Managing Risk in the NHS

Andrew Selous Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

Promises were made before the reorganisation to my hon. Friend and his colleagues in St Helens, Knowsley and Halton about the future of the hospital, because there was concern that certain commitments would not be honoured by the new organisations. And it came to pass: they were not honoured. My hon. Friend asked whether the Secretary of State had been to an A and E. We know that he did not turn up at one until April, yet he had already stood up and criticised hospitals for “coasting”. How on earth could he make such comments when he had not bothered to get his feet on the ground to see what was happening in the NHS? Unbelievable.

The Government took a huge gamble when they proceeded with the reorganisation at a time of financial stress and in the teeth of opposition from the public and the professions. If the Secretary of State truly believes, as he said yesterday, that transparency is a disinfectant—he is nodding—and if he wants to show leadership from the front from today onwards, should he not now commit to publishing the risk register that accompanied the Government’s reorganisation of the NHS? [Interruption.] He claims again that this was all about the last Government, but let me explain the difference to him. This Government withheld the risk register in defiance of the Information Rights Tribunal and the Appeal Court. Is he proud of that? What message does he think that that sends to the boards of those NHS organisations that he is now asking to act with maximum transparency? I am afraid that it sends absolutely the wrong message. He will not foster the right culture in risk management in the NHS if there is one rule for the Department and another for everybody else.

[Andrew Selous (South West Bedfordshire) (Con)]

What is the right hon. Gentleman’s view of the previous culture of secret board-to-board meetings, at which the boards of a local trust and a strategic health authority met in private to try to deal with issues? In retrospect, does he agree that that was probably not the best way to deal with serious issues, because the very people who were responsible would perhaps not get the blame?

[Andy Burnham]

Let me give the hon. Gentleman a direct answer. One of the things that shocked me most when I received the Francis report, which I commissioned under the previous Government, was the revelation that on receiving foundation trust status, the board of Mid Staffordshire NHS Foundation Trust had begun to hold its meetings in private, rather than in public. It had taken the freedoms, yet decided to become more secretive. That was fundamentally unacceptable, and I made that point loud and clear to the NHS when I received that report. I do not think that there is any difference between us on this. I believe in openness and transparency too. Ours was the Government who brought in the Freedom of Information Act and independent regulation for the NHS. On that matter, we can make common cause.

Tobacco Packaging

Andrew Selous Excerpts

Friday 12th July 2013 Commons Chamber

[Anna Soubry]

I think this is important. I also spoke with one of the leading experts who have been involved in the legislation in Australia, and I was quite surprised that even after about three or four months, they could not give me a picture of any emerging evidence. That is why we need this time. I believe all good legislation should be based on firm, good strong evidence.

[Andrew Selous (South West Bedfordshire) (Con)]

I am all for evidence-based policy making, not least from Australia—I declare an interest in being half Australian myself—but the Minister will be aware that my step-sister died of lung cancer at the age of 49, leaving four children. The Minister was kind enough to meet her late husband, whose children have set up the Deborah Hutton campaign to do work, particularly with young people, to prevent them from taking up smoking through innovative use of film and suchlike. What are the Government doing to prevent young people—particularly girls, whose lungs are more severely damaged by smoking—from taking up smoking?

[Anna Soubry]

I am grateful to my hon. Friend, and it was a great honour to meet members of his family. My own father died, after a lifetime as a heavy smoker, from lung cancer, so we are all well aware of the health risks. My hon. Friend makes the good point about what we are doing specifically to stop children from taking up the habit. I have explained about vending machines. Of course, there is also an EU directive; although it may not find a great deal of favour with some Members on my side of the House, it is a very good directive. Work began on it only a few weeks ago, which will mean, for example, that we will not—[Interruption.] The hon. Member for Streatham (Mr Umunna) is chuntering, Mr Speaker, and it is not always very helpful, as I know.

Accident and Emergency Waiting Times

Andrew Selous Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

My hon. Friend is absolutely right. Two-thirds of NHS finance directors have identified social care and its collapse as the single biggest driver of the pressure on A and E. The Government do not like to talk about that because of the record my hon. Friend just outlined, and I will come to that later in my remarks.

The Secretary of State visited his first A and E in April, and NHS England requested action plans only on 9 May, when hospitals had already been battling with the problem for months. It is simply not good enough. The NHS needs leadership and he has not provided it; instead, he has stuck to the spin. He continued to blame the GP contract, even when experts queued up to tell him it was not the cause of the problem. The NHS Confederation, the Royal College of General Practitioners, the King’s Fund and the Foundation Trust Network all told him that the causes lay elsewhere, but he was not listening because it did not suit his argument. When the NHS needed a Secretary of State, it was left with a spin doctor-in-chief.

That brings us to the crux of this debate and the charge that I lay directly at the Secretary of State’s door. By persisting with spin and by diverting attention elsewhere, the real causes of this crisis have been left neglected.

[Andrew Selous (South West Bedfordshire) (Con)]

If the right hon. Gentleman looks at the graph of A and E attendances, he will see that the figure was pretty constant at 14 million until 2003-04, when it rose steadily to 21 million. Why does he think that there was that big rise in A and E attendances at the time of the change to the GP contract?

Immigrants (NHS Treatment)

Andrew Selous Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

My hon. Friend might be right—we need to look at that—but as I have told my hon. Friend the Member for Dover (Charlie Elphicke), one factor is that a number of our pensioners retire to sunnier climates, which leads to that imbalance.

[Andrew Selous (South West Bedfordshire) (Con)]

Is the Health Secretary aware that general practitioners have been calling for the measures to be taken for some time? The Bedfordshire and Hertfordshire local medical committee wrote to me some time ago expressing its concerns that overseas nationals were coming here for expensive operations. It will be very pleased at what he has done today.

[Mr Hunt]

My hon. Friend speaks wisely. NHS professionals on the front line have been conscious of the problem for a long time, but have been frustrated that nothing has been done. I therefore hope that they very much welcome today’s announcement.

Accountability and Transparency in the NHS

Andrew Selous Excerpts

Thursday 14th March 2013 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

The NHS saved my life when I was 24 with an emergency operation in the middle of the night. It was there for me when I needed it, which is why I care so deeply for it.

We have heard some bad examples of what goes on in the NHS, but there are also many examples of excellent care in the NHS every day. NHS staff, especially nurses on busy wards, work extremely hard. They often rush around, have to miss their breaks and get home exhausted. We must all acknowledge that.

Today, we are debating what happened in Mid Staffordshire, but, as others have said, it was, sadly, not an isolated case. We know that 6,000 deaths in 14 other hospitals are being looked at. One area that no other Member has mentioned so far today is the training of our nurses and our doctors. Of course we want our nurses and doctors to be professionally well trained, but it is important that they do not just have academic skills. However good their biology, chemistry or maths, if they are not kind, if they are not compassionate and if they are not caring individuals, perhaps the people responsible for their training need to say to them that a career in the NHS might not be the right career for them and that research or something else might be more appropriate.

The most worrying thing that I have heard in the debate today is the comment that was allegedly made by a nurse to a patient and that was quoted by the right hon. Member for Cynon Valley (Ann Clwyd): “I am a graduate, I don’t do sick.” That is not acceptable. Other Members may also have read the article by Charles Moore in The Daily Telegraph a number of weeks ago, in which he looked in detail at whose job it is to make sure that patients are cleaned up if they need to go to the lavatory and do not get there in time. The faculty of health sciences at Southampton university made the point that ward sisters always have this responsibility, but went on to say that it is everyone’s job.

When I go round a school, I find that if a head teacher picks up the litter on the ground, surprise, surprise, there is not a lot of litter. When a doctor, however senior, sees a patient to give a diagnosis or a prescription, if that patient needs basic nursing care, no level of seniority in the NHS should be above that. That would send a powerful message that that was everyone’s job, as the faculty of health sciences at the university of Southampton said.

I am pleased that in Bedfordshire clinical commissioning group, the excellent Dr Paul Hassan has told me that there will be unannounced GP visits to the wards of the Luton and Dunstable hospital and other hospitals to which Bedfordshire sends its patients. There will be private TripAdvisor-style patient reports coming back—not report forms handed by a sister to a patient and filled in while the sister is leaning over them, but done genuinely in privacy so that GPs can get a proper report of what is happening. There will be real-time alert buttons on the keyboards of GPs and clinicians so that they can flag it up immediately if things are going wrong. That is excellent. That is the way to get an early indication of what is going wrong.

In addition to outstanding nursing care by caring, compassionate nurses, we need clinical leadership. We need the medical directors and the chief nurses of hospitals to step up to the plate. We need medical directors who are front-line clinicians—that is really important—and we need hospital boards to make sure that they have the proper data. Data on bedsores, for example, should be available at every trust board meeting. If the incidence of bedsores is increasing, that may be an indication that things are going wrong in the hospital. That information should be seized on and acted on urgently.

Above all, we need the medical director and the boards of hospitals to foster an esprit de corps and to create an understanding among all the staff that “we don’t do average” and that excellence is what they should aim for. We need a culture where peer review and challenge are normal, natural, accepted and of benefit to everyone. In that vein I commend the “Getting it Right First Time” report by Professor Tim Briggs, which is looking at a clinically-led hub and spoke peer review model in orthopaedics. That could usefully be extended across the whole of the NHS.

NHS Funding

Andrew Selous Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Burnham]

This is the reality on the ground, as my hon. Friend says. There is also the mental health budget cut. There has been a mismatch; people see all those things, yet they hear the statements from the Government, and it does not make any sense, but now the truth and the facts about our NHS are being told, and things will begin to make sense to people.

What I find most troubling about all this, and most revealing about the Government’s style and the way that they work, is that even when they are warned by an official watchdog, they just carry on—as they are doing today—as if nothing had happened. When they admitted cutting the NHS in 2011-12 by amending their website, what was the excuse that they offered to Sir Andrew? Labour left plans for a cut; that is what the Prime Minister said at the Dispatch Box last week. It is what the Secretary of State said in a letter replying to Mr Dilnot. Again, that is simply untrue.

According to Treasury statistics, Labour left plans for a 0.7% real-terms increase in the NHS in 2011-12. From then on, we had a spending settlement giving real-terms protection to the NHS budget. It was this Government who slowed spending in 2010-11, who allowed the resulting £1.9 billion underspend to be swiped back by the Treasury, contrary to the Secretary of State’s promise that all savings would be reinvested, and who still have published plans, issued by Her Majesty’s Treasury, for a further 0.3% cut to the NHS in 2013-14 and 2014-15, contrary to the new statement that the Conservatives have just put on their website. The Secretary of State has a lot of explaining to do.

[Andrew Selous (South West Bedfordshire) (Con)]

I should be interested in the right hon. Gentleman’s comments on the statement by John Appleby, the chief economist of the King’s Fund, who said that before the general election, the former Chancellor left plans for 2011-12 and 2012-13 that would see a cut in real terms. What does the right hon. Gentleman say to that?

[Andy Burnham]

I have not seen the quote, but I did the deal with the former Chancellor of the Exchequer just months before the general election, protecting the NHS in real terms. A deal was done for schools and for the Home Office too. Those were the plans. At the election I was arguing for real-terms protection. The Secretary of State was on the hustings calling for real-terms increases. I said it would be irresponsible, yes, to give real-terms increases over and above real-terms protection because the only way he could pay for that would be taking it off councils, hollowing out the social care budget. That is what I said at the election, but the right hon. Gentleman has not even given real-terms protection. He has cut the NHS in real terms, so it beggars belief that he has the nerve to heckle and shout out from the Front Bench, when he has cut the NHS lower than the plans that I had left in place.

Winterbourne View

Andrew Selous Excerpts

Monday 10th December 2012 Commons Chamber

[Norman Lamb]

I thank the right hon. Gentleman for his important questions. First, we want to ensure that advocacy is available to help those families and individuals, ensuring that they are placed in appropriate settings and away from these long-stay institutions that we all find completely unacceptable. I very much agree with him on that, and I find myself in agreement with him again on prisons. We shall come forward next year with some clearer proposals on approaches to diversion—assessing someone’s needs before they end up in prison, diverting them, if at all possible, to much more appropriate settings.

[Andrew Selous (South West Bedfordshire) (Con)]

I was not sure I heard the Minister correctly when he said that the average fee was £3,500 a week, which is £182,000 a year. Is it not possible to pay some of the caring staff slightly more and demand not only the highest level of skills, but the highest level of compassion for that level of fee from the state?

[Norman Lamb]

I thank my hon. Friend for that question. He is absolutely right that an extraordinarily high sum was being paid to put people at risk of abuse —and to be abused, as it turned out in Winterbourne View. Pay rates are not ultimately the responsibility of Government, but one would hope that responsible organisations look to train their staff to a high standard—that is absolutely a prerequisite and they will be held to account by the Care Quality Commission for proper training—and, wherever possible, to provide better pay rates so as to ensure that people are rewarded for the incredibly important work in our care sector.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Lansley]

No, I will not accept any such thing. We are aiming to reduce agency staffing costs in the NHS under QIPP—the quality, innovation, productivity and prevention programme—by £300 million, and we have already made a reduction of more than £120 million. Since the election, in complete contrast to the situation beforehand, we have reduced the number of administrative staff in the NHS by 15,000, including a reduction of more than 6,000 managers. We have also increased the number of clinical staff by 4,000 since the election.

[Andrew Selous (South West Bedfordshire) (Con)]

4. What steps he is taking to improve the quality of care provided in residential and nursing homes.

[Laura Sandys (South Thanet) (Con)]

9. What steps he is taking to improve social care services.

[The Minister of State, Department of Health (Paul Burstow)]

The White Paper introduces new measures to help us to deliver better quality services and to improve the care that people experience, including through greater transparency, with new provider quality profiles and new care audits. It also clarifies what quality in care and support means, by setting out principles, standards, roles and responsibilities for driving up the quality of care. The White Paper makes it clear that we will rule out crude commissioning by the minute, which turns care workers into clock-watchers, and that we will work with commissioners, care providers and people who use services and carers in order to bring to an end commissioning practices that undermine people’s dignity and choice.

[Andrew Selous]

I recently visited Ashton Lodge residential home in Dunstable, and I was delighted to hear from the residents how kind the staff were. Occasionally, however, I get letters from constituents detailing simply unacceptable levels of care for their family in residential homes. How can we involve local communities more so they take a role in ensuring that all residential homes have consistently high standards of care?

[Paul Burstow]

I am grateful for that question. Indeed, one of the issues set out in the White Paper is the collaboration by the Department of Health and others with leaders in the care sector to make sure that care homes become much more embedded as part of their local communities and much more genuinely open to their local communities—working with local schools and working with HealthWatch, which will have powers of entry to work with those care homes as well. By turning the spotlight on in a benign way, making sure that all care homes are more open to their public, I think we can significantly improve quality.

Health

Andrew Selous Excerpts

Tuesday 17th July 2012 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

I wish to raise the issue of neuroblastoma. I do so as someone who is proud of this Government’s record on the health service and who strongly supports their introduction of the cancer drugs fund.

Neuroblastoma is an aggressive childhood cancer affecting about 100 new children in the UK each year. It is the most common cancer diagnosed in infancy and is responsible for 15% of cancer deaths in children. There are very few treatments available in the United Kingdom for children with high-risk neuroblastoma, particularly those who have relapsed, and they have to travel abroad for treatment, generally to Germany or the USA.

I had never heard of neuroblastoma before my constituent, Mr John Macglashan of Dunstable, came to see me in March this year. His two-year-old daughter Lilly has stage 4 neuroblastoma. The Neuroblastoma Alliance, along with the people of Dunstable and the surrounding area with the help of The Dunstable Gazette, have helped to raise funds to send Lilly for treatment in America. The whole family is going through an enormous ordeal, and I want to relay their experiences to the House, and make four suggestions to the Minister as to how the UK can improve the provision of treatment for children with neuroblastoma.

First, I know that the Government want high-quality treatment for children with neuroblastoma to be available in the United Kingdom, and I strongly support that. To that end, the Government are participating in a European collaborative research network on neuroblastoma through the Société Internationale d’Oncologie Pédiatrique en Europe. That European trial does not appear to adhere to UK ethical standards of offering the best treatment available as a baseline for all children meeting the eligibility criteria. I urge the Minister to make sure that the best treatment available is offered as a baseline for all children in the United Kingdom.

My second concern is that clinical trials in the UK are taking far too long to begin. In March 2010, the Department of Health agreed to commence a new trial to give monoclonal antibody therapy to all children who might benefit from it, but according to the Neuroblastoma Alliance, that has not yet begun. The Government should ensure that this trial commences as quickly as possible.

Thirdly, it is important that the Government ensure that there is a standard procedure for allocating funds for treatment abroad across all primary care trust areas. That is particularly important as there are currently no NICE guidelines on the subject, which remains important while there is no viable treatment available in the UK. My constituent Mr Macglashan has taken his daughter Lilly to the Memorial Sloan-Kettering cancer centre in New York at considerable personal expense and with huge funds raised by the Neuroblastoma Alliance, a charity that campaigns for children with the condition. Mr Macglashan tells me that in the same hospital there are children from Norway, France, Spain, Italy and Greece, all of whom are being funded by their national health services while his family has had to rely on charity.

Fourthly, it is important that the best treatment options from abroad, whether from Germany or the USA, should be examined and, where the clinical evidence supports the case, introduced into the United Kingdom as quickly as possible. At the moment, there are too few options available for high-risk neuroblastoma children who fail to achieve a lasting remission after front-line treatment. In the UK, parents see a system that gives up on their children too soon while there should still be hope. Much higher numbers of children are surviving for much longer with the American treatment, and some are achieving permanent remission following treatment at the Memorial Sloan-Kettering cancer centre in New York. We need to make sure that that level of expertise is available here in the United Kingdom.

This is not simply a call for even greater NHS spending than the Government are currently budgeting for, as the costs of prolonged chemotherapy and radiotherapy in the UK are not cheap and have been shown to have less success than the treatments provided in America. It appears that the UK is not spending its health budget as effectively as it could in this regard, and I ask the Government to look again at the issue. The NHS already sends children suffering from cancer for treatment in America—for proton radiation treatment, for example—so no precedent would be set by sending more children for treatment in America and Germany.

Finally, I ask the Government to look at the training of consultants in neuroblastoma, as there are too few who specialise in this area.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Lansley]

I am grateful to my right hon. Friend. I have no proposals for sanctions, but I commend to him and his trust the many mechanisms that are available, which they may know about, such as sending text messages to mobile phones. I have seen them in practice, and they do stimulate patients to attend their appointments and so reduce what has been an unacceptable level of non-attendance.

[Andrew Selous (South West Bedfordshire) (Con)]

9. What recent progress the NHS has made in improving outcomes for orthopaedic patients.

[The Secretary of State for Health (Mr Andrew Lansley)]

Substantial progress has been made through innovative approaches and improved risk management, leading to increased survival after fragility fracture, improved trauma care and better governance of hip implants. The latest results to December 2011 show improvements in patient reported outcomes for both hip and knee replacements.

[Andrew Selous]

Does my right hon. Friend share my concern about the significant increase in hip and knee revisions over the past five years or so? Does he support Professor Tim Briggs’ proposals to deal with that in his report, “Getting it right first time”, which is supported by all the professional associations and which NHS London is looking to adopt?

[Mr Lansley]

An increased number of hip and knee revisions is one of the consequences of an ageing population. I welcome Tim Briggs’ report, “Getting it right first time”. His recommendations are sensible. I am pleased to note that it has the support of the British Orthopaedic Association, as well as clinicians in London. It will help us build on the progress that is being made, to which I referred. The latest figures show that the proportion of hip fracture patients who receive all elements of the best practice tariff has risen from 24% in 2010 to 37% in 2011, and to 55% in 2012. That achievement has attracted international interest and is undoubtedly saving lives.