Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 9th February 2016 Commons Chamber

[Mr Hunt]

It is stretching things a bit to call that an austerity-driven problem when, next year, we are putting in the sixth biggest increase in funding for the NHS in its entire 70-year history. There are some severe problems at Barts, but we will tackle the deficit. We also need to ensure that we improve patient safety and patient care.

[Jeremy Lefroy (Stafford) (Con)]

The staff of the University Hospitals of North Midlands to whom my right hon. Friend entrusted the care of County Hospital in Stafford and the Royal Stoke University Hospital have done a great job both in improving the quality of care and in bringing down the deficit. Will he ensure that a long-term approach is taken to the finances of that trust so that we do not make rapid decisions that could result in difficult situations in the future?

[Mr Hunt]

As ever, my hon. Friend speaks very wisely. When we are reducing these deficits and costs, the trick is to take a strategic approach and not to make short-term sacrifices that harm patients. That is why, at the weekend, we announced a £4.2 billion IT investment programme, which will mean that doctors and nurses spend less time filling out forms and more time with their patients.

NHS Trusts: Finances

Jeremy Lefroy Excerpts

Monday 1st February 2016 Commons Chamber

[Ben Gummer]

I thank the hon. Lady, who asked some salient questions that I will address. She asked about the deficits across the system. It is true that there are some particularly challenged providers where the heaviest deficits fall, and they account for the larger part of the accumulated deficit, but it has been a very challenging time across the system, not only because of the demographic challenges facing the NHS that have got worse in every year of this and the previous Parliaments, but because of the effect of the excessive charges of agencies levied after the increase in staffing levels in the wake of Mid Staffs. To seek to address that area, which makes up the majority of the cost of the deficit, we have brought in the controls not only on agency spend—on locums—but on very high salaries and on consultancy spend. Taken together, that will make a significant difference to hospital trust finances.

The hon. Lady talked about public health. We accept that that is a very important part of achieving “Five Year Forward View”. That is why, over the course of this Parliament, we will invest £16 billion in public health across England, to ensure that we can achieve the kind of transformation that she wishes to see.

On GP recruitment, we intend to have 5,000 additional GPs by the end of this Parliament. I am glad to say that Health Education England is so far meeting its targets in filling those training places. I congratulate its chief executive, Professor Ian Cumming, on the work he has done in that regard.

The hon. Lady mentioned safe staffing and the NICE guidelines. During the process of NICE looking at safe staffing levels, it became clear, as the chief nurse identified, that we need to look more broadly at team staffing levels, not just at individual positions on wards. I think that the hon. Lady in particular will understand that. That is why the chief nurse and Dr Mike Durkin were commissioned together to look at and build on the advice of NICE. The safe staffing guidance, which will be released in the next few months, will show a broader and more complex understanding of staffing levels, which I know the hon. Lady will appreciate from her time on the wards.

I want to be clear that that staffing guidance will be signed off only once it has the approval of NICE, Professor Sir Mike Richards, the Care Quality Commission and Dr Mike Durkin, the head of safety and quality at NHS England. It will require their imprimatur.

[Jeremy Lefroy (Stafford) (Con)]

Our experience in Staffordshire is that it takes a medium to long-term plan to put things right. I pay tribute to the work of the staff at the Stafford County hospital and the Royal Stoke University hospital. Will the Minister assure me that any measures put in place, both in Staffordshire and across the country, will take a long-term view and not be driven by the need to cut costs within a financial year? A five-year plan, at the very least, is vital.

[Ben Gummer]

I could not agree more with my hon. Friend. It is important to take a long-term view. That is something that has bedevilled the NHS under all kinds of Administrations since its creation. For the first time, it has a five-year forward view, which means that it can begin to transform properly. The very best trusts in the country, such as that in Northumbria, previously run by Jim Mackey, have been able to do that. We want to bring that kind of excellence to hospitals across England, to ensure that they provide the sustainable staffing and quality levels that my hon. Friend is beginning to see at Mid Staffs after the long-term view taken by that hospital.

NHS and Social Care Commission

Jeremy Lefroy Excerpts

Thursday 28th January 2016 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

It is an honour to follow the right hon. Member for Don Valley (Caroline Flint), my hon. Friend the Member for Lewes (Maria Caulfield), the right hon. Member for Sheffield, Hallam (Mr Clegg) and other Members who have spoken. Excellent points have been made in every single contribution to the debate. One reason why I support the motion is that in my first contribution during this Parliament I said:

“Let us use the five years of this Parliament to set up a cross-party commission to look at health and social care for the next 20 to 30 years.”—[Official Report, 2 June 2015; Vol. 596, c. 524.]

I believed that then and I believe it now.

A substantial reason why I believe that comes from my experience representing Stafford since 2010 and my involvement in the community in the years before that. In the previous Parliament, there was a tremendous coming together of people from all parties in Stafford so that we could protect our health services and respond to the serious problems that we faced. We made proposals to the Government, as well as arguing with them and opposing some of their ideas, but we wanted to support our area’s health services. It was a privilege to be part of a process in which people from all the main political parties and none were putting aside their differences and working together. I know that a similar thing happened in other constituencies, but I was especially grateful that that happened in Stafford, given what we had been through.

Another reason why I strongly support a commission—or a commitment, or a way of bringing us together—is that there are incredibly important issues to decide. My hon. Friends the Members for South West Wiltshire (Dr Murrison) and for Bracknell (Dr Lee) made important points about the issue of specialism and generalism. There is a danger of going too far down the specialist route and thinking that everything must be in a specialty. According to the Royal College of Physicians, this country has something like 62 specialties, yet some of the royal colleges want to go even further. Indeed, I understand that there is a desire further to split up cardiology into interventional and non-interventional cardiology, although I hope that that is not the case.

By contrast, the RCP pointed out that in Norway there were just over 20 specialties—it is a more generalised system. Whereas I agree that specialties need to be concentrated in the way that my hon. Friends have suggested, we must not cast out general medicine. We must not cast out those who would like to work in a more general way in a more localised setting. For many people that can be a more satisfying route, seeing the broad range of health, rather than one increasingly narrow part of healthcare.

[Dr Murrison]

Does my hon. Friend agree that one solution might be to develop further the GPs with specialist interest model, which was started some years ago but, if we are honest, has never really found its place in our NHS?

[Jeremy Lefroy]

That is an excellent point. I declare an interest, being married to a GP. Many GPs are already doing that—many have specialist interests. Perhaps there could be a specialism of generalism, if that is not a contradiction in terms—the idea that it is possible for someone to say, “I want to practise my medical career in a smaller place where I do a wider variety of tasks, but I have the knowledge to recognise the limits of my competence and when to refer onwards.”

I welcome the motion and the commission, although I will suggest some boundaries to it. The points that have been made about not going over old ground and not making the commission’s remit so broad that it is of no earthly use are valid. The Barker report has done some tremendous work in that respect and I will come on to that. There are other reviews going on, which I am sure have not escaped Members’ notice. The maternity review under Baroness Cumberlege, to which I have made a submission, is extremely important.

Here again, we see the contrast. On the one hand, we want the best possible care for mothers, pregnant women and their children when they are born; on the other hand, women want to be as close to home as possible. In some cases, and with midwife-led units, which we have just got in Stafford to replace our consultant-led unit, that can work for a limited number of women, but probably only about 30% of women will be able to go into such units; 70% will have to go further afield. We need to think about whether that is the right model. In the UK the largest unit, I believe, is in Liverpool, with more than 8,000 births a year. In Germany the largest is the Humboldt in Berlin, with about 4,500 births a year. Is there something to learn from that model, from the French model, from the Dutch model? I am hoping that Baroness Cumberlege’s report will show us that and give us a clear path for maternity and newborn care in the NHS.

I welcome the Government’s commitment to fund the five-year plan. That was not an easy step to take, but it was extremely important. As far as I can see, funding has been increased even since the election, but as others have said, it is a very challenging plan. Nobody has ever managed to achieve £20 billion or £22 billion of savings and we are already seeing some potential problems with that. I was lobbied yesterday by community pharmacists, who are seeing potential cuts in the sums allocated, which may result in the closure of pharmacies in the future. Of course, reform is needed, but the Government need to look carefully at that area.

I welcome, too, the additional money for child and adolescent mental health services. I chaired a roundtable of mental health providers in my constituency a couple of weeks ago. The additional money, the first part of which is just coming through, was welcomed and should plug some of the gaps in that service, although there remains an awful lot to do, as the right hon. Member for Sheffield, Hallam so eloquently pointed out.

I shall focus on two areas—integration and financing. At present the two main acute hospitals serving my constituents, the Royal Stoke and the County hospital in Stafford, are full. As other Members have pointed out, this is at a time when we have not had a major flu epidemic or abnormal winter pressures. We have something like 170 beds at the Royal Stoke with patients who should really be out of hospital but cannot leave, and in the County hospital we have around 30 beds. Of course, that means it becomes more difficult for their A&E departments to meet their targets.

I must say that the people in those departments are doing a great job. I urge Members to watch the little online video recorded in the Royal Stoke by The Guardian and see just how hard they are working in a hospital that this time last year was going through a very difficult time. It shows exactly what we are talking about, with people working long shifts and putting patients first, as they are in the County hospital and, indeed, in hospitals up and down the country.

We clearly have a problem in getting people out of hospital. As Members have said, that was raised 10 years ago, but we have still not fixed it. That is a real reason for integration. It is something the commission needs to look at, not to reinvent the wheel, but to look at where things are working and say, “Let’s get this right across the country.”

I think that the supported housing review, which was discussed in yesterday’s Opposition day debate, is critical. If a lot of the funding for supported housing goes as a result of changes to housing benefit, we will see a greater problem, with more pressure on A&E departments and in-patient services.

I very much endorse what Members have said about community matrons and district nurses, who perform a vital role. Only this week my wife was talking about the work of the district nurses in Stoke-on-Trent and how valuable and appreciated it is. However, not many of them are available at any one time, particularly over the weekend, which means a lot of juggling to see when they can go out to see her patients. Members have talked a lot about integration, and they have far greater knowledge than I have. I will just make the point that the commission needs to look at best practice.

I want to spend some time focusing on financing. It is absolutely right that the commission should examine all the options, but I have to say that, having looked at this quite carefully over a number of years, I do not think that we have too many options. I tend to agree with the Barker commission on that. Its report states that there should be a ring-fenced budget for NHS and social care, and it rejects new NHS charges, at least on a broad scale, and private insurance options in favour of public funding.

I have come to that view because I do not think that there is any other way in which the volume of extra resources needed will be raised. At the moment—I stand to be corrected on this—we probably spend between 2% and 3% less of our GDP on health than France or Germany does, which could amount to an additional £35 billion to £45 billion a year that we need to raise and spend.

I have to say that the NHS is a very efficient system. Given that efficiency, just think what would be possible if we came up with that extra 2% to 3% of national income, as our neighbours in France and Germany do. I am not talking about the 18% that the US spends, which in my view is far too much. A huge amount is wasted in the US system, and it does not necessarily achieve the right outcomes, particularly for people who are uninsured—thankfully that is changing as a result of recent reforms—or in lower income groups.

That is where we will run into political problems, which is why it is so important to put it into a cross-party, non-party political commission. In our fiscal system we lump together many different things and call them public expenditure, but what is called public expenditure is, in fact, made up of very different categories of spending. There is spending on state functions, such as defence, policing and education, and then there is spending on individuals, of which the biggest categories are pensions, welfare and, of course, the national health service, yet we are coming to a situation in which we talk about it all as if it is tax. So often in politics tax is bad, yet a lot of this spending is good; the two things do not make sense. In countries such as Germany, the latter forms of expenditure—the more personal ones—are often provided more through income-based social insurance. In the UK we started with that system more than 100 years ago, with national insurance, but over the past 50 years we have allowed national insurance to become less relevant, except in relation to eligibility for the state pension and certain benefits.

[Maria Caulfield]

On finance, I know from talking to my local council leaders that because for the past few years there has been a cap on how much they can raise their council tax by, they have not been able to raise it in order to pay for social care. I speak to residents who say that they would be more than willing to pay more if it was ring-fenced for social care and meant that there were more home helps and more services available. I welcome the announcement in the spending review of the 2% ringfence for social care because the NHS has had to pick up the bill due to the inability to properly fund social care.

[Jeremy Lefroy]

My hon. Friend is absolutely right. In fact, last year Staffordshire County Council raised its council tax by 1.9% but ring-fenced that part for social care, so it was ahead of the game. I believe that it is looking at doing the same this year, possibly taking advantage of the Government’s welcome proposal.

[Dr Philippa Whitford]

My concern about the 2% precept is that wealthy areas will obviously get a lot more money than poor areas, and that will increase health inequalities. Would the hon. Gentleman consider, for example, combining tax and national insurance? National insurance has become an anomaly in that people pay it even when they earn very little and stop paying it when they retire, even if they are very wealthy, so should something more radical be looked at?

[Jeremy Lefroy]

I do propose something radical, but in completely the opposite direction, because I believe that national insurance is an incredibly good thing. I always listen to the hon. Lady with great respect, but let me argue the case for national insurance, and she may disagree with me by way of intervention or otherwise.

We have allowed national insurance to become less relevant, with the exception of the various eligibilities I mentioned. As a result, it has come to be viewed by Her Majesty’s Treasury as just another form of raising funds. There was a proposal for a consultation on merging income tax and national insurance. I would vehemently oppose that, because my perception is that our constituents still, understandably, see national insurance as something different from income tax in being their contribution to the NHS, pensions, and welfare. Indeed, about £60 billion a year of the national insurance money that is raised, although this is a bit of a fiscal fiction, still goes towards the NHS. That is far less than we spend on the NHS, but it is still there.

The notion that, as I contend, our constituents see national insurance differently from income tax was particularly evident when Gordon Brown raised national insurance in order to put additional money into the NHS. He rightly viewed that as the best way of raising additional money for the NHS because it was more acceptable than putting a couple of pence on income tax. The best way—I think the only way, but a commission would need to be very broad-minded in its views—to ensure that we can finance the NHS and social care properly in the long term is through progressive, income-based national insurance with a wider base, as Kate Barker said, whereby by it does not stop when people retire and does not stop at the upper national insurance limit, as it does at the moment at only 1% over it. Broadening the base of national insurance should make it possible to keep the percentage rate reasonable for all while paying for the services needed.

I welcome this motion and the proposal for cross-party work, whether through a commission or whatever, but I would plead that it be fairly focused. It should not cover ground on the details of healthcare that has been well covered elsewhere—probably better than we could cover it—but it should look at integration and, most important of all, future finance for the next 20 or 30 years.

Southern Health NHS Foundation Trust

Jeremy Lefroy Excerpts

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

The hon. Lady is absolutely right. The 30% figure was for people with mental health conditions, not for all adults, but I question why we are investigating only 30%—the highest figure at Southern Health NHS Trust—of unexpected deaths. These were not just deaths; they were unexpected deaths, and it is the duty of medical directors in every trust to satisfy themselves that they have thought about every unexpected death. We must reflect on these serious matters.

The hon. Lady is right about the need to systematise processes when there is an unexpected death, so that we do not have a big variation between trusts. The exercise that Sir Bruce Keogh is doing, going around all the trusts, is about trying to establish a standardised way of understanding when a death is or is not preventable. The hon. Lady has been a practising clinician, so I am sure she will understand that at the heart of this issue is the need to get the culture right. Clinicians should not feel that a trust will take the easy route and blame it all on them, rather than trying to understand the system-wide problems that may have caused a clinician to make a mistake in an individual instance, and that is what we must think about.

[Jeremy Lefroy (Stafford) (Con)]

Behind each statistic is a person and a family, and the Secretary of State is right to say that finger-pointing should not be directed at clinicians alone; it is more important to consider the whole system and the culture in a trust. Will he encourage all trusts, and all medical and nursing schools, to make the Francis report on Mid Staffordshire compulsory reading? There is so much in there that could prevent such occurrences in future.

[Mr Hunt]

No one knows more about the Francis report than my hon. Friend, because of the direct impact that it had on his local hospital, and he is right to talk about that culture change. There is an interesting comparison with the airline industry: when it investigates accidents, the vast majority of times, those investigations point to systemic failure. When the NHS investigates clinical accidents, the vast majority of times we point to individual failure. It is therefore not surprising that clinicians feel somewhat intimidated about speaking out. People become a doctor or nurse because they want to do the right thing for patients, and we must support them in making that possible.

Junior Doctors Contract

Jeremy Lefroy Excerpts

Monday 30th November 2015 Commons Chamber

[Mr Hunt]

My attitude is very straightforward: I need to do the things that will make patients in the NHS safer, and I want to negotiate reasonably with anyone where there is a contractual issue that needs to be resolved. I think that the Government’s position has been reasonable. The vast majority of doctors will see their pay go up, and the pay for everyone else working legal contracted hours will be protected. This is a very reasonable offer that does a better job for patients, but it has been difficult to get through to the BMA. I urge the hon. Gentleman to talk to his friends at the BMA and to urge them to be reasonable and talk to the Government, whereby we could have avoided some of the problems.

[Jeremy Lefroy (Stafford) (Con)]

I thank the Secretary of State and the BMA for their work over the past few days in bringing this matter—I hope—to a resolution, and encourage that spirit in moving forward. May I suggest that the main way in which morale can be restored is to see that both sides are acting in the interests of patients and, in particular, patient safety, which is so vital to doctors and to all of us?

[Mr Hunt]

No one knows more about campaigning for patients than my hon. Friend, as he has done in his constituency, and I congratulate him on that. He is right. There does not need to be an argument on a matter such as this, because it unites the Government in what we want to do to make the NHS the provider of the safest care in the world with what doctors themselves want to do. The best way forward is to put aside suspicion and for both sides to recognise that we are trying to do the right thing for patients, for doctors, and for the NHS.

Antibiotics (Primary Care)

Jeremy Lefroy Excerpts

Monday 23rd November 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Let me begin by congratulating my hon. Friend the Member for Erewash (Maggie Throup) on securing this very well-attended debate on a very important issue. The hour is late, but there are a number of hon. Members in the Chamber, reflecting the importance of the debate, and they have made well-informed interventions. I will attempt to address all the issues raised, but if there is anything I do not get to I will look to write to hon. Members.

This debate is timely. Antimicrobial resistance awareness week, a news item in The Lancet and news from other countries, in particular China, have helped to underline the issue that, on occasion, can sound quite dry. If people wonder what the issue is, it has been aptly illustrated in recent weeks. The prescribing and use of antibiotics has a direct impact on antimicrobial resistance. As my hon. Friend made clear, it is one of the biggest global health challenges we face and I spend a lot of time talking about it to Health Ministers from other countries. The costs of antimicrobial resistance are very significant. The O’Neill review on antimicrobial resistance, commissioned by the Prime Minister, estimates that a continued rise in resistance by 2050 would lead to millions of additional deaths worldwide each year and an economic cost of up to $100 trillion worldwide. This is a really big issue.

My hon. Friend described exactly the problem we face in terms of the appearance and spread of bacteria that are resistant to treatment by current antibiotics, and the threat that poses to modern medicine. She provided some examples of that threat. Without effective antibiotics, medical advances such as organ transplants, and even minor surgery and routine operations, will become high-risk procedures. Procedures we assume can now be done as minor day surgery will suddenly become again a serious threat because of serious resistant infection. Antimicrobial resistance is a global problem that needs to be tackled at a national and global level to ensure antibiotics are used wisely.

As my hon. Friend and others will know, in 2013 we published the “UK Five Year Antimicrobial Resistance Strategy” to address this significant threat. It takes a “one health” approach, addressing human, animal, food and environmental aspects of antimicrobial resistance. The hon. Member for Strangford (Jim Shannon) is, as ever, in his place. On many occasions I disappoint him by saying that matters are England-only, but I am delighted to be able to confirm that this is a UK-wide strategy. We are working on it in close collaboration with Scotland, Northern Ireland and Wales. At the heart of our strategy is the need to use antibiotics more effectively. The key is how we change both public and health professional behaviour, and my hon. Friend described the challenge we face.

The English Surveillance Programme for Antimicrobial Utilisation and Resistance—just another one of those catchy little titles we come up with in the health world—is a very important programme. The 2015 surveillance report shows that general practice accounts for 74% of prescribed antibiotics. The number of antibiotic prescriptions in primary care has declined for the last two years and are now lower than in 2011. However, analysis of the data suggests that although there have been fewer prescriptions, higher doses or longer courses of antibiotics are being prescribed. Total use of antibiotics continues to increase in the NHS, albeit at a slower rate. We still have a significant challenge. It is a challenge for all of us and, as my hon. Friend said, behaviour change is right at the heart of how we tackle the problem, both for those who prescribe and for those who use antibiotics—both are crucial to our response.

In August, the National Institute for Health and Care Excellence produced its stewardship guidelines for the health and social care system, which covered the effective use of antimicrobials, including antibiotics. We understand the pressures, as have been well described here, that primary care prescribers face every day. We know, as my hon. Friend the Member for Torbay (Kevin Foster) illustrated, that sometimes people expect to leave their doctor with a certain prescription, even if it is not the right thing. To support GPs, therefore, we have been working with the Royal College of General Practitioners to provide them with suitable tools to reduce levels of inappropriate prescribing.

Last week, research by Antibiotic Research UK found that doctors prescribed 59% more antibiotics in December than in August, despite many of the illnesses treated by antibiotics not being seasonal. That, too, touches on the challenges. One of the key resources doctors have at their disposal is TARGET—treat, antibiotics responsibly, guidance, education, tools—which is hosted on the RCGP website and aims to increase primary care clinicians’ awareness of the importance of antimicrobial resistance and responsible use. Health Education England continues to work with Public Health England to ensure that the competence and principles of prescribing antimicrobials are embedded throughout the professional curricula.

In a recent trial, the chief medical officer, Dame Sally Davies, wrote to a sample of high-prescribing GPs in England, explaining that their prescribing rates were significantly higher than those of other similar GPs and asking them to reassess their prescribing protocols. This intervention resulted in a 4% reduction in levels of prescribing in those practices. That is encouraging and more trials are planned. I put on the record the gratitude of this Government and Governments around the world to Professor Dame Sally Davies for the work she has done in spearheading not just our national AMR campaign but the international campaign. I have watched her galvanise whole countries to action on this subject. We are extremely lucky that she is leading the charge.

NHS England’s introduction of a quality premium on antibiotic prescribing for 2015-16 is another significant step. The purpose is to act as an incentive to reduce levels of antibiotic prescribing in both primary and secondary care. We are encouraged by the early results and expect a reduction in levels of antibiotic prescribing in the next set of data covering 2015-16.

We are not overlooking the consumers of antibiotics: the public. We need to improve their understanding about their appropriate use and are active participants in European antibiotic awareness day, which has just passed and which looks to engage the wider public. My hon. Friend the Member for Erewash highlighted the extremely important antibiotic guardian programme. We have set a target to reach 100,000 antibiotic guardians by next March. We also urge all colleagues—this is where MPs can be extremely helpful—to bring this up with their local NHS. If they ask about it, people will realise its importance, so I ask them to do so as part of their routine contact with local NHS institutions.

Public Health England, working in conjunction with the RCGP, has developed a range of patient information materials to help them think about how they care for themselves when they have a self-limiting infection, such as a cold, and when to consult a health professional. Critically, my hon. Friend referred to diagnostic testing, particularly the C-reactive protein test. I understand her frustration—sometimes it feels like things move rather slowly—but I hope that the attention the strategy has received illustrates our desire to move faster. In fact, the driving force behind the UK-wide strategy is about gearing up the whole health system to react more quickly.

Most antibiotic prescribing is done in the absence of a test to determine the nature of the illness and whether an antibiotic prescription is likely to help. Making better use of technology is a key part of our work. Greater access to and use of rapid diagnostic tests will help us to avoid unnecessary treatment and provide more targeted treatment where infections are diagnosed, which, of course, will mean better outcomes for patients.

[Jeremy Lefroy (Stafford) (Con)]

My hon. Friend might note that, in the case of malaria, the introduction of rapid diagnostic tests has substantially reduced the inappropriate use of important antimalarials.

[Jane Ellison]

That is an excellent illustration of the potential of rapid diagnostic tests, and of course we had exciting news on malaria recently.

In December last year, NICE recommended that GPs should consider carrying out C-reactive protein testing for people presenting in primary care with symptoms of lower respiratory tract infection if, after clinical assessment, a diagnosis of pneumonia has not been made and it is not clear whether antibiotics should be prescribed. I understand that the test is increasingly being used in primary care, although the evidence for its use is mixed and the role of normal clinical diagnosis remains critical.

We want the right test available in the right place, from patients’ homes and the high street to primary and secondary care. That work is being undertaken as part of the implementation of the UK antimicrobial resistance strategy. To further develop the use of diagnostics in clinical practice, we are investing £1.3 million of research funding through the National Institute for Health Research. That research is being undertaken by Cardiff University, focusing on GPs’ use of the C-reactive protein test to help to target antibiotic prescribing to patients with chronic obstructive pulmonary disease. It will be interesting to see how that research goes, and I am sure we will return to it.

In addition to the important work to improve appropriate prescribing, we should not forget the vital role of infection prevention and control—it was good to hear my hon. Friend the Member for Erewash note that. We have made significant progress, with dramatic reductions in some infections in recent years, but there is always more to do. We can make a significant contribution to that agenda by improving our ability to prevent infections in the first place. That includes work with NICE to develop clinical guidance and best practice information.

We have strengthened the code of practice on the prevention and control of infections to clarify for providers the measures needed to ensure effective infection prevention and antimicrobial stewardship. We will also improve infection prevention and control by introducing an indicator, as part of local antimicrobial resistance implementation plans from April next year, to help CCGs. That will be another good opportunity, from the spring, to ask CCGs how their plans are going and whether they can explain what they are doing locally. It was good to hear Erewash CCG being cited. I am sure my hon. Friend will hold its feet to the flames, as will others.

Let me touch briefly on the international scene. It was good to hear my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) talk about India. I had the pleasure of talking to the Indian Health Minister about this very topic at the World Health Assembly in Geneva in May. Tonight’s debate is not about the international aspect, but I would be delighted if any Member wanted a debate focusing on that, because the UK can be proud of our record in that regard. To give one example, as part of our focus on global antimicrobial resistance, the UK has committed £195 million over five years to the Fleming fund, which will support antimicrobial and infectious disease surveillance in developing countries, where we know drug resistance has a disproportionate effect. We were delighted to see all 194 member states agree to the World Health Organisation’s global action plan at the World Health Assembly earlier this year. The Government are now working towards the UN General Assembly in 2016 and are continuing to champion this agenda there.

Let me conclude by reaffirming our commitment to delivering improvements in the way antibiotics are used in the NHS. I take the challenge that my hon. Friend the Member for Erewash has highlighted and we will make sure that the NHS hears that from tonight’s debate. The work we have undertaken, and are continuing to undertake, means that we now have significantly better data and information on how antibiotics are used in both primary and secondary care, but we have much more to do. I welcome tonight’s debate as a reminder of the task that lies ahead of us.

Question put and agreed to.

NHS (Charitable Trusts Etc.) Bill

Jeremy Lefroy Excerpts

Friday 6th November 2015 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

I rise in support of this Bill, which has been promoted by my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton).

I simply wish to make one point about the enormous role that charities and volunteers play in hospitals, particularly those such as Great Ormond Street. I recall that when I was growing up in London my parents used to offer accommodation to the parents of children who were at Great Ormond Street because, as many speakers have said, these people would come from all over the country and accommodation in London, even then, was expensive—now, of course, it is extortionate. Therefore, it is vital that hospitals, particularly children’s hospitals, can accommodate parents, siblings and loved ones in order that they can be close to their children in these times of need. That is why it is so important that whenever we are looking at the movement of hospital services for children, as is happening in my constituency with some in-patient services going north to Stoke or south to Wolverhampton, real consideration is given to providing full access to the children for relatives and loved ones at all times of day or night, with proper accommodation being provided, whether by volunteers in the community or by the hospital trust itself. It is often the role of these charities, as well as the hospital itself, to do that.

I welcome this Bill and all the work done by the charities linked to all the hospitals mentioned today, particularly Great Ormond Street. They do a tremendous job and it is vital that this Bill is enacted at the earliest opportunity.

--- Later in debate ---

[Mr Rees-Mogg]

I am grateful to my hon. Friend for making that point; occasionally there are innovations that are welcome, and this is one of them. For those who do not know, I should add that in the draw No. 1 used to be done first but now No. 20 is the Bill done first. It is like a game show: it brings more tension and atmosphere into the proceedings. That is how it has worked and how the Bills have come out in the way they have.

This is a superb Bill. It is the reason why private Members’ Bills exist, because it is deregulating. It is such a wonderfully Tory Bill. It is a properly Conservative Bill, because it takes—[Interruption.] I am so sorry, but I could not quite hear what the hon. Member for Newport West (Paul Flynn) was saying from a sedentary position. I am happy to give way if he wishes to intervene.

Why is it such a wonderfully Conservative Bill? It is because of its fundamental deregulatory nature. We have built up a state where more and more powers have been gathered to the centre, where Whitehall has the rule over all it purveys. It tells people what they must do. When it says jump, people have to say, “How high?” It was of course a Labour Cabinet Minister who said, “The fact of the matter is the man in Whitehall really does know best.” It has to be said that that was in 1947, but the fundamental principle underpinning what the socialists believe remains the same: that control should be centralised; that if instructions and diktats come from on high, the government of the country will be better run; and that individuals are not the people who can best take charge of this.

We, as Conservatives, reject that fundamentally, and it is this philosophy that underpins the Bill. We take the view that the millions of random decisions taken by individuals over how they should lead their lives means better decision making, better allocation of resources and a more contented and unified society overall. By taking power away from the Secretary of State—removing appointments from his control—the Bill allows every charity across the country that is involved in supporting the health service to set out what is appropriate for its community, for its region, for its county and for its area. In Somerset, we may well want different approaches from that which is suitable for the centre of London. Different approaches will be wanted in Dorset, Devon, Sussex and Surrey. Even in Gloucestershire they may have some thought as to how they wish to approach these things. [Interruption.] And in Hampshire, that fine county. Hampshire, one of the great counties, which was on the right side when Alfred beat Guthrum, is always to be admired in these contexts. These charities will decide what is appropriate and suitable for them, how they appoint and whom they have.

One of my colleagues speaking earlier, I believe it was my hon. Friend the Member for Torbay (Kevin Foster), was talking about the risk that people would be appointed for nefarious political purposes, and of course that is what has always happened. In the 18th century, it was called jobbery. I always thought that was a good word because it so nicely encapsulates what happens as we get that corruption of baubles. The Government are the owner and disperser of baubles, and there is a corruption built in, as they give those baubles, initially, not to their friends specifically, but merely to those who are not opposed to them. In the case of somebody who is opposed, it would be “going too far” to allow an appointment to be made by the Secretary of State. It really “would not do” to appoint somebody on the other wing of politics.

[Jeremy Lefroy]

My hon. Friend shares my dislike of overweening Executive action. Does he agree that sometimes in this place, particularly on Report, too little time is given to Members to allow us to discuss the kinds of thing that the Executive wish to impose on us centrally?

[Mr Rees-Mogg]

I have great sympathy with what my hon. Friend says; it is so important that we have enough time. It is why Fridays are such a pleasure, because there is time to discuss a Bill in full and in the round, and to consider the principles underpinning it, the details of it, and what would happen to it if it were to be brought into effect. That is proper parliamentary procedure. I have such admiration for those great heroes of the 19th century—[Interruption]—talking of which I give way to my hon. Friend the Member for Beckenham (Bob Stewart).

Junior Doctors’ Contracts

Jeremy Lefroy Excerpts

Wednesday 28th October 2015 Commons Chamber

[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]

My hon. Friend is absolutely right. The fact is that this is a package designed to ensure that we eliminate the weekend effect, and it involves both junior doctors and consultants, because they both have their part to play.

NHS Reform

Jeremy Lefroy Excerpts

Thursday 16th July 2015 Commons Chamber

[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.

NHS Success Regime

Jeremy Lefroy Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

I welcome my hon. Friend to her seat. I hope to make a whole series of visits soon and I will certainly talk to her about her hospital. She will have noted that the very first speech given by my right hon. Friend the Prime Minister was about the NHS. That reaffirms our commitment to the NHS. We were the only major party to commit to the NHS’s own plan for success over the next five years. That is why the Conservative party, to be frank, is the only one that can now be called the party of the NHS—[Interruption.]

[Jeremy Lefroy (Stafford) (Con)]

Will my hon. Friend confirm—[Interruption.]

[Mr Speaker]

Order. I want the hon. Gentleman to be heard.

[Jeremy Lefroy]

Thank you, Mr Speaker. Will my hon. Friend confirm that at the heart of the success regime will be the provisions of the Health and Social Care (Safety and Quality) Act 2015 on integration and quality?

[Ben Gummer]

It must have been a great pleasure for my hon. Friend to have taken personal possession of the 2015 Act, which he helped steer through Parliament and piloted himself. It is a significant contribution to the cause of patient safety, which lies at the heart of the Government’s vision for the NHS.