Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 1st April 2014 Commons Chamber

[Jane Ellison]

I know of my hon. Friend’s extraordinary work as a first responder, and we all greatly admire it. He makes another great point about how we tackle this long-term challenge of the sustainability of our acute services. I am happy to draw his comments to the attention of NHS England. I am sure that it is one part of all the things it is looking at as it addresses this issue.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The complacency of this Minister knows no bounds. In 2011, the Prime Minister said:

“I refuse to go back to the days when people had to wait for hours on end to be seen in A and E.”

In 2013-14, the first year after the Government’s reorganisation, we saw the worst year in A and E for a decade, with almost 1 million people waiting longer than four hours to be seen in accident and emergency. As A and E is the barometer of the whole health and care system, is this not the clearest sign that the NHS is getting worse on their watch?

[Jane Ellison]

So desperate are the Opposition, I think the shadow Minister actually used the same opening line that he used at the last Health orals. It really is time to change the script. The NHS has seen more people in A and E than ever before. Waiting times have halved since the last Government left office. If he wants to come to the Dispatch Box and highlight problems in A and E, why does he not try the 86.6% of people being seen in Wales, which is a truly shocking performance statistic.

Stillbirths and Infant Mortality

Andrew Gwynne Excerpts

Wednesday 26th March 2014 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I pay tribute to the hon. Member for Chatham and Aylesford (Tracey Crouch) for securing this important and sensitive debate. There are few more pressing issues than protecting the health of small babies and reducing the deaths of babies under one.

I want to put on record my appreciation of the Rainbow clinic at St Mary’s hospital in Manchester. Mancunians—I am proud to be one—are incredibly proud of the work not only of the Rainbow clinic, but of St Mary’s in general. It is a centre of excellence for Greater Manchester and the north-west, and I am not just saying that because I was born there as a premature baby almost 40 years ago. It genuinely is a superb facility not only for babies, but for mums, and I commend its work, just as the hon. Lady has done.

Members on both sides of the House will know from their experiences and as constituency MPs the heartbreak and pain that the death of an infant can cause a family. I was particularly touched by the powerful speech by the hon. Member for East Worthing and Shoreham (Tim Loughton) about stillbirth. From a recent tragic occurrence in my family where stillborn twins were induced, I sadly know just how painful such an experience can be not only for parents, but for family members and how upsetting losing a child before birth can be. I know how unfair the law is; those children are not legally recognised by the state. The hon. Gentleman is absolutely right that it is important that the law be changed to reflect the realities, so that parents and grandparents can get closure, support and relief during such dreadful occasions.

We have seen some significant advances over the decades. It is easy to forget where we have come from, but we should recognise the work of health professionals and scientists to reduce the infant mortality rate in England and Wales to its lowest levels. In 1981, there were 11.1 infant deaths per 1,000 live births. In 2011, that had dropped to 4.2 per 1,000, equating to a 62% decrease over 30 years. It is worth reminding ourselves that, in 1911, before the introduction of the social security system and the NHS, the rate was 130 deaths per 1,000 live births.

One result of the major improvements in public health over the 20th century, such as slum clearances, the provision of fresh water, mass inoculation, health screening and the NHS, has been a huge reduction in the tragedy of infant mortality. I am proud that the previous Labour Government reduced infant mortality by 27% between 1997 and 2010, which equates to more than a 1,000 fewer baby deaths a year. As we have heard today, however, there is no room for complacency. Hundreds of babies still die each year from perinatal respiratory problems, bowel failure or infection. Such deaths are not evenly distributed across our society, which raises critical questions as to how we tackle health inequalities. In his groundbreaking report on these matters, Sir Michael Marmot said that

“one quarter of all deaths under the age of one would potentially be avoided if all births had the same level of risk as those to women with the lowest level of deprivation”.

Things are getting better, however. We achieved our ambition to narrow the gap of infant mortality by at least 10% between routine and manual socio-economic groups and the England average, but there is still far more work to do.

Office for National Statistics infant mortality statistics for 2011 show that infant mortality rates were highest for babies with fathers employed in semi-routine occupations, such as shop assistants or care assistants. One of the Minister’s predecessors as Minister responsible for public health, the hon. Member for Guildford (Anne Milton), has said that disadvantaged groups and areas have higher infant mortality rates and that poor health outcomes such as that are often linked to social factors, including education, work, income and the environment. I welcome the Government’s recognition of the link between poverty, housing, diet, neighbourhood and health, a point which was made powerfully by the hon. Members for East Worthing and Shoreham and for Chatham and Aylesford. We must continue to tackle the conditions that cause health inequalities and the unfair distribution of infant mortality across society. There is no good reason why, in the seventh richest country on this planet, the likelihood of a family’s baby surviving its first year of life should depend on their socio-economic background. Will the Minister address directly the inequalities around infant mortality and still birth?

We should also note that women over 40 are at greater risk of having a baby who dies before it is one year old. Women under 20 are at greater risk, too. Will the Minister’s speech address how health services can be specifically targeted to support pregnant women over 40 and under 20?

There is a growing understanding that early intervention is the key to preventing infant mortality. The Royal College of Paediatrics and Child Health states:

“The evidence quite clearly states that early intervention is the best form of prevention. Early intervention will not only lead to significant financial savings in the medium to long term, it is underpinned by sound science.”

A healthy pregnancy begins before conception. Action on health issues before pregnancy can prevent many problems for the mother and baby.

The hon. Member for East Worthing and Shoreham made a powerful point about understanding risk factors such as exposure to smoke and prenatal drug or alcohol use by mothers, but there are also positive steps that pregnant women can take to improve their and their unborn baby’s health, such as maintaining a healthy diet and weight, getting the right vitamins, taking folic acid and regularly being physically active. Women need proper advice, information and support to help them to understand the risk factors and make informed, healthy choices. What is the Department of Health doing to promote early intervention, and what resources is the Minister making available for that?

Of course, appropriate information continues to be important during pregnancy and after the child is born. Midwives and health visitors are our most crucial resource in ensuring that women have the information they need at every stage, and in supporting the development of confident, effective parenting. Forming trusting relationships with the women they care for is a critical part of the process, but many women do not have one midwife or health visitor whom they see regularly and with whom they can build a relationship. I hope that the Minister will explain what steps the Government are taking to deal with the problem and improve the consistency of care that women receive in pregnancy and after the birth of their child.

Two hundred babies a year die of sudden infant death syndrome and I welcome the work of the Lullaby Trust and the charity Bliss, which do an important job in advising and supporting parents in that connection. Tragically, five babies a week die without any explanation. Thanks to the “Back to Sleep” campaign, which advised parents to encourage their children to sleep on their backs, the figure is down from five babies a day in the mid-1980s; but five babies a week is still five too many, and I should like to know what the Minister and the Department are doing to try to reduce the figure further.

We have come a long way, but we still have some way to go. Advances in medical science must be matched by provision of NHS services and other social services in every part of the country. No one should be significantly disadvantaged by where they live. For pregnant women and young mothers to take responsibility for their health and that of their babies, they need the warm embrace of a strong system of health care, advice and support. If we want the coming decades to be characterised by further falls in infant mortality, and if we want many fewer families to suffer the terrible tragedy of a baby’s death, we need a continued, concerted and co-ordinated effort throughout Government.

I congratulate the hon. Member for Chatham and Aylesford on securing the debate, because it is important to discuss the matters in question. It was perhaps remiss of me not to convey the apologies of my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), the shadow Minister who leads on these issues. Sadly, just before the debate, she dislocated her shoulder and hopefully she is now receiving excellent NHS treatment at accident and emergency. I know she would want to pass on her thanks and appreciation to the hon. Member for Chatham and Aylesford for securing the debate and raising an important matter.

Francis Report

Andrew Gwynne Excerpts

Wednesday 5th March 2014 Commons Chamber

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I will focus on the impact of the Francis report on my local hospital in Tameside.

Tameside hospital has been a major issue for me, as the MP for Stalybridge and Hyde, and it featured prominently in my election literature in 2010. At the general election, I pledged to work with my hon. Friends the Members for Denton and Reddish (Andrew Gwynne) and for Ashton-under-Lyne (David Heyes), to resolve what we believed to be the serious problems at Tameside hospital by building on their work and statements in the previous Parliament. Securing improvements at the hospital has been a priority for all of us and it will continue to be so. The stance that we have taken, combined with the work of Sir Bruce Keogh, has allowed genuine improvements to take place at Tameside and I am proud of that work.

I regret the journey that there has been in this Parliament towards making Francis a more partisan issue. The Prime Minister’s initial statement on the matter was quite admirable and the work of Sir Bruch Keogh offered a way forward for problem hospitals such as mine. We all stand to lose that if we try to game it for partisan advantage. There is a feeling that the Government have tried to obscure the unpopularity of the NHS reorganisation by doing so. Surely we can all agree that the two matters should not be conflated.

I love the NHS, but I love my constituents even more. If any institution is letting them down, I will not hesitate to call it out. I believe that that is true of all my Opposition colleagues.

The recommendations of the Francis report were, without doubt, an important contribution to improving the quality of health care in England. The circumstances that led to the creation of the Francis inquiry threatened to undermine public faith in the NHS, and a serious and independent investigation into those factors was crucial to maintain people’s trust in the NHS. That investigation was begun by my right hon. Friend the Member for Leigh (Andy Burnham), in whom I have tremendous faith.

The stories of poor care at Mid Staffordshire and other NHS trusts were indefensible and often heartbreaking. I hope that we never see such instances again in the NHS. However, it is important that we also take this opportunity to commend the thousands of doctors and nurses who work tirelessly to provide people in this country with the very best of care. The people who work for the NHS, including those from overseas who choose to come and work in the NHS, do an incredible job and they must always know that we appreciate them greatly.

Following the publication of the Francis report, my local trust, Tameside Hospital NHS Foundation Trust, was one of five trusts that were investigated by Sir Bruce Keogh. It was not the work or recommendations of the Francis inquiry that were of the most immediate significance to my area, but the fact that the publication of the report sparked a chain of events that had a significant impact on the delivery of care at the local hospital in Tameside.

At the time of publication, Tameside had the second worst record for hospital deaths. Data from the summary hospital-level mortality indicator showed that 18% more patients than expected died at Tameside in the 12 months leading up to June 2012. The standards of care at the hospital had been of concern to the public for some time. I should perhaps mention that the information on Tameside hospital was complicated by the legacy of the crimes of Harold Shipman in my constituency. That had a huge impact on how people thought about care at the end of their life and on where they went for that care. That was always a plausible excuse for the mortality scores, but there was a need to push past the excuse and discover the real causes.

In the light of those problems, I cited my concerns about aspects of care at Tameside hospital on the record on several occasions, acting in conjunction with my hon. Friends the Members for Denton and Reddish and for Ashton-under-Lyne. We had already called for the resignation of the trust’s chief executive so that the hospital could improve.

The problems at Tameside were indicative of the broader issues that Francis and Keogh were attempting to address. The confidence of the local community in members of the senior management team had all but disappeared. That led to problems often not being adequately addressed or even acknowledged. The hospital became defensive and saw the issue as one of public relations management, rather than service improvement.

There is a fundamental point that we must grasp if we are properly to understand what factors contribute to the level of public trust. People understand that mistakes are sometimes made. That is the case in all professions and walks of life. However, people cannot understand it—and nor should they—when mistakes happen but no serious attempt is made to address the concerns of patients or clinicians in an open and transparent way to resolve the issues.

Sadly, that is exactly what happened for too long at Tameside hospital. In the worst cases, the hospital management actively tried to downplay the problems raised by patients, family members, elected representatives and even, in some cases, each other. That behaviour is not acceptable and a failure to address it undermines public faith in the NHS.

Putting the spotlight on these hospitals has had some success in breaking through this culture, and Tameside now has a clear set of objectives on which to develop a strategy for improvement. Without the Francis report and the subsequent work of Sir Bruce Keogh, that long overdue process of improvement at Tameside hospital might not have happened. We as local MPs would still be calling for those changes to happen, but we would not have had the expert analysis that the process provided to back up what we were saying.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I am grateful to my hon. Friend for setting out the case. Does he share my confidence that the hospital has indeed turned a corner? Part of that is down to the buddying arrangements with the University Hospital of South Manchester in Wythenshawe and the excellent interim leadership of Karen James.

[Jonathan Reynolds]

I endorse those comments entirely and thank my hon. Friend for his contribution. The negative attention that the hospital received as part of the Keogh investigation was undoubtedly the catalyst for the departure of the former chief executive in 2013, and the first step on the road to improvement.

It is important, however, for us to note the limits of Government’s capacity to push this agenda. Of course, Government have to be the ones who set the framework for improvement in the NHS, but cultural changes can properly come only from the front line. What Tameside hospital now has is a set of recommendations to be implemented, a framework for the delivery of those changes, and new leadership which, ultimately, will deliver the improvements that patients in our area need. I still visit the hospital regularly; indeed, I was there on Friday last week, and I am pleased to say that in my view it is certainly turning a corner. I hope the Government maintain their commitment to all the Francis recommendations, and ensure that the high expectations are hardwired into the NHS’s leaders.

Just before Christmas, I was walking my dogs in Stalybridge as usual, and a friend of mine whom I had not seen for quite a long time shouted over to me. He explained that he had been receiving treatment for more than a year at Tameside hospital. Over that time he had been able to witness, in his words, visible improvements to his care and to how the hospital was run and how it functioned, due to the changes facilitated by the Francis report, the Keogh inquiry and, I believe, the work of myself and my hon. Friends. We will not stop that work or feel self-satisfied because of it, but I am pleased that we have been able to make that difference. That, ultimately, is what we should all be trying to bring about by discussing the anniversary of the Francis report.

NHS Patient Data

Andrew Gwynne Excerpts

Thursday 27th February 2014 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure, as ever, to serve under your chairmanship, Mr Amess. I congratulate the hon. Member for Mid Norfolk (George Freeman) on securing this timely and important debate and on his extremely thoughtful and powerful opening contribution. I congratulate other hon. Members on their contributions, too.

I know how strongly the hon. Member for Mid Norfolk feels about this issue, and he is right. He has been instrumental in establishing the Patients4Data group. I commend also the work of the co-founder, Graham Silk, and of Patients4Data in campaigning for the opening up of data in the national health service. That group has been very good at bringing the issue of patient data to the forefront of debate on health policy across England. I was pleased to share a platform with the hon. Gentleman earlier today at the summit that he hosted in Parliament.

It goes without saying that a growing population, an ageing population, the rise of co-morbidities and the necessary drive to improve the quality of care and treatments available to patients mean that, in future, the success of the NHS will increasingly rely on the data to which it has access. Indeed, if we take as a starting point the fact that the health and social care worlds, through both desirability and financial factors, are heading towards proper and full integration, it goes without saying that in breaking down the structural silos between the NHS and social care and, within the NHS, between community services, acute services, primary care services and mental health services, we also need to break down the information silo mentality in the NHS.

Genuine “whole person” care will require “whole person” information. Let me put the current controversy over care.data to one side for the time being. The fundamental principle is to create a system designed to link together medical records from general practice with data from hospital activity and eventually extend that to cover all care settings inside and outside hospital. As even my hon. Friend the Member for Leeds East (Mr Mudie) said, no one wants to wreck that. It is a really good thing for the future of health and social care in this country.

The improvement of health care in England depends on the removal of the barriers between primary and secondary care—between the GP, the surgery and the district general hospital, and between social care providers and traditional health care providers. Integration is the key to meeting the needs of patients, and the availability of integrated data is central to shaping the services that will meet those needs. It is in that context that the need for data sharing should be seen.

Let me make it clear to the House that Labour supports the principle behind the proposal. Whole-person care must have at its heart a whole-person approach to information. It is important that key statistics drawn from that data set can be used to further clinical research or even future service planning. Let us not forget that if it were not for medical data sharing, the link between thalidomide and deformities at birth would never have been identified, and it would have taken decades longer to establish clearly and definitively the link between smoking and lung cancer, which the hon. Member for Worthing West (Sir Peter Bottomley) mentioned. Good medicine is determined by access to good data.

If we are to improve the lives of our children and reduce health inequalities, we must ensure that data are readily available to researchers. Making data at the local GP practice level available for the first time will give us an unprecedented insight into local health outcomes. Which GPs are over-prescribing antibiotics or antidepressants? What factors are causing delays to early diagnosis of cancer? If we are truly to tackle health inequalities, which are a huge issue in a constituency such as mine, we need a joined-up approach. That is simply not possible without ready access to data.

Most people readily recognise the clear benefits of a data-sharing scheme, but there is rightful concern about how the care.data initiative has been implemented so far. Mistrust of care.data is not surprising given the nature of the data involved and the typically haphazard communication about the scheme, particularly the opt-out programme for patients who do not wish to take part. Many people did not even know that the scheme was happening in the first place, at least until the recent media reports. To be fair, if the only information that someone has about care.data is what they have read in the newspapers, they will probably get on the phone to their GP to make an appointment to opt out straight away.

I do not know whether it is the result of incompetence, a reflection on how we live our lives today or a combination of both, but the conventional methods of public information campaigns simply have not worked. Every home in England should have received the leaflet entitled “Better information means better care”, which my hon. Friend the Member for Leeds East happily brought with him.

The blunt truth, however, is that most people either have not received the leaflet or have not looked at it. Questioning of Ministers during the recent Committee stage of the Care Bill, in which approval for care.data sits, revealed that even Ministers do not know whether every house has received the leaflet, what the opt-out rate is or what the regional variations are.

Although I do not get to see much TV these days—such is the nature of the job we do—the first I saw of the advert for care.data was on BBC “Newsnight” last week. That is an important point for Governments of all political persuasions. As I said at the summit earlier, if we think back to the success of some of the big public health campaigns, such as the “AIDS: don’t die of ignorance” campaign nearly 30 years ago, we remember the hard-hitting TV adverts, the big posters with the tombstone on and the powerful leaflets. Today, as my hon. Friend the Member for Leeds East pointed out, we are bombarded with so much junk mail—pizza menus, UPVC window offers, supermarket offers and, dare I say it, even the odd political leaflet—

[Mr Tobias Ellwood (Bournemouth East) (Con)]

It is a two-horse race.

[Andrew Gwynne]

It certainly is a two-horse race in my constituency; do not let the Liberals tell you otherwise. The point is that it is very easy for someone to miss the leaflet about care.data even if they received it. I received it and I read it, but I think that is probably the neurosis of politicians; when a leaflet comes through the door, we automatically think that our opponents have started the general election 16 months early.

Many of my neighbours, who I assume must have received the leaflet, claim that they did not. Likewise, we can easily skip the adverts on TV. In my home, we have Sky Plus, that wonderful technology that allows us to press fast forward as soon as the advert break starts and skip all the adverts. Conventional methods now fail to penetrate with the vast majority of the general public. We probably need to implement a more personalised approach to make the public aware of the scheme, of the benefits, of the implications and of their individual rights.

Incredibly, we have heard stories of people who want to opt out of the system and have had to make an appointment with their already overburdened GPs to do so. I do not think that that is necessarily the right approach. GPs are already struggling to use their time to deliver good quality general practice and primary care services, and perhaps an easier way to allow people to opt out using a variety of methods should be explored. As the Minister will be aware, the chief executives of Mencap, Sense, the Royal National Institute of Blind People, the National Autistic Society and Action on Hearing Loss have written to the Secretary of State expressing concerns that information about care.data is not being communicated in an accessible way to disabled people, who are consequently being deprived of the opportunity to make an informed choice about the future of their medical records.

We want care.data to work, and it is in everyone’s interests that it does, but—this is where the pause is welcome—the Government need to get a grip before the aims of the project are lost on a suspicious public anxious about what care.data is for and how their personal data will be used. That risks compromising a project that I think we all recognise to be vital. The proposal by the hon. Member for Mid Norfolk for the Government to establish a working group of campaigners and opponents—their inclusion is important—to try to resolve the differences is a sensible way forward. Consensus is the key here.

The Government must understand that the data do not belong to them or to the NHS, but to each of us individually. That should be the starting premise. The combined data that the NHS holds about me are mine and no one else’s, and that should be enshrined. Only then will the Government be able to make the case that inappropriate use of the data could never be sanctioned.

Let us be honest—if the data are mine and they are recognised to be so, that is empowering for me as an individual and a patient. “No decision about me, without me” has been the mantra of Ministers of all political parties in the Department for some years, but how about “no information about me, without me” as the next guiding principle? Our most intimate details are wrapped up in this system. The Government will be able to shore up public and institutional support only when they have convinced the public that the data will not and cannot be abused, and when they have been honest about the potential risks.

The data are owned by the patient, and all parts of the NHS must be their legal custodian. Rights and proper responsibilities must go together—the legal responsibility to use data for necessary purposes, and only for necessary purposes, with proper safeguards in place and, to agree with my hon. Friend the Member for Leeds East, tougher sanctions to underpin them. We need to convey to the public the laudable intention behind the proposals, because even professional trust in the programme is so low that a poll for the Medical Protection Society found that 80% of family doctors believed that the system could undermine public confidence in the principle of medical confidentiality.

[Sir Peter Bottomley]

I often try to look at the questions that people are asked. I am not absolutely certain that doctors were asked, “On balance, would you recommend that people stay in to contribute their information for the benefit of all?”

[Andrew Gwynne]

I entirely take the hon. Gentleman’s point, but if we are to reintroduce the element of public confidence, enshrining proper rights and responsibilities will start to build that sense of trust. As the hon. Member for Mid Norfolk suggested, it is consensus that will get us where we want and need to be.

One example of the problems that can arise lies in recent media reports, which we have heard about again in this debate, including those about the Institute and Faculty of Actuaries, which obtained at least 13 years of hospital data equating to 47 million patients. Often, media reports are not quite what they seem, but the damage is, sadly, done as a consequence. I would hate for the benefits of information sharing within the NHS, and of drawing out anonymised data sets from that system for beneficial medical research, to be jeopardised by incorrect assumptions made from media reports. There would be rightful public revulsion if identifiable or cross-identifiable information were to fall into the hands of insurers and other private interests that do not have the public good in mind, but such reports are potentially damaging to public confidence in care.data, which is already quite low.

That is why we welcome the Government’s decision to pause the scheme. I hope that they will use the opportunity wisely to reflect on how better to engage with the public about the real benefits that we have discussed in this debate, and to revolutionise patients’ rights: make the data theirs; make the NHS their custodian; put in real safeguards and, importantly, proper penalties; and have rights with responsibilities and whole-person information for the age of whole-person care. That would be genuinely transformational.

I reiterate to the Minister that we are happy to support the measures in the House, but as it stands, we fear that the security regime is woefully inadequate. There is still time to save it, and we on the Labour Front Bench have offered the Secretary of State for Health our full support if he can come up with an offer that satisfies everyone. On Tuesday, those points were put to the Health Secretary at Health questions by my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Health Secretary. Maybe the desire for consensus and a way forward is sometimes lost in the theatre of the Chamber of the House of Commons, so I repeat those points to the Minister in this debate, which has been much more consensual and informative than it would ever be on the Floor of the House during Health questions. I sincerely hope that she will respond to them positively.

There are five key protections that Labour wants to introduce. First, we want tougher penalties for any misuse of data; my hon. Friend the Member for Leeds East made that point far more eloquently than I. We also want to keep the requirement for the Secretary of State to sign off on any new application to access the data, which the Government are seeking to remove in the Care Bill. Accountability to the Secretary of State, to Parliament and to us as Members of Parliament on behalf of our constituents is a fundamental requirement that would start to satisfy the need for oversight.

We want and need full transparency for all organisations granted access to the data, so there is full openness about who has access and what data they have. We need a proper targeted and personalised awareness campaign for people with a learning disability, autism or sensory impairments, so we think that GPs should be issued with clear guidance to ensure that all of their patients are informed. We want easier opt-out arrangements than those possible at present. If the Secretary of State is happy to ensure that the new provisions are in place, we are happy to lend our support to make it happen.

In closing, I should say that confidentiality has always had a tense relationship with scientific progress when it comes to clinical research, but it is only right that information is made available outside the NHS in a completely anonymised form. The hon. Member for Mid Norfolk is quite right about clinical data: their potential is enormous, they can revolutionise systems and processes and they can get to the heart of problems in certain areas far sooner. It is hugely empowering for future patients to get away not just from the silo mentalities of the structures of our health and social care system—all parties want to do that—but from the silo mentality about data that exists in parts of the health and social care system: whole-person care and whole-person information.

I commend the hon. Member for Mid Norfolk for his work on this hugely important issue and congratulate him on securing this important debate, on the summit in Parliament earlier today and on the work that he is doing alongside patients for data. Hopefully, we can get some movement on this from the Government, so that we end up with a scheme with the appropriate safeguards. I look forward to the Minister’s response.

Health

Andrew Gwynne Excerpts

Thursday 27th February 2014 Ministerial Corrections

The following is an extract given by the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), to the hon. Member for Denton and Reddish (Andrew Gwynne), from Oral Question number 16 on 25 February 2014.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Ministers again deny that England’s A and E departments are in crisis. The Secretary of State did so in response to my right hon. Friend the Member for Leigh (Andy Burnham) earlier. It just will not wash any more. In the past two weeks, 10,743 patients waited on trolleys for up to 12 hours because no hospital beds were available and 52 patients waited for even longer. Does the Minister really think that it is acceptable that patients are experiencing the worst fortnight in A and E this winter while she is complacently sitting on her hands?

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 25th February 2014 Commons Chamber

[Jane Ellison]

As the hon. Gentleman knows, we have often debated in this House the many reasons for the increased pressure on A and E. However, the rate of growth in the first three years of this Government has been lower than the rate of growth in the last three years of the last Government. We are responding to the pressures. That is why the Secretary of State has addressed issues such as named GPs for older patients and the integration of social care. We acknowledge that there is pressure on A and E; it is the action that the Government are taking to respond to it that really counts.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Ministers again deny that England’s A and E departments are in crisis. The Secretary of State did so in response to my right hon. Friend the Member for Leigh (Andy Burnham) earlier. It just will not wash any more. In the past two weeks, 10,743 patients waited on trolleys for up to 12 hours because no hospital beds were available and 52 patients waited for even longer. Does the Minister really think that it is acceptable that patients are experiencing the worst fortnight in A and E this winter while she is complacently sitting on her hands?[Official Report, 27 February 2014, Vol. 576, c. 10MC.]

[Jane Ellison]

There is no complacency on the Government Benches, and attendances are half what they were under Labour. Week after week we have heard those on the Opposition Front Bench come to the House to talk up a crisis in our NHS, but the NHS has responded incredibly well throughout the winter. I pay huge tribute to the staff of the NHS for what they have done in responding to this. The Government are taking long-term action to reduce pressure on A and E; even the College of Emergency Medicine rebuts the Opposition line that there is a crisis in A and E this winter.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Hunt]

We know that every year, 1.2 million of 5.2 million admissions to hospitals are avoidable if we have better alternatives in the community. The Government believe that restoring that personal link between doctors and the people on their lists—the people in their communities—who could often be much better looked after outside hospitals is the way to deal with that. That is why we are making that major change to the GP contract—it is the biggest change since named GPs were removed in 2004. That will benefit my hon. Friend’s constituents and those of all hon. Members.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Before Christmas, the Secretary of State said that the A and E crisis is behind us. However, NHS data released last Friday show that patients have just experienced the worst week in A and E so far this winter. The A and E target was missed; 103 trusts failed to meet their individual target; and, shockingly, more than 5,000 patients were left waiting on trolleys for more than four hours—more than double the number in the previous week. The Secretary of State asks us to look at the facts, but those are the facts. They are apparent to all except, seemingly, him. Is he really still of the view that the crisis is behind us?

[Mr Hunt]

Let us look at those facts for last week and compare them with the facts in the identical week when the right hon. Member for Leigh (Andy Burnham), the shadow Health Secretary, was Secretary of State. When he was Secretary of State, 362,462 people were seen within four hours. Last week, we saw 365,354 people—3,000 more people—within the target. A and E is doing better under this Government than it ever did under Labour.

Health Care (London)

Andrew Gwynne Excerpts

Wednesday 8th January 2014 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my hon. Friend the Member for Westminster North (Ms Buck) on securing this very important debate about health care in London. I hope that hon. Members will forgive this Mancunian for gatecrashing the debate to respond for the Opposition.

The future of health services and especially accident and emergency services across London is an important issue of genuine concern to a great many of the constituents of hon. Members present. It is definitely an issue of real significance right across our capital city. I pay tribute to all the hon. Members who today have made contributions, long and brief, on a wide variety of matters.

Let me take this opportunity to pay tribute to the staff working in the national health service for their commitment in providing a first-class service to patients in what has been a very trying period for the NHS. As we know, there have been important changes in the provision of hospital care in London. We have had “Health for North East London”, “Shaping a healthier future”, the Barnet, Enfield and Haringey clinical strategy, the trust special administrator’s review of South London Healthcare NHS Trust and the NHS in south-east London and “Better Services, Better Value” in south London, to name a few of the reconfigurations that have taken place in the capital.

My hon. Friend the Member for Westminster North is right to point to extreme financial pressures on hospital services. North-west London hospital services must accommodate a £125 million reduction in service between 2011 and 2015. The people who use hospitals in London are rightly concerned about the changes to the services on which they rely. We have heard about the proposals that will lead to the loss of accident and emergency departments at Charing Cross, Ealing, Hammersmith and Central Middlesex hospitals.

However, it is not only my hon. Friends who are concerned about the future of A and E departments in London; local authorities are, too. Local authorities such as Ealing have voiced their concerns about the downgrading of their A and E services. As we have heard from my hon. Friend the Member for Hammersmith (Mr Slaughter), A and E facilities that both the Prime Minister and the Secretary of State had promised to save across north-west London and elsewhere in the capital will be closing. I hope very much that the meeting between the Secretary of State and the hon. Members who represent Ealing and Hammersmith can be reconvened as requested.

Of course, all this is in direct contradiction to what the Prime Minister said during the general election, when he promised to halt the closures of hospitals, accident and emergency departments and maternity units. Why does the Minister think that there is such widespread concern about the lack of leadership in the health service in London at a time when the NHS is dealing with unnecessary upheaval?

Frankly, it was a disastrous decision on the part of the Government to spend billions of pounds on an unnecessary top-down reorganisation, which has led to a loss of financial grip in the NHS. Now, more than 6,000 nursing posts have been lost, waiting lists are getting longer and we are seeing the return of patients on trolleys in corridors. Indeed, we are now seeing A and Es not just in London but across the country facing a winter crisis after an unprecedented summer A and E crisis. At the same time, local authorities are having a huge cut to their social care budgets. More and more elderly people are therefore ending up in A and E, because there is no one at home to care for them, adding even more pressure to a pressured system.

Labour Members warned Ministers repeatedly during the passage of the Bill that became the Health and Social Care Act 2012 that the legislation would lead to the break-up of the NHS. The public rightly expect to have easy access to health services, and Ministers have a heavy responsibility to show leadership and to act to prevent people’s lives being put at risk. Ministers must also tell the House today what action they propose to take to ensure that London’s growing population will continue to have good access to hospital and other health service provision in their local areas. Those points were made eloquently by a number of hon. Members, but I have to mention my hon. Friend the Member for West Ham (Lyn Brown) in relation to Newham.

Of course, Labour Members do not oppose all the changes to local health services. Surely, it is right that hospitals and services evolve and change. However, it must be change based on good clinical reasons and not just financial necessity.

[Ms Abbott]

Does my hon. Friend agree that the issue in London is not just provision for its size of population, but the extreme diversity and complexity of the population? It is a very mobile population. There are large numbers of refugees and asylum seekers, and London has the largest lesbian, gay, bisexual and transgender community in the country. That is what people have to pay attention to if they are reconfiguring services.

[Andrew Gwynne]

My hon. Friend is right. London is a global city. It has people coming in from all over the world, not just from elsewhere in the United Kingdom. It is a diverse city. It is an exciting, vibrant city—I am probably over-egging it for a Mancunian, but it is a great place. Those complexities are what makes London fantastic, but they are also what makes delivering health services a real challenge.

To make the change work, there must be clarity and partnership. Everyone must understand what is being proposed and how the decisions are to be taken. That brings me on to the issue of Lewisham and clause 118 of the Care Bill. We saw in Lewisham the power of an effective campaign in the face of unpopular change to health services and what that can achieve.

I pay tribute to the Lewisham MPs and to the campaigners, who fought tirelessly for their local hospital. The proposal to close their A and E department was rightly met by a strong local campaign, which included protest marches and a successful legal challenge to the closure. Indeed, the Court of Appeal ruled that the Health Secretary did not have the power to implement the cuts at Lewisham hospital. If only he had listened to my hon. Friends in Lewisham—they had been arguing that beforehand.

Clause 118 should give very real concern to all hon. Members in the debate, because in future it will give carte blanche to the Secretary of State and the Department of Health to reconfigure services right across the country as they sought to in Lewisham, disfranchising the communities that have spoken out very loudly across London against some of the changes. Labour Members are rightly concerned about that measure and we will be opposing it during the next stages of proceedings on the Care Bill.

In conclusion, I pay tribute to my hon. Friend the Member for Westminster North and to all my right hon. and hon. Friends who have taken part in the debate. Hospital services are very important to the capital. We must make sure that there is proper strategic planning across London, not the piecemeal approach to reconfigurations of services that we have seen, so that the complexities in health needs—including mental health, which my hon. Friend the Member for Hampstead and Kilburn (Glenda Jackson) mentioned—are taken on board fully for the betterment of people living in London.

Accident and Emergency

Andrew Gwynne Excerpts

Wednesday 18th December 2013 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a good debate, with many powerful contributions from my hon. Friends the Members for Mitcham and Morden (Siobhain McDonagh),for Wigan (Lisa Nandy), for Eltham (Clive Efford), for Stretford and Urmston (Kate Green), for Chesterfield (Toby Perkins), for Worsley and Eccles South (Barbara Keeley) and for Middlesbrough South and East Cleveland (Tom Blenkinsop).

I have to say, however, that people outside listening to some Government Members’ contributions will think that they simply do not get it. They simply do not understand how hard it is to get a GP appointment; they do not understand the real issues facing their own local A and E departments; and they do not understand the pressures hitting the NHS in England. I politely suggest that they do what the shadow Health team has done—go and spend an evening at their local A and E to see for themselves the real pressures that departments serving their constituents are under.

It would be remiss of me not to place on record my own tribute to the doctors, nurses, health care assistants and other dedicated NHS staff who—as I found out myself when I visited Tameside hospital’s A and E department last Friday night—provide such extraordinary and professional care. We have a work force who are completely dedicated and caring, but the House should be in absolutely no doubt that they are under increasing pressure, and that this is a crisis of the Secretary of State’s making. The Secretary of State may wish that Labour Members had short memories, but we remember the summer news reports of ambulances queuing outside hospitals with unacceptably long waits, and some people even having to be treated in tents erected in car parks, while the Secretary of State and his Ministers buried their heads in the sand and the Secretary of State’s “Crisis, what crisis?” strategy unravelled. Labour Members highlighted those problems, as would have been expected of us.

What we are seeing in A and E is also the culmination of three and a half years of mismanagement of our NHS, with a needless top-down reorganisation and the waste of billions of pounds that could and should have been spent on front-line care. It is little wonder that, as we discovered last week, 79 A and E departments missed the Government’s own targets.

As we have heard in the debate, the reasons for the crisis are many and complicated, but it is on the lack of access to GPs’ services that we have focused today. Surely no amount of spin can hide the fact that this Government have made it harder to obtain an appointment to see a GP. All Members will know of constituents who have had to phone their doctors only to be told that no appointments are available and that they should ring back the next day, which they do, only to experience the same problem again.

Is it not obvious to all—except, seemingly, the Secretary of State and his Ministers—that many patients who phone the surgery at 9 am and find it impossible to obtain an appointment will turn to A and E for help? That is not just my conclusion. According to an analysis carried out for the Department of Health, 42% of A and E attenders had attempted to contact their GPs beforehand, and researchers at Imperial College London found that patients who were able to see their GPs within 48 hours made fewer visits to A and E departments.

Here are some inconvenient truths that the Minister and other Government Members need to consider. First, by the time Labour left office, 98% of patients were being seen within four hours at A and E departments. Secondly, by May 2010 more than three quarters of the general practices in England offered extended opening hours at weekends and in the evenings. It is also clear that Labour’s achievement in widening access to primary care is being undone on this Government’s watch: data released by the Health and Social Care Information Centre have revealed that 854 fewer general practices now offer extended opening hours than was the case in 2009.

The truth is that now, during evenings and at weekends, many people are left with no alternative but to go to A and E because of this Government’s actions. It was this Government who cut funding for extended opening hours for GPs’ surgeries, it was this Government who scrapped Labour’s guarantee that patients would be able to obtain an appointment with a GP within 48 hours, and it is this Secretary of State who shows not one degree of regret for those actions: actions that have piled more unnecessary pressure on A and E departments and more misery on patients, at the very time when they need the NHS to help them.

No wonder things are going so wrong so quickly. To put it simply, under this Secretary of State and under this Prime Minister, it has become harder, not easier, to see a doctor, and as a result more people are heading towards A and E. What more evidence do Ministers need that A and E departments in England are under real pressure and that action is needed now to prevent them from struggling further over the winter months? Their confusion has been laid bare today for all to see. In three weeks, they have gone from “Crisis, what crisis?” to “The crisis is behind us.” It does not sound as though the Secretary of State is in control; people will struggle to take reassurance from his mixed messages. The problems in A and E have the fingerprints of the Secretary of State and the Prime Minister all over them. The components of the A and E crisis might be complex, but the real cause is very simple: you just cannot trust the Tories with the national health service.

[The Minister of State, Department of Health (Norman Lamb)]

We have heard a lot of scaremongering about the NHS today, including endless claims about a crisis. If the Opposition are thinking about new year’s resolutions, I have one for them: stop misleading and misinforming the public. Let us look at the evidence.

[Andrew Gwynne]

rose—

[Norman Lamb]

I will not give way; I do not have time.

Up until this week, A and E targets were met in the past 32 weeks in a row. Is that evidence of a crisis? The average wait for people in A and E during Labour’s last year was 77 minutes; it is now 30 minutes. Is that evidence of a crisis? Even though more people are coming through the doors, 2,000 more patients are being seen in less than four hours every day under this Government than under Labour. Evidence of a crisis? I don’t think so. The Opposition are scaremongering, plain and simple. In fact, the College of Emergency Medicine’s president, Cliff Mann, has today said that any crisis in accident and emergency is “behind us”.

[Norman Lamb]

I applaud the cross-party effort of those Members campaigning for their community, and I am very happy to engage with them further on that matter.

[Andrew Gwynne]

rose—

[Norman Lamb]

I will not give way again; I do not have time.

Last year, of the 21.7 million people who visited accident and emergency departments, almost 96% were admitted, transferred or discharged within four hours. Target achieved. So far, it is the same this year: target achieved. The right hon. Member for Leigh (Andy Burnham) missed his A and E target in two of the three quarters when he was in charge. Did he go around telling everyone that there was a crisis at that time? No, of course he did not—

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 26th November 2013 Commons Chamber

[Norman Lamb]

I have had a similar experience at the Norfolk and Norwich hospital. It is clear that the number of delays in the east of England has reduced substantially, and I pay tribute to everyone involved. Getting urgent care right requires collaboration between ambulance trusts, acute care and GPs and social care workers on the ground. Significant improvements have been made in the east of England, as well as across the rest of the country.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Minister surely knows that deteriorating ambulance handover times are just one of a growing number of signs highlighting what is going wrong with A and E on this Government’s watch. Now we see the Secretary of State and his Ministers in full panic mode after denying for months that there was a problem. The question is: why was the Health Secretary the last person in the entire NHS to realise that there was an A and E crisis?

[Norman Lamb]

It seems as if Labour is always desperately in search of a crisis, even if there is none to be found. If the hon. Gentleman had listened to the answer that I gave to the hon. Member for West Lancashire (Rosie Cooper), he would have heard me say that there had been a 38% improvement in waiting times for ambulance handovers between last November and this November. I am sure that he will welcome that.