Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 11th June 2013 Commons Chamber

[Anna Soubry]

I pay tribute to my hon. Friend’s campaign, which he has been running for some time, and to all the great work that he does for Lister hospital. I am slightly worried that if I give him any support it might be the kiss of death for his campaign, but I wish him all the very best and all power to his elbow.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

One group of people greatly affected by a cancer diagnosis are the carers who suddenly find themselves to be carers of people with cancer. Yesterday I met some people who are carers of people with cancer, and they told me that they did not get the information, advice and support that they needed to tackle that important caring role. Does the Minister agree that it is about time that we recognised those carers and started to give them the advice and support that they need because they suffer financial loss, hardship, loss of career and impacts on their own health?

[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.

Accident and Emergency Waiting Times

Barbara Keeley Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

It is important for me to answer the Chairman of the Health Committee. Those of us who are in the club of former Secretaries of State understand that the health and social care systems are interconnected and must be seen as one system, because the failure of social care lands on the doorstep of the NHS.

To answer the right hon. Gentleman’s point directly, the money that I was talking about would come from the underspend. It is part of the allocated budget that his Government gave to the Department of Health for 2012-13. The Department did not spend the whole budget so there was a £2.2 billion underspend. As he knows, the practice has been that Departments can take forward that resource to meet new pressures in later years. I am asking the Secretary of State please to ask for access to that money to relieve the pressure on social care. Simply handing it back to the Treasury when there is an A and E crisis and social care is collapsing is not good enough.

The third point I want to address is out-of-hours advice and the introduction of the 111 service. Last week’s summit heard worrying evidence that the problems of 111 are not just teething problems, as the Secretary of State has claimed. We were told that the problems were more structural and were a result of how 111 has been set up—a feature of the cost-driven contracts that have replaced the successful and trusted NHS Direct. Contracts have gone to the lowest bidder, and they are saving money by having inexperienced call handlers working to a computer algorithm that too often results in the advice “Go to A and E”. There has also been a huge reduction in nurse-led call back, which was the norm with NHS Direct.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Does my right hon. Friend know that we had a useful debate on this subject in Westminster Hall this morning, when I made the point that the dropping back from clinician-led triage has caused a problem that the chief executive of my local hospital told me about—that falling back on computer and non-clinician advice has led to patients being brought into the emergency departments when they were actually on end-of-life pathways and should have community input?

[Andy Burnham]

That shows the human cost of the failure that we have seen in recent weeks; my hon. Friend has identified yet another aspect of it.

There has been a huge reduction in nurse-led call back, so inexpert advice is being to people who should probably have other options put to them. An internal graph produced by NHS Direct shows that under the old 0845 NHS Direct service, about 60% of calls received a nurse call back; under 111, that has now dropped to between 17% and 19%. What is happening to these people? They are getting poor advice, so they are frightened and are going to A and E. What is this Secretary of State doing about it? Absolutely nothing.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

We have a crisis in A and E; that is clear from this afternoon’s debate. The King’s Fund report this week detailed the worst performance in nine years, with 5.9% of patients waiting more than four hours. It has been suggested that patients are just going where the lights are on. Is that the case?

I got information on A and E from the chief executive of Salford Royal NHS Trust, comparing the third and fourth quarters of 2011-12 with those in 2012-13. He found that there are 10% more ambulance arrivals every day. We actually have sicker patients, with more arriving by ambulance. There has been a 13% increase in admissions of people staying longer than 72 hours, and fewer are staying for shorter periods. There are 25% more triages into the hospital’s resuscitation area, and there has been a significant increase in risk and co-morbidity among patients and increased admissions into critical care. There is something going on there.

We know that the rising demand for A and E is particularly concentrated in those aged over 85, and cuts in social care budgets are now widely acknowledged as contributing factors. My local authority of Salford must make £24 million of cuts this year. It is the third year of cuts, and now the authority, having held on to services meeting a moderate level of eligibility, is moving to meeting only substantial levels of eligibility, taking £3.5 million out of adult social care this year and £3.5 million next year. Our former Salford primary care trust had already cut the two walk-in centres that we had, and axed the pilot of active case management for people with long-term conditions.

How is that affecting people? What do carers say? Carers UK has carried out a survey of 3,500 carers, 55% of whom are caring for a person who has been admitted to emergency hospital services in the past three years. A significant percentage of those carers referred to areas where additional support could have prevented those emergency admissions. What types of care were needed? Six per cent. said that they, the carer, needed replacement care because they were ill themselves; 21% per cent. needed a higher quality of care and support for the cared-for person; 10% needed adaptations in the home, and 7% would have been helped by telecare and telehealth. Those findings tie in with some of my casework in recent weeks, when I have heard some very similar cases.

The King’s Fund report tells us that the prospects for adult social care are bleak. Councils are planning to reduce their budgets by another £800 million a year. That is a cumulative cut since 2010 of 20% in adult social care. My local hospital tells me that patients are coming in sicker, they are admitted for longer stays, they require more time and attention and they are now heavy resource-users. It is time that Ministers stopped making excuses and started dealing with this crisis.

[Madam Deputy Speaker (Dawn Primarolo)]

I call Andy Slaughter. You have one minute.

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[Anna Soubry]

That sort of cheap comment does the hon. Lady no justice whatsoever or credit. Let me explain to her—I was here for the debate, and she was not—that I did not in any way blame women doctors. As someone who has worked as a woman professional all my life, I really do not want to hear any lessons from Opposition Members. What I did was echo the comments of the president of the Royal College of General Practitioners, and I paid tribute to all our GPs for their hard work and dedication to our NHS, and to their patients.

There are immense pressures on the NHS as a whole, and on A and E in particular. Our A and E departments are dealing with 1 million more people than they did when the previous Government were in power. The causes of that increase in demand are complex: a long, cold winter; an ageing population; and more people with long-term conditions. The system itself, let us be honest, has not helped, from poor integration between health and social care to the lack of public confidence in out-of-hours primary care services. We can have an argument about the 2004 GP contract, but as the hon. Member for Southport (John Pugh) rightly said, it has not helped. Today, we have a situation in which, if people do not know where to go, or they are not sure that they will get a good service, they go to A and E. In a recent hearing by the Select Committee on Health, Dr Patrick Cadigan, a registrar from the Royal College of Physicians, set out the position perfectly:

“Patients will go where the lights are on. In many of these alternatives, the lights are not on after five o’clock in the evening or at weekends.”

That presents a set of challenges that the Government are determined to address. First, it is important that we deal with the current situation, and we are.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No.

Already, emergency departments have recovered from the dip in performance over the winter. [Interruption.] The hon. Member for Denton and Reddish did not give way, and I am adopting his admirable approach in this debate.

For each of the past five weeks, the four-hour waiting time target has been either reached or exceeded. The average wait in A and E is currently 50 minutes. More importantly, we are making the NHS fit for the future: a future where care is designed and delivered around the specific needs of an individual patient; where care is integrated across primary and secondary care and across health and social care; and where local clinicians, not national politicians, decide what is best for their communities. The Government have taken tough decisions that will create a strong and sustainable NHS, now and for generations to come. The Health and Social Care Act 2012 has finally brought local health and social care communities together to design integrated services around the needs of their patients, building in strength for the future. So if more services are needed outside hospitals, local clinicians working with community partners can make those decisions, without having to wait for a Minister to tell them what to do.

We have not stopped there. We have provided £7.2 billion to local authorities for social care. We have given hospitals the ability to carry over underspends—free to pool their budgets locally to improve care for patients. We have new urgent care boards which will use the savings from the marginal rate emergency tariff to reduce pressure on A and E. The NHS Medical Director, Sir Bruce Keogh, is currently reviewing the provision of urgent and emergency care. This autumn the vulnerable older people’s plan will set out how we will improve primary and out-of-hours services for the frail and the elderly and how we can remove barriers to integrated care. At every step of the way we are putting local doctors and nurses in charge and designing care around the patient.

I shall deal briefly with some of the very good speeches that were made on both sides of the House. We heard first from two former Secretaries of State for Health, the right hon. Member for Holborn and St Pancras (Frank Dobson) and my right hon. Friend the Member for Charnwood (Mr Dorrell). Both were eloquent and informed. I have to say that the speech and the comments of my right hon. Friend found more favour with me. The hon. Member for Lewisham East (Heidi Alexander) asked for a grown-up debate, and we had a good contribution from my hon. Friend the Member for Totnes (Dr Wollaston). I have addressed the unfortunate remarks that she made, perhaps not having read Hansard, if I may say so.

I turn to other valuable contributions. The right hon. Member for Cynon Valley (Ann Clwyd) made a contribution, as we would expect. Then we heard from my hon. Friend the Member for Brigg and Goole (Andrew Percy), who spoke briefly about his local experience in his constituency and brought those experiences, rightly, into the debate. He touched on walk-in centres, an issue that was raised by—I nearly said my hon. Friend; I beg his pardon if that is in any way disparaging to him—the right hon. Member for Rother Valley (Mr Barron), who beautifully forgot that any decision about the future of any walk-in centre is a local decision. It is for local people—[Interruption.] I am not knocking anybody; I am explaining the facts. I appreciate that the right hon. Member for Leigh (Andy Burnham) has a problem with the facts, but the facts are that these are local decisions made by local communities and local clinicians.

My hon. Friend the Member for Bracknell (Dr Lee) gave a thoughtful and challenging speech, and I hope that many will take that away and listen to what he said. I shall deal briefly with the comments of my hon. Friends the Members for Lancaster and Fleetwood (Eric Ollerenshaw) and for Stevenage (Stephen McPartland) and the hon. Member for Cheltenham (Martin Horwood), who spoke about some of the difficulties that we have with the recruitment of doctors. Departmental officials have met. We know that it is a problem. We have worked with the College of Emergency Medicine and we know that we need to tackle the problem. We did that in 2011 and those issues will in due course be considered. I hope we will see some changes.

The hon. Member for Mitcham and Morden (Siobhain McDonagh), as ever, championed her local hospital, as I expect her always to do, but she spoke about a lack of public consultation and many of us will take away her wise observations on that. It is important to remind the House of the comments of my hon. Friend the Member for Lancaster and Fleetwood. He, like others in the debate, reported that his constituents get a good service from good staff. All of us should remember that.

To conclude, in challenging circumstances, and with this Government’s support, the people of our NHS are performing admirably. There are over 400,000 more operations now than under Labour. The proportion of cancellations remains unchanged. Fewer than 300 people—276—are waiting more than a year for an operation, compared with 18,000 under the Labour Government. Some 8,500 more clinical staff are working in our NHS, including 5,700 more doctors. MSRA rates have halved. Mixed-sex wards have been practically abolished. We are finally moving towards a paperless NHS by 2018. In addition, in stark contrast to the Labour party’s plans, we now have a protected NHS budget, with real terms—

111 Telephone Service

Barbara Keeley Excerpts

Wednesday 5th June 2013 Westminster Hall

[Miss McIntosh]

I believe a local solution should be found. A question I will come to is whether there is a difference in the roll-out of the service in rural and urban areas—in my hon. Friend’s case, an island. Local solutions must be found. To me, the best solution will always be for someone to see their own GP on the day they are ill.

I hope that my hon. Friend the Minister will put our minds at rest and say that the story in the newspapers about rationing our visits to GPs is a myth. We cannot dictate how often we will be ill. If an elderly person has a chronic condition, they cannot limit the number of times they might have to call on a medical service in one year.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

rose—

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

Will my hon. Friend give way?

[Miss McIntosh]

If I may, I will give way first to the hon. Member for Worsley and Eccles South (Barbara Keeley).

[Barbara Keeley]

I thank the hon. Lady; she is being very generous with her time. Dr Clare Gerada of the Royal College of General Practitioners told the Health Committee yesterday that many GPs’ books are now full at 8.30 in the morning, and that if they have open slots there are often queues down the street, which she said she had not seen for years. I agree with the hon. Lady that we need more GPs, because that is what most patients want.

[Miss McIntosh]

I know what I am going to say is controversial but perhaps I, as a woman, can say it. Some 70% of medical students are women and they are well educated and well qualified, but when they go into practice, many marry and have children—it is the normal course of events—and they then often want to work part time. Training what effectively might be two GPs working part time obviously puts a tremendous burden on the health service. I will now give way to my hon. Friend the Minister.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak under your chairmanship, Mr Robertson. I congratulate the hon. Member for Thirsk and Malton (Miss McIntosh) on securing this debate and on the way that she has opened it, which has been really helpful.

The British Medical Association has consistently expressed serious concerns about the transition from NHS Direct to NHS 111. I understand that the BMA wrote to the then Health Secretary—the Leader of the House of Commons, the right hon. Member for South Cambridgeshire (Mr Lansley)—in February and April 2012, to warn

“of the dangers of rushing implementation of NHS 111.”

It also wrote to Earl Howe, the Health Minister, and to the chief executive of NHS England, David Nicholson, urging them

“to delay the launch of NHS 111 beyond April 2013, due to concerns that many areas were not ready for the transition.”

Those concerns were borne out when the service was launched in Greater Manchester on 21 March, prior to the national launch one week later. I have collected information on the launch in Greater Manchester from the chief executive of Salford Royal NHS Foundation Trust. He told me:

“Significant operational problems were experienced when 111 first launched at the end of March and these problems persisted for the first two weeks of operation. 111 did not equip their call centre with the required levels of trained staff and were therefore unable to deal with the volume of calls received; some patients were left waiting up to an hour to get through on the phone lines and as a result patients just turned up at A&E/GP Out Of Hours Service causing significant capacity and demand issues.”

That is just the point that the hon. Member for Thirsk and Malton made about what people would do if they could not get through to 111.

Senior staff of the Salford clinical commissioning group told me that NHS Direct had given assurances that it had the capacity to handle calls, but after the failures that we experienced in Greater Manchester, NHS Direct admitted that it had insufficient call handlers in place. Apparently, when these problems occurred, 111 asked all GP out-of-hours providers to return to their pre-launch call-handling service. However, that was not an option for us in Salford, as our previous call handlers had transferred all their staff over to 111 under TUPE arrangements. So the problems with NHS 111 continued. Salford CCG staff also told me that the out-of-hours service in Salford came under pressure owing to this NHS 111 failure, and that pressure had to be met with increased staff capacity.

Salford Royal NHS Foundation Trust has commented that further improvement to the service is still required. It feels that

“the care pathways still need further modification to reflect local services”

and that

“there are currently gaps in alternative routes of care”,

which the 111 service is showing up. If there are issues with social care, the community team, the district nurse or self-care, that becomes apparent. The trust also said—this is important for our debate this morning—that

“there are also concerns that what we have done with this service is to replace clinician triage in Out of Hours service with computer or non-clinician advice.”

To give an example of the problems that this change has caused in Salford, I will quote the trust again:

“This has led to patients being brought to the emergency department when they are actually on end-of-life pathways”

and should have “community input”. That is just the problem that the hon. Lady talked about—that situation has happened in Salford. It is distressing to think of people who are in their last few days of life being dragged into hospital, when they should really receive care in their own community and in their own home, which is the care that they probably desire.

Salford CCG has reported that feedback forms on NHS 111 have been received from clinicians and that two “significant events” were recorded, which are under formal investigation. The feedback tends to relate to delays in treatment. The CCG also says that its

“immediate priority has been to stabilise the service after a disappointing start. Some positive improvement has occurred but long term there are serious doubts, with NHS Direct identifying the need for extra investment about the contract level to make the service effective.”

I was also told by staff at Salford Royal NHS Foundation Trust that they felt that expectations were set too high about the outcomes that 111 would deliver. They commented that NHS 111 was operating at a level and in a role that an “experienced grandmother” might historically have achieved. That is an important point; my local NHS trust thinks that is what it is getting from the service. That advice—that of an “experienced grandmother”—could be seen as helpful, but staff told me that their preference was for

“an alternative service which had at its core clinically trained primary care staff available over an extended working day, 7 days per week.”

They also believe

“that this service would be better if it was included within a single integrated urgent care service, incorporating responsibility for GP out-of-hours triage.”

[Guy Opperman]

I am listening to the hon. Lady’s contribution, and given her background, it is clear that she is a specialist in this area. Like her, I met staff from my local CCG and local ambulance service last week to discuss the development of this system. I note that she talks about integration. Does she agree that the integration of those various parts of the NHS system is the absolutely crucial thing going forward?

[Barbara Keeley]

Indeed. We talk a lot about integration, but the feedback that I have received from both my local CCG and my local NHS trust is that we have just taken a backward step. We had a nurse-led service that was working fairly well, although it was not as integrated with other services as it should have been. We now have a system that is led by computer scripts and non-clinicians, in which the patients calling the service—if they get through to it—do not have confidence, and as a result, they are falling back on visiting their GPs or going straight to A and E. My point was that that single, integrated urgent care service—the single service that the hon. Gentleman just talked about—should include responsibility for GP out-of-hours triage, and at the moment it does not. The system could have been set up that way, but it was not. Does the Minister believe that the alternative that I have just put forward is the right direction for an improved NHS 111?

Beyond our experience in Greater Manchester, there have been many criticisms of the NHS 111 service and the shambolic transition to it from NHS Direct. Dr John Hughes, a GP from Manchester, said the service had been withdrawn in his area hours before the launch, owing to problems. He told the BBC that it was “an omnishambles” and

“a waste of public money.”

Dr Hughes has called for a full public inquiry into the procurement of that service, because he feels that it was

“forced forward to meet a political objective.”

Janet Davies of the Royal College of Nursing has argued that nurses from NHS Direct have been running NHS 111. She told the BBC for a report:

“Staff from NHS Direct, the service being abandoned, are supplementing the work of 111—staff that were being made redundant and still are at the end of this month… Specialist nurses that can talk to patients have not left and they are propping up that service.”

She felt that, unlike the nationally run NHS Direct, NHS 111 was a

“fragmented service with local contracts”,

which in her view was “very, very chaotic”. She also said that NHS 111 was an attempt to cut the cost per call, by using non-clinical staff to handle the majority of call time, and that it was

“not using qualified nurses, people with the skills to talk to people and make a sensible decision”.

She felt that the Government had thought about costs but not value. As we have seen, NHS 111 is offering poor value if patients turn away from that service, because it is far more expensive to go to A and E or a GP than to have a conversation with a trained nurse.

In Salford, patients were left waiting on phone lines for up to an hour and then turned to the more expensive options of a GP visit or A and E. Our out-of-hours service came under pressure and extra staff capacity had to be brought in. The opinion of staff at Salford Royal NHS Trust is that NHS 111 operates at a level and in a role that an “experienced grandmother” might achieve. Surely, we can and should do better.

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[Mr Reed]

I am going to make some progress, because I want to get on to the substantive issues in play.

When Labour first suggested a new NHS 111 service, we were clear—the hon. Gentleman should listen—that it would not replace NHS Direct. Our manifesto in 2010 said:

“A new national 111 telephone number will make nonemergency services far easier for people to access and book.”

The 111 service was planned to help people find an emergency dentist, a late-night pharmacy or an out-of-hours primary care GP. This Government scrapped that and instead pressed ahead with the botched implementation of a system that just could not cope with what it was expected to do. They were warned, but, as usual, they did not listen.

There is no doubt that the 111 service is not fit for purpose. The statistics show it, the examples given by Members today show it and, most importantly, patient testimonies show it. Indeed, the Minister herself acknowledged it in response to the right hon. Member for Mid Sussex (Nicholas Soames) in late May, when she stated:

“We recognise that the service has not been good enough and we are working closely with NHS England to ensure improvement in performance. NHS England have put a number of measures in place already.”—[Official Report, 21 May 2013; Vol. 563, c. 740W.]

I hope the Minister will outline what those measures are and what their effects have been, because the contributions we have heard today suggest they are having a negligible effect.

The implementation of the system has undoubtedly caused serious problems; indeed, in my area, NHS Direct is having to be maintained alongside the 111 service to cope with demand. The Minister must explain in detail how a botched, fragmented implementation was allowed to happen despite there being a significant pilot scheme.

[Barbara Keeley]

On the issue of propping up NHS 111, I wonder whether this is the point at which to give credit to the NHS Direct nurses whom Janet Davies of the Royal College of Nursing cited. Even though some of them are being made redundant, they were prepared to prop up the service during its few weeks in places such as Greater Manchester. We really should give those nurses credit. What a dreadful experience, just before they were made redundant, to have to prop up the service that was replacing them.

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

It is a pleasure to serve under your chairmanship, Mr Robertson, for what I believe is the first time.

My hon. Friend the Member for Thirsk and Malton (Miss McIntosh) made an admirable speech, raising many points and asking many questions—some of which, I will say bluntly, I will not be able to answer in my speech. I assure her that she will receive an answer to those by way of a letter. Before I discuss her speech, I want to deal with the points raised by the hon. Member for Copeland (Mr Reed). It does neither him nor his party any credit to use the serious problem in A and E as a political device to attack the coalition Government. It is not as simple as that. To suggest that the problem has been caused by the Government is plain, simple rubbish. It is accepted that there are many complex reasons for the situation, although I am reliably informed that the number of people being seen within the four-hour target is improving and that many accident and emergency departments are achieving the target, and have been doing so for some weeks. Some, indeed, are exceeding it.

There is much evidence emerging that a firm grip is being taken on the situation, but things are complex. There is no magic bullet. It does not matter which party is in power, the Government would face the problem that we have, because there are many causes. One of them, which people on all sides of the argument have identified, is the fact that we do not have the out-of-hours service we want.

[Barbara Keeley]

The Minister says that the issue is complex and accuses the shadow Health Minister of making political points. It is about time that Health Ministers stopped making excuses. They have been in office three years and it is time they started to take responsibility for what they are doing.

I have gathered evidence, and the causes of what has happened clearly include insufficient call handlers, which is not complex—it is just a shortage of staff. Another factor is the replacement of trained nurses and trained clinician input for phone triage with computer-led or non-clinician advice. Those things are not complex. They are just wrong.

[Anna Soubry]

I am not for a moment saying that there are not difficulties and problems in 111. We know there are, but if only the issue were as simple as solving the 111 problems. The out-of-hours service is just one of many factors. [Interruption.] I want to make some progress on this point: 111 is one factor among the failings in relation to the sort of out-of-hours service that people want. We have also had the difficulty of a long, cold winter, which has added pressures—that is something that often happens. Also, there are 1 million more people attending A and E. That is not the fault of the Government. We have not suddenly caused it. It is because of changes—

--- Later in debate ---

[Anna Soubry]

I will not accept any of what the hon. Gentleman says, because he does his cause no service when he makes cheap political points. The matter is hugely complex, but it is wrong to say that the Government caused the problems in A and E. He is wrong in that. It is difficult and complex.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No, I will not. The responsibility, if we are honest—would not it be refreshing if we could for once have an honest debate about the national health service?—probably goes back 10 or 20 years, a period encompassing Governments of different political colours. I am happy to say that—by which I do not mean I am happy that those Governments have failed, but people may think the honesty is refreshing.

I want to deal now with the excellent speech of my hon. Friend the Member for Thirsk and Malton. I pay tribute to her and her work in this place, but also to the considerable efforts and work of her late father. I am sure that if he could have heard his daughter’s speech he would have been very proud. I remember my own father saying that out of all evil comes some good, and perhaps some good may come from her late father’s terrible experience of 111 and the fact that he died shortly thereafter.

I pay tribute to all GPs. There are huge difficulties with the GP contract, which was introduced in, I think, 2004. The consequences have included the loss of the out-of-hours service that I enjoyed as a child, teenager and young woman. With few exceptions, we have wonderful general practitioners, and many whom I know, including my own, and others who are friends of mine, work long, difficult hours. It is important to make that point.

As you know, Mr Robertson, during the recess, far from enjoying holidays, as the popular press makes out, we go back to our constituencies and use the time to make or renew contact with, for example, our local clinical commissioning group or ambulance trust. Alternatively we just go out and about, as I have done, knocking on doors and talking to people. One of the things I did during my recess was meet the head of the A and E department of the Queen’s medical centre, which is the local hospital in my constituency of Broxtowe in Nottingham. The head happens to be one of my constituents, and they tell me that there is much improvement at the Queen’s medical centre, as I know from the stats and so on. I also talked to GPs, and the CCG in my constituency now opens its doors for Saturday morning surgeries, which do not replace any other surgeries; they are extra facilities. The CCG has done that for two simple reasons: first, to improve the service it gives to its patients, and, secondly, in recognition of the need to reduce the pressure on the A and E department of the Queen’s medical centre.

It is right and fair to say that many GPs look with concern at what is happening in many of our A and Es, and with 111, which is commissioned in some areas by CCGs and in other parts of England by clusters of GPs. They are by no means fools. What motivates anyone to enter the medical profession, in my experience, is a real desire to serve people. They want to help and treat people. They are motivated by the very best of motives, so of course our GPs are concerned about the situation.

There is much work to be done with the GP contract to improve out-of-hours service, but we also have to be honest in this debate. There are often urban myths and anecdotes, but it is a fact that many GPs have already said that, far too often, people who come to see them in their surgeries, who attend A and E or who dial 999 or 111, are calling when they do not need to make that call or that appointment. They might be better off making their pharmacist their first port of call.

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[Barbara Keeley]

The Minister talked earlier about the issue being about out-of-hours service. The NHS 111 problems in Greater Manchester put greater pressure on our out-of-hours service. She said there was a long winter, but 111 was rolled out at the end of March. Does she think that was a sensible time? It was not even the end of a very hard and long winter. Finally, she said that we have had more A and E attendances, but the problems have caused further pressure on A and E. The point many hon. Members have made, which I hope she accepts, is that the chaotic launch of NHS 111 in the end part of winter caused more problems than it solved.

[Anna Soubry]

Again, I do not think it is as simple as that. Of course we have not been happy with the roll-out of 111, which is accepted. The service has not been the success that we had hoped. We agree on that.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No; forgive me. The most important thing, though, is that things are improving.

A and E Departments

Barbara Keeley Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

My hon. Friend will be pleased to know that that actually happens in many places throughout the country, but we need to go even further. When it comes to the most frail, vulnerable older people, we need to commission services in a way that ensures that someone outside hospital knows what is happening with them the whole time, is accountable for their care and treatment, and can pre-empt the need to seek emergency care in the middle of the night. That will be the key to ensuring that the pressures on A and E are sustainable.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Today, the Health Committee heard that this Government’s cuts to social care were a direct cause of increased A and E attendances: patients cannot be returned home on time, and all the services that used to keep people well have been cut. This Government cut local authority budgets, resulting in £2 billion going out of adult social care. Will the Health Secretary now accept what the experts are telling us on the Health Committee: that that is the direct cause of the increased A and E attendances?

[Mr Hunt]

Once again, the Labour party opposes every single cut made by this Government then tries to pretend that it is serious about getting the deficit under control. On this point, I remind the hon. Lady that the NHS is giving £7.2 billion of support to the social care system for health-related needs, precisely in order to ensure that services are not compromised. Where they have been compromised, we are looking into it and we are disappointed about it, but we continue to monitor the situation and to urge local authorities to ensure that they discharge their responsibilities properly.

Health and Social Care

Barbara Keeley Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Hunt]

I will make some progress, then take more interventions.

The Care Bill will allow for comprehensive Ofsted-style ratings for hospitals and care homes, so that no one can pull the wool over the public’s eyes as to how well or badly institutions are performing. The Bill will make it a criminal offence for any provider to supply or publish deliberately false or misleading information. We cannot legislate for compassion, but in a busy NHS, we can ensure that no institution is recognised as successful unless it places the needs of patients at the heart of what it does. The Care Bill will be a vital step forward in making that happen. That compassion should extend not just to patients, but to carers. The Bill will put carers’ rights on a par with the people for whom they care. They will have a right to a care assessment of their own and new rights to support from their local authority.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Is the Secretary of State as disturbed as I am that the Bill puts young carers backwards a step? Adult carers’ rights might be taking a step forward, but young carers’ rights are not. We must address that during the passage of the Bill.

[Mr Hunt]

We are not putting young carers backwards. We very much recognise their needs—and a children’s Bill will address their concerns in a way that I hope will put the hon. Lady’s mind at rest.

The second issue that we need to address for the NHS going forward is joined-up care. It is shocking that, in today’s NHS, out-of-hours GP services are unable to access people’s medical records; that paramedics and ambulances answer a 999 call without knowing the medical history of the person whom they are attending; and that A and Es are forced to treat patients with advanced dementia, who are often unable to speak, without knowing a thing about their medical history.

--- Later in debate ---

[Andy Burnham]

I assure the hon. Gentleman that I will come on to that, but I have a job to do in holding this shambles to account and that is exactly what I am doing.

Under this Government, people are paying more out of mum or dad’s bank account for care, which often does not come up to the standards that they want, because their council has been cut to the bone. What are they meant to make of a promised, far-off cap of £72,000, or £144,000 for a couple? The Government are giving a little with one hand, while with the other they are grabbing a fortune from people’s bank accounts.

[Barbara Keeley]

Does my right hon. Friend acknowledge that this is not even a question of £72,000 or £144,000, because those caps will be metered at the level that the council would pay, and will take no account of top-ups or accommodation costs? I have seen examples that show that people might have to pay £250,000 before they get anywhere near the cap and any help from the state.

[Andy Burnham]

My hon. Friend is absolutely right. The cap is a mirage, and this will not feel like progress to people who are paying care charges. Indeed, it is a cruel con trick. The Government are loading extra charges on people while telling them that they might benefit from a cap in a number of years. This simply means that more people will be paying right up to the level of that £72,000 cap.

How can it be fair to pay for the cap by raiding council support? That does not make sense. Those of us who were involved in the cross-party talks—the failed cross-party talks, I might add—will remember that a question was put directly to Andrew Dilnot. He was asked whether, if there was not enough money around, it would be better to pay for a cap or to pay to support councils to ensure that the baseline was not cut further. His clear answer was that we had to do both. He said that it would not make sense to do one without the other, yet that is what this Government are doing—

--- Later in debate ---

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I welcome the fact that we have a Care Bill to debate. I pay tribute to the hard work of colleagues on the Joint Committee on the draft Care and Support Bill. I also welcome the fact that the Government have taken on board a number of the Committee’s recommendations. However, some have not been adopted. I want to speak about the areas where the Bill could be improved and strengthened: the identification of carers and, as the right hon. Member for Sutton and Cheam (Paul Burstow) mentioned, the clauses relating to young carers.

[Roberta Blackman-Woods (City of Durham) (Lab)]

Does my hon. Friend agree with the National Young Carers Coalition, which has written to all Members pointing out that the Bill does not do enough for young carers and needs to be amended so that there is a greater responsibility for identifying young carers? Does she agree that the Government should have taken heed of her excellent private Member’s Bill and incorporated it into the draft Bill?

[Barbara Keeley]

I am absolutely bound to agree with that point, and I will come on to it shortly.

As has been said, we cannot separate the funding of social care from the law on social care. We need to take on board the fact that the Bill will not help those who are struggling without the social care support they need, either today or in the months and years ahead.

The Bill builds on the recommendations of the Law Commission’s review on social care and carers, but we should remember that until the Care Bill, carers had been given rights only through measures in private Members’ Bills: the Carers (Recognition and Services) Act 1995, the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004. We should pay tribute to the late Malcolm Wicks, Tom Pendry and my hon. Friend the Member for Aberavon (Dr Francis) for their work on that early legislation to give rights to carers.

When I came to Parliament in 2005, I raised the issue for the first time that GPs and other health professionals needed to identify carers within their practice population. GPs are best placed to help carers at the start of caring, which is when they need that help and advice. It is the GP who deals with the patient with dementia, the patient recovering after a stroke, or the patient with cancer. The GP and primary health care team are, after those life-changing events, well placed to see if there is an unpaid family carer. It is then a simple step for them and their teams to take time to check the health of the carer and to refer them to sources of advice and support. Caring can have a serious impact on the health of carers. In a recent survey of 3,000 carers, Carers UK found that 84% said that caring was having a negative impact on their own health—up from 74% in 2011-12.

I have introduced three private Members’ Bills on the identification of carers, and in September I introduced the Social Care (Local Sufficiency) and Identification of Carers Bill. The Bill had good support in the House. My hon. Friend the Member for City of Durham (Roberta Blackman-Woods) and 11 MPs from across most parties were supporters. We also had support from 27 national charities, the National Union of Students, the business group Employers for Carers and 2,000 individual carers. However, the Government did not support the Bill. In the debate, the Minister of State, Department of Health, who is responsible for care services, stressed that it was best to get everything codified in one place so that one piece of legislation addressed all issues of care and support. However, the Care Bill does not help with the identification of carers; it puts the duty of assessment on to local authorities. It is questionable whether cash-strapped local authorities will be able to assess the needs of large numbers of carers in any way that makes it a worthwhile exercise for those carers. If the Minister wants to look at the Joint Committee’s web forum on the draft Care and Support Bill, he will see that many of those who commented said that local authority assessments are of little practical help in their caring role.

[Mrs Moon]

Last week, I had a telephone call from a young man who is caring for his father. His father has the same condition as my husband, and he contacted me because of the debate we had on dementia. He told me that he had phoned his social services department twice and the psychiatric nurse twice to ask for help and support. He did not know where to turn. Is this not increasingly the problem? There is just no money: no money to provide the assessments and no money to provide the care if those assessments are carried out.

--- Later in debate ---

[Barbara Keeley]

I agree with my hon. Friend: it is about carers knowing where to go for that help and support when they are so desperate.

In contrast to assessments, projects that work within primary care to help identify carers are producing outcomes that are genuinely helpful to carers. I spoke at an event last Friday organised by Salford carers centres for staff from those teams. The staff will help to identify carers and refer them to help and support. They will have a list of agencies and know where to go.

[Paul Burstow]

The hon. Lady is making important points about carers—an issue on which she has campaigned consistently. Would she join me in welcoming the announcement from the Royal College of General Practitioners over the weekend about the priority it wants attached to carers and the guidance it is now issuing to GPs to ensure that they do more? One in 10 of a typical practice’s patients are carers, so they could do a great deal more by identifying them.

[Barbara Keeley]

Very much so, but the difficulty is that GPs do not have to do it. It is good that some of them are, but they do not have to. We have a duty of assessment, which is an excellent thing, but we also have GPs who might not be doing it.

One important group of carers in great need of being identified is young carers. As we have heard, young carers are in a unique position, being directly impacted on by the health and independence of adults. The care provided to that adult should help to sustain the whole family and reduce the impact of any caring requirements on the child. We know that if care services ensured that all adults needing care received it, that would help the children in the family, but frequently, we must admit, they do not get it, and the person needing care then starts to rely on the child providing it, which impacts on the child’s well-being.

That is where improved identification and support for young carers is valuable, because it can prevent negative and harmful outcomes for those children and reduce the cost of expensive crisis intervention. We spent much time on this in the Joint Committee, and the Care Bill now provides a unique opportunity to ensure that young carers have equal rights. We shared the concern of our witnesses that it appeared that clauses in the draft Bill applied only to adult carers, leaving young carers with lesser rights. Some amendments have been made, but it has not progressed as much as it should have done, and I found it disappointing that in a recent Committee debate on the Children and Families Bill, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children, did not accept the amendments on young carers put forward on a cross-party basis.

My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) made the case for the amendments very powerfully. Interestingly, the children’s Minister argued in response that the draft Care and Support Bill already allowed for the assessment of adults with care and that that could be linked to other assessments, which he thought would allow for consideration of the effects of adult support needs on the rest of the household, but that is not happening on the ground. Only 4% to 10% of referrals to young carers services are from adult social care, so that route is not working. He said he wanted more adults to be given the support they needed in order to protect children from excessive caring, which is a fine sentiment, but the reality for young carers is that life is getting harder as adult care services fall away.

[Norman Lamb]

I look forward to visiting the hon. Lady in her constituency on Thursday and discussing this matter further. I totally agree with her concerns about young carers, and will seek to meet the children’s Minister to discuss it further. It is really important that we get the framework right.

[Barbara Keeley]

Indeed, but a cross-party approach did not convince the children’s Minister in Committee, which is why I am stressing it today. It is very important. I welcome the Minister of State’s assurance just now, but he has given assurances before. We cannot let the opportunity presented by these two Bills pass. Younger carers and their organisations feel that the coalition Government are leaving them out of the equation. At the moment, the threshold for an assessment is higher for young carers than for adult carers. In its evidence to the Joint Committee, the Law Commission said that the inclusion of clauses on young carers was an important area of improvement for the draft Care and Support Bill. Frances Patterson QC told us that the Bill should make provision for services for young carers as well as their assessments, and that the assessments were of limited use for young carers.

The picture of provision for young carers is now very confused, and it is a priority for Parliament to sort it out. It is not good enough to have this partial recognition of young carers in the Care Bill or to have the children’s Minister rejecting cross-party amendments on provision for young carers. The Minister of State, who is responsible for care services, has said several times that he wants a single statute. If that single statute is the Care Bill, it has to deal with young carers properly. It is plainly wrong that it does not. I am grateful for his intervention, but we need to get this right. Does he still support a single statute, and if so, can we get it right for young carers?

I welcome the steps being taken in the Care Bill, but it must be strengthened and improved in the ways I have outlined, because things such as assessments are not very helpful for carers and young carers, if that is all we are offering. As was said earlier, older people face continuing increases in home care charges. The number of people receiving publicly funded care has fallen by 7%. Unmet need is soaring, which is putting pressure on carers and our acute services. We need a bold response to the crisis in care, greater investment in social care and genuine integration of health and care services.

--- Later in debate ---

[Mr Leigh]

I have no idea when that will happen.

I said I wanted to talk about opinion in Lincolnshire. Despite all the Government’s success in their central aim of attempting to cut the deficit—we have cut it by a third—people there undoubtedly feel that their voice is not being heard. We have to listen to that voice. If I may be forgiven for being party political for a moment, I should point out that there is absolutely no enthusiasm for the Labour party, because people have not forgotten who created the borrowing mess we are in. We heard a lot about plain packaging from the right hon. Member for Leigh (Andy Burnham), who led for the Opposition today, but the whole Labour party is plain packaged. We have no idea, frankly, what it will do.

[Barbara Keeley]

I cannot speak for all parts of the country, but I campaigned in the recent county elections in Lancashire and there was huge enthusiasm for the Labour party.

[Mr Leigh]

We will have to see what happens in various parts of the country.

It is said that this is a thin Queen’s Speech. As a Conservative, I do not object to a thin Queen’s Speech. I do not object to deleting unnecessary legislation either, whether on minimal alcohol pricing or plain packaging. I view all these as creatures of the nanny state, so it is good conservatism that we are not introducing them. However, if we are to have a Queen’s Speech that is, shall we say, somewhat light and has lots of room in it, that means there are various other things that we could do. One thing we do not need to do, I would have thought, is persevere with the Marriage (Same Sex Couples) Bill. I will not repeat all the arguments, but this is an area where many people in Lincolnshire feel that their opinions are being not represented.

If anybody wants to look at an excellent article on this subject, they should read Charles Moore’s in The Daily Telegraph on Saturday. There is a real problem. We are trying to deal with an economic crisis and the very first thing we will do after this Queen’s Speech debate—although it was not mentioned in it; as far as the Government are concerned, this is the Bill that dare not speak its name—is have two days on same-sex marriage. The Bill will then go to the House of Lords. There are enormous, complex issues at stake for the Church of England. I have no doubt that we are moving to a world in which the Church of England will be allowed to conduct only religious marriages, but will not be able to complete them. They will have to be completed by the state because of equality legislation. These are serious issues. The Government could easily mend fences with many of their supporters by putting the Bill out to further consultation.

--- Later in debate ---

[Norman Lamb]

What I would say to the shadow Minister is that since 2010, 1 million extra people have visited A and E. These are real pressures and we all have to think about how we manage them. Surely the way to do that is to try to improve people’s care so that they avoid ending up there in the first place. Tomorrow I will announce a decisive shift towards integrated care, which will be part of a major strategy for vulnerable older people, whom the Secretary of State talked about earlier. We have to focus on preventing people’s health from deteriorating, stopping the crises that end up with people in A and E despite the system’s best efforts.

Several hon. Members referred to pressures in social care, including the hon. Member for City of Durham (Roberta Blackman-Woods) and my hon. Friend the Member for Bradford East (Mr Ward). The Government have done what they can. We have put £7.2 billion extra into social care and local government to support the system through these difficult times because of the local government settlement, but we all know that things have to be done differently. The Care Bill is totally consistent with that approach: it focuses on prevention, co-operation, integration of care and spending money more effectively to improve care for patients. I was pleased that the hon. Member for Easington (Grahame M. Morris) welcomed the Bill, as did the hon. Member for Salisbury (John Glen) and many others. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for his work as Minister and subsequently as Chair of the pre-legislative scrutiny Committee. He has done a lot of brilliant work to highlight the issues that the Bill deals with.

It is hard to exaggerate just how badly the Care Bill is needed. Previous legislation is now hopelessly outdated and almost irrelevant to the needs of today’s society. Tinkering around the edges was keeping the system afloat, but no more than that. The shadow Secretary of State was dismissive of the value of the Bill, but it will be a big social reform—one of which this coalition Government should be proud. The new Care Bill will reform an antiquated, paternalistic system, improve people’s experience of care and establish both health education England and the health research authority as non-departmental, stable, independent public bodies. The Bill will pool together threads from more than a dozen Acts into a single, modern framework for care and support, but it is far more than a mere compilation. The Bill will fundamentally reform how the system works, prioritising people’s well-being, needs and goals, so that they no longer feel they are battling against the system to get good care.

[Barbara Keeley]

The Minister is back on his point about the Bill creating a single statute, but it will not do that for young carers, who will be left with the protection only of the private Member’s Bills I mentioned earlier. It is not good enough for young carers to face a higher threshold than other carers before their needs are assessed. That has to be looked at. The children’s Minister has let the House down on this issue; I hope that this Minister will not do that.

[Norman Lamb]

I was coming on to pay tribute to the hon. Lady for the work she has done. I absolutely agree with her that we need to get this right. We have the juxtaposition of two Bills, dealing with children on the one hand and adult social care on the other. Earlier I made a commitment to meet the children’s Minister; I had an opportunity to speak to him briefly when he was in the Chamber earlier. I am also meeting the hon. Lady later this week. I am committed to doing everything I can to get this right, and to ensure that young carers are not let down.

The Care Bill also highlights the importance of preventing and reducing ill health and of putting people in control of their care and support. This will involve the right to personal budgets, taken as a direct payment if the individual wants it, and putting people in charge of their care and of how the money is spent. This will put carers on a par with those for whom they care for the first time. The hon. Lady has consistently argued her case, and I am determined that we should get this provision right. The hon. Member for Rotherham (Sarah Champion) also made some powerful points on the subject.

The Bill will also end the postcode lottery in eligibility for care support. My hon. Friend the Member for Totnes (Dr Wollaston), the hon. Member for Easington and others raised concerns about the level of the eligibility. That question will obviously have to wait until the spending review, but I point out that if we were to set it at moderate need, the cost attached would be about £1.2 billion. All hon. Members need to recognise that this is difficult, given the tough situation with public finances. We also need to do longer-term work on developing a more sophisticated way of assessing need and providing support before people reach crisis point.

The Bill will refocus attention on people rather than on services. It will bring in new measures based on the Francis inquiry, ushering in a new ratings system for hospitals and care homes, so that people will be able to judge standards for themselves. The hon. Member for Walsall South (Valerie Vaz) criticised the idea of appointing a chief inspector of hospitals, but I disagree with her. It will be really important to identify where poor care exists and to expose it so that improvements can be demanded without fear or favour. The chief inspector will be able to do just that. It will also be really important to celebrate great care, so that those people in the health and care system who are doing everything right can be applauded and recognised for the work they are doing.

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 16th April 2013 Commons Chamber

[Norman Lamb]

I pay tribute to the hospice movement, including Katharine House in my hon. Friend’s constituency. It is crazy that we are spending a lot of public money on caring for people at the end of life in places where they do not want to be. Most people do not want to end their life in hospital, yet about 50% of people still die in hospital. We are looking to create a new funding regime where money will follow the patient, to ensure people’s choice is respected so they can die where they want to, and so that hospices have fair funding.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I recently had a case of very poor care of a terminally ill patient in the last few days of her life. She was let down by a GP who refused to prescribe the pain relief she needed and a district nursing service that provided wholly inadequate support. Given what the Minister has just said and that 20% of people want to die at home, what action will be taken to ensure that such cases do not happen and that instead we start to provide much better support for people so they can die peacefully at home?

[Norman Lamb]

My ambition is that the UK have a global reputation for the best possible care at the end of life. Whether we are talking about the Liverpool care pathway and concerns that have been raised about some care in hospital or care in the community and caring for people at home at the end of life, it is essential that people have a dignified death and the best possible care. Everything we are doing is aimed at achieving that. Where there are specific cases such as the one the hon. Lady raises, the relatives have the right to pursue a complaint, and ought to do so if care has fallen below an acceptable standard.

Mid Staffordshire NHS Foundation Trust

Barbara Keeley Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. It is important that these assessments are made not just at an organisation level, but drill down into the different parts of a hospital, and we have taken that message on board from the Nuffield report on ratings. She is right that it is not just about resources, but sometimes it is about resources. Parts of a hospital can be understaffed when it comes to people who are required to perform basic and important roles in terms of care. Because it is a complex picture—and because numbers can be part of the problem, but are certainly not the whole problem—we want a chief inspector who will take a holistic view of every aspect of the performance of a hospital and be able to give proper feedback that a hospital can use to improve its performance.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

May I press the Health Secretary on this point? I have raised several times the point that adequate staffing levels are crucial to patient safety and good care, but we seem to dodge around saying that it is a question of values, not of numbers. Francis said clearly that one of the issues was numbers. I have given examples of my local hospital, which views it as crucial that it has the right staffing mix, which it adjusts every single day, for the patients that it has. Will he stop avoiding this question and address it directly, because one in 10 hospitals do not have adequate staffing levels?

[Mr Hunt]

I am not avoiding it. I agree that adequate staffing levels are essential to patient care. I remind the hon. Lady that the shadow Health Secretary said to the Francis inquiry:

“I do not think that the Government could ever mandate a headcount in organisations. Whilst we could recommend staff levels, we were moving into an era when trusts were being encouraged to work differently and cleverly, and take responsibility for delivering safe care whilst meeting targets”.

Immigrants (NHS Treatment)

Barbara Keeley Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

Obviously, I want to ensure that as much money as possible goes to residents throughout the country by tackling abuse, and I would not want to minimise what the issue might be in Worcestershire. I stress, however, that the biggest problem we face is in big urban centres where there are large numbers of illegal immigrants, and we must get a grip of that problem for the sake of the elderly population in those cities.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

If the Secretary of State is concerned to protect NHS budgets, why is he allowing a £2.2 billion raid from the Treasury? Is that not a much more serious cut in the NHS services we can pay for in this country?

[Mr Hunt]

If the hon. Lady is worried about that, perhaps she might like to complain to her own party leadership, which, during Labour’s last five years in office, had an average underspend in the NHS of £2 billion.

Accountability and Transparency in the NHS

Barbara Keeley Excerpts

Thursday 14th March 2013 Commons Chamber

[Rosie Cooper]

Yes, and if MPs have problems, God help members of the public and patients.

We had to demonstrate that we were really listening to patients. The medical and managerial staff had to take ownership and responsibility for complaints. They knew that at each board meeting they could be questioned and challenged. If we accept that there are large parts of the system that work well and focus our time and resources on areas that do not, we can raise standards and tackle deep-seated problems. As chair, I sought to build in assurance and be transparent about complaints; to solve them, not hide from them, and ensure that everyone was accountable right up through the management structure. I never believed in no blame; I believed in fair blame. Each time a problem was resolved properly, we became a better hospital. We were rightly proud that on the front page of the Liverpool Echo Liverpool Women’s hospital was called an NHS gem. Sadly, the main board’s complaints report stopped after I stepped down as chair.

We do not need to reinvent the wheel or have more reorganisation in the NHS, but we must make the complaints system work. From that important but simple action, culture changes happen and become embedded in the organisation. We then have real change, real transparency, real openness and real accountability—something we can all be proud of.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

A complaints system sounds very useful. When staff knew that complaints were being assessed and reported on every month, what impact did it have on them?

[Rosie Cooper]

In essence, it encouraged a change of culture. They were not operating in a vacuum, where patients did not matter and where the complaint might not ever get resolved—where, if a manager said it was okay, it disappeared. The fact that the light was switched on and that people could ask questions was valued.

There is a huge disconnect between the rules and the enforcement of rules. When local resolution fails there must be another, proper avenue for patients to appeal that decision: just having the NHS investigate the NHS is not the way to improve the health service, or patients’ confidence in it. Currently, the message we send out is that unless people have the financial resources to fight the system in the courts it is easy for families and patients to be ignored.

Chief executives and boards know that the ombudsman investigates only a tiny proportion of the cases referred to it, and it is not as feared as it should be. I say to the Secretary of State that we need an ombudsman service that is properly resourced, has the necessary investigative powers and sanctions, and makes public in its reports its findings to everybody who pays for the NHS, not just to Ministers. Being able to name and shame in the spirit of openness and transparency will be a powerful tool, especially when, in these times of foundation trust hospitals competing to attract business, reputation is the key.

Given that all hospitals will eventually become foundation hospitals, is the Secretary of State willing to say that foundation hospitals will have to report all their statistics openly and that every board meeting should be a public meeting? There should be no hiding; there should be openness and transparency right across the NHS. The light needs to be switched on not just in individual rooms but in the NHS, full stop.

I have on the wall of my constituency office this quote from an editorial in the Liverpool Echo:

“Doing the right things does not automatically follow saying the right things”.

At present, everyone in the national health service is saying the right things. What assurance can the Secretary of State give us that the NHS will do the right things? Frankly, the public do not want any more politics from anybody. They do not want warm words or excuses; they want actions that will lead to real change. No more big reorganisations; we just need to make a difference. He must listen to the people’s complaints. Actually, in Mid Staffs the complaints could not have been any louder.

I said to the hon. Member for Bristol North West (Charlotte Leslie) earlier that we cannot keep on saying that it is somebody else’s fault, that somebody else should be held accountable and that somebody else is going to supervise. This goes to the core of the Department of Health. If we listen to the people and give the ombudsman—the right person for the job—the powers to deliver, we will see a culture change.

[Mr Stephen Dorrell (Charnwood) (Con)]

I want to follow the hon. Member for West Lancashire (Rosie Cooper) on to very similar territory. She and I both sit on the Health Select Committee, which I chair. I want to start where my right hon. Friend the Secretary of State and the right hon. Member for Leigh (Andy Burnham) started, with what happened in Mid Staffordshire. It was shameful, and we will be judged today by whether we show a serious willingness to learn and apply the lessons of the Francis inquiry.

Francis made 290 recommendations, but they amount to just one core recommendation, which is that there needs to be a fundamental culture change through the whole of the national health service. With respect to the shadow Secretary of State, that is the sense in which challenges are posed for the health service way beyond Staffordshire. We have to learn the lessons of Staffordshire and apply them beyond it, as well as demonstrating that we understand what we mean—in the modern jargon, we “get it”—when we talk about the need for a culture change.

My hon. Friend the Member for Bristol North West (Charlotte Leslie) encapsulated that when she used the words “accountability” and “transparency”. I will not follow her down the route that she took in her speech. I want to focus exclusively on what we mean by those two words. They seem to trip too easily off the tongue, without anyone understanding what they mean, and that must change if we are to sustain a culture change in the health service.

My first proposition is that accountability without transparency is entirely meaningless. The ability to see what is going on and how decisions are being made in the health service, and to see the effects of those decisions, is fundamental to the delivery of the objective of culture change. With respect to the right hon. Member for Leigh—and, indeed, to some of the points that my right hon. Friend the Secretary of State made—we have to acknowledge that a lack of transparency lies deep in the culture of the health service, and that it goes back to way before the previous Government were in office. It was present in my time as Secretary of State and well before that, too. I was regularly accused of supporting a gagging culture in the health service, although nothing could have been further from my intention. However, that charge was made against me, against the right hon. Members for Leigh and for Kingston upon Hull West and Hessle (Alan Johnson) and, in truth, against all our predecessors right back to 1948.

The instinct to protect, rather than the instinct to reveal, is deeply embedded in the health service. When something is said to be going wrong, there is an instinct for the wagons to gather round. That is why Francis’s recommendation for a duty of candour is key to the delivery of the objective of greater accountability and transparency.

[Barbara Keeley]

Was the right hon. Gentleman as disturbed as I was to hear that the £500,000 gag at the United Lincolnshire Hospitals NHS Trust was put in place without any sign-off whatever, on the basis that it had involved judicial mediation? The Secretary of State refused to answer my question about this. Does the right hon. Gentleman agree that the Secretary of State really has to stop that, because it involved a very large amount of money, which was used very ill-advisedly?

[Mr Dorrell]

The position I take is the one set out in the Francis report, which was explicitly endorsed by Sir David Nicholson in the Select Committee inquiry to which the hon. Lady has referred. I believe that it would also be endorsed by my right hon. Friend the Secretary of State, but he must speak for himself. That position is that it is hard to imagine circumstances in which the use of public money in the context of a compromise agreement should be governed by a confidentiality clause. In an age when a bill from Pizza Express has to be published on the internet, decision makers should be held publicly accountable for the use of large sums of money in the context of a compromise agreement.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

I was appalled to read in the Francis report on the Mid Staffs inquiry the stories of the unnecessary suffering of hundreds of people and, indeed, to hear the examples given by my right hon. Friend the Member for Cynon Valley (Ann Clwyd) in this debate. Those Mid Staffs patients were let down and there was a lack of care, compassion, humanity and leadership. The most basic standards of care were not observed and fundamental rights to dignity were not respected.

Our Health Committee has taken evidence from Robert Francis, who has said that there was a failure of the NHS system

“at every level to detect and take the action patients and the public were entitled to expect.”

He has summarised his own recommendations as: fundamental and easily understood standards; openness, transparency and candour; accountability to patients and the public; enhanced training for nurses and leaders; and ever-improving measures of performance.

In the short time available, I want to focus on two areas: first, accountability or, indeed, the lack of it in our NHS structures, and secondly—this has already been touched on—the question of what is good practice on patient safety.

The Health Committee is increasingly seeing examples of a gap in accountability in the restructured NHS and I will touch on one small example that we heard this week. We had a session with senior Department of Health staff—the director of mental health, the national clinical director of mental health and the deputy director of secure mental health services—who are responsible for advising Ministers on mental health strategy, for devising mental health legislation and for clinical leadership on mental health. They did not know that patient groups were reporting cuts to community mental health services or that they lacked access to therapeutic services, with very long waits.

[Alison McGovern (Wirral South) (Lab)]

Does my hon. Friend agree that scrutiny to make sure that the dignity of mental health patients is protected is of utmost importance?

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[Barbara Keeley]

Indeed. It is disturbing that the people responsible for advising Ministers on legislation are not aware of what is going on. In fact, they started by trying to tell me that they thought that community services were still expanding, as they had been up to 2010. They did not have a picture of the services. Indeed, they told us that there was no routine collection of waiting times for mental health services and they did not have data on readmissions. They did not even seem to understand the trends involved in those important issues.

The exchange left me feeling very concerned about accountability in our new NHS structures. If staff at the most senior levels of the Department of Health who are responsible for strategy and legislation have no idea what is going on in health services across the country, that is serious. The major restructuring of the NHS seems to us—this has been mentioned by fellow members of the Health Committee—to represent a decline in accountability.

We need to learn from good practice to improve patient safety, which has been touched on by my hon. Friends the Members for West Lancashire (Rosie Cooper) and for Walsall South (Valerie Vaz). A major review is taking place of the 14 hospitals with the worst mortality rates. In recent Health questions, I told the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) that good practice in hospitals with low mortality rates should be investigated alongside the review of high mortality rates and poor practice in the worst-performing 14 hospitals. He did not take that point on board, so I will try again today.

I want to talk about what has been achieved at my constituency’s local hospital trust, Salford Royal NHS Foundation Trust. I visited the hospital recently in the wake of the Francis report and was impressed to hear what it has achieved over the past five or six years. It already seemed to have in place many of Robert Francis’s recommended actions, which I touched on earlier. Salford Royal has taken action on nurse staffing ratios, which my right hon. Friend the Member for Leigh (Andy Burnham) touched on; reducing MRSA infection and pressure sores; the transparency of patient information; and involving clinical staff in quality improvement.

[Mr Jeremy Hunt]

I completely agree with the approach that the hon. Lady is taking. One of the jobs of the new chief inspector of hospitals will be to identify the outstanding hospitals, the safest hospitals and the hospitals with the best compassionate care, so that other hospitals can learn to do the same things.

[Barbara Keeley]

That is very good. I hope that the Secretary of State will make that point to the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, because he did not seem to appreciate it when I made it to him in Health questions.

Let me touch on what other hospitals might find if they start looking at the excellent practices at Salford Royal. I do not underestimate the importance of the terrible examples that we have heard about, but at the same time, my trust has had a quality improvement strategy since 2008, with specific projects that are aimed at reducing falls, unexpected cardiac arrests, surgical site infections, sepsis and other harms. Because harm tends to be caused to patients much more over the weekend—we have seen many examples of that in the cases that we have looked at—the trust has moved back to seven-day working in an attempt to achieve the same standard of care on the weekend and overnight as people receive on a weekday during working hours.

I believe that having the right nurse staffing ratios is vital to patient safety, but that issue keeps being glossed over by NHS leaders and Ministers. I have asked questions about it repeatedly in this House. Salford Royal uses a safe staffing tool to ensure that it works to safe staffing levels. There are minimum staffing requirements throughout the hospital and incident reports are completed if the ratios are not met. Each division reviews its staffing establishment every day and escalates concerns if the numbers fall below the minimum safe level. Salford Royal is a mentor site for nurse rounding which, as we have heard, means that nurses go round their patients each hour to ensure that their needs are being met.

My right hon. Friend the Member for Cynon Valley gave examples that showed the impact of hospital-acquired infections. All the work that is done to reduce MRSA and other infections is crucial. As in the other examples of flattened hierarchies that we have heard about, anyone at Salford Royal can challenge others on issues related to infection control. There is also mandatory training in aseptic non-touch techniques.

Teams design their own quality improvement projects in a clinical quality academy. There has been a specific quality improvement project over the past two years that is aimed at reducing the number of pressure ulcers. Each pressure ulcer is declared, the root causes are analysed and the patients are involved in the investigations. Nurses can monitor the positioning of patients on their hourly rounds and help to turn them if required. Those examples of good patient care can help us to get over the kinds of awful care that have been described today.

My final point is about transparency. Patients and families can check the harm data, because they are shown on a whiteboard at the entrance to every ward. The board records not only how many days it is since the last MRSA infection or pressure ulcer, but provides assessment scores on 13 fundamental nursing standards. Such public reporting to patients and families is important because it aids accountability and helps staff to feel accountable for the standards on their ward. We need that now more than ever.

Unsurprisingly, Salford Royal has achieved the highest rating in the NHS staff satisfaction survey for acute trusts in the NHS. Staff are supported to challenge existing systems and test new ideas to improve standards. I am aware of how much of a contrast that is to what we have heard this afternoon. The NHS is a system in which one area has had a catastrophic failure at all levels of patient safety, while other areas have achieved the highest standards of safety and patient care. We must look at both if we want to understand why that is.

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[Mr Slaughter]

I am grateful for that. I did a company profile for Harmoni. It revealed that, although he might have sold his shares for that amount of money, Dr Goodman is still listed as head of clinical spine. A series of press articles deals with the failings of Harmoni—failures that have caused deaths through under-staffing or poor-quality staffing—and why it is under investigation.

Let me return in the time I have available to my attempts to get to the bottom of the matter. The same day as I read the article in The Guardian, I wrote a short letter to the chief executive of the NHS in north-west London. I said:

“I attach the front page article from today’s Guardian, which you may have seen, regarding the sale of out of hours GP service provider Harmoni to Care UK. The article states that a number of GPs will make substantial sums from the sale.

I note that four of the CCG chairs in NW London declare shareholding or directorship in Harmoni, as does your Medical Director. It would be helpful to know if they are beneficiaries of the sale and by what amount.”

I then asked for assurances as to the future.

A month later I received a non-reply reply, the most relevant sentence of which was:

“Any member who declares an interest in a meeting is expected to take no part in discussions and step out of the meeting.”

I wrote back a much longer reply, in which I pointed out that the chair of the Royal College of General Practitioners had said:

“it is not about excluding yourself from the room whenever there is a discussion; it is about how it will drive your decision-making overall”.

I pointed out that, as a consequence of hospital closures in north-west London, there had been a shift in funding from hospital to primary care, a greater involvement of private companies in the primary care sector, and an opportunity for those companies to increase their profits by cutting back on the level of service offered.

I principally raised the fact that the information that should be provided is not provided on declaration of interest forms, especially the scope and value of any interest. I listed doctor by doctor and CCG chair by CCG chair what those interests were and how they were not adequately declared. I dealt with seven out of the nine CCG chairs and the medical director. That was in a letter on 20 December.

I received a reply on 3 February which said:

“The Cluster does not hold this data.”

So three months on from my original inquiry, I am none the wiser in relation to these matters.

I advise any hon. Member to look at their CCG declarations of interest online—not Hillingdon, because it does not publish them online. I use Hammersmith and Fulham as an example here. The husband of one member is a partner of Drivers Jonas Deloitte. The first thing I found on the website of Drivers Jonas Deloitte was that it had been appointed to sell the Kent and Sussex hospital in Royal Tunbridge Wells when it closes in 2011. Another member is the owner of a provider of home care services. Another is the brother of the director of a design company that holds a number of contracts with NHS organisations. It might be that none of them has a direct financial pecuniary interest now or in the future, but it shows touching naivety, complacency or worse.

Before the 28 members of the joint PCT board made the decision to close the four A and Es in north-west London, I said at the public meeting that if any of them had or was likely to have interest of a pecuniary nature they should not take part in that decision. One of them rather touchingly volunteered the information that they had sold their shares. What world are we living in when a third of GPs on the new CCGs can hold financial interests in anything from land sales to an alternative provider?

I raised the question with the Prime Minister yesterday and mentioned Dr Goodman, although not by name, and his estimated minimum return of £2.6 million. Again, I got a non-reply in reply. Sooner or later the Government will have to address these matters.

There is another story in the Daily Mail today that states:

“In 1981 there were eight NHS press officers in Britain. Now there are 82 in London alone”.

It is not that there is a lack of spending on publicity in the NHS. Indeed, almost £1 million has been spent on a private consultancy firm simply to carry out the bogus and botched consultation on the closure of A and Es.

We are seeing the creation of a second-grade health service in north-west London.

[Barbara Keeley]

A number of months ago, I raised the case of a person who rejoices in the title “NHS head of brands”. There seem to be a whole set of units that keep cropping up.

[Mr Slaughter]

I am sure that all Members will have similar examples. It is an obscenity that millions of pounds are being spent on spin and disinformation while basic information is not being provided even to Members of Parliament after three months and persistent requests. Sooner or later, these issues will have to be addressed.

Of course, our main preoccupation is to maintain our first-rate health service—our blue light A and Es, our stroke centres and our major hospitals—rather than having it replaced by urgent care centres and minor primary care facilities. That is what we face in north-west London and, I am sure, around the rest of the country. It adds insult to injury if the individuals who are making the decisions to sell the land and to transfer services into the private sector are also the shareholders and owners or if they benefit in any other way. This is a corrupt act and it must be addressed by the Government. They cannot continue to turn a blind eye to it.

NHS Commissioning Board

Barbara Keeley Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

It is absolutely not the case that the regulations, as currently drafted, drive the privatisation of the NHS. As the hon. Gentleman will discover in the next few days, the amended regulations will make it abundantly clear that CCGs will be in the driving seat—the letter from the former Secretary of State made that clear back in 2012. They will take into account the importance of co-operation, integration and putting the patient’s interest first.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

On competition and integration, my hon. Friend the Member for Walsall South (Valerie Vaz) and I spent some time this morning talking to academics from Sweden, who told us how competition and fragmentation were preventing them from moving ahead with integration. The Minister should be concerned about the integration of health care and social care, so will he address that point? We will certainly never make progress on integrating health care and social care if we move ahead with all this privatisation, which will lead to a lot more fragmentation. Leaving that aside, 70 of my constituents also think this is just the wrong way to go.