Children and Mental Health Services

Rosie Cooper Excerpts

Tuesday 16th July 2019 Westminster Hall

[Andrew Griffiths]

The hon. Lady makes a powerful point. It is true that her constituent is not alone. When I publicised this debate on my Facebook page, I was amazed by the number of parents who got in touch. I was overwhelmed by parents who have either battled through and managed to get to the other side, or are in the midst of fighting to keep their children alive, safe and well. As a parent, I realise what a scary thought that is.

[Rosie Cooper (West Lancashire) (Lab)]

To reiterate that point, does the hon. Gentleman agree that this is a state of emergency? In my constituency, the parents of a 12-year-old boy are being advised that there is a 72-week wait for their son to get help, even though there is a risk of serious self-harm.

[Andrew Griffiths]

I agree that we are in a crisis. The Government are putting record amounts of money in, but the hon. Lady is absolutely right to say that that is an unacceptable wait. I will discuss waiting times later in my speech. Any parent would be terrified at the thought of that long wait and their child being further harmed by it.

Integrated Care Regulations

Rosie Cooper Excerpts

Monday 18th March 2019 Commons Chamber

[Lyn Brown]

My hon. Friend is absolutely right. I believe, and I know he believes, that these changes are important and should not be done by statutory instrument. The goal of healthcare integration can and should be pursued with the full scrutiny provided by primary legislation.

Locally, these plans have raised huge concerns. Currently, Newham is in a sustainability and transformation partnership with seven other boroughs—Havering, Redbridge, Barking and Dagenham, Waltham Forest, Tower Hamlets, Hackney and the City of London. Those are really very different places, not only politically but in terms of age, ethnicity and levels of deprivation. Any integration plan that covers that wide an area will be incredibly difficult to get right.

I understand that the current thinking is more about dividing that eight-borough STP into three new integrated care systems, or ICSs. Newham will be lumped together with Waltham Forest and Tower Hamlets. I am very worried that pushing these areas together, with one extremely overstretched budget, will result in money being taken away from my constituents in Newham, whose needs are extremely high. If the Government were talking about enabling greater integration at local authority level, where democratically elected councillors could be properly involved, the issue would not be that much of a concern.

To be frank, I have absolutely no confidence that there would even be a proper consultation about integrating Newham into a three-borough ICS. I know that that is what local leaders expect only because I asked them about it before the debate. I am told that not one health body locally actually wanted to sign up to the STP—not one local body. But that did not matter to those who are really in control, so it was just put in place anyway as the East London Health & Care Partnership. This supposed partnership was given an incredibly complicated governance structure. Again, no one actually wanted it. That was not because health bodies do not want to collaborate; it was because this Government’s failed reforms do not have the confidence of clinicians.

There are many basic questions that need to be answered and that have not been. I have five for tonight. One, how do the Government plan to prevent fragmentation, given that there are so many different ways that these arrangements could be made? Two, how will existing borough-level partnerships slot into these new structures? Three, how are dedicated NHS staff, elected local representatives or even—horror!—patients themselves going to have control over how these structures are implemented, which areas are joined together and which services are included? Who will have that control?

Four, once one of these integrated bodies has been set up, what actual accountability will there be? As we know, public health and social care services are currently in the hands of councils. Even beyond that, many health and wellbeing objectives are the statutory responsibility of local councils too. Therein lies accountability to local people, but it is totally unclear to me how councillors will be able to hold the new ICPs to account in turn. If those new bodies are going to be responsible for making decisions, they should have to be transparent and accountable. I am not at all opposed to the integration of services, but we must create more accountability, and not risk losing the little that is currently there.

My fifth and final question is this. How will the Government guarantee to my constituents that this change will not become another back-door privatisation? How can they reassure me that the enormous, inefficient, profiteering “health maintenance organisation” monsters that exist in the United States will not be given a foothold here in exchange for, say, a trade deal post Brexit? This is what I find most offensive about the statutory instrument. Ministers have been offered the chance, time and again, to say that private companies will not be able to act as integrated care providers, and will not be able to bid for the huge contracts that will be created. But I have heard no good reason why the Government will not make those commitments.

[Rosie Cooper (West Lancashire) (Lab)]

The House of Commons Library recently confirmed that 26 health service contracts worth more than £128 million are currently out to tender, on the basis of legislation that NHS England recently urged the Government to repeal. Does my hon. Friend not think that private companies should be blocked from securing these contracts, and that the Government should deal with the counter- productive effect that these competition rules and powers have on the integrity of NHS care? There is a branch of Virgin Care in my local community. Someone who attends a podiatry appointment, for example, will be told that no qualified staff are on hand, but only people who can cut nails. It is outrageous that those people are being paid on the same basis as everyone else.

[Lyn Brown]

My hon. Friend is absolutely right. Private companies are able to work within the structure set out in primary legislation such as the 2012 Act. The Minister said in an interview that one of the reasons why we cannot have this in a Bill is that it would be too complicated to draft. As far as I can see, however, it is quite simple. The Government should bring forward new legislation to put these reforms on a proper transparent footing with full scrutiny, and should argue for the decisions that they want to make—including decisions about openness to private contractors, if that is something that, ideologically, they want to defend.

The Government should give the English electorate a plan that they can see and can judge for themselves. The Government should tell the electorate what they are doing with the NHS. My feeling is that their proposals are contained in an SI because they hoped that they would slip by, would not be seen and would not be judged, but I tell the Minister that he will be judged.

Question put.

The Deputy Speaker’s opinion as to the decision of the Question being challenged, the Division was deferred until Wednesday 20 March (Standing Order No. 41A).

Oral Answers to Questions

Rosie Cooper Excerpts

Tuesday 19th February 2019 Commons Chamber

[Matt Hancock]

I pay tribute to my hon. Friend, who recently announced that he will be standing down at the next election, for the amount of attention he has given to broadening people’s minds and to looking at what works and what the evidence shows works. We know, for instance, that social prescribing can help people and ensure that they get the support they need, and he has made a great contribution to that debate.

[Rosie Cooper (West Lancashire) (Lab)]

After reviews by ACAS, Capsticks and Dr Bill Kirkup, will the Minister outline how he intends to deliver justice for both staff and patients of the Liverpool Community Health NHS Trust? How will he ensure that the board members who disgracefully refused to give evidence to Kirkup will be held to account and made to give evidence in future investigations?

Oral Answers to Questions

Rosie Cooper Excerpts

Tuesday 19th June 2018 Commons Chamber

[Steve Brine]

We assess the plan all the time, and we make progress reports on it, as we did last month with the sugar report. However, when I addressed the Health Committee recently, I could not have made it clearer that we think there has been progress.

This is a world-leading plan. When we talk to other people around the world, they are very keen to hear about what we are doing and very interested, and we are interested in learning from them. If we do not take action, one of our biggest public health challenges will get worse and worse, and that will have implications for the health service and for all our constituents.

[Rosie Cooper (West Lancashire) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

When something goes tragically wrong in healthcare, the best apology to grieving families is to guarantee that no one will experience the same heartache again. Last week I accepted the recommendations of the Williams review of gross negligence manslaughter, and we announced a new national clinical improvement programme to provide NHS consultants with confidential data on their clinical outcomes. From next April independent medical examiners will examine every hospital death, and the learning from deaths programme will be extended to primary care.

[Rosie Cooper]

Will the Secretary of State encourage NHS England to respond to my freedom of information request of 13 March this year regarding Greater Manchester Shared Services and the likely failure of the NHS to correctly enforce guidance on recruiting agency staff in the reappointment of Deborah Hancox after her criminal conviction and two-year prison sentence for defrauding the NHS? How can we employ these people?

[Mr Hunt]

The hon. Lady has highlighted what is potentially an extremely serious issue. Obviously the FOI is a matter for NHS England, but let me reassure her that the Minister for Health, my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay)—the hospitals Minister—met the chief executive of the NHS Counter Fraud Authority this morning.

Privatisation of NHS Services

Rosie Cooper Excerpts

Monday 23rd April 2018 Westminster Hall

[Rosie Cooper (West Lancashire) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hosie. I thank my hon. Friend the Member for Hartlepool (Mike Hill) for securing the debate. It gives Members such as me the opportunity to talk about how the privatisation of NHS services affects us all and, in particular, our own constituents.

I will make three points about privatised healthcare, from commissioning right through to practice. First, it lacks transparency; secondly, it is removed from adequate accountability; and, thirdly, it prioritises shareholder gains over patient care. It only takes a glance at the situation over the past two years in my constituency, where privatisation is not creeping but galloping in, to witness numerous examples of those three points.

After NHS West Lancashire clinical commissioning group announced in February 2016 that it was liaising with two private companies, Optum Health Solutions and Virgin Care, to deliver urgent care services—among them walk-in centres, out-of-hours and acute visiting services and community health services, including district nursing—it quickly became clear that the process would leave residents, healthcare professionals and, indeed, me in the dark, unable to see the details of the selection process and the contract and now unable to see performance figures against that contract. At the time, Southport and Ormskirk Hospital NHS Trust was delivering those services, yet the CCG excluded it from bidding, amazingly without any real explanation from any of the bodies involved.

When I attempted to question the CCG, NHS England and NHS Improvement about the situation, the phrase “commercially sensitive” was frequently deployed to avoid answering. The people of West Lancashire and the people of this country fund those services, so I ask the Minister to explain why there are not more stringent procedures in place to ensure that the taxpayers know where their money goes and why.

I also ask the Minister to consider an investigation into the phrase “commercial confidentiality” and its very frequent use by CCGs. It should be stated clearly that the lack of transparency and accountability among private healthcare providers is a trend that continues nationally, and not just within commissioning. As many of us are aware, the British Medical Association has long warned the Government that there continues to be no obligation for private providers to report even on patient safety incidents and performance data. Although the Care Quality Commission requires non-NHS providers to abide by a duty of candour, there is no obligation to make publicly available any information about the nature or severity of any such incidents, and the CQC does not publish the information either. Additionally, private providers are not required to regularly update the CQC on less serious safety incidents and, according to the think-tank, the Centre for Health and the Public Interest, only 63% of hospitals do so.

Will the Minister address how the CQC, NHS England, NHS Improvement and Members of Parliament are meant to hold CCGs and private providers to account if information, including that relating to patient safety, remains behind closed doors, without the possibility of scrutiny, let alone action being taken about it? I understand that regulators may request some of the information, but that is simply not good enough. The regulators are not always on top of their game, as evidenced in Liverpool Community Health NHS Trust, where, as the Minister knows, every regulator missed the poor services delivered to patients, as evidenced by both Capsticks and Kirkup—and that is an NHS trust, not a secretive private provider. Openness, transparency and accountability should be an integral part of a democratised healthcare service, right through from commissioning to practice. The extent of the secrecy surrounding the process in West Lancashire led to me raise it with the Public Accounts Committee and the National Audit Office. Does the Minister think it should have got to that stage at all? What does he recommend we do in the future?

Without scrutiny, we risk events happening such as the recent one in which a company operating one of the first integrated NHS 111 and GP out-of-hours services was forced to hand back its contract to the NHS just seven months into a three-year contract. In 2016, CCG board papers rated the proposed transfer of services as “red”. The deal went ahead anyway. Where is the accountability, and where was NHS England? Were other regulators on the missing list yet again? A similar event was recently about to happen in Liverpool, where the CCG wanted to award the contract to run the majority of community services to Bridgewater Community Healthcare NHS Foundation Trust. That would have been a disaster, as anyone looking at the current state of that trust would have been able to see. Yet all the detail was hidden from the public. Incidents involving GP out-of-hours services like that send shivers down my spine.

Fewer than two weeks ago, it was announced that Totally plc, a private provider of out-of-hospital services, had been awarded a four-year contract with Virgin Care for 18 GP out-of-hours services in West Lancashire. It then transpired that Vocare, a subsidiary of Totally, was going to run the services on its behalf. In case Members got lost in that little trip, I will outline the process in full: NHS England devolves commissioning to NHS West Lancashire CCG, which contracts to Virgin Care, which subcontracts to Totally, which hands its contract over to its subsidiary, Vocare. You really could not make it up, could you? I have to ask the Minister: does that constant subcontracting between private companies not further dampen our abilities to hold private providers to account? Where does the increasingly complex and inward-looking operation end? Perhaps I already know the answer, because Totally’s chief executive, Wendy Lawrence, commented in a press release on the recent contract award:

“also ensuring we create value for our shareholders by securing important strategic contracts such as this one”.

Does that explain why, in 2017, constituents of mine who received urgent care from Virgin were informed that wounds could be dressed only once and my constituents would then need to go to the local chemist and purchase further dressings? Will the Minister explain how that is healthcare free at the point of delivery?

In 2017, the operating hours of the Ormskirk urgent care centre were 8 am to 8 pm. It used to be open from 8 am to 10 pm. The initial contract was to allow the centre to be open to enable my constituents to go to the urgent care centre when GPs surgeries were closed and to ease the burden on A&E. The opening hours do not meet that need, and it transpired later last year that Virgin does not always have a GP on site. When there was a computer problem at the walk-in centre, my constituents were simply told to go home or go to A&E.

Since the Health and Social Care Act 2012, CCGs and private contractors have promised us that patients would receive quality treatment and care, but the reality has often been starkly different. With privatisation rising year on year, Ministers must ask why Members of Parliament, regulatory bodies and, worst of all, health service patients have been unable to hold private contractors and those who commission services to detailed account. They have dampened or refused transparency. There is a lack of accountability, and the service people receive can prove inadequate. Taxpayers are not being offered the high-quality patient care they expect and deserve. Many Members on the Government Benches blindly follow statements made to them and think that the situation is okay everywhere. It certainly is not. We have proved that regulators are not regulating. If we cannot get the information from private providers, Government Members cannot assert that everything is great, because we do not know.

GP Recruitment and Retention

Rosie Cooper Excerpts

Wednesday 28th March 2018 Westminster Hall

[Bridget Phillipson]

Attracting medical students to areas of the country with the greatest need is important. That is something I have been seeking to do, and I am sure the hon. Gentleman will continue to make that case as well.

[Rosie Cooper (West Lancashire) (Lab)]

I am absolutely delighted that Edge Hill University in my constituency has just been granted a medical school. Does my hon. Friend, or indeed the Minister, have any view on how to retain the doctors who will train there and ensure that they can practise in the area? Lancashire has seen the largest fall in the number of GPs of any county since 2015—it is nearly 10% down. We need solutions to make areas attractive in order to retain the medical students who train there.

[Bridget Phillipson]

My hon. Friend is entirely right. I will say a bit more about Sunderland’s successful bid for a medical school—a number of parts of the country have benefited from those new schools. She will no doubt accept that this is part of a much longer-term solution to resolving the crisis we face. Meanwhile, we need action from Ministers to deal with some of the short-term pressures on local services.

The most vulnerable patients, who already find it difficult to get to their local practice, will undoubtedly be further inconvenienced if that practice moves further away. The creation of larger super-practices also risks breaking the critical link between family doctors and the patients they serve. In any case, the national and local strategic push for larger practices appears to be having little impact on GP numbers, as I have sought to make abundantly clear.

I do not believe that we can go on like this. We should rightly celebrate that people are living longer, which is in part a testament to the world-class care that the NHS provides, but we need to acknowledge that an ageing population with increasingly complex long-term care needs is likely to put further pressure on GP services in years to come. The British Medical Association is clear that general practice in England is under unprecedented pressure to deliver more support to patients with fewer resources. As the problems grow increasingly severe, GPs are being forced to test their resilience beyond reasonable limits and to confront issues from a multitude of directions.

I am deeply concerned that eight out of 10 GPs feel unable to deliver safe care; that seven in 10 feel that patient access to services has decreased of late; and that six in 10 have reported a rise in their stress levels. There is a workload limit beyond which we cannot reasonably expect family doctors to go. Given that more than half are now considering the temporary suspension of new patient registrations to ease the burden, it seems that we are close to that point.

If we are to address the crisis in general practice, we must first consider the factors that drive it. The Sunderland CCG practice area is grappling with several problems that I am sure will be familiar to GPs in other parts of the country. I have mentioned the long-term challenge of coping with an ageing population that has longer and more complex care needs, but that is coupled with rising public expectations of what their local general practice should be able to deliver. Let me be clear: demands for flexibility in terms of evening and weekend opening hours are not unreasonable at a time when so many people work during the week. After all, public services must be responsive to how people live their lives. That said, it is inevitable that offering round-the-clock access to GP practices will increase the pressure on existing workloads unless more family doctors come into the system.

Unfortunately, the opposite is happening in my area, where there are significant issues with recruitment not only of GPs, but of nurses and other healthcare professionals. Meanwhile, existing GPs and practice managers are dealing with additional work moving from hospitals into the community without associated funding. Added to that is the increased pressure on budgets resulting from rising estate costs from NHS Property Services, and the fact that the percentage of the NHS budget allocated to general practice has not kept pace with the rest of the health service. Finally, the cost of medical indemnity for GPs has risen significantly in recent years, pushing up the cost of insurance and making some work, especially unscheduled care, prohibitively expensive for GPs.

We therefore have a perfect storm of pressures on general practice that is driving experienced family doctors from the profession, with a third of GPs in the Sunderland CCG area considering retirement in the next five years. The dramatic fall in the number of GP partners over the last year should also come as no shock given the increasing responsibilities of running a practice where income is falling but workload is rising. In that context, it is easy to understand why more and more experienced GPs are opting for locum work instead, which allows them to work set hours with a set fee to a very specific set of tasks.

However, the cost to the NHS of this shift in culture cannot be measured only in financial terms, although that is certainly a major concern. As I mentioned earlier, the closure of a local practice is often devastating for a local community and can leave the most vulnerable patients with less access to the long-term care they need.

The crisis in GP retention therefore needs to be urgently addressed, and I ask the Minister to explain what the Government are doing to stem the flow of GPs quitting the workforce or rejecting partnerships. The GP retention scheme has proved a popular way to help family doctors who are considering leaving the profession to remain in work for a reduced number of sessions, but the Government simply must do more to ease their workload if they are serious about their commitment to attract and retain at least an extra 5,000 GPs in England.

On the other side of the coin is recruitment. Given the challenges for retention I have outlined, improving recruitment is critical if the general practice forward view target of increasing the number of GPs by 5,000 by 2020 is to be met. The BMA has warned that that target looks increasingly unachievable without a significant increase in the number of doctors through the expanded international GP recruitment programme.

Sunderland CCG is part of the NHS Cumbria and North East submission to that programme, and at least four local practices have expressed an interest in hosting a minimum of 10 GPs. In addition, the CCG is running other schemes to attract more family doctors, such as the GP career start scheme, the golden hello scheme and the GP bursary, yet whatever additions those can make to the workforce will clearly be insufficient to address the long-term drop in the number of hours made available for general practice in our area, with the number of full-time equivalent GPs falling from 201 in 2013 to just 139 in December last year. I know that the methodology for measuring that number has changed, but it is evident, whatever way the figures are measured, that there are simply not enough new doctors coming on stream to plug the ever-widening gap in service need in Sunderland.

I hope the Minister will take responsibility for this situation, and that he will agree that this is a national crisis, rather than an issue to be dealt with by local NHS managers. He will be aware that, in addition to the GP shortages we have discussed, the most recent figures show more than 100,000 NHS posts currently lying vacant—this is before we have even left the European Union.

What assessment has he made of the impact of Brexit on EU workers in the NHS, and does he agree that the Government’s increasingly hostile attitude towards migrants from both inside and outside the EU risks exacerbating the jobs crisis within the NHS at a critical moment? Rather than creating a hostile environment, should the Government not celebrate those who have come to our country to keep our NHS going, and who have made such a fantastic contribution to our health service since its inception?

I hope the Minister will at least acknowledge the problems that the north-east faces in recruiting new medical students into general practice. We in the House have a duty to confront those challenges and to support creative efforts to help the NHS to attract more students into the profession in the areas of greatest need. That is why I was so delighted by the news last week that the University of Sunderland was successful in its bid to set up a new medical school. My hon. Friend the Member for Sunderland Central (Julie Elliott) and I supported the bid, because the school will focus specifically on addressing workforce need in general practice and psychiatry in the north-east. It will deliver an additional 150 graduates into general practice between 2024 and 2028. All the experience is that GPs tend to stay in the longer term in the areas where they train, so the creation of a dedicated medical school in Sunderland is an important development for the city and the wider area.

The bid should also be praised for seeking to widen access to medical schools by ensuring that those with the talent and motivation to succeed are encouraged to apply regardless of background or social connections. The new medical school will champion general practice as a career path for researchers, offering them opportunities to explore their chosen field of interest after their training is complete. It will focus on reflection, responsibility, leadership and motivation when recruiting students to the programme in order to identify those who are most passionate about building a career in general practice. The creation of an institute for primary care practice and a general practice society should also help to foster communities of practice that will last for many years to come.

I have every confidence that the new medical school will play an important role in addressing health inequalities across the north-east in the long term, while improving social mobility in the region. I therefore wish it every success and hope that other medical schools will replicate its innovative approach to attracting talented students from less advantaged backgrounds into medicine and, specifically, general practice. I want to take this opportunity to thank all those who were involved in putting together the bid, especially Professor Scott Wilkes and Vice-Chancellor Shirley Atkinson. Without their determination, dedication and leadership, the bid would never have succeeded. They deserve a great deal of credit.

We can all agree that training new family doctors in this country is the most sensible and sustainable way to improve recruitment and retention in general practice in the long term, but that will do nothing to address the immediate crisis facing the GP workforce. I have already discussed some of the programmes that have been put in place to meet the target of 5,000 new GPs by 2020, and I agree with the BMA that it is encouraging that the number of GPs entering training has risen for the third year in a row. However, as I mentioned, those gains are being offset by the fact that many existing GPs are choosing to work less or retire completely because of rising workload pressures. Furthermore, the BMA is clear that the overall intake for GP training places still falls far short of the Health Education England target.

Nowhere is the problem more apparent than in the north-east, where the fill rate for GP specialty training vacancies last year was just 77%. That is by far the worst rate in England and it is nothing new. Two years ago, for example, the north-east fill rate was a shocking 62%, which at the time was the lowest in the whole country. There is a real problem in relation to general practice in the region that has some of the most acute health inequalities in the country. Sunderland, South Tyneside and Hartlepool are ranked in the top 20 of 326 local authorities for bad or very bad health, and Sunderland has some of the worst health metrics in the UK for diabetes, hypertension, respiratory disease and many other health conditions. Setting aside for a second the increased demands that the forecasted ageing population will place on primary care provision, we can see that there is an urgent need for more family doctors to deliver health improvements today.

I raised this issue with senior NHS leaders during a recent session of the Public Accounts Committee, but I want to put it to the Minister again. Will he tell the House what exactly the Government are doing to ensure that the regional imbalances in GP recruitment are addressed, and how does he intend to ensure that the right people are trained in the right places? That is a crucial aspect of the challenges facing general practice in my area, and put simply, we need to know that Ministers and the Department have got a handle on it. Furthermore, will the Minister tell us whether his Department is looking at ways to open up access to medicine more broadly—not just supplementing existing provision, but looking at creating new and different ways of getting people into medicine in the way the University of Sunderland is seeking to do? Those are critical questions and they deserve concrete answers. I am sure the Minister will not disappoint.

On that note, I will draw my remarks to a close. I am sure that all hon. Members in the Chamber will agree that the challenges for general practice are significant and require a range of approaches, none of which will be quick fixes. To meet those challenges, the Government need to take a long, hard look at the things that they can do in the short, medium and long term to help to reverse the growing crisis in GP recruitment and retention. We cannot do otherwise, because this is simply too important to our constituents and to the future sustainability of our precious NHS.

Acute and Community Health

Rosie Cooper Excerpts

Thursday 8th February 2018 Commons Chamber

[Stephen Barclay]

My right hon. Friend raises an important point on the draft Bill and the consultation. I am not in a position to announce a date; that will be announced by business managers in the usual way.

My right hon. Friend is right to allude to that Bill as one of a suite of measures following Sir Bruce Keogh’s review and the Francis report, which are all part of changing the culture. I acknowledge the importance of those measures, but I want to signal to the House today that Dr Kirkup’s report identifies remaining issues that need to be tackled. He has done us that service, and that is where I am keen that we focus as a Government.

[Rosie Cooper (West Lancashire) (Lab)]

Thank you for your indulgence, Mr Speaker. I do not intend to test your patience today by dealing with the details of these matters; I will do that through Adjournment debates, questions, the Health Committee and other mechanisms available to me.

I thank the Minister for his kind words and his comprehensive statement in response to the excellent work of Bill Kirkup and his team. I pay tribute to Dr Kirkup for his thoroughness and independence, and I thank him most sincerely, on behalf of the staff and patients in Liverpool who suffered really badly at the hands of what I want to call a dictatorship—the regime. Whatever it was, what was done was done in our name and the name of the NHS, and those people deserve justice.

After the ACAS review, the Capsticks report and now the Kirkup report, with a National Audit Office report on the way and Nursing and Midwifery Council hearings due soon, it really is important that the NHS ensures that justice is not only done but seen to be done. Under Governments of all parties, the higher echelons of the NHS have closed ranks to protect themselves. That has got to stop. That senior people were able to inflict such harm on staff and patients and then just walk into other senior NHS jobs with six-figure salaries, and that in this case it could be arranged by the north regional managing director of NHSI, Lyn Simpson, is simply staggering.

I still cannot answer the question that the Minister posed—why were the chief executive and the board not fired? Why were they not sacked? It is incomprehensible. Nothing has been learnt over the past four years. As of only a few weeks ago, NHSI is presiding over another potential LCH, over in the Wirral’s hospitals trust.

I will obviously continue to pursue these matters with vigour on behalf of the staff and the patients, and I want to place it on the record for everyone who is affected that I do not see the Kirkup report as the end—far from it. The Minister has a legal and forensic background. How will he assure the House that these matters will be dealt with properly, and that cover-ups and backdoor deals have ended once and for all? The Secretary of State has said so many times, “This will stop. We are not going to keep moving failed executives around,” yet it continues to happen.

I will say quite honestly that I asked a question of a Minister last year and he answered me in good faith. He said, “NHSI doesn’t participate in moving staff around.” Not only can we now prove that it is true that it does, but it nearly happened in the Wirral a few weeks ago. The message has got to go out: “If you do this kind of stuff, you are responsible. You will not escape.” The NHS must be accountable, and those in it held responsible.

[Stephen Barclay]

I thank the hon. Lady for those comments. As I said, I have asked NHS Improvement and NHS England to clarify the circumstances under which roles were found or facilitated for individuals identified in the report as bearing some responsibility for the issues at the trust. I await the answer to that central question, which the hon. Lady posed.

On the sense of cover-up, the Secretary of State has provided leadership in bringing about the culture change on patient safety. Following the awful situation in Mid Staffordshire, it was recognised across the House that changes needed to be made on patient safety, and I think the NHS itself has recognised that. NHS Improvement has new leadership, who commissioned the Kirkup report themselves.

On the changes that have been put in place, I alluded to the CQC regime and the chief inspector and the methodology. I spoke to the chief inspector yesterday. Every hospital has now been visited, using that new methodology, and obviously that programme will start to accelerate and target as further work visits are done. The methodology used for that has also evolved to include staff surveys, for example. So a number of measures have been taken, and the special measures regime is also very much at the heart of that.

A number of steps are being taken, but the approach that underpins those is that although we must create a duty of candour, enabling people to learn from the mistakes that will happen in an organisation employing more than 5 million people, there should not be the sense that people can escape their responsibility by moving within the system. I have discussed that with people in the NHS, and I believe there is a wide recognition that the culture has changed significantly. But clearly, as we consider the issues that emerge from the Kirkup report, the House will need to see further reassurance.

The hon. Lady asked how I and the Government will ensure that these issues are addressed, not covered up. First, no one doubts that the hon. Lady will use all the parliamentary tools to pursue this matter, including in her role as a senior member of the Health Committee. I am aware that other members of the Committee, such as the hon. Member for Liverpool, Wavertree (Luciana Berger), a former shadow Health Minister, will take a significant interest in this issue. I know that the Chair of the Health Committee will do so. I have regular discussions with her, and as we address the “fit and proper” test and other issues, I look forward to benefiting from the expertise on that Committee.

It is clear that measures have been taken, and it is right that we recognise that much work has been done in the NHS to change the culture, to ensure that the warning signs are seen, and to ensure that something like this never happens again, but it is also clear that there are specific issues in the report to be responded to, and I very much share the desire of the hon. Member for West Lancashire that we do that.

Oral Answers to Questions

Rosie Cooper Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Hunt]

At the heart of the Dilnot proposals was the idea of risk pooling—that there is a randomness in the illnesses that affect us in the later years of our life that we would want, as a society, to do something about. I will confirm what the Prime Minister said in the election campaign: we will consult on a cap on social care costs.

[Rosie Cooper (West Lancashire) (Lab)]

T4. I am shocked that my local hospital, Southport and Ormskirk, has unused bed and theatre capacity despite the huge winter crisis and the pressures on the NHS locally. In that same trust last night, the Virgin-run walk-in centre had a computer glitch and told people, “Either go to A&E or come back tomorrow.” Has the Department made any assessment of the number of beds and theatre hours that could have been sourced to relieve winter pressures and save lives?

[Stephen Barclay]

The hon. Lady highlights an important point about the variance in performance between trusts and how we look at some of the lessons from, for example, Lords Carter’s work on efficiency, rotas and how to maximise the value of funding. I am happy to consider her specific point, but she is right that how we manage the patient pathway, in particular the 43% of hospital beds occupied by 5% of patients, is a key challenge.

North West Ambulance Service

Rosie Cooper Excerpts

Monday 22nd January 2018 Commons Chamber

[Tony Lloyd]

The right hon. Gentleman is of course absolutely right on both counts. First and foremost, we must value the paramedics and the technicians who make our ambulance service work, and nothing whatever of what I am saying is critical of them. They joined the service to help save lives and to get people into our national health service, but this is of course the reality, and I am grateful to people who have spoken privately about what is going on. Whistleblowers are really important.

To make another point briefly, I wrote to the North West Ambulance Service about its failings—I will come on to the particular failing later—in the middle of August, but I had to raise the issue on the Floor of the House to get an answer two and a half months later. Quite frankly, the answer is almost not worth the paper on which it is written because the climate of secrecy—the climate of “Mind your own business,” which is said even to Members of Parliament—is very unhealthy. I hope that the Minister will take that on board.

[Rosie Cooper (West Lancashire) (Lab)]

I agree very strongly with my hon. Friend’s comments. I recently wanted to get a transcript of some calls—harrowing calls—in cases where people had died because of the inefficiency of the ambulance service. Last year, for example, my office got a call about a family waiting 90 minutes for an ambulance to arrive for somebody who had had a heart attack. The management of the organisation several times missed an opportunity to send an ambulance, and there is no excuse for this. People are depending on this service. We need whistleblowers and we need people telling the truth, but for such an organisation not to make transcripts readily available is a disgrace.

[Tony Lloyd]

Absolutely. My hon. Friend’s point speaks for itself. We need a climate of openness and one in which people who work in the service and care about it can feel emboldened to speak out. The law actually protects them, so it is outrageous that a public service should put people under such pressure, and it is outrageous that a Member of Parliament should struggle to get transcripts relating to her own constituents. There is a lot going wrong.

The reality—the Minister may want to reflect on this—is that over the past six years, the demands in the highest category in the north-west have gone up by some 50%. We can discuss what that means, but at the same time the number of paramedics has increased by only 16% and the number of those in technician grades by some 28%, so the staffing simply is not keeping pace with the change in demand.

There is something worse. I have already mentioned the fact that we have seen the closure of A&Es and the increased pressure that those closures inevitably bring, but on top of that we face the daily reality—again, this is not part of the winter crisis—that our ambulances and our skilled paramedics are having to wait outside our hospitals in some cases for hours on end. Let me give the House a few illustrations. At one of our local hospitals, Royal Oldham—an important hospital for my hon. Friend the Member for Heywood and Middleton (Liz McInnes) and me—an ambulance had to wait for three hours and 46 minutes before it could discharge one of its patients on 7 January. At North Manchester—again, one of the hospitals that Rochdale borough depends on—an ambulance took eight hours and 50 minutes to do so on 3 January: somebody waited in the back of an ambulance for eight, or nearly nine, hours. At Fairfield, which is also one of our local hospitals, a figure of over 10 hours was recorded in December.

Something is going fundamentally wrong when people are waiting in the back of an ambulance for the care that they ought to be getting inside our hospitals. However, something else is going wrong, because such cases mean that the skilled staff in those ambulances cannot be out on the road going to the next job where they are needed and to the one after that. One of the paramedics—a whistleblower, as it were—with over two decades of service in our ambulance service told me that when he started, he typically went to nine different jobs during a working shift. It is now sometimes as few as three or four jobs a night, because he and his colleagues spend their time waiting outside hospitals, for reasons that have already been identified.

I know from the different roles I have had that things have been going wrong for years with the quality of our ambulance services. When I was a police and crime commissioner, the police would complain to me that, when attending a situation, they would often be forced to wait because there was a clear need for an ambulance, and sometimes they would have to deliver people to hospital because the ambulance could not arrive in time. The police certainly do not say that critically of their colleagues in the ambulance service, but they know that they are not the right people to be charged with carrying sick people to hospital.

The Minister has probably been told that one of the palliatives in the system is the series of green cars staffed by paramedics who are first on the scene. If we had a properly funded, properly staffed system of ambulance provision across the north-west, that might be a very intelligent design, but it is a very stupid design when paramedics are in short supply, because if the job the paramedic attends turns out to be really serious, they cannot operate as a paramedic, because the green cars are not ambulances; they are simply a means of transit. The paramedic then has to ring for an emergency ambulance. A paramedic told me that he attended a cardiac arrest where the patient was in a serious condition, but he had to wait with them for 45 minutes, without being able to give more than basic attention, before the ambulance arrived. Such situations should not be routine, but paramedics tell me that they happen regularly, so we know that things are going wrong.

I want the Minister to consider one issue particularly seriously. When Rochdale A&E was closed, a commitment was made to the people of my constituency that there would be a paramedic on every ambulance coming from Rochdale. We have found out that that is simply an illusion. My constituents were lied to—I think I can use that term, Madam Deputy Speaker—because there was no circumstance under which that promise could ever have been delivered. We were told at the time, “Don’t worry. You’ll have to travel a little bit further, but you’ll be travelling with highly skilled paramedics.” One in four of the most serious category calls across the north-west do not have a paramedic in attendance, because we do not have enough paramedics in the service.

The story I am telling is a seriously unhappy one. It would be unhappy if this were some kind of intellectual game, but as the experience of Ron and Pat Gerner shows, this is about people’s lives. It is about people, sometimes at the most difficult point in their lives, who are anxious and concerned about what will happen next at a time of individual and family crisis. This does matter and it matters enormously that something is done about it.

I say to the Minister that certain things that need to be done almost leap off the page. First and most obvious, we need a better handover system from ambulances to A&E units. It is not beyond the wit of health professionals to come up with something better. If we are saying that one of the skills shortages in the health services is that of paramedics, we must use them intensively. That is what the paramedics want. They do not want to be sat in stressful conditions outside a hospital. We need to better deliver the service. Ministers have to drive that through. They have to seize this important opportunity.

Deafness and Hearing Loss

Rosie Cooper Excerpts

Thursday 30th November 2017 Westminster Hall

[Rosie Cooper (West Lancashire) (Lab)]

It is a pleasure to serve under your chairmanship today, Ms Buck. I thank my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) for securing this debate. This is one of those occasions when the only suitable ministerial and departmental response to the words spoken in the debate is urgent action to review, reconsider and change course. That means helping deaf people, working across Government instead of in silos, and putting deaf people at the centre of the decision-making process. I include an important area that people have talked about quite a lot today: the Department for Work and Pensions, where Access to Work needs to be promoted, not capped. Unfortunately, that cap will affect so many of our deaf and hard of hearing constituents when we come to the end of the grace period in April 2018.

I am the eldest child of deaf parents, and I was their voice and ears from a very young age. That was invaluable to them, enabling them to be easily heard and understood in a hearing world. My dad was born deaf and my mum became deaf at four years of age. I say that I was kidnapped by the deaf community at birth, because my culture, language and community are theirs. That poses me some difficulties on occasion, because I can be very straightforward in the way I deal with matters. My first language is BSL, not Sign Supported English—most people think that is BSL, but it is not.

I was tempted to sign my whole speech. I was going to do that and have the interpreters voice over my comments for my colleagues, to give everybody a feel for how it is not to be able to communicate directly—not for a minute, not for a sentence, but for five minutes or however long it takes me to finish this speech. Not to be able to communicate directly with the person we are talking to is really, really strange and difficult. Deaf people feel and experience that every single minute of their lives.

My experiences and the communication difficulties I saw led me, when I was Lord Mayor, to provide every deaf person in Liverpool with a minicom. We paid for them by getting children in schools to learn the deaf alphabet. They saw it as a secret language and really enjoyed it, and I got minicoms for everybody who was deaf in Liverpool. Some might ask why that was so important. We talk about isolation, but even though I thought, as a product of that environment, that I understood it, I came home with a minicom for my dad and gave it to him. He looked at it and was so happy, and then he took it and pressed “Nine… nine…” I said, “Whoa!” and he said, “Who else can I call? Nobody else has got one, only the emergency services and the doctor.” I thought, “Right, I get the message: every deaf person in Liverpool needs one.” That made me realise that I needed to get on with it and get everybody a minicom.

Mobile phones have improved the situation, but as the hon. Member for Milton Keynes South (Iain Stewart) has outlined, we are not progressing with transmission services as we should. I have known Chris Jones for many years, and it is a really important thing, but the agenda is so large that we need Ministers across Government to start tackling it quickly. Being able to communicate is fundamental to someone doing their job and doing a good job. The evidence is clear that Access to Work is a system that enables deaf people, particularly those who use BSL, to use their own voices in the workplace, with the communication support they need.

When I think about it, I am probably one of the first examples. My dad was a plasterer and he was so good—I genuinely mean that—that directors of building companies, since they could not phone him, used to come to my house and sit down around the table. As a child, from the age of eight or nine onwards, I used to sit on a Friday night and instead of all the millions of bits of paper going back and forth, I was drafted in to be the person from Access to Work. My dad did really well. He kept getting more and more money. They wanted him, the prices went up, and I did that every few months.

To me, the evidence is clear: the cap does not simply hinder deaf people’s ability to do their jobs, but will cause them to turn down employment offers and promotions. It might have meant that my dad did not get such a good deal on his next contract. It leaves self-employed people in a precarious position, where the small profits they have worked hard to earn go toward expensive interpretation costs. That is absolutely not a cost-effective way to work. The UK Council on Deafness found that nearly half of those whose income will be capped in April said that they would not even apply for promotion in future because they worried that they would not receive enough communication support. That presents barriers to those aspiring to careers in professional, managerial and senior roles. I have a friend who was the headteacher of a deaf school. Without support, how will that happen in the future?

We need to allow deaf people to progress as far as their talent allows. I have spoken to many other deaf people in lower roles but who aspire to do better. They have stopped looking forward and now live every day in fear that they may lose the job they have. Every day is a challenge, especially if they lose that support for two days a week. We must all be clear that deafness is not a limiting learning disability. There is no reason why deaf people cannot secure employment in senior roles, so long as Government decisions do not dampen down the support that they require.

Central Government just cannot sit back in the hope that employers and the self-employed will simply make up that two-day deficit in support costs that the cap is estimated to impose, especially when employers are already saying that they are not confident about their businesses employing a person with a hearing loss. We simply cannot waste huge swathes of talent. I know that, because my dad, who was born deaf, was probably one of the greatest men I have ever known. He was fantastically clever, and he was deaf, but that did not prevent him from doing anything—and we should not allow it to.

Does the Minister accept that the cap reimposes limits on the ambitions and financial security of deaf people, and leaves the next generation without the belief or ability to succeed in a 21st century workplace? They can. My dad has died now—he was 91—but he did it before; he was a trailblazer. Do not stop the new trailblazers. Help them to forge ahead.

It is also vital that the Minister recognises that, outside this place, the majority of British citizens and employers lack awareness of Access to Work. That really helps to explain why a recent labour force survey found that 30% of working-age people who identify themselves as having a hearing loss are not employed; I actually believe the proportion is higher than that. Does he recognise the need for a single gateway that would provide assistance and advice for employers seeking Access to Work support for their employees who are deaf or have a hearing loss?

I have listened to people refer to deafness as an invisible handicap, and it absolutely is; it is an invisible disability. However, that also means it is an easy target for cuts, especially in the NHS, Education and the DWP. We must guard against taking that easy, quick solution in the hope that deaf people and the hard of hearing will not be able to articulate the anger they feel at their treatment. I have two hearing aids, and I ask the Minister: if my hearing deteriorated to such an extent that I needed communication support to do my job as an MP, would these rules enable me to do the job effectively? If not, how is everybody else supposed to do their jobs under these rules? Do the rules not jeopardise employment, rather than helping to increase it within the deaf and hard of hearing community?

On a slightly different subject, as I said before, my first language was sign language, and I was delighted that the Labour party general election manifesto earlier this year committed to giving BSL full legal recognition. That would improve the structures and the expectation of full language access, through fully qualified interpreters, in all aspects of public life. However, that leads to a question: if the Government do not value interpreters, how will that encourage people to take up those roles?

What will we do if people do not learn BSL and are not there as interpreters? We already have cases of unqualified people interpreting in courts. That is wrong. They have no idea about deaf culture or the nuances and what people really mean. There is a difference between somebody who is just learning sign language and somebody who is really fluent or speaks it as a first language and understands what a deaf person is really saying. We need to value those interpreters.

My final question to the Minister is: does he agree that legal recognition will provide another means of improving awareness of deafness and of the barriers that deaf people and those with hearing loss deal with in the workplace? We need to ensure that Access to Work is extended to many more employers than the current minuscule few who actually use it. I look forward to hearing the Minister’s reply. Ultimately, he will be judged on the ability of the deaf community and those with hearing loss to succeed and to realise their potentials. That means in every part of their lives—particularly in the workplace, education and health, because without those things, what are we to do? Please give them the same chances that we get.