to develop practical proposals for the NHS National Information Board on how we can ensure increased take-up of new digital innovations in health by those who will benefit from them the most.
When we first introduced transparency into the system to strengthen the voice of patients, some called it “running down the NHS”. Since then, public confidence in the NHS in England has risen 5 percentage points. By contrast, in Wales, which resisted this transparency, a survey has seen public satisfaction fall by 3 percentage points. Over the previous Parliament, the proportion of people who think that the NHS in England is among the best healthcare systems in the world increased by 7 percentage points, the proportion of those who think NHS care is safe increased by 7 percentage points and the proportion of those who think that they are treated with dignity and respect increased by 13 percentage points. That demonstrates beyond doubt the benefits of an open and confident NHS, which is truly focused on learning and continuous improvement.
As we make progress in this journey, we must never forget the people and the families who have suffered when things have gone wrong. In particular, there are the families and patients at Morecambe Bay and Mid Staffs, the whistleblowers who contributed to Sir Robert Francis’s work, and everyone who has had the courage to come forward in recent years to help reshape the culture of the NHS. Without their bravery and determination, we would not have faced up to the failures of the past or been able to construct a shared vision for the future. We are all massively in their debt. This statement remains their legacy, and I commend it to the House.
Andy Burnham (Leigh) (Lab)
I thank the Secretary of State for his statement and for advance sight of it. Let me say at the beginning that I support much of what he said. I will focus my remarks on his plan for seven-day working, and then touch on some of the other issues he raised.
Ensuring that our health services are there for everyone whenever they are needed—be that a weekday or a weekend—should be our shared goal across this House for a 21st-century national health service. Illnesses do not stop at the weekend and nor should our NHS. Although we support the principle of what the Secretary of State is trying to achieve with seven-day working, and will work with him where possible, I urge some caution in the manner in which he is attempting to drive through these changes. His remarks contain no acknowledgment that the NHS right now is in a very fragile condition. It has gone backwards, not forwards, in recent times. A&E is in crisis, and primary care services are overwhelmed. There is a shortage of staff and an over-reliance on agency workers. Staff are demoralised and worn out. If he does this in the wrong way, many may walk away and that would make matters even worse. Given all that, it is not immediately clear how seven-day services can be delivered in the timeframe he has set out without significantly impacting on the rest of the NHS.
The Secretary of State said that around 6,000 people lose their lives every year because we do not have a proper seven-day service. Of course that is an appalling statistic, but is there not a risk of implementing seven-day services by simply spreading existing resources more thinly? A recent study published in “Health Economics” concluded:
“There is as yet no clear evidence that 7-day services will reduce weekend deaths or can be achieved without increasing weekday deaths.”
Will the Secretary of State tell us on what evidence he has based his announcement and, crucially, what steps he is taking to guard against what the study warns could be an increase in weekday deaths?
If the Secretary of State wants to make changes on this scale, it is vital that he works in partnership with NHS staff. I gently say to him that briefing headlines such as “Declaring war on doctors” have not got us off on the right foot, as doctors are already feeling worn out and put upon. The British Medical Association said:
“Today’s announcement is nothing more than a wholesale attack on doctors to mask the fact that for two years the Government has failed to outline any concrete proposals for introducing more seven-day hospital services.”
Will the Secretary of State take care to avoid provocative statements such as “Declaring war” and will he rethink the manner in which he is pursuing these negotiations? Talk of imposing deals at this stage is not helpful; it is premature and it would be better to proceed in a more constructive manner.
Staff across the entire hospital system—not just doctors —will be needed to run these services, but the Government confirmed only last week that many of them will face another five years of pay cuts. In total, that will amount to a decade of pay cuts. Has the Secretary of State looked at the detail of the Chancellor’s announcement on pay for NHS staff? Will he tell the House what effect he believes this deal could have on staff numbers and retention?
The Secretary of State said very little about how he will fund seven-day services, but given that the NHS is struggling to fund weekday services, it is likely to need significant investment over the next five years, over and above funding attached to the five-year forward view. Can he confirm that the money allocated to fund the five-year forward view does not include seven-day working? That is not specifically mentioned in the “Five Year Forward View”. If so, what extra funding will be made available specifically to deliver seven-day working, and when will this funding be available? The announcement today appears to be unfunded and it will not escape the House’s attention that the 2010 Conservative manifesto also promised to deliver seven-day services. The Secretary of State has a lot of convincing to do if he expects people to believe him this time.
In a statement last week in another place, Lord Prior, the Under-Secretary of State with responsibility for NHS productivity, said he was establishing an independent inquiry into extending charges in the NHS. This has sounded alarm bells among many patient groups. Will the Secretary of State say more about the terms of reference for this independent inquiry and when it will proceed with its work?
The Francis “Freedom to speak up” report contained a number of important recommendations to foster a more open culture and we support his work to implement them. The right hon. Gentleman will know that there have been a number of appalling examples of poor care in recent times at Orchid View, Oban Court and Winterbourne View, and these scandals were exposed only when undercover reporters infiltrated the care home. Will he look seriously at the idea of an independent body to receive complaints from NHS staff and social care staff so that they are not faced with the problem of always going to their employer if they are to blow the whistle?
I welcome what the Secretary of State had to say about the Kirkup report and his acceptance in full of its recommendations. We, too, think of the families affected by the failures at Morecambe Bay. I supported steps to improve the regulation of midwives, but the big question mark over the right hon. Gentleman’s commitment is the failure to bring in a Bill on professional regulation. This was an important recommendation of the Francis report and the continued delay in implementing this proposal is putting patients at risk and preventing regulators from doing their job. Will the Secretary of State now commit to legislating at the earliest opportunity for the Law Commission’s reforms?
These are extremely serious matters and I do not believe that some of the Secretary of State’s more political comments today were appropriate, nor do I believe they will build the consensus that will be needed across this House to deliver these important changes. Labour introduced more transparency into the NHS with the establishment of independent regulation and the inspection of hospitals. I appointed Robert Francis to begin the work of looking at what went wrong at Mid Staffs. Where the Secretary of State seeks to build on these constructive changes, we will support him, but he will not achieve his goals by provoking confrontation with doctors or playing politics with patient safety.
Mr Hunt
I thank the right hon. Gentleman for his support on many of the measures that we are announcing today. Where we can work together, we should. I thank him for his support for the principle of seven-day working, although I gently point out that this was in our manifesto in May and it was not in his. I shall deal in turn with the points that he raised.
On funding for seven-day services, the right hon. Gentleman has just fought an election on plans that would have meant that the NHS would get £5 billion less than this Government are prepared to commit. We are committing £10 billion to the NHS to implement the five-year forward view, which we can do on the back of a strong economy. That includes plans for a seven-day service.
The right hon. Gentleman talked about comments by Lord Prior in another place. There is no independent review on charging for NHS services. After the election, he should be very careful of such scaremongering. That is what he was doing for the whole election. When he makes such comments, he frightens NHS staff. He should think about the effect on morale when he does that.
The right hon. Gentleman said that the NHS has gone backwards, not forwards, but I have just presented figures showing that public confidence in the NHS is going up; the number of people who think that the NHS is one of the best systems in the world has increased. I gently point out that the reports we are publishing today are a response to problems that happened on his watch and that we are facing up to, so he should have a little modesty in this situation.
The right hon. Gentleman asked an important question about spreading services currently offered on five days over seven days. A lot of work has been done on this. The truth is that having services only on five days is not only dangerous for patients but incredibly inefficient for hospitals. For example, someone admitted to hospital on a Friday in need of a diagnostic test might not get the result until the following Monday or Tuesday so will have to stay in hospital for the weekend even though they could possibly have been discharged. That is bad for the patient and expensive for the NHS, so these measures will result in huge cost savings.
Most importantly, the right hon. Gentleman talked about carrying staff with us. Doctors go into work every weekend throughout the NHS and do a fantastic job, but often it is not recognised and they are not thanked. We want a more professional contract that recognises that contribution. That is why these measures are supported by the Royal College of Surgeons, the Royal College of Physicians and the Royal College of Emergency Medicine.
When the previous Labour Government changed the consultants’ contract in 2003, senior doctors did not like it. They said that it led to
“a loss of a sense of vocation and what it means to be professional”.
That quote is from a King’s Fund report. It undermined the basic relationship between doctor and patient. We are not blaming doctors, and actually we are not blaming unions, because unions will always ask to see what they can get—the right hon. Gentleman spends more time with unions than I do, so he knows that better than I do. The people responsible for that decision in 2003 were the Ministers who signed off changes to the consultants’ contract and the GPs’ contract. It was Labour politicians who were responsible for those changes, and they must take responsibility for the fact that it was the wrong thing to do.
Finally, this is the most important question of all, and we have not heard an answer today: does the right hon. Gentleman support the measures that the Government are putting forward to make our hospitals safer with seven-day working or not? Leadership is about making choices, and today’s choice is this: is he on the side of the patient or on the side of the union? We know whose side we are on. For Labour, once again, the politics matters more than the patients.
Dr Sarah Wollaston (Totnes) (Con)
I welcome the Secretary of State’s vision of an NHS that is empowered to focus more fully on the people and communities it serves and that is more transparent, less bureaucratic and as safe on a Sunday as it is on a Wednesday, and I welcome his comments about culture change. Does he agree that meeting that challenge will also depend on financing? As welcome as the extra £8 billion announced in the Budget is, will he join me in urging colleagues to ensure that as much of that as possible is front-loaded, because it is so necessary for the transformational changes he has talked about? In encouraging leadership across the NHS, will he ensure that the changes that are needed at a local level, and the systems we can integrate for the benefit of patients, can be introduced more quickly and effectively?
Mr Hunt
I thank my hon. Friend for her important comments, and for sitting through a very long speech I gave this morning. We are trying to achieve many things. At their heart, as she rightly says, is a recognition that culture change does not happen overnight. She is right that the profiling of the extra money that the Government are investing in the NHS is important, because we need to spend money soon on some things, such as additional capacity in primary care, as in two to three years’ time that will significantly reduce the need for expensive hospital care. We are going through those numbers carefully. She is also right that local leadership really matters. I know that she will agree, especially as she comes from Devon, that leadership needs to be good at a CCG level as well as a trust level, because CCGs have a really important role in commissioning healthcare in local communities. That is an area where we need to make a lot of improvements.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I have to declare an interest: like most doctors, I am a member of the British Medical Association.
I commend the Secretary of State for his announcement about a national officer for whistleblowers. Shona Robertson, Scotland’s Cabinet Secretary for Health, announced this in June, and we are taking action on the Francis report in the same direction. It is vital that members of staff feel they have someone to speak to if things are not going well, and that if they are not being responded to locally there is an independent voice that they can go to.
With regard to seven-day services, the excess deaths of people who are admitted at weekends is recognised and abhorred by the vast majority of doctors. I do not know anybody who gets up and works the hours we do and does not care that someone did not do well. However, I think we are blurring the lines between the elective and emergency systems. The sickest people the Secretary of State mentions—those who run the risk of dying if admitted on a Friday or a Sunday—are not part of the elective system but of the out-of-hours emergency system. It is suggested that hospitals are like the Mary Celeste and there are no doctors. In fact, any service with an emergency component runs 24/7, but there is a multi-disciplinary team. Sometimes patients will be stuck on a ward because they cannot get access to a scan or there is no physiotherapist to help them recover from their stroke.
We are already working towards solving this in Scotland. We are doing so in a more collaborative way, and that is important. There is no resistance to that, because it is recognised that we need all parts of the service. This is different from people coming in for a routine check-up on a Sunday when that does not result in a detriment to them if it is not available. The biggest shortage we have is in human resources—doctors, nurses, physios, occupational therapists and radiographers. I recommend that the Secretary of State separate these two aspects. The first is that hospital consultants did not get the option to opt out of 24/7 care for emergency patients in the contract, whereas GPs did. It is a matter of providing, funding and setting up a full service with all that is behind it to deal with ill patients seven days a week, no matter when they come in.
The other aspect is trying to get value for money. If we have invested in expensive machines and theatres, we want them to work as many days a week as possible so that we get value for money, but that must be secondary to the first priority, which is looking after sick people. I suggest that the Secretary of State starts talking about the two aspects on separate tracks and not crossing backwards and forwards, and that this should be collaborative. I echo the hon. Member for Totnes (Dr Wollaston) in saying that we require the money to be front-loaded so that we get it to start changing the service now.
Mr Speaker
Order. May I gently say that from now on we are going to have to enforce the time limits on Opposition responses to ministerial statements much more strictly? Otherwise they eat into the time available for other colleagues. The shadow Secretary of State has five minutes in response to a 10-minute statement and the third party spokesperson has two minutes. That really does have to be adhered to as a matter of course from now on.
Mr Hunt
The hon. Lady speaks with the authority of someone who works in hospitals, and I always listen to her very carefully. I do not think it is easy to make a rigid distinction between elective and emergency care. The opt-out in emergency care does apply, for example, to accident and emergency doctors. Sometimes when people are admitted to hospital because they are ill—they would not be admitted if they were not—their condition may not appear to be life-threatening on a Friday afternoon but then, over the course of the weekend, they deteriorate, and by the time they are seen by a senior consultant on a Monday or a Tuesday, it is too late. The trouble is that we have a culture in which a lot of major services are available only from Monday to Friday, and that is what is causing these avoidable deaths. The hon. Lady is right to say that this is not just about senior consultant cover; it is also about diagnostic care, handovers and many other things, and we are working at those. The Royal Edinburgh Infirmary has done a very good job of eliminating the difference between weekday and weekend mortality rates, as have Salford Royal and Northumbria hospitals in England. We need other hospitals to follow those examples.
Mr Graham Brady (Altrincham and Sale West) (Con)
Senior clinicians in my constituency are warning of a major threat to patient safety as a result of a proposed downgrade of one of Britain’s best hospitals, Wythenshawe. The regional transplant unit is a world-class centre for heart and lung and there is a major trauma centre adjacent to Manchester airport, where it should be. That must all be protected. The Secretary of State knows my view that the consultation has been opaque, and that the decision-making process has been flawed. Will he review the decision as urgently as possible, and meet me and other Members for local constituencies as a matter of urgency before the summer recess to discuss what can be done?
Mr Hunt
I am more than happy to meet my hon. Friend to discuss those matters. Wythenshawe is an excellent hospital—I have been there—and it has provided a number of staff who have helped to turn round the standard of care at Tameside hospital, which has seen dramatic improvements. I recognise that Wythenshawe is an excellent hospital, and I am very happy to meet him to listen to his concerns.
Mr Ben Bradshaw (Exeter) (Lab)
How will the Secretary of State pay for his very laudable objective of seven-day working when he has lost control of NHS finances? Contrary to what he claimed about the situation in Devon, as things now stand our patient care is suffering, waiting times are rocketing and we are facing a £434 million deficit.
Mr Hunt
Let me tell the right hon. Gentleman why so many places are going into deficit. They have looked at the lessons of Mid Staffs and said, “We don’t want that to happen here.” That is why, in the past two and a half years, hospitals have employed 8,000 more nurses on hospital wards to deal with the scandal of short staffing that they faced and wanted to do something about. In the end, if it is not sustainable, it is not quality care, so we have to find smart ways to control deficits—not by reducing the staff and making care unsafe, but by making changes to process and through efficiencies, such as making sure that nurses do not spend too long filling out forms and can spend more time with patients. In terms of funding, I would just say that the only way to fund a strong NHS is to have a strong economy, and that is why the country voted in a Conservative Government in May.
Dr Tania Mathias (Twickenham) (Con)
I declare an interest as a member of the BMA.
I absolutely agree with all the points made by my hon. Friend the Member for Totnes (Dr Wollaston). I like the reforms of leadership, but will the Secretary of State recognise the existing great leadership in the NHS? A safe NHS is one in which staff morale is at its best. If every leader in the NHS was at the level of Professor Sir Peter Morris, we would already have the best and safest health service in the world.
Mr Hunt
My hon. Friend obviously speaks with huge knowledge—I am wondering whether she is the first Conservative MP who is also a member of the BMA —and is extremely welcome for the insights she brings to the House.
Leadership and morale are absolutely crucial. One of the ways in which we can improve morale is by giving patients and doctors alike the sense that we are honest about the problems and have good plans in place to tackle them. Nothing eats away more at morale than people going in day in, day out and not giving patients the care that they want to give and feeling that nothing is being done about it. That is why the move towards transparency, which I know my hon. Friend supports, is so important.
Mike Kane (Wythenshawe and Sale East) (Lab)
I echo the comments of the hon. Member for Altrincham and Sale West (Mr Brady). Despite a public consultation wanting five major trauma receiving sites in Greater Manchester and Wythenshawe hospital being the public choice, it did not receive specialist status at the end of the Healthier Together process yesterday. What assurances can the Secretary of State give the people of Trafford and south Manchester, particularly in relation to the 18 specialisms that are underpinned by Wythenshawe being a major trauma receiving site?
Mr Hunt
As I said to my hon. Friend the Member for Altrincham and Sale West (Mr Brady), I will look into the decision made by Healthier Together. The assurance that I can give to the constituents of the hon. Member for Wythenshawe and Sale East (Mike Kane), and indeed to all people in the Greater Manchester area, is that with some of the most exciting changes, such as the integration of health and social care and the transformation of out-of-hospital care—it has just been announced that there will be seven-day GP services across Greater Manchester—they are blazing a trail. It will be exciting for his constituents; none the less, I understand their concerns about their local hospital and I am happy to look into that.
Christopher Pincher (Tamworth) (Con)
We in Staffordshire know better than most what the denial machine that the Secretary of State referred to meant to local people, so I congratulate him on his commitment to transparency and consistency. Will he encourage the Heart of England NHS Foundation Trust and the Burton Hospitals NHS Foundation Trust to work much more collaboratively, so that that commitment to transparency and better service is delivered to my constituents in Tamworth and Fazeley?
Mr Hunt
I will absolutely encourage that. The Heart of England NHS Foundation Trust is one of the biggest in the country and has had significant challenges. The Burton foundation trust has been through the special measures process, and patient care has improved as a result. Collaborative working will be the way forward. We need to break down the silos that have cursed so much of the NHS, and I will happily pass on that message.
Norman Lamb (North Norfolk) (LD)
I advised food manufacturers in the ’90s about bringing in seven-day working to keep supermarket shelves stacked. Twenty years on we are still talking about seven-day working in the NHS, and it seems to me that good care and saving lives are rather more important. Will the Secretary of State ensure that exactly the same principle applies to mental health? Does he recognise that it is just as important to ensure that people can leave hospital and go home on a timely basis, seven days a week, but that with cuts to local government funding there will be more pressure and it will be more difficult to achieve that? Together with the extraordinary pressure that the system is under, does that not make the case even more strongly for a new settlement for the NHS and social care?
Mr Hunt
I thank the right hon. Gentleman for finding time to come to the Chamber on what I know is an important day. I am not sure whether I am allowed to wish him luck, but I greatly value the time that I spent working with him as a ministerial colleague, and I know he will make an important contribution to the House. He is right, as ever, to speak about mental health. The programme towards seven-day working is as important for mental health as it is for other services, and we must also ensure that the revolution happens for things such as suicide rates and crisis care. He is right about the importance of the social care system; and in my mind when I speak about seven-day care I am thinking about social care and health as one entity.
Andrew Percy (Brigg and Goole) (Con)
Our doctors no doubt work incredibly hard in our hospitals. The people of Brigg and Goole and the Isle of Axholme work at weekends, whether in factories, at the docks or in the fields, and they want an NHS that does the same. The Secretary of State will know about my passion for ambulance services, which at weekends are often the last line of support for patients. What will his plans mean for ambulance services and the incredible job that paramedics do across the country?
Mr Hunt
I thank my hon. Friend because he leads by example as a first responder and does a fantastic job in his constituency—indeed, that role takes place at weekends. Paramedics and ambulance services operate a seven-day service. Nurses, paramedics and others who work in hospitals currently do not have an opt-out; consultants are the only ones who do. These measures will give ambulance services confidence that if they take someone to hospital at the weekend, there will be a proper senior consultant present and their patient will get in front of the right person. That will make their job all the more rewarding.
Valerie Vaz (Walsall South) (Lab)
The Secretary of State has not outlined what steps should be taken to recruit, train and retain front-line staff who are key to patient safety.
Mr Hunt
We have big plans to recruit and retain staff, and those are being worked up by Health Education England. We think that we will need extra doctors to deliver seven-day care, just as we will need more GPs. We think we can afford that within the extra £10 billion that we are putting into the NHS, and we are ensuring that all the numbers add up. I am sure that I will inform the House once we have come to a conclusion.
Maria Caulfield (Lewes) (Con)
I declare an interest as an NHS nurse. Does the Secretary of State agree that the UK has one of the worst one-year cancer survival rates compared with the rest of Europe, with one in five cases being diagnosed as an emergency admission? Having a prompt diagnosis is very important. A seven-day-a-week service would be a major step forward, because patients should be seen when clinically indicated, not when indicated by the calendar. With a seven-day service they will be seen more quickly and be less poorly. Not only will that save money but—more importantly—it will save lives.
Mr Hunt
Absolutely. May I say how pleased I am to welcome my hon. Friend’s experience to the Conservative Benches? It makes a big difference. She is absolutely right. NHS England will be saying more about how we intend to deal with the problem of late diagnosis of cancer, which is critical if we are to improve our cancer survival rates. One point that links to the announcements I have made today is better collaboration between senior cancer consultants and GPs. If GPs are to be able to spot cancers earlier, they will need to link into the learning they can receive through closer contact with consultants and hospitals. That is something we need to think about.
Mr Dennis Skinner (Bolsover) (Lab)
As someone who has spent quite a bit of time going to hospitals over the past 16 years, I have learned a little about it. I suspect that some people, like the doctors who the Secretary of State wants to collaborate with, just might have reflected on why this Tory Government are more concerned with getting in agency nurses and doctors than giving nurses a decent pay increase. Has it not crossed his mind that by telling nurses they are worth only 1% more, he will finish up with more agency nurses? The truth is that doctors see this happening every day. The main reason is that the Government have tried to reform and privatise the NHS for the past five years. The doctors and the nurses do not trust him—it is time he got out.
Mr Hunt
Let me tell the hon. Gentleman what the doctors and nurses working in our NHS hospitals see. They see 8,000 more hospital nurses on full-time contracts than when his party was in power, because we are doing something about the scandal of short-staffed wards that was left behind by his Government.
Mr Steve Baker (Wycombe) (Con)
Will my right hon. Friend ensure that neither the revalidation regime nor the NHS’s status as a near monopsony employer is allowed to promote anxiety among NHS staff who would otherwise wish to speak up? It is essential that they know they have that freedom and security.
Mr Hunt
As ever, my hon. Friend is spot on. At the heart of what I am saying today is creating a new learning culture inside the NHS where people are able to be open. In the airline industry, it is much easier for a junior pilot to talk to a senior pilot about a mistake they think the senior pilot has made without feeling it will impact on their career. We need to break down the barriers, so that when people talk about their concerns—even about what their boss has done, which is never easy—they are listened to and treated seriously, and there are no consequences as a result. We absolutely have to make that change.
Catherine West (Hornsey and Wood Green) (Lab)
Are the Government considering the introduction of charging in the NHS, as a member of the Secretary of State’s ministerial team, Lord Prior, suggested in the other place in response to Lord Patel?
Mr Christopher Chope (Christchurch) (Con)
Given the political priority which my right hon. Friend attaches to 24/7 consultant cover for accident and emergency hospitals, why was his Department unable to answer the question I put about which hospitals in England currently provide such cover? Will he collect that data and make sure that it is published?
Mr Hunt
The truth is that all hospitals have been moving in this direction in the past five years in different ways. My hon. Friend is absolutely right to say that, to make sure we deliver on our manifesto commitment, we will be doing a full and comprehensive audit of which people are delivering which types of services. It is partly about senior consultant cover, which we are talking about today, partly about seven-day diagnostic services, partly about handover, and partly about mental health and many other standards, but, yes, that work is being done.
John Woodcock (Barrow and Furness) (Lab/Co-op)
The Secretary of State was unclear before. May I say that, as far as I am concerned, Labour Members are absolutely in favour of measures that will increase safety at the weekend, and that my party will never prosper as a mouthpiece for the British Medical Association? Is he not concerned that the porters and nurses, who are being asked to swallow a decade-long real-terms pay cut, will not be able to deliver such change given the level at which they are being demoralised?
If you will permit me, Mr Speaker, may I also say that I very much welcome the full acceptance of the recommendations of the Morecambe Bay inquiry? Will the Secretary of State ensure that the families will remain fully involved in ensuring that these measures are implemented, as well as accepted, by Government?
Mr Hunt
Of course. The hon. Gentleman has liaised very closely with the Morecambe Bay families over the period of the inquiry. I am happy to give him the assurance that they will remain closely involved.
I am very pleased that the hon. Gentleman says he does not want his party to be the mouthpiece of the BMA, but if that is the case, it needs to get behind the proposals that the Government are making today and say it supports them. We have not heard that from his party and that is what the public want to hear.
Jeremy Lefroy (Stafford) (Con)
The trust or place that has probably learned the most from Mid Staffordshire is Mid Staffordshire, or, as it now is, County Hospital, Stafford. Quality of care and performance has increased dramatically, with 98% and more patients seen within four hours at A&E. That is why we need a 24/7 A&E. May I urge the Secretary of State to ensure that the new independent patient safety investigation service is truly independent, despite being housed in the Monitor-Trust Development Authority building?
Mr Hunt
I thank my hon. Friend for the amazing work he has done in supporting County Hospital through the most unimaginably difficult circumstances. I put on record my thanks to the doctors and nurses working in that hospital who are doing a fantastic job. They have improved care. Many of them were working at the old Mid Staffs hospital and, even during the period of those problems, they were working incredibly hard and doing a very good job for patients. They did not want to be associated with any of the bad things that happened. They are a shining example to all of us. Yes, the independent patient safety investigation service needs to be independent, but I think trusts will welcome this measure. It will mean that a trust has a body, which is completely independent of anyone working in the trust, that it can call in. In a no-blame way, it can find out exactly what happened—a bit like a French juge d’instruction; that kind of principle. I think that will be really welcomed in the NHS, but independence is vital.
Karin Smyth (Bristol South) (Lab)
I declare my interest as a former NHS manager, latterly for a clinical commissioning group. I very much welcome the focus on patients, transparency and the use of digital, which will be very helpful for the challenges we will face. As a former NHS manager, I would make the plea that management needs support in facing the challenges ahead. I am afraid that confrontation with local doctors as the first step over the summer period is not helpful. Will the Secretary of State please support NHS managers in this difficult task ahead, across clinical and non-clinical standards? I very much welcome the Rose review, but can we please give managers the support they need?
Mr Hunt
I am really grateful to the hon. Lady for making that point. NHS managers have one of the most difficult challenges in the country. Not only do they have to balance revenue and expenditure; they have patients’ lives at risk and public accountability. It is really difficult to run a hospital or a clinical commissioning group. These are some of the most difficult jobs one can imagine. We need to support them. I hope they will agree and welcome a move away from targets as the main way of driving change in the NHS to intelligent transparency and peer review. This is not a confrontation with doctors. Doctors overwhelmingly support a seven-day service. It is, I am afraid, a battle with the BMA, with which we have been trying to negotiate on the matter for nearly three years. It has refused to move. It needs to get in touch with what its members want and what the public want, and then I hope we can make much faster progress.
David Mowat (Warrington South) (Con)
A characteristic of the health system in our country is that we have something like 20% to 25% fewer doctors per head of population than comparable countries such as France, Germany and Spain. Is it part of the Secretary of State’s vision to correct this over time, and will that make reforms such as these easier to push through?
Mr Hunt
We do need more doctors and more nurses. We saw an increase of about 8,000 nurses and 10,000 doctors in the previous Parliament. We will need more for the simple reason that we will have 1 million more over-70s by the end of this Parliament. That said, the NHS is admired in the other countries my hon. Friend talks about for our models of care, which are sometimes less hospital-centric and therefore inherently more efficient than what happens in some other systems. The learning should go both ways.
Diana Johnson (Kingston upon Hull North) (Lab)
My question is about whistleblowers. I want to know whether the Secretary of State is really satisfied that the fit and proper person test for managers is working, when it allows a chief executive who bullies and mismanaged, as happened in Hull, as the Secretary of State knows, to move with the help of the Trust Development Authority to another job as a chief executive, paying £170,000, and yet the whistleblower has to fight for her rights. When the fit and proper person test was invoked, the TDA investigated and the new trust, unsurprisingly, said that that chief executive was okay. I do not think that that is independent, transparent or in the spirit of Francis.
Mr Hunt
I recognise that the hon. Lady has legitimate concerns about the way that the whistleblower, who I think is one of her constituents or is near to her constituency, was treated. I have, as she requested, looked into that very carefully. She will understand that it would not be right or proper for me to comment on an individual case. She knows that, as a result of requests by her and fellow MPs, I looked into whether due process was followed in the case that she mentioned. All I will say is that bullying behaviour should not happen anywhere in the NHS. That is a very important part of the culture change that I want to see.
Kevin Foster (Torbay) (Con)
In Torbay, there are a number of concerns about access to primary care, due to issues of recruitment and retention of GPs. Recognising the comment that the Secretary of State made earlier in response to my hon. Friend the Member for Totnes (Dr Wollaston), how does the Secretary of State see his statement today helping to improve this situation?
Mr Hunt
We have some fantastic primary care in Torbay. I remember visiting my hon. Friend during the election campaign and going to a hospice run by an absolutely inspirational lady. We need to build on those traditions, and modern technology offers us an opportunity to go even further. In the end, this is about having a less hospital-centric system and prevention rather than cure, and our great tradition of general practice will be our strongest asset in that change.
Sue Hayman (Workington) (Lab)
The idea of seven-day working sounds absolutely fantastic for supplying services, but in west Cumbria, where we struggle to deliver services five days a week, it sounds like nothing more than a fantastic pipe dream. I am aware that the Secretary of State understands the specific problems we have in west Cumbria, but I want to ask him about a letter that I recently wrote to him to do with Cockermouth hospital—a beautiful new hospital which sits half empty. Will he meet me and clinicians from that hospital to see how we can deliver and solve the problems in Cockermouth?
Pauline Latham (Mid Derbyshire) (Con)
I was shocked to hear the right hon. Member for Leigh (Andy Burnham) running down the NHS yet again. He obviously has not been watching the series on television about the Royal Derby hospital, or looked at its website, where most of the comments are incredibly positive. Also in Mid Derbyshire we have surgeries that wish to take some of the burden away from hospitals. Does the Secretary of State agree that we should be encouraging that, where they can offer services to save people from going to hospital?
Mr Hunt
I absolutely agree. I commend the Royal Derby, which is an excellent hospital, and thank my hon. Friend for mentioning it. It is really interesting: around the country the number of people per thousand who use A&E varies from 166 to 355—a dramatic variation—and a lot of that relates to the availability of good primary care services, which is why our plans for seven-day GP appointments are also a very important part of the programme.
Wes Streeting (Ilford North) (Lab)
I welcome the partnership on patient safety that is being announced today between Queen’s hospital in Romford and King George hospital in Ilford and the Virginia Mason Institute, and echo some of the comments made by my hon. Friends about the Government taking staff with them and looking at issues around pay and workforce. May I gently point out to the Secretary of State that it is now two months since I wrote to him about pressures in our local health economy and the future of our A&E department. Can he offset my disappointment by agreeing to meet me and my hon. Friend the Member for Ilford South (Mike Gapes) and other local MPs to discuss those issues?
Mr Hunt
I know that the hon. Member for Ilford South (Mike Gapes) secured a Westminster Hall debate on this yesterday, during which I hope the hon. Member for Ilford North (Wes Streeting) covered most of the issues he wants to address, but I am happy to arrange to meet him or to get the Under-Secretary of State for Health with responsibility for hospitals, my hon. Friend the Member for Ipswich (Ben Gummer), to meet him to discuss those issues in more detail. The hospital trust that the hon. Gentleman talks about—Queen’s and King George are covered by the same trust—has been through a very challenging period. It is a big trust; it is going through special measures, but I think it has good new management. I think they have really turned things around, and that staff are to be absolutely commended. The link with Virginia Mason in Seattle will be as inspirational for them as it has been for me to see what is possible.
Andrew Stephenson (Pendle) (Con)
I welcome today’s statement about transformation of our NHS. Will the Secretary of State join me in welcoming the progress made by East Lancashire Hospitals NHS Trust, which came out of special measures about 12 months ago, and particularly the fact that a Health Service Journal and Nursing Times survey recently ranked the trust among the top 100 places to work, with improved staff engagement and morale, which is a huge transformation from where we were when the trust was put into special measures?
Mr Hunt
I thank my hon. Friend for his passionate support for that trust through a very difficult period. I also thank him for giving us perhaps the single biggest insight into how to transform a hospital in difficulty: according to all the measures, the most important single thing is to engage with staff. If staff feel supported and listened to, the result is safer care for patients and better outcomes. That is something they have done in East Lancashire, and it is something that many other hospitals could learn from.
John Pugh (Southport) (LD)
Many current failures in care are caused by poor integration of services, not the failure of a specific service. What, in the proposals announced, addresses that problem?
Mr Hunt
The integration of the health and social care systems, as talked about by the right hon. Member for Leigh (Andy Burnham), is a very big priority. It is a vision shared by all parties. That is part of delivering safe seven-day care. The consequences for the health and social care system if we do not have safe hospital care are people with much greater medical needs, creating much more pressure in the system, so it is part of the same picture.
Mr Peter Bone (Wellingborough) (Con)
I thank the Secretary of State for coming to the House and also, I think, for making two written statements. There are only 32 other written statements from Ministers. I remember that when I first got here, there would be 87 written statements on the last day of term, with no chance to scrutinise the Minister. Following what my hon. Friend the Member for Lewes (Maria Caulfield) said, has the Minister had a chance to look at my Ovarian Cancer (Information) Bill, which would help reduce the number of ovarian cancer deaths through earlier detection?
Mr Hunt
I thank my hon. Friend for his support for that Bill. I hope that plans that NHS England will announce shortly about how we can improve early cancer detection will give him much encouragement. He will see that some of the things that he is campaigning for are actually going to happen.
Emily Thornberry (Islington South and Finsbury) (Lab)
Everyone supports seven-day-a-week, 24-hour NHS care—who would not? But the bottom line is that there are insufficient resources and insufficient people at the moment for it to be possible to deliver those services. For the Secretary of State to try to blame the health unions for that is not fair, and there are people behind that. The tone of the statement that the Secretary of State made this morning at the King’s Fund has already caused alarm among GPs, and Maureen Baker, chair of the Royal College of General Practitioners, said that this announcement
“will sound…alarm bells for hardworking GPs who fear we will be next in line—even though we are already being pushed to our limits in trying to provide a safe five-day”
a week
“service for our patients.”
Mr Hunt
I do not blame doctors; I do not blame the unions. I blame Ministers from the hon. Lady’s Government who gave consultants an opt-out at weekends that has had a catastrophic impact on patient care. I am delighted that she supports seven-day care, but it was not in the Labour manifesto; it was in the Conservative manifesto, and we are putting in extra money—£5.5 billion more than Labour was promising—to ensure that we can pay for it.
Graham Evans (Weaver Vale) (Con)
I welcome the changes that my right hon. Friend has announced today in turning the NHS into a learning organisation rather than a denial machine. Does he agree that there should be a best practice industry standard for healthcare in this country, which learns and compares itself with other countries’ healthcare systems, such as Germany, France and Canada?
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
The Secretary of State might be in aware that in Huddersfield we are having great difficulty in attracting and recruiting A&E specialists, nurses and GPs. He will know that I am more an education specialist than a health specialist, but given that this is an NHS reform statement, is it not time that we had a serious, fundamental look at how we educate and train everyone in our health service—doctors, nurses, technicians, the whole lot? At the moment it seems more appropriate to sometime in the 20th century than to looking forward in the 21st.
Mr Hunt
The hon. Gentleman makes an important point. As part of what I said in my statement, we are looking at how we train doctors. My hon. Friend the Member for Weaver Vale (Graham Evans) talked about creating a learning culture, and the big change that we need to make is creating a culture in which people feel supported to speak out about any concerns or anything on which they think they can see a way of doing something better. They must not feel that that could threaten their career prospects. We do not have that culture in the NHS at the moment, but we need it if the NHS is to be the world’s largest learning organisation, as I argued in a speech this morning. I think staff are up for it, but it is a big change.
Mr Bernard Jenkin (Harwich and North Essex) (Con)
I thank my right hon. Friend very much for his extraordinarily embracing response to the Public Administration Select Committee report on clinical incident investigation. We started less than a year ago with the germ of an idea, and it has turned into what amounts to a radical reform of safety investigation in the health service. That is a tribute to him and to the Committee’s witnesses, but it is a tribute to the health service itself that it has embraced the idea, which is a big change that I believe will be transformative.
May I pick up on the Secretary of State’s reluctance to provide special legislation for the immunity of those giving evidence to the new patient investigation body? Will he keep an open mind on the subject? If he wants that body to be truly independent and to have a special status, he should remember that the marine accident investigation branch and the air accidents investigation branch have specific legislation to provide for such immunity. Public interest disclosure protection must not be challenged by freedom of information requests, given that freedom of information has been extended into areas where we never imagined it would go. We have to be specific in legislation that that cannot happen in this instance.
Mr Hunt
It will, Mr Speaker.
My hon. Friend’s idea is really interesting, and I am happy to take it up and explore whether we need to replicate that immunity so that we can get to the truth more quickly in a no-blame context.
I thank my hon. Friend for the work of the Public Administration Select Committee. I think it is true to say that we would not have the new patient safety investigation service, modelled on the air accidents investigation branch, which has worked so well in the airline industry, if it had not been for the work of PASC. It brought the idea to my attention and it was a good idea, and I know that he will help me make sure that it is a success in practice as well.
Kate Green (Stretford and Urmston) (Lab)
I support the comments of my neighbours, the hon. Member for Altrincham and Sale West (Mr Brady) and my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane). Three years ago the new health deal for Trafford resulted in the reduction of overnight and weekend services at Trafford General hospital on the basis that patients would receive better specialist care at Wythenshawe hospital. Does the Secretary of State understand that local people feel that the process has been chaotic, opaque and unresponsive to their concerns, and will he undertake to review the decision as a matter of urgency?
Mr Hunt
I thank the hon. Lady for the responsible approach that she took to the changes at Trafford general. Of course, I will listen to her concerns carefully, alongside those of her colleagues, and take them up with the NHS. Perhaps if she comes to the meeting that I am organising for her colleagues, that will provide an opportunity for me to do that.
Helen Whately (Faversham and Mid Kent) (Con)
I welcome a huge amount of the statement, particularly about the balance between transparency and more autonomy and the combination of scrutiny and support. Does the Secretary of State agree that not only hospitals and GPs but community and social care services need to be 24/7?
Mr Hunt
My hon. Friend speaks with great knowledge about health matters, because of her previous job. [Hon. Members: “McKinsey.”] Yes, McKinsey, which does some important work for the NHS. She is absolutely right that we need to be able to discharge into the community on all seven days, and it is important that the primary care and social care systems are part of that change.
Liz McInnes (Heywood and Middleton) (Lab)
When does the Secretary of State intend to implement the recommendation of the Royal College of Pathologists and introduce the role of medical examiner, to provide independent scrutiny of deaths? That has been repeatedly delayed, despite the success of five pilot schemes and the fact that it was recommended in the Francis report.
Tom Pursglove (Corby) (Con)
Local people in Corby and east Northamptonshire want to see a truly seven-day NHS. One way of achieving that in our area is to get moving on the new urgent care centre at Kettering, which has attracted cross-party support. Some Members could learn valuable lessons from that project and from what has been going on in Northamptonshire. I thank Ministers for all that they have done in the past to help get that project moving. Will the Secretary of State do everything he can to help it come to fruition in the months ahead?
Mr Hunt
It sounds a promising project, and I will keep myself closely informed of its progress. We need to better integrate urgent care centres into the work of GPs and hospitals so that, for example, somebody’s GP medical record can be accessed in those centres and any advice that people get there can be seen by their hospital consultant or GP at a later date.
Rachael Maskell (York Central) (Lab/Co-op)
I must first declare an interest as a state-registered health clinician who worked in acute medicine until the election.
I have witnessed pilots of seven-day working, on the ground and across the country, that have just taken five-days-a-week services and stretched the same complement of staff to seven days a week, therefore not making the service any more efficient or safe. With £22 billion of efficiency savings, or cuts, how will we fund seven-day working?
Mr Hunt
A lot of the efficiency will come from seven-day working, and I do not agree with the hon. Lady that there will be a simple cost increase. The cost to a hospital of cranking down all its services on a Friday afternoon and then having to crank them up on a Monday morning is huge, and it is not efficient. Part of the savings will come from having more streamlined services that operate to a consistently high standard across the week.
Bob Blackman (Harrow East) (Con)
Many of my constituents complain about the lack of availability of GP appointments at weekends and outside normal hours. The consequence of that is that people who are ill turn up at A&E, causing pressure on it. I know that my right hon. Friend is taking action on that, but what is he doing to ensure that we have proper seven-days-a-week working across the NHS in primary care as well as in hospitals?
Mr Hunt
My hon. Friend is absolutely right to draw attention to the fact that our manifesto commitment was to a true seven-day service across hospitals and general practice. That is why, a few weeks ago, we announced in our new deal for general practice plans to recruit 5,000 GPs so that we can increase capacity and make sure that people can get routine appointments in the evenings and at weekends.
Jim Shannon (Strangford) (DUP)
I welcome the NHS Pay Review Body’s report on seven-day services. There is a compelling case for such services, but contractual barriers to reform need to be addressed. Today’s statement refers to England and Wales, and the Northern Ireland Assembly has devolved responsibility for health. Will the Secretary of State consider having contact with the other UK regions, to assist them in engaging with national bodies based here on the mainland on how this important matter can be taken forward?
Oral Answers to Questions
Jeremy Hunt Excerpts(9 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Bridget Phillipson (Houghton and Sunderland South) (Lab)
2. What recent estimate he has made of the proportion of patients who waited for at least one week for a GP appointment in the past 12 months.
The Secretary of State for Health (Mr Jeremy Hunt)
While we do not record the proportion of patients waiting a week for their GP appointment, the latest GP patient survey results show that 85% of patients reported that they were able to get an appointment to see or speak to someone, and only a very small percentage ended up not speaking to or seeing someone.
Bridget Phillipson
Unfortunately, many of my constituents would not recognise the picture that the Secretary of State seeks to paint. The British Medical Association recently said that waits of one to two weeks were becoming the norm for patients. Why is it becoming harder, on his watch, to get a GP appointment?
Mr Hunt
If I may gently say so, the under-investment in general practice has been going on for decades, according to the BMA and the Royal College of GPs. We have announced that we are putting that right with our plans to recruit 5,000 more GPs during this Parliament. That is the biggest increase in the number of GPs in the history of the NHS, with £1 billion going to upgrade GP and primary care premises, and 18 million people by the end of this financial year benefiting from evening and weekend appointments. That is a big, positive change, and I hope the hon. Lady would welcome it.
David Tredinnick (Bosworth) (Con)
Has my right hon. Friend had a chance to read the report by the Professional Standards Authority for Health and Social Care, which says that pressure would be taken off doctors and nurses if greater use were made of the 63,000 practitioners that it regulates on 17 separate registers covering 25 occupations? Will he look at the report and write to me?
Mr Hunt
I am very happy to do that. My hon. Friend is right to point out that the solution to the problem is not just about expanding the number of appointments offered by GPs, although we are doing that; it is also about looking at the very important role that pharmacists and other allied health professionals have to play in out-of-hospital care.
Dr Philippa Whitford (Central Ayrshire) (SNP)
The Secretary of State mentions recruiting 5,000 extra GPs, but I note in a recent speech that that was downgraded from a guarantee to a maximum. With 10% of trainee posts unfilled and the BMA’s recent survey suggesting that a third of GPs will leave in the next five years, is that not going to be difficult? Has the Secretary of State had any consultation with the BMA and the royal college to ask why they are leaving?
Mr Hunt
It will be difficult. The commitment has never been downgraded: we always said that we needed about 10,000 more primary care staff, about half of whom we expected to be GPs. We have had extensive discussions about the issues surrounding general practice, such as burn-out, the contractual conditions and bureaucracy. We are looking at all of those things. The commitment is to increase the number of GPs by about 5,000 during the course of the Parliament, and that is a very important part of our plan to renew NHS care arrangements.
Dr Whitford
I assume the Secretary of State is aware that two of the pilot sites for the seven-day, 8 till 8 working—one in north Yorkshire and the other in County Durham—have abandoned the project owing to poor uptake by patients, with only 50% of appointments used on a Saturday and only 12% on a Sunday. Given that they found that it had a detrimental effect on recruiting cover for out-of-hours GP urgent services, does not he feel that this needs a rethink and that consultation with the profession and looking at cover would be of most benefit?
Mr Hunt
The hon. Lady is presenting only a partial picture. In Slough there are about 900 more appointments every week as a result of the initiative for evening and weekend appointments. Birmingham has dramatically reduced the number of no-shows and Watford has reduced A&E attendance measurably. Some really exciting things have happened, but of course we will continue to consult the profession to make sure that the programme works.
Johnny Mercer (Plymouth, Moor View) (Con)
Radical and innovative steps were taken in Plymouth this April to integrate not only front-line health and social care services in the city, but all the council and clinical commissioning group resources into a single fund. Will my right hon. Friend describe how the success regime in the Plymouth and Devon area will build on those achievements?
Mr Hunt
Absolutely; I had the pleasure and privilege of visiting Plymouth during the election campaign to see some of the radical changes being offered in community care. There is huge enthusiasm for transforming the situation in Devon. It is a very challenged economy, but by bringing together the health and social care system and by putting more resources into primary and out-of-hospital care we will be able to give a better service to my hon. Friend’s constituents, which I know he will welcome.
Andy Burnham (Leigh) (Lab)
Ten years ago, this great city lived through one of the darkest days in its history. Our thoughts today are with all those who were affected and we pay tribute to the heroic staff of London’s NHS, who did so much to help them.
The latest GP patient survey is important for the simple reason that it covers the first full year of the Government’s GP access challenge fund. The results do not make good reading for the Secretary of State. The percentage of patients dissatisfied with their surgery’s opening hours has increased and patients found it harder to get appointments last year than the year before. Will the Secretary of State admit that his policies are simply not working and that GP services are getting worse on his watch?
Mr Hunt
First, I echo the right hon. Gentleman’s comments about the extraordinary bravery of the emergency services, particularly the London Ambulance Service, in response to the terrible tragedy of 7/7.
I do not accept the picture the right hon. Gentleman paints of general practice. The Prime Minister’s challenge fund has been extremely successful: by the end of this year, 18 million people will be benefiting from the opportunity to have evening, weekend and Skype appointments with their GP. We have also announced the biggest increase in the number of GPs in the history of the NHS. The Labour party left us with a GP contract that ripped the heart out of general practice by removing responsibility for evening and weekend care and by getting rid of personal responsibility by GPs for their patients. The right hon. Gentleman should show a little contrition and modesty about Labour’s mistakes.
Andy Burnham
People who have been ringing surgeries this morning unable to get appointments will not be convinced by what they have just heard. The truth is that the disarray in the Secretary of State’s primary care policy goes much deeper. Not only has he made it harder for people to get a convenient appointment, but he now wants to charge people who miss the appointments they are able to get. We all want to reduce waste, but there are many reasons why people do not turn up, including family emergencies. That is presumably why No. 10 slapped him down. He will have worried people, so for the avoidance of doubt, will he today confirm that he will not return to that idea in this Parliament?
Mr Hunt
There are no plans to charge people who have missed appointments. That is precisely the sort of scaremongering that the British public rejected at the last election. The right hon. Gentleman put the NHS on the ballot paper, and the country voted Conservative; he might want to think about the lessons from that. Missed appointments cost the NHS £1 billion a year. We want that money to be spent on doctors and nurses. Labour spent billions on wasted IT contracts and the private finance initiative, and did not spend enough on front-line staff. We are putting that right.
Harry Harpham (Sheffield, Brightside and Hillsborough) (Lab)
3. What steps he is taking to ensure that clinical commissioning groups routinely fund cough-assist machines for people with muscle-wasting conditions when a clinical need has been identified.
Heather Wheeler (South Derbyshire) (Con)
10. What progress the Government have made on improving safety in hospitals in special measures.
The Secretary of State for Health (Mr Jeremy Hunt)
The 21 hospitals that have been put into special measures under the new inspection regime have recruited 458 more doctors and 1,012 more nurses, and all of them have made good progress, including the Medway and Burton hospitals.
Rehman Chishti
I thank the Secretary of State for the support that he has given Medway Maritime hospital. Will he welcome the appointment of a chief quality officer at Medway hospital? It is one of only two trusts to have done that, and it is helping to improve safety and bring Medway out of special measures. Will he join me in paying tribute to the brilliant staff at Medway hospital, who are working day and night to turn things around?
Mr Hunt
I do pay tribute to them, and I welcome Dr Trisha Bain to that post. Ten years ago, that hospital had one of the worst mortality rates in the country. Since then, it has recruited nearly 100 more doctors and 83 more nurses, and has teamed up with Guy’s and St Thomas’. There is a culture of transparency and honesty about failings and a rigorous focus on improvement that were not there before. I hope that the whole House will welcome that change in culture.
Heather Wheeler
My local hospital, Queen’s hospital in Burton, has worked closely with Monitor to improve while it has been in special measures. Does the Secretary of State agree that, although spending four nights in ward 7 was not the best way for me to start the general election campaign, all the staff should be congratulated on the way they have approached the need to improve?
Mr Hunt
I am sorry that my hon. Friend had to go to hospital at the start of the election campaign, but I congratulate her on being probably the only Member of the House to have launched their campaign from an NHS hospital ward. I trust that all the nurses voted for her as a result.
Inexplicably, the trust that my hon. Friend talked about was made a foundation trust in 2008, despite a number of problems that were not recognised. Since then, it has made dramatic improvements in its care, with more doctors and more nurses. I am delighted that it is on track to deliver better care.
Valerie Vaz (Walsall South) (Lab)
How many of the hospitals in special measures have implemented recommendation 13 of the final Francis report on fundamental standards?
Mr Hunt
I would expect that all trusts have done so. If they have not, they will not come out of special measures. That is the benefit of a rigorous, independent inspection regime. Seven trusts have come out of special measures. I hope that the others will come out in due course, but that is not a decision for me; rightly, it is a decision for the chief inspector of hospitals.
Sue Hayman (Workington) (Lab)
The NHS in my constituency has moved beyond special measures into the success regime. Will the Secretary of State consider innovative models of care, because my constituency is very different from others and the trust will not achieve success without looking at how it can deliver safety in different ways?
Mr Hunt
The hon. Lady is absolutely right. The big change that we need in the NHS is to move away from the dependence on hospital care as the only way to deliver safe, effective care. That is why we put £200 million into the vanguard programme last year, which is looking at such models. I hope that the success regime will hasten the innovation in her area.
Amanda Milling (Cannock Chase) (Con)
20. Now that the Mid Staffs trust board has been dissolved, will my right hon. Friend advise me on which is the appropriate body to deal with historic complaints against the previous trust, not only to provide answers for patients and family members, but to ensure that lessons are learned to improve patient safety?
Mr Hunt
In the first instance, patients who are concerned about safety should contact the trust concerned, even though it is a different trust legally from the one that was there before. The CQC is there to ensure that any lessons about the safety of care are disseminated throughout the NHS. That is an important part of the transparency culture that we are introducing.
Matthew Pennycook (Greenwich and Woolwich) (Lab)
6. What progress the Government have made on achieving parity of esteem for physical and mental health services.
Margaret Greenwood (Wirral West) (Lab)
8. Whether he expects that the efficiency savings identified in NHS England’s most recent “Five Year Forward View” will entail a reduction in staff numbers.
The Secretary of State for Health (Mr Jeremy Hunt)
The “Five Year Forward View” is about meeting increasing demand through new models of care, not cutting staff numbers. In fact, we are planning an additional 10,000 staff in primary and community settings, including around 5,000 doctors.
Margaret Greenwood
The Secretary of State will be aware that Sir Robert Francis specifically recommended that the National Institute for Health and Care Excellence provide guidance on safe staffing levels because it is independent and can establish guidance based on the needs of patients. The Government’s decision to suspend that work and transfer responsibility to NHS England has been met with criticism from patients’ groups right across the NHS. Will the Secretary of State please explain why he thinks NHS England is better placed than NICE to carry out that vital work?
Mr Hunt
The important thing is that that work happens. NICE did a very good job in delivering safe staffing guidance for acute wards. It is important to recognise that that guidance was interpreted as being about simply getting numbers into wards, but the amount of time that doctors and nurses have with patients is as important. The work will continue and we are proud of the fact that we are dealing with the issue of badly staffed wards. We will continue to make progress.
Dr Sarah Wollaston (Totnes) (Con)
In trying to reduce waste as part of the drive for efficiency savings identified in the “Five Year Forward View”, the Secretary of State spoke recently about the possibility of putting a price label on high-value items in prescriptions alongside a label saying that they are paid for by the taxpayer. Will he reassure the House that such a measure would be carefully piloted and evaluated first, so that we can avoid any unintended consequences for those who might consider discontinuing very important medication?
Mr Hunt
We will look at all the evidence. The evidence we have seen from other countries is very encouraging. Apart from ensuring that NHS patients and the public understand the cost of NHS care, one of the main reasons why we want to do that is to improve adherence to drug regimes by making people understand just how expensive the drugs are that they have been prescribed. We will of course look at all the international evidence.
Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)
16. NHS England consulted in the last Parliament not just once but twice on downgrading the economic deprivation part of the funding formula, which would have had the effect of taking some £230 million per year out of the primary care budget for the north-east and Cumbria. Will the Secretary of State give the House a commitment—we got one from the Minister in the last Parliament—that he will not downgrade the economic deprivation part of the funding formula?
Mr Hunt
I give an absolute commitment that economic deprivation will be a very important part of the funding formula, but the right hon. Gentleman will appreciate that things such as the number of older people in a particular area is as important in determining levels of funding. We are committed to reducing health inequalities, but that also means making sure that similar levels of care are available in similar parts of the country. That has not always been the case.
David T. C. Davies (Monmouth) (Con)
Does my right hon. Friend agree that the efficiency savings our Government are introducing have led to the lower waiting lists and the better access to cancer drugs for patients in England that are the envy of my patients in Wales? What can I tell them about how we can get greater access and better standards in Wales while the NHS in Wales is run by Labour?
Mr Hunt
My hon. Friend can tell them that when Labour Members opposed the Health and Social Care Act 2012, we were doing the right thing for patients, with 18,000 fewer managers, 9,000 more doctors and 8,500 more nurses, whereas the Labour party was posturing. We can see the results of that posturing in Wales, where more people wait for A&E, more people wait for their cancer operation, and 10 times more people are waiting for any kind of operation.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Secretary of State talks about having similar levels of care, but we do not have similar levels of safe staffing around the country. Peter Carter has said about the decision on NICE:
“If staffing levels are not based on evidence there is a danger they will be based on cost.”
Is my hon. Friend the Member for Wirral West (Margaret Greenwood) not right? NHS England should reverse that decision and let the independent body be the judge of safe staffing levels.
Mr Hunt
I gently say to the hon. Lady that we will not take any lessons in safe staffing from the party that left us with the tragedy of Mid Staffs. We have recruited 8,000 more nurses into our hospitals because we have learned the lessons of the Francis report. The important lesson in the report is that it is not simply about the number of nurses; it is about the culture in hospitals and making sure that nurses are supported to give the best care. We want to learn those lessons as well.
Mr Peter Bone (Wellingborough) (Con)
In reference to the “Five Year Forward View”, the Secretary of State talked about new modes of working. A very simple thing that could be done is for women’s smear test results to refer to the fact that it is not a test for ovarian cancer, and to then list the symptoms of that cancer. That would not cost any money, but it would save lives.
Mr Hunt
I am very happy to look into that. The general direction of travel my hon. Friend is talking about is right. We need to empower patients. We need patients to become expert patients, so that they take responsibility for their own healthcare. That means giving them much more information to help them to make the right decisions.
Liz Kendall (Leicester West) (Lab)
The Secretary of State is trying to avoid the question asked by my hon. Friend the Member for Wirral West (Margaret Greenwood). It was a key recommendation of the Francis review into Mid Staffs that safe staffing guidelines should be drawn up independently from Government and NHS managers to make sure people are confident that they are based on what is best for patients, not budgets. Why has he gone against Francis? What was wrong with what NICE was doing? He has published no new criteria for NHS England and no process or timetable for action. Will he now commit to doing that, so that patients, staff and Members of this House can be confident that this is not just a cover for cuts?
Mr Hunt
We will not take any lessons from the Labour party about what needs to be learned from Mid Staffs. Labour Members should be ashamed of the state of hospital care they left behind. There are 8,000 more nurses in our hospitals as a result of the changes that this Government have made. They should welcome that, not criticise it.
Helen Jones (Warrington North) (Lab)
9. What recent discussions he has had with NHS England on the future of district general hospitals; and if he will make a statement.
Rachael Maskell (York Central) (Lab/Co-op)
12. What changes in funding he plans to make to address the NHS funding shortfall forecast in NHS England’s most recent “Five Year Forward View”.
The Secretary of State for Health (Mr Jeremy Hunt)
We have committed to providing additional funding to the NHS of at least £8 billion by 2020-21, over and above inflation. This is in line with the funding identified in the NHS England “Five Year Forward View” and in addition to the £2 billion extra for NHS front-line services this year.
Rachael Maskell
With trust deficits reaching £822 million at the end of the last financial year, commissioners, chief executives and NHS professionals are saying that it is impossible to achieve £22 billion of efficiency savings without cutting services, staff numbers or staff pay or even stripping out the market. Which will the Secretary of State choose?
Mr Hunt
Of course, it will be very challenging to find those savings, but I gently remind the hon. Lady that Labour’s manifesto at the last election promised £5 billion a year less for the NHS than we promised, and that was because of our confidence in a strong economy, which is what the NHS needs.
Kevin Hollinrake (Thirsk and Malton) (Con)
The five-year forward plan will need to deal with the outstanding issue of the contaminated blood scandal, as a result of which one of my constituents suffered devastating consequences, including having to take the terrible decision to terminate their unborn child. When might we expect a statement and final resolution on this matter?
Mr Jamie Reed (Copeland) (Lab)
The House will have seen that the pitch is being carefully rolled by the Secretary of State today for future service closures around the country. Last week, a former care Minister was reported as saying that the £22 billion of efficiency savings the Government had signed up to were “virtually impossible” to achieve and that everyone knew it. Given that he is one of the few people to have seen the detail of the efficiency savings, this does not fill anybody with confidence. Will the Secretary of State now commit to publishing the details of the efficiency savings so that Members, the public at large, patient groups and medical professionals can have a proper and open debate about what it means?
Mr Hunt
We will of course publish how we are going to make these efficiency savings. We have already started with a crackdown on agency spend and a crackdown on consultancy spend, and with the work that Lord Carter, a Labour peer, has done to improve hospital procurement and rostering.
Let me gently say to the hon. Gentleman, however, that he went into the election promising £2.5 billion more for the NHS—£5.5 billion less than we did—and most of that was from the mansion tax that Labour now says was a bad idea. So there would have been nearly £8 billion more of efficiency savings under Labour’s plans than under this Government’s plans, and he should recognise the progress we are making.
Bill Esterson (Sefton Central) (Lab)
13. What recent assessment he has made of the implications for his policies of guidance from the chief medical officer on the consumption of alcohol by pregnant women.
Vicky Foxcroft (Lewisham, Deptford) (Lab)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
The Government’s priority for the NHS this Parliament is to put Mid Staffs behind us by transforming the NHS into the safest healthcare system in the world, and in particular, through seven-day hospital care so that we end the tragedy of up to 6,000 lives lost because people do not have access to consultants or diagnostics at weekends. It means recognition that safer care costs less, not more, which is why we are cracking down on expensive agency staff who cannot give the continuity of care that is best for patients.
Vicky Foxcroft
Almost two years ago, Lewisham took the Secretary of State to court over the closure of Lewisham A&E and maternity services—and won. In the light of the new report, “Our Healthier South East London”, can the Secretary of State promise me that any further shake-up of the NHS in south-east London will not involve the closure of services at Lewisham Hospital?
Mr Hunt
What I can assure the hon. Lady is that we inherited deep-seated problems in the old South London Healthcare Trust and we have dealt with them. We have more doctors and nurses looking after her constituents, and care is getting better as a result of the difficult decisions we have taken.
Maria Caulfield (Lewes) (Con)
T2. Part of my constituency is served by Eastbourne District General Hospital, which is run by East Sussex Healthcare NHS Trust. The trust was recently deemed “inadequate” by the Care Quality Commission. Residents are obviously concerned, and both East Sussex County Council and Polegate Town Council have gone on record as saying that they have lost confidence in the hospital’s management. Will the Minister look into the matter urgently, in order to reassure my constituents?
Andrew Gwynne (Denton and Reddish) (Lab)
We have heard a number of fair questions from Opposition Members, and, I am afraid, nothing but woeful and inadequate answers from Ministers so far. Let me try again by asking the Secretary of State about GPs. As we have already heard, before the election he promised that there would be an additional 5,000 GPs by 2020. However, now that the election is over, he says that that promise requires “some flexibility”, and he was similarly evasive in an earlier answer. Given that there is, in the words of the Government’s own taskforce, a “GP work force crisis”, will the Secretary of State now clear things up? By 2020, will there be 5,000 extra GPs—on today’s figures—as he promised, or is this yet another example of the Conservatives not being straight with people on the NHS?
Mr Jeremy Hunt
I think that those were woeful and inadequate questions. What I said after the election was exactly the same as what I said before the election, which was that a number—[Interruption.] Yes, we will have about 5,000 more GPs by the end of the Parliament, which is just what I said before the election. I said that a total of 10,000 more people would be working in primary care. I also said before the election that the woeful problems in general practice would be dealt with only if we unpicked the terrible mistakes made by Labour in the GP contract. That is why this year we are bringing back named GPs for every single NHS patient.
Mr Christopher Chope (Christchurch) (Con)
T4. Does the Secretary of State accept the verdict of the Competition Commission, which decided recently that it would be against the interests of patients for Royal Bournemouth General Hospital and Poole Hospital to merge? The clinical commissioning group has responded by saying that one of the hospitals will have to give up all its services.
Mr Hunt
I think that we must respect the independent view of the Competition and Markets Authority, but I also think that there are lessons to be learned by the NHS more generally from the way in which that process was conducted. There will have to be changes on the ground if we are to give patients the care that they need in the very constrained financial circumstances in which we operate.
Paul Blomfield (Sheffield Central) (Lab)
T3. In March this year I had a very useful meeting involving Devonshire Green & Hanover Medical Centres in my constituency and the then Under-Secretary of State, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who recognised the threat posed to practices that serve patients with complex, demanding, and therefore costly needs by the withdrawal of the minimum practice income guarantee. The hon. Gentleman promised to follow up that meeting, but since then we have heard nothing. Will the Secretary of State guarantee that no practice will close as a result of the withdrawal of MPIG, and what will he do to ensure that that is the case?
Richard Burgon (Leeds East) (Lab)
T8. Millions of people are worried about the privatisation of our national health service, so it is a real concern that the health sector remains part of the negotiations on the Transatlantic Trade and Investment Partnership. Tomorrow the European Parliament votes on TTIP, but the European Commission has already said it will not remove health from those negotiations, so can the Government confirm that they will defend the NHS and support the removal of health and other public services from future TTIP negotiations?
Mr Jeremy Hunt
Really, the Labour party has got to stop this scaremongering that it did so much of, and to so little effect, at the election. Privatisation is not happening, but I will tell the hon. Gentleman what is happening: at his hospital, 85 more doctors in the last five years, 185 more nurses, 7,700 more operations, 20,000 more people being seen within four hours at A&E—progress in the NHS with a strong economy.
Helen Whately (Faversham and Mid Kent) (Con)
In the last Parliament we made great strides using transparency to drive improvement in the quality of patient care. Does my right hon. Friend agree that we can and should go further, particularly on the transparency of performance in primary and community care?
Mr Jeremy Hunt
My hon. Friend is absolutely right and has great experience in this area. We are now having a lot of transparency at an institutional level, but individual doctors and nurses in primary and secondary care are still finding it too hard to speak out if they have concerns. Getting that culture right has to be a big priority for this Parliament.
Mr Speaker
Emulating Strangford brevity, perhaps, I call Mr Greg Mulholland.
Mr Peter Bone (Wellingborough) (Con)
Does the Secretary of State agree that hospital parking charges are unfair?
Ms Margaret Ritchie (South Down) (SDLP)
Will the Secretary of State outline when compensation will be made available to those who were infected by contaminated blood products in the 1970s and 1980s?
Jason McCartney (Colne Valley) (Con)
When will the Secretary of State be making a full statement in response to the Penrose inquiry into those affected by contaminated blood?
Oral Answers to Questions
Jeremy Hunt Excerpts(9 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mrs Emma Lewell-Buck (South Shields) (Lab)
1. What assessment he has made of recent trends in ambulance waiting times.
The Secretary of State for Health (Mr Jeremy Hunt)
As you said, Mr Speaker, we shall have those tributes tomorrow, but I should like very briefly to echo your comments, because I know that the whole House is shocked and deeply saddened by the umtimely passing of Charles Kennedy. He was a giant of his generation, loved and respected in all parts of the House. Our thoughts are particularly with Liberal Democrat Members who knew him well, and to whom he was a very good friend over many years. We shall all miss him as a brave and principled man who had the common touch, and who proved that it is possible to be passionate and committed without ever being bitter or bearing grudges. Our thoughts are with his whole family.
I can tell the hon. Member for South Shields (Mrs Lewell-Buck) that the ambulance service is performing well under a great deal of pressure. Although a number of national targets are not being met, the service is responding to a record number of calls, and is making a record number of journeys involving all categories of patients.
Mrs Lewell-Buck
I echo the comments made about the late Member for Ross, Skye and Lochaber. He was one of the kindest Members of the House, and he will be greatly missed by many of us.
As for the Secretary of State’s response to my question, I think that his assessment was a bit off. When my constituent Malcolm Hodgson’s son-in-law broke his leg in a local park, he waited in agony for 50 minutes for an ambulance, and then waited a further five days for an operation. Can the Secretary of State explain how our ambulance and health services were allowed to fall into such a dire state over the past five years, and will he apologise to that young man for the delay and the pain that he suffered on the right hon. Gentleman’s watch?
Mr Hunt
I take responsibility for everything that happens on my watch. [Interruption.] I think it is a little early to ask the Secretary of State to resign—but maybe not. The ambulance service is under great pressure, but across the country we have 2,000 more paramedics than five years ago, we are recruiting an additional 1,700 over the next few years, and from March this year, compared with March the previous year, the most urgent calls—the category A red 1 calls—went up by 24% and the ambulance service answered nearly 2,000 more calls within the eight-minute period. There is a lot of pressure, we have a plan to deal with it, but we need to give credit to the ambulance service for its hard work.
Mr James Gray (North Wiltshire) (Con)
I stood against Charles Kennedy in 1992 in Ross, Cromarty and Skye and will take the opportunity tomorrow of remembering what a very happy occasion it was and how very glad I was to lose to Charles at that election.
I strongly opposed the creation of the South Western Ambulance Service because I believed the Wiltshire Ambulance Service did a better job on its own. I know the Secretary of State has been monitoring the calls received by the South Western Ambulance Service—one of the two trial areas. Will he tell the House whether response times in the south-west have improved or got worse in recent years?
Mr Hunt
NHS England will be updating the House on the results of that trial. It was a very important trial because it was designed to stop the dispatch of ambulances to people who did not need one within eight minutes, in order to make sure ambulances were available for people who did need one. South Western was very helpful in taking part in that trial and we will update the House shortly on the results of it.
Clive Lewis (Norwich South) (Lab)
Yesterday 400 people in my region expected to begin a paramedics course put on by the East of England Ambulance Service only to discover that there is no course and they are now £4,000 out of pocket. That is because the University of East Anglia and Anglia Ruskin University could not get accreditation for the courses. Does the Secretary of State think this event is going to help the ambulance service in the east of England where staff are already overwhelmed? It is a critical service—a vital service. Does he think this will contribute to hitting those targets, which at the moment are being inadequately met?
Mr Hunt
I welcome the hon. Gentleman to his place. It is important that we train more paramedics. It is one of the most challenging jobs in the NHS and I will take up the issue he raises with the Secretary of State for Business, Innovation and Skills to understand precisely what the problem was and to try to resolve it as quickly as possible.
Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
Will the Secretary of State consider reviewing the protocol, which is unique to the ambulance service in terms of our emergency services, that breaks cannot be broken into even if there is a category A incident in the area? We had the loss of a young man in Berwick recently; the ambulance which was in post in the ambulance station a mere four minutes down the road was not called and the boy died. That is the cause of enormous distress across the rural areas of Northumberland.
Caroline Nokes (Romsey and Southampton North) (Con)
2. When he expects NHS England to reach a decision on access to Translarna for the treatment of Duchenne muscular dystrophy; and if he will make a statement.
Jeremy Lefroy (Stafford) (Con)
3. What progress he has made on the implementation of the trust special administrators’ proposals following the dissolution of Mid Staffordshire NHS Foundation Trust.
The Secretary of State for Health (Mr Jeremy Hunt)
We are putting the terrible tragedy of the old Mid Staffs behind us, and I congratulate my hon. Friend and the staff at the hospital on their superb efforts under a great deal of pressure. We are also investing over £300 million in the Staffordshire health economy, and the local trust and commissioners are making good progress on implementing the recommendations made by the trust special administrators.
Jeremy Lefroy
I thank my right hon. Friend for his reply. He will have seen the reports over the weekend on the severe pressure on accident and emergency services at the Royal Stoke University hospital, while Stafford’s County hospital A&E often meets the 95% four-hour target. The trust special administrators assured us that the Royal Stoke would have the capacity to cope with additional patients from Stoke and Stafford. Given that that is not the case, will the Secretary of State ensure that A&E in Stafford is reopened to operate 24/7 as soon as is clinically possible?
Mr Hunt
I share my hon. Friend’s concern about what is happening at the Royal Stoke. Some of the care there was totally unacceptable; there should be no 12-hour trolley waits anywhere in the NHS. I have said that I support a full 24/7 A&E service at County hospital as soon as we can find a way of doing it that is clinically safe, and I will certainly work hard to do everything I can to make that happen.
Valerie Vaz (Walsall South) (Lab)
Will the Secretary of State ensure that other local hospitals, such as the Manor hospital, which have had to take up the slack following the closure of A&E and maternity services also get some support?
Stephen Phillips (Sleaford and North Hykeham) (Con)
4. What steps he is taking to reduce the burden of administration on GPs.
Graham Evans (Weaver Vale) (Con)
5. What steps he plans to take to improve dementia diagnosis and care.
The Secretary of State for Health (Mr Jeremy Hunt)
Following a sustained effort to improve dementia diagnosis rates in the last Parliament I am pleased to report that in England we now diagnose 61.6% of those with dementia, which we believe is the highest diagnosis rate in the world. But there is much work to be done to make sure that the quality of dementia care post diagnosis is as consistent as it should be.
Graham Evans
I thank my right hon. Friend for his answer. A long-standing Weaver Vale constituent, Mrs Gladys Archer, successfully looked after her husband for many, many years at home until he was admitted to hospital for a routine operation. Following a misdiagnosis, he has had to go into a care home with all the personal cost and trials and tribulations that that involves. Will my right hon. Friend look into that case, and highlight what measures are in place and how we can improve matters so that we can stop patients with Alzheimer’s or dementia suffering when they are admitted to hospital?
Mr Hunt
I thank my hon. Friend for raising that case and I will happily look into it. That is a perfect example of why we need to change the way we look after people with long-term conditions, such as dementia, out of hospital. If we can improve the care that we give them at home and give better support to people such as that man’s wife, we can ensure that the kind of tragedy my hon. Friend talks about does not happen.
Barbara Keeley (Worsley and Eccles South) (Lab)
Unpaid family carers play a key role in the care of people with dementia, many with heavy caring workloads of 60 hours a week or more. Can the Health Secretary understand how fearful carers now are of talk of cutting their eligibility for carer’s allowance and will he fight any moves within his Government to do that?
Mr Hunt
I absolutely recognise the vital role that carers play and will continue to play, because we will have 1 million more over-70s by the end of this Parliament, and we need to support them. I hope that she will recognise that we made good progress in the previous Parliament with the Care Act 2014, which gave carers new rights that they did not have before.
Michael Tomlinson (Mid Dorset and North Poole) (Con)
18. Two weeks ago, it was dementia friendly care week and I had the pleasure of spending a part of that at a picnic in the village of Corfe Mullen in Mid Dorset and North Poole. Does my right hon. Friend agree that although much progress has been made in diagnosis, there is still a long way to go in terms of care, especially for those individuals in Mid Dorset and North Poole?
Mr Hunt
I welcome my hon. Friend warmly to his place; he hits the nail on the head. We had a big problem with diagnosis—less than half of the people who had dementia were getting a diagnosis—and we have made progress on that. It is still the case that in some parts of the country, although I hope not in Mid Dorset, when someone gets a diagnosis not a great deal happens. We need to change that, because getting that support is how we will avoid tragedies such as that in Weaver Vale, which we heard about earlier.
Andrew Gwynne (Denton and Reddish) (Lab)
The Secretary of State knows that the availability of social care for vulnerable older people has a big impact on the NHS, especially for people with dementia, yet 300,000 fewer older people are getting help compared with 2010. Given that the Secretary of State has said that he wants to make improving out-of-hospital care his personal priority, can he confirm that there will be no further cuts to adult social care during this Parliament, which would only put the NHS under even more pressure?
Mr Hunt
I can confirm that we agree with the hon. Gentleman and the Opposition that we must consider adult social care provision alongside NHS provision. The two are very closely linked and have a big impact on each other. I obviously cannot give him the details of the spending settlement now, but we will take full account of that interrelationship and recognise the importance of the integration of health and social care that needs to happen at pace in this Parliament.
Ms Margaret Ritchie (South Down) (SDLP)
6. What recent discussions his Department has had with the Royal College of Emergency Medicine on the recruitment of additional middle-grade doctors for NHS hospitals.
Neil Carmichael (Stroud) (Con)
7. What steps he is taking to increase access to GPs’ surgeries.
The Secretary of State for Health (Mr Jeremy Hunt)
The Government have committed to make sure GPs can be accessed when needed seven days a week, ensuring that people are able to access primary medical care when they need to.
This is already being rolled out through the GP access fund, which will enable 18 million patients to benefit from improved access to their local GP, including extended hours, telephone or Skype consultations.
Neil Carmichael
Does the Secretary of State agree that the news he brings will be of great comfort to elderly people in particular, but in addition the signposting of people towards GPs rather than acute hospitals will be very important and a very useful addition to our policy?
Mr Hunt
My hon. Friend makes an important point. It is partly the availability of services seven days a week, which we need to provide because illnesses do not happen on only five days a week and we need to respond to changing consumer expectations; but it is also about the signposting. That is absolutely critical, so that people know where to go and do not overburden A&E departments, which should be there for real emergencies.
Emily Thornberry (Islington South and Finsbury) (Lab)
The right hon. Gentleman talks about access to GPs. Will he wait a moment and think about Islington South, where this month we have three GP surgeries closing because our GPs have all resigned? Given the changes in the funding formula that this Government have overseen, will he meet a group of inner-London MPs to talk about our grave concerns about the change to funding and the lack of resources available to GPs?
Mr Hunt
I am happy to ensure that inner-London MPs have a meeting with the Minister to discuss those issues. The underfunding of general practice has been an historical problem, because we have had very strong hospital targets, which have tended to suck resources into the acute sector and away from out-of-hospital care. We want to put that right.
Mr Philip Hollobone (Kettering) (Con)
The problem in Northamptonshire is that because of rapid population growth, the gap between the appointments required of GP surgeries and the slots available is one of the biggest in the country. There are 333 Northamptonshire GPs at the moment; Healthwatch Northamptonshire estimates that another 183 will be required within the next five years. How are we going to fill that gap?
Dr Philippa Whitford (Central Ayrshire) (SNP)
How does the Minister intend to find the 5,000 extra GPs when many surgeries throughout the United Kingdom cannot fill the spaces that they have, and how does he plan to fund it? The proposals appear to only fund the setting up of seven-day-a-week, 8 till 8 GP services and not running costs—and these are big running costs.
Mr Hunt
I welcome the hon. Lady to her place. We do need to find these extra GPs and we will do that by looking at GPs’ terms and conditions. We need to deal with the issue of burnout because many GPs are working very hard. We also need to raise standards in general practice. In the previous Parliament, an Ofsted-style regime was introduced, which is designed to ensure that we encourage the highest standards in general practice. That is good for patients but also, in the long run, good for GPs as well.
Dr Whitford
Just so that the Secretary of State is aware, it takes 10 years to produce a GP, so that will not be an immediate response. The £8 billion that the Conservatives have suggested they will add by 2020 was just to stand still, not to fund a huge expansion, and as change, which the NHS requires, costs money, can the Secretary of State perhaps give us an indication of what extra we may expect in the next two years?
Mr Hunt
Well, I can, but may I gently say that under this Government and under the coalition we increased the proportion of money going into the health budget, whereas the Scottish National party decreased the proportion of money going into the NHS in Scotland? The £8 billion is what the NHS asked for to transform services, and that will have an impact, meaning that more money is available for the NHS in Scotland. I hope the SNP will actually spend it on the NHS and not elsewhere.
Jake Berry (Rossendale and Darwen) (Con)
I thank the Secretary of State for personally intervening to enable the Ilex View medical centre in Rawtenstall to open for longer hours, despite that being precluded under its private finance initiative lease of that building. Will he update the House on what steps can be taken to ensure that where GPs are in a building that is subject to a PFI lease, he will be able to intervene to ensure that they can truly open seven days a week and for extended hours?
Mr Hunt
This is one of the main reasons why the Chancellor allocated £1 billion to modernise primary care facilities in the autumn statement. We recognise that many GP premises are simply not fit for purpose. If we are going to transform out-of-hospital care, we need to find ways to help GPs move to better premises, to link up with other GP practices, and that will be a major priority for this Parliament.
Liz Kendall (Leicester West) (Lab)
The 2010 Conservative manifesto promised every patient seven-day GP access from 8 am to 8 pm, but access has got worse and almost half of all patients now say they cannot see a GP in the evenings or at weekends. Five years on, the Conservatives made the exact same promise. Can the Secretary of State tell us why he has failed?
Mr Hunt
I welcome the hon. Lady back to her place, although I know she hopes it will be for only a brief time, and say to her that we have not failed. We made very good progress delivering seven-day access to GP surgeries for nearly 10 million people during the last Parliament, and we have committed to extending that to everyone during this Parliament. I think the hon. Lady said that what is right is what works, and what works is having a strong economy so we can put funding into the NHS that will mean more GPs.
Andy Slaughter (Hammersmith) (Lab)
8. What effect the implementation of the Keogh urgent and emergency care review will have on type 1 A&E departments in England.
Helen Jones (Warrington North) (Lab)
12. What estimate he has made of the anticipated levels of deficits in hospital trusts for the current financial year.
The Secretary of State for Health (Mr Jeremy Hunt)
The NHS faces significant financial challenges this year and beyond. That is why we have now committed £10 billion extra for the NHS—£2 billion for this year and at least £8 billion more by 2020. Individual trust plans for 2015-16 are still being worked up but, with concerted financial control from providers, we expect to deliver financial balance in 2015-16.
Helen Jones
But does the Secretary of State accept that in trusts such as mine, which anticipates a £15 million deficit this year, that cannot be done without cuts to staff, beds and services? What happened to the Prime Minister’s pledge on a bare-knuckle fight to protect district general hospitals, when trusts such as mine are facing such circumstances?
Mr Hunt
I will tell the hon. Lady what has happened to the Prime Minister’s pledge to protect hospitals: an extra £10 billion that we have promised for the NHS, which her party refused to promise. Her local hospital has 88 more doctors since 2010, and it is doing an extra 2,000 operations for her constituents year in, year out. I will tell her what makes the deficit problem a lot worse: the heritage of the private finance initiative, which means £73 billion of debt that her party bequeathed to the NHS.
Mr Jonathan Djanogly (Huntingdon) (Con)
In 2004 the then Huntingdonshire primary care trust said that it would give Hinchingbrooke hospital a grant of £8 million towards the cost of a new PFI treatment centre. Shortly before the PCT’s demise, it changed without discussion the terms of the grant and made it a loan, which has since been treated in its accounts as a deficit. If I write to my right hon. Friend, will he look into that patently unfair treatment?
Andy Burnham (Leigh) (Lab)
On behalf of everyone on the Opposition Benches, I echo the Secretary of State’s warm tribute to Charles Kennedy. I cannot have been the only person this morning wondering why politics always seems to lose the people it needs most. Charles was warm, generous, genuine and principled. We will miss him greatly. We send our love and deepest sympathy to his family.
I congratulate the Secretary of State on his reappointment, but I commiserate with him on the financial position in the NHS that he inherits from himself. He told The Daily Telegraph today that the NHS has enough money, but that is not true. The deficit in the NHS last year was nearly £1 billion. Can he tell the House what the projected deficit is for the whole of the NHS for this year?
Mr Hunt
I welcome the right hon. Gentleman to his place. We have seen many feisty disagreements on health policy, and that is just in the shadow Health team. Perhaps he no longer believes his mantra about collaboration, not competition—we know that the shadow care Minister has disagreed with that for some time. To answer his question directly, there is a lot of financial pressure in the NHS, and that is because NHS hospitals took the right decision to respond to the Francis report into Mid Staffs by recruiting more staff to ensure that we ended the scandal of short-staffed wards. As a temporary measure it recruited a lot of agency staff, which has led to deficits, and that is what we are tackling with today’s announcement about banning the use of off-framework agreements for recruiting agency staff.
Andy Burnham
It is a new Parliament, but there are the same non-answers from the Secretary of State. He did not answer; he never does. I will give him the answer: NHS providers are predicting the deficit to double this year to more than £2 billion. Why has financial discipline been lost on his watch? It is because early in the previous Parliament the Government cut 6,000 nursing posts. They cut nurse training places and, when the Francis report came out, they left hospitals with nowhere to turn other than private staffing agencies. The Bill for agency nurses has gone up by 150% on his watch. He even admitted on the radio this morning that it was a mess of their making. Will he now apologise for this monumental waste of NHS resources and get our hospitals out of the grip of private staffing agencies by recruiting the 20,000 nurses that the NHS needs?
Mr Hunt
I have here the figures on nurse training placements, which started to go down in 2009-10, by nearly 1,000. Who was Secretary of State at the time? I think it was the right hon. Gentleman. [Interruption.] I have the figures here, and they show that planned nurse training places went down from 21,337 to 20,327. He talks about apologies, but where is the apology for what happened at Mid Staffs, which led to hospitals having to recruit so many staff so quickly? That is the real tragedy, and that is what this Government are sorting out.
Andrea Jenkyns (Morley and Outwood) (Con)
14. What the NHS’s criteria are for dispensing eculizumab.
The Secretary of State for Health (Mr Jeremy Hunt)
During the previous Parliament I made it my priority to ensure that NHS hospitals learned from the tragedy of Mid Staffs to transform themselves into the safest hospitals anywhere in the world. That work will continue. Today NHS England has announced measures to ensure that even more funding is available to improve the quality of care. These include restrictions on the use of agency staff and management consultancies, and on senior pay. It is right that the NHS takes every possible measure to direct resources towards improving patient care.
Andrew Stephenson
I thank the Secretary of State for supporting the bid by East Lancashire Hospitals NHS Trust for £15.6 million to improve the surgical centre, opthalmology and out-patient services at Burnley General hospital, on which I lobbied him extensively. Thanks to the hard work of the trust’s staff, it has exited special measures. What progress has been made on improving safety in hospitals via the special measures regime?
Mr Speaker
Order. I remind the House at the start of the Parliament—this might be of particular benefit to new Members—that topical questions are supposed to be significantly shorter than substantive questions: the shorter the better, and the more we will get through.
Mr Jamie Reed (Copeland) (Lab)
The Secretary of State has said that safe care and good finances go together, but clinical negligence claims are up by 80% since 2010, while trusts are posting huge deficits. Does he think that finances have deteriorated because care quality has deteriorated or that care quality has deteriorated because finances have deteriorated?
Mr Hunt
The evidence is very clear that safer hospitals end up having lower costs, because one of the most expensive things that can be done in healthcare is to botch an operation, which takes up huge management time as well as being an absolute tragedy for the individual involved. My message to the NHS is this: the best way to reduce your costs and deliver these challenging efficiencies is to improve care for patients. Our best hospitals, like Salford Royal and those run by University Hospitals Birmingham NHS Foundation Trust, do exactly that.
Derek Thomas (St Ives) (Con)
T2. Bringing health and social care together in meaningful integration is a priority for me and my constituents in St Ives. What can the Secretary of State do to help achieve this for the good people of west Cornwall and the Isles of Scilly? Will he accept an invitation to come to west Cornwall to discuss this challenge and see some of the good work that is already being done?
Heidi Alexander (Lewisham East) (Lab)
T3. For the first time in recent history, many of London’s more prestigious teaching hospitals—King’s College, University College London, Guys and St Thomas’s, and the Royal Free—are all forecasting deficit budgets. Apart from crossing his fingers and hoping the economy picks up to fund investment, what exactly is the Secretary of State going to do to tackle this problem?
Mr Hunt
I would not expect the hon. Lady to want to listen to me on the “Today” programme, but I have been talking a lot today about the measures, including in my topical statement. I will tell her exactly what we are doing: this week we are announcing measures to restrict the use of agency staff, which was an important, necessary short-term measure in response to what happened at Mid Staffs. We need to move beyond that. Later in the week we will be helping trusts reduce their procurement costs and taking a number of measures, so a lot is happening. There are a lot of challenges, but I know that NHS trusts can deliver.
Christopher Pincher (Tamworth) (Con)
T5. Burton hospital trust and the Heart of England foundation trust are discussing how they can make better use of the facilities at the Sir Robert Peel hospital. Will colleagues on the Treasury Bench encourage both trusts to make better use of the facilities, provide new facilities and services at the hospital, and make sure that local people are properly consulted?
Ian Lavery (Wansbeck) (Lab)
T4. The Secretary of State has admitted this morning that under his watch the NHS and the taxpayer have been ripped off to the tune of somewhere in the region of £1.8 billion for temporary workers and £3.3 billion for agency workers. How many fully qualified NHS nurses could have been employed with that type of finance?
Mr Hunt
I will tell the hon. Gentleman what we have done: on my watch, there are 8,000 more nurses in our hospitals to deal with the tragedy of the legacy of poor care left behind by his party. That is what we have done. As part of that, trusts also recruited temporary staff. They have become over-dependent on them, which is why we have taken the measures we announced this morning.
Mr Simon Burns (Chelmsford) (Con)
T6. What measures are being taken to improve A and E departments such as that at Broomfield hospital in Chelmsford?
Emily Thornberry (Islington South and Finsbury) (Lab)
T8. I am very grateful to the right hon. Gentleman for agreeing to meet me and some inner- London MPs to discuss the crisis of GPs in Islington and the surrounding area. In preparation for that meeting, will he look very carefully at the funding formula? It has changed, which means that resources have moved out of inner London to areas such as Bournemouth, where there are more older people. We need to look very carefully at that. Three surgeries have closed in Islington.
Andrea Jenkyns (Morley and Outwood) (Con)
T7. The rate of hospital-acquired infections improved dramatically and halved in the last Parliament. Having lost my own father to a hospital-acquired infection, I am fully aware of the challenges we face. Will the Secretary of State look into ensuring that surgical site infections are included in all future statistics? In doing so, we can work on eradicating them, as they are a common way to catch an infection.
Mr Hunt
May I start by saying that it was an incredible privilege to work with the right hon. Gentleman on the Government Benches on mental health issues over many years? He was a great inspiration to many people in the mental health world for his championing of that cause. It is my absolute intention to ensure that his legacy is secure and that we continue to make real, tangible progress towards the parity of esteem that we both championed in government.
Mr Nigel Evans (Ribble Valley) (Con)
I welcome the expansion of GP services to seven days a week. Will the Secretary of State remember rural areas such as Ribble Valley when GP services are expanded? Funnily enough, people who live in rural areas also get ill at the weekends.
Jim Shannon (Strangford) (DUP)
With almost 82,000 people living with diabetes in Northern Ireland over the age of 17, does the Minister agree that this ticking time bomb needs more research into better treatments? One way of doing that would be to ensure that there is sufficient funding for Queen’s University in Belfast, in the hope of providing a superior treatment for the many who are affected and living with that disease.
Jack Dromey (Birmingham, Erdington) (Lab)
With the accident and emergency crisis, over which the Secretary of State has presided, more and more police officers are queuing outside fewer A&E departments in ever-lengthening queues. Last year, there were 1,000 incidents in the Metropolitan police alone. In Liverpool, Patrick McIntosh died after waiting for an ambulance for an hour. Does the Secretary of State accept that after 17,000 police officers have been cut by his Government, this is the worst possible time to ask the police service to do the job of the ambulance service, and that he is guilty of wasting police time?
Mr Hunt
I think that is harsh. Let me tell the hon. Gentleman some of the progress that was made under the last Government, and that this Government will continue, to reduce the pressure on police, particularly with regard to the holding of people with mental health conditions in police cells. We are in the process of eliminating that; it has seen dramatic falls. We recognise that the NHS needs to work more closely with the police, particularly in such circumstances, and he should recognise the progress that has been made compared with what happened before.
Mr Speaker
Order. I am genuinely sorry that some colleagues were disappointed today; I ran things on a bit, but we need to move on. In one respect, Health questions is analogous to the national health service, under whichever Government, in that demand always exceeds supply, but I have noticed colleagues who were trying to take part today and I will seek to accommodate them on a subsequent occasion.
Health and Social Care
Jeremy Hunt Excerpts(9 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
It is an honour to speak about health and social care in our debates on the Gracious Speech, because nothing matters more to this Government than providing security for all of us at every stage of our life, and nothing is more critical to achieving that than our NHS.
I start by welcoming the right hon. Member for Leigh (Andy Burnham) and his colleagues back to their positions. I will not take it personally that two of them want to break from debating with me to go elsewhere. However, it is a topsy-turvy world when the shadow Health Secretary who was the scourge of private sector involvement in the NHS now wants to be the entrepreneurs’ champion. As one entrepreneur to another, may I put our differences to one side and on behalf of the whole Conservative party wish him every success in his left-wing leadership bid? This is perhaps the only occasion in history when my party’s interests and those of Len McCluskey are totally aligned.
That is not to mention the hon. Member for Leicester West (Liz Kendall), who is, in her own way, a kind of insurgent entrepreneur, taking on the might of the Labour establishment, in the mould of Richard Branson or Anita Roddick. Sadly, I fear that she will demonstrate that pro-business, reform-minded, centre-ground policies are as crushed inside today’s Labour party as they would have been in the country if Labour had won the election.
The shadow Health Secretary said countless times during the election campaign that the NHS would be on the ballot paper. He was right—the NHS was indeed the top issue on voters’ minds—but not with the result he had intended. So, just as he has now done significant U-turns on Labour’s EU referendum policy, economic policy and welfare policies, I gently encourage him to do one on Labour’s health policies too.
The Queen’s Speech committed the Government to the NHS’s Five Year Forward View and the £8 billion that the NHS says it needs to fund it. The shadow Health Secretary refused to put such a commitment in Labour’s manifesto, and I hope today he will change that policy so that we can have cross-party consensus on this important blueprint for the NHS.
James Morris (Halesowen and Rowley Regis) (Con)
Does the Secretary of State agree that one of the biggest challenges we face is to achieve parity of esteem between mental health and physical health in the NHS, and that the way to achieve that parity is by ensuring that mental health services are properly funded and that we have a culture change in the NHS that means that physical health and mental health are treated as the same?
Mr Hunt
My hon. Friend is absolutely right, and I want to thank him for his tireless campaigning on parity of esteem for mental health in the last Parliament. One in 10 children aged five to 16 has a mental health problem, and it is a false economy if we do not tackle those problems early, before they end up becoming much more expensive to the NHS as well as being extremely challenging for the individual involved. We are absolutely determined to make progress in that area.
Philip Davies (Shipley) (Con)
The Secretary of State has quite rightly said that the NHS needs to become more efficient. May I encourage him to visit Advanced Digital Institute Health, based in Saltaire in my constituency, so that he can see at first hand the wonderful work it is doing using modern technology to improve the quality of healthcare in our communities and to make it much more efficient, helping NHS resources go as far as we need them to go?
Mr Hunt
I would be delighted to visit my hon. Friend as soon as I can find the time, but I have already seen some great technology at Airedale hospital, which I think is in or near his constituency. It had some incredibly innovative connections with old people’s care homes, where people could talk to nurses directly, so there is some fantastic technology there, and I congratulate his local NHS on delivering it.
In the election campaign, the right hon. Member for Leigh talked constantly about NHS privatisation that is not actually happening. Now that he is the entrepreneurs’ champion, will he speak up for the dynamism that thousands of entrepreneurs bring to the NHS and social care system, whether they be setting up new dementia care homes, researching cancer immunotherapy, developing software to integrate health and social care or providing clinical services in the way he used to approve of when, as Health Secretary, he privatised the services offered at Hinchingbrooke hospital?
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
I am glad that the right hon. Gentleman is getting to the meat of the debate. My constituents and people around the country want to know whether the big issues will be tackled, and the big issues are difficult ones, such as tackling the royal colleges about the training of medical people, from nurses, doctors and other A&E professionals right the way through the system. Is it not time we had a radical approach to how we train our medical staff in this country?
Mr Hunt
We do need to make important changes to the training of medical staff, and I shall give the hon. Gentleman one example of where that matters: creating the right culture in the NHS so that doctors and nurses feel able to speak out if they see poor care. In a lot of hospitals they find that very difficult, because they are working for someone directly responsible for their own career progress, and they worry that if they speak out, that will inhibit their own careers. We do not have that culture of openness. The royal colleges have been very supportive in helping us make that change, but yes, medical training is extremely important.
David Tredinnick (Bosworth) (Con)
To build on the point made by the hon. Member for Huddersfield (Mr Sheerman), is not a critical aspect—something that the Health Committee has looked at—what doctors are learning now? More needs to be done about prevention. Has my right hon. Friend seen early-day motion 1 about reducing levels of obesity, and is not reducing the amount of sugar in fizzy drinks a key challenge for him?
Mr Hunt
My hon. Friend is absolutely right. The big change we need to see in the NHS over this Parliament is a move from a focus on cure to a focus on prevention. In this Parliament, we will probably see the biggest single public health challenge change from smoking to obesity. It is still a national scandal that one in five 11-year-olds are clinically obese, and I think we need to do something significant to tackle that in this Parliament.
Andy Burnham (Leigh) (Lab)
There is a big difference between the Secretary of State’s view of the health service and mine—he believes in a market; I do not. It is as simple as that. But I want to correct him on something. He just said that privatisation was not happening, but I will not let him stand at that Dispatch Box and claim that black is white any more. Figures show that as many contracts are going to private sector organisations as to NHS organisations. Will he confirm that that is the case and stop giving wrong information to the people of this country?
Mr Hunt
I gently say to the right hon. Gentleman that I believe in exactly the same use of the independent sector in the NHS as he did when he was Health Secretary; there is no difference at all. What has happened is that for whatever reason—I dare not think what—since he became shadow Health Secretary, he has changed his tune. The facts on privatisation are that it increased from 4.9% at the start of the last Parliament to 6.2% towards the end of the Parliament. That is hardly a massive change. Our approach is to be neutral about who provides services but to do the right thing for patients.
Paula Sherriff (Dewsbury) (Lab)
I worked on the front line of the NHS, in a service providing exemplary care, for more than 11 years. Just over two years ago that same service was privatised, and it has proved to be very damaging for patients, staff and the taxpayer alike. Will the Secretary of State continue to allow companies such as Virgin Care, which exists purely to make profits out of ill people, to continue to bid for NHS services?
Mr Hunt
May I welcome the hon. Lady to her place and say that I welcome to this place as many people with experience of working in the NHS as possible, because every Parliament has important debates on the NHS? Let me gently say to her that the biggest change made in the last Parliament was to take the decision about whether services should be provided by the public sector or the private sector out of the hands of politicians who might have an ideological agenda, and give it to local GPs so that the decision can be taken in the best interest of patients.
I happen to agree with the shadow Health Minister—the hon. Member for Leicester West (Liz Kendall)—but not the shadow Health Secretary that what is best is what works. Where it is best for patients to use charities or the independent sector, I support that, but I do not think it should be decided for ideological reasons by politicians.
Mr Hunt
Let me make some more progress, and I shall give way later.
The Queen’s Speech also talked about a seven-day NHS as part of our determination to make the NHS the safest healthcare in the world. When the right hon. Member for Leigh was Health Secretary, things were different, and he knows that we had a culture of targets at any cost and a blind pursuit of foundation trust status, which led to many tragedies. I hope he will today accept that if we are to make the NHS the safest and most caring system in the world, we must support staff who speak out about poor care, and stop the bullying and intimidation of whistleblowers that happened all too often before.
Finally, I hope we can agree on something else today—namely, that with the election behind us, we all use more temperate language in our health debates. There are many pressures on the NHS from an ageing population, tight public finances and rising consumer expectations, but the one pressure people in the service can do without is constantly being told by politicians that their organisation will not exist in 24 hours, 48 hours, one week, one month or whatever. It is a toxic mix of scaremongering and weaponising that is totally demoralising for front-line staff.
Paul Farrelly (Newcastle-under-Lyme) (Lab)
The Secretary of State has said that privatisation is not happening, but in Staffordshire the £1 billion end-of-life cancer care contract is up for tender, threatening the hospital finances at Royal Stoke even further. Before the election, my right hon. Friend the Member for Leigh (Andy Burnham) gave a commitment to the Royal Stoke University Hospital that it would be the preferred provider for this contract. Will the Secretary of State give that commitment today?
Mr Hunt
As I said earlier, I do not think these decisions should be made by politicians; I think they should be made by GPs on the ground, on the basis of what is best for the hon. Gentleman’s constituents. That is a dividing line between me and the shadow Health Secretary, if not the shadow Health Minister, because I think there is a role for the independent sector when it can provide better or more cost-effective services to patients. It appears that the Labour party, under the leadership of the right hon. Member for Leigh, would rule that out in all circumstances.
Andy Burnham
The right hon. Gentleman said right there that there is a role for the independent sector and that he is neutral about it but wants to see it increase. Then he says that privatisation is not happening. Is he trying to take everybody for mugs? He needs to come to this Dispatch Box and be quite clear about what is happening. Section 75 of his Health and Social Care Act 2012 does not give discretion to doctors; it forces NHS services out on to the open market. That is why we are seeing privatisation proceeding at a pace and scale never seen before in the NHS.
Mr Hunt
I am afraid that this is exactly the sort of distortion and scaremongering that got the right hon. Gentleman nowhere in the election campaign. He knows perfectly well that the 2012 Act does nothing different from what the EU procurement rules required under the primary care trusts when he was Health Secretary. Yes, I do believe that there is a role for the independent sector in the NHS, but I think the decision whether things should be done by the traditional NHS or the independent sector should be decided locally by GPs doing the right thing for their patients. That is the difference between us.
Andrew Percy (Brigg and Goole) (Con)
The Secretary of State is spot on with regard to the use of language. In the last Parliament the Health Select Committee saw an attempt to paint a picture of privatisation as equalling the provision of private health care. Will my right hon. Friend confirm that under the previous Government private sector activity in foundation trusts fell and the rate of privatisation was slower than in the preceding five years—something that the Committee noted in a report that was blocked by Labour members of the Committee?
Mr Hunt
Yes, I will. The figures that my hon. Friend cites are right. I will tell him something else. Half a million fewer people took out private health insurance in the previous Parliament because the quality of care that they could get on the NHS was rising. The Government are committed to the NHS. If the right hon. Member for Leigh does not want to believe what I am saying about privatisation, perhaps he will believe the respected think-tank the King’s Fund, which is clear that his claims of mass privatisation were and are exaggerated.
Jesse Norman (Hereford and South Herefordshire) (Con)
My right hon. Friend spoke eloquently about the importance of supporting mental health care, of parity of esteem and of technology. Does he share my view that the NHS has a strong embedded interest in the spread of fast broadband in rural areas, which would allow people better access to telemedicine and online psychotherapy?
Mr Hunt
Absolutely. I had a good visit to my hon. Friend’s county hospital, but I also remember seeing at Airedale hospital how reassuring it was for a vulnerable old lady to be able to press a red button on her armchair, be connected straight through to the local hospital and talk to a nurse within seconds. With that kind of service, that person is less likely to need full-time residential care. That is much better for her and more cost-effective for the NHS.
Gareth Johnson (Dartford) (Con)
Much has been made of finances during this debate. I do not know whether my right hon. Friend is aware of this, but Darent Valley hospital in my constituency underspent by some £250,000 last year while providing the best services in Kent. The challenge that it is still dealing with today is the legacy of the private finance initiative that created the hospital in the first place.
Mr Hunt
My hon. Friend has an excellent hospital, which I hope to visit at some stage. A third of the hospitals that are in deficit have PFI debts that make it much harder to get back into surplus. That is a persistent problem, and we are doing everything we can to help them deal with it.
The reality is that hard-working NHS staff have made terrific progress in incredibly tough circumstances in recent years. More than a million more operations were performed last year compared with five years ago, yet fewer people are waiting more than 18 weeks for their operation. Seven hundred thousand more people were treated for cancer in the last Parliament than the one before. Despite winter pressures, we have the fastest A&E turnaround times of any country in the world that measures them. There is more focus on safety than anywhere in the world post Mid Staffs, with 21 hospitals in special measures, seven that have exited special measures, and improvements in quality and safety at all of them.
There are more doctors and nurses than ever before in the history of the NHS. Public satisfaction with the NHS was up 5% last year; dissatisfaction is at its lowest ever level. The independent Commonwealth Fund found that under the coalition the NHS became the top performing health system of any major country—better than the US, Australia, France and Germany. That is not to say that there are not huge challenges, including the fact that by the end of this Parliament we will have a million more over-70s, so we need important changes, especially a focus on prevention, not cure. That means much better community care for vulnerable people so that we get help to them before they need expensive hospital treatment. Part of that is the integration of health and social care, which the right hon. Member for Leigh deserves credit for championing. It also means transformed services through GPs, including the recruitment of more GPs to expand primary care capacity, and a new deal that puts GPs back in the driving seat for all NHS care received by their patients.
Kate Green (Stretford and Urmston) (Lab)
The Secretary of State is right to emphasise the need for greater resourcing and support for GPs. What steps is he taking to help GPs with earlier diagnosis of complex cancers? Early diagnosis leads to more effective treatment and less need for hospitalisation.
Mr Hunt
The hon. Lady is right. This week we saw the results of the international cancer benchmarks study, which showed that our GPs take longer than GPs in Norway, Sweden, Canada and Australia to diagnose cancers, and we still have a survival rate that lags. This needs urgent attention. The chief executive of Cancer Research UK is putting together a cancer strategy for the Government that I hope will address this issue. We will bring the results of that to the House.
John Woodcock (Barrow and Furness) (Lab/Co-op)
Does the Secretary of State accept that the Better Care Together report on future services in Morecambe Bay put precisely that innovative focus on primary care and prevention, but that recognition of Morecambe Bay’s unique geography and extra funding are needed to implement it? The right hon. Gentleman said that he was sympathetic to that before the election. Has he now concluded that it is the way forward?
Mr Hunt
I will just make some progress.
Prevention also means transforming mental health services. I paid tribute earlier to my former colleague the right hon. Member for North Norfolk (Norman Lamb), who did a terrific job. I welcome in his place my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), the Minister for Community and Social Care, who I know will build on his legacy. It also means a big focus on public health, especially tackling obesity and diabetes. It remains a scandal that so many children are obese. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), is working hard on a plan to tackle those issues.
We must continue to make progress on cancer. We have discussed some of the measures that we need to take, but independent cancer charities say that we are saving about 1,000 more lives every month as a result of the measures that have already been taken. We want to build on that.
We have also talked about technology a number of times today. It will remain a vital priority to achieving the ends that I have described. In the last Parliament, I said that I wanted the NHS to be paperless by 2018. In this Parliament, I would like us to go further and be the first major health economy to have a single electronic health record shared across primary, secondary and social care for every patient. Alongside that, our plans to be the first country to decode 100,000 genomes will keep us at the forefront of scientific endeavour, ably championed by the Minister for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman).
Andrew Stephenson (Pendle) (Con)
I welcome what my right hon. Friend is saying about transforming services. He has mentioned Airedale hospital twice. I thank him for visiting Pendle a few weeks ago, and visiting Marsden Grange, one of my local care homes, where he saw the telemedicine service from the care home perspective. Will he say more about how telemedicine and improved technology in the NHS can help improve patient care?
Mr Hunt
Yes, I absolutely can. Let me give him one specific example. A couple of years ago, I noted a statistic that showed that 43 people died because they were given the wrong medicine by an NHS doctor or nurse. That problem could be avoided if doctors and nurses had access to people’s medical records so that they could see whether patients had allergies and give them the right medicine. The previous Labour Government had a crack at electronic health records. It was not successful, but they were right to try. We have to get it right if we are to have the best health service in the world. I am committed to that.
Steve Rotheram (Liverpool, Walton) (Lab)
The Secretary of State will know that prevention is better than cure. He spoke about parity of esteem for mental health services. I wrote to him last year about a teenager who was threatening to commit suicide. He had been given a counselling appointment through his GP four weeks ahead, even though the kid was saying that he was going to kill himself that day. What will the Secretary of State do about improving counselling services to stop young people wanting to take their life because their appointment is many months away?
Mr Hunt
The hon. Gentleman is right to raise that issue. The previous Minister with responsibility for mental health set up the crisis care concordat, which he got all parts of the country to sign up to, to provide better care. There is a big issue with the quality of child and adolescent mental heath services provision. We want to cut waiting times for people in urgent need of an appointment, so I recognise the problem and I hope that the hon. Gentleman will give us some time to bring solutions to the House.
Bill Esterson
The Secretary of State has spoken of the importance of people’s ability to secure hospital appointments. The same applies to GP services, but when I wrote to him about my constituents’ difficulties in securing appointments with their GPs, he told me that that was the responsibility of NHS England, not his Department. Will he now recognise that he must take responsibility for dealing with the problems of GP surgeries, so that my constituents, and those of every other Member, can make appointments with their family doctors when they need them?
Mr Hunt
I absolutely do recognise that. One of my key priorities is to deal with the issues of GP recruitment and the GP contract, and to make general practice an attractive profession again. If we are to deal with prevention rather than cure, vulnerable older people in particular will need more continuity of care from their GPs, and we must help GPs to provide it.
None of those big ambitions will be achieved, however, if we do not get the culture right for the people who work in the NHS. One of the reasons that Mid Staffs—and, indeed, so many other hospitals—was in special measures was the legacy which, for too long, put targets ahead of patients. We should never forget that Mid Staffs was hitting its A&E targets for most of the time during which patients in the hospital were experiencing appalling care. In that context, Sir David Nicholson used the phrase “hitting the target and missing the point”.
Through the toughest inspection regime in the world, we are slowly changing the culture to one in which staff are listened to and patients are always put first. However, although we identify hospitals that are in need of improvement much more quickly, we are still too slow in turning them around. I know that the new hospitals Minister, my hon. Friend the Member for Ipswich (Ben Gummer), will be looking closely at that, and I warmly welcome him to my team. Like me, he believes it is wrong that we have up to 1,000 avoidable deaths every month in the NHS, that twice a week we operate on the wrong part of someone’s body, that twice a week we leave foreign objects in people’s bodies, that almost once a week we put on the wrong prosthesis, and that people die because they are admitted on a Friday rather than a Wednesday.
We will leave no stone unturned in our quest to make a seven-day NHS the safest healthcare system in the world. Nye Bevan’s vision was not simply universal access or healthcare for all. The words that he used at this Dispatch Box nearly 70 years ago, in 1946, were “universalising the best”, which meant ensuring that the high standards of care that were available for some people in some hospitals were available to every patient in every hospital. Our NHS can be proud of going further and faster than anywhere in the world to universalise access, but we need to do much more if we are to complete Bevan’s vision and universalise quality as well. The safest, highest-quality care in the world, available seven days a week to each and every one of our citizens: that must be the defining mission of our NHS, and this Conservative Government will do what it takes to deliver it.
Andy Burnham
That is exactly the point. When we are in a crisis like this, short-term, knee-jerk cuts are made, which make the situation wrong in the long term.
When I raised these deficits in the election campaign, the Secretary of State said I was scaremongering, but just two weeks after the election the truth emerged. [Interruption.] He says I was, but we now know the truth. There was an £822 million deficit in the NHS last year, a sevenfold increase on the previous year. [Interruption.] The Secretary of State says he is dealing with it. That is not good enough. That is appalling mismanagement of the NHS. Financial grip in the NHS has been surrendered on this Secretary of State’s watch, and things are looking even worse this year. Far from scaremongering, these issues are real and should have been debated at the last election. The NHS is now facing a £2 billion deficit this year. As my hon. Friend the Member for Warrington North (Helen Jones) said earlier, that will mean cuts to beds, to staff and to services.
Mr Jeremy Hunt
The right hon. Gentleman talks about appalling mismanagement. Why did we have that growth in deficits? We had it because those hospitals were, in the wake of the Francis report and the appalling tragedy at Mid Staffs, desperately trying to make sure they did not have a crisis of short-staffed wards. If there was any appalling mismanagement, it was when the right hon. Gentleman was Health Secretary; he left behind an NHS where there were too many wards and too many hospitals that did not have enough staff. We are doing something about that. That is not mismanagement; that is doing the right thing for patients.
Andy Burnham
I am grateful that the Secretary of State has intervened because yet again he has got his facts wrong. Am I not correct in saying that in the first two years of the last Parliament the Government cut staffing further from the levels I left by 6,000? [Interruption.] No, he and his predecessor cut nurse places by 6,000 in the first two years of the last Parliament. Separately, they cut nurse training places, leading to a shortfall in nurse recruitment of around 8,000 in the last Parliament. When the Francis report was published, the NHS had fewer staff than it had in 2010 and fewer nurses coming through training.
The Secretary of State likes to blame everybody else, but how about taking a bit of blame himself for once? He left the NHS in the grip of private staffing agencies, and since the Francis report a small fortune has had to be spent on private staffing agencies. The figures have gone through the roof on his watch and he has failed to do anything about it. That is why people will not believe that the NHS is safe in his hands.