Capital Funding: New Hospital in Harlow

Philip Dunne Excerpts

Wednesday 18th October 2017 Westminster Hall

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure to serve under your chairmanship, Mr Howarth. You have chaired the debate admirably in allowing my hon. Friend the Member for Hertford and Stortford (Mr Prisk) to get in to support my right hon. Friend the Member for Harlow (Robert Halfon) in his excellent speech, which was both concise and heartfelt.

I visited the hospital with my right hon. Friend a year ago, shortly after the trust went into special measures. I share his view about the commitment of the staff, which was evident to us on that occasion, at a time when, it would be fair to say, there was a state of some unease, the trust having just gone into a special measures regime. In part, we were there to reassure them that it could be a learning process from which they could improve the services offered to their patients, notwithstanding the challenges presented by the consequences of the CQC report.

My right hon. Friend is a consistent and persistent champion for his area and for this project, which has been in germination for some time. It is timely that he should bring it to the House’s attention; I will go on to explain why. I may not be able to satisfy him completely on the questions he has put to me, but I will do my best.

The Princess Alexandra Hospital faces many issues with its estate, as is evident to anyone who visits the site. My right hon. Friend has explained that it has an aged infrastructure and a strong reliance on temporary buildings—it has “sub-optimal clinical adjacencies”, which is the civil service phrase for bits of activity dotted around the place in an unco-ordinated way—much of which is in a fragile condition. There are also capacity challenges posed by the growing demand that he referred to from a combination of demographics and increases in housing, which are happening all around him. That is a shared picture recognised by the Department and the local NHS.

Any service change that might come to the Princess Alexandra Hospital is primarily a matter for the local health authorities. They recognise that and therefore have come up with various proposals. As my right hon. Friend would expect, any proposed changes that are pursued will be subject to the usual procedures and public consultation.

My right hon. Friend pointed out that the local NHS trust looked at five options for a potential redevelopment of the Princess Alexandra Hospital. The strategic case for change concluded that a new hospital on a greenfield site would be not only the most affordable solution but the one that would deliver the most benefit for the local population. West Essex CCG, as lead commissioner for services provided by the Princess Alexandra Hospital NHS Trust, supports that proposal.

Harlow is due to undergo significant economic and residential housing growth in the next 10 years. I am pleased that my right hon. Friend referred to the contribution that Public Health England will be making to that: it remains our ambition to create a world-class health life sciences facility in his constituency. I understand that as part of the potential development of some 10,000 homes in the Gilston area to the north of Harlow, there is the possibility of a new junction for the M11. That gives rise to potential greenfield sites and the opportunity for significant planning gain. That will be available to the local authority as it considers assisting with the financing of any scheme. That puts the proposition in a somewhat unusual light in relation to other competing claims for capital on the NHS.

Before I return to the central issue of capital raised by my right hon. Friend, I will touch on the special measures regime, which the hospital has been in since October last year, following a CQC report that rated the trust as “inadequate” overall. He identified the new management and since we visited, the trust has got a new improvement director in post. I think the new chair was in post when we visited, and he has recently recruited a new chief executive with whom he worked in a previous trust to drive through turnaround improvement. They are individuals in whom the Department has considerable confidence. It is good to hear that much of that improvement work is starting to come through.

A multidisciplinary transformation team called “quality first” has been established, which aims to drive through quality improvement and service reconfiguration across the hospital. Peer reviews are taking place on a two-weekly basis, which are being fed down to departments and wards within the hospital to drive improvement from the bedside. The most recent external peer review was conducted in June and helped to highlight areas of focus to assist the trust in its journey out of special measures status.

A consequence of that work is that there is now compliance at the trust with referral-to-treatment waiting times, which is not universal across the NHS at the moment—would that it were. It is also meeting cancer standards and ensuring that cancelled operations are rebooked within 28 days. That is positive concrete evidence of progress coming through the regime. There have also been improvements in critical care and end-of-life care since the CQC inspection. The trust has developed and launched a framework for a five-year plan, “Your future, our hospital,” and is currently preparing for its next CQC inspection, which will take place next month. We will all look at the outcome of that with great interest.

To return to the core question of capital, my right hon. Friend is right to identify the emergence of Department funding from which Harlow benefited: waves 1 and 2 of the current £100-million A&E pot. There is a bid in train for the final tranche of that funding. We will see whether or not that succeeds, but, certainly off the top of my head, I think Harlow has achieved more than any other trust in securing capital to help improve the situation in its emergency department.

More significantly, the trust has submitted additional capital bids to cover funding for other ancillary aspects of improving care in the hospital: a second maternity theatre, urgent estates infrastructure work and strategic estates transformation. All capital funding bids have to follow the same course as those of any other trust in the country. As a result, I am not in a position to confirm the trust’s prospects for success in this competitive round. The timeliness of the debate is that all STP areas have submitted bids for the next round of capital funding. I confirm that a proposal has gone in for Princess Alexandra. We await the Budget this autumn to see whether the Chancellor will allocate phase 2 capital for STP transformation. He indicated in March that he was intent to do so, so we are hopeful that that will occur. The extent to which there is capital available to support very significant projects will depend on how much is made available by the Treasury.

My right hon. Friend has rightly pointed out that this is a high priority for the region, for the county and clearly for the residents of Harlow. I wish him every success in advancing his cause—as he has done so admirably here today—when we see the allocation of that capital following the Budget later this year.

Question put and agreed to.

Healthcare in Oxfordshire

Philip Dunne Excerpts

Tuesday 17th October 2017 Westminster Hall

[John Howell (Henley) (Con)]

Thank you, Sir Roger. I do apologise that I have to go to meet the Minister of Agriculture from Nigeria. He is here at my own invitation, so I can hardly be absent from the meeting.

Let me say straightaway that I chair a group of Oxfordshire MPs who meet approximately every six weeks to discuss their relationship with the CCG. The meetings were started in order to discuss delayed discharges of care, and I have to say, from the last meeting that we had, they are going very well. Oxfordshire had the difficulty that it was one of the worst performers in delayed discharges, but is now coming back to being one of the best. I have been outside the STP process because my area was handled separately in advance. Townlands Hospital in Henley needed a multi-million pound investment before the STP process started, but I agree with my hon. Friend the Member for Witney (Robert Courts) that the process of consultation that was started by the CCG left a lot to be desired. As a former professional in the area of consultation, I looked with some disdain at what was taking place, but I appreciate that the CCG had a particular difficulty in seeing the hospital as Henley’s or south Oxfordshire’s, which they deliberately intended it to become. In the villages outside Henley that make up the largest proportion of people in south Oxfordshire, there was enormous support for the proposals. It was only in Henley that people took the opportunity to complain about the lack of beds.

Let me turn to the lack of beds. My hon. Friend the Member for Witney spoke about treating people in hospitals close to them. I fully agree with that, but a better model would be to treat them in their own homes. That healthcare system is called ambulatory care. I have spoken about that in this Chamber at length, so I will not repeat all of what I have said before. Ambulatory care requires a full integration of social care activities and medical activities in an area, because it turns the hospital into an extremely efficient medical campus-type facility, with very few people needing to stay in overnight.

In fact, if people stay in overnight, the effects on them are quite horrendous. Anyone over the age of 60 who stays in for four or five days is immediately incontinent. Without wishing to comment on people’s ages, some of us in the Chamber would look at that with great horror. If people stay in for a lot longer than that, other bad effects come from that.

When the consultation took place, there was a tremendous amount of antagonism about the beds being put—

[The Minister of State, Department of Health (Mr Philip Dunne)]

Will my hon. Friend give way?

[John Howell]

Of course.

[Mr Dunne]

I am sure that my hon. Friend, who is making a powerful, constructive contribution to the debate, would not want to give colleagues the impression that of necessity, someone over the age of 60 would become incontinent if they spent four nights in a hospital. I think he is trying to suggest that there is a greater risk of adverse effects the longer one stays in hospital.

[John Howell]

I thank the Minister for that point; I was not suggesting that it was an inevitability. However, at this stage let me extend an invitation to him to visit the hospital so he can see how it works and how it has integrated social care with the medical activities there. It is based around a RACU—a rapid access care unit—which is similar to the EMU—emergency multidisciplinary unit—in Abingdon that is being proposed elsewhere. As I said, it turns the hospital into a diagnostics hospital, similar to a hospital developed in Welwyn Garden City that I went to see.

I saw the difficulty for the CCG with regard to its consultation when I went to a SELF—a South East Locality Forum—meeting. People from Henley were sitting around the table with big beaming smiles on their faces saying how wonderful the hospital was, and a member of the CCG had to stop them and say, “Well, it is a pity you didn’t say that when we were developing the hospital. Right to the end of the consultation you were attacking us on this and on taking the beds out and putting them in a care home at the side of the hospital. That is working very well and now you say that it is absolutely wonderful.” The fact is that, apart from some minor snags with the new hospital, it is a fantastic new investment by the Department of Health. It shows the way a community hospital should be developed not just in Oxfordshire but across the country. I repeat my invitation to the Minister to come and visit.

The great thing about the hospital was not the consultation initiated by the CCG but the support that I got from the Royal College of Physicians, which came out very strongly in favour of an ambulatory healthcare model and very favourably in support of the hospital. That is an interesting point, which goes back to my comments in support of my hon. Friend the Member for Witney about the lack of consultation experience on the part of the CCG. That organisation is willing to learn, and I hope that it will. I also hope that we, as MPs who meet it from time to time, will be able to keep up our pressure on it to deliver the sort of services that we feel our constituents want.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure to speak under your chairmanship, Sir Roger. I congratulate my hon. Friend the Member for Witney (Robert Courts) on securing the debate and on the manner in which he spoke. I share the admiration of my right hon. Friend the Member for Wantage (Mr Vaizey) of the forensic skills he has brought here from a former life, and I feel somewhat fortunate that I am sitting on the same side of the Chamber as he is.

We have heard many powerful contributions about the strength of feeling in Oxfordshire from its many impressive elected representatives, and about how a large number of the service changes that are under consideration in the county have suffered from a lack of engagement, with the clinical commissioning group in particular failing to explain to local residents the purpose of and the objectives behind the changes. I take that on board, as something that needs to improve, and I will come back to it at the end of my remarks.

It is very clear, from the Government and the Department of Health, through the NHS leadership, that all proposed service changes should be based on clear evidence that they will deliver better outcomes for patients. That is at the heart of why service change is proposed. We have made an explicit commitment to the public that all proposed service changes should meet four tests. Just to rehearse them, they are that they should have support from GP commissioners, be based on clinical evidence, consider patient choice and, most specifically for the purposes of this debate, demonstrate public and patient engagement. In the case of the service change proposals that have been made thus far in Oxfordshire, when they are capable of coming to us for determination, for ministerial decision making on appeal, my colleague the Secretary of State and I are placed in some difficulty, because we need to remain impartial and consider the issues on their merits. I am sure that my hon. Friend the Member for Witney and other colleagues will therefore appreciate that I am unable to offer opinions on the merits of the proposals from the two transformation consultations, whether actual or anticipated.

We recognise that Oxfordshire, like many areas across England, faces unprecedented demand for its services. We are all aware of the growing number of older people, many of whom are living with more complex, chronic conditions, partially thanks to the success of the NHS in keeping people going for longer, but we have also heard from a number of colleagues that Oxfordshire faces particular population pressures, with welcome increases in house building planned for the coming decades. In addition, as my hon. Friend the Member for Banbury (Victoria Prentis) said when she intervened on the Opposition spokesman, the hon. Member for Burnley (Julie Cooper), there are particular challenges in recruiting high-quality NHS staff into many of our facilities, not just in rural and coastal areas but across the country. We accept that, and are looking to increase the numbers of medical and nursing staff being trained. There was an unprecedented 25% increase in doctors in training, announced last year by the Secretary of State, and earlier this month a record increase of 25% in the number of nurses in training was announced for the next two years. Those are all reasons why the Oxfordshire transformation programme has been reviewing the model of care to ensure that future health service provision in the county is clinically and financially sustainable.

My hon. Friend the Member for Witney began his remarks by referring to the closure of the Deer Park medical practice in Witney. I will not go into the full history, but he acknowledged that the closure took place in March this year. In the previous December, a judicial review had been requested and, as my hon. Friend pointed out, this was the first time in recent years that such a thing had happened to a primary care facility. The judge who heard the case refused permission to bring it for judicial review, and it was therefore passed to the independent review panel in March of this year. The panel concluded that the referral was not suitable for full review because further local action could address the issues raised.

The Secretary of State considered and accepted the recommendations—some of which my hon. Friend the Member for Witney read out—and the Oxfordshire CCG is now working to address them. Foremost among the recommendations was that all former patients of Deer Park medical practice should be registered at an alternative practice as soon as possible. My understanding is that, of the 4,400 patients who were registered with the practice, more than 4,000 had been reregistered, as of mid-September, and that the CCG is acting to encourage the remaining 400 patients to register at one of the three other GP practices in and around Witney, whose lists remain open so that patients can register at a practice of their choice, as long as they live within its catchment area. I believe that a further letter will be sent out to all those remaining patients, to encourage them to register with another GP.

The second key recommendation, which my hon. Friend the Member for Witney also referred to, was that a primary care framework be developed to provide direction for a sustainable GP service in Witney and the surrounding area. That is at the crux of his concern about the way in which the CCG engages. I happen to have a copy of its locality place-based plan for primary care, and I note that the consultation on how primary care services should be developed for west Oxfordshire opened last week. I strongly encourage my hon. Friend to engage with the CCG and to encourage his residents to do so, so that it learns from the lessons of the Deer Park lack of consultation and, in devising services for the future, fully takes into account local residents’ concerns. I believe that the consultation period is six weeks and is due to conclude at the end of November. A common theme in colleagues’ contributions today has been that lack of engagement, as they see it, with the local CCG.

My hon. Friend the Member for Banbury raised again today her historic championing of the cause of Horton General, which clearly goes beyond primary care into secondary care. She gave us another history lesson. She has been campaigning on this issue since she was seven years old, and I think she could probably trump any Member who wanted to stand up and say that they had been consistently campaigning on any issue since a young age. Having said that, I suspect that one or two older Members have been campaigning on the same issues for longer, but certainly not from such a young age.

My hon. Friend referred to the temporary suspension last October of the obstetric-led service in the Horton because of the difficulties in recruiting doctors and midwives. It has temporarily become a midwife-led unit. As she also pointed out, at a public board meeting this August, the CCG accepted recommendations following consultation. [Interruption.] She may regard that as inadequate, but there has been some consultation. Those recommendations include one to centralise Oxfordshire’s obstetric facilities in the John Radcliffe Hospital and one to make the midwife-led unit at Horton General a permanent establishment. As she has pointed out, that decision is subject to judicial review and referral to the Secretary of State, so no action will be taken to make that recommendation permanent until the referral process has run its course.

My hon. Friend has referred to a number of the challenges posed for local residents and for pregnant women in labour in getting access to Horton General. I have taken note of the comments made by her and other Members on the reliance on Google Maps to determine travel times. I understand that the CCG has undertaken an extensive travel survey. If a mother is in labour and is in an ambulance, she has the benefit of the blue light service to get through the traffic. That can mean a more rapid journey time than ordinary residents would expect or experience.

[Victoria Prentis]

I am so grateful to the Minister for giving way and for the comments he is making. Most people who go to hospital while in the later stages of labour to have a baby are not in an ambulance. The ambulance times relate only to transfers from the midwife-led unit to the Radcliffe. Although a significant number of the people who give birth in the MLU have to transfer during or immediately after labour—we are told that it is up to 40%—that is nothing compared with the vast majority of women, who travel in a private car, if they are lucky enough to have one.

[Mr Dunne]

Indeed, I recognise that. If we are moving to an obstetric-led service at the John Radcliffe, any mother who is high-risk or is expected to give birth will have time to travel in good order, rather than in an emergency. I accept that emergency transfers do take place from midwife-led units during the course of labour.

I have heard the criticism about the overall transformation programme for Oxfordshire being divided into two phases. At this point, we are where we are. The first phase has come to a conclusion, and we are entering the second phase. I recognise some of the criticisms that it is hard to comprehend a coherent system without seeing it all laid out together.

[Mr Vaizey]

I hate to interrupt the Minister’s flow as he is getting stuck into the STP, but as time is running out, will he prevail on his officials to write to me after this debate and answer two questions? First, when will the next tranche of capital funding be available for GP surgeries in Oxfordshire? Secondly, what engagements could his Department facilitate between Assura, myself and the clinical commissioning group to try to break the logjam at the Wantage surgery? I do not want to waste any more of his time, and I feel reluctant to prevail upon his officials’ time, but that would be very helpful.

[Mr Dunne]

I can do better than that; I can answer my right hon. Friend’s first question directly. The bids for STP capital funding have been made by all 44 STP areas. They are being assessed at the moment, and we will be making submissions to the Chancellor for the Budget to see whether there will be a capital release for phase 2 of STPs. It is a competitive process. I can confirm that the STP area covering Oxfordshire has made a bid, but I cannot confirm whether it will be successful, because we will not know until we know how much the Chancellor is prepared to release in the Budget. I will happily write to him on his second question and his concerns about Wantage.

Members have said much about some of their concerns about their community hospitals. In his absence, I thank my hon. Friend the Member for Henley (John Howell) for his invitation to visit his hospital and look at the rapid access care unit. I am pleased that he supports the impact it is having in ensuring that elderly and frail people are seen quickly and can return to their homes without needing to be admitted. As he pointed out, and I think we all agree, care at home is how we should be seeking to treat as many people as possible, because that allows people to lead longer independent lives instead of having a prolonged stay in hospital.

The second phase of the Oxfordshire transformation programme is continuing. As has been pointed out in the debate, the CCG leadership is going through a transition period. We have a process under way to recruit a new chief executive, who is expected to be in post in the coming weeks. I am sure that the chairman will read this debate and take note of the comments that have been made on the challenges in engaging in recent years, as will the new clinical lead, who was appointed only yesterday. It is important that Oxfordshire CCG undertakes full public engagement for the second phase of the transformation, and I am aware that that is what it is intending to do. It is likely to begin early in the new year, and I strongly encourage all Members to engage with that consultation in as forceful and impressive a way as they have with this debate, led by my hon. Friend the Member for Witney. I pay tribute to the passion with which everyone has spoken about their commitment to their local residents in providing high-quality healthcare in Oxfordshire.

Oral Answers to Questions

Philip Dunne Excerpts

Tuesday 10th October 2017 Commons Chamber

[Thelma Walker (Colne Valley) (Lab)]

6. What recent assessment he has made of trends in staffing levels in the NHS.

[The Minister of State, Department of Health (Mr Philip Dunne)]

Not only has the number of nurses on our wards increased by more than 11,000 since May 2010, as my right hon. Friend the Secretary of State mentioned earlier, but the NHS has nearly 11,300 more doctors, over 2,700 more paramedics, over 26,000 more supporters for clinical staff, and 5,700 fewer administrators. However, we recognise the pressures on staff from increasing demand. That is why last year my right hon. Friend announced a 25% increase in the number of doctors in training, and why last week he announced a 25% record increase in the number of nursing training places.

[Thelma Walker]

Huddersfield Royal Infirmary, which is in my constituency, is currently facing plans for a downgrading that would result in the loss of 500 hard-working professionals. Is it too much to ask for the Minister, or the Secretary of State, to visit the hospital, as I have requested, before those hard-working trained professionals are lost, and can he assure me—and my constituents—that those cuts, and the pressures on nearby hospitals, will not jeopardise the safety of patients?

[Mr Speaker]

Order. There is a growing tendency for colleagues to ask two questions rather than one, which is not fair on other colleagues who are trying to get in. Forgive me, but the questions are too long, and frequently the answers are as well.

[Mr Dunne]

I will try to keep this answer short, Mr Speaker.

As the hon. Lady will know, the local joint health overview and scrutiny committee has referred those proposals to the Secretary of State, and it would not be appropriate for me to visit the hospital while the referral is in progress.

[Julie Cooper (Burnley) (Lab)]

On the subject of vital NHS staff, will the Minister join me in congratulating the thousands of community pharmacists on their daily commitment and professionalism? Will he confirm, once and for all, that he has no intention of downgrading their role and putting patients at risk? Surely he agrees that the Prime Minister would have been well advised to seek a cough remedy from a qualified community pharmacist rather than relying on an unqualified Chancellor of the Exchequer.

[Mr Dunne]

As the hon. Lady will know, we have inserted payment for extra activity into the contract for community pharmacists because we want more activities to take place in community pharmacies. For example, many flu vaccinations throughout the country are now being carried out by pharmacists.

[Martin Vickers (Cleethorpes) (Con)]

I thank the Minister for the recent meeting that he had with me and other colleagues about Grimsby Hospital, which is in special measures. It was clear from a recent meeting I had with the chief executive that staff vacancies are one of the biggest problems preventing the hospital from getting out of special measures. What additional support can the Department offer in order to get the hospital back on track?

[Mr Dunne]

I was pleased to welcome my hon. Friend to a meeting a few days ago to discuss the situation, together with his Opposition constituency neighbours. One of the things that we will be looking at in the coming weeks is the allocation of the new doctor training places. As part of the criteria, we will be looking to ensure that some of those places are allocated to areas where it is difficult to recruit, such as rural and coastal areas.

[Mr Philip Hollobone (Kettering) (Con)]

The Minister has visited Kettering General Hospital and knows the wonderful work that the doctors and nurses there do. The problem that the hospital faces, however, is that too few of the doctors and nurses are full-time permanent members of staff, and too many locums are being hired, at great expense to the hospital budget. What is my hon. Friend’s advice for Kettering hospital on tackling the issue?

[Mr Dunne]

When I visited Kettering General Hospital we discussed excessive agency staff costs. One of the measures announced last week by my right hon. Friend the Secretary of State was a drive to invest more in both regional and local bank agencies within the NHS so that we can reduce the reliance on more expensive agency staff.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

7. What steps his Department is taking to improve end-of-life care.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

As the hon. Lady knows, the adult congenital heart disease service provided in Manchester has been included in the long-standing clinical assessment of CHD services undertaken by NHS England, which is now reviewing the more than 7,500 responses to the public consultation, which ended in July. The adult CHD service in Manchester was suspended by the trust in June, when the only CHD surgeon left. Hospitals in Leeds and Newcastle continue to deliver level 1 care and paediatric CHD services continue to be provided by Alder Hey Children’s Hospital in Liverpool.

[Lucy Powell]

Is not the truth behind what happened that Ministers and NHS England prejudged the review and therefore left services untenable and unviable in Manchester? There are no level 1 adult congenital heart services anywhere in the north-west and patients are having to travel to Leeds and Newcastle for the treatment. Will the Minister apologise today to those patients for this botched review, which has left patients with a great deal of uncertainty and has meant that they have had to travel huge distances?

[Mr Dunne]

I am sure that the hon. Lady will not want to confuse her patients by suggesting that relying on a single surgeon for prolonged periods is necessarily in their best interests. The facilities that remain in Central Manchester University Hospitals NHS Foundation Trust are intended to remain and include CHD outpatient services for adults and children. Level 2 services also continue to be provided in Manchester.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

15. What estimate he has made of the number of people living with unmet social care needs.

--- Later in debate ---

[Jack Lopresti (Filton and Bradley Stoke) (Con)]

T9. The last Labour Government downgraded Frenchay hospital in my constituency. My constituents and I have been waiting for several years for the much-needed and much-promised community hospital. What action are the Government taking to ensure that that finally happens?

[The Minister of State, Department of Health (Mr Philip Dunne)]

My hon. Friend is a doughty campaigner for Frenchay hospital and keeps it uppermost in our minds. The way in which we are looking at the pattern of health provision for the next period is through the STP process, and I encourage him to engage with the STP leadership in his area and make the case for Frenchay hospital.

[David Linden (Glasgow East) (SNP)]

T3. The palliative care we provide to terminally ill children is an incredibly serious topic. I want to refer to the point made by the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) and to press the Minister on giving children’s care parity of funding with adult care. Will she follow the example of the Scottish Government and provide parity of funding?

--- Later in debate ---

[Richard Graham (Gloucester) (Con)]

The Gloucestershire Hospitals NHS Foundation Trust capital expenditure bid would fund a 24-hour urgent care service, and it would also increase bed capacity and improve hospital performance in Gloucester and Cheltenham, to the benefit of patients throughout the county. When do Ministers expect to announce the results of the bid? Will they take this particular bid into careful consideration?

[Mr Dunne]

I am aware that, under the Gloucestershire STP, a proposal has been submitted for capital funding to support plans to improve the clinical environment for patients and staff at the Gloucestershire Royal Hospital. I am afraid that my hon. Friend will have to join me in awaiting the Chancellor’s announcement in the Budget as to whether there will be a second phase of capital funding for STPs. If there is any funding, it will be allocated thereafter.

[Kate Green (Stretford and Urmston) (Lab)]

GPs in my constituency tell me that because of changes to personal data rules they will no longer be able to charge for providing reports for private insurance and legal claims. Will Ministers update the House on the situation? What assessment has been made of how GPs will cope with the additional costs they will face?

--- Later in debate ---

[James Frith (Bury North) (Lab)]

Newly released NHS guidance makes it clear that walk-in services can have a future as part of urgent treatment centres. Does the Secretary of State agree with me and thousands of patients in Bury North that Bury walk-in centre can, should and must stay open and that Bury CCG should ensure this when it concludes its review?

[Mr Dunne]

Current plans by NHS England to look at the urgent and emergency care pathways include creating 150 urgent treatment centres by the end of this year. I am happy for the hon. Gentleman to write to me about Bury and will respond in due course.

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

Is the Secretary of State aware that there is widespread support in the House for his Government’s commitment to enact the principle of deemed consent for organ donation? He knows from a previous meeting that my private Member’s Bill is due for its Second Reading early in the new year. Will he therefore agree to an early meeting now, so that we can co-ordinate the two and see how to advance his intentions? I know that my hon. Friend the Member for Barnsley Central (Dan Jarvis) will be with me again and, with the Secretary of State’s commitment to this, we look forward to an early meeting.

--- Later in debate ---

[Mohammad Yasin (Bedford) (Lab)]

Yesterday the private ambulance service that provided non-urgent patient transport at Bedford hospital ceased trading, leaving the East of England Ambulance Service NHS Trust to pick up the pieces. Will the Minister order an inquiry to establish what went wrong, and does he agree that using private companies to run key services for our NHS is simply not working?

[Mr Dunne]

The hon. Gentleman will be aware that private and independent providers of patient transport services provide services all across the country and support the ambulance services in that work. I will look into the case that he raises in relation to Bedford and write to him.

[Ruth George (High Peak) (Lab)]

All of the local dementia and rehabilitation beds in my rural constituency of High Peak are earmarked for closure. In some cases, patients and their families will have to travel 25 miles across the moors to Chesterfield. Given the importance of staff being able to work with families to support patients to return home, will the Minister agree to look again at such decisions, which make this work practically impossible?

[Mr Dunne]

The hon. Lady will be aware that the STP plans being considered for her area include providing more services in the community by community nurses and other nurses in our community hospitals being reassigned, which will allow them to undertake care for more patients than they can at present within community hospitals.

[Several hon. Members rose—]

Baby Loss Awareness Week

Philip Dunne Excerpts

Tuesday 10th October 2017 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

Before I start the debate, Madam Deputy Speaker, let me say that I am delighted that you were able to pay tribute to all of our Doorkeepers and, in particular, to Trevor, on his last day here.

I beg to move,

That this House has considered Baby Loss Awareness Week.

I am personally very pleased that this debate is being held in Government time, having participated in last year’s debate on baby loss. It was one of the most moving experiences I have had in this Chamber, as Members from both sides of the House gave expression to their own experiences. That helps to send a signal outside this place of the significance that we accord this, not just within the Department of Health and the NHS; Members of this House sympathise with the many members of the public who go through such experiences. It does this House a good service when Members who feel able to do so place on the record their own experiences. It is right and important that we continue to raise awareness of the devastating impact of baby loss.

I wish to restate at the outset this Government’s commitment to providing high-quality bereavement care and to reduce the numbers of babies who are lost too soon through miscarriage, stillbirth or other causes such as sudden infant death syndrome. I pay tribute to all those who are sharing their personal experiences this week. In particular, I thank my hon. Friends the Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince), who are in the Chamber today, and all members of the all-party parliamentary group on baby loss, which they co-chair, for achieving so much in raising awareness during this past year.

I wish to update the House on some of the initiatives that the Government and the NHS have put in place since last year’s debate to improve safety, reduce stillbirths and other adverse maternity outcomes and improve bereavement care. I believe that all hon. Members support the ambition of the Secretary of State to halve the rates of stillbirth, neonatal and maternal deaths and brain injuries that occur during or soon after birth by 2030, and to achieve a 20% reduction in rates by 2020.

Shortly after the debate last October, the Secretary of State launched the safer maternity care action plan, which set out additional support for the maternity and neonatal services working to achieve that ambition. The plan set out a range of initiatives on five themes. First, there is a focus on leadership, with the establishment of local, regional and national maternity safety champions to promote professional cultures, teamwork and continuous improvement. Every trust with maternity services has pledged to appoint a maternity safety champion, and 88 out of the 134 trusts that provide maternity services now have named leads.

Secondly, there is a focus on learning and best practice. This includes the Saving Babies’ Lives care bundle to reduce stillbirths, which was launched by NHS England in March 2016. Saving Babies’ Lives brings together four elements of care that are recognised as evidence-based and/or best practice: reducing smoking in pregnancy; risk assessment and surveillance for foetal growth restriction; raising awareness of reduced foetal movement; and effective foetal monitoring during labour. The Department has also funded Sands and Best Beginnings to develop and promote the “Our Chance” campaign to give parents knowledge and confidence to maximise their chances of healthy outcomes.

Thirdly, there has been a focus on multi-disciplinary teams with an £8.1 million maternity safety training fund, which is designed to ensure that staff have the skills and confidence they need to deliver world-leading safe care. All 134 trusts with maternity units have now received funding and are implementing training packages. Many of those are being delivered by the charity Baby Lifeline, which I met this morning to learn some of the benefits that this training is bringing to improving safety, reducing error, and helping patient outcomes.

I visited Leeds teaching hospital a couple of weeks ago and heard from midwives about their multi-disciplinary training programme “Deliver me safely” in which they and doctors undergo training together in the recognition that human factors can contribute to harm in maternity systems. These simulations focus on situational awareness and team interactions, challenging some cultural hierarchical attitudes, which I am afraid can be prevalent in parts of the NHS, and encouraging everybody to speak up if they have safety concerns.

Lastly, there has been a focus on innovation, with the launch of a maternity safety innovation fund of £250,000, which has supported 25 local maternity services to create and pilot new ideas, and of the national maternal and neonatal health safety collaborative to build local capability in quality improvement and to provide structured support for local teams. One example of this is the safer films project at the University Hospitals Coventry and Warwickshire NHS Trust, which is developing staff training films, using headcam devices to show interactions with clinicians from the mother’s perspective. The patient’s view of the drills undertaken around her allows clinicians to look back at the impact that their activity, including how they communicate with women and their partners, has on the patient.

Just last month, the Secretary of State hosted a roundtable with 25 key partners across the health system to discuss evidence and current NHS clinical practice on supporting women to have safe births. There has been an enthusiastic response to the Secretary of State’s ambition, with a range of initiatives developed by national and local NHS organisations, royal colleges and charities. We will continue to work with our partners to align these initiatives with the work of the maternity safety action plan. I am happy to report that we are on track to achieve our 2020 ambition. The stillbirth rate in England has fallen from 5.1 per 1,000 births in 2010 to 4.4 in 2015. The neonatal mortality rate was 2.6 deaths per 1,000 births in 2015, down 10% from 2.9 in 2010.

I would like to touch briefly on the importance of learning from when things go wrong in clinical care. Many parents I have spoken to have made it clear they want maternity and neonatal services to learn from the deaths of their babies so that other families do not have to go through the experience of losing a much-loved and wanted child if that can be prevented. Recent publications from the Royal College of Obstetricians and Gynaecologists and MBRRACE-UK—Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK—found that some local reviews of stillbirths and neonatal deaths were of poor quality. Input from parents or independent experts is not routinely sought, and there is insufficient information to understand the quality of care provided.

To improve the quality of those reviews and to learn from them, the Department of Health, together with the Health Departments in Scotland and Wales, has funded the development of a national standardised perinatal mortality review tool to support systematic, multidisciplinary reviews of the circumstances and care leading up to every stillbirth and neonatal death. The tool, which will be available at the end of this year, will also support clinicians to talk with parents about the care review and how they can contribute to the process.

Last month, I laid the draft health service safety investigations Bill in Parliament. This Bill will take forward the work of the current independent healthcare safety investigation branch, which came into operation last April. Under the proposals, HSIB will have far-reaching access so that it can investigate serious safety incidents or risks to patient safety; help to develop national standards on investigations; and provide guidance and training to improve investigative practice across the health service.

Earlier this year, we also consulted on proposals to introduce a system of consistent and independent investigations for all instances of severe avoidable birth injury, along with access to ongoing support and compensation for eligible babies through an administrative scheme. The public consultation into a rapid resolution and redress scheme for severe avoidable birth injury concluded at the end of May, receiving more than 200 responses. We are currently in the process of listening to people’s views, and we aim to publish a formal response soon.

Turning to bereavement care, a clear message that we heard last year, particularly from my hon. Friends the Members for Eddisbury and for Colchester and the hon. Member for Kingston upon Hull North (Diana Johnson), who I am pleased to see with us this evening, was about the need for a bereavement care pathway to ensure that all families experiencing baby loss receive the highest quality of care, no matter where they live.

Since last year’s debate, the Department has funded Sands to deliver a national bereavement care pathway. I am delighted that 11 wave 1 pilot sites were announced yesterday. I know from the experience of my friends and colleagues that care in bereavement is best described as patchy. In some cases, I could use a less flattering adjective. There is no doubt that we need to do more to raise the training of staff and the facilities available to look after families who go through a bereavement in a hospital setting, and indeed to provide care and support to those who suffer loss outside a hospital setting. That is an important initiative.

Earlier this year, Sands, NHS England and the London maternity clinical network published a new maternity bereavement experience measure. That tool aims sensitively to enable parents whose baby has died to feed back about the care they received. It also aims to support services to learn from the experiences of bereaved parents and identify where local improvements may be needed.

Sands is also working on a project for NHS England on the role of the bereavement midwife. The project will make recommendations for the remit of the role of the bereavement midwife and give guidance on the support structures required around the role.

Since 2010, the Government have invested £35 million in the NHS to improve birthing environments, including better bereavement rooms and quiet spaces at nearly 40 hospitals to support bereaved families. Whenever I visit maternity units, I ask to see the bereavement suite. I am always impressed by the quality of the suites, by the feedback from families and staff alike and by how the commitment of many families who have gone through such terrible loss has often led to them raising funds to help to create better bereavement facilities in hospitals.

[Anna Soubry (Broxtowe) (Con)]

I commend the Minister for his excellent speech. I am sure that he will join me in congratulating Forever Stars, which is exactly the sort of charity that he has described. It was started by two of my constituents, who sadly lost their baby, Emily, who was stillborn. They have raised about £200,000 for two suites. A third is on the way, and they are now fundraising for counselling services for the siblings of babies who have not survived.

[Mr Dunne]

I congratulate my right hon. Friend and thank her for drawing that to the House’s attention. That is one of the most significant examples of fundraising for such suites that I have come across. I pay tribute to the family involved and to the efforts to raise funds for the counselling of siblings, who go through a traumatic experience as well.

I conclude by reiterating that the Government are fully committed to reducing the number of babies who die during pregnancy or in the neonatal period, and to providing support for bereaved families.

--- Later in debate ---

[Mr Dunne]

I am grateful for the opportunity to respond to some of the points that have been raised during this excellent debate. It is important to recognise and welcome the cross-party support from Members, including the hon. Member for Ellesmere Port and Neston (Justin Madders). We heard 14 contributions from other Members, including five, by my count, who have personally suffered—or their families have suffered—the loss or miscarriage of a baby, as well as two from experienced doctors: my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) and the hon. Member for Central Ayrshire (Dr Whitford), who brought their particular expertise to the debate. I am grateful for the support from Members on both sides of the House for the Government’s action plan—for what we have done in the 12 months since our last debate on this subject, and for what we are planning to do.

A number of issues have been raised today. I will not go into detail about Members’ constituency concerns, although I will say to the hon. Member for Kingston upon Hull North (Diana Johnson) that when, as a Shropshire Member, I was dealing with one of my constituents who suffered an inability to find out what had happened to the ashes of the baby they had lost, which was similar to what occurred in Hull, my experience was of talking to the local authority and persuading it that this was the right thing to do. I should be happy to help the hon. Lady, if she needs help from the Department, to emphasise again to her local authority that it is indeed the right thing to do.

Members have challenged me on a couple of issues, particularly that of coroners’ reports. We are introducing a perinatal mortality review tool to allow investigations to be undertaken, with information collated in a manner that can then inform and be learned from. We will watch with interest what happens in Scotland, but at this point I think we need to get the tool working and see how it goes. In my opening speech, I mentioned the health service safety investigations branch on which we are consulting. We envisage it as having a role in looking at some of the more extreme cases, but only if it decides to do so.

A number of colleagues talked about the use of private Members’ Bills to try to drive this agenda forward. I can confirm to my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) that the Government will support his Bill on bereavement leave, which was also mentioned in the excellent speech of my hon. Friend the Member for East Renfrewshire (Paul Masterton). I cannot promise that we will support all the other measures that the all-party parliamentary group comes up with, but we will certainly look at them with interest.

Following last night’s launch of the national bereavement care pathway, I am particularly pleased, in Baby Loss Awareness Week, that that has received so much support from the APPG, the charities and the healthcare professionals who work in this field. Finally, let me say a big thank you to all the midwives, doctors and healthcare support workers who do such a fantastic job, delivering more than 700,000 babies successfully and also helping parents who, sadly, do not experience the happiness of a healthy baby.

Question put and agreed to.

Resolved,

That this House has considered Baby Loss Awareness week.

Corby Urgent Care Centre

Philip Dunne Excerpts

Wednesday 13th September 2017 Westminster Hall

[The Minister of State, Department of Health (Mr Philip Dunne)]

Thank you, Mr Chope, for chairing the debate in your inimitable style. I was intrigued to learn that my hon. Friend the Member for Corby (Tom Pursglove) had not used the precincts of Westminster Hall to raise an issue before; I was somewhat surprised, because he is such an assiduous campaigner for his constituency and such a frequent contributor in the main Chamber. The reason may simply be that he does not manage to find time to get into Westminster Hall, so often does he raise his constituents’ interests on the Floor of the House. It is good to see him so well supported again today by his constituency neighbours from Wellingborough and Kettering.

We have discussed this matter privately and, to a limited degree, on the Floor of the House. My hon. Friend the Member for Corby referred to the Adjournment debate to which he contributed before Parliament rose for the summer recess. We have also discussed during the summer, as events unfolded in a more unpredictable way, what could be done to secure the future of the facility for which he has advocated so well today.

I feel reasonably up to speed with events in Corby; for the benefit of other Members present, I will rehearse a small number of them. I will not go into too much detail, not least because at the heart of the issue has been a contractual dispute, which has limited the ability of participants to describe the nature of it. That has, in itself, given rise to some problems in communicating to the local population what the problem has been. We remain bound by the confidentiality arrangements around the legal procedure, but suffice it to say that, as my hon. Friend correctly observes, we are close to a point where action has to be taken to maintain the facility from the end of this month.

From my conversations with the CCG leadership in preparation for this debate, I can assure my hon. Friend that on that side of the negotiating table they are determined to ensure that continuity of service is provided through the rolling four-month contract. They alerted him to that contract at the end of last month and are engaging with the provider, Lakeside Plus, to try to reach agreement. There is no doubt that without an agreement, some of the services would have to be provided in an alternative and less satisfactory way for the local population. That is inevitable, if it is put together in a short timeframe.

It is in everybody’s interest to make this work, but it will be a precursor to a longer-term solution, which is clearly required for the local population. I am pleased that my hon. Friend recognises that such a solution needs to be widely consulted on. Indeed, he is pressing for a more fulsome consultation than is perhaps typical. Given the circumstances surrounding this case, I will be urging the CCG regarding that full consultation. I have been alerted that it is due to start in November, and think that he has been given the same information.

I was not aware of a pre-consultation, and am not quite sure what it means. Hopefully, it means providing an opportunity to ensure that the full consultation is as detailed as necessary. I am quite sure that my hon. Friend will encourage all those who have been in touch with him to participate in that consultation when it gets under way. I was pleased to learn from him about the cross-party nature of the support and full engagement that he has been working, alongside the action group, to generate. I am sure that all those taking an interest will participate in the consultation.

To touch on the substance of the issue, I should say that the GP practice co-located with the urgent care centre has the largest patient list of any GP practice in the midlands, certainly, and possibly across NHS England’s footprint, so it has some unusual characteristics. One of the pressures on that practice, which my hon. Friend alluded to, is access to that GP surgery. Pressure is put on the urgent care centre by the difficulty in securing access to that part of the GP provision in the area. My understanding is that there is a federation of GPs, beyond the immediate catchment of the UCC but within the CCG area, that has much better access. Work should be done as part of the consultation to see how the performance across the entire CCG area can be improved to relieve some of the pressure on the urgent care centre.

A consequence of that pressure is that the original contract, designed to undertake 120 patient episodes a day, has been dealing with more like 170 patients a day attending the urgent care centre. Of those patients, the vast majority—88%—could be dealt with either in that facility or in the GP practice itself. As I understand it, 12% definitely require treatment at the urgent care centre, and some of those are then referred to either Kettering General Hospital or, in a small number of cases, to Northampton’s A&E facility.

There is a need for an urgent care setting, but there is as much of a need to ensure that those who could be treated in the primary care environment can be. Part of the consultation will look at the appropriateness of a primary care home arrangement. That is an establishment that brings together primary care providers, social care providers and other providers, such as pharmacies, within an area, to provide a more integrated primary care service. That in itself might have benefits for improving access to treatment for the population served by the UCC at present.

My hon. Friend will be well aware of the history of the contracting challenge between the CCG and Lakeside Plus. I will not exhaust his patience by going into that in any detail, but will simply say that it is the intent of the CCG to re-establish a contractual relationship. The CCG wishes to have this moving forward on a four-month rolling basis while the consultation takes place, and then any subsequent arrangements will need to go out to tender. The intent is that this contract will continue until the successor arrangements are in place, so that there is continuity of care for his constituents—something that the Department absolutely supports.

I conclude by saying that it is really important that we use this public consultation to get the model of care right for the people in the area served by the UCC. That needs to take into account the evidence base for the clinical model, the right to patient choice for the people who will be using it, to meet the local need—my hon. Friend spoke eloquently about the particular local needs in the Corby area, and those are recognised—and also value for money. The approach has to be coherent and comprehensive, to come up with the right solution for the future.

I heard what my hon. Friend’s neighbour, my hon. Friend the Member for Wellingborough (Mr Bone), said about looking for a similar hub in Wellingborough. I will look with interest to see how his private Member’s Bill progresses, to endeavour to bring that about. I also note his comments regarding the structure of the CCGs in the area. That is really a matter for the STP—the sustainability and transformation partnership—to make progress on and decide the structure of both commissioning and provision of service in the area. It is not really for me to comment on that off the cuff here today, but I note what he says and am aware that this is one of the smallest CCGs in the country. I am also aware that there is a very substantial programme of collaboration already underway with the neighbouring CCG at Nene, so I think that the CCGs themselves see the benefits of closer integration of their working.

On that basis, I say to my hon. Friend the Member for Corby that I will endeavour to keep him informed as matters come to my attention, and I am quite sure he will continue to keep me and the Department informed as well.

Question put and agreed to.

[Mr Christopher Chope (in the Chair)]

Order. As we have got a minute and a half spare, we can go straight on to the next debate because the Minister is here. I now call the next speaker, Mr Linden.

NHS Recruitment

Philip Dunne Excerpts

Thursday 7th September 2017 Written Statements

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am today updating the House on the future of NHS Professionals Ltd (the company).

The Department of Health has today announced that NHS Professionals Ltd—a company which supplies flexible staffing to the NHS—will remain in wholly public ownership, after offers to buy a majority stake in the company undervalued its growing potential.

In November 2016, the Government decided to instigate a sale of a majority share in NHS Professionals Ltd as a potential path to providing it with the extra expertise, technology and investment it needed to work with more hospitals and drive greater savings for the NHS. However, after careful consideration, the Government have concluded that none of the offers received for the company through the open, rigorous bidding process reflected the company’s growing potential and improved performance.

NHS Professionals was established as a limited liability company by the last Labour Government in 2010, with a specific intention to give it greater commercial freedoms and “prepare it for sale” (Department of Health, “Explanatory Memorandum to The NHS Professionals Special Health Authority (Abolition) Order 2010”, February 2010). It currently holds a bank of over 90,000 workers filling more than 2 million shifts, saving the NHS £70 million every year. However, it only works with around a quarter of trusts, meaning that many others rely heavily on more expensive agencies to supply additional staff. We would like more trusts to work together to fill shifts via collaborative banks, and there will be opportunities for NHS Professionals Ltd and others to support this work.

Since the decision was taken to seek offers for the company, NHSP has significantly increased its performance such that audited profit before tax for the year ended 31 March 2017 was 44% higher than in the previous year. This improvement in financial performance continues to be built upon in the first quarter of the current year. The company’s improved financial and operational performance means it can now invest in improved IT infrastructure, expand its services to the NHS and transform into a world-class provider of flexible staff while remaining under public ownership—generating further savings for the NHS, all of which will continue to be reinvested in frontline services.

The Government are fully committed to providing world-class NHS services that are free at the point of the use, now and in the future.

[HCWS116]

Contaminated Blood

Philip Dunne Excerpts

Thursday 20th July 2017 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is disappointing that we are here again today, so soon after last week’s announcement. A week ago, this House united in agreement to finally facilitate justice for those tragically affected by this scandal. Yet, as we have heard, in recent days Ministers have reneged on last week’s promises and run roughshod over the affected community.

[The Minister of State, Department of Health (Mr Philip Dunne)]

indicated dissent.

[Mrs Hodgson]

The Minister of State may shake his head, but that is how the community feel; we have spoken to them. There are three key questions that the Under-Secretary before us this morning must answer, and I hope she will be more forthcoming with much-needed answers than she was to my hon. Friend the Member for Kingston upon Hull North (Diana Johnson).

Understandably, the community have deeply held suspicions when it comes to the Department of Health, so why are Ministers ignoring these concerns and the demands to facilitate an inquiry through another Department, such as the Ministry of Justice? This concern has been well documented in the letter to the Prime Minister by my hon. Friend, the Haemophilia Society, the 10 campaign groups and the law firms Collins Law and Leigh Day. Why does the Minister think the Government can so easily disregard all these people?

Events over the past few days have shown that last week’s promise to consult, engage and listen to the community was simply warm words. The audacious move to hold a roundtable meeting this morning with so little notice to potential attendees from throughout the UK has hindered many from being involved in the process of setting up the inquiry. Will Ministers explain why the meeting was held at such short notice? Who did they plan to invite so that the meeting was properly consultative? In the end, who was scheduled to attend following the mass boycott by many of those invited, who felt that the offer of a meeting was a slap in the face?

It is important that the inquiry is held sooner rather than later, but not at the risk of jeopardising justice. Will the Minister publicly outline, now, the timetable for the inquiry? Do the Government intend to initiate the inquiry in September? If so, why has that not been made public? Why is it that we must bring Ministers to the House again to make this clear? Does that not go against everything we were promised last week? The Minister must remember the promises made just last week and ensure that consultation is central to the whole process; otherwise, the Government will fail this community, who must have the justice they so rightly deserve.

Future of the NHS

Philip Dunne Excerpts

Thursday 20th July 2017 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a great pleasure to join you in the House for the last debate before the summer break, Mr Deputy Speaker.

I congratulate my hon. Friend the Member for South Dorset (Richard Drax) on securing this debate and commend his timing, as it is two days after we laid the Department of Health and NHS entities’ 2017 accounts before Parliament. He will note from what I am sure will be his diligent scrutiny of those accounts that provider deficits have been much reduced in the year that has just ended compared with the figure he cited for the previous year. That is a tribute to the focus of managers and trust leaders on securing the financial balance that the NHS as a whole has delivered over the past year.

To put all that in context, this is a time when more people than ever are using the health service. In 2016-17, some 23.4 million people attended A&E departments in England—2.9 million more than in 2010. The overwhelming majority of patients continue to be seen within four hours, and the NHS overall sees more than 1,800 more patients within the four-hour standard every day compared with 2010. In the previous year, the NHS carried out 11.6 million operations—some 1.9 million more than in 2010. That provides the context of the achievement and the treatments that have been given to patients throughout the land.

I am pleased that my hon. Friend recognised the excellent care that the NHS provides, which has been demonstrated for the second year running by the Commonwealth Fund report: in its international study published last week, the UK was ranked as the No. 1 health system in a comparison of 11 countries. That is a testament to NHS staff. The patients who benefit from those treatments rate their experience of care highly. The adult in-patient survey, which was released in May, shows that the majority of patients report that their overall experience was good, with 85% rating it as at least seven out of 10—a slight improvement on the previous year.

Looking to the future, which is the subject of the debate, the Government are committed to increasing the NHS budget to ensure that patients get the high-quality care they need. By 2020-21, NHS spending will increase by £8 billion in real terms from the 2015-16 baseline. That will deliver an increase in real funding per head of the population for every year of this Parliament. Nevertheless, my hon. Friend is right to point out that whatever funding we provide, it is important that we spend it to achieve the best possible outcomes for patients.

It is essential that we ensure that the NHS continues to make the most effective use of its resources to deliver high-quality patient care, so I recognise what I think was my hon. Friend’s motivation in securing this debate and raising this subject before the House rises for the summer recess. We all agree that it is important to target NHS funding to frontline services, which is why we are investing in the workforce and there are already more than 33,800 extra clinical staff, including almost 11,700 more doctors and almost 13,000 more nurses on our wards since May 2010.

NHS management is an important element of ensuring an efficient NHS, but of course we are keen to ensure that an increasing proportion of NHS funding goes to patient-facing services. Between 2010-11 and 2016-17, the proportion of the NHS pay bill spent on managers declined from 6.5% to 5.8%, which I am sure my hon. Friend will welcome. We are also reducing the number of people involved in management, which he called for. Between May 2010 and March 2017, the number of managers and senior managers in NHS providers and support organisations reduced from some 37,000 to around 31,000—I think that is similar to the effective percentage to which my hon. Friend referred. We are also looking to manage the rate of pay of senior managers, again to ensure that as much as possible is focused on the frontline.

It is important that we recognise that leadership is as important in the NHS as it is in any organisation—we must ensure that we have high-quality leadership across organisations. I for one am keen not to bash the managers in a somewhat traditional manner, but to recognise that high-quality leadership in our NHS organisations is important in driving high-quality performance for patients. That is why I have been working with the leadership academy in Health Education England to ensure that we have two things: a pipeline of talent so that we can identify quality individuals at the beginning of their careers in the NHS and track them as they pursue their careers, identifying the leaders of tomorrow, in a similar system to that with which my hon. Friend will be familiar from his service in the military; and some consideration of how we can get more clinicians involved in leadership roles in their organisations. Clearly, we have directors of nursing and medical directors in all provider trusts, but too few go on to take up the most senior leadership positions as chief executives.

[Richard Drax]

I am listening carefully to the Minister. Would it be naive to say that what we want to see is matron, in the form of Hattie Jacques, back on the wards and to hand far more administrative work, if that is the right phrase, back to clinicians, with whom it originally lay?

[Mr Dunne]

I am not keen to hand administrative work to clinicians, but I recognise that there is a role for ensuring that senior clinicians are present and in charge of activity in wards. That is the experience I am seeing as I visit acute hospitals around the country: senior members of staff, normally coming out of nursing staff —so they are a matron or other senior nursing officer—are responsible for what happens on their ward.

My hon. Friend says that an independent review might be appropriate, and I say gently to him that we think that the right way to drive improvement across the NHS and help position it for the challenges of the future is to back the plans prepared by the leadership of NHS England with colleagues from across the system through the five year forward view. This is the NHS’s own plan for change and it lays out how the NHS can transform services and improve standards of care while building a more responsive modern health service. We are backing this plan, enabling the NHS to deliver Government objectives including seven-day services and improved access to cancer treatments and mental health services. We agree that the answer to the challenges faced by the NHS lies in modernising services and keeping people well and independent for longer.

The NHS is using the sustainability and transformation partnerships mentioned by my hon. Friend to deliver that vision through transformation across local areas. These are clinically led, locally driven and can deliver real improvements for patients. The five year forward view also announced the development of new care models and we are already seeing the results.

My hon. Friend referred to the announcement yesterday about the first allocation of capital funding for the most advanced STP areas, including Dorset, which covers his constituency. It is fortuitous that the largest single beneficiary of capital through the STP allocation was Dorset, and what a great day for him to secure this debate and give an albeit somewhat guarded welcome to that significant capital injection. I am aware that he has a number of issues with how that money will be spent.

[Richard Drax]

It was totally unguarded. I am extremely grateful, as I am sure all clinicians and all those who work in the NHS in Dorset will be.

[Mr Dunne]

That applause is on the record, and I am delighted that my hon. Friend takes that view.

We see this investment as backing the exemplar STP plans that have been published thus far, and we hope that other areas, whose plans are in less good shape, will be encouraged to look at those that have succeeded to see what they can do to follow their example for the next phase of the roll out in the coming years.

I will conclude with a couple of comments about how we drive efficiency through the NHS and make best use of resources. My hon. Friend referred to the Carter and the Naylor reviews. Carter is driving heavily towards using best practice and removing variability across the NHS, whether in clinical practice or in financial performance, in areas such as procurement. Alongside that, Naylor is looking at how we drive out inefficiency from back-office functions, from estates and from the facilities management element of running such a substantial network of hospitals and facilities across the country. There is scope to do more. That will appeal to my hon. Friend’s desire to put more resources on the frontline. We are looking at encouraging organisations to share back-office facilities—as he called for—to bring down cost and drive up efficiency and operational productivity, which is the right way to go.

I conclude by confirming that we are making good progress in small steps. We need to continue to make progress to try to raise the depth of the tread of the steps that we are taking to ensure that the NHS is fit to serve the health needs of this population for the future.

Question put and agreed to.

Ambulance Services (Devon)

Philip Dunne Excerpts

Wednesday 12th July 2017 Westminster Hall

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure to serve under your chairmanship, Mr Davies. I wish you every success in your endeavours elsewhere today. On that note, I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing not only this debate but unopposed re-election to the Chair of the Select Committee on Health, which role I am delighted to see her continue in.

By happy coincidence, I had the pleasure of visiting the South Western Ambulance Service NHS Foundation Trust only last week. Having visited the chief executive in his office, and seen for myself some of the challenges presented by the rurality and the distances—as mentioned by hon. Members in this debate—I feel slightly better briefed than I would otherwise have been. I drove from Exeter to Barnstaple to Plymouth on the same day, in the height of summer, on a Friday, when the roads were, it is fair to say, not at their least busy. I do absolutely appreciate some of the challenges reflected in this debate that are imposed on the ambulance service’s ability to deliver the service to residents in this large, very rural and very beautiful county. It is particularly appropriate therefore that we have the chance to discuss this briefly this afternoon.

I thank my hon. Friend for the characteristically considerate and appropriate way she posed challenges to me and thanked people employed in the ambulance service, and those who support it as volunteers, for the magnificent work that they do. She began her speech by recognising that the ambulance service in the south-west, like all other ambulance services in the country, is busier than ever. Demand has been rising significantly. Across the country, there were some 7 million face-to-face responses from the ambulance service in the year ending 31 March—a 14% increase over the last five years. In the south-west of England, demand has increased even more sharply, with a 29% increase over five years; I think she mentioned a 19% increase in her area of south Devon.

The trust is challenged by the geography of the area it serves, with its greater distances and slower transport routes. Nevertheless, it is doing well, not just in meeting national targets but in comparison with other trusts. We should congratulate all those involved, but that does not mean that there are not a number of challenges. My hon. Friend the Member for Totnes mentioned a particularly difficult case in which an elderly lady was left waiting for some time, and my hon. Friend the Member for Torbay (Kevin Foster) raised a case from his constituency in which a child had to wait some time for an ambulance.

This is clearly an operational issue. I strongly encourage hon. Members who are concerned about individual cases to bring them to the attention of the chief executive of the relevant trust, and to continue to represent to their constituents that even if the overall number of such incidents is not great, the ambulance service is required to provide an appropriate response through the disposition of its resources. From experience in my own area, I know that MPs are listened to by chief executives of ambulance trusts and can make a difference in securing deployment of resource to meet the particular demands and concerns of their constituents. It is well worth pursuing that approach.

Let me touch on some of the initiatives under way to meet the challenges that we all recognise and that have been referred to in the debate. Sir Bruce Keogh undertook a review of the NHS urgent and emergency care system, which is trying to cope with the root causes of demand. Following the review’s recommendations, ambulance services will increasingly be transformed into mobile treatment centres, with greater use of “hear and treat”, in which telephone calls are closed with advice, and “see and treat”, in which paramedics are equipped to treat patients on the scene without a conveyance. There will also be greater integration with the rest of the health system. Some 2,600 more paramedics are now operating within our ambulance services across the country than in 2010, and in the past year 1,400 trainees have started on paramedic courses. There has been a big shift towards training more ambulance staff to undertake treatment on the ground.

The Care Quality Commission has recognised that SWASFT is one of the highest-performing trusts in England, particularly in its “hear and treat” service, which enables clinicians to assess and triage patients over the phone and close the call without the need to send an ambulance. In April, 49.1% of calls to SWASFT were resolved without transportation to A&E—the highest percentage of any trust in England. That allows more patients to be treated in their own home or in the community without needing to be taken to hospital, helping not only the patient, but the system.

Another way in which SWASFT is addressing the growing demand for services and the need to better manage peaks of activity is through reviewing how emergency vehicles and staff are rostered. Its review has moved ambulance resources closer to areas of high public demand. Instead of a paramedic crew logging on for a shift at a rural station and then getting pulled into an urban area—an issue highlighted by my hon. Friend the Member for Totnes as a particular challenge in her constituency—resources should now be positioned in the right places and should stay more local, more of the time. She expressed a degree of scepticism about whether that is actually happening. I can confirm that in my area in the west midlands, we have worked with the ambulance service to ensure that ambulance stations are not necessarily kept in the same physical location, but are placed in parts of the country where demand is highest. This can now be well mapped by ambulance systems to ensure that service is provided as close to areas of demand as possible.

Evidence from the trust’s rota review shows that the patients with the most serious, time-critical and life-threatening injuries have experienced improvements in response times, and that ambulance resources stay local more of the time. My hon. Friend makes a perfectly reasonable challenge for that to be proven—for the facts that demonstrate it to be provided to Members of Parliament and the public—and I will encourage the trust to provide that information.

My hon. Friend and other hon. Members referred to the trust’s fleet. It is being reviewed to enable the right resource to be sent the first time. The trust has invested £3.6 million, which has allowed an additional 61 double-crewed ambulances—an increase of 20%—across the operational area, meaning that in South Devon four more double-crewed ambulances will be available this year than last year. This approach has allowed a reduction in rapid response vehicles, which—as my hon. Friend said—are not being utilised as fully as the ambulance crews themselves and are therefore not always the best resource to send.

There are now some 57 fewer rapid response vehicles. My hon. Friend the Member for North Devon (Peter Heaton-Jones) highlighted some areas in which that has caused local concern. I would say to him that the ambulance service needs to demonstrate to local people that fully crewed paramedic-staffed ambulances are now more readily available to serve communities, so that the people in most need of conveyance to hospital are more likely to get there more quickly. The trust needs to demonstrate that as it moves its resources to this new pattern.

My hon. Friend the Member for Totnes is aware of the ongoing review of the way in which ambulance services respond to calls through the ambulance response programme. SWASFT has been involved in piloting new operating models. The new programme seeks to deliver clinically appropriate responses to all patients and is part of ensuring that the ambulance service in England remains sustainable. The evidence behind the ARP is extensive, covering data collected from more than 14 million emergency 999 calls. The review has looked at a number of key issues for the south-west, including the provision of ambulance services in rural areas and putting an end to unacceptably long waits by removing the long tail of ambulance response times.

A revised operating model is crucial to achieving sustainability in the ambulance service, given the growing demand that we have all described. Trials have been independently evaluated, and the Secretary of State has recently received recommendations from NHS England. I hope to report to the House the ARP’s findings and NHS England’s recommendations shortly.

In addition, SWASFT has adopted a number of recommendations to improve response times, particularly in rural areas. One such initiative, which my hon. Friend referred to, is the increasing use of community first responder groups across the south-west. Totnes is one of the focuses for the next phase of recruitment in South Devon, which will start later this month. There are some 458 community first responders and a further 110 fire co-responders across the county, alongside the network of public access defibrillators that she mentioned. SWASFT is in discussions with three of its local fire services about introducing a conveyance and support service by fire crews, which would help to supplement conveyance when ambulances are not available. These initiatives do not change the priority or category of a 999 call, but they help to ensure that a patient with a life-threatening emergency can begin to receive the required care as soon as possible.

My hon. Friend rightly raised staffing. I understand that the clinical vacancy rate at the trust is currently 7.7%. The trust has undertaken a very successful graduate recruitment campaign, which has resulted in 130 graduates accepting offers to join it. They are expected to start in September, including 31 who will start in the west division, which covers Devon.

Motion lapsed (Standing Order No. 10(6)).

Contaminated Blood

Philip Dunne Excerpts

Tuesday 11th July 2017 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

I thank you, Mr Speaker, for explaining to the House the sequence in which we are speaking today in this very important debate.

I wish to start by offering my personal apology to all those who have been affected by the tragedy of infected NHS-supplied blood or blood products. This has had a terrible impact on so many individuals and families. I know that, quite rightly, there have been many debates on the subject in this Chamber, which have been prompted by the quite proper concern of Members on both sides of this House over many years.

There have been two previous inquiries on this issue: the privately funded Archer report, which was published in 2009, and the Scottish Government-funded Penrose inquiry report, which was published in 2015. However, I am aware that, over the years, there have been several calls for a full independent inquiry.

In addition to those reports, the Department of Health has worked to bring greater transparency to the events. Many documents relating to blood safety, covering the period from 1970 to 1995, have been published and are available on The National Archives website. Those documents provide a comprehensive picture of events and decisions, many of which were included in the documents reviewed by the Penrose inquiry. However, I recognise that, for those affected, these steps do not go far enough to provide the answers that they want or to get to the truth of what happened.

In the light of those concerns and of reports of new evidence and of allegations of potential criminality, we think that it is important to understand the extent of what is claimed and the wider issues that arise. I am pleased to be able to confirm to the House that the Government intend to call an inquiry into the events that led to so many people being infected with HIV and/or hepatitis C through NHS-supplied blood or blood products.

[Norman Lamb]

I am very pleased with the news that the Minister has just confirmed. Will he ensure that the process that is followed—I very much support a Hillsborough-style inquiry—facilitates the ability to bring criminal charges so that the full force of the law can be applied to anyone who may be guilty of criminal wrongdoing?

[Mr Dunne]

I shall come on directly to the form that the independent inquiry should take, and I hope that that will help to address the right hon. Gentleman’s question.

We have heard calls for an inquiry based on the model that was used to investigate the Hillsborough tragedy—the so-called Hillsborough-style panel—which would allow for a sensitive investigation of the issues, allowing those affected and their families close personal engagement with an independent and trusted panel. There have also been suggestions that only a formal statutory inquiry led by a senior judge under the Inquiries Act 2005 will provide the answers that those affected want. Such an inquiry would have the power to compel witnesses and written evidence—an apparent shortcoming in previous reports. The Government can see that there are merits in both approaches, and to ensure that whatever is established is in the interests of those affected we will engage with the affected groups and interested parties, including the all-party parliamentary group, before taking a final decision on the type of inquiry.

[David T. C. Davies (Monmouth) (Con)]

Will the terms of the inquiry allow for recommendations to be made about the correct levels of compensation for those who have been affected?

[Mr Dunne]

I shall make a little progress, then endeavour to answer that.

My right hon. Friend the Secretary of State and Ministers at the Department of Health will meet those affected and their families so that we can discuss the issues and understand their preferences directly about the style, scope and duration of the inquiry.

[Diana Johnson]

I am grateful for what the Minister is saying, but can he give a time estimate of when the meetings will take place? My experience of the Department of Health is that, on this issue, deadlines are not met and things have to be dragged on to the Floor of the House to get Ministers to respond. Is there a set timetable for when a decision will be made and those meetings held?

[Mr Dunne]

The hon. Lady, who has taken an active lead in encouraging inquiries, will want to make sure that we get it right. We will take the time that is necessary to consult colleagues and interested groups. Our intention is to be able to come back to the House as soon as practicable—I anticipate in the autumn.

[David Hanson]

The Minister has mentioned the Department of Health, and he will know that my constituents live under a devolved Administration in Wales but were infected in a hospital in Liverpool. What consultation is he undertaking with the Welsh Assembly, including on the schemes that it is running, and on the liability ultimately for any objective?

[Mr Dunne]

We recognise that there is a legitimate interest for all constituent nations in the United Kingdom. As many of these incidents took place before devolution, we intend to consult devolved Governments.

[Andrew Bridgen (North West Leicestershire) (Con)]

Does my hon. Friend agree that, quite rightly, the inquiry has to give answers to the victims of the scandal and their families? There will be great interest in the conclusions of the inquiry in the House and among the wider public to ensure that historical circumstances that led to the scandal are never repeated.

[Mr Dunne]

I completely agree with my hon. Friend.

[Several hon. Members rose—]

[Mr Dunne]

I shall make a little progress on devolved matters before responding to other colleagues. Regardless of the style of the inquiry, our intention is that it should cover the whole of the UK, so we will be in direct contact with counterparts in Wales, Northern Ireland and Scotland to discuss that with them and to seek their views before determining those aspects of the inquiry.

[Lady Hermon (North Down) (Ind)]

First, I apologise to the House, the Minister and to you, Mr Speaker, for not being present at the beginning of this very, very important debate. The Minister said that he is going to consult on the inquiry, which will be UK-wide. He will know that we do not have an Assembly, and there is no corresponding Health Minister in Northern Ireland, which is absolutely disgraceful. There is no prospect of our having such a Minister before the autumn, so with whom will the Minister liaise in Northern Ireland in the Assembly’s absence?

[Mr Dunne]

We will ask the Northern Ireland Office to facilitate discussions with officials and representatives in Northern Ireland.

[Albert Owen]

On the point about devolution made by my right hon. Friend the Member for Delyn (David Hanson), is the Minister telling the House that this is a UK-wide inquiry and that the consultation will take place across the UK, so that there will be equality for people such as Mr and Mrs Hutchinson in my constituency in the outcome of the inquiry?

[Mr Dunne]

The scope of the inquiry will be determined as part of the discussions which, as I have said, will take place over coming weeks and short number of months. Our intention is that the devolved Administrations and their residents will have full access to participation in the inquiry, irrespective of where people live or were infected.

The Government intend to update the House once the discussions are complete, and I encourage colleagues with a specific interest to engage in discussions through the all-party group or other relevant groups. In the meantime, if anyone in the House or outside has any evidence of criminality, they should take that evidence to the police as soon as possible. If anyone has any other evidence that they want the inquiry to consider, I would request that they submit it to the inquiry once it has been established. The Government will write to everyone in receipt of payments from the current schemes to make sure that they all know about today’s announcement and to inform them of next steps.

[Kevin Foster (Torbay) (Con)]

I very much welcome the Minister’s comments. Will he confirm that when the scope of the inquiry is drawn up care will be taken not to do anything that might endanger future trials? Will he further emphasise that anyone with information should make sure that it is made available to the police?

[Mr Dunne]

My hon. Friend will recollect that the recent Hillsborough inquiry gave rise to certain information that was made available to the police and led to charges being made. We would envisage that the inquiry that is established would have the ability to do the same thing if appropriate.

[Several hon. Members rose—]

[Mr Dunne]

I must make progress, because Mr Speaker has encouraged me to take 10 minutes so that everyone can make a contribution, and I have already exceeded that.

I should like to take the opportunity to inform the House that implementing the reforms to the infected blood ex-gratia support scheme remains a priority for the Government. That is why, as David Cameron established a year or so ago, within this spending review period, until 2020-21, up to £125 million of additional funding has been added to the budget for the ex-gratia support scheme. That more than doubles the annual spend over the spending review period. The second consultation on scheme reform, which closed on 17 April this year, received over 250 responses. The consultation contained proposals for a special category mechanism that would allow people with stage 1 hepatitis C to apply for the higher annual payment, greatly increasing the number of individuals eligible for the higher payment. The responses are being looked at and the consultation response will be published in due course. All the annual payments will remain linked to the consumer prices index and will be disregarded for tax and benefit purposes.

[Stephen Doughty]

I thank the Minister for what he said about input into the inquiry. As the new chair of the all-party group on HIV and AIDS, I am sure that our members will want to contribute. I want to press him on the financial liabilities arising from the inquiry and the impact of devolution. Will he guarantee that, no matter where anyone was infected or where they live now, they will be treated with equality across the United Kingdom when it comes to financial liabilities and payments arising from the inquiry?

[Mr Dunne]

I have just described the additional contribution to the financial scheme for England. It will be for the inquiry to decide whether it wants to make recommendations about financial arrangements. At present, I am not in a position to give the hon. Gentleman the confirmation that he is seeking. That will have to come through the inquiry.

[Dr Julian Lewis (New Forest East) (Con)]

My constituent Lesley Hughes was infected with hepatitis C in 1970, but this was discovered only about three years ago. Will any consideration be given to those long years of suffering when the compensation scheme is put into effect?

[Mr Dunne]

I offer my sympathy to my right hon. Friend’s constituent for the challenges she finds herself facing. We have to say at this point that it will be down to individuals to make their applications. We will respond to the consultation in due course. I strongly encourage my right hon. Friend to make representations on his constituent’s behalf to the inquiry when it is established.

[Chris Stephens]

I thank the Minister for being extremely generous in giving way. May I press him on the issue of health records? Many families are still trying to establish what has actually happened, while the Minister is discussing the scope of the inquiry. Should we write to the Minister if there are any issues with families obtaining health records?

[Mr Dunne]

I think it would be appropriate to write to the inquiry, once it is established. I completely concur with an earlier point about ensuring that any evidence of medical records being tampered with should be made available to the inquiry.

I am afraid that I must bring my remarks to a conclusion. I thank those on both sides of the House who have worked tirelessly on the issue over the years. I add my voice to those of others who have already spoken to commend the hon. Member for Kingston upon Hull North (Diana Johnson). She has spoken very powerfully in the House on this subject not only today, but on many occasions and for many years. I also commend my hon. Friend the Member for Worthing West (Sir Peter Bottomley), who co-chairs the all-party parliamentary group. As the hon. Member for Kingston upon Hull North did, I thank past and present members of that group, notably the former chair, Jason McCartney, late of this parish. Finally, I thank ministerial colleagues who have handled this delicate issue in previous Administrations, particularly my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who has worked so hard not just for his constituents, but for all those affected by the tragedy.

--- Later in debate ---

[David Hanson]

I am grateful to my hon. Friend. The point that I want to finish on—[Interruption.] Does the Minister want to intervene?

[Mr Dunne]

Briefly. I remind the right hon. Gentleman, who is making some important points, that we intend to contact all the families who are in touch with us through the different schemes to alert them to today’s announcement, so that they will have the opportunity to contribute to our determination of the best form of inquiry. On the hon. Gentleman’s second point, it will be for the inquiry, once it is established, to determine how it engages with people, and those involved will be interested in any advice from Members or others.