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.

Hepatitis C (Haemophiliacs)

Andrew Gwynne Excerpts

Tuesday 29th October 2013 Westminster Hall

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

As always, it is a pleasure to serve under your chairmanship, Mr Dobbin. I apologise on behalf of my hon. Friend the Member for Copeland (Mr Reed), who was scheduled to respond for the Opposition. Sadly, St Jude’s storm meant that he was stuck in the wilds of Cumbria yesterday and was unable to travel down in time for this morning’s debate.

I echo the thanks given to my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) for securing this debate on an extremely sobering and important issue that has affected many people across the country. I also welcome the new public health Minister to her post, and I wish her the best of luck.

This has been a powerful debate, with many moving contributions from Members on both sides of the House. I thank right hon. and hon. Members for contributing, including my right hon. Friend the Member for Wythenshawe and Sale East, my hon. Friends the Members for Kingston upon Hull North (Diana Johnson) and for Hammersmith (Mr Slaughter), and the hon. Members for Strangford (Jim Shannon), for North East Bedfordshire (Alistair Burt), for North Devon (Sir Nick Harvey) and for Stratford-on-Avon (Nadhim Zahawi).

We must remember that 4,500 patients contracted HIV or hepatitis C due to one of the gravest failures in modern medicine. That failure hit innocent and trusting people, and, to date, it has claimed thousands of lives. Members from both sides of the House will be well aware of how the rowdier moments in the House of Commons are perceived by our constituents, but I believe that debates such as this, conducted with great dignity while addressing serious failures and harrowing accounts, are a credit to the institution of Parliament, and I look forward to working with the Minister to help reach a speedy and satisfactory outcome for those who are campaigning for support to maintain a good quality of life.

The failures in our health system in the 1970s and 1980s, and the struggle for help and support fought by those affected, are a stark reminder of our responsibilities in this place. As we have heard today, progress has been painfully slow—that point was eloquently and powerfully put by the hon. Member for North East Bedfordshire. The previous Government and the devolved Administrations established the Skipton Fund in 2004 to make ex gratia payments to those who were infected.

In May 2009, Lord Archer published a report on NHS-supplied contaminated blood and blood products. We implemented many of his recommendations, including giving the Haemophilia Society £100,000 for haemophilia doctors and committing to phasing out prescription charges for patients with long-term conditions.

In April 2010, the then public health Minister, Gillian Merron, decided to bring forward a review of the Skipton Fund—we had previously committed to reviewing the fund in 2014. Announcing that decision, she said:

“We have listened carefully to the views of those infected, their families, carers and many in this House, who have told us that our intended review date of 2014 will be too late for many of those affected.”—[Official Report, 6 April 2010; Vol. 508, c. 133-134WS.]

I welcome this Government’s work in continuing to build on the foundations laid by the previous Government. The issue must transcend party politics. Our focus from now on must be on what we can do to support those who bear financial burdens as a result of contracting hepatitis C or HIV.

I hope that the Minister is able to give us a comprehensive account of what the Government are doing to build on the actions set out by the Leader of the House when he was Secretary of State for Health in his statement to the House on 10 January 2011. He announced changes to the financial support schemes for those infected with HIV and hepatitis C, including the introduction of an annual payment of £12,800 for those with the most serious hepatitis C-related disease as a result of NHS blood transfusions and blood products, in line with payments received by people infected with HIV. Those groups need Government support more than ever, and I want the Minister to give assurances that work on this issue will not be undermined by budget reductions.

I cannot even begin to imagine the pain and suffering inflicted on the victims who received infected blood. To those who relied on receiving blood regularly as part of their treatment for haemophilia, only to have a life-changing diagnosis thrust on them; to those still facing daily challenges; and to the dependents of those who are, sadly, no longer with us, we owe help, support and justice.

I pay tribute to the work done by the many campaigners and organisations across the country, which is a credit to the tireless efforts of those affected and their families. Their efforts could have been no better espoused than by my right hon. Friend, who set out the experiences of his constituents. It is right that such people are exempt from the Atos processes, and my right hon. Friend’s points about the financial burdens that such things put on families were extremely timely. Changes to qualifying criteria for a range of illness-related benefits will unnerve those who depend on such income to make ends meet. I am sure that the Minister will welcome this opportunity categorically to state that the Government will protect payments to those who have been affected. Leaving aside the health issues caused by the transmission of infections, the stress brought on by worrying about bills and security can have an extremely damaging impact on the lives of those concerned.

On top of dealing with financial concerns, we must provide a health care system that makes it as easy as possible for people with hepatitis C to use the services they need to maintain a good quality of life. I therefore hope that the Minister can give us an indication of the reforms that are being made to support patients.

My right hon. Friend’s proposal to unite stage 1 and stage 2 under one fund warrants serious consideration, and I would welcome a pledge from the Minister seriously to look at it and to try to bring it about. My right hon. Friend was also right when he said that the Government must take any action in conjunction with those who have been affected.

As I said, this is not a debate for political point scoring, and I assure the Minister that the Opposition want to see swift action to ensure a good outcome for those affected—something eloquently pledged by my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Secretary of State for Health, in an intervention earlier. We will therefore be happy to work with the Government to introduce proposals finally to achieve a good and proper conclusion for those affected and their families and, I hope, to draw a line under one of the darkest failings seen in our country.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Mr Hunt]

The figures for September, the last month of the summer, were 95.8% in England and 90.6% in Wales. It was not coalition-controlled England that had a summer A and E crisis, but Labour-controlled Wales.

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

The Secretary of State for Health is clearly not adequately monitoring performance. If he was, he would be aware that serious problems remain across the accident and emergency departments of the trusts that were placed in special measures by Professor Sir Bruce Keogh. On his watch, the A and E performance at eight of the 11 trusts has got worse since Keogh reported, including at my hospital in Tameside. The A and E performance has got substantially worse at East Lancashire Hospitals NHS Trust, where the number of patients waiting for more than four hours has doubled since Keogh reported, and at Medway NHS Trust, where the figure has quadrupled. When will he stop all the grandstanding, cut the spin and get a grip on his A and E crisis?

[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.

Managing Risk in the NHS

Andrew Gwynne Excerpts

Wednesday 17th July 2013 Commons Chamber

[Derek Twigg]

My right hon. Friend makes an important point. That is one of the things that we explored during the Committee stage of the Health and Social Care Bill and of course we got no answers. The then Minister, now Minister of State, Department for Transport, the right hon. Member for Chelmsford (Mr Burns), said that as time goes on the NHS will be more open to the competition laws of both the EU and the UK. That is the real story here, and we will not have that transparency. That is a major part of the problem we are having to deal with.

No matter what statistics we are talking about, losing a friend or loved one is a massive human tragedy that affects everybody. We want to do all we can to reduce the number of early and preventable deaths—that is absolutely right—and put patients’ interests and those of families first. Given what we have heard in the last day or so, one would think that we somehow left an NHS in crisis—an NHS that was not delivering—yet when we left office it had the highest satisfaction rate in history. We had the lowest waiting lists in history and massive reductions in early deaths from cancer, coronary problems and so on. We also saw massive increases in doctors and nurses. We hear this Government talking about increasing the number of doctors, but when did those doctors start their training? They started under Labour.

To give an example, so that we can be a bit fairer about the situation, the Commonwealth Fund produced an international health policy survey in 2010 that looked at 11 countries—and guess what? The UK health service came out best. Just as an example, when those on above average incomes and those on below average incomes were asked whether they were confident that they would receive the most effective treatment if sick, the best results—95% and 92%—were in the UK. That was an international survey. Another question was whether people were confident that they would receive the most effective treatment if sick—and guess what again? The UK came out on top, at 92%. That is the real picture of the NHS that we left behind in 2010—although it was not without its problems and challenges, because pressures were always building up.

I also noticed that pages 4 to 5 of the Keogh report say—this is an important comment that has not been looked at much in the press—the following:

“Between 2000 and 2008, the NHS was rightly focused on rebuilding capacity and improving access after decades of neglect. The key issue was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment.”

That is where Labour made one of the biggest differences. I remember regularly having people write to me back in the late 1990s and the early 2000s about having to wait over two years for an operation. People were literally dying because of that. Addressing that was one of the biggest gains that Labour made.

The Secretary of State has now left the Chamber, but earlier I raised with him the issue of mortality. He refused to correct the record. He said that there had been a “slight” improvement by 2010, yet Professor Keogh talks about a 30% improvement in mortality in all hospitals, including those that have been under investigation. That is not to say that those hospitals should not be doing better, but he was talking about all hospitals.

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

Professor Keogh’s report also shows that although mortality has dropped by 30% in all hospitals, it has dropped by between 30% and 50% in the 14 hospitals subject to the Keogh review. Although those hospitals are still outliers, the drop has been greater at those 14 hospitals.

[Derek Twigg]

My hon. Friend makes a strong and important point. I referred earlier to figures from the Library, but those figures are from the NHS. Just to repeat, the rate of deaths per 100,000 within 30 days of a non-elective hospital procedure in England was 4,850 in 2001-02 and 3,684 in 2010-11. That is a significant drop, so I hope the Secretary of State will correct the record, change his view that there was a “slight” improvement and confirm that it was a significant improvement, because that is what the evidence from his own Department says. Why is that important? It is important for a number of reasons. It is important to see improvements, but we should also bear in mind that the fall from 2001 took place against a massive increase—4 million additional admissions—in the number of people admitted to hospital. It is also important because people want to see continual improvements and be assured that their relatives and friends are receiving the best possible treatment.

In the short time I have available, I want to talk about a couple of local issues. Staffing plays a fundamental part in regard to risk. Many hospitals are having real difficulty with staffing at the moment, and many more will do so. I will say more about that in the context of my own hospital in a second. We need to address the problem, and the mix of staff is also a factor.

The Warrington and Halton Hospitals NHS Foundation Trust serves my constituency. We have been told by the chief executive and the chair of the board of governors that our hospital will run out of money in about 18 months’ time. It has already had to make savings in staff numbers of about 200, and implement a £7 million cut. The hospital will be unsustainable in that situation. What are the Government going to do about that? It is a foundation trust, and as far as I am aware, there are no significant performance issues. I get complaints about the different hospitals, but it is no worse than any of the others. It will run out of money, however.

My hon. Friend the Member for St Helens North (Mr Watts) has mentioned the St Helens and Knowsley NHS Trust. The Whiston hospital was rebuilt under Labour’s plan to rebuild hospitals. We replaced Victorian hospitals—and workhouses, as in the case of the Whiston—with more than 100 new hospitals. The deal on the Whiston hospital under Labour involved a private finance initiative, with the difference being paid for by the two primary care trusts. This Government have got rid of the PCTs, but they have still not put in place a way of funding the hospital on a long-term basis. The uncertainty continues, despite debates on the matter in this place and meetings with Ministers, and we still do not know what is going to happen. It is an excellent hospital with brand-new facilities, but it is facing a real challenge. We need the Government to make decisions about hospital funding, to ensure that it and others can continue; otherwise, many more hospitals will get into difficulty.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right to say that NHS resources must be allocated in a way that fairly reflects the need for the NHS in every area. Rurality and age are two important factors in that regard. I can reassure him that the current allocations are not set in aspic. The problem with the recommendations from the Advisory Committee on Resource Allocation that NHS England received before was that they would have meant increasing resources to the areas with the best health outcomes at the expense of those with the worst ones. NHS England thought that that would be inconsistent with its duty to reduce health inequalities, but it is looking at the issue this year and we all hope that it will make good progress.

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

We all know that one of the most important drivers for improving the quality of care for vulnerable and elderly patients is to ensure the adequate training and regulation of health care assistants. That is something that Labour and Sir Robert Francis QC have called for, but that the Government have so far ducked. Will the Secretary of State now accept that crucial Francis recommendation to help to drive up care standards for the elderly and the vulnerable—yes or no?

[Mr Hunt]

The reasons that Robert Francis recommended statutory regulation of health care assistants were twofold. First, he wanted to ensure that people who had been involved in incidents of poor care could not pop up somewhere else in the system. Secondly, he wanted to ensure that everyone had proper training. We are going to solve both those problems, but I am not convinced that a big new national database of 300,000 people is the way to do it.

Herbal Medicine (Regulation)

Andrew Gwynne Excerpts

Tuesday 9th July 2013 Westminster Hall

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

It is a pleasure to see you in the Chair, Mr Bone. I congratulate the hon. Member for Bosworth (David Tredinnick) on securing the debate. As someone who, over the past few days, has been suffering with quite bad hayfever, I would quite like a remedy, herbal or otherwise, for my suffering. I am pleased that we have had a chance in today’s debate to discuss some very important issues in relation to the regulation of herbal medicine. I know from the hon. Gentleman’s previous contributions in the House that he takes a very keen interest in and is a committed supporter of various forms of alternative medicine, including homeopathy and herbal medicine. He continues to raise these issues passionately in the House, most recently in the estimates day debate last week. I also congratulate the hon. Members for Strangford (Jim Shannon) and for Kettering (Mr Hollobone) and my hon. Friend the Member for Vauxhall (Kate Hoey) on echoing the many issues and problems. There are issues with the provision of non-manufactured herbal medicine due to the absence of regulation of herbal regulation practitioners. There have admittedly been delays in making progress on the regulations, which all relevant parties agree with, and all sides agree that the unexplained delays are frankly unacceptable. I will return to that later in my contribution.

As we know, the MHRA is responsible for medicines. It explains the licensing of manufactured herbal medicines as follows:

“The new European Traditional Herbal Medicinal Products Directive…came into effect on 30 April 2011. The Directive establishes a regulatory approval process for herbal medicines in the European Union...It requires each EU Member State to set up a traditional herbal registration scheme for manufactured traditional herbal medicines that are suitable for use without medical supervision. Companies are no longer able to sell manufactured unlicensed herbal medicines unless they have an appropriate product licence”.

The supply of non-manufactured medicines is permitted, but there remains a long-standing concern with the non-regulation of herbal medicine practitioners. Currently, anyone can set up as a practitioner. The guidance states:

“Regulation 3 of The Human Medicines Regulations 2012 (formally Section 12(1) of the Medicines Act 1968) is commonly referred to as the ‘herbalist exemption’ and permits unlicensed remedies to be made up and supplied by a practitioner to meet the needs of an individual patient following a one-to-one consultation. The existence of this regime is greatly valued by herbal practitioners and by many members of the public. However, there are widely acknowledged weaknesses in the public health protection given by the regime. Regulation 3 remedies are not subject to a regime of specific safety or quality requirements. There are no restrictions in terms of those who operate under the regime. Anyone—irrespective of qualifications or experience—can practise herbal medicine and, after making a diagnosis and forming a judgment about the treatment required, can make up and supply an unlicensed herbal medicine.”

As we heard in the debate, there was a great deal of discussion about regulation under the previous Government. They supported moves towards statutory regulation of herbal medicine practitioners, which was the subject of consultation in 2004. The consultation report stated:

“The majority of the responses indicated strong support for the introduction of statutory regulation, in order to ensure patient and public protection and enhance the status of the herbal medicine and acupuncture professions.”—

That point is important in its own right. In 2008, a report to Ministers from the Department of Health steering group on the statutory regulation of practitioners of acupuncture, herbal medicine, traditional Chinese medicine and other traditional medicine systems practised in the UK concluded:

“The Steering Group is strongly of the view that the decision to statutorily regulate professions practising herbal medicine and acupuncture is in the public interest.”

It also urged that there be no Government delay in introducing regulation, saying:

“The Steering Group is of the view that there is an urgent need to proceed without delay with the statutory regulation of practitioners of acupuncture, herbal medicine, traditional Chinese medicine and other traditional medicine systems. The Department of Health has been working with practitioners from these sectors, in some cases for over a decade, and a timeframe has been published that has not been adhered to.”

On 3 August 2009, the four Health Departments of the UK published a consultation paper on statutory regulation of practitioners of acupuncture, herbal medicine, traditional Chinese medicine and other traditional medicine systems practised in the UK. A clear majority of responses—85%—were in favour of statutory regulation, but, as we have heard, there has been little progress, despite the then Secretary of State for Health, the right hon. Member for South Cambridgeshire (Mr Lansley), pledging on 16 February 2011 to regulate herbal medicine practitioners, as the hon. Member for Bosworth pointed out. The Health and Care Professions Council was asked to establish a statutory register for practitioners supplying unlicensed herbal medicines, but there has been no further progress. When does the Minister expect that he will establish a statutory register for practitioners supplying unlicensed herbal medicines? The National Institute of Medical Herbalists is rightly critical of the lack of progress:

“In February 2011, the Secretary of State for Health announced that UK herbalists were to be statutorily regulated. He pledged that, subject to the usual procedures, the Department of Health (DH) would have this ready by 2012. Statutory Regulation (SR) is urgently needed to protect the public from untrained herbalists and also to allow trained herbalists to continue to practice within the constraints of EU Directives. Regulation will be via the Health and Care Professions Council (HCPC) which regulates dentists, dieticians and physiotherapists. Two years later the DH has failed to publish the draft legislation and there is no sign of progress. The fear is that with many other priorities the DH will let the issue drop. Failure to implement SR for herbal medicine practitioners is disastrous…In short, statutory regulation is clearly in the public interest!”

A recent MHRA survey showed that about a quarter of the population use over-the-counter herbal medicines. If that continues, as I suspect it will, surely the Government have a responsibility to ensure that arrangements are in place to make certain that such medicines are safe, as far as they can be, and that those who prescribe and dispense such medicines are appropriately qualified and regulated. It is therefore important that we get a clear view from the Government today on whether they will continue with the statutory registration proposals. It is also important that they give us some confidence that it will be done within a reasonable time frame, so that we can give that confidence back to the industry and those who use herbal medicines.

I commend the hon. Member for Bosworth for his persistence in this matter and for securing the debate today. I look forward to the Minister’s assurances that the Government still take regulation seriously—I hope— and are looking for practical ways to ensure that it can proceed swiftly.

Health and Care Services

Andrew Gwynne Excerpts

Wednesday 3rd July 2013 Commons Chamber

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

May I begin by thanking the Health Committee and its Chairman for the report and the clarity with which he presented its findings, and Members from all parties for the thoughtful way in which they have debated the issues today? The right hon. Member for Charnwood (Mr Dorrell) is known for his diligence and attention to detail, and his speech clearly illustrated those instincts.

Before I address the points raised by the report, let me put on record our gratitude to the many thousands who work in our health service. As we approach the 65th anniversary of the NHS, we should take a moment to pay tribute to those staff who are doing a tremendous job, often in difficult and challenging circumstances.

With the indulgence of the House, I would also like to place firmly on the record my support for and appreciation of the dedicated doctors, consultants, nurses, carers and support staff in Tameside general hospital, many of whom will be feeling battered and bruised today. Tameside general hospital serves most of my constituency and today’s media reports highlight some of its failings. Deep-seated issues need to be grappled with urgently, but we should also recognise and listen to the many decent, good and hard-working staff who work there, because they often have many of the solutions and have not been listened to in the past.

I also apologise for leaving the Chamber briefly during the speech of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley). There was no discourtesy intended to either her or the House: I was dealing with the BBC’s breaking news that both the chief executive and the medical director of Tameside general hospital have resigned, which I support. Sadly, it has come three years too late—I called for it to happen three years ago—but, nevertheless, it is a step in the right direction to ensure that Tameside general hospital has a safe and secure future.

[Barbara Keeley]

We heard from the hon. Member for Southport (John Pugh) about the value of executive leadership. Our conurbation of Greater Manchester has one of the best and safest hospitals in the country. The Salford Royal hospital is the seventh safest in the country and has an excellent chief executive. Today the leadership of Tameside hospital has changed and I hope that the people of Tameside will end up with an excellently led hospital. I agree with the hon. Member for Southport. My example shows the difference between a hospital that is well led and one that is not.

[Andrew Gwynne]

I agree with my hon. Friend. Had she been listening to BBC Radio Manchester this morning, she would have heard me making precisely that point. The situation at Tameside is incredibly frustrating for me and my hon. Friends the Members for Stalybridge and Hyde (Jonathan Reynolds) and for Ashton-under-Lyne (David Heyes). Whenever we meet the chief executive and chair of Tameside hospital—we do so frequently—they always give us excuses as to why Tameside is different from the rest of Greater Manchester because of the industrial legacy and poor health outcomes in the borough, but one could make exactly the same arguments for Salford: there is no reason why one part of Greater Manchester should have an excellent hospital while another has one with long-term problems.

Following that slight indulgence, I want to turn to the report and focus on four key areas. First, the right hon. Member for Charnwood made some pertinent points about the Nicholson challenge. To be fair, in previous reports the Health Committee has taken the consistent view that the Nicholson challenge can be achieved only by making fundamental changes to the way in which care is delivered. It makes that argument in this report too. It states:

“Too often…the measures used to respond to the Nicholson Challenge represent short-term fixes rather than long-term service transformation.”

The Select Committee is right about that.

If we are to sustain the breadth and quality of health and care services, we need a fully integrated approach to commissioning—something that the right hon. Member for Charnwood and others have spoken about powerfully. The Opposition agree with that. I hope that the right hon. Gentleman will agree that we have put forward bold proposals for a genuinely integrated NHS and social care system that brings physical health, mental health and social care into a single service to meet all our care needs.

We know that that approach works. In Torbay, integrated health and care teams have virtually eliminated delayed discharges. Partnerships for older people have helped older people to stay living independently in their own homes and have delayed the need for hospital care—something that my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) rightly referred to. Where physical and mental health professionals have worked closely together, they have shown that a real difference can be made.

An integrated, whole-person approach is the best way to deliver better health and care in an era when money remains tight. As the Committee’s report notes,

“the care system should treat people not conditions.”

The right hon. Member for Charnwood was right to point out that developing the role of health and wellbeing boards is the best way to plan such integrated care. He reaffirmed that he is “happy to endorse” the Burnham plan. We were happy to hear that. He is right that there is an issue with single commissioning budgets without checks on local government. As somebody who has a background in local government, I think that he is right about the need to extend the ring fence to social care spending. Unless those budgets are protected, there will be a temptation to siphon off the money that is needed to provide the integration that we all want to see.

[Mr Dorrell]

I do not want to detain the House, but will the hon. Gentleman confirm that the Opposition support the proposals set out by the Chancellor last week that will provide exactly that principle?

[Andrew Gwynne]

I will come on to the Chancellor’s proposals. We do have concerns because there is an immediate care crisis that needs to be tackled now. There are also wider issues. My hon. Friend the Member for Worsley and Eccles South rightly raised the concern of local government that it will not have the funds to implement the new requirements in the Care Bill. We need reassurances about that.

My second point is about the cost of the Government’s reorganisation, about which my hon. Friends the Members for Easington (Grahame M. Morris) and for Birmingham, Selly Oak spoke eloquently. In the update from the Government last autumn, the overall cost was up by 33% or £400 million, making a total of £1.6 billion so far. What is that money being spent on? A full £1 billion has been spent on redundancy packages for managers, 1,300 of whom have received six-figure pay-offs and 173 of whom have received pay-offs of more than £200,000, all while the number of nursing posts has been cut by more than 4,000—six-figure pay-outs for managers; P45s for nurses.

The really unfortunate thing is that the reorganisation has diverted money and attention away from the front line. The Committee’s report notes that the reorganisation has

“had an impact on the NHS budget”.

I do not want to get into that debate. I will leave it to the UK Statistics Authority, which confirmed that spending on the NHS was lower in real terms in 2011-12 than in 2009-10, albeit marginally. We have seen reductions in NHS spending. Mental health spending has been cut in real terms for two years running, cancer spending has fallen in real terms and social care budgets have been slashed.

Let me now turn to the funding crisis in social care. The Library’s analysis, which is borne out by the Local Government Association’s statistics, shows that Government funding reductions have forced local authorities to reduce their adult social care budgets by £2.7 billion over the last three years. They have had to slash services and increase charges in order to balance their books, leaving thousands of vulnerable older and disabled people facing a daily struggle to get the care and support they desperately need.

That is why what the Chancellor announced last week in the spending review is at best a sticking plaster, or if I am feeling generous, a plaster cast. Sadly, it will not solve the financial pressures on councils, break the flow of funds into the acute sector or address the fundamental problem of two systems operating to conflicting rules.

To be fair, the Government have started talking Labour’s language of integration—the right hon. Member for Charnwood would say that it is the Select Committee’s language—but as the Committee notes, the only way to achieve what we want to see is by making fundamental system changes, which brings me to my final point, which is the Department of Health underspend.

I note that the Committee has raised concerns about the operation of the Department of Health policy on underspends and budget exchange. The small print of this year’s Budget revealed that the Department of Health is expected to underspend against its 2012-13 expenditure limit by £2.2 billion. That would be the biggest underspend of any Department in this financial year. Page 70 of the Budget document appears to show that none of this has been carried forward to be used in subsequent financial years as part of the Budget exchange programme. Perhaps the Minister could explain why—at a time when the NHS is facing its biggest financial challenge, when 4,000 nursing posts have been lost and when there is a crisis in A and E—they have decided to hand the full £2.2 billion back to the Treasury. Can the Minister also confirm that this means the underspend for 2012-13 would be 2% higher than the 1.5% figure that his Department says is consistent with “prudent financial management”?

We think that people will struggle to understand why this money has not been spent on the NHS. That is why we proposed that the Treasury exceptionally allows a £1.2 billion “end-year flexibility” carry-forward of around half of this year’s under-spend. We would ring-fence this money for social care budgets this year and next, to tackle the immediate crisis, with £600 million allocated for 2013-14 and a further £600 million allocated for 2014-15. With that extra investment, we could relieve the pressure on A and E and help to tackle the scandal of care services being withdrawn from older people who need them, enabling more people to stay healthy and independent in their own homes, and help families being squeezed by rising charges for care.

I thank the right hon. Member for Charnwood and members of the Committee—and other hon. Members on both sides of the House—for the sterling and thorough work that they have done and the powerful arguments they have made, especially on integration. They are right to highlight those issues, because it is the only way in which the NHS and care services will be able to make the necessary step changes to meet the challenges of an ageing society within the financial constraints we face. It is just as important that we get it right in terms of outcomes for patients, because the care services they receive will be greatly strengthened and improved through integration.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 11th June 2013 Commons Chamber

[Anna Soubry]

I very much do agree. That is why I am so pleased that the Care Bill that is making its way through both Houses has special provision for people who are caring for others with cancer in the way that the hon. Lady describes.

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

Last week Monitor, the regulator for foundation trust hospitals, said that cancer patients are now waiting longer for treatment and diagnosis because of the A and E crisis in hospitals. Official NHS figures published that same day show that the number of patients waiting over three months for cancer, heart disease and other life-saving tests has more than doubled compared with only last year. Is it not obviously the case that this Health Secretary’s failure to cut the spin and get a grip on the A and E crisis is now seriously damaging patient care?

[Anna Soubry]

That was a very interesting speech but I am afraid that I do not accept the hon. Gentleman’s analysis at all. All cancer waiting time standards are being met, with over 28,000 patients being treated for cancer following a GP making an urgent referral for a suspected cancer. We have already heard about the action that this Government are taking to address the situation in accident and emergency; it was very well explained in last week’s debate

Accident and Emergency Waiting Times

Andrew Gwynne Excerpts

Wednesday 5th June 2013 Commons Chamber

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

We have had a full and thorough debate, with some 18—or perhaps 17 and a half—Back-Bench speeches. I pay tribute to my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson), my hon. Friend the Member for Lewisham East (Heidi Alexander), my right hon. Friend the Member for Exeter (Mr Bradshaw) and my right hon. Friend the Member for Cynon Valley (Ann Clwyd), who made a very personal contribution to the debate, as well as my hon. Friends the Members for Ealing North (Stephen Pound), for Harrow West (Mr Thomas) and for Mitcham and Morden (Siobhain McDonagh), my right hon. Friend the Member for Rother Valley (Mr Barron), and my hon. Friends the Members for Worsley and Eccles South (Barbara Keeley) and for Hammersmith (Mr Slaughter). I also pay tribute to the right hon. Member for Charnwood (Mr Dorrell) and the hon. Members for Totnes (Dr Wollaston) and for Southport (John Pugh), and other Members, too many to mention individually, who contributed to the debate.

I start by paying tribute to the thousands of doctors, nurses and health care assistants who provide extraordinary and professional care in our A and E departments. They are there for us when we need them most and we owe them a huge debt of gratitude. It was apparent from the Secretary of State’s speech that he has absolutely no plans to deal with the disastrous situation in A and E that is entirely of this Government’s own creation. We know that, since this Government came to power, there are 4,000 fewer nurses, the disastrous NHS 111 service is in meltdown, walk-in centres are being closed and social care is in crisis. All those factors contribute to the current crisis in our A and E. We have all seen the news reports of ambulances queuing outside hospitals, with unacceptably long waits and some people even having to be treated in tents in car parks. It is time for Ministers to stop blaming others and to get a grip on the crisis in A and E.

Bluntly, what we are seeing today in A and E is the culmination of three full years of mismanagement of the 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. The truth is that there is no grip on the NHS in England. No wonder things are going so wrong so quickly.

When Labour left office, A and E was performing well, with 98% of patients seen within the four-hour target time. Since the election, the number of patients waiting more than four hours has nearly trebled and ambulance queues have doubled. Only yesterday, in a report by the King’s Fund, we saw that A and E waits are at their worst for nine years, with more than 313,000 patients waiting more than four hours between January and April this year. Simply put, under this Government more people are waiting longer. The proportion of patients attending A and E who have to wait longer than four hours is at its highest for 10 years. What more proof do Ministers need to understand that A and E departments are under real pressure and that action is needed, and needed now?

Many patients cannot even get through the doors of our hospitals. We have a shameful situation in which growing numbers of patients are waiting in ambulances to get into A and E because those departments are full. Equally shameful is the number of patients experiencing the indignity of waiting for hours on trolleys in A and E before they can be found a bed on the main hospital wards. It is almost as though we are back to the future—back to the bad old Tory days of the 1980s and ’90s.

There are many other factors that have pushed A and E into the danger zone. Indeed, A and E is a bellwether for the overall state of the NHS and social care. The Government’s cuts to local authority budgets have seen £2.6 billion taken out of adult social care since the election alone. As a result, many older and vulnerable people are having services withdrawn that could have helped them to stay healthy and independent in their own homes, and many others face rising charges for the care that they need. That is a major cause of the A and E crisis, as fewer older people get the care that they need at home, and ever more have to be admitted to hospital. It also means that there are delays in ensuring that appropriate support is available at home, or in the community, which delays a patient’s discharge. That has a knock-on effect right through the hospital: with no free beds on the wards, A and E staff cannot admit patients to the hospital wards, and with A and E full, ambulance staff cannot hand over patients.

As we have heard, under-staffing is also causing huge problems in the health service. Since the election, more than 4,000 nursing posts have been lost from the NHS, and the Care Quality Commission has warned that one in 10 hospitals is failing to meet the standard for adequate staffing levels. Hospitals are continuing to make severe cuts to front-line staffing, with many operating below recommended levels. Under this Government, right across England, we are seeing the closure of well-used NHS walk-in centres, meaning that more people are having to go to major A and E departments when they could be helped elsewhere.

Lastly, there is the meltdown of the 111 helpline; NHS England identified the poor roll-out of 111 services as one of the main reasons for the deterioration in A and E department performance. As the 111 service uses staff who do not always have clinical training, they are more likely to play it safe, meaning that more people are being directed towards A and E departments. Over Easter, callers in 30 areas waited for more than an hour for a call back, and in some regions more than 40% of calls were abandoned by patients. One patient waited 11 hours and 29 minutes.

It is no good Ministers arguing that there has been a large increase in the number of people attending A and E, driven by changes to out-of-hours care that were caused by Labour’s renegotiation of the GP contract in 2004; that was nine years ago. The Secretary of State’s spin was blown out of the water by the Chair of the Select Committee on Health, the right hon. Member for Charnwood—and by the chief clinical officer at Stockport clinical commissioning group, who said:

“The focus on the 2004 GP Contract as a main cause is not only a incorrect assumption but also serves to distract the public from the urgent debate that’s needed about the choices the NHS, the public, media and politicians now need to make”—

his words, not mine.

The Government parties should and must do more to protect the NHS from the immediate crisis, so will they now implement our A and E rescue plan? The Secretary of State derided our initiative to use underspends in the NHS budget to put an extra £1.2 billion into social care over the next two years, but that investment would not only relieve pressure on A and E, but help tackle the scandal of care services being withdrawn from older people who need them.

Will the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), review all 111 contracts? Early indications are that the number of cases referred to nurses has fallen from 60% through NHS Direct to just 17% with 111. What will she do about that? Will she also ensure that all hospitals have safe staffing levels, and intervene to prevent further job losses? Will she halt the closure of NHS walk-in centres and await the review that is being conducted by Monitor to see what the impact is on the local community and the NHS? Will she immediately and personally review all planned A and E closures and downgrades, and use the very latest evidence of local pressures to ensure that plans are based on robust clinical evidence?

Instead of accepting responsibility for the mess that they have created, the Government have spent recent weeks casting around for scapegoats. We have seen them blame the winter weather; influenza; bank holidays; immigrants; GPs; and today’s latest from the public health Minister, female doctors, because they get married, have children and work part time. [Interruption.] She protests, and I notice she had to put out a statement this afternoon to

“clarify discussion on female GPs” .

She said:

“I fully support women GPs, my comments were not intended to be derogatory.”

The truth is that this Government do not even know who to blame any more. It is just not good enough. While the components of the A and E crisis might be complex, the real cause is simple: you just cannot trust the Tories with the NHS.