Junior Doctors Contracts

Lord Soames of Fletching Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

I think that sums up the difference between the two parties. It is true that Labour would take “as long it as takes” to negotiate the changes, which is why we ended up with poor contracts in 1999, 2003 and 2004. After three years of trying to get reforms to contracts to make the NHS safer for patients and better for doctors, we need to proceed with a manifesto commitment. Ministers have to decide and act as well as talk. We did not choose this outcome and tried hard for a negotiated decision, but when the hon. Lady says that talks should go on for “as long as it takes”, she is actually saying that the other party has a veto over change. No one should have a veto over an elected Government’s manifesto commitments.

[Sir Nicholas Soames (Mid Sussex) (Con)]

One thing that the whole House can agree on is that the postponement of treatment or operations is never cost-free for patients. Every hospital has an ethics committee, so does my right hon. Friend agree that all striking doctors should consult their hospital’s ethics committee? Does he agree that the removal of emergency cover by any doctor for industrial reasons would be unlikely to meet with the approval of any medical ethic committee? Finally, does he agree that it is unacceptable for any doctor to act unethically, and that that would place him or her in serious jeopardy?

[Mr Hunt]

My right hon. Friend speaks wisely. A whole chorus of senior doctors, from Professor Sir Bruce Keogh to Dame Sally Davies to Lord Darzi, have urged doctors to think hard about the ethics involved. My right hon. Friend is absolutely right to say that consulting the ethics committee in the trust is a wise thing to do. Doctors might also take note of what the General Medical Council said about it being increasingly difficult to justify the withdrawal of emergency care and about the ethics involved. In the end, this is a personal decision for doctors, and it is about whether it is right to withdraw emergency care from patients in an industrial dispute about pay. This is a bridge that the NHS has never crossed before. It is a very big decision, not only for the NHS, but for every single doctor inside it.

NHS (Five Year Forward View)

Lord Soames of Fletching Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

I hope I can reassure the hon. Lady, because today’s announcement includes £1.5 billion extra for the NHS front line next year. That will include mental health services, and we would expect commissioners to observe parity of esteem as they decide how to allocate those additional resources. It also includes £1 billion to improve primary care facilities, which will be used by many mental health patients. There is a lot in today’s announcement that I hope will relieve pressure. She is right to say that we need to do better on child and adolescent mental health services. This has been a long-standing problem, but we have been taking forward some important work to make a reality of our commitment to parity of esteem, which is something we are very proud to have legislated for.

[Sir Nicholas Soames (Mid Sussex) (Con)]

May I report to my right hon. Friend that, despite the dismal rant he heard from the shadow Secretary of State, the Princess Royal hospital in Haywards Heath and the Royal Sussex county hospital in Brighton, and their doctors and nurses, are doing a magnificent job in treating local people? Will he also accept that the problem with mental health services in this country goes back a long way? It will not be fixed overnight. I have had the same problem in my constituency of someone being put in a police cell. The problem fell entirely on the staff of the local trust, who simply did not deal with the matter properly. This is going to take a long time to fix, and I greatly welcome my right hon. Friend’s statement.

[Mr Hunt]

I thank my right hon. Friend for his comment, because the use of police cells is not an issue with which we should be playing party political games. As it happens, their use was much higher under the last Labour Government. We are starting to address that issue, and he is right: even one person spending a night inappropriately in a police cell is one person too many. That is why we are making good progress, but in the end it will require people who purchase health care in local areas to look at people with mental health needs in a holistic way—not just trying to solve issues problem by problem, but looking at and addressing the whole problem and making sure they get the treatment they need.

Oral Answers to Questions

Lord Soames of Fletching Excerpts

Tuesday 25th February 2014 Commons Chamber

[Mr Jeremy Hunt]

I welcome the hon. Gentleman to the House and congratulate him on representing in his constituency a fantastic hospital; I have been to Wythenshawe hospital and it is superb. Some big changes are happening in the Greater Manchester area that will lead to that part of the country having some of the best NHS care in the country. Obviously there is a difficult transition in A and E services between Trafford and Wythenshawe, and I am happy to meet him to discuss it further.

[Nicholas Soames (Mid Sussex) (Con)]

Does my right hon. Friend agree that it is unacceptable that investigations into failures in hospital services take so very long? There has recently been one in my constituency: a very sad and badly handled case connected with mental health. Does my right hon. Friend agree that the authorities need to provide answers very promptly to families who are left completely beleaguered by such behaviour?

[Mr Hunt]

I absolutely agree with my right hon. Friend. One of the tragedies that the Francis report helped us to uncover was that so many failings had been allowed to persist for so long: in the case of Mid Staffs, between 2005 and 2009. We owe it to families to be much quicker, which is why there is now a time limit on the failure regime: hospitals must be turned around within a fixed period of time or go into administration. Otherwise, we will not have safe hospitals in our areas.

NHS

Lord Soames of Fletching Excerpts

Wednesday 5th February 2014 Commons Chamber

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

Given the heated exchanges we have just had, I want to make it clear that I am speaking in support of the Opposition motion.

Given the extent of the crisis that is being faced by accident and emergency departments around the country, one would be forgiven for thinking that this Government must have inherited an NHS on the brink of collapse. In fact, the opposite is true. I know we have stopped doing the patient satisfaction surveys, but at the time that was discontinued, patient satisfaction was at an all-time high and we must not forget that the national health service had been transformed by the Labour party. I worked in the health service and I remember what it was like in the 18 years when the Tories were running it. The NHS that the Labour party inherited in 1997 was transformed. The budget for the NHS was £30 billion then, but when we left the NHS in good health in 2010, the budget was over £100 billion. The 18 years of Tory neglect had been thoroughly addressed with new hospital buildings. Every single A and E department was replaced.

What have we seen since? We have seen an unwanted top-down reorganisation, which nobody wanted and nobody voted for, coupled with under-investment, and the slashing of alternative services has placed a huge burden on our A and E services. By referring to alternative services I am talking, for instance, about walk-in treatment centres, including my own excellent Healthworks in Paradise lane, Easington Colliery. It is under enormous pressure yet offers a fantastic service with out-of-hours and weekend opening, but we are not sure whether that will continue because of pressures that the clinical commissioning group is facing. By almost any standard, it is clear that the performances of accident and emergency departments are struggling under the current Government. It is clear that patients are waiting longer to be seen and that the numbers of delayed discharges and emergency admissions are up—I think the Secretary of State admitted that. The number of cancelled operations is certainly up.

[Nicholas Soames (Mid Sussex) (Con)]

I am following carefully what the hon. Gentleman is saying; he is making some very good points. Does he acknowledge that 45% of the health service budget is spent on 5% of the population—namely, those vulnerable people with multiple chronic illnesses? Getting that right must be the key to the future. What does he think the solution is?

Accident and Emergency

Lord Soames of Fletching Excerpts

Wednesday 18th December 2013 Commons Chamber

[Dr Lee]

I agree with the hon. Lady that the plans for many of the configurations have been somewhat made up on the hoof. They have usually been created and pushed by a series of local issues—such as 19th or 20th-century buildings that can no longer deliver 21st-century health care—but I recognise the need for a plan, and I will come back to that at the end of my speech.

I fear that a perfect storm is looming at the moment. [Interruption.] If the hon. Member for Eltham (Clive Efford) will allow me, I will come on to what I think we need to do. The perfect storm is that we have infrastructure that is not fit for purpose, too many hospitals that we cannot staff properly—one of the contributory factors in Mid Staffordshire was poor staffing levels, because it was trying to work over two hospital sites for a population that is not big enough to support one—and an ageing and increasingly obese society, as well as changes in people’s attitudes to pain and suffering and to seeking health care.

I have not yet heard a speech about the type of presentations occurring in casualty departments. Such presentations are rarely accidents and are extremely rarely emergencies. We must ask ourselves how we can address that. I am standing here with a dreadful cold and feeling pretty lousy. I have seen hundreds of patients who have presented to me as a GP or in A and E feeling like I do, but I will not go either to my GP or to A and E, because I understand that I have a viral infection that will get better by itself. The problem at the moment is that people just rock up at A and E because they think that it is the only place they will get seen, and no one questions whether they should just not bother turning up.

[Nicholas Soames (Mid Sussex) (Con)]

I am following what my hon. Friend is saying very carefully. Does he agree that part of the problem with A and E is the tremendous back-up of people who are admitted, and the inability to discharge people who ought not to be in hospital?

[Dr Lee]

Yes, we need to integrate. The shadow Front-Bench team is right to call for more integration, which is part of the issue.

That perfect storm is coming and I suspect it will hit this or the other side of 2020, when we will have such an ageing society with such expectations, and a creaking infrastructure that is not able to deliver the best care that can be delivered.

Given the time available, I shall be brief, but we need to have a cross-party plan. I suspect that we have twice as many acute hospitals as we need, and that we probably need only about 100 in England and Wales. The population served by each acute hospital should be about 500,000, 600,000 or 700,000, which is nine or 10 constituencies, so we would not all be able to come to the Chamber to defend our local district general hospital. I am sorry, but those days have passed. If you think that I am a maverick, I am backed up by every single royal college, the King’s Fund, the NHS Confederation—I could go on. Therefore, we need to deal with the issue.

I recognise that the politics is very difficult. I think that we should convene a cross-party committee and have a cross-party understanding. We will have to do that at some point in the next five to 10 years, and it would be remiss and wrong of us as an institution to ignore that reality. I am tired of sitting here and listening to hon. Members trying to score political points on this issue. Of course we can argue about the funding of health care and there is scope to debate philosophical differences about health care provision, but when it comes down to it, we need a hospital infrastructure that can deliver the best acute emergency and surgical care to everybody at their time of need. I fear that we do not have that.

We need to integrate social care with health care. There are some models—Cambridgeshire has embarked on a very good plan—but it needs to happen up and down the country. We need seven-day-a-week care, but to staff that appropriately, we need fewer hospitals. We will not be able to have seven-day-a-week consultant care on every district general hospital site in this country. I wish I had a bit longer, but I will conclude. I think that we really need to raise the bar, because everyone in this country wants the best care for all.

Health and Social Care

Lord Soames of Fletching Excerpts

Monday 13th May 2013 Commons Chamber

[Nicholas Soames (Mid Sussex) (Con)]

I am grateful for the opportunity to speak in the debate on the Address.

In nearly 30 years in the House, it has been my experience that Governments are always accused of having either too much or too little in their Queen’s Speeches. As my hon. Friend the Member for Banbury (Sir Tony Baldry) rightly said in his excellent contribution, however, they are works in progress. I congratulate the Government on bringing forward a measured and carefully thought-out programme, which has been welcomed by my constituents and which will make a positive contribution to the lives of many of our fellow citizens. The immigration measures, the national insurance contributions Bill and the deregulation Bill are particularly important to the work that the Government are doing—in my view far more successfully than they are being given credit for—in fixing the British economy, which is showing clear signs of real improvement.

I would like to report to the House that at the Burgess Hill Business Parks Association business exhibition on Friday there was a solid mood of determination to grow our local economy, as well as considerable satisfaction at the progress being made. The message that I take back from that admirable gathering is one that all our colleagues will find when they go to gatherings of that type: people want the Government to press on with getting rid of regulation and bringing in lower taxes—above all, they want to get on with growth. This Queen’s Speech presses on with a number of key reforms on welfare, on education and by the Home Secretary in her excellent work on immigration.

We were fortunate to have exceptionally good local election results in Mid Sussex, where the combination of a prudent and well-run West Sussex county council and an extraordinarily efficient and well-led district council have delivered with confidence the Government’s agenda, which is welcomed and well understood. What is clearly most important locally, however, is the state of the economy. For all of us, that must be at the very top of all our constituents’ concerns about the future of the country. Our constituents want the Chancellor and the Prime Minister to press on. If they do and the economy grows, much of the country’s serious anxieties will begin to disappear like the winter snow.

I am delighted that my right hon. Friend the Prime Minister is in Washington today with President Obama in our pursuit of the European Union-United States free trade agreement, which is clearly extremely important to our future, not only for our national trade and commerce in Europe and elsewhere, but as a mark of stability in world trade, which is vital to the ordinary conduct of economic and world trade growth. All of us here know that the opportunities in that regard are enormous.

[Mr Robert Walter (North Dorset) (Con)]

Does my right hon. Friend agree that if we were to vote to leave the European Union, we would no longer benefit from that free trade agreement?

[Nicholas Soames]

I do agree, but I will come to that point in a moment, if I may.

As co-chairman with the right hon. Member for Birkenhead (Mr Field) of the cross-party group on balanced migration, I warmly welcome the considerable progress that the Government have made on the difficult and sensitive matter of immigration. They have succeeded in driving down numbers and there is real progress, but there are no easy solutions. I welcome the carefully thought-out work of my right hon. Friend the Secretary of State for Health on those services. The cross-party group, and I think most of the House, knows that the most careful attention must now be paid to the question of access to benefits and the health service. Thus, the immigration Bill is an important step forward.

I know the Government do not underestimate the anger and frustration that many people feel about too many people arriving in Britain and accessing public services before they truly should. To that end, I will conclude by saying a few words about the European issue.

The House knows that I am a staunch but not uncritical pro-European. I acknowledge the profound frustration of dealing with Europe, and there are certainly the most serious problems with the European Union that we must fix. The Conservatives are committed to doing that. In many of these matters, we will find solid support across the continent from our European partners, and my right hon. Friend the Prime Minister will do that.

People need to understand that the Prime Minister has committed to the negotiation of a new settlement between Britain and the European Union. People questioned whether he would veto an EU treaty, but he has vetoed an EU treaty; people questioned his ability to get the EU budget cut, but he has succeeded in getting it cut; and people questioned his ability to get powers back from the EU, but the fact is that he got us out of the EU bail-out mechanism and saved this country hundreds of millions of pounds.

The Prime Minister has said that he is committed to negotiating a new settlement for Britain within the EU and I have every confidence that that is precisely what he will achieve. It will be then for the British people to judge that settlement in a referendum. There will be a referendum on our membership of the EU; the commitment on that is absolute. Some of my hon. Friends and indeed some of my right hon. Friends need to be a little cautious about trivialising what is involved. The decision on a referendum is hugely important for this country; it is probably the most important decision that it will have to take for generations. It is not to be lightly taken, or on the basis of prejudice or pub rhetoric.

[Sir Gerald Howarth (Aldershot) (Con)]

Will my right hon. Friend give way?

[Nicholas Soames]

No, I will not. No good is done to the public governance of this country by a constant chipping away at trust and at the Government’s integrity. If the Prime Minister says that something will happen, such is the momentous nature and importance of this decision that it will happen with orderly process and proper debate, and not with some hysterical, knee-jerk, publicity-seeking action.

I beg this House to remember that, with all the EU’s imperfections and all its problems, it gives our country free and fair access to the single largest integrated economic area in the world; a single market of 27 countries and 500 million people with a gross domestic product of $16 trillion. I could not possibly look my constituents in the eye and tell them I was prepared to risk that. I urge the House to support the Prime Minister and the Government in the orderly process that has already been announced, which will result in a referendum. I am confident that it will be a positive referendum for the United Kingdom.

Immigrants (NHS Treatment)

Lord Soames of Fletching Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

The directive to which the right hon. Gentleman refers was issued by an independent NHS body, not my Department. The sorry truth is that it is consistent with the current rules on access to primary health care, which is what we believe is wrong. I think that one of the big problems in the current system is that we have free access to primary care for anyone visiting the UK, however short their visit is. Through that access to primary care, they get an NHS number, which should not entitle them to free care but is often treated by hospitals as such. That is what we have to put right. He is absolutely right that we need a system that properly identifies whether people should have care that is free at the point of access without impinging on the ease of access for British citizens, which is one of the things they treasure most about the NHS.

[Nicholas Soames (Mid Sussex) (Con)]

Does my right hon. Friend agree that it is through access to primary care that the initial control must take place, but that all hospitals should have an overseas visitors manager who should be designated and required to collect overseas visitors’ moneys on a more regular basis and using a more joined-up and coherent way of working with the other agencies involved?

[Mr Hunt]

What my right hon. Friend says bears very careful consideration. He is absolutely right that primary care is a critical access point, and we need to look at that. We also need to look at the burdens we place on GPs. I think that ultimately the easy way we will do that is through proper digital patient records, which will allow NHS professionals to find out about the medical history of people accessing the NHS at any point, including whether they are likely to be eligible for free treatment.

With regard to hospitals, my right hon. Friend makes a very interesting point about an overseas visitors manager. One of the problems we have is that the incentives in the system positively disincentivise hospitals from declaring foreign users of the NHS. If they declare someone not to be entitled to free NHS care, they have to collect the money from that person themselves, whereas if they do not declare the person not to be entitled to free NHS care, they get paid automatically by their primary care trust or clinical commissioning group. The incentives in the system have acted to suggest that this is a much smaller problem than I believe it is.

Accountability and Transparency in the NHS

Lord Soames of Fletching Excerpts

Thursday 14th March 2013 Commons Chamber

[Andy Burnham]

I will make some progress.

The first point is about implementation. I would like to take this opportunity to thank Robert Francis for his work on this inquiry and the previous inquiry, which I commissioned. Robert Francis has taken the best part of three years to consider these matters in detail and has made 290 measured and proportionate recommendations. The people affected by these events should reasonably be able to expect that they will be implemented without delay.

I make a genuine offer today to the Secretary of State. If he brings forward proposals, he will have our support in speeding up implementation. I say that because I am becoming concerned about the timetable for the Government’s response. On 6 February, the Prime Minister told this House:

“We will study every one of the 290 recommendations in today’s report and we will respond in detail next month”.—[Official Report, 6 February 2013; Vol. 558, c. 281.]

Since then, the Government have commissioned a review of the recommendations, which is due to report in July. Although, like the hon. Member for Bristol North West (Charlotte Leslie), I have great respect for Don Berwick, I am surprised that the response to a long public inquiry is to set up another review. Is it still the Government’s intention to respond in detail this month? Although I welcome this debate, it is narrow in focus, so will the Secretary of State consider having a full day’s debate in Government time? Instead of more delays and reviews, we need action and a timetable for implementation. I would be grateful if the Secretary of State would respond to my offer today.

[Nicholas Soames (Mid Sussex) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

No, I am making some progress.

The second area where more transparency and accountability is urgently needed is on staffing levels. If the Government are not yet able to commit to all the recommendations, I ask them to expedite their response to Robert Francis’s important recommendation on patient-staff ratios. The board of Mid Staffs embarked on a dangerous programme of staff cuts, and yet public and staff representatives had no outside guidance to challenge it. The chief nursing officer said yesterday that staffing should be a local decision. Surely the lesson of Mid Staffs is that there is a need for much clearer national standards and guidelines, as suggested by the Francis report?

This week, the Care Quality Commission reported that one in 10 hospitals in England and, worse, one in five learning disability and mental health services do not have adequate staffing levels. Surely that should ring alarm bells in the Department as it suggests that parts of the NHS are already forgetting the lessons of the recent past.

The third area on which we need a clear statement from the Government today is the accountability and transparency of all organisations providing NHS services. Under “any qualified provider”, the Government are persisting with their assumption that all NHS contracts should be open to full competitive tender. Despite a promise to rewrite the section 75 regulations that are being made under the 2012 Act, my reading of the rewritten regulations is that regulation 5 will not let doctors decide, but will in effect force clinical commissioning groups to open tender for contracts. That raises the prospect that there will be a significant increase in the coming years in the number of private and voluntary sector organisations providing NHS services.

If we believe in transparency and accountability, surely they have to apply across the board and on a level playing field. The problem is that private and voluntary sector organisations are not subject to the same strictures on freedom of information and whistleblowing. If action is not taken, we face the prospect of a serious reduction in transparency and accountability. Our attempts to find out new information under FOI requests on providers selected under AQP have hit the brick wall of “commercial confidentiality”. I say to the Secretary of State that that is not good enough. Accountability and transparency must always be paramount, as the motion says.

Will the Secretary of State require all providers of NHS services to adhere to FOI principles, and will he ensure that whistleblowers working in organisations that provide NHS services have the legal protections that he has announced today? I draw the attention of the Secretary of State to an early-day motion tabled by my hon. Friend the Member for Easington (Grahame M. Morris) on this subject, which has attracted the support of 109 Members.

The fourth area on which the people of Stafford need openness and transparency is the future of their hospital. They will understandably be worried about the recent recommendation from Monitor that the trust should be placed into administration. People will recall, as I said to the hon. Member for Stone (Mr Cash) a moment ago, that I commissioned Robert Francis in July 2009 to conduct an independent inquiry. I know that many people, including the hon. Gentleman, wanted me to go further and order a full public inquiry, but I stopped short because I was concerned about the effect that that would have on the hospital and its viability.

All of us in this House now have a responsibility to help this hospital heal. After all that they have been through, it would be highly unfair to the people of Stafford if, at the end of all this, they were to lose their hospital or their A and E. They deserve a safe and sustainable hospital and I hope that the Secretary of State’s response to Monitor’s recommendation will map out a way to achieve that.

--- Later in debate ---

[Mr Hunt]

I obviously take on board what my hon. Friend says, but I want to move on to other aspects of the report.

[Nicholas Soames]

rose—

[Mr Hunt]

I shall give way on that point, and then I will make some progress.

[Nicholas Soames]

I am grateful to the Secretary of State. May I follow up on one point that he raised? He said that a number of those managers have disappeared or melted away to other jobs in the service. Does he agree that whatever else happened, there was a monumental failure of leadership at many levels, and that it is a failing of public services in this country—and the national health service in particular—that failing managers are too often recycled through the service to the great and constant cost of patient care?

[Mr Hunt]

I absolutely agree with my right hon. Friend. We will respond to the Francis report this month, as the Prime Minister has committed to do, and make plain measures to ensure that the situation cannot continue. My right hon. Friend is right to raise that point.

Oral Answers to Questions

Lord Soames of Fletching Excerpts

Tuesday 12th June 2012 Commons Chamber

[Nicholas Soames (Mid Sussex) (Con)]

No-shows and people failing to keep appointments in out-patient departments are costing Brighton and Sussex University Hospitals NHS Trust nearly £6 million a year. Does my right hon. Friend agree that this is extremely selfish, and would he propose sanctions on those who fail to show up for their appointments?

[Mr Lansley]

I am grateful to my right hon. Friend. I have no proposals for sanctions, but I commend to him and his trust the many mechanisms that are available, which they may know about, such as sending text messages to mobile phones. I have seen them in practice, and they do stimulate patients to attend their appointments and so reduce what has been an unacceptable level of non-attendance.

NHS White Paper

Lord Soames of Fletching Excerpts

Monday 12th July 2010 Commons Chamber

[Mr Lansley]

That is my statement. When the right hon. Gentleman reads the White Paper, it will become obvious to him that, yes, we are looking to GPs to take responsibility for commissioning, but, unlike the problems that arose with fundholding, there will not be an opportunity for GPs to generate surpluses on their commissioning budget, and so money in their pocket. It will not work like that: there will be a clear separation between the commissioning budget and their personal budget. We will focus on the thing that really matters, which is GPs taking a commissioning responsibility in designing services.

[Nicholas Soames (Mid Sussex) (Con)]

I welcome the Secretary of State’s bold and imaginative statement on a White Paper that I am sure will be broadly welcomed in the NHS, not least because it will give people within the NHS the opportunity to give true vent to their creativity. Does he agree, however, that he is setting very demanding targets and challenges; and what time line does he envisage before this is finally implemented?

[Mr Lansley]

I am grateful to my hon. Friend. I will not go through the White Paper in detail now, but within it he will find that we look towards some GP commissioning consortiums taking an early adopter place from 2011-12, with consortiums generally taking, as it were, a shadow responsibility but not a legal responsibility in 2012-13, and then taking full responsibility, subject to the passage of the legislation to establish that, from April 2013 onwards—the point at which we anticipate that primary care trusts will be abolished.