Oral Answers to Questions

Andrew George Excerpts

Tuesday 26th November 2013 Commons Chamber

[Norman Lamb]

First, it is worth us all recognising that there is an increase in the number of frail elderly people in our society living with chronic conditions and that that is putting additional pressure on accident and emergency departments. The numbers have increased by over a million a year since 2010. However, the fact that there has been a reduction of 50,000 in the number of delayed discharges demonstrates that the social care system is doing incredibly well, and we should pay tribute to social care workers across the system who are doing so well to ensure that that improvement is taking place.[Official Report, 4 December 2013, Vol. 571, c. 13MC.]

[Andrew George (St Ives) (LD)]

Bottlenecks in A and E are certainly not new, and they are not aided by the mantra that acute hospitals should be able to manage with fewer acute beds. On my hon. Friend’s point about shared and integrated planning, is he prepared to go further and push the Government in the direction of shared and integrated budgets as between health and social care?

[Norman Lamb]

I thank my hon. Friend for that question. We are creating a pooled budget in 2015-16 with this £3.8 billion fund. I can remember in opposition frequently making the case for integrated care and not really getting much of a positive response from the then Government. As the Chair of the Select Committee, my right hon. Friend the Member for Charnwood (Mr Dorrell), said, the great thing is that this Government are actually doing it.

Mid Staffordshire NHS Foundation Trust

Andrew George Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

I am very happy to share any of the lessons we have learned, but I do so from a position of humility, because we still have to address very serious challenges in our NHS in England. It will take us time to sort them out. I am happy to work with any devolved Administrations. Indeed, I would like to work with other countries across the world, because the challenge of how to deliver high-quality, compassionate health care when resources are tight and with an ageing population is one that all countries face.

[Andrew George (St Ives) (LD)]

The Government’s position on the publication at ward level of safe registered nurse staffing levels is a welcome step in the right direction. My right hon. Friend will be aware that I have consistently argued for safe registered nurse-to-patient ratios at ward level, and no manner of enhancements of culture and leadership can ever be used to mask the risk to patients if there are not enough nurses on the ward. Is he aware that some trusts are conflating trained care assistants with registered nurses, and will he reassure me that, in enumerating the number of registered nurses on wards, trusts cannot conflate trained care assistants, welcome though they are, with registered nurses?

[Mr Hunt]

My hon. Friend makes a very important point, because in an era of transparency we depend on honesty from the people supplying the information being used. It is not always possible independently to audit every single piece of information. What we have said today is that deliberately supplying false or misleading information will be a criminal offence, which is a much tougher sanction than anything else we are saying today. We think that the most important thing is to establish a culture in which people tell the truth and speak out if there is a problem, because then something can be done about it.

Oral Answers to Questions

Andrew George Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Mr Hunt]

I hope that the hon. Gentleman will be pleased that something is happening under this Government that did not happen under the Labour Government: we are putting those hospitals into special measures and sorting out the problems, including the long-term problems with A and E such as the GP contract—a disaster that was imposed on this country by the Labour Government.

[Andrew George (St Ives) (LD)]

6. What the current (a) highest, (b) lowest and (c) mean average registered nurse-to-patient ratio is on acute hospital wards.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

As my hon. Friend is aware, we do not hold information on registered nurse-to-patient ratios on acute hospital wards. Local hospitals must have the freedom to decide the skill mix of their work force and the number of staff they employ to deliver high-quality, safe patient care.

[Andrew George]

I am grateful to my hon. Friend. The Government should be monitoring the situation, but he will be aware of the concern, which I have consistently highlighted, about inadequate registered nurse ratios in acute hospital wards, and of the Health Committee’s report into the Francis inquiry, which made recommendations in that regard. In inspecting hospitals, what objective measure should the Care Quality Commission use when looking at safe staffing levels on acute hospital wards?

[Dr Poulter]

The CQC is working with the National Institute for Health and Care Excellence and NHS England to devise tools to do exactly that. As my hon. Friend will be aware, the number of front-line staff required, whether nurses or doctors, to look after a patient who is in a cardiac intensive care unit will differ from the number required in a rehabilitation setting. The tools that the chief inspector of hospitals will be able to apply are being developed.

Accident and Emergency Departments

Andrew George Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

The decision on which 53 areas to concentrate the resources was not made by me; it was made by NHS England, talking to Monitor and the NHS Trust Development Authority, on the basis of where, in their professional assessment, the highest-risk areas are. That is a sign that hospitals in the north-east are performing extremely well. In the past few months I have visited Newcastle, and I thought the hospital was absolutely fantastic; I did a stint on the front line there. There are some outstanding hospitals across the country, and there is very good NHS provision in the north-east. That is probably the reason.

[Andrew George (St Ives) (LD)]

I wish my right hon. Friend well in his quest to reintegrate a fragmented service —a trend which was largely started under the previous Government—but given the fact that the ambulance service provides a very good bolster, and indeed support, and helps to remove pressure from many A and E departments, how much of the £500 million will be made available to support ambulance services in their support of A and E departments?

[Mr Hunt]

Quite a lot of the money will help ambulance services indirectly because it will be intended to reduce the number of blue light calls by, for example, providing primary care alternatives to A and E by better integrating health and social care economies, but the long-term change that we announced last week, which I think will make a real difference to ambulance trusts, involves IT. In this day and age it is crazy that an ambulance can answer a 999 call and go to someone’s home not knowing that they are a diabetic who has mild dementia and who had some falls last year. That information could be incredibly helpful to paramedics and we want to make sure that, with patients’ consent, they have it at their fingertips.

Managing Risk in the NHS

Andrew George Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

The Keogh report exposes alarming ratios at my hon. Friend’s hospital and others. We have been warning the Government for months—years, in fact—about cuts to nursing numbers. It is neither right nor fair to criticise nurses for being uncaring when too many of them are unsupported and are working in conditions in which they have to make compromises that they would rather avoid.

Staffing emerged as the main concern arising from the Keogh report, but the problems go way beyond 14 trusts. The CQC says that one in 10 trusts in England does not have adequate staffing levels. Can we agree today that the staffing in all hospitals must urgently be brought back up to adequate levels, as defined by the commission, with clear benchmarks set for the future? [Interruption.] I am pleased if the Secretary of State is agreeing, because that represents progress, so I look forward to finding out how his plan will be delivered.

[Andrew George (St Ives) (LD)]

The right hon. Gentleman will remember that yesterday I drew attention to the fact that all but one of the 14 hospitals Keogh reviewed had staffing and skill mix issues that needed to be dealt with, but it would be quite wrong to suggest that that has happened only in recent years. Graham Pink drew attention to the problem in the early ’90s, and it also happened during Labour’s years in government. I think that it would be good for this debate if the right hon. Gentleman at least acknowledged that it has been going on for more than three years.

[Andy Burnham]

I will acknowledge that. A moment ago, I mentioned the Francis report, which I commissioned, which revealed the dangerous cuts to front-line staffing that the hospital pursued as the primary cause. I accept what the hon. Gentleman has just said. Rather than always pursuing central regulation as the solution, if local communities had identifiable benchmarks that they could use to check up on their local hospitals, surely that would be progress we could all get behind.

On the duty of candour, the Government are legislating for a duty on organisations, but not on individuals. I think that we all agree that changing the culture of NHS organisations is essential if we are to move forward. The Francis recommendation is a necessary part of bringing about that culture change. Rather than being a threat to staff, as some have argued, it would protect them when they make known any concerns. Will the Government look at that again and legislate for the full Francis recommendation in the Care Bill? That is incredibly important in the light of yesterday’s report by Sir Bruce Keogh. He revealed—this will shock anyone who has not spotted it yet—that some trusts were telling members of staff what they could and could not say to his review. Surely we can all agree that is fundamentally unacceptable.

Oral Answers to Questions

Andrew George Excerpts

Tuesday 16th July 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Absolutely. I would be delighted to come along and visit the school. May I give full credit to the right hon. Gentleman for his campaign and to the Silver Star charity, which does great work? That is why it is so right that we put public health back in local authorities, where it should always have been and where it was, historically. This sort of local action is very much the way forward, so I congratulate the school and the right hon. Gentleman again.

[Andrew George (St Ives) (LD)]

Further to the question raised by the hon. Member for Walsall South (Valerie Vaz), I have met the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) regarding safe staffing levels and I provided a substantial file of evidence on behalf of the Florence Nightingale Foundation in support of its 1:8 registered nurse to patient ratio. What part of that evidence are Ministers unconvinced by?

[Mr Jeremy Hunt]

I am sure the evidence to which the hon. Gentleman refers is very persuasive, but I am sure he would agree that a ratio such as 1:8 cannot be applied uniformly across his local hospital or across all local hospitals. It can vary from day to day, depending on the level of illness and the age of the people going into particular wards. The best hospitals have computer models that change the numbers of nurses operating in different wards on a daily basis. Other hospitals do not do that, except on a quarterly basis. That is the change that we need to make.

Hospital Mortality Rates

Andrew George Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

Improving leadership is vital throughout the NHS. All Governments must take responsibility for what happens on their watch, and I have taken responsibility today for those 14 hospitals and all their serious problems. The right hon. Gentleman should accept that between 2005 and 2010 his Government received 142 letters about his hospital which they did nothing about, and introduced a regulatory system that did not expose poor care and ensure that it was addressed.

[Andrew George (St Ives) (LD)]

I welcome Sir Bruce Keogh’s important report. However, although I admire my right hon. Friend, I totally dissociate myself from his ill-judged attempt to drag this important issue into the gutter of partisan politics and petty point-scoring. I expect better of him than that.

It is clear from annex A of the report that in all but one of the 14 hospitals, problems relating to staffing levels and the staff mix need to be addressed, and ambition 6 recommends action to address them. As my right hon. Friend knows, I campaign on this issue. What will the Government do to ensure that staffing levels are adequate in our acute hospitals?

[Mr Hunt]

Tackling failure in our NHS is not an easy path to take, but it is the right thing to do for patients. If my hon. Friend believes that all the care problems in the NHS started in 2010, I think he is the only Member who does. [Interruption.] Opposition Members must bear their share of the responsibility for the failures that they did not sort out. Staffing is indeed a problem that needs to be sorted out in many trusts, which is why we commissioned the review and why we are sending in turnaround teams to do just that.

Health and Care Services

Andrew George Excerpts

Wednesday 3rd July 2013 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

It is one of the more endearing characteristics of the House of Commons that although the motion before us and those that follow it involve £517 billion of public expenditure, it falls to a Back Bencher to make the case on behalf of the absent Financial Secretary. It is obviously a minor detail that the House of Commons should be asked to approve £517 billion of public expenditure. Also, I suspect that all parties in the House are on a one-line Whip on this minor matter.

Having made that observation on the slight absurdity of parliamentary process, I will begin by saying a word about the approach to public expenditure and health policy that the Health Committee, which I have the honour to chair, has adopted since the beginning of this Parliament. We have our differences within the Committee; it would be absurd to pretend otherwise. We were elected from different party platforms and have different views about how health care can best be delivered in our society. However, from the beginning of this Parliament, we have taken the view that there is not much point in using the Select Committee as the platform for elaborating those differences, because there are many other platforms where they may be amplified. We have sought consciously to explore areas of common ground in the delivery of health and social care, and to establish where there can be cross-party agreement.

The easy way to achieve that objective would be to avoid all the difficult political questions. We have consciously not done that—we have dealt with the difficult questions. We have talked about commissioning in the context of the Health and Social Care Act 2012. We had a hearing this morning on the developments in the Care Quality Commission. We have not sought to avoid difficult territory, but when we are in it, we look for areas of common ground. That means that we are not grandstanding on health policy, but seeking to develop a coherent or, given what I will go on to say, integrated view of how health care ought to develop on a cross-party basis.

Against that background, it is significant that we have had a consistent and serious view since the beginning of this Parliament on the questions that are raised for those who work in the health and care sector by the pressures on public expenditure that exist in this Parliament and, I believe, will exist for the foreseeable future. It is not a coincidence that the first substantive report that we issued in this Parliament was on public expenditure. In that report, the Committee coined the phrase “the Nicholson challenge”, which has passed into common parlance, to refer to the challenge faced by the health and care system to deliver quality care against the background of rising demand and, roughly speaking, flat real-terms budgets.

That challenge was articulated first not by the Select Committee or the coalition Government but by Sir David Nicholson, a distinguished public servant, in his capacity as chief executive of the national health service in May 2009. It was endorsed by the previous Government. The Committee has sought to explore the success of the coalition Government in meeting that challenge and to bring to the surface some of the choices and challenges that are implicit in the phrase “the Nicholson challenge”. Incidentally, we know that the challenge lives beyond Sir David Nicholson.

Let us be clear what we are talking about. Since May 2009, the core issue has been that resources are growing extremely slowly, if at all, while demand continues to rise. One does not need a degree in mathematics to know that if demand for health and care services rises, as it has in this and every other country for the last 50 years, by roughly 4% per annum and there is no new money coming into the system, the only way in which demand can be met is by increasing the efficiency with which the resources are used by an equivalent percentage each year. In other words, the Nicholson challenge is how to deliver health and care to the required standard—I will come back to that point—4% more efficiently year on year.

I emphasise that it is not my view, nor the Committee’s view, that there are no political choices to be made about the level of resources that are committed to health and care. It falls to the Government of the day to make those choices every year when resources are voted on, as we are doing this afternoon on the estimate of £105 billion. That represents a political choice. However, members of the Committee read the newspapers, understand the laws of arithmetic and understand the broader political environment in which we live. We hear it when the Leader of the Opposition says that an incoming Labour Government would have to live with the spending plans of the current Government, at least for their first year in office. That is, to put it mildly, an exercise in expectation management by the Leader of the Opposition.

It is against that background that the Committee recommends in paragraph 16 of the report on health and social care:

“In our view it would be unwise for the NHS to rely on any significant net increase in annual funding in 2015-16 and beyond. Given trends in cost and demand pressures, the only way to sustain or improve present service levels in the NHS will be to continue the disciplines of the Nicholson Challenge after 2015, focusing on a transformation of care through genuine and sustained service integration.”

That is an example of a recommendation that was reached on a cross-party basis. We are not signing up to decisions about funding, but saying that the health and care system faces a huge challenge to deliver more integrated services if it is to meet the quality and economic standards that are likely in any political scenario.

[Andrew George (St Ives) (LD)]

I thank my right hon. Friend for the way in which he is introducing this subject. He will acknowledge that the Nicholson challenge and the need for year-on-year efficiency gains of 4% were originally proposed under the last Labour Government. There is therefore continuity from the previous Government, through the coalition and on to any subsequent Government. Does he agree that the result of the efficiency gains must not be that NHS rank and file staff are subjected to lower regional pay and conditions, as was proposed in one region of the country?

[Mr Dorrell]

I will come on to the impact on pay later. My hon. Friend is right that the challenge antedates the election of this Government and that it increasingly looks beyond this Parliament, as did last week’s public expenditure announcements. There are specific challenges implicit in the Nicholson challenge for the coalition and for the Opposition. To my colleagues in the Conservative party, who sometimes ask why we have a ring fence around the national health service, I simply say, “Understand what you are asking.” We are already strapping ourselves to the mast indefinitely into the future of meeting a rise in demand of 4% per annum without substantial growth in real resources. Looking back, we see that the national health service has delivered a 1% efficiency gain trend rate over its first 60 years, and the national average for the rest of the economy is 2%. We are expecting the health and care system to deliver a 4% efficiency gain. To anyone believing that we are likely to be able to meet demand for health and care to acceptable standards against a background of reduced resources—in other words, more than a 4% efficiency gain year on year—I say, “Do the maths.” That is the challenge to the Conservative party.

Oral Answers to Questions

Andrew George Excerpts

Tuesday 11th June 2013 Commons Chamber

[Andrew George (St Ives) (LD)]

10. Whether he has any plans to review his policy on resource allocation in the NHS.

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

Allocations to the NHS are the responsibility of NHS England. However, I have been advised that it will rely on the advice of the Advisory Committee on Resource Allocation for changes to the allocations formula.

[Andrew George]

While many wealthy areas are overfunded, Cornwall is more underfunded than anywhere else in the country. In the past six years, it has received in excess of £200 million less than the Government say it should receive. It also receives the lowest tariff in the country for acute care. Is the Secretary of State prepared to meet me and other representatives from Cornwall to address the serious issues that that is causing in front-line care?

[Mr Hunt]

My hon. Friend has had meetings with my ministerial colleagues on that issue and knows that such decisions are made at arm’s length from Ministers by NHS England. The allocation for NHS Kernow is £1,235 per head and the average baseline clinical commissioning group allocation is £1,184 per head. However, I recognise that there are issues with rurality and the age profile of the population. That is why a fundamental review is taking place of the approach that ACRA takes.

Accident and Emergency Waiting Times

Andrew George Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andrew George (St Ives) (LD)]

With the Serco contract for out-of-hours GP services in Cornwall having been referred to the Care Quality Commission, the manipulation of the data, falsely representing the outcomes of the service, has been identified. It is worth reminding the right hon. Gentleman that this was set up under a contract that resulted from decisions made when he was in government.

[Andy Burnham]

I remember debating that with the hon. Gentleman when I was the Secretary of State. Those problems rightly needed to be addressed, and the particular issue he raises today should be investigated. I hope, however, that he will also understand the problem that I am describing to the House. If we go down the path of fragmenting services—if we take a successful national service such as NHS Direct, for example, which was trusted by the public, and then break it up into a patchwork of fragmented, some privatised, services—this sort of chaos will be the result.

A report has emerged this afternoon, showing that the viability of NHS Direct is in serious question. The headline states, “Leaked report casts doubt over NHS Direct’s ‘overall viability’ in the wake of NHS 111 failings”. This is a warning that NHS Direct may well go down altogether. What an indictment that would be of this Government’s mismanagement.