UK Ebola Preparedness

Barry Gardiner Excerpts

Monday 5th January 2015 Commons Chamber

[Mr Hunt]

I could not agree more with the hon. Lady. Some 382 health care workers have died of Ebola, and it is worth saying that they include not just local people from Sierra Leone, Liberia and Guinea, but people from all over Africa as well as small numbers from other parts of the world. The very least we can do is to continue to support an aid budget, which will allow them to continue to improve their local health care systems.

[Barry Gardiner (Brent North) (Lab)]

The Prime Minister said over the weekend that those displaying symptoms at Heathrow would be referred straight to Northwick Park hospital in my constituency because the isolation units are based there. Those isolation units are, however, strictly limited—I think there were only six at the last count—so can the Secretary of State advise us whether back-up facilities will be put in place? Given the nature of this disease, six isolation may prove inadequate.

[Mr Hunt]

I would like to reassure the hon. Gentleman that isolation facilities are available at other London hospitals. The ones he mentioned happen to be the closest, so they are the ones we would use first. Let me briefly clarify that it has always been the case that if someone showed any symptoms, we would isolate them and put them into quarantine. The change in protocol I am announcing today—we enacted it last week, but I wanted to report it to the House at the earliest opportunity—will mean that even if someone is not displaying the symptoms but says that they are feeling a bit under the weather, they will be isolated if they are in the high-risk category.

National Health Service (Amended Duties and Powers) Bill

Barry Gardiner Excerpts

Friday 21st November 2014 Commons Chamber

[Andy Burnham]

No. The hon. Gentleman needs to get his facts straight before he tries to shout the odds in my direction.

The Bill gives back to this House sovereignty over the national health service, which millions of people will welcome. The Bill means so much to so many people who are concerned about what is happening to the NHS right now under this Government.

[Barry Gardiner (Brent North) (Lab)]

My right hon. Friend says that the Bill will mean so much to so many people. He will recall that in 1997 the waiting lists at Northwick Park hospital were the highest in the country, with people having to wait for 21 hours on trolleys. He will also know that the people in Brent and Harrow who rely on that hospital today are now enduring the highest waiting lists in the country again. Waiting lists came down on his watch, but they are back up again. What message does that send to the people of Brent and Harrow?

[Andy Burnham]

My hon. Friend is right to remind the House that in 1997 people were spending years on NHS waiting lists, and even dying while still on them. As my hon. Friend the Member for Bolsover (Mr Skinner) said, we brought those waiting lists down, and by the time we left government in 2010 this country had the lowest ever NHS waiting lists and the highest ever level of public satisfaction in the NHS. That is Labour’s record, and we will not let the Government forget it.

What is happening now? NHS waiting lists are back at a six-year high. That is the result of the reorganisation that the Government ploughed through, which nobody wanted. The country did not want it. There are millions of people out there who are concerned about what the Government are doing. It will not have escaped their notice that scores of Government MPs have failed to turn up today to defend what was one of their flagship Bills. What a shower! There are people who kept a vigil outside the House last night, in cold temperatures, imploring Members to be here to pass this Bill because the issues it raises matter so much to them. Then we have the spineless MPs of a disintegrating Government, some loaded up to the eyeballs with links to private health care, who do not have the guts to come here today to argue for what they have done. Is it any wonder that people are losing faith in this place?

Oral Answers to Questions

Barry Gardiner Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Speaker]

Order. We are very pressed for time, but I want to accommodate a couple of remaining colleagues.

[Barry Gardiner (Brent North) (Lab)]

I am grateful, Mr Speaker. In Brent we have the highest incidence of TB and of type 2 diabetes in the country. We have just received a cut of £450 million in the money allocated to the CCG. The Secretary of State says that this is fair, but my constituents want to know whether it is in accordance with need.

[Jane Ellison]

The hon. Gentleman is right to draw attention to the problem of TB in London. As a London Member myself, I know what he is talking about. I encourage him to participate in the current consultation on Public Health England’s comprehensive TB strategy. It is a very important document which marks a step change in the way we confront the problem. That will help us to allocate resources to need and to address serious problems.

Care Homes

Barry Gardiner Excerpts

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

I agree with my hon. Friend. I have spoken to the chair of the CQC, David Prior, specifically about this matter. It is looking at both the use of hidden cameras in appropriate circumstances and at mystery shopping—going into care homes, finding out what is going on and getting a real picture, rather than things perhaps being hidden away from view when a named inspector turns up. All these mechanisms have to be used. We have to be prepared to do these things to ensure that people in very vulnerable situations, particularly people with dementia, are cared for with dignity.

[Barry Gardiner (Brent North) (Lab)]

The care homes sector is growing in size and in profitability. In his remarks, the Minister focused on the low wages that are paid to care workers in the sector. Often, the pay reflects the value that is put on the work that is being done. Will he look at pay and profitability in the sector, and consider the impact that it may have on bad practice?

[Norman Lamb]

The hon. Gentleman makes a fair point. The difference in the providers that pay people properly is clear. Incidentally, domiciliary care is another area where there are concerns. My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) visited Wiltshire recently, which has moved away from the old style of paying people a pittance and now gives care workers a salary. When that happens, the whole culture starts to change completely.

We must ensure that there is compliance with the minimum wage, as well as advocating wages that are better than the minimum. Her Majesty’s Revenue and Customs has done a lot of work in the sector to address the abuse of the minimum wage regulations, which is far too widespread. It is completely intolerable for any care provider not to meet its statutory obligations. As the shadow Minister said, we have to ensure that when they commission care, councils cannot be complicit in an arrangement that they know will end up with people not receiving proper pay.

Health

Barry Gardiner Excerpts

Wednesday 9th April 2014 Ministerial Corrections

Livestock: Diseases

[Barry Gardiner]

To ask the Secretary of State for Health how many instances of (a) pneumonia, (b) septic pneumonia, (c) Pericarditis, (d) Septic Pericarditis, (e) Peritonitis, (f) septic peritonitis, (g) Oedema, (h) Emaciation, (i) Bruising or trauma, (j) Abscesses in offal, (k) Abscesses in carcases, (l) Pyaemia, (m) animals with septicaemia, (n) Animals with tumours, (o) Hydronephrosis, (p) Nephritis and septic nephritis, (q) Lymphadenitis, (r) Tuberculosis, (s) Erysipelas in pigs, (t) Steatosis, (u) Actinobacillous and (v) Actinomycosus in red meat animals have been identified at official post mortem inspection and prevented from entering the food chain by officials working for an on behalf of the FSA since 1 April 2012.

[Official Report, 1 April 2014, Vol. 578, c. 573W.]

Letter of correction from Jane Ellison:

An error has been identified in the written answer given to the hon. Member for Brent North (Barry Gardiner) on 1 April 2014.

The full answer given was as follows:

[Jane Ellison]

The following quantity of conditions have been identified in red meat animals at official post mortem inspection and prevented from entering the food chain by officials working for and on behalf of the Food Standards Agency (FSA) since April 2012:

Some conditions are not recorded by the FSA. The list of conditions for cattle, sheep, goats, pigs and poultry were created following expert working group workshops for each species over the last five years. Members of the workshops included stakeholders from the Department for Environment Food and Rural Affairs, Animal Health, EBLEX, BPEX, private veterinarians, industry vets, FSA, Association of Meat Inspectors.

The data for sheep, goats, deer and horses is from April 2012 to December 2013, all other species is April 2012 to March 2014.

Tobacco Products (Standardised Packaging)

Barry Gardiner Excerpts

Thursday 3rd April 2014 Commons Chamber

[Jane Ellison]

I thank my hon. Friend for those comments. The issue is looked at in some detail, and as I said, Sir Cyril said that he was not convinced by the arguments in this respect.

[Barry Gardiner (Brent North) (Lab)]

I came to the House prepared to attack the Minister because I thought she was going to kick this into the long grass. I am absolutely delighted that she has assured the House that she is not going to do that. In the light of the reception from her own Back Benchers, which I am afraid has not been friendly, she can at least be assured of the friendliness from those on the Labour Benches. She is doing exactly the right thing. My father died of lung cancer when I was eight, so I never took up smoking, but many of my friends did. They are now dead and I am still going. What the Minister is doing today will mean that more children will not take up smoking in the first place.

[Jane Ellison]

I thank the hon. Gentleman for those generous comments. I think that many people in the House will have had their personal family situation touched in the way that he mentions. I never knew my grandparents, so I recognise the power of what he says. We are proceeding, as I hope the House can see, in a sensible but robust way. I have signalled my view that I am minded, as a Health Minister, to accept Sir Cyril’s report and the evidence therein, but there are other considerations, and we will take those into account and bring a final decision to the House as soon as possible.

Oral Answers to Questions

Barry Gardiner Excerpts

Tuesday 25th February 2014 Commons Chamber

[Mr Hunt]

I absolutely agree with my right hon. Friend. One of the tragedies that the Francis report helped us to uncover was that so many failings had been allowed to persist for so long: in the case of Mid Staffs, between 2005 and 2009. We owe it to families to be much quicker, which is why there is now a time limit on the failure regime: hospitals must be turned around within a fixed period of time or go into administration. Otherwise, we will not have safe hospitals in our areas.

[Barry Gardiner (Brent North) (Lab)]

The Minister earlier told the House that 1,500 new midwives had come on stream since the Government started, but, of course, the Government promised that there would be 3,000 delivered by 2015. Midwives are very good at delivery; how good is the Department?

[Dr Poulter]

We have trained more midwives. To go back to a previous question, it was under the previous Government that trained midwives from this country were having to go and work overseas. That is no longer the case. We now have 5,000 more in training—a record number—to make sure that we provide more midwives. I would also like to welcome the hon. Gentleman back to this country.

Accident and Emergency

Barry Gardiner Excerpts

Wednesday 18th December 2013 Commons Chamber

[Andy Burnham]

I will make some progress because I am conscious that many Members want to speak in both debates.

The picture that emerged from our summit was of a health service on the edge, creaking at the seams, with corners being cut and A and E as the last resort for people failed by other services—people who, in an ideal world, ought not to have been there. We heard of people with severe mental health problems in A and E because of a lack of crisis beds, people with severe dental pain who could not afford treatment, disorientated older people with dementia and, perhaps saddest of all, palliative patients in A and E waiting areas.

It is clear that the cost of living crisis and this Government’s failure to support people through it might also be driving people to A and E. The House is soon to debate the scourge of food poverty that now blights our land. Food banks are growing at an exponential rate. Indeed, we now read that it is Government policy to ask councils to set up more, even though they have just cut the funding of the councils with the most food banks. It is unbelievable. It suggests to me that they expect food poverty to be with us for some time to come and have no real intention of tackling it. People will go on having to choose between eating properly and putting the heating on—[Interruption.] The Secretary of State chunters, but he has no idea what it is like to do that, has he?

People are making other impossible choices that might damage their health. I am told of the growing number of people now taking prescription medicines on an empty stomach because they cannot afford to eat properly. Dr Ellie Cannon, a GP who also writes for The Mail on Sunday, recently tweeted:

“I’m sad to say that at my NHS practice if we have a patient who has unexplained symptoms, we have started asking if they can afford to eat”.

How can that possibly be right in England in 2013? Has the Secretary of State considered reviewing the effect on people’s health of the growing problem of food poverty and has he discussed the effects of benefits policy on people’s health with the Secretary of State for Work and Pensions? If he has not, I suggest that he does so immediately.

[Barry Gardiner (Brent North) (Lab)]

As my right hon. Friend is talking about general practitioners, does he agree that the Government’s failure to honour the guarantee that we gave that people could see a GP within 48 hours means that more and more people are going directly to A and E?

Patient Diagnostic Services

Barry Gardiner Excerpts

Monday 4th November 2013 Commons Chamber

[Barry Gardiner (Brent North) (Lab)]

As it is the first time I have had the pleasure of speaking in the House since your election to the Chair, Madam Deputy Speaker, may I congratulate you and say how pleased I am to be speaking this evening under your guidance?

The doctors and consultants in Brent, like those in the rest of the country, are highly respected members of our community. Their work is part of the glue that keeps our society together and enables people to function and get on with their daily lives. Doctors, though, would be the first to admit that they are not omniscient—well, some of them would. Their work depends upon the work of many others in the health care sector—in particular, the work of laboratory and radiography technicians who provide the evidential base for diagnosis and treatment. The quality of patient outcomes will always depend on the quality of diagnostic services because a diagnosis delayed is a treatment delayed, and an incorrect diagnosis is potentially fatal.

This evening, I wish to detain the House and suggest to the Minister that the structural changes that his Government have introduced in the national health service have had a seriously adverse and dangerous impact on patient care.

In May 2012, the decision was made to outsource pathology services in Brent and Harrow. Previously, it had been provided by the NHS at a facility at Northwick Park hospital. The decision was taken because the hospital wanted to invest in improvements to the system. Rather than incur those financial costs, it was considered more efficient to outsource the contract to TDL Ltd—otherwise known as The Doctors Laboratory. That was a mistake.

The first indication that there was a problem came when a GP identified a serious technical flaw in the way patient test results were presented through the computerised system. The GP had received a list of multiple test results in respect of a patient. When looking at one set of results on the list and closing it or archiving it to the patient file, the GP realised that it was possible inadvertently to apply that same action to all the other test results returned on that list. Pathology results that required urgent action could be accidentally archived owing to an error in the TDL reporting system. Critical patient test results could be missed altogether or inappropriately actioned.

The GP reported that as a serious incident and immediately flagged up the issue to the North West London Hospitals NHS Trust, on the assumption that pathology services were still being carried out there. In fact, the service has been provided by TDL since May 2012. The hospital trust passed the concerns on to the Brent and Harrow clinical commissioning group, which was now responsible for managing the contract with TDL. At that time, the matter was not thoroughly investigated and was deemed to be a single incident and not a cause for concern.

However, GPs began to talk to each other about their concerns and realised very quickly that they were not alone in seeing a sudden change in the quality of results they were receiving from the service that had, up until 2012, been carried out adequately at Northwick Park hospital. At an emergency meeting with representatives of NHS Brent and Brent CCG, the GPs were led to believe that steps were being taken to resolve the matter.

The problem got worse. GPs across the borough were receiving many more abnormal results than they would ordinarily expect: test requests were ignored or the results were never reported back to them; other tests were being returned incomplete with only partial results and data omitted; and some samples were being incorrectly marked as complete and being discarded without being tested.

This alarming downward trend in the quality of the results finally prompted NHS Brent and NHS Harrow to launch a proper investigation, which commenced on 20 December 2012. Let me quote this root cause analysis investigation report, which finally reported in March of this year and found

“spurious results, missing results and samples not processed...reference ranges had changed and...the presentation of the results into groupings that did not make sense”.

One GP wrote to me to say:

“In the new year the scale of serious anomalies and problems had become so great that individual practices started to send out e-mails to each other to see if the problems were as isolated as we were being led to believe…The response was shocking. Our patients are at serious risk. Unless we have these basic services reliably we cannot diagnose and treat our patients.”

[Keith Vaz (Leicester East) (Lab)]

The situation in north London is clearly shocking. Does my hon. Friend know whether any of the tests that were outsourced relate specifically to diabetes, which is a huge problem for people who live in Brent? About 10% of the population is thought to suffer from diabetes.

[Barry Gardiner]

I am grateful to my right hon. Friend for his intervention, and he is absolutely right that diabetes is a major problem in the Brent area. Given that many of the tests related to phlebotomy, I would assume that some of them might have related to diabetes, but I do not have that specific information to hand.

I was explaining that GPs across the borough were receiving many more abnormal results than they would ordinarily expect, that the downward trend in the quality of the results had prompted an investigation and that the GPs had expressed their own concerns by exchanging information among themselves to ascertain the extent of the problem.

The interim deputy director of quality and safety for Brent, Ealing, Harrow and Hillingdon CCGs reported

“many incidents of patients attending for repeat blood tests at both the practice and within the hospital and some patients…referred to A&E Department because of high potassium levels.”

Many consultants began to experience similar problems with the service and were also having to carry out further unnecessary tests. One consultant, when pressed, scribbled a note setting out a variety of issues:

“Immunology—assay results; Calcium results—change in calculations; Change in reference ranges; Potassium—delays in transfer and refrigeration”.

I am sure the Minister will agree that such failings in service are wholly unacceptable.

The question then arises how any competent company of qualified health professionals could come to make such errors. After all, its website states that it is

“providing quality accredited pathology services to the UK and worldwide”.

I trust the Minister will be as surprised and as disappointed as I was to learn that, at the time the service was outsourced, TDL was

“not currently registered with Clinical Pathology Accreditation (UK) but is working towards this”.

The words “working towards this” should be accompanied by some degree of scepticism, given that the final report on the root causes of the problem identified that TDL was so incompetent that

“There was an operational issue with the new robotic sorter which resulted in a number of samples being filed incorrectly as ‘analysis complete’ and subsequently discarded. There was also a problem with one of the lines in the calcium analyser as a result of which samples were transferred to another laboratory, and a number of issues were attributed to human error.”

Compounding the confusion, when the service was transferred, TDL used different reference value ranges to assess and analyse results in order to fit in with its own IT systems. Unfortunately, it failed to communicate this change to the GPs or consultants who were now expected to interpret results that they did not understand, based on reference ranges with which they were not familiar. TDL was found to have not followed its own procedures, which required it to flag up to its service users when systems were changing. Owing to this transition, GPs and consultants were effectively left blind about the difficulties they might experience with pathology reports.

Of course, the quality of any test results will always depend on the quality of the samples received. Just as in the world of computing, “garbage in leads to garbage out”. One would imagine that when the decision was taken to outsource the pathology courier service that delivers samples to the pathology laboratory, clear and appropriate clinical advice was sought about precisely how this contract should be specified—and it was. In fact, GPs suggested that a courier service carrying samples for potassium tests must be refrigerated in order to avoid the impact of temperature change on the quality of the sample. However, the terms of the contract failed to specify that, and the eventual service that was commissioned did not provide for temperature control.

I have also received complaints about delays in delivery, as well as allegations that damage to samples in transit has made it difficult to record and analyse them properly. Indeed, the NHS Brent CCG noted in a report to the Brent health overview and scrutiny committee that issues of transportation quality and service delays on the part of the courier service, Revisecatch Ltd —trading as Courier Systems—

“appear to play a seasonal role in the variation of potassium levels; in that they add to the instability of the samples due to fluctuation in temperature during storage at the GP practice and/or during transportation to the laboratory in both summer and winter”.

Another privatised diagnostic service, the London NHS Diagnostic Service, is provided by InHealth. It is designed to enable London GPs to make direct referrals for their patients so that they have already had tests before being referred to specialist consultants. The tests might include ultrasound, echocardiography, audiology, cardiac physiology, magnetic resonance imaging, X-ray, endoscopy or phlebotomy scans. The intention was to reduce the CCG’s consultant costs by referring only patients who really needed their attention. In other words, GPs would filter patients to avoid unnecessary and costly referrals.

GPs have objected that that practice has simply introduced a middleman to the process, and that delaying a diagnosis from a specialist consultant may put patients in danger. I am told that the problem is compounded because the scans received from InHealth are often themselves delayed, and are frequently found to be of such poor quality that the patient must be referred to a specialist consultant in any event. My office has also been given anecdotal evidence that staff at diagnostic centres do not possess the necessary skills or understanding to handle complex diagnostic services.

General practitioners are not specialists. They are not consultants, and they are seeing scans which they cannot decipher or which are in a format that they cannot use. The patients are sent for another scan, or often are simply referred to the consultant whom they would have seen under the old system, who then usually orders a further scan at his or her own site. What started off as a way of saving money and freeing consultants to focus on clear cases of need becomes a bureaucratic process that puts patient outcomes at risk and costs more money as a result of duplication and delay. I should like to know from the Minister whether it is still the case that a patient has a statutory right to see a consultant, and whether a patient can insist on a direct referral from his or her GP without the interposition of additional diagnostic tests.

However, it is not just those diagnostic support services that are being privatised; front-line diagnostic services are being outsourced as well. I am, of course, referring to the NHS 111 service. The service was designed to ease pressures on accident and emergency departments by providing telephone-based triage, but many criticisms have already been made of it. Reference has been made to patients’ calls being answered by medically illiterate staff and to failure to meet targets to transfer calls to a clinician or nurse within 60 seconds or return them within 10 minutes, and there have been stories of patients simply being referred to A and E departments because call centre staff do not know what alternative facilities are available.

I do not wish simply to add to that catalogue of failings. My concern is more specific. In Brent and Harrow, we have an NHS 111 service that was awarded to Harmoni. That in itself was cause for some concern, as the company’s shareholders included the majority of the Harrow clinical commissioning group board that had decided to award it the contract. However, that is not the potential conflict of interest on which I wish to focus.

The urgent care centre at Central Middlesex hospital happens to be owned by Care UK, the company that also now owns Harmoni. Let me make clear that I am not accusing Care UK of encouraging its NHS 111 staff to make referrals to Central Middlesex in the knowledge that they will benefit from the treatment of any patients at the urgent treatment centre there, because I have no information to suggest that that is the case. Nevertheless, it is clear that there is a serious conflict of interest that any contract must monitor and guard against.

The interests of Care UK are clear, but its performance is not. I wrote to the Secretary of State for Health asking how the service in Brent had performed relative to the service specification. I asked,

“how many calls have not been (a) answered, (b) referred to a clinician or trained nurse within the appropriate timescale or (c) in receipt of a call-back from an appropriate clinician within 10 minutes”.

I received the following response:

“Local commissioners are responsible for performance management of NHS 111 services, and set their own performance targets for services…Data…is not available in the format requested.”—[Official Report, 23 October 2013; Vol. 569, c. 213-4W.]

In other words, the only people responsible for policing such conflicts of interest are the very people who have stood to gain from them.

The final issue I wish to raise with the Minister is that of the National Clinical Assessment Service. In many respects, this could merit an Adjournment debate all of its own. NCAS was established to undertake performance assessments of GPs and clinicians when primary care or hospital trusts had expressed concern that their clinical results or statistics appeared to have been outside normal parameters. There are more than 1,000 referrals a year, and in the vast majority of cases NCAS will assist simply by advising the trust in order to return the clinicians to safe and effective practice. However, in 50 or 60 cases each year an extraordinarily detailed and intensive process of assessment and remediation is required. Only about 60% of those who undergo that process make it back into safe and effective practice, while 40% never return to work in the NHS. NCAS is therefore one of the key guardians of patient safety.

In 2010, it became clear that NCAS would be restructured as part of the reconfiguration of the NHS. Its budget was cut by 20%, and it was told that it would have to become self-funding by 2013. In 2012, Deloitte was asked to conduct a review of the service, but it is due to publish its report only on 14 November, 10 days from now. In April this year, NCAS was joined to the NHS Litigation Authority, which has since consulted on a new structure prior to publication of the Deloitte report.

I understand that senior clinicians in NCAS are deeply worried that the head of the NHSLA has simply dismissed the very serious concerns that senior and experienced practitioners fed into the consultation about the proposals and the impact they might have on patient safety. NCAS is now haemorrhaging junior staff, whom it is allowed to replace only with agency people. The advertisement for a replacement for the senior assessment adviser specifies that the person concerned must be someone on secondment, and for one year only. The restructuring proposals dispense with the post of the director responsible for the “back on track” service, but no one else in the service has the clinical capacity to perform the role.

For some 50% of those who come for assessment, previously unidentified patient safety issues are revealed, often involving the cognitive impairment of the clinician himself or herself. I believe that before the proposed changes are allowed to proceed, the Minister must provide satisfactory answers to two questions. First, how will those patient safety concerns be discovered under the new model? Secondly, how will doctors who present a risk to the public be remediated and returned to safe and effective practice, given that the proposal specifically does not replace the key post with the clinical capacity to carry that out?

The problems and failings I have outlined this evening are not a series of unfortunate but unrelated events, but the logical consequence of a restructured NHS that has put competition and cost, rather than patient care and patient safety, at the heart of the health service. There has been a failure to ensure quality commissioning of the services being provided. In fact, one GP has written to me noting:

“It perhaps raises an interesting learning point for the future; that being if GPs are going to commission services and deal with private providers, what mechanisms are in place to stop patients being harmed by”

our

“negotiating a less than water tight contract? We are GPs not lawyers.”

Certainly with respect to the takeover of the pathology laboratory by TDL, no risk assessment was carried out to predict the potential problems that might arise from a change in both system and process, and no suitable performance measures were implemented, nor was a structure of monitoring put in place to ensure that a good quality of service was maintained. The Health Secretary has been keen to argue that privatising these services is on the basis of improvements to patient welfare and sound clinical evidence. It is not.

The awarding of the contract to Revisecatch Ltd shows that the clinical advice was ignored on the basis of cost, despite the clear implications for patient safety. The irony is that the subsequent change in contract specification almost always results in much higher costs, to the benefit of the private provider.

Patient care and patient safety can only be prioritised in a system where transparency thrives. Only in such a system can mistakes be learned from and become the basis of better future practice, but it is not in the interest of private companies to disclose any aspect of failing service. The root cause analysis report notes:

“The report provided by TDL on 08 March, was light on detail in parts and so it was difficult to identify lessons learned. TDL enjoy a good reputation and it is understandable that they would wish to protect this. However, in light of the requirements to put patients first and the duty of openness, transparency and candour, as recommended by Francis, it is felt that all involved could have been more open throughout the process.”

This issue of transparency and openness will remain a serious challenge for as long as private companies compete for contracts on the basis of cost.

Too many medical professionals are having to discover to the detriment of their patients that, for all their clinical expertise, they were never trained in the dark arts of commercial contract law, contract specification, negotiation and monitoring. It is the dogma of this Government that has put competition at the heart of our national health service, where patients should rightly be.

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

It is a great pleasure to be speaking in the Chamber under your chairmanship for the first time, Madam Deputy Speaker. I congratulate you on your success in being appointed.

I congratulate the hon. Member for Brent North (Barry Gardiner) on securing this debate. Before I correct some of the assertions he has made, I want to highlight the fact that the diagnostic services in England, and especially in Brent, are in rather robust health under this Government. Average waiting times for a diagnostic test remain low and stable, despite the NHS carrying out over 2 million more key tests a year since May 2010. The percentage of patients waiting six weeks or more at the end of June and July 2013 was 0.9% of the total number of waits. We can therefore see that the number of diagnostic tests is increasing, the availability of diagnostic services to patients has improved under this Government, and very few patients are waiting in excess of six weeks for the services provided.

Latest provisional data from the diagnostic imaging dataset show that almost 32 million imaging tests were reported in England in the 12 months from June 2012 to May 2013. Diagnostics have a key part to play in reducing premature mortality, particularly as NHS England estimates that over 1 billion diagnostics tests are carried out within the NHS every year. Access to safe and high-quality diagnostic services, such as endoscopy, genetics, and imaging, is critical to all clinical pathways. They underpin over 80% of clinical decisions and they contribute to the holistic care of patients, not just single episodes of care.

It is worth reminding the hon. Gentleman that the previous Government introduced, and championed the role of, the private sector. I believe we are all Blairites in this Chamber, in that we all believe in respect of publicly funded care that where the provider—be it the NHS, a private provider or a local charity or voluntary sector organisation—gives high-quality patient care, that has to be a good thing because it improves the quality of care. It is also important to highlight that the previous Government introduced private sector providers into the NHS to reduce waiting times for operations, which were unacceptably high at that time. I think we would all agree that it was a good thing that waiting times were reduced so patients no longer had to wait unacceptably long times for treatment they so desperately needed.

The first independent sector treatment centres were opened in October 2003, under the previous Government, and they gave £250 million to private providers of independent sector treatments. To their shame, they paid the independent sector on average 11% more than the NHS price for the same treatment.

Our intention in the reforms we introduced was to look at the mistakes the previous Government made in commissioning private sector services, to make sure there was a level playing field. There is no competition on price, as the hon. Gentleman asserted; there is only competition on quality in NHS services. It is important that any provider of NHS services and care to patients does so in an integrated way that delivers joined-up and integrated care based primarily in the community. Providing early diagnosis and early treatment and improving diagnostic services is a key part of that.

The big challenge that faces the whole of the NHS and the health and care sector is the fact that many people are living longer, and often with multiple medical conditions like diabetes, dementia and heart disease. The challenge is to make sure that we treat them with dignity and respect. We must also make sure that when we can diagnose a problem or illness early, we do so. That is why we are very proud to have increased the amount of early diagnosis and the number of diagnostic tests available in our NHS. The remaining challenge is to make sure we continue improving early diagnosis in Brent, London and throughout the country.

We know that when disease is diagnosed early, patients have a better chance of a good outcome. One-year survival for kidney and bladder cancers is as high as between 92% and 97%. At a late stage, however, it drops to between just 25% and 34%. The clinical case for early diagnosis and the investment we are making in diagnostic services is very clear, therefore.

Of course, apart from the clinical benefits of early diagnosis, there are other benefits. When people are ill, they want to know as soon as possible what might, or might not, be the cause of their illness. Having to wait a long time for diagnostic tests can be hugely stressful for patients.

Let me deal with the issues the hon. Gentleman raised about the commissioning of services. Since the beginning of April 2013, clinical commissioning groups have been responsible for commissioning many health care services to meet the requirements of their population. In doing so, CCGs need to ensure that diagnostic services are considered fit for purpose and reflect the needs of the local people as part of their process for commissioning clinical pathways. Local clinicians are best placed to understand the needs of their local population and commission the diagnostic services they need.

Local clinicians are commissioning in a way that is increasingly effective in diagnostics and elsewhere, so more choice in diagnostic services is essential. Many patients who require diagnosis—perhaps an ultrasound scan—will be working, and traditionally some of the NHS diagnostic models have not embraced seven-day working. We know that it is much easier for working people to access NHS services in the evening or at weekends. Therefore, bringing providers that supply greater choice for patients into the NHS makes it much more likely that patients will receive appropriate services at the right time and in a convenient way. It also increases patient compliance, not only with treatments, but with making sure they have their scans and diagnostics in a timely manner.

[Barry Gardiner]

The Minister rightly says that clinicians are best placed to make clinical judgments about their patients’ needs, and there is no dispute between us on that. My concern is that in a case such as that of TDL the clinicians understood the clinical need but clearly did not have the expertise to ensure that the contract was properly engaged in; that it was risk-assessed in the first place; that it was properly monitored; and that it was executed in a manner that was going to ensure the proper relationship between the practitioner and the tests that were being done. Similarly, on the courier service, they had the clinical evidence right, saying that refrigeration was needed, but when it came to putting the contract in place there was no such refrigeration.

[Dr Poulter]

I hope that the hon. Gentleman will forgive me for saying that many of the contracts to which he is alluding were put in place under the old arrangements, before this Government’s reforms, which have delivered clinical leadership. Many of these contracts were negotiated under the powers put in place under the previous Government, whereby people without clinical experience often negotiated the contracts and so did not always understand what the important clinical factors were. He rightly raised the point about potassium and the refrigeration of biochemical samples. It is important that we preserve the integrity of all samples collected. Of course, a clinician, a biochemist or someone with clinical experience would understand that, whereas someone who is commissioning services without that background might not. We saw that happen far too often with primary care trusts. The clinical input under the new arrangements will put us in a much better place to commission services in the future. Many clinical commissioning groups have been saddled with those old arrangements and so are having to enforce arrangements and contracts that they did not directly negotiate. We hope that when the contracts come up for renegotiation that problem will be put right, thanks to the reforms that we have introduced. They will lead to clinical leadership at CCGs, so that doctors and nurses are in charge of negotiations, rather than people who have not necessarily had the relevant clinical experience and do not have the knowledge to understand what the contract they are commissioning is about. National frameworks are being developed for some commissioning contracts by NHS England. So if concerns arise locally on the part of a CCG about the commissioning of contracts, NHS England is always available to provide advice.

I wish to reassure the hon. Gentleman that not just any old health care provider can deliver diagnostic services. By law, health care providers must register with the Care Quality Commission to carry out diagnostic services. That helps to ensure that patients receive only high-quality care, because the CQC, to which the Government are granting greater independence and strengthened powers to intervene where there are quality of care concerns, is the organisation that will be able to intercede if there are concerns about the quality of any health care service which may affect patient care. Service providers must be registered with the CQC and they must prove that they can meet strict quality criteria. That regulated activity includes a wide range of procedures related to diagnostics, screening and physiological measurement, including all diagnostic procedures involving the use of any form of radiation, including X-ray, ultrasound or magnetic resonance imaging. Regulated activities are listed in schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

[Barry Gardiner]

The Minister will have been aware of the report on TDL in north-west London and in no sense could it have been said that a satisfactory service was being delivered. So why did the CQC not intervene in a timely fashion? Why, when the initial report by the GP was made about a serious incident, was it not taken seriously? Why did it take so long to make sure that these services were being provided properly and that my constituents were being kept safe?

[Dr Poulter]

Clearly, the events that the hon. Gentleman has raised were distressing and appear to have caused difficulties for patients, and I know that local commissioners found that regrettable. I do not know whether the case was reported to the CQC. He will also be aware that the CQC has come on a considerable journey, from being an organisation that was not fit for purpose a few years ago to being an organisation, with new chief inspectors in place, that is in a much more robust state of health now. The Secretary of State has put in place a number of measures to beef up and improve the inspection regimes in all care settings. We now have a chief inspector of care, a chief inspector of hospitals and a chief inspector of general practice. Following the Francis inquiry, there is now much more transparency, openness and passing of information between health care commissioners at a local level and the CQC. That did not happen as effectively as it should have done in the past, and that was to the detriment of those in Brent.

[Barry Gardiner]

This was in 2012.

[Dr Poulter]

Indeed, and the Francis inquiry took place this year and a lot of action has been put in place by the Secretary of State to recognise where there have been failings in the health system in the past. We know that the majority of the health service, however it is commissioned, be it through a provider of NHS services, through the voluntary sector or through private providers, provides fantastic care on a day-to-day basis. We are proud that we have a publicly funded health service that has many fantastic front-line staff—I count myself still to be one—who do a very good job of looking after patients.

We know that things sometimes go wrong: the hon. Gentleman has highlighted what went wrong in his constituency and in the wider NHS things went wrong, very tragically, at Mid Staffordshire. We need to learn from those mistakes and ensure that they are put right in future, whether they are in the commissioning process—clinically led commissioning should put us in a much better place in that regard—or in the care that is provided to patients. We need to ensure that all hospitals, as well as other health care providers and care sector providers, step up to the plate, recognise that patient safety must always be paramount and ensure that the lessons that need to be learned from the Francis report are learned. My right hon. Friend the Secretary of State will report back to the House in due course—later this month, I believe—with further recommendations that will, I hope, reassure the hon. Gentleman.

In conclusion, let me turn specifically to diagnostic services in Brent. I am aware that the hon. Gentleman has recently asked questions about referral processes for diagnostic services provided in his constituency. As he knows, the contracts for those services were originally let by the then PCT under arrangements encouraged by the policies of the previous Government and are managed by the North and East London commissioning support unit on behalf of the CCGs. The London NHS Diagnostic Service, provided by InHealth, offers GPs and other health care professionals direct access to high-quality diagnostic and imaging scans and tests throughout London delivered from a range of sites, including mobile, fixed and community-based facilities.

I hope that it reassures the hon. Gentleman to hear that between September 2010 and August 2011, 2,397,018 diagnostic tests were carried out in London but more recently, between September 2012 and August 2013, there was an increase of about 300,000 to 2,651,560. That shows that the service in London is in robust health and is being used to facilitate scans and other procedures to diagnose many more patients today than two to three years ago.

I understand that the hon. Gentleman has been in communication with local commissioners and that the relevant NHS England area team has advised him that GP practices do not receive any referral payment when patients are referred to the London NHS Diagnostic Service provided by InHealth. I know that that is an area of concern to him and he was possibly suggesting that there might be some cosy internal relationship among local health care services to the detriment of patients. I can reassure him that that is certainly not the case. GPs make clinical decisions on the basis not of financial bribes, but of what is best for their patients. I hope that he will be reassured by the answer he has received from the commissioners and I do not think that it is in any way likely that GPs or other health care professionals will act in a way that is outside the best interests of their patients. It has always been my experience that front-line health care professionals, with very few exceptions, act with openness and integrity and always advocate for their patients’ needs. I hope he will be reassured by that.

I hope that the hon. Gentleman is reassured that diagnostic services are in robust health under this Government nationally, and in Brent.

Question put and agreed to.

Changes to Health Services in London

Barry Gardiner Excerpts

Wednesday 30th October 2013 Commons Chamber

[Mr Hunt]

My hon. Friend is right to draw attention to the pressures. I am sure that most A and E departments, including his own one in Northampton, would say that the biggest single cause has been the increase in the frail elderly population and the inadequacy of the care those people receive outside hospital. We are trying to put that right by having named, accountable GPs responsible for out-of-hospital care, reversing the historic mistake made in 2004, when that personal link between GP and patient was abolished.

[Barry Gardiner (Brent North) (Lab)]

This decision is devastating for my constituents. The Secretary of State will know that in the last winter period, Northwick Park hospital and Central Middlesex hospital, which comprise the North West London Hospitals Trust, were the worst-performing hospitals when it came to meeting A and E targets not only in London, but in the country. The trust scored 81.03%. That is an appalling record. What he has done today, by announcing the almost immediate closure of Central Middlesex, can only make that much worse. The College of Emergency Medicine has said that his reconfigured hospitals should have at least 16 consultants in their emergency departments, but his decision will give them 10—and that is not for major trauma centres. Will he elaborate on what he will do to bring the number of consultants up to the level required by the college?

[Mr Hunt]

Has the hon. Gentleman, who is so against these proposals, not noticed the proposals for more emergency care doctors, more critical care doctors and more psychiatric liaison support for A and E departments, which will reduce pressure on A and Es and mean that people admitted through A and Es for emergency care will not have a 10% higher chance of mortality if they are admitted at weekends? His constituents will be among the first to benefit from that. I would caution him, therefore, against saying that this is devastating for his constituents. We were reminded in Prime Minister’s questions earlier of how Labour suffered from predicting massive job losses, when in fact there was an increase in jobs. This announcement is good news for the hon. Gentleman’s constituents, and he should welcome it.