Draft Nursing and Midwifery (Amendment) Order 2017
Philip Dunne Excerpts(7 years, 10 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
I beg to move,
That the Committee has considered the draft Nursing and Midwifery (Amendment) Order 2017.
It is a great pleasure to serve under your chairmanship this afternoon, Mr Paisley.
The Nursing and Midwifery Council is the independent regulator for nurses and midwives throughout the UK. It sets the standards of conduct, performance and behaviour for more than 657,000 nurses and almost 35,000 midwives. To improve public protection and to address concerns expressed during investigations into systemic failures in the care of mothers and babies at the University Hospitals of Morecambe Bay NHS Foundation Trust, the draft order separates midwifery supervision and regulation, giving the NMC sole responsibility for midwifery regulation. It also makes a series of changes to modernise the regulation of nurses and midwives.
Specifically, the draft order does three things: it removes the statutory system of supervision and local investigation that is unique to midwifery in the national health service; it removes the statutory requirement for the NMC to have a midwifery committee, which again I think is unique in the NHS; and it improves the efficiency, effectiveness and proportionality of the NMC’s fitness to practise processes for both nurses and midwives. The Department of Health publicly consulted on the measures set out in the draft order and received more than 1,400 responses. The consultation highlighted concerns, in particular from within the midwifery profession, about the removal of both statutory supervision and statutory requirement for a midwifery committee, but the proposed legislation is required to enhance patient safety, to modernise the regulation of midwifery and to improve the fitness to practise processes for both nursing and midwifery.
The principles of midwifery regulation are based on a model that was established more than 100 years ago, back in 1902, when midwives worked as independent practitioners. Under the existing statutory provisions, supervisors of midwives, who are established in each of the four nations of the UK, have a role in investigating and resolving fitness to practise concerns at local level—that is, within their nation. Among the professions in the NHS, that system of supervision and local investigation is unique to midwifery. There is a lack of evidence to suggest that the risks posed by contemporary midwifery practice require that additional tier of regulation. More significantly, a number of reports have been critical of the system of statutory supervision, in particular the role that supervisors of midwives have in conducting investigations.
Following the completion of a number of investigations into complaints by the families of those affected by the tragic events at the Morecambe Bay trust, the Parliamentary and Health Service Ombudsman highlighted potential conflicts of interests in midwives investigating other midwives. The report stressed that the existing arrangements do not always allow information about poor care to be escalated effectively into hospital clinical governance systems or to the NMC. A subsequent report by the King’s Fund highlighted confusion resulting from local investigations being carried out in parallel with employer-led investigations. Similar concerns were expressed about the effectiveness of the statutory supervision of midwives in Dr Bill Kirkup’s report on the Morecambe Bay investigation.
Given the evidence set out in those reports, I am confident that separation of regulatory investigations from the supervision of midwives will be a positive step in enhancing public protection. To ensure that midwives continue to have access to support and development, the four UK nations through their chief nursing officers have collaborated to develop new non-statutory models of supervision to deliver those elements. While taking account of the requirements in each country, the four countries have been working within UK-agreed principles to develop employer-led models of supervision. Those models will have no role in fitness to practise matters concerning midwives. The new models of midwifery supervision will be introduced following the removal of the current statutory requirements and will build on the systems and processes for good governance and professional performance already in place through employers.
The second change the order will make is to remove the statutory requirement for the NMC to have a specific midwifery committee. The role of the midwifery committee is to advise the NMC council on matters affecting midwifery. The statutory requirement for the regulator to have a committee for a specific profession is unique to the NMC. In effect, it reflects a historical accident. The removal of that requirement does not prevent the NMC from establishing committees or groups in relation to midwifery; it simply removes the statutory requirement to do so.
The NMC is working to ensure that appropriate non-statutory routes are put in place so that the NMC council can continue to obtain expert advice on midwifery matters. To that end, it has already established a strategic midwifery panel to advise the NMC council on key midwifery issues and to develop strategic thinking on the future approach to midwifery regulation. The panel has representation from each of the four countries in the UK and the Royal College of Midwives. The NMC has also appointed a senior midwifery adviser to provide expert advice on midwifery issues. The NMC still has a statutory duty to consult persons who appear likely to be affected by any proposed rule changes and when establishing standards and guidance, including consulting midwives and those with an interest in midwifery.
I assure the Committee that the Government value the contribution made by all midwives to ensuring the informed and safe delivery of maternity services and the best outcomes for mothers and their babies. I hope the Committee is reassured that the changes are consistent with our commitment to the continued development of the midwifery profession.
The third set of changes concerns the NMC’s fitness to practise processes. In 2015-16, the NMC brought 1,732 cases to a conclusion before a panel at a hearing or a private meeting. The cost of those fitness to practise cases was more than £58 million—about 76% of the NMC’s budget. The changes in the order will enable the NMC to take proportionate action to address less serious concerns more efficiently and effectively while maintaining public protection.
The Department believes that the principles of better regulation centre on giving greater autonomy and flexibility to the regulatory bodies to enable them to deal more effectively with fitness to practise cases. Changes include new powers for the investigating committee to agree undertakings with the registrant or issue a warning or advice to a registrant, and replacement of the conduct and competence committee and the health committee by a single fitness to practise committee, where both conduct and health issues can be considered. Those changes will ensure that the NMC is able to respond to fitness to practise allegations in a more efficient and proportionate way, benefiting patients, midwife registrants and employers as well as nurses.
The NMC will need to amend its fitness to practise rules before some of the changes come into effect. The order of council with the proposed changes to the fitness to practise rules will be laid in Parliament for consideration. The changes that the order makes to the governing legislation of the NMC will ensure that the regulation of nurses and midwifes continues to be fit for purpose, with patient safety at its heart. I commend the order to the Committee.
Mr Dunne
I welcome the support of the hon. Member for Ellesmere Port and Neston, who speaks, again, with great clarity and thoughtfulness on behalf of Her Majesty’s Opposition, and the support of the spokesman for the SNP, the hon. Member for Linlithgow and East Falkirk. That support is much welcomed. I will try to address their points in a second. I would first like to make a suggestion to the hon. Member for Poplar and Limehouse, who gave us an interesting insight into some of the activities in his constituency. He should put himself forward to be a dad in the next series of “Call the Midwife”. I am sure he would be given a part if he could spare the time.
The hon. Member for Ellesmere Port and Neston specifically asked whether we are striking the right balance between efficiency and a proportionate response to regulation. He will not be surprised to hear me argue that we are. In essence, many of the measures are designed to bring regulation of midwives up to date with regulation of other professions across the NHS.
Removing a unique statutory provision to have a committee within the NMC is an efficiency issue. The proportionate nature of the change is that it provides more flexibility to the NMC in its fundamental role in addressing fitness to practise. We think that that is the most meaty issue in the order and that is where we will need to continue to monitor the effectiveness. That will be done on a routine basis through NHS England, in response to another question put by the hon. Gentleman.
The hon. Gentleman also asked whether we intended to appoint a chief midwifery officer. At present, the chief nursing officer is the professional lead for both nursing and midwifery and we intend that to continue. That role is supported by the head of maternity in NHS England, which will continue to be the case. What will be new is the structure of regional leadership for midwife professionals across England. There will be a regional maternity lead and a deputy regional maternity lead in each of the four NHS England regions. Those leaders will take up position once the new law changes, which, provided the order is approved today, will be from the beginning of the new financial year, 1 April.
The hon. Gentleman asked whether we would be funding training requirements for new supervisors. Of course, each nation will have its own responsibilities for funding trainers. In England, the standard NHS contract, which has already been entered into for 2017-18, sets out that providers must have systems in place to ensure that staff receive appropriate continuing professional development supervision and training in accordance with the clinical supervision of midwives guidance issued by NHS England. That matter has been considered in that contract, and I believe arrangements have also been put in place in each of the other nations.
The hon. Gentleman also asked whether there would be any negative impacts on midwives from the arrangements, given concerns raised in the consultation response. The important point is that we do not see the measures as downgrading midwives’ status in the NHS in any way. We absolutely recognise the important role they play in one of the most fundamental things that the NHS provides—enabling babies to be brought into the world in a safe environment. Midwives should not see the order as downgrading their status; we do not think it does. It puts them on a statutory footing similar to that of other professions. We shall continue to provide midwives with the professional training, support and recognition that they have always had.
As for a parliamentary review of the procedures, I am not inclined at this point to give the hon. Gentleman a commitment. We shall certainly carry out a review within the Department. NHS England, as I have said, intends to conduct monitoring. He may want to make a diary note and consider whether he would want to bring the matter to Parliament in a year or so. I should rather approach the matter in that way than give a commitment now.
I thank hon. Members for their contributions. I hope that I have addressed the questions that were asked.
Question put and agreed to.
Oral Answers to Questions
Philip Dunne Excerpts(7 years, 10 months ago)
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Karin Smyth (Bristol South) (Lab)
The Minister of State, Department of Health (Mr Philip Dunne)
Sir Robert Naylor’s report on the NHS estate will be published shortly. In developing his recommendations, he has worked and engaged with leaders from across the NHS. This will ensure that his recommendations are informed by sustainability and transformation plans, and are designed to help to support their successful delivery.
Karin Smyth
I look forward to seeing the report, which has been due “shortly” for a while. Knowle West health park in my constituency is exactly the sort of community-based model that we should be promoting in STPs. It was established by the NHS and the council to prevent illness, to promote good health and to assist recovery after medical treatment. However, the NHS Property Services regime means that its bill has increased more than threefold—from £26,000 to £93,000. What assurances can the Government give that the Naylor report will ensure that there is co-operation on estates planning so that my constituents, who rely on the health park’s contribution to preventing ill health, can face the future with confidence?
Mr Dunne
We have already accepted one of Sir Robert Naylor’s recommendations ahead of the publication of his report, which is to look into bringing together NHS Property Services and other estates services in the NHS. With regard to allocations to the clinical commissioning group, the Department of Health has provided £127 million to CCGs precisely to contribute towards increases in the move towards market rents for property.
James Duddridge (Rochford and Southend East) (Con)
Keith Vaz (Leicester East) (Lab)
In Leicester, the CCG is proposing to close a walk-in centre in North Evington and move it to another part of the city. Rather than being a walk-in centre, it will become a drive-in centre. Does the Minister agree that it is important that local people are consulted fully on the proposals?
Mr Dunne
As the right hon. Gentleman knows, service reconfigurations require public consultation. I am not sure whether that particular walk-in centre qualifies, but I am happy to have a look at that. A number of walk-in centres were established under the previous Government in a random way, and they need to be located more appropriately for local people.
Sir Simon Burns (Chelmsford) (Con)
Does my hon. Friend agree that the driving force of STPs is to improve and enhance patient care for our constituents? With regard to the STP for mid-Essex, will he confirm that no proposal that has been put forward involves any closure of an A&E and that, far from downgrading the existing A&Es, this is about upgrading the quality of care for my constituents?
Mr Dunne
My right hon. Friend is a regular attender at Health questions, and I am pleased to be able to confirm to him, once again, that the success regime for mid-Essex is looking at the configuration of the three existing A&Es, none of which will close, and each of which might develop its own specialty.
Justin Madders (Ellesmere Port and Neston) (Lab)
Analysis of the STPs by the Health Service Journal this week found that a substantial number of A&E departments throughout the country could be closed or downgraded over the next four years. The Royal College of Emergency Medicine has described that approach as “alarming”. Over the past month, we have all seen images of A&E departments overflowing and stretched to the limit, so surely now is not the time to get rid of them. Will the Minister pledge today that the numbers of both A&E beds and A&E departments will not be allowed to reduce below their current level?
Mr Dunne
The hon. Gentleman is right to point out that the STPs are looking at providing more integrated care across localities. A number of indicative proposals have to be worked through. At the moment, NHS England is reviewing each of the STPs, and the results will be presented to the Department for its consideration in the coming weeks and months. On bed closures, I gently remind him that, in the past six years of the previous Labour Government, more than 25,000 beds were closed across the NHS. In the six years since 2010, fewer than 14,000 were closed by this Government and the coalition.
Marie Rimmer (St Helens South and Whiston) (Lab)
Michelle Donelan (Chippenham) (Con)
The Minister of State, Department of Health (Mr Philip Dunne)
Developing a variety of routes into nursing is a priority to widen participation and reflect the local populations served by nurses. That is why we have developed a new nursing associate role and nursing degree apprenticeships, which are opening up routes into the registered nursing profession for thousands of people from all backgrounds and allowing employers to grow their own workforce locally.
Michelle Donelan
Are there any plans to roll out the associate role to include Wiltshire, and to enable the new nursing degree apprenticeship schemes to be offered in larger further education colleges so that counties like Wiltshire that have no university can still make that provision?
Mr Dunne
We have announced the first 1,000 nursing associates. In fact, the first cohort commenced at the beginning of this month. I visited, in Queen’s hospital, Romford, the first very enthusiastic group of nursing associates. We have announced a second wave of 2,000 associate roles. I regret to say that Wiltshire does not have any of those at the moment, but that will not stop it bidding for them in future. I will look at my hon. Friend’s point about further education colleges.
Andy Burnham (Leigh) (Lab)
When the Secretary of State scrapped the nursing bursary, he claimed that his reforms would lead to an increase in nursing applications. Last week, figures from UCAS showed that there had been a drop in nursing applications of 23%—a worrying trend when the demands of Brexit will mean that we need more home-grown nurses. Will he scrap this disastrous policy or, at the very least, give Greater Manchester the ability to opt out of it and reinstate the nursing bursary?
Mr Dunne
I urge the right hon. Gentleman not to indulge in scaremongering about the number of people applying to become nurses. There are more than two applications for each of the nursing places on offer to start next August. He needs to be careful about interpreting this early the figure for applications from EU nationals, which has gone down significantly, because it coincided with the introduction of the language test for EU nationals.
Dr Philippa Whitford (Central Ayrshire) (SNP)
With the reduction of 23% in applications to English nursing schools, the Minister might want to re-look at the policy. There has been a significant drop—a 90% drop—in EU nationals applying. With one in 10 nursing posts in NHS England vacant and a cap on agency spend, who exactly does the Minister think should staff the NHS?
Mr Dunne
I say gently to the hon. Lady that there are 51,000 nurses in training at present. The number of applications through the UCAS system thus far suggests that there will be more than two applicants for each place. As I have just said to the right hon. Member for Leigh (Andy Burnham), the reduction in application forms requested by EU nationals has coincided with the introduction of a language test.
Dr Whitford
Language test applications were more than 3,500 last January, so the reduction after the language test was from that to 1,300. In December, there were only 101 applications. This cannot all be blamed on the language test, so what is the Minister going to do to protect nursing numbers?
Mr Dunne
There are over 13,000 more nurses working in the NHS today than there were in May 2010. As I have just said to the hon. Lady, the language test came into effect from July last year, since when the number of applicants has been somewhat steady. It is down very significantly, but that is because, frankly, we have had applications from nurses from EU countries who have not been able to pass the language test.
Rob Marris (Wolverhampton South West) (Lab)
Mark Menzies (Fylde) (Con)
The Minister of State, Department of Health (Mr Philip Dunne)
I am grateful to my hon. Friend for recognising the work that went into reopening the A&E at Chorley last month. I am delighted, in particular, by the work that was done by the Deputy Speaker and my hon. Friend the Member for South Ribble (Seema Kennedy).
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
Mr Steve Baker (Wycombe) (Con)
A small business in my constituency was driven out of business by slow payments for relatively small sums by NHS providers. Will he ensure strict compliance with the guidelines for timely payments?
Mr Dunne
My hon. Friend will be aware that best practice for NHS bodies is to pay within 30 days. I am pleased to be able to tell him that figures for the quarter ending in September show that the Department of Health paid 98.4% of our bills within five days—one of the best performances across government.
Steven Paterson (Stirling) (SNP)
The Royal College of Psychiatrists warns that half of all child and adolescent mental health training posts are unfilled. With 11% of trainees being EU nationals, how do the Government plan to avoid a Brexit-inspired staffing crisis?
Ms Margaret Ritchie (South Down) (SDLP)
What further efforts have been made to increase the level of nurses’ pay, many of whom have high levels of training, expertise and qualifications?
Several hon. Members rose—
National Health Service
Philip Dunne Excerpts(7 years, 10 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
My hon. Friend the Parliamentary Under-Secretary of State (Lord O’Shaughnessy) has made the following written statement in the House of Lords:
This Government are committed to making sure that only those people who are living here and contributing to the country financially will get free National Health Service care. Following a two year programme of work to improve identification and cost recovery from chargeable patients in hospitals we consulted on extending the charging rules to areas of NHS care that are currently free to all. Proposals for this were set out in a public consultation entitled “Making a fair contribution—a consultation on the extension of charging overseas visitors and migrants using the NHS in England”, which ran from December 2015 to March 2016.
The proposals explored within the consultation aimed to support the principle of fairness by ensuring those not resident in the United Kingdom pay for NHS care. The proposals would not restrict access, but rather make sure that everyone makes a fair contribution towards the cost of the care they receive.
We are today publishing our response to that consultation. It summarises respondents’ views and sets out how the Government intend to extend charging and increase cost recovery from patients not eligible for free care, including:
Requiring NHS providers to obtain charges upfront and in full before a chargeable patient can access non-urgent treatment.
Including out-of-hospital secondary care services and NHS-funded services provided by non-NHS organisations within the services that chargeable patients will have to pay for.
Removing NHS assisted reproduction services from the range of services provided free of charge under immigration health surcharge arrangements.
The principle that the NHS is free at the point of delivery for people ordinarily resident in the UK will not be undermined by this work.
The most vulnerable people from overseas, including refugees, will remain exempt from charging. Furthermore, the NHS will not deny urgent and immediately necessary healthcare to those in need, regardless of payment. Exemptions from charging will also remain in place for the diagnosis and treatment of specified infectious diseases in order to protect the British public from wider health risks.
The potential income generated through the extension of charging will contribute towards the Department of Health’s aim of recovering up to £500 million per year from overseas migrants and visitors by the middle of this Parliament (2017-18). The recovery of up to £500 million per year will contribute to the £22 billion savings required to ensure the long-term sustainability of the NHS.
We are also publishing today on gov.uk the evaluation of the initial phase of the programme, the lessons from which we are factoring in to the future operation of the programme.
It is also available on line at: http://www.parliament.uk/business/publications.
[HCWS460]
Public Administration and Constitutional Affairs Committee
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Mr Jenkin
I am most grateful to the hon. Gentleman for his question and for his support. I am also extremely grateful to my Committee for its work on this report.
I hesitate to lose the progress that we have made. We have approved the appointment of the chief investigator of HSIB, who spent 25 years as chief investigator of the Air Accidents Investigation Branch of the Department for Transport. He brings with him that wealth of experience and perspective about how this organisation should work. The answer is, as the hon. Gentleman suggests, for the Government to bring forward the legislation as quickly as possible. I know that efforts are being made in that direction, but perhaps the Minister will have something to tell us.
The Minister of State, Department of Health (Mr Philip Dunne)
I wish to add my thanks to my hon. Friend and members of the Committee for their considered report. He has succinctly described to the House what more needs to be done systematically to transform the way in which the NHS learns from errors to improve patient safety. We support the main thrust of the Committee’s recommendations and will offer a detailed response to the report in due course. Like the Committee, we put this matter right at the top of our agenda to change the culture within the NHS, of which he has spoken so eloquently today.
We are committed to making our hospitals and GP surgeries the safest in the world, supported by the NHS as the world’s largest learning organisation. The only way in which we will achieve that is through a learning rather than a blame culture characterised by openness, honesty and candour; listening to patients, families and staff; finding and facing the truth; and learning from errors and failures in care.
As my hon. Friend has indicated, the Government have accepted the recommendation of PACAC’s predecessor Committee to establish an independent healthcare safety investigation service. The Healthcare Safety Investigation Branch will be up and running from April. I join him in welcoming the appointment of Keith Conradi, the former chief inspector of the Air Accidents Investigation Branch, who has a strong track record of delivering high-quality investigations in aviation.
The hon. Gentleman’s Committee has again called for HSIB to be statutorily independent, and we agree that it should be as independent as possible if it is to discharge its functions fully and effectively, and we would not rule out the option of legislation. His Committee has also raised, in this week’s report, various suggestions for HSIB and its potential role in setting standards. We will be responding to that formally in due course.
We are committed to ensuring that the NHS becomes an organisation that learns from its mistakes. In response to the Care Quality Commission’s report, “Learning, Accountability and Candour”, from April this year all NHS trusts will be required to publish how many deaths they could have avoided had care been better, along with the lessons that they have learned.
Before I pose my question, I should like to thank the Committee for its response to the Government’s recent consultation, “Providing a Safe Space in Healthcare Safety Investigations”, and we will be responding to it shortly.
Improvements in safety, incident handling and learning in the NHS will not happen overnight, but does my hon. Friend agree that the shared programme of work demonstrates a commitment, across the care system, to improve the way in which all serious patient safety incidents are viewed and treated, and is that not a crucial foundation for lasting change?
Mr Jenkin
I am most grateful to the Minister for his question and for the fact that he has personally appeared at the Dispatch Box today with his opposite number from Her Majesty’s Official Opposition. I know that his presence here underlines the commitment of the Secretary of State to this programme of change.
I very much welcome the shared programme of work to which my hon. Friend refers, but, in taking evidence for this particular report, we found that there was some dislocation between the various bodies involved in it. We conclude that it is only Ministers, and probably only the Secretary of State, who can draw this together to ensure that there is a coherent strategy and a plan, which is what we emphasise in this report.
Finally, my hon. Friend refers to legislation in passing, but I hope that valiant efforts are being made in that regard. Perhaps something can be included in Her Majesty’s Loyal Address later this year. I must point out that it is not just about statutorily underpinning the independence of HSIB, but the safe space to which he refers and on which he thanks the Committee for its contribution. The safe space has to be legislated for. Without legislation, there is no safe space. The AAIB, the Marine Accident Investigation Branch of the Department for Transport and equivalent bodies could not possibly function unless they can provide people with protection, so that those people can come and talk openly and off the record about what has happened. That has transformed the safety culture in other areas, and it is the transformation that we need in the health service. I leave with the Minister the word “legislation” echoing in his ears, and I very much look forward to making further progress with him on these matters.
Doncaster and Bassetlaw NHS Trust STP
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The Minister of State, Department of Health (Mr Philip Dunne)
I start by paying tribute to the passion with which the hon. Member for Bassetlaw (John Mann) laid his case before us this evening, and I share his welcome to my hon. Friend the Member for Newark (Robert Jenrick), who joins him here.
The hon. Gentleman’s remarks are clearly timely, and he started his contribution by laying out his vision for innovative technology to be brought to bear for the people of South Yorkshire and Bassetlaw through the emerging sustainability and transformation plan. He drew on his experience from across the world in his previous life to try to bring innovation to bear, and I will touch on the STP towards the end of my remarks.
The hon. Gentleman spent most of his contribution talking about the more immediate issue of the challenge of maintaining a 24-hour children’s ward in Bassetlaw hospital. He has given us many examples of the impact of the current closure—or the fear of the impact of the closure—on families in his constituency and their children who have had experience in the ward. He did so with considerable empathy and conviction, and I am sure his constituents will be grateful for that.
I wish to start my remarks by setting out the facts as they have been presented to me in preparing for this debate. It is the case that Bassetlaw hospital stopped providing an overnight children’s service today. Children who would have been treated at Bassetlaw overnight will now be treated at the Doncaster royal infirmary or Sheffield children’s hospital. The closure is being undertaken by the trust on safety grounds, as there are workforce shortages for both paediatric medical and nursing staff, despite attempts to fill the gaps with locum staff. This is a patient safety issue; the current situation does not offer a safe and sustainable service, which the hon. Gentleman would expect for his constituents. That is the fundamental premise on which this decision has been taken. The replacement service will be monitored to ensure it is safe and effective prior to any decision in October about the long-term future of the service.
In December 2016, the trust identified an emerging issue with safely staffing children’s nursing, as there were gaps of six whole-time-equivalent registered children’s nurses. The trust has attempted to source children’s nurses through locum agencies but has been unsuccessful. Additionally, there is currently a three-person gap on the junior doctor rotation at the trust. I am advised that the trust has undertaken an overseas recruitment drive for medical staffing through an agency, but this has also, unfortunately, not been successful.
The situation with the workforce and the unpredictability of the locum doctor cover has resulted in the ward being temporarily closed at night to new admissions on many occasions in recent months, but children admitted earlier in the day who are stable have remained on the ward overnight. To put this into context, between 1 November and last Friday the trust had transferred 23 children out of the ward, averaging two per week. The total number of children remaining in the ward overnight from 1 September was 452, an average of three per night. I want to assure the hon. Gentleman that the trust appreciates that some children are admitted to the ward regularly—he gave us such examples from constituents’ emails—but due to the nature of their illness it is impossible to predict when this will be. The trust is contacting regular users of the children’s ward individually to discuss their particular care needs and how these can be best delivered under the new system. The trust will continue to provide a seven-day “hot clinic” service for ill children who need to be seen quickly for clinical diagnosis but are unlikely to need an admission for assessment. I understand that this clinic will also invite children discharged from the assessment unit on the previous day for a consultant review, if clinically necessary. This will offer parents confidence about their child’s progress if they have been in the assessment unit the day before.
The service that has become operational as of today is a consultant-led paediatric assessment unit, providing services seven days a week. The intention is that this will run from 8 am to 10 pm, with a cut-off time for the last admitted child for assessment of 8 pm each day. At the moment, the cut-off time for assessment is 7 pm, and that will move to 8 pm following a review after the new model has been operational for two months. As ever, the paramount consideration is the safety of the children.
Children admitted during the day who have been assessed by a consultant as “acutely unwell” will be rapidly transferred to a centre such as the Doncaster royal infirmary or Sheffield’s children’s hospital. I understand that the new model of care for the trust is consistent with Royal College of Paediatric and Child Health guidance, and represents the latest and safest national guidance.
The hon. Gentleman referred to long waits for non-urgent patient transport, and I can provide some reassurance on that. The trust and the CCG have, from today, jointly commissioned a dedicated urgent transport facility to be available from 4 o’clock in the afternoon to 2 o’clock in the morning, seven days a week, specifically to cater for any necessary children’s transfers. The trust is committed to providing the highest-quality care for children, as recently demonstrated when it invested around £250,000 to build the assessment unit and new children’s out-patient area.
We should remember that the decisions on how to provide safe care for children, which come into force today, are a matter for the local NHS. It is right for these issues to be addressed at a local level, where the local healthcare needs and demands are thoroughly understood and considered. The local NHS makes decisions to ensure the safety and welfare of patients. Although the decision may cause upset and disruption for patients and families, it is for the local NHS to ensure that the services provided are of the highest quality possible and are safe and sustainable. Above all, parents with sick children need to have confidence that their child will be treated at the safest level and by the most appropriately qualified staff. I am sure the hon. Gentleman will agree that that is paramount.
Nottinghamshire County Council’s scrutiny committee has been informed of the service changes, and I understand that no decision was made to refer the changes to the Secretary of State.
John Mann
Part of the weakness of the structure is that not a single person from Bassetlaw sits on Nottinghamshire County Council’s scrutiny panel. Not a single person from Bassetlaw has been consulted, including none of the staff who work at the trust. Is it not time that the people of Bassetlaw, including the staff, were listened to? At my public meetings on Saturday, there will be an opportunity for the trust to come along and hear precisely what parents, staff and others have to say.
Mr Dunne
I understand that the hon. Gentleman has already held a meeting for the public to discuss this matter. I am also aware that, as would be expected, he has been in touch with the trust and the CCG to make his representations directly. I am sure that if he has not yet had the opportunity to discuss this matter with the scrutiny committee at the local authority, he will have every opportunity to do so.
The South Yorkshire and Bassetlaw sustainability and transformation plan covers an area that has funding in the current year of £2.7 billion. Under the current plans, funding will rise over the remainder of this Parliament by £400 million to 2021—a cash increase of just under 14%. The plan is one of 44 STPs that are being developed by local NHS leaders and local authorities, with providers, commissioners and other health and care services coming together to propose how, at local level, they can improve the way that health and care is planned and delivered in a more person-centred and co-ordinated way. That is the ambition, and one that I think the hon. Gentleman shared in his hope that the STP will generate an NHS fit for the future.
For all STPs, there will be no changes to the services that people currently receive without local engagement. If plans propose service changes, formal consultation will follow in due course, in line with legislative requirements and procedures. The Government are clear that all service changes should be based on clear evidence that they will deliver better outcomes for patients. Any changes proposed should meet four tests: they should have support from GP commissioners; they should be based on clinical evidence; they should demonstrate public and patient engagement; and they should consider patient choice. I am also aware of a consultation that is currently under way on children’s surgery and anaesthesia services in South Yorkshire, Mid Yorkshire, Bassetlaw and North Derbyshire.
I reassure the hon. Gentleman that the changes happening in the children’s ward at Bassetlaw hospital are unrelated to the STP or to the current consultation on changes to children’s surgery and anaesthetic services, which are not currently conducted at Bassetlaw. The decision was taken as a result of insufficient staffing to maintain patient safety.
In conclusion, I fully appreciate the concerns that the hon. Gentleman expresses on behalf of his constituents, particularly the families of the young children who have been used to the service being provided 24 hours a day in Bassetlaw. I encourage him and his constituents—he has told us he is doing this—to maintain a proper, open dialogue over the coming weeks and months with Doncaster and Bassetlaw Hospitals NHS Foundation Trust, and the Bassetlaw clinical commissioning group to ensure that there continues to be a safe and sustainable service for the children of Bassetlaw. That service should be provided in the hospital during the day and, for those who are stable, overnight. However, children who have an urgent problem that needs attention overnight must go somewhere safe for that service.
Question put and agreed to.
Agenda for Change: NHS Pay Restraint
Philip Dunne Excerpts(7 years, 10 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
Mr Evans, I am grateful to you for calling me to wind up the debate. It is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) on taking up the petition and giving a well-constructed speech, with which many people listening to the debate—not just Members from her party, but those outside—will feel considerable sympathy. I express similar sentiments towards the hon. Member for Ellesmere Port and Neston (Justin Madders). Although I do not agree with his prescription, I thought that he conducted himself in a thoroughly considered way, as usual. It is a pleasure to be shadowed by him, as well as by the hon. Member for Central Ayrshire (Dr Whitford), who as usual made a constructive contribution.
[Sir Roger Gale in the Chair]
First, I should say that we are all rightly proud of our national health service and the staff who work incredibly hard day and night for the benefit of patients. They undoubtedly deserve a cost of living increase, but we must recognise that the financial and quality challenge facing the NHS is unprecedented. These are not normal times. I deny the allegation that Agenda for Change staff are undervalued, as the right hon. Member for Leigh (Andy Burnham) indicated in his speech, which was knowledgeable, given his previous role as Health Secretary. Staff at all levels in the NHS do a fantastic job, and it is vital that we in Government and the leaders of the NHS recognise that staff morale is important to maintaining staff commitment to services.
In my experience of making visits across the NHS, hard-working staff put patients first every single day of the week. They do so because caring for sick and vulnerable people is as much a vocation for them as it is a job. I know that pay restraint is challenging, but when I speak to staff, they tell me that they want to know that the right number of staff will be working alongside them in the hospital or community setting. The Government have listened. Contrary to some of the contributions made by hon. Members, staff numbers have increased significantly across most grades since May 2010. We have recruited almost 11,800 more doctors. More than 13,300 more nurses are working on our wards today than in May 2010—the overall number of nurses working for the NHS is at an all-time high. There are over 2,100 more midwives, and more than 6,300 currently in training, as well as over 1,500 more health visitors and over 2,400 more paramedics.
The allegation that people are leaving the NHS in droves is simply not borne out by the facts. The most recent workforce statistics were published last week, covering the period ending October 2016, and they showed that a record number of full-time equivalents were working in our NHS.
Dr Huq
The Minister is giving figures for the current workforce, but does he have any for the future workforce? I mentioned my constituent, Dr Linda Burke, of nursing and education studies at the University of Greenwich. She is worried that due to the cut in nursing bursaries, the number of applications is falling, possibly by as much as 30%. The RCN itself has said:
“We have consistently raised concerns to the Government… Despite 100 years of nursing knowledge and expertise, our advice fell on deaf ears.”
The RCN is effectively saying, “We told you so.” Will he remark on that?
Mr Dunne
I can say to the hon. Lady that there are 51,000 nurses in training today—I cannot tell her whether that is a record number, but it is a very significant number. There are 1,600 paramedics in training, which I believe is a record number. She and one or two other hon. Members have given anecdotes today about applications for new courses starting in the autumn, but I cannot tell her what the figures will be, because I have not yet seen any numbers published by UCAS. I think that they are due in the coming days, so we will have to see.
Dr Whitford
Honourable but not right—I accept that. The figures from NHS England itself suggest a drop in nursing applications of at least 20% to 25%.
Mr Dunne
The hon. Lady must have access to figures that my Department and I do not have. My information is that we have yet to receive any formal numbers from UCAS; there may be some early indications, but they do not represent the actual numbers. We will just have to wait for them. There is no point in speculating any further.
A number of hon. Members mentioned the potential impact of Brexit on EU staff, who currently represent a significant number of the professionals working in the NHS. Some 43,000 non-UK-born nationals work in the NHS—about 15% of the workforce—and about half of them come from the EU. It is very important that none of those staff are unnecessarily concerned about their future. The Prime Minister has sought to make it clear on several occasions that she wants to protect the status of EU nationals who are already living here and that the only circumstances in which that would not be possible would be those in which the rights of British citizens living in EU member states were not protected in return. We wish to provide as much reassurance as we can, both to NHS workers and to their employers, that they have a constructive future here in the UK.
However, it is important that we move towards a self-sustaining workforce. Frankly, that is at the heart of the reason behind the change in funding for nursing places, which is to bring nurses in line with doctors and those doing other degrees in England, so that from this autumn onwards they receive funding through student loans rather than bursaries.
Dr Poulter
The Minister is right to highlight the increases in many staff numbers across the NHS. He will also be aware that because of the increased focus on quality of care, many trusts have had to acknowledge that they did not have enough staff in the first place. If there are enough staff working in the NHS at the moment, why is the locum bill about £3 billion a year?
Mr Dunne
I will come on to agencies shortly. I am not denying that there are vacancies within the NHS, but my point is that there has been and continues to be a significant investment in increasing the number of people working in the NHS, which was not the impression that other hon. Members gave.
Lady Hermon
I have listened very carefully to the Minister, but I have to tell him that nursing staff, midwives and others in the nursing profession—certainly those in Northern Ireland who have contacted me—feel very demoralised by the attitude that the Government have held for several years. People in the nursing profession do a wonderful job and perform a great service for us all and for our families and friends when we have accidents or are ill, and the Government really must recognise their sense of demoralisation. If the Government will not change their policy on pay restraint—the Minister has already hinted that they will not—what steps will they take to address the serious problem of low morale in the nursing profession?
Mr Dunne
Obviously I cannot speak about circumstances in Northern Ireland, because we do not have responsibility for that. As I develop my remarks, I will go on to explain some of the things that we are doing to ensure that people who work in the NHS feel valued, as the hon. Lady asked, and get the kind of motivation that encourages them to get out of bed every morning and come into work day in, day out.
Mr Dunne
I will make some progress.
We recognise that the NHS faces a number of very challenging pressures: not just the ageing population, but the expectations of the public, who rightly demand quality personalised care at home or in hospital every day, not just from Monday to Friday. Those pressures will not be resolved just through pay, but by engaging with staff as they adapt and respond to new ways of working, including by introducing change that comes with scientific development and by supporting them through appropriate training and development.
We know that inflation is increasing. We continue to rely on the independent pay review bodies, which for decades have applied their expertise and objectivity in making recommendations to Government, and we have huge respect for their important work. The hon. Member for Newcastle upon Tyne North and the hon. Member for Torfaen (Nick Thomas-Symonds) referred to the NHS Pay Review Body’s 2014-15 recommendations. Last year the Government accepted its recommendations for 2016-17. We have provided our evidence to the current round—as have others, including trade unions—and we expect its recommendations in the coming weeks.
Mr Dunne
I will first answer, if I may, some of the comments made about the NHS Pay Review Body’s recommendations and how they sit alongside other elements of the NHS.
The allegation was made that there have been significant pay rises across NHS boardrooms, which are demoralising for those who have suffered pay restraint. However, I say to the hon. Members who raised that point that in 2016 the median rise across all board positions in NHS trusts was 0%. There are individual examples, when very senior managers are introduced to trusts that are going through a management change or are in difficulty, where higher pay rates may have to be introduced than for the previous incumbent, but generally speaking the opposite is happening: in many cases, those coming into new positions are coming in on slightly lower salaries.
Justin Madders
The Minister talks about respecting the independent NHS Pay Review Body’s recommendations. Without having seen them, can he say whether the Government are likely to respect those recommendations?
Mr Dunne
The hon. Gentleman will not be surprised to hear that I cannot give him any reassurances on that. We will have to see what the recommendations are and then take a view. However, we are not very far away from that point now.
The hon. Member for Foyle (Mark Durkan) referred to the national living wage. I got the impression from him that some NHS staff members in Northern Ireland are earning only the national living wage; I can reassure him that no NHS staff in England are earning only at that level.
Dr Whitford
Looking at the graph going forward, however, those on bands 1 and 2 of Agenda for Change will fall not only below the real living wage, which they are already below, but below the national living wage, which is the minimum wage, in the coming years—2018-19 and 2019-20.
Mr Dunne
Once again, the hon. Lady is speculating about what might happen in future, and I am afraid that not only can I not comment on that, but I am not sure whether she is correct or not. There are some assumptions in what she said about what will happen to the national living wage. The Government are making some assumptions, but what the Government choose to do about the matter we will have to see. At present, the policy is certainly that nobody will be paid less than the national living wage. I can reassure her about that.
Mark Durkan
Just to clarify, like the hon. Member for Central Ayrshire (Dr Whitford), I was referring to the living wage and not to the national living wage, which is a figment of Government policy.
Sir Roger Gale (in the Chair)
Order. You cannot take one intervention following another intervention. I call the Minister to speak.
Dr Whitford
I was basing my assumptions and suppositions on what the Government themselves announced when they said that the pay freeze would continue in the next four years. That was announced in the comprehensive spending review, so I am not just making it up, and if pay goes on the trajectory that was announced last year, it will fall below the national living wage, which is obviously due to rise towards 2020.
Mr Dunne
I have made the Government’s current position clear and we will have to see what emerges from the NHS Pay Review Body’s recommendations, and then how those are implemented over the coming years. I think it is fruitless to speculate on what might happen in future years, based on the suppositions that the hon. Lady made—
Dr Poulter
On the current position, can my hon. Friend clarify what the average annual increase in pay in real terms is for NHS staff who have been at the top of the Agenda for Change pay scale since 2010?
Mr Dunne
No, I am afraid I am going to make some progress.
Hon. Members need to recognise that there is clearly a balance between pay and jobs in the NHS and across many public services. I note that the Opposition spokesman was full of recommendations about what not to do but had none, as far as I could calculate, about what should be done in relation to the delicate balance between pay and jobs. If pay were increased beyond the proposal from the NHS Pay Review Body, or beyond what the Government intend to pay, clearly there could be an impact on the number of jobs that can be afforded in the NHS within the financial envelope that we have.
Justin Madders
We are very clear that we believe that the recommendations of the independent NHS Pay Review Body should be accepted. Much of what I said was about how we should recognise that, given the pressures on nurses’ pay, that will not necessarily cost the Exchequer anything in the long run.
Mr Dunne
I am not sure that that provides much clarification, but I thank the hon. Gentleman for having a go.
Employers in the NHS know that they need to deliver greater efficiencies and improved productivity to help protect frontline jobs. Making the workforce more expensive, through higher pay rises, will not help.
It is therefore disappointing that trade unions have alleged that staff have suffered a pay cut of about 14% in real terms—an allegation that has been repeated by a number of hon. Members in the debate. The truth is that the Government have ensured that no NHS employee —indeed, no employee—should be paid below the national living wage. As I have said, no NHS employee employed under the Agenda for Change pay system is paid below that.
The truth is that average earnings of NHS staff as a whole remained well above the national average salary for 2015, which was £27,500, and have increased by more than annual pay awards. For most NHS staff groups, half of employees employed in 2010 and still in employment in 2015 benefited from double-figure increases in earnings, equating to between 2.2% and 2.9% annually, depending on staff group. The average annual consumer prices index figure over the same period was 2.4%.
Dr Poulter
I specifically asked about those who are at the top of the Agenda for Change pay scale, which many Agenda for Change staff are. Can the Minister confirm what the figures are for that group, because I think that the figures he has given include those in receipt of incremental rises?
Mr Dunne
They do, and it is important for hon. Members to understand the impact of incremental pay rises. The truth is that some half a million Agenda for Change staff are eligible for incremental pay rises each year of more than 3% on average, on top of annual pay awards. I am not saying that NHS staff should have no concerns about the level of pay award they receive; what I am saying is that since the 2008 recession, NHS earnings and public sector earnings have generally compared well with those in the wider economy.
A number of hon. Members talked about regional pay and in particular the challenges of working in London. Of course, we are very sympathetic to individuals who face the pressures of working in London—in both inner and outer London—and that is why we have the increments available to recognise the extra costs of living there.
Mr Dunne
I will make a little progress, if I may.
NHS organisations spend about two thirds of their entire expenditure on pay. Ensuring that the NHS has the staff it needs relies, crucially, on controlling pay and on making every penny count for the benefit of patients.
I give way to my hon. Friend.
Dr Poulter
My hon. Friend the Minister may not have the answer to my specific question here today, but will he write to me after the debate to confirm the answer to my question about those members of staff who are at the top of the Agenda for Change pay scale? What, in real terms, has been their pay increase since 2010?
Catherine McKinnell
I thank the Minister for giving way. I am slightly concerned by his response, in that he does not seem to be taking on board the very significant concerns that have been raised right across the board, not only by unions but, significantly, by the National Audit Office. Last week, in its report on ambulance services, the NAO said:
“Ambulance trusts face resourcing challenges that are limiting their ability to meet rising demand.”
One of the “challenges” that is specifically cited is “pay and reward”, which is hampering recruitment. It is not just the unions and NHS staff who are saying these things; it is the NAO and other bodies as well.
Mr Dunne
The hon. Lady refers to ambulance staff. In recent weeks—just before Christmas, in fact—the Department agreed a deal with trade unions whereby paramedics working in ambulances would have their banding increased from band 5 to band 6, phased in over two years so that they can demonstrate they have the increased skill competence required. That represent a significant increase in reward for paramedics; some 12,000 paramedics will receive a higher pay award, precisely to address recruitment challenges for that specific profession. So we are listening and we are doing something about this issue. I will try to give the hon. Lady other examples of where we are responding to specific pressures.
Mr Dunne
No. The hon. Lady has had a fair crack. I will make a bit more progress.
I was challenged in this debate to refer to what the Government are investing in the NHS and I obviously take some relish in responding to that challenge. We are investing an additional £21.9 billion in nominal terms, which is equivalent to £10 billion in real terms, to fund the NHS’s own plan for the future. By doing so, we believe that we are playing our part, through the measures announced over the last 12 months or so, to help the NHS achieve its five year forward view. It needs to do that not only by realising benefits from the Carter review to improve productivity, but by clamping down on rip-off staffing agencies and encouraging employers to use their own staff banks for temporary staffing needs, so that they can invest in their permanent workforce. That has been referred to by a number of right hon. and hon. Members.
Agency and bank working provide an opportunity for NHS staff to engage in more flexible working to suit their own circumstances, so I would not want to characterise all agency working as bad. What is challenging is when NHS organisations need, in some cases, to go out to external agencies beyond their immediate bank and pay significantly higher rates. That is why the Department introduced, a year ago, a number of measures to start to limit the ability of agencies to charge the NHS such high fees, and we have had some success in that. In the period for which I have figures—roughly the middle of last year—the agency costs to the NHS had been reduced by 19% over the equivalent period the year before, so we are doing something about those fees. We are apprised of the problem and are bringing down the cost to the NHS of employing agency staff.
This issue is not just about pay. NHS staff, like many people, work hard to improve our public services. They have families and commitments, and they deserve to be rewarded fairly for what they do. However, as has been said, pay alone will not necessarily persuade the skilled and compassionate people that we need to choose a career in the NHS. It would be wrong to see the NHS employment package as just about headline pay. NHS terms and conditions have been developed over many years, in partnership with trade unions, and they recognise that it is a combination of pay and non-pay benefits, which need to keep pace with a modern, changing NHS, that help to recruit, retain and motivate the workforce.
Dr Whitford
Certainly the nurses I met during the lobby here, who had come from all over England, but particularly from London, described literally struggling and facing great financial hardship. That is very difficult for them. They work so hard for the benefit of all of us, yet feel that they cannot go on in their profession because they simply cannot keep their families here in London.
Mr Dunne
I have already explained to the hon. Lady that we have a London weighting, which reflects the increased costs of living in London. I have also explained to her that average pay for nurses is significantly above the national average pay. She herself referred to average nursing pay of some £31,000—
Mr Dunne
If not her, then another hon. Member referred to it, and that is from the latest available workforce statistics.
Picking up on the hon. Lady’s point, it is important that NHS staff are confident that their employment package is competitive. We want employers to make better use of the full package in their recruitment and retention strategies. NHS Agenda for Change staff have access to an excellent pension scheme, far in excess of arrangements in the wider economy, which includes life assurance worth twice the annual salary, and spouse, partner and child benefits. They have annual leave of up to 33 days—six and a half weeks—plus the eight bank holidays, which is far better than that which is available in the private sector, and in many other elements of the public sector. They have sickness and maternity arrangements that go well beyond the statutory minimum and, as I have touched on, there are flexible working, training and development opportunities for staff at all grades. For too long, the NHS employment package has been a well-kept secret and we want leaders to make the very best use of the overall NHS employment offer to help recruit and retain the staff they need.
Tom Elliott (Fermanagh and South Tyrone) (UUP)
The Minister has outlined the pay and conditions package—or part of it. Does he believe that staff within the nursing profession are confident at the moment about their pay and conditions package, or does he feel, as I hear, that they are undervalued within the system?
Mr Dunne
I have tried to indicate in my remarks that we do not undervalue anyone who works in the NHS. The role of our nurses in particular provides the backbone of the entire health service. Understandably, people are concerned about their level of pay. With several years of pay restraint, that is no surprise—it is the case right across the economy—and that is why we will look carefully at the recommendations of the NHS Pay Review Body. I have already said that we recognise that there should be some increase in the award to take into account the cost of living.
You will be pleased to hear, Sir Roger, that I am going to conclude my remarks, by reconfirming that as a nation we are extremely proud of our NHS. The patient surveys we undertake every year tell us that our patients are proud of our NHS. Our staff tell us, in the surveys we undertake of them, that they are proud of working in our NHS. This is not just me saying this, reading it from a sheet; it is what staff tell me whenever I visit an NHS facility. They are proud of their job. They are proud of looking after their patients, and they want to continue to do so.
The Government have to take tough decisions, and in this area we have done so to protect jobs through pay restraint. Average NHS earnings for most staff groups have continued to grow. We are committed to ensuring that they have the right number of colleagues working alongside them in hospitals and in the community.
I strongly believe that the issue of recruitment and retention is not just about pay. It is about creating a culture in which learning, development and innovation are encouraged. It is about creating an environment where staff want to work, take pride in what they do, and are well motivated and feel safe; an environment where employers promote the importance of the values of the NHS and work incredibly hard to keep staff safe, and where bullying and harassment are not tolerated.
Pennine Acute Hospitals NHS Trust
Philip Dunne Excerpts(7 years, 11 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
It is a pleasure, Mr Streeter, to serve under your chairmanship in such a well-attended debate. I congratulate the hon. Member for Blackley and Broughton (Graham Stringer) on securing the debate and on encouraging so many of his neighbours, who clearly have an interest in healthcare in the area served by the Pennine trust, to attend and to make such powerful contributions. Everyone has spoken from the heart and with true sensitivity.
As the hon. Gentleman said at the start of the debate, it is difficult to strike the right balance between drawing attention to trusts’ obvious failings, which need to be brought into the public domain and dealt with, and not seeking to lay blame on individuals. We all recognise that the individuals who work in the trust, as we heard so powerfully from the hon. Member for Heywood and Middleton (Liz McInnes), who worked at the trust for many years, give of their best and wish to provide the best possible care for their patients. Often the systems and structures around the individuals can inhibit that good intent.
I applaud the hon. Member for Blackley and Broughton for highlighting some dreadful examples of very poor care in the trust over many years, but especially those that came to light last year. As he well knows, the problems at Pennine go back many years. The trust is 16 years old, as other Members have said. Within three years of its creation, consultants at the trust had passed a vote of no confidence in its then management, as the hon. Member for Heywood and Middleton reminded us.
The hon. Member for Ellesmere Port and Neston (Justin Madders) pointed out that, in the days before the CQC, Sir George Alberti was asked to report on what was happening. Much of last year’s CQC report, however, echoes the findings of the 2005 Alberti report, as the hon. Gentleman said in his constructive contribution. We must try therefore not only to learn the lessons, but to implement them; they clearly have not been in the past few years. I will touch on some key findings of the CQC report before I develop my remarks on what we are doing to respond to the findings and shortcomings.
The CQC report was based on an inspection in February and March last year, which rated the Pennine Acute Hospitals NHS Trust overall as inadequate. In particular, the trust was rated inadequate for safety and leadership. As the hon. Gentleman pointed out, however, it was rated good for care, which is a visible tribute to the quality of care provided by the dedicated staff in the main.
The report found other problems: shortages in nursing, midwifery and medical staff, which have been touched on by other hon. Members; a lack of understanding of key risks at departmental, divisional or board level; problems in services, including in A&E, maternity, and children’s and critical care; key risks were not recognised, escalated or mitigated effectively; and there was inconsistent performance reporting and concern about the quality of data to support performance reporting.
In addition, the CQC identified low morale in a number of services, in particular maternity, and described a poor culture with deeply entrenched attitudes. Regrettably, some staff accepted suboptimal care as the norm, and patients’ individual and specific needs were neither appropriately considered nor met.
Those were the CQC findings. In contrast to what has happened following previous problems and subsequent actions, the new CQC regime is introducing beneficial change—which I hope is recognised by the hon. Member for Heywood and Middleton—and improvement. An inadequate rating by the CQC would normally result in the trust being put into special measures, but in this case a different remedy is being used to turn the trust around and, in particular, to address the obvious challenge of leadership, which almost every contributor to the debate has identified as an historical failing at the trust.
In April last year, the management team of the neighbouring Salford Royal, led by Sir David Dalton and Jim Potter, took over the chief executive and chair roles at Pennine acute on an interim basis. That team is in the process of guiding a management contract for the long term to continue providing the strong leadership needed to drive the improvements that we all recognise. The new management team at the Pennine trust got to work immediately. In July last year, the Salford team completed a diagnostic assessment of the issues facing Pennine and developed a short and long-term improvement programme based on patient safety, governance, workforce, leadership and operational performance.
Debbie Abrahams
Given the Pennine trust’s current position and the staff shortfalls that the Minister has also mentioned, what additional funding support can he offer Pennine acute?
Mr Dunne
I will not be drawn too far down that route at this point, because I would like to develop my overall response. This is not all about funding, as many hon. Members have said. Staff shortages are not necessarily driven by funding either; they are often driven by a trust’s difficulties making it an unattractive place to work. I do not have in my head the number of applicants for vacancies, or the number of vacancies, but I will tell the hon. Lady in a moment how many staff have joined the trust—what increase there has been—under its new leadership.
Debbie Abrahams
Maintained vacancies have caused significant pressure on, for example, middle-grade clinicians in the A&E department. Vacancies have been maintained to try to save money, and that has been a real issue.
Mr Dunne
I am grateful to the hon. Lady for her intervention. I will come on to staff issues in a few moments.
As several hon. Members have said, local political leaders have broadly welcomed Sir David Dalton’s appointment as the chief executive of the Salford Royal trust, which is one of the finest trusts in the country and was one of the first to be rated outstanding by the CQC. He is listening to staff and, where appropriate, deploying Salford’s systems and experience to help to support staff in Bury, Rochdale, Oldham and North Manchester to deliver the high standards of service that we all want. I welcome the support that has been expressed for Sir David’s efforts by everyone who has spoken in this debate, in particular the hon. Member for Blackley and Broughton.
Sir David believes that all the evidence shows that staff are best placed to know what needs to be improved in their ward or department. He has introduced a system—tried and tested in Salford—that involves staff and supports them to test their ideas for improvement. Ideas that are shown to work will be replicated across the whole hospital. That approach turns on its head the idea that people in senior management positions always know what is best for patients on a ward, and instead recognises that frontline staff have expertise in spades and supports them. It will help to develop the culture change that was called for in particular by the hon. Member for Oldham West and Royton (Jim McMahon), who rightly identified that as a fundamental problem in the Pennine acute trust.
As my hon. Friend the Member for Bury North (Mr Nuttall) called for, Sir David Dalton at the beginning of this month introduced new site-based leadership teams in each of the four hospitals. For the first time since the creation of the trust 15 years ago, each hospital site and place-based team will consist of a medical director, a nursing director and a managing director, each dedicated to the daily oversight of that hospital. Together, they will manage the services of a care organisation. That site-based arrangement will give leadership teams a clearer focus and enable them to offer staff better support and engagement and take operational decisions for each site. Those leaders will also have the benefit of being in post on site to strengthen local relationships and promote joint working with other partners in the health economy, including local authorities and commissioners.
The hon. Member for Blackley and Broughton and my hon. Friend the Member for Bury North highlighted poor maternity care. The newly appointed director for women’s and children’s services led an internal review of maternity services under the new management arrangements. That review dug deeper and revealed even more than the CQC was able to. Some of the instances of poor care that were revealed are truly shocking, and I express my sincere regret to everyone affected by those tragic incidents, some of which the hon. Member for Blackley and Broughton highlighted. As an immediate result of those reviews, an improvement plan and a new management team for maternity services have been put in place at North Manchester general hospital. Central Manchester University Hospitals NHS Foundation Trust maternity staff are working alongside Pennine staff to develop a clinical leadership and staffing support programme.
The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) asked about staffing. I am advised that between March 2016, when the new management team came into place, and December 2016, the number of people employed on a full-time or part-time basis by the trust increased by more than 300. I think that is 300 more full-time equivalents. That includes seven doctors, 133 registered nurses and 58 midwives and is a net addition to the trust.
The A&E departments remain under pressure, not least given the winter pressures that have been common across the NHS in the past couple of weeks. That is particularly true at North Manchester, but that department has been stabilised and measures have been put in place to support staff, including direct GP and primary care input into the A&E department from Manchester GPs. Those GPs are supporting the department seven days a week and seeing around 30 patients a day, taking pressure off the service and ensuring that patients see the right professionals and receive the right care. Similarly, the local NHS in Oldham is piloting embedding enhanced primary care support in the A&E and urgent care system. Two GPs a day work between 11 am and 11 pm to support that system.
Measures have also been taken to stabilise children’s services; there has been a temporary reduction in beds at the Royal Oldham and North Manchester hospitals to reflect the workload that staff, given their current numbers, can deal with safely. Those measures are having an impact on turning around the performance of the hospitals in the trust. Additionally—the hon. Member for Ellesmere Port and Neston asked about funding—extra financial support of £9.2 million was secured in year to enable the trust to put in place immediate and short-term measures to stabilise services.
The hon. Members for Blackley and Broughton and for Oldham West and Royton asked about avoidable deaths and the culture of silence when problems arose. The new management have been determined to change that culture. Since April 2016, the trust has investigated and closed down 489 serious incident cases, and the average investigation time has been reduced from 156 days to 90 days. Considerable progress has been made on changing the culture of how problems and complaints are dealt with.
Hon. Members talked about the future and expressed concern, particularly from a staff perspective, about yet another change happening. As all Members are aware, NHS England is in the midst of implementing sustainability and transformation proposals and turning those into plans for 44 areas across the country. Greater Manchester’s five-year plan, “Taking charge of our Health and Social Care”, predates the request for STPs, but NHS England has agreed that that plan meets the STP requirements and they are now effectively one and the same thing. There is, therefore, a real opportunity for healthcare in Manchester, with devolution of control to the council and opportunities for the local authority to work with the NHS to improve services for all the people of Manchester, to become a model for the rest of the country.
The NHS in Manchester has been looking at how acute services can best be organised to deliver benefits, including operational financial efficiency, for quality of care, patient experience and the workforce. As has been said, the proposal is to create a single acute provider for Manchester, with the Wythenshawe hospital and the North Manchester general hospital joining the Central Manchester foundation trust. That is an ambitious proposal, and the organisational change it requires is complex, but we believe that the potential benefits are considerable and offer a real chance for care to be standardised across the city. I know that hon. Members will be concerned about what that means for the Pennine trust. If that proposal proceeds, services at North Manchester general hospital will be combined with those at the other hospitals in Manchester, but the intention is for the remaining hospitals in the Pennine acute trust to continue to work with Salford Royal in a new relationship, which is under active consideration.
Hon. Members mentioned resources for estates. Like any trust, the Pennine acute trust needs better-quality, flexible and fit-for-purpose buildings. I have little time in which to outline what is happening but, as some hon. Members will be aware, construction has begun of a brand new, purpose-built 24-bed community intermediate care unit on the grounds of North Manchester hospital. That unit will cost £5 billion and will take 12 months to build. The Royal Oldham hospital, which includes the old workhouse, is being developed into a high acuity centre to serve the population of north-east Manchester.
Motion lapsed (Standing Order No. 10(6)).
NHS and Social Care Funding
Philip Dunne Excerpts(7 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister of State, Department of Health (Mr Philip Dunne)
I am pleased to follow the hon. Member for Worsley and Eccles South (Barbara Keeley) and to be able to close this debate. I thank all 34 hon. Members for their contributions, some of whom—mostly those on the Government Benches—managed to rise above party politics and make some constructive comments.
I join my right hon. Friend the Secretary of State in thanking the 2.7 million staff working in our NHS and social care system. As the Prime Minister said earlier, we recognise that they have never worked harder to keep patients safe, with A&Es across the country seeing a record number of patients within four hours in one day last month.
Regrettably, after five and a half hours of debate and criticism from Labour Members, we have heard little, if anything, about how to provide solutions to the challenges that our A&Es face.
Once again, the Opposition have touted more funding as their only answer to solve public sector challenges. In fact, they have pledged to raise corporation tax eight times, promising an unspecified amount from an unspecified source. That will not help our NHS and it will not fool the public. There is much to do to protect the system and ensure a sustainable future, but it is this Government who have plans in place to get through this extremely challenging period and sustain the NHS for the future.
The shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), spoke for about three quarters of an hour without making a single suggestion about how to solve the problems that face the NHS—not one. He should have stayed to listen—he may have done and I apologise if I did not pay enough attention to his presence in the Chamber.
The former Health Minister, the right hon. Member for Doncaster Central (Dame Rosie Winterton), asked specifically for community pharmacists to be paid for providing minor ailments services. I am pleased to be able to tell her that that is precisely what we are doing. The Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), was discussing that only this morning in Westminster Hall, and I regret to say that not a single Labour Member was present to hear what he had to say. [Interruption.]
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. Surely the House wants to hear the Minister after this long debate—with courtesy.
Mr Dunne
We have heard a number of comments from Opposition Members—I am pleased to say that they were outnumbered in this Opposition day debate by Government Members—rehearsing some tired phrases to mislead the public over alleged increasing independent provision in the health service and also misrepresenting what my right hon. Friend the Secretary of State was saying in his remarks about A&E targets. Having said that, I wish to pay tribute to the hon. Member for Chesterfield (Toby Perkins), who is in his place, and the hon. Member for Workington (Sue Hayman), both of whom showed considerable personal courage in explaining the circumstances surrounding the death of each of their fathers, and they did so in an entirely honourable and sensible way, and I am grateful to them for sharing that experience.
I congratulate my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) on managing to get her son into hospital to have his appendix treated on Boxing day. As she said, that showed that that service was working well.
The Opposition sought to take the moral high ground in this debate. The hon. Member for Dewsbury (Paula Sherriff) challenged Government Members on whether they had visited hospitals over the Christmas period other than on an official visit. Her position was completely punctured by my hon. Friend the Member for Lewes (Maria Caulfield) who pointed out that she was doing a night shift between Christmas and new year in her role as a nurse—she was not on an official visit.
There have been some impressive contributions. I thank the Chair of the Select Committee on Health, my hon. Friend the Member for Totnes (Dr Wollaston), who was supportive of a more nuanced target for A&E, and for her calm and generally constructive comments, and my right hon. Friend the Member for Chelmsford (Sir Simon Burns) for his support for the success regime in Essex and for pointing out that it is not closing any of the three A&E departments in the hospitals there. I also thank my hon. Friend the Member for Crawley (Henry Smith), who made a very thoughtful speech and welcomed the opening of an assessment unit in Crawley to help to relieve pressure on the A&Es nearby. Finally, I thank my right hon. Friend the Member for Forest of Dean (Mr Harper) for another thoughtful contribution from the Back Benches.
Of course, the Conservative party and the Government recognise that our NHS faces the immediate pressures of the colder weather and the wider pressures of an ageing and growing population. There were nearly 9 million more visits last year to our A&Es compared with 2002-03—the year before the four-hour commitment was made. That is more than 2 million A&E attendances every month, and our emergency departments are now seeing, within the four-hour target, 2,500 more people every single day compared with 2010.
Mr Dunne
I will not give way. The hon. Lady did not give way and I have a very short time left in which to speak.
Compared to when the Conservative party came into office in May 2010, in 2015-16 there were 2.4 million more A&E attendances. That is in the context of a much busier NHS overall. The NHS is delivering 5.9 million more diagnostic tests. Some 822,000 more people are seen by a specialist for suspected cancer and 49,000 more patients start treatment for cancer every year compared with the year before we came to office. It is therefore the case that a Government of any colour would be faced with the same problems, but it is this Government who have committed to funding the NHS’s own plan for a sustainable future. Had we followed Labour’s plans, the NHS would have £1.3 billion a year less, which is equivalent to 13,000 fewer doctors or 30,000 fewer nurses.
We remain committed to the vital four-hour A&E promise for those patients who need to be there. We are proud to be the only country in the world to commit to all patients that we will sort out any urgent health need within four hours. Only three other countries—New Zealand, Australia and Canada—have similar national standards, but none of theirs is as stringent as ours.
Today it is the Conservative party that is the party of the NHS. That is why we pledged more than Labour did and why we are delivering more funding with a higher proportion of total Government spending going into health in each year since 2010. Funding for the NHS will rise in real terms by £10 billion by 2020-21 compared with 2014-15. That sum is front-loaded with £6 billion being delivered by the end of this year, as the NHS asked for. It was this Government who established an independent NHS with an independent chief executive. It was this NHS that came up with its own plan and we were the only party to back it. We agree that the NHS and social care face huge pressure and, yes, there is more for us as a Government to do. However, we entered winter with a more comprehensive plan than ever before, and we have confidence that plans are in place to cope with the current pressures we face—winter, A&E and delayed discharges—and to sustain the system for the future.
I conclude by saying a huge thank you to the 1.3 million staff in the NHS and the 1.4 million people who provide social care. They are the ones who continue to make this possible. We are aware of the pressures they are under, especially during winter. We have increased the number of doctors and nurses, as the Secretary of State said earlier, especially in A&E, and we have launched plans to recruit more doctors and nurses. Without them, we would not have a national health service that provides such a high level of care.
Madam Deputy Speaker
I understand the hon. Lady’s point of order. It is not a matter for the Chair, but I understand why she wished to make the point.
Madam Deputy Speaker
It looks as though the Minister would like to say something further to that point of order.
Mr Dunne
Further to that point of order, Madam Deputy Speaker. To give the House complete clarity, I understand that two Labour Back Benchers were present and made minor interventions in the Westminster Hall debate, but there were no speeches or substantive contributions by those Labour Members.
Madam Deputy Speaker
I am sure that the House is grateful to the Minister for clarifying what he said in his speech, and to the hon. Lady for clarifying the position. The matter is now closed.
Oral Answers to Questions
Philip Dunne Excerpts(8 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Rehman Chishti (Gillingham and Rainham) (Con)
The Minister of State, Department of Health (Mr Philip Dunne)
We want the NHS to offer the safest, highest quality care anywhere in the world, so we are now tackling unacceptable performance. That is in contrast to the Labour party, which ignored failures for so long. Since introducing the rigorous special measures inspection regime, 31 provider trusts have gone into Care Quality Commission special measures, of which 15 have been turned around as a result of significant quality improvements. I congratulate again the staff of Sherwood Forest, Wye Valley, Norfolk, and Suffolk trusts, all of which have come out of special measures in recent months.
Rehman Chishti
Medway Maritime Hospital has made significant improvements since it was put into special measures: mortality rates and length of patient stay are down; leadership is excellent; and there has been extensive investment in the A&E. Does the Minister agree that it is the right time for the hospital to come out of special measures? Will he join me in paying tribute to the excellent work of the hospital’s staff?
Mr Dunne
I congratulate my hon. Friend on his role in championing Medway Maritime Hospital, which I visited earlier this autumn. The CQC is in the process of re-inspecting Medway and will publish its findings in the new year. I congratulate the trust on its improvements thus far that were highlighted by my hon. Friend, which include reducing its average length of stay on admission wards from 11 days to only 3 days.
Liz McInnes (Heywood and Middleton) (Lab)
A recent damning report on maternity care from the Pennine Acute Hospitals NHS Trust care referred to appalling neglect that lead to the avoidable deaths of mothers and babies. The trust has implemented an improvement plan, but plans for maternity services under the Making It Better scheme were based on a predicted birth rate of 3,500 a year, and the reality is that the trust deals with 10,000 deliveries a year. What action will the Minister take to address that situation?
Mr Dunne
I am grateful to the hon. Lady for raising some of the issues at the Pennine trust. We are well aware that it needs improvement, which is why we have buddied it up with the outstanding Salford Royal NHS Foundation Trust next door. The Salford trust is led by Sir David Dalton and the Secretary of State referred to it earlier. I will take up the matter raised by the hon. Lady directly with Sir David.
Lyn Brown (West Ham) (Lab)
Andrew Bridgen (North West Leicestershire) (Con)
The Minister of State, Department of Health (Mr Philip Dunne)
The NHS is a national, not an international, service. This Government were the first to introduce tough measures to clamp down on visitors accessing free NHS care, including introducing the immigration health surcharge. The steps we have taken have meant that income raised from visitors and migrants has risen threefold in three years, from £97 million in 2013-14 to £289 million in 2015-16.
Andrew Bridgen
I thank the Minister for that answer, but does he agree that recovering more money from chargeable patients requires a culture change among NHS staff? Does he therefore share my dismay that the leader of the doctors union dismisses the need even to address this issue, while calling for additional investment in our NHS?
Mr Dunne
I agree with my hon. Friend that we need increased awareness and appropriate participation by all NHS staff in achieving this policy, but I also agree with one thing that Dr Mark Porter said—that sick and vulnerable patients must not be put off seeking necessary treatment, as this may be bad for their health and for that of the public in general. This has always been a clear feature of our policy, so to be clear, this policy does not withhold immediately necessary or urgent treatment, but it makes sure that the NHS is fairly reimbursed by those who are not entitled to free care.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
As the Minister will know, the Public Accounts Committee has looked in detail at this issue, and we were rather shocked to discover that the Government themselves are woeful at collecting money from EU citizens who use our hospitals and for whom the Government are then responsible for getting the money from their home Government. When will the Government get their act together to make sure that this money comes into our NHS?
Mr Dunne
I am always grateful for advice from the Public Accounts Committee, which looks into areas where the Government can recover moneys to which they are entitled. There was an article in today’s Times which referred to outstanding sums, and we are taking steps to try to increase recovery rates in the years ahead.
Tom Brake (Carshalton and Wallington) (LD)
The Minister of State, Department of Health (Mr Philip Dunne)
The sustainability and transformation plan for south-west London sets out how the area will implement the NHS’s five year forward view. The local NHS is looking to strengthen primary care and ensure closer working across NHS bodies, with more sustainable acute services, developing centres of expertise to ensure high-quality service, as well as closer co-ordination with social care providers.
Tom Brake
The Epsom and St Helier Trust is a high-performing trust, hitting A&E and cancer treatment referral targets. It is confident that it can deliver sustainable and transformed care services, but will struggle to do so in St Helier hospital, built in the 1930s. The trust has previously secured a commitment from two Governments that funding would be available. Will the Minister give the same undertaking and confirm that once the STP process is complete, funding will be available to the trust to enable it to continue delivering excellent sustainable services from a new hospital?
Mr Dunne
I am aware of the right hon. Gentleman’s campaign on this matter. It would be wrong for me to pre-empt the work that is being done in reviewing both the STP process and the policy priorities of NHS England. Once those plans have been put forward to Ministers, we will be able to consider which we can prioritise.
Dr Tania Mathias (Twickenham) (Con)
The STP for south-west London includes mental health crisis needs, but there is a current crisis of lack of in-patient facilities for mental health patients. Will the Minister look into extra immediate funding to increase the number of in-patient mental health beds?
Margaret Greenwood (Wirral West) (Lab)
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
The Minister of State, Department of Health (Mr Philip Dunne)
I am aware of the case that the hon. Lady refers to. In the week of the incident, the London ambulance service received 40,433 emergency calls—an 8% increase on the previous week. We are trying to do something about this. We have recruited 2,200 more paramedics since 2010 and increased the number of paramedic training places by 60% in this year alone. The London ambulance service has recruited 107 more paramedics since September 2015 to help with this increased demand.
Fiona Bruce (Congleton) (Con)
Dr Andrew Murrison (South West Wiltshire) (Con)
With acute hospital bed blocking at a record high, do Ministers agree that it is a great pity that so very few of the 40 sustainability and transformation plans now in the public domain deal directly with step-down care and, in particular, with community hospitals?
Kerry McCarthy (Bristol East) (Lab)
Recent figures from the Royal College of Psychiatrists show that children and adolescent mental health services are still underfunded in many parts of the country—particularly worrying for me is the fact that Bristol seems to be the 13th lowest in the country. What are Ministers doing to ensure that children across England and the rest of the UK get the health services that they need?
Mrs Maria Miller (Basingstoke) (Con)
My constituency has been waiting some time for the go-ahead for a new critical treatment hospital providing 24/7 care for the sickest patients, which is very much in line with Government policy. The hospital’s chief executive, Mary Edwards, retires this month after 21 years of exceptional service. Will the Secretary of State give her a retirement present and help me to secure a decision from NHS England?
Mr Dunne
I join my right hon. Friend in congratulating her chief executive on her commitment to the NHS. As I said in answer to a previous question about the STP for my right hon. Friend’s area, the issue is being reviewed at the moment by NHS England, and I am afraid that I am not in a position to give her any advance notice of the outcome.
Norman Lamb (North Norfolk) (LD)
The Secretary of State will be aware of the horrifying case of Fiona Hollings, a 19-year-old with anorexia who for the past four months has been nearly 400 miles away from home, in a bed in Glasgow. Her family have travelled 8,000 miles in that time to see her. The Government commit to ending this horrific practice by 2020, but do families really have to put up with it until then? How would he feel if it was his child?
Lilian Greenwood (Nottingham South) (Lab)
In the east midlands, the average ambulance arrival time for life-threatening cases has almost doubled in the last three years, and Nottingham’s A&E waiting times are the worst in a decade. Will Ministers apologise to my constituents, including hard-working NHS staff, for their failure to fund health and social care adequately?
Mr Dunne
I would like to add my tribute to the work of ambulance staff up and down the country, particularly over the busy Christmas period ahead. As I have already said today, we have increased funding for ambulance services. We have increased the number of paramedics, both in training and employed. Earlier this month we announced that we had increased the payments to paramedics to move them from band 5 to band 6, to help to retain and recruit more staff.
Several hon. Members rose—
Health Service Medical Supplies (Costs) Bill
Philip Dunne ExcerptsTuesday 6th December 2016
(8 years ago)
Commons ChamberRead Full debate Health Service Medical Supplies (Costs) Act 2017 View all Health Service Medical Supplies (Costs) Act 2017 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 6 December 2016 - (6 Dec 2016)
Rob Marris
Medical supplies in this part of the Bill seem to be to do with physical equipment. But, again, what is equipment? We can refer to the definitions, which state:
‘medical supplies’ includes surgical, dental and optical materials and equipment”.
Drugs are dealt with elsewhere in the legislation.
I think the Minister has got the point, but I will repeat it very briefly. He is seeking clarification for the Wales legislation through amendment 7 when I understood him to say that he did not think such clarification was needed for the same definition contained in the legislation pertaining to England. I would like him to explain that apparent anomaly. If it is not an anomaly, perhaps he could tell the House that he is going to clarify the definition as it relates to England in the later stages of this Bill.
The Minister of State, Department of Health (Mr Philip Dunne)
I rise to speak to the new clause, the Government amendments and all other amendments tabled on Report. I want to start by expressing my gratitude to the Opposition Front-Bench spokesmen, who both confirmed their intent to continue in the spirit of constructive dialogue we have had thus far in our consideration of the Bill. I am pleased that they support the Bill’s objectives, and I will seek to respond to their amendments.
Hon. Members will recall that we debated at length in Committee the issue raised in new clause 1. I want to take this opportunity to provide some additional reassurance that this is an important issue for the Government. We have already included in the illustrative regulations for both the statutory scheme, in regulation 32, and the information regulations, in regulation 14, an annual review of the regulations and a requirement to publish our report of each review. These annual reviews go further than the specific single review proposed by the hon. Member for Ellesmere Port and Neston (Justin Madders) in new clause 1, the effect of which would require the Government to only undertake a single review within six months of the Act coming into force.
We accept that reporting is an important principle. However, setting out the requirements in primary legislation is too restrictive. We believe that the proposed single review within the first six months of the Act coming into force would provide an insufficient timeframe in which to assess the impact of the provisions, whereas the annual reviews we have set out in the illustrative regulations in effect place a duty on the Government to review both the statutory scheme and the information regulations to ensure their effectiveness, and to do so every year. Of course these provisions will be subject to consultation as part of the wider consultation on the regulations.
Over time we expect that both the statutory scheme and the information requirements will be amended through their respective regulations to reflect changing circumstances. It is essential that the review and reporting arrangements are able to be similarly flexible so that they remain appropriate to the schemes in operation.
The hon. Member for Ellesmere Port and Neston asked whether objectives should be set out before the regulations come into force. As I have said, the Government will consult on regulations before they come into force. The objectives of the regulations will be explored in the consultation and set out in the Government response to that consultation. I hope that addresses his point.
The illustrative regulations require an annual review to set out the objectives of the scheme, assess the extent to which they have been achieved, and assess whether they remain appropriate. These requirements will be tested through the consultation on the regulations, and we will of course take account of those views.
Rob Marris
First, I say again that I am very grateful to the Government for publishing the illustrative draft regulations to help us debate the Bill. Let us consider the provision of information in connection with the draft health service products regulations 2017. Regulation 14(2)(a) states that the report must in particular
“set out the objectives intended to be achieved by these Regulations”,
and then regulation 14(2)(b) says it must
“assess the extent to which these objectives are achieved.”
It seems a bit odd to say that in one review we are going to set out the objective and then decide whether the objective has been achieved or not. That seems, temporally, to be a bit wrong.
Mr Dunne
As I have indicated, we intend to undertake these reviews every year. It will probably be impossible to assess in the first review whether the objectives have been achieved—there might be some ability to assess it—but in subsequent iterations we will be able to look back and see how well they have been achieved.
I notice that the right hon. Member for Leicester East (Keith Vaz) is heading for the exit—[Interruption.] He has now resumed his seat. This is not specifically the right point in my speech to pick up on the points he has raised, but I would like to respond to his characteristically constructive contribution on the subject of diabetes. He is the chair of the all-party group on diabetes, and he might recall that I used to be the vice-chair of that group, as I have family members with type 1 and type 2 diabetes. I have considerable sympathy with the points that he made about the importance of adequate advice for individuals who might be unaware that they have diabetes. He also talked about the importance of adopting innovation through NHS treatment of the condition. We share that objective, and nothing in the Bill will do anything other than to continue to encourage innovation. I will be making further remarks, perhaps when the right hon. Gentleman is not with us, on the subject of innovation, but I just wanted him to be aware that I had taken his points on board. He might be disappointed by my conclusion on the specific amendment, but I shall go on to explain how his point is being addressed in other ways.
Returning to new clause 1 and the question of regulations, I wish to make a further point. Much of the information provided to the Secretary of State will be commercially confidential. We touched on this in Committee. I am sure that suppliers have every confidence that the Government will maintain that confidentiality in anything we publish, but it is important to reinforce the principle. This means that there is a limit to the level of detail we are able to publish, and I am sure that the hon. Member for Ellesmere Port and Neston will appreciate the commercial sensitivity reasons involved. Any information we do publish will be at a consolidated level, protecting suppliers’ confidentiality but allowing the Secretary of State to be clear on the basis of the conclusions of his review. We will of course be able to use supporting information to evidence our conclusions.
Turning to the detail of the new clause, its requirements reflect the duties placed on the Secretary of State in the Bill, but I must be clear that the content of such a report should not be restricted and must be able to address the key issues arising during the year that may affect the operation of the schemes. The other significant element of the new clause, which I have touched on in response to the right hon. Member for Leicester East, was discussed at length in Committee. This was the question of whether it would be appropriate for such a report to address matters relating to the NHS duty to promote innovation.
The Government’s position is clear that it is not appropriate to link the measures in the Bill, which relate purely to the cost of medicines and medical supplies, to the NHS duty to promote innovation. Promoting innovation is a high priority not only for the Government and the NHS but for many other stakeholders. Promotion of innovation quite properly requires action across many different fronts, and it would not be possible to quantify the contribution of the schemes in the Bill to that endeavour in any meaningful way. The NHS is already doing great work to promote innovation, and I would like to draw hon. Members’ attention to the latest data from the innovation scorecard, a quarterly data publication showing the uptake of innovative drugs and medical technologies following NICE approval in England. This is now a nationally published statistic.
The hon. Member for Wolverhampton South West (Rob Marris) asked specifically about this in his remarks. I can tell him that the latest publication, on 12 October this year, shows that the rate of uptake for 85 medicines recommended by NICE is increasing, that 77% of those medicines had positive growth uptake between March 2015 and March 2016, and that 54% of the 85 medicines had a growth uptake greater than 10%. These data are made available on a quarterly basis, and hon. Members can follow their progress through the official national statistics.
The Government are taking broader action to secure the UK’s future as an attractive place for the life sciences sector, particularly in the light of the EU referendum and the consequent Brexit. We are clear in our commitment to the life sciences, and to building a long-term partnership with industry. The hon. Member for Wolverhampton South West also asked me to address the question of the NICE process and whether this takes evidence into account. He also asked about the process for the subsequent review of previous decisions. This is a continuous process. It does not happen for every drug all the time, but there is a routine procedure under which, on the basis of new evidence, NICE will look again at a decision and decide whether to uphold or amend it. That procedure could allow drugs that had previously not been approved to become approved on the basis of new evidence, and NICE will look at evidence from wherever it comes. I hope that that reassures the hon. Gentleman.
Dr Whitford
It is a new medicines and rare diseases fund, and it includes orphan, ultra-orphan and end of life, but it is not only about end of life.
Mr Dunne
No, it is not only for end of life, but also for rare diseases. That was my understanding, but I stand corrected. However, my main point is that it should be for clinicians to decide what is spent across the range of activity. If money is ring-fenced into a specific fund for new medicines, that might not always be the right clinical decision.
Dr Whitford
Does the Minister accept that it is a slightly bizarre public relations thing to have a medicines fund that is only for cancer, ruling out people with other life-threatening illnesses? That is the case here in England.
Mr Dunne
The new cancer drugs fund was set up specifically to provide funds to deal with one of the most common causes of mortality in the country, and was a priority of the previous Government; I will not go into the reasons for that.
Returning to amendment 8, it was suggested that what happens to the receipts is not clear, but all income generated by the voluntary and statutory schemes is reinvested in the NHS. Estimates of income from the pharmaceutical payment regulation scheme are part of the baseline used in the Department’s spending review model. The model was used to calculate the funding increase that the NHS sought at the time of the 2015 spending review, and it helped to secure the £10 billion of real-terms funding over the course of this Parliament. The income from the voluntary and statutory schemes can and does fluctuate; that is the biggest problem with ring-fencing, which could bring risks in this area. For example, the annual income from the PPRS has varied between £310 million and £839 million in a full financial year in England, so there is the potential for the income that it generates to vary widely, which could disadvantage patients by making treatment dependent on income from a pricing scheme with unsteady income generation.
Rob Marris
I understand where the Minister is going with that, but I want to caution him. He spoke earlier about flexibility—my word, not his—and his example was that a clinical commissioning group or a medical body might want to spend some of this money on staffing. Owing to the fluctuation to which he refers, however, spending funds on staffing is probably not a good idea.
Mr Dunne
I am grateful to the hon. Gentleman for his advice, but I am afraid that I do not think it is relevant to my point about the fluctuation in income coming from the scheme. It is relevant in relation to whether NICE or politicians make such decisions. They need to be made by clinicians.
Dr Whitford
I thank the Minister for kindly giving way. The cancer drugs fund has a budget of some £350 million, so if he is saying that the money that can be retrieved varies from £300 million to over £800 million, that would allow for the expansion of a new medicines fund.
Mr Dunne
It might if the move was always in the same direction. My concern is that the amount could decline between one year and the next; it may not always go up—certainly not up in a straight line.
Separately from the Bill, the Government are taking action to secure the UK’s future as an attractive place for the life sciences sector and to support faster patient access to medical innovations. I have already touched on the recently published accelerated access review, which sets out ways to increase the speed at which 21st-century innovations in medicines, medical technologies and digital products get to NHS patients and their families. The review’s recommendations included bringing together organisations from across the system in an accelerated access partnership, and creating a strategic commercial unit within NHS England that can work with industry to develop commercial access arrangements. We are considering those recommendations with partners and will respond in due course.
NHS England and NICE are jointly consulting on several proposed changes to NICE standard technology appraisals and highly specialised technology appraisals, including around speeding up the appraisal process. The Department of Health continues to work closely with NHS England and other stakeholders to improve uptake of new medicines. A key element of that is the innovation scorecard that I have already referenced. With those comments about our concerns about what is proposed in amendment 8, I ask the hon. Member for Burnley (Julie Cooper) not to press her amendment.
Turning to amendment 9, tabled by the hon. Member for Central Ayrshire, the Government recognise that section 260 of the National Health Service Act 2006 does not explicitly state that the Government are obliged to consult industry. However, I am aware that the Act does explicitly state that there is an obligation on the Government to consult when it comes to controlling the cost of medicines. A similar amendment was tabled by the hon. Lady in Committee. I want to reiterate that I am happy to consider with her how we could best introduce a general requirement to consult industry in section 260. Indeed, my officials have been in discussions with her, and I am grateful for her time and constructive comments.
I note the hon. Lady’s reference to the effect of any pricing controls for medical supplies on maintaining the quality of those supplies. I assure her that the Government would take into account all relevant factors, including any concerns raised by industry about the quality of medical supplies, when making and consulting on any price controls for medical supplies. The Government would not however be in favour of putting one of those many factors in the Bill.
The Medicines and Healthcare Products Regulatory Agency is responsible for the safety, efficacy and quality of medical supplies, and the Bill will not change that. The MHRA has assured me that any use of the price control powers in the Bill would not affect any of the quality or safety requirements that must be met before medical supplies can be placed on the market.
The hon. Lady referred to the procurement system in Scotland; I assure her that the Government are committed to improving procurement across the NHS. She will be well aware of the Carter report, which concluded that there is considerable variation in the value that trusts extract from their expenditure on goods and medical supplies. NHS Supply Chain is working hard to deliver procurement efficiencies, to meet recommendations to increase price transparency, to lower costs, and to reduce the number of products and suppliers used across the NHS to deliver economies of scale. The hon. Lady referred to 600,000 products, but it has had success in reducing the range in the catalogue down to 315,000 to help NHS organisations purchase products more efficiently. It continues to work to reduce that number. I am aware of similar work in Scotland. In England, we are using the Carter review to deliver that.
While I understand the intent behind the hon. Lady’s amendment, I am not fully convinced that, as drafted, it would have the desired effect. If she will continue to work with me and my officials, the Government would be happy to consider, while the Bill is in the other place, how we could best introduce the requirement to consult into section 260. On that basis, I invite her not to press her amendment for now.
Mr Dunne
I am afraid that I must press on to cover the Government amendments.
Government amendments 1 to 5 address a possible loophole in the Bill. Clause 6 amends the National Health Service Act 2006 to give the Secretary of State the power to make regulations to obtain information from any UK producer that is not an excepted person. A “UK producer” is defined in the Bill as anyone involved in the manufacture, distribution or supply of health service medicines, medical supplies and other related products required for the purposes of the health services in the United Kingdom. An “excepted person” is defined in the Bill as any person providing pharmacy or GP services for the health services in Scotland, Wales and Northern Ireland. The purpose of these provisions was to reflect the agreement with the devolved Administrations that, for devolved purposes, they would collect information from pharmacies and GP practices in their nation. However, there may be circumstances in which a company supplies products in the devolved Administrations and also in England, and could claim that the provision, as drafted, would allow it to become an excepted person, because it was operating in the devolved Administrations. That is clearly not the intent of the Bill, so we have proposed these amendments to address this loophole.
Government amendment 6 is a minor consequential amendment that was unintentionally omitted when the Government tabled amendments in Committee. The amendment relates to clause 6, which provides the Secretary of State with the power to disclose information to the list of bodies set out in proposed new section 264B. The amendment clarifies that the list of people to whom the Secretary of State can disclose information includes those persons providing services to the Regional Business Services Organisation in Northern Ireland; it had previously been omitted. I hope that hon. Members will accept these amendments.
Mr Dunne
I would like to conclude this point for the hon. Lady, as I hope it will satisfy her. Her concern is about how the Government will behave in response to requests from devolved Administrations; we recognise that we need to give reassurance to the devolved Administrations that, in the light of the constructive conversations we have already had with them, they will have full access to all relevant data that the Government collect. We are quite happy to do that. We have indicated that we will enter into a memorandum of understanding, which will be discussed and agreed with the devolved Administrations. Those discussions will cover whether they have automatic access to this information—in real time, or in some other format—and whether that is done through giving them direct access to the systems, or by forwarding the data that we collect, immediately on request. We need to get into the detail of that in discussion on the memorandum of understanding, rather than committing that to the Bill at this stage. On that basis, I hope that the hon. Lady will not press her amendment to a vote.
Dr Whitford
I welcome the Minister’s comments, and I am happy not to press the amendment if we can reach the point of a clear memorandum of understanding. I just point out that all my amendment does is to say that the groups listed by the Bill should be able to ask for data on request; it does not add anyone else. I understand that my attempt at the amendment in Committee included groups that it should not have, but that has been corrected. This amendment does not spread confidential information any more widely.
Mr Dunne
I am grateful to the hon. Lady for that clarification. I think this is best addressed through a memorandum of understanding, rather than in primary legislation, in case we need to adjust the memorandum in subsequent years.
Finally, I wish to address Government amendment 7, which provides a definition of “equipment”. The hon. Member for Wolverhampton South West took us through the drafting on the definition of “medical supplies”. The amendment gives a definition of “equipment” in the National Health Service (Wales) Act 2006 to ensure consistency with the National Health Service Act 2006. “Equipment” is defined as including
“any machinery, apparatus or appliance, whether fixed or not, and any vehicle”.
When taken in tandem with the common definition of “medical supplies”, the definition is broad enough to capture any medical supplies on the market, from bandages to MRI scanners. The point of distinction was not so much the definition of “medical supplies” as the definition of “equipment”, which is a subset of the medical supplies definition. I hope, therefore, that hon. Members will accept the amendment.
I have spoken at length on these amendments. I hope I have made my position clear, that Opposition Members will not press their amendments to a vote, and that the House will accept the Government amendments.
Justin Madders
I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
Clause 6
Provision of information to Secretary of State and disclosure
Amendments made: 1, page 4, line 12, leave out from “products,” to end of line 13.
This amendment is linked to amendments 2 to 5. It is directly consequential on amendment 4.
Amendment 2, page 4, line 17, at end insert—
“(subject to subsection (6A)).”
This amendment is linked to amendments 1 and 3 to 5. It flags that the provision made by section 264A(2)(a) and (b) of the National Health Service Act 2006 is subject to the provision made by amendment 3.
Amendment 3, page 5, line 47, at end insert—
“(6A) Regulations under this section may not do any of the following—
(a) require any person who provides primary medical services under Part 4 of the National Health Service (Wales) Act 2006, or any person who provides pharmaceutical services under Part 7 of that Act, to record, keep or provide information relating to any Welsh health service products which are supplied by the person in providing the services in question;
(b) require any person who provides primary medical services under section 2C(1) of the 1978 Act, or any person who provides pharmaceutical care services under section 2CA(1) of that Act, to record, keep or provide information relating to any Scottish health service products which are supplied by the person in providing the services in question;
(c) require any person who provides primary medical services or pharmaceutical services under Part 2 or 6 of the Health and Personal Social Services (Northern Ireland) Order 1972 (S.I. 1972/1265 (N.I. 14)) to record, keep or provide information relating to Northern Ireland health service products which are supplied by the person in providing the services in question.”
This amendment is linked to amendments 1, 2, 4 and 5. It ensures that regulations under section 264A of the National Health Service Act 2006 may not require the persons specified to record, keep or provide the information specified.
Amendment 4, page 6, leave out lines 3 to 15.
This amendment is linked to amendments 1 to 3 and 5. It is consequential on the new provision made by amendment 3.
Amendment 5, page 6, line 36, leave out “(8)(d)” and insert “(6A)(b)”.
This amendment is linked to amendments 1 to 4. It is a consequential amendment.
Amendment 6, page 7, line 8, leave out “(h)” and insert “(i)”.—(Mr Dunne.)
This amendment makes a change which is consequential on the amendments made in Committee. The effect is to allow the Secretary of State to disclose information to a person who provides services to the Regional Business Services Organisation in Northern Ireland.
Clause 7
Provision of information to Welsh Ministers and disclosure
Amendment made: 7, page 9, line 38, at end insert—
“(and for this purpose ‘equipment’ includes any machinery, apparatus or appliance, whether fixed or not, and any vehicle).”— (Mr Dunne.)
This amendment provides a definition of “equipment“ for the purposes of the definition of “medical supplies” in section 201A(8) of the National Health Service (Wales) Act 2006.
Third Reading
Mr Dunne
I beg to move, That the Bill be now read a Third time.
As we have already discussed today, it has been a pleasure to take this short, albeit technical, Bill through the House with such a wide degree of consensus from all participating parties.
We have had a very constructive debate. Points have been raised by hon. Members from both sides of the House through amendments and in debate, and we have sought to take them on board. We will look to take some of them forward as the Bill moves to the other place.
I thank Opposition Members for their contributions. They include the hon. Members for Ellesmere Port and Neston (Justin Madders), for Burnley (Julie Cooper), who is just about in her place, and for Central Ayrshire (Dr Whitford), who leads for the Scottish National party. We have had some strong contributions from Back Benchers, including the hon. Member for Wolverhampton South West (Rob Marris), who served on the Committee in his usual diligent fashion, and the right hon. Member for Leicester East (Keith Vaz). We have also had contributions from Government Members. In particular, I thank my hon. Friends the Members for Peterborough (Mr Jackson) and for Torbay (Kevin Foster), who was active in Committee. I also thank my Parliamentary Private Secretary, my hon. Friend the Member for Halesowen and Rowley Regis (James Morris), and the Whips on both sides of the House.
More than £15.2 billion has been spent on medicines in the most recent full year—an increase of nearly 20% since 2010-11 and of over 7% since last year. The purpose of the Bill is to close loopholes to ensure that the NHS secures as much value for money as it can from this very significant spending on pharmaceutical and medical products. We are looking to clarify and modernise provisions to control the cost of national health service medicines and to ensure that sales and purchase information can be appropriately collected and disclosed.
Briefly, the Bill puts it beyond doubt that the Secretary of State can require companies in the statutory scheme to make payments to control the cost of NHS medicines. That is expected to save the health service across the UK some £90 million a year.
Secondly, the Bill would enable the Secretary of State to require companies to reduce the price of an unbranded generic medicine, or to impose other controls on that company’s unbranded generic medicine, even if the company is in the voluntary scheme—currently the 2014 pharmaceutical price regulation scheme—for its branded medicines.
Members will recall the examples raised on Second Reading and in Committee of companies charging the NHS unreasonably high prices for unbranded generic medicines. Without competition, companies have raised prices totally unreasonably—in the most extreme case by as much as 12,000%. Companies can do that because we rely on competition to keep prices of unbranded generic medicines down. Although that generally works well, the Government need the tools to be able to address the situation in which a small number of companies are exploiting the NHS, patients and the taxpayer by raising prices when there is no competition.
Thirdly, the Bill enables the Secretary of State to make regulations to obtain information on sales and purchases of health service products from all parts of the supply chain, from manufacturer to pharmacy, for defined purposes. These purposes are reimbursement of community pharmacies and GPs, determining the value for money that the supply chain or products provide, and schemes to control the costs or prices of medicines. By bringing these requirements together, the Bill streamlines and clarifies all the relevant requirements currently in place, providing a statutory footing for them all. This includes the existing statutory requirements already in the NHS Act 2006, and those agreements that currently have a voluntary basis only.
In Committee, the Government tabled a number of important amendments to reflect the views and requests of the devolved Administrations on how they want to apply the information power in their territories. We tabled the amendments following constructive discussions that resulted in agreement that the UK Government will collect information from wholesalers and manufacturers for the whole of the UK. It would not make sense for each nation to collect its own information from wholesalers and manufacturers, which would lead to duplication of effort and unnecessarily increase costs across the system.
We have also agreed that each nation will collect information from its own pharmacies and GPs. The devolved Administrations will have full access to all the information that the Government collect. I have committed to develop a memorandum of understanding to underpin these arrangements, and my officials are working closely on that with officials in the devolved Administrations.
To ensure that the Bill makes the Government’s intentions absolutely clear, we tabled a small number of minor and technical amendments on Report to close a potential loophole that would have enabled some companies not to provide us with any information if they also provided pharmacy or GP services to the devolved health services.
This is a relatively small Bill, technical in nature, which has received considerable support from across the House, for which I am extremely grateful. The Bill will help to secure better value for money for the NHS from its spending on medicines, while ensuring that the decisions made by the Government are based on more accurate and robust information.
I thank you, Madam Deputy Speaker, for presiding over today’s debates. I also thank the members of the Panel of Chairs, especially my hon. Friend and neighbour, the Member for Telford—