Oral Answers to Questions

Andrew George Excerpts

Tuesday 24th February 2015 Commons Chamber

[Dr Poulter]

They are in the monthly staff statistics survey. As the hon. Gentleman would like some detailed information, I am sure he will be pleased to hear that in his constituency there are now 386 more nurses than there were in 2010 under the previous Government, and nationally there are 7,500 more nurses, midwives and health visitors working in the NHS.

[Andrew George (St Ives) (LD)]

Does my hon. Friend agree with me and with the nursing profession that if nurse staffing levels on acute hospital wards fall below one registered nurse to seven acutely ill patients, excluding the registered nurse in charge, it will significantly increase the risk to patient care and result in avoidable excess deaths?

[Dr Poulter]

My hon. Friend and I have discussed this many times and I do not agree with him, as he knows. What is important is that patients are assessed on their clinical needs. A rehabilitation ward will need a different number of nurses—indeed, it may need physiotherapists and occupational therapists—from intensive care nursing, which often requires one-to-one care, so setting arbitrary staffing ratios is not in the best interests of patients.

Francis Report: Update and Response

Andrew George Excerpts

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

I agree with the hon. Lady’s argument. Just as poor care has been identified in hospitals, so we have seen terrible examples of things happening in residential care and of inadequate domiciliary care. It is more complex, because the delivery of social care is more diffuse, but one way to deal with this is through the proper integration of health and social care and the proper assessment of quality based on the entire package of care that people receive, not just in individual institutions but across the board. We are doing a lot of work on that.

[Andrew George (St Ives) (LD)]

Like others, I welcome the report, but may I urge my right hon. Friend to reconsider the issue of safe staffing levels on acute hospital wards? I know that Robert Francis pointed to issues of culture and standards, but those are areas of interpretation and disputation. If we had the measuring stick of safe standards, particularly where a ward has less than one registered nurse to seven acutely ill patients—the level recommended by the Safe Staffing Alliance—whistleblowers would be able to point to a clear failing and service risk, which is especially important if the Secretary of State is worried about avoidable hospital deaths.

[Mr Hunt]

The hon. Gentleman makes an important point, but I hope I can reassure him, because NICE has published guidelines on safe staffing levels, although they are different for different parts of a hospital: in intensive care, it is 1:1; for less severe illnesses, it is one nurse to eight patients; and in other parts of a hospital, it is one nurse to four patients. Those are all published, and I hope they will help whistleblowers in Cornwall and elsewhere.

National Health Service

Andrew George Excerpts

Wednesday 21st January 2015 Commons Chamber

[Andy Burnham]

I will give way one more time.

[Andrew George (St Ives) (LD)]

At the start of his speech, the right hon. Gentleman said he was calling for common ground and consensus in this debate, although he seems to have become somewhat deflected from that path. He knows that I very much agree with his criticisms of the Health and Social Care Act 2012 and other things. He has said, on a constructive basis, that he wants to bring health and social care together. There is potential consensus and common ground in that regard. I would like to hear what more he can say constructively on the areas where, I think, we can find, across all parties, common ground and a way forward.

[Andy Burnham]

To find common ground, one has to tell it straight and put on the table the real reasons why there is pressure in A and E. I bet the hon. Gentleman would not disagree with a single reason I have given: NHS 111, closure of walk-in centres, difficulty in getting GP appointments, the collapse of social care—[Interruption.] Yes, he says he does not disagree with any of those things. If we have a shared analysis, then he and I will have a basis on which to devise solutions. I will come to those solutions later.

Oral Answers to Questions

Andrew George Excerpts

Tuesday 13th January 2015 Commons Chamber

[Norman Lamb]

As I said in response to the previous question, there is a real case for constantly seeking to refine the way the service works. The urgent and emergency care review pointed to ways in which we could do that to ensure that, in appropriate cases, people could get through to a doctor or a nurse to give them the right advice. That, in turn, would reduce the number of people turning up at A and E.

[Andrew George (St Ives) (LD)]

Further to the previous question, will the Minister urgently review the operation of NHS 111, as not only did it experience meltdown over the Christmas period in my area, but it is run from a call centre in Newport, 200 miles away, and it uses algorithms that involved staff asking a patient in my constituency, “Are you conscious?”?

[Norman Lamb]

Call volumes doubled over the Christmas period compared with those a year ago, so the system was certainly under enormous pressure. As I say, the survey results show that a lot of people were diverted away from A and E, but there is absolutely a case for seeking to improve 111.

A and E (Major Incidents)

Andrew George Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I am afraid that what the right hon. Gentleman says is simply not correct. We have continued with key operational targets. A number of them are under pressure, but when we look at each of them we see that the reason is that the NHS is treating more people than ever before but demand is outstripping supply. For example, nearly half a million more people visited A and E in the most recent quarter than in the last quarter of the previous Labour Government, and we have 1,000 more doctors in our A and E departments. That tells us that, along with short-term help with these pressures we need a long-term solution, which is what this Government are committed to.

[Andrew George (St Ives) (LD)]

This is a serious and complex issue, and one of the factors causing it is that many seriously ill patients cannot be admitted to acute hospital wards because there are insufficient beds. In the light of that, I draw the Secretary of State’s attention to an NHS Confederation report from May 2006, “Why we need fewer hospital beds”. I cautioned at the time that it would be unwise to pursue such a policy without first front-loading primary and social care. Will he look at enhancing acute hospital beds until primary and social care have the capacity to help out the acute sector?

[Mr Hunt]

The hon. Gentleman makes an important point. In fact, I was talking with someone senior at the Royal Cornwall hospital on Monday about the particular pressures there. Indeed, some of the funding that we allocated to the NHS in the autumn statement for next year is designed to do precisely that—to allow hospitals to maintain bed capacity while we ramp up facilities in community and primary care. It is very important to get the timing absolutely right.

A and E and Ambulance Services

Andrew George Excerpts

Thursday 18th December 2014 Commons Chamber

[Mr Hunt]

Interestingly, the Opposition, who are trying to make so much of this, have actually run out of questions in an urgent question on a matter that they said was very urgent. I commend my hon. Friend’s interest in the east of England and I reassure him that we discuss it most weeks in my Department, because two of my ministerial colleagues are covered by the east of England ambulance service and we are very conscious of the problems there. The situation is getting better but there is a long way to go.

[Andrew George (St Ives) (LD)]

My right hon. Friend is fully aware, because he attended the Health Committee last week, that accident and emergency services do not operate in isolation. So does he not agree that integrating not only in-hours and out-of-hours GPs, NHS 111, ambulances services and minor injuries units, but social services, mental health services and dental services is essential to ensure that we have fewer avoidable A and E admissions and that we therefore reduce the pressure we are debating today?

[Mr Hunt]

I do agree. The first thing we could do as a step towards that is properly integrate out-of-hours care, linking out-of-hours GP services, A and E departments and 111 departments. Obviously, that needs to be linked into the in-hours GP care that people will give. I wish to commend the efforts being made in Cornwall to improve A and E performance, which has been getting better in recent weeks. We are all very encouraged by that, because there have been a lot of challenges in that area.

NHS (Five Year Forward View)

Andrew George Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

It really demeans debate in this House to go on about some phoney argument that one side of the House cares about the NHS while the other does not. We have shown our commitment to the NHS by announcing today £2 billion of additional funding. That is a big deal and it shows our commitment. We have also given all nurses a 1% pay rise.

[Andrew George (St Ives) (LD)]

I welcome the additional money. My right hon. Friend is right that health providers need a stable financial environment, but many of them have been left with a debilitating legacy of debt. The Royal Cornwall Hospitals Trust in my own area has a legacy of debt, which is just a fraction of the amount by which the Government have admitted that they have underfunded the local health economy over many years. Rather than having distorting activity going on in that trust, would it not be better for it to start with a clean sheet of paper and to build for the future rather than constantly having to work from a position of debt?

[Mr Hunt]

I sympathise, because the previous Labour Government left hospitals with more than £70 billion of PFI debts. Those debts must be paid off and that money cannot be spent on front-line patient care. We have done what we can on a case-by-case basis to help trusts deal with those debts. It is extremely difficult when resources are tight and of course I will consider the trust’s particular case.

Five Year Forward View

Andrew George Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

Two things. I have had a very interesting visit to Goole hospital. It was very impressive to see how it has responded to the special measures programme and how, as a result of the new inspection regime, which Labour Front Benchers tried to vote down, it has made real improvements in care on the front line for the hon. Gentleman’s constituents. Those at the hospital will be pleased to see that this report endorses the new transparent approach to dealing with variations in care. It also says that we need to continue with increases in real-terms funding for the NHS, which we only get with a strong economy.

[Andrew George (St Ives) (LD)]

The theme of integration is re-emphasised in this plan, but how can commissioners ensure that they achieve that integration if they are forced against their will to outsource many services and also fear that their commissioning decisions will be challenged for being anti-competitive?

[Mr Hunt]

They are not forced against their will to outsource. They make the decisions as to where they want to purchase services from, and they do so on the basis of what is best for patients. Just like the primary care trusts that they succeeded, they have to follow European law in the way that they do that.

Oral Answers to Questions

Andrew George Excerpts

Tuesday 21st October 2014 Commons Chamber

[Dr Poulter]

I hope that I can reassure the hon. Gentleman that there are now 1,000 more GPs in training and working in the NHS under this Government than when we came to power in 2010. We are committed to training even more GPs to ensure that we can widen access to general practice services.

[Andrew George (St Ives) (LD)]

In what circumstances can clinical commissioning groups treat the NHS as a preferred provider, and in what circumstances are they forced to contract out services?

[Dr Poulter]

As my hon. Friend will be aware, when commissioning services, it is important that regard is given not only to competition because, under the 2012 Act, we have ensured that there must be regard to delivering an integrated and joined-up approach for local services. That is an issue for local commissioners to decide in the best interests of the patients they look after.

NHS Services (Access)

Andrew George Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

We brought in other providers in a supporting role to add capacity to bring down NHS waiting lists to the lowest ever level. That is what the previous Government did. By contrast, this Government are doing something different. It is mandating tendering on GP commissioners, requiring people to compete, wasting money on running tenders and privatising the national health service, which is why they must be stopped.

[Andrew George (St Ives) (LD)]

It is fair to say that the previous Labour Government did introduce the private sector to many areas of the NHS. They also introduced a requirement for the tendering of many NHS services. If we follow the logic of Lord Warner, who is setting out the general direction of Labour party policy, we will find that that is clearly where the heart of Labour party policy has been and probably will go.

[Andy Burnham]

May I remind the hon. Gentleman, for whom I have a lot of respect, that I, as Health Secretary in 2009, introduced to the national health service a policy of NHS preferred provider? That is because I am not neutral about the NHS. I believe in the public NHS and what it represents, which is people before profits. Any policy that I develop will always be based on that principle. I was attacked at the time by the Conservative party for introducing such a policy, but I make no apology for it. We used the private sector in a supporting role, but the Government want to use it in a replacement role, and there is a very big difference between the two things. If they were continuing what we had done, why did they need a 300-page Bill to rewrite the whole legal basis of the national health service?

--- Later in debate ---

[Andrew George (St Ives) (LD)]

It was in fact the Liberals who were the architects of the NHS, but perhaps that might be lost from history. The fact is that we have yet another occasion when the nation will be looking down and counting their shirt buttons as Members on the two Front Benches trade dodgy statistics and rewrite history. I am talking about the nature of the rather tribal debate that we had in the opening exchanges. My fear is that that is the biggest risk to the NHS—too much tribalism and not enough time spent addressing the serious issues of the NHS.

The right hon. Member for Leigh (Andy Burnham) is absolutely right that there are serious issues in the NHS that need to be addressed. What usually happens on these occasions is that the Secretary of State beats the right hon. Gentleman around the head with a report from Mid Staffs. I am pleased that on this occasion he did not, because that is often done in very bad taste and rather inappropriately.

Equally, I have to say to the right hon. Member for Leigh that, as the Secretary of State reasonably pointed out, he failed to acknowledge that Labour cannot ignore the fact that it ushered in and rolled out the red carpet for the private sector. The arrangements for the tendering for Hinchingbrooke hospital happened under a system set up by the then Labour Government. No matter at which stage various companies or NHS trusts fell out of or withdrew from the process, the course had been set by Labour. Unless he is telling us that he was going to preordain the outcome of a proper and open tendering process, which would of course be anti-competitive, he must have known that one of the options—this is what happened—was that a private company would take over the running of the hospital.

[Andy Burnham]

I am grateful to the hon. Gentleman for giving way, as I want him to be absolutely clear about how I operated that process. It followed the NHS preferred provider principle, which I introduced, and I began by asking the officials in the Department to see whether a local NHS trust was prepared to come in and take over. Addenbrooke’s was the trust I had in mind, but for some reason it was not prepared to do so at that point so we had to find a runner. I said that we had to go out more broadly, but my intention was clear: I wanted an NHS provider. That was where things had got to. The former Minister, the right hon. Member for Chelmsford (Mr Burns), mentioned March, but things were going into purdah at that point. That was where the process was when we left government and I want the hon. Gentleman to be clear on that point.

[Andrew George]

I am grateful to the right hon. Gentleman and, of course, he has now had the opportunity to put that point on the record. However, he must recognise that as others have said—indeed, I made this point when I intervened on him—the Labour Government rolled out the red carpet with the policy of independent treatment centres, walk-in centres and other services, where the taxpayer paid dearly for services that were not delivered.

The right hon. Gentleman knows that I did not support the Health and Social Care Act 2012. I saw it as a missed opportunity to address a large number of issues and it engaged in a top-down reorganisation that was not necessary. I fear that both the Conservative party and the Labour party appear to have been beguiled by a set of PowerPoint-wielding management consultants who have persuaded them that changing how the system works is an easy solution when, as a number of Members have mentioned, more than anything else the NHS needs much more integration of services—certainly not fragmentation—and for standards within it to be addressed.

The House knows that I always look to make a constructive contribution to such debates, so, as the Minister knows, I have been championing the case for safe staffing levels. The campaign of the Safe Staffing Alliance has argued for no more than eight acutely ill patients for every registered nurse, excluding the nurse in charge, on acute hospital wards. We need to establish a floor below which standards cannot fall, because services are often engaged in a race to the bottom because of financial pressures. That is very important. It is encouraging that that issue is now being taken seriously and I hope that the Government will consider the recommendations from other bodies to advance the cause.

With regard to the integration of health and social care in the wider community, there has always been the mantra that we need fewer hospital beds, and that certainly happened under Labour. That has resulted in many of our acute hospitals being on red alert and unable to manage the situation, with patients on inappropriate wards or stuck in ambulances queuing outside. That was clearly predicted by many people, not least me, when the policy was being pursued.

What we need to do is front-load the system to ensure that we can discharge patients from hospitals safely. We do not have the facilities for that, either in the community or in primary care. Of course, having that system of discharge and avoiding unnecessary admissions depends on having adequate services at home. Ultimately, that falls on the shoulders of home care workers, who themselves face a race to the bottom, as they are often paid the minimum wage and their travel times and costs are not properly covered. We therefore need a new benchmark that puts a floor in the system by paying those workers a living wage, covering their travel times and expenses, and protecting them so that we do not end up with the race to the bottom that I fear we are seeing in the system.

We need to ensure that we have safe services. Ultimately, we need to address care standards in our hospital wards and press for, rather than simply talk about, the integration of health and social care in order to address the fundamental challenges that the NHS faces.