Mental Health and NHS Performance

Lord Walney Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

With respect to the hon. Lady, who I know cares passionately about the NHS and often asks me questions about it, we now have 11,400 more doctors and 11,200 more nurses in the NHS than in 2010. We protected the NHS budget in 2010, when her party wanted to cut it, and we promised £5.5 billion more for the NHS than her party was prepared to promise at the most recent election. Her characterisation of this Government as not being prepared to back NHS staff is utterly absurd.

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

The Prime Minister’s focus on mental health today is welcome, but does the Secretary of State accept that we will achieve parity of esteem only if we are prepared to accept how far we currently are from it? It is not a recent problem: the lack of recognition for mental health dates back to the inception of the national health service and is driven by our culture and choices as a country, rather than by any particular Government. Nevertheless, does the Minister accept that even the measures set out today, each of which is welcome in and of itself, will only really provide a sticking plaster for the problem? As it stands, on current progress, we are looking at having to wait decades before we achieve parity of esteem for mental health conditions.

[Mr Hunt]

I thank the hon. Gentleman for his interest in that issue. Sometimes, this is a challenging area. We legislated for parity of esteem, with cross-party support, in 2012. The danger is that such a concept can be nebulous, which is why we asked Paul Farmer, the chief executive of Mind, to look independently at what would be reasonable, fair and sensible progress towards parity of esteem by 2020. He said that he thought it would be a 10-year process, but that this was the right ambition for 2020. It was his report that the Prime Minister accepted this morning. We are making progress against benchmarks that independent people have looked at. The hon. Gentleman is right to say that we will not get there by 2020, but we must make sure that we deliver on that commitment while he and I are both MPs.

CQC: NHS Deaths Review

Lord Walney Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

I absolutely do so. I know that the family of David Hinks have campaigned very strongly on this matter. The key point about families is that they are often the people who know best what happened to individuals when something went wrong, because they saw the care at every single stage. Whether the care took place in a care home, hospital or a GP surgery, families are likely to have seen the whole thing, and can really help us to understand what might have gone wrong. They are therefore a positive force in this process.

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

I am so pleased that the Secretary of State took the time to praise James Titcombe and other campaigners in my constituency who have done so much to help to break down the culture of secrecy and cover-up that has afflicted too many of our trusts. The right hon. Gentleman deserves real credit for his determination, and I hope that the tone he has struck today will last and that we do not go back to the accusatory and vindictive tone that, I am afraid, too often marred discussions about this during the last Parliament. Finally—thank you for your indulgence, Mr Speaker—will the Secretary of State say more about the tension between the families’ desire for individual accountability and the need to encourage a culture of openness in which people can come forward?

[Mr Hunt]

In fairness to the hon. Gentleman, he makes two important points. I know that he worked very closely with James Titcombe, who is one of his constituents.

We are now learning the right way to deal with the tension between accountability and having a learning culture. Essentially, this boils down to an understanding that 98% of the time a mistake is made because of a systems problem—a structure or a framework that did not enable a doctor or a nurse to operate to the best of their ability—while 2%, 1% or perhaps even less of the time it is a case of genuine negligence by an individual that deserves full accountability. When we understand it in that way, we start to realise that the first thing to ask is what could be changed in the system, but if we uncover bad behaviour by individuals—there are 1.3 million people in the NHS, so it is obviously going to happen at some stage—then there of course needs to be full accountability.

On the tone of these exchanges, let me say something optimistic: I really do believe that the NHS can become the safest, highest-quality healthcare system in the world. That would be welcomed by the Labour party, as the party that was in power when the NHS was set up, and we would welcome it as part of our absolute commitment to higher standards in public services. There is no country in the world that is even considering what we have announced today, which is to ask hospitals to publish the number of their avoidable deaths on a quarterly basis. It is a very big step that can happen in a system built around public service.

Social Care

Lord Walney Excerpts

Wednesday 16th November 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. Although this afternoon’s debate is about the social care system, the sustainability and transformation plans are a critical part of the long-term solution for financial efficiency and for improving the quality of care.

I congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on introducing this debate, which is the first Opposition day debate that she has led. I also pay tribute to the fact that she has had a long-standing interest in these issues. She has asked me questions about the social care system on many occasions. She was particularly right to focus on the impact on the NHS, which is real, and on the impact on family carers, which is also real. She talked about Susan and about the impact on people who are finding that they are giving more hours of care than they were planning or are sometimes even able to give. That is something of which we must all be aware. She asked me to answer a direct question: do I recognise the scale and seriousness of the issues faced by the social care system? The answer is, yes, I do. I want to try to address, as comprehensively as I can, some of the substantive issues faced in the social care system.

Let me start by saying that, although today’s debate and the majority of the hon. Lady’s comments were around funding, the issue is not only about funding. The hon. Member for Chesterfield (Toby Perkins) mentioned that social care is not just about older people. In 2011, we had the shock of what was uncovered at Winterbourne View by a BBC “Panorama” programme. We have had a number of examples of horrific abuse at care homes. The Ash Court Care Home case in Kentish Town was one that came to light in 2012. The abuse there was filmed by a relative on a hidden camera. Those issues were primarily not about funding, but about cruelty—a strong word—that we have tolerated in our system. We have had some very significant policy responses since then, which are making a real difference. The first is that this Government, under the coalition, introduced the toughest system of care home inspection in the world.

We often talk in this House about the work of the chief inspector of hospitals, but I wish to pay tribute today to the work done by the chief inspector of adult social care, Andrea Sutcliffe, and her team. She has completed the inspection of nearly 90% of care homes and domiciliary care services. It is encouraging that, despite the pressures that we have been talking about this afternoon, 72% of the places that she inspected were good or outstanding. More importantly, the 28% that are not are the 28% that we know about and are therefore able to do something about.

I take issue with the way the shadow Health Minister presented her findings. She said that a quarter of the inadequate places were unable to improve following re-inspection. However, the reality is that more than three quarters of places that got an inadequate inspection did improve, which is a huge step forward from where we were a few years ago when we did not know where those places were and when there was no change happening at all.

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

The Secretary of State is right to highlight the need to improve standards and the need for a rigorous inspection regime, but—taking on board what his former ministerial colleague, the right hon. Member for North Norfolk (Norman Lamb), said—does he accept that even if every single care home in the country reached the appropriate standard, there would still be a care crisis? There is not sufficient funding in the system to make it work. Will he agree to work with all parties to do what we should have done many years ago—before the general election in 2010, as he will recall—and get a grip on the issue and, as a country and as a House, try to sort it out?

[Mr Hunt]

I am more than happy to work with people of all parties to come to a sensible consensus. The one thing that unites all the major parties is a commitment to the NHS and social care system. With respect to the other issues, it is not just about rooting out poor care. It is also about something that the hon. Member for Worsley and Eccles South mentioned earlier—giving a career structure to people who work in the care system and giving them recognition. That is why in April last year we introduced the care certificate, which is based on achieving 15 standards. It is a voluntary system, but the CQC inspects against it, so there is a strong incentive for care providers to get their staff enrolled for the care certificate. I pay tribute to the work done by Camilla Cavendish, who did a lot of thinking and had a long-standing interest in this issue in her time as a journalist and at No. 10, and on whose proposals we are basing our work in this area.

World Autism Awareness Week

Lord Walney Excerpts

Thursday 28th April 2016 Commons Chamber

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

I will try to reduce my speech to below five minutes to give others a chance to speak in this excellent debate, Madam Deputy Speaker.

[Jess Phillips (Birmingham, Yardley) (Lab)]

Thank you.

[John Woodcock]

You are welcome.

We have heard erudite contributions in the debate so far, and I just wish to make two main points. The first is on understanding the scale of the problem. People have talked at length about this, giving some excellent examples, but I want to go further on the fact that we are still far from seeing the true scale of the autism problem in our country. This is partly because although recognition is growing, it remains insufficient among members of the community. It is also because of the number of worrying ways in which the true extent of the lack of capacity in local services is being hidden, and I hope the Minister will take up that point; the extent to which people are being denied is also being masked. The hon. Member for Glasgow East (Natalie McGarry) talked about the long referral times, way beyond the recommended limits. In Cumbria, the time taken is even longer than the average, which shows the problems.

I wish to relate some of the concerns that parents of autistic children consistently raise in their local support group, and when talking with charities and directly to me. They suggest that even the acknowledged level of deficiency of the service does not reflect the true picture. They tell of their repeated frustration at contact just being ignored and how difficult it can be to get service practitioners even to pick up the phone. That is not properly documented. If people cannot even get on the waiting list to be seen, or they cannot get their request to be acknowledged because their contact is not being acknowledged, the problem is even bigger than is stated. Particularly worryingly, parents have a strong sense that people will tell them orally that the service is not sufficient for them but will refuse to put it in writing in a way that could allow them then to escalate it through the system. I would like the Minister to reflect on that and say whether he believes that that is a genuine problem and whether it is a wider problem.

My second point is about my pride in what my constituency has been able to contribute to the wider awareness debate. First, I should mention “The A Word”, which many hon. Members doubtless watch, as it is filmed in Broughton-in-Furness, in the north of my constituency. As Members will see from the programme, it is a fabulous place to go. I commend all involved in that programme for doing important work in a mainstream, prime-time BBC programme that is getting the message out in a really effective way.

I have delayed my congratulations to the right hon. Member for Chesham and Amersham (Mrs Gillan), but I thank her for the way in which she has engaged with my constituent Deborah Brownson, who has produced an excellent book. It is a children’s guide to autism called “He’s Not Naughty”, which she is trying to get into every school she can. I want to thank the Mayor of Barrow, who has financially facilitated, just yesterday, getting it to all the schools in the borough. Ministers on the Front Bench are asking for personal copies, and I would be delighted to help in doing that. I ask anybody listening to this debate who can contribute to her financial drive to get this illustrated book to other schools to do so—all we need is the postage and some of the printing costs covered. It is an excellent illustrated guide that will explain to children just what is going on in the minds of autistic—[Interruption.] I am afraid that I have completely failed in my task and I am on my last five seconds.

Junior Doctors Contracts

Lord Walney Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for what she says about consultants in her local trust and, indeed, up and down the country, as well as nurses, paramedics and many other people who will be working to keep the public safe. I salute all of them. She is absolutely right: those leaked emails show that those on the junior doctors committee know that had they been prepared to negotiate on Saturday pay we would not have had an imposed contract, so it was completely in their hands to avoid this outcome. They chose not to do that; they wanted war. That was a totally irresponsible thing to do. They need to recognise that the way we will build a safer NHS is by sitting round and talking to a Government who want to create it.

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

Why does the Secretary of State suspect the motives of his former ministerial colleague, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter)? Why has he taken to Twitter to accuse him of political opportunism?

[Mr Hunt]

My hon. Friend—the one Conservative who signed up to that proposal—when he was Health Minister proposed a contract that was much tougher on junior doctors than the contract we have ended up introducing. This has been a very interesting U-turn on his part.

NHS: Learning from Mistakes

Lord Walney Excerpts

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

I feel prompted by my hon. Friend’s question to investigate what I am sure is excellent practice at St John of Jerusalem eye hospital. If I may, I will take away her very good point about exit interviews. We also heard a good point about agency staff. Part of the thing that inhibits a learning culture is if a large percentage of staff are in an organisation only on a provisional or temporary basis, rather than being part of regular teams and therefore not being able to transmit lessons learned. That is why we have to deal with the virus of an over-reliance on agency staff in some parts of the NHS.

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

May I gently ask that the Secretary of State, if he is going to list Morecambe Bay in a litany of things to bash the previous Government over the head with, to do so while also acknowledging that the situation continued for some time under his Government and is still taking some time to turn around?

I wholeheartedly welcome the Secretary of State’s focus on patient safety and his overall approach, and I pay tribute again to the Morecambe Bay campaigners, who have done so much to trigger this improvement. However, does he share my concerns about trusts such as Morecambe Bay being forced, for a number of reasons, including for safety, to use a large number of agency staff, and about the difficulty in changing culture when that staffing situation persists?

[Mr Hunt]

Let me commend the staff at Morecambe Bay, who have been through a very difficult patch. The trust has now exited special measures, which is a very exciting step for the trust, and there has been a huge amount of work to make that possible. It feels to me that they really have turned a corner at Morecambe Bay, and we should support the staff, who have done a great job in that respect.

The hon. Gentleman raises an important point about agency staff. In particular, it is challenging to get permanent recruitment to more geographically isolated places—we find that that is a problem not just at Morecambe Bay, but across the country. However, sometimes, it can be false comfort to get in large numbers of agency staff, as not only are they extremely expensive, but they cannot offer the continuity of care that is at the heart of a safer culture, so we have to find better ways to support places such as Morecambe Bay further to improve safety.

NHS Reform

Lord Walney Excerpts

Thursday 16th July 2015 Commons Chamber

[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.

Health and Social Care

Lord Walney Excerpts

Tuesday 2nd June 2015 Commons Chamber

[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 understand that geographical isolation is a particular issue and may have led to some of the problems at the trust that the hon. Gentleman and I have discussed on many occasions. We need to be sensitive to that in helping the standard of services to improve going forward.

--- Later in debate ---

[Jane Ellison]

I am sorry that I was not in the Chamber for the right hon. Gentleman’s speech. I was briefly attending a meeting of directors of public health, but I know he asked a specific question about the turnaround plan in his area. I believe it has been presented to the new governing body of Devon CCG, but I am happy to pick up the detail. As he says, we have debated the issue.

On the deficit in the NHS, my right hon. Friend the Secretary of State for Health responded in great detail in his opening address, but the thing about NHS finances that the Labour party never gets its head around is that, yes, they are under pressure, but one has to have a long-term plan for how to address that—plans for integration, out-of-hospital care and prevention. One has to be able to say—[Interruption.] The hon. Member for Denton and Reddish asks where the money will come from. That is a question the electorate asked the Labour party all the way through the election—that was the No. 1 question the electorate of this country asked the Labour party, and answer came there none.

I am proud of the work we have done in the past five years, in which the NHS has built capacity and improved the care it delivers. It is worth reiterating the facts that my right hon. Friend the Secretary of State gave at the beginning of the debate. The NHS is now performing more than 1 million more operations; it has 9,400 more doctors and 7,700 more nurses; it sees, treats and discharges more than 3,000 more people within four hours every single day. By the end of the last Parliament, public satisfaction with the NHS was up 5% and it was deemed the best performing health system in the world by the Commonwealth Fund.

[John Woodcock]

The Minister is being very accurate and precise about the figures for the NHS. Would she mind answering the shadow Minister’s question about the cancer targets for next year?

[Jane Ellison]

I have already responded to that issue. One would think that Her Majesty’s Opposition would have learned by now that to constantly denigrate the things the NHS does so well in pursuit of making political points does them no service at all.

There is a great track record for the NHS in the face of growing demand and tight financial pressures, but the NHS cannot go on treating more people at this rate. We need to move up several gears in prevention. If we prevent avoidable ill health, as well as enhancing the lives of so many of our citizens, we will get more out of the precious resources available for the NHS. In that vein, we are transforming access to GP and out-of-hospital care. It is all about relieving the pressures that we know exist in the health system and building on our work to bring about full parity between physical and mental health. Those measures will help us to ensure that people get the right care at the right time in the right place, and bring prevention to the fore.

The right hon. Member for Leigh asked specifically about the Bill on professional regulation. I can confirm that the Government remain committed to taking forward recommendations for reformed legislation on regulation of the health and care professions. Work is being done on that important piece of business.

My hon. Friend the Member for Totnes (Dr Wollaston), the former Chair of the Health Committee, and others welcomed our announcement of a clampdown on agency pay. That goes to the heart of how we tackle financial pressures in the NHS. She also asked how agency rates will be set. It will be done on a local basis, agreed by providers and taking into account local circumstances and the regional labour market. Restrictions will not apply to internal “bank” staff—that was one of the specific questions she asked—which we see as a better and cheaper alternative to external agencies.

I said that it was important to get serious about prevention. As the Public Health Minister, I am delighted to see prevention right at the heart of the NHS’s own plan, the plan that we on the Conservative Benches are backing: the Five Year Forward View. We know that to ensure that our NHS is sustainable in the long term, we need to stop many people getting ill in the first place and ending up in hospital, so prevention is key. As the party of aspiration, we want everyone to achieve their potential and get on in life, for themselves and their family. Preventable ill-health and the burden of disease are a barrier to this and can hold people back. As we heard in many of the maiden speeches today, it is a burden that falls disproportionately on the most deprived communities. One of the frustrations that we on the Government Benches often feel is that it is not recognised by the Opposition that tackling health inequalities is something that we all feel passionately about. Improving the health of the most deprived communities in our country is a key part of tackling inequality in our society.

Maternity Services (Morecambe Bay)

Lord Walney Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Mr Hunt]

I am happy to do that. In fact, I can not only tell my hon. Friend what we are going to do, I can tell him what we have done. The main purpose of the new CQC inspection regime, with a chief inspector of hospitals and a special measures regime, is to make sure that these issues come to light much more quickly. The new regime has been very active: 20 trusts—more than 10% of all trusts in the NHS—have gone into special measures. We have seen dramatic improvements.

I would like to make a broader point to my hon. Friend’s constituents. He speaks very wisely when he says that this is not about the dedication and commitment of front-line staff. He is absolutely right. The Royal Lancaster infirmary is not the main focus of the Kirkup report, but of course as part of the same trust it suffered from the same management failings. There are Members of this House who have had problems at the Royal Lancaster infirmary and found that they were not listened to when they made complaints, because proper management was not in place. That will have affected his constituents. I hope they will take encouragement from the changes that have happened recently in that regard.

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

I thank the Secretary of State for the dignified and fitting way in which he was able to name some of the grieving parents and the babies they lost. We cannot escape the painful conclusion from the report that our hospital was compromised by some shocking failures in care and a deeply inappropriate defensiveness from certain individuals. Does he agree that the scale of failure laid out in the report may well serve to reopen the criminal investigation? Will he support the healing process that is now needed in our community, with resources if necessary, so that we can move on from this? Finally, will he set out a timetable by which he will look through all the recommendations and report back to the House on whether the Government will accept them? Will that be before the election?

Francis Report: Update and Response

Lord Walney Excerpts

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

I add my congratulations to my hon. Friend, who makes an important point. The heart of the problem of whistleblowing is the confusion between employment law and patient safety. We need to divorce those two things and put in place a proper procedure to ensure that the right thing happens if someone raises a concern about patient care, and that it can be externally investigated to ensure that the trust did the right thing. Issues of employment law and someone’s professional behaviour should be pursued on a completely different track—those things are rightly and properly a matter for the courts. It is precisely because of the kind of issue he talks about that people are afraid to speak out. They worry that if they do, even if they win at an employment tribunal, they might never get a job again. For that reason, we welcome the shadow Secretary of State’s commitment to work with us and put on the statute regulation-making powers making it illegal for NHS organisations to discriminate against former whistleblowers.

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

The Secretary of State and I spoke last week about the importance of the upcoming Kirkup report. Grieving families in my constituency want to be able to move on from the tragedies they have suffered and see proper change in the culture at Morecambe Bay. What happened was not right and is still under criminal investigation. Will the improvements the right hon. Gentleman has announced today be in place when the report is published, and does he agree that the response to it must be neither whitewash nor witch hunt? If he does, how can he help make it happen?

[Mr Hunt]

I thank the hon. Gentleman for the close interest he has shown in this issue and the constructive way in which he has engaged with families locally to try to get to the bottom of a really terrible tragedy. He puts it better than I could. We need to implement the recommendations in a tangible and real way so that something actually changes, but we do not want to do it in a way that has unintended consequences. That is why the focus of what Sir Robert is saying this time is not about new criminal sanctions. Although the law has a role—we changed the law on wilful neglect, for example—this is about creating a supportive culture through which people want to listen and learn when others speak out. Of course, if people do not, there should be sanctions, but that should not be the primary motivator.