Capsticks Report and NHS Whistleblowing

Ben Gummer Excerpts

Wednesday 13th July 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a great pleasure to respond to this debate that you are chairing, Mrs Main. I echo the compliments paid by the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), to the hon. Member for West Lancashire (Rosie Cooper). The hon. Lady has been very brave in pursuing this cause, which she has taken up on behalf of her constituents. I agree that it is striking that this matter would not have come to the fore had she not had very sad and unfortunate personal experience of the failure of care at Liverpool Community Health. I thank her for her persistence in the face of opposition, not just from the usual quarters but from places that might not have been considered to be inimical to a Labour party Member. That is why I particularly commend her for what she has done and for continuing to fight the cause for her constituents. It is absolutely true that as a result of what she has taken up on their behalf, the care being provided is now safer than it would otherwise have been. Sometimes we need to remind ourselves that doing this job is worth while, and she has done that in great measure for herself and other Members of Parliament.

I would like first to offer an apology. It is right that the Government recognise it when things go wrong even if they are not within the direct control of Ministers. Everything in the NHS is the responsibility ultimately of the Secretary of State and of the ministerial team, and I am sorry that the NHS in this instance let down the hon. Lady’s constituents. At the same time as saying that, I hope that she and other hon. Members recognise that it is partly through the measures put in place by the previous Government that we have been able to flush out some of the problems that she identified. It was a Care Quality Commission inspection, under the new regime, that really began to unearth the problems in LCH, and it has been the tougher management of failing trusts that has meant we have been able to bring reform to this trust quickly. Not all is perfect; not everything is right in terms of the CQC or of the Trust Development Authority or its new iteration, but we are a great deal further forward now than we would have been five years ago. To be completely fair, we would have been further forward five years ago than we would have been 10 years before that. We are on a journey, and I appreciate the collegiate atmosphere that has been created in this debate and elsewhere.

I will answer the specific points and questions, because I do not want to reiterate the excellent exposition given by the hon. Member for West Lancashire. She asks who polices HR departments. The simple answer is that the Care Quality Commission, in its well led domain, as it looks at organisations will continue to look at the quality of leadership within an organisation. I will talk in a second about the kinds of thing that I think it should be looking for in the new round of inspections that it will begin in due course.

The hon. Lady asks about the fit and proper persons test. As it is currently constructed, it is for boards to be judging people by the fit and proper persons test. That is the way I think it should be, and there is consensus on that, but clearly those boards need to be properly constituted and know what they are doing. I think that that gets to the crux of what she is saying.

To answer the point made by the hon. Member for Ellesmere Port and Neston about training for non-executive directors, that is, funnily enough, something we are actively looking at to try to improve the quality of boards precisely so that they can ask the questions that are needed, not just in terms of a fit and proper persons test but in order to hold their executive directors fully to account.

The hon. Member for West Lancashire asks about the need for a review, and I know that that is the main purpose of bringing this matter to the attention of the House. I have commissioned NHS Improvement to do a review or at least to ensure that a review happens. As she will be aware, there has been some discussion about the terms of reference for that. I know that Jim Mackey has talked to her about it; she is in communication with him. I, too, am in communication with Jim and I hope that in the course of the next few weeks I or my successor will ensure that that review is as robust as it needs to be. The hon. Lady knows my view on that, which is that I do not want something excessively expensive and excessively long, because that will serve no one’s interests. We need to get the balance right, so that it is timely and good value for money and we are not taking money out of the NHS that would be better spent on her constituents’ care. If we can get to the root cause of these problems in a timely and efficient manner, that will serve her and her constituents well. I commit myself to ensuring that that happens quickly.

The hon. Lady asks about conflicts of interest. As it happens, NHS England is looking at precisely that at the moment. It is an area that we need to be much better in. However, I hope that as we see an evolving NHS, which is far more about collaborative working than the purist approach to competition that was the drive under the original foundation trust mechanism set up in the early 2000s, it will be less of a problem than she correctly anticipates it might be in this instance.

The hon. Member for Central Ayrshire (Dr Whitford) makes a number of important observations about her experience in Scotland, but I am afraid she is wrong on two points. NHS Improvement is not just interested in money; it is very firmly an improvement agency that deals with quality as well as financial performance. She will know that the two do go hand in hand. The best run trusts tend to be those that look after their money as well as their patients. We can see that relationship in the CQC inspections and their relationship with deficits. I suggest that she speak to the director of quality in NHS Improvement, Dr Mike Durkin, who was moved across from NHS England precisely so that NHS Improvement could become a true quality organisation. I am sure she will know him from the past. He is a globally respected expert in the issues of quality and institutional learning.

The hon. Lady is also wrong to say that the national guardian was an NHS manager. She is one of the leading chief nurses in the NHS, and I am sad that she felt unable to continue with that role. The hon. Lady will be pleased to know that her replacement, Dr Henrietta Hughes, is also a clinician—a practising general practitioner. It is very important that we give the right message to whistleblowers, and that is as much the case in Westminster Hall as it is outside in the public space.

[Dr Philippa Whitford]

The feedback that I have had from whistleblowers is that they see the new replacement national guardian as someone who is in an NHS manager role, and they feel that that is not sufficiently independent for the national guardian for whistleblowers. They are talking about the new guardian.

[Ben Gummer]

The new guardian is a practising GP and her office is deliberately set aside from the Department of Health; it is not part of our structures. The purpose of that is to ensure that the person is independent. I hope that that will give confidence to whistleblowers. I have asked her to make a decision on the helpline, because it is important that she makes that decision, not I, in the future.

Finally, I come to the questions asked by the shadow Minister. He talks about FT status. Much was right about the drive for foundation trusts, but a lot of things went wrong. We saw that at Mid Staffs and we have certainly seen it in this instance. I think that he will have noticed a far more considered approach to the FT pipeline in the past few years than previously. I know from experience of my own hospital, which failed to get FT status but is now a very good hospital, that the two do not necessarily correspond.

In all of this, we have to strike an important balance whereby we ensure that hospitals are performing while spending public money properly. The best hospitals and community care organisations do that by energising their staff, eradicating bullying and harassment and ensuring that people are free to speak up and exercise the duty of candour. That is why the thrust from the Department in the past 18 months to two years has been about living the values of the Francis inquiry. We have been putting that into practice in terms of the duty of candour, the whistleblowing apparatus that we have set up, and freedom to speak up.

We are at the beginning of a long journey. There is much to do to make the NHS the world’s largest learning organisation, but we have begun that process. I hope that the report that comes out—the further clinical review for the hon. Member for West Lancashire and her constituents—will be a further step on that journey, not just to correct and expose the failings in her area, but to ensure that the system as a whole, including the Department of Health, learns from them so that they are not repeated elsewhere and we continue to make the NHS the best healthcare organisation in the world.

North Middlesex University Hospital NHS Trust

Ben Gummer Excerpts

Tuesday 12th July 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank the right hon. and hon. Members who have given such thoughtful, considered, well-researched and knowledgeable speeches, and also the hon. Member for Hackney North and Stoke Newington (Ms Abbott) who provided such a thoughtful reflection from the shadow Front Bench. Members will be pleased to know that I agree with much of what they have said. I will come on to how I think the NHS has let Members and their constituents down and what we will do to try to fix the situation.

If Members do not mind, I will first set the issue in a bit of context. North Middlesex hospital was classed by the Care Quality Commission as requiring improvement for reasons that have been mentioned. The quality of care was not consistent enough and there were concerns about patient safety. It was not one of the worst hospitals in London, or in the country, but it was certainly not one of the best. Until July 2015, it was largely meeting its institutional standards. The 95% waiting time target for A&E was being met most months, even though the department is one of the larger ones in the capital, and in spite of the reorganisations that were discussed at length by the right hon. Member for Enfield North (Joan Ryan).

We need to be careful, therefore, with causality, and I will not give a definitive reason why the problems came about. A direct connection between the reorganisation of Chase Farm, which began under the Government before the coalition, and the problems experienced at North Middlesex over the past year, cannot be made with great surety because the hospital was dealing with the A&E caseload within the required timelines, albeit with a standard of care that was not at the level it should have been.

Nor is this about money. It is important to point out that organisations across the NHS, as the shadow Minister knows well, have reported deficits in the past year and this is one of the smaller ones. The posts that are established in the hospital are fully funded; the problem is trying to get the right people into them. I do not deny that the hospital has a staffing problem—I will come on to that in a second—but it is not connected with funding.

Let us get to the core cause of the problems that Members have noticed and brought to the attention of the House. I am afraid that I am not able to give a complete answer at this stage, but Members are entirely right to ask why this happened. We need a better explanation. This morning, I agreed with officials and NHS England that we will look in detail at the reasons within the hospital why the performance standards slipped so significantly in the middle of last year, and why the training routines and practices slipped as well. That is the first part of the review.

The second part is on why the system did not react with the speed it needed to when concerns were first expressed about a year ago. Here, I offer an apology to Members on behalf of NHS organisations. Members were not informed at the pace and the time they should have been, and for that I offer regret. Members are right to say that they should have been the first to know there were problems so that they could properly represent their constituents and hold local leaders to account.

I offer that apology within the context of a much better story across the NHS of what happens when hospitals fail. A warning notice was issued—that was the first reason that the right hon. Member for Enfield North knew something was going wrong—because of a change to the law under the coalition Government in 2014 on when the CQC was able to issue warning notices.

[Ms Abbott]

Will the Minister give way?

[Ben Gummer]

I will in a second. The whole system of CQC Ofsted-style inspection ratings, which are designed to be user-friendly so that non-clinicians can understand how well hospitals are performing, was instituted by the Secretary of State because we wanted to shine a light on the performance and quality of care in hospitals. Through two and a half years of having special measures routines and regimes for hospitals, we have a much better understanding of why things go wrong and can put them right far more quickly. Most importantly, we have a process for engaging Members of Parliament right at the beginning. That did not happen in this instance, and I will explain why after I have taken the right hon. Lady’s intervention.

[Ms Abbott]

The Minister may be coming to this, but I wanted to ask who Members should look to inform them of a catastrophic drop in standards. They should not have to wait for the CQC to issue a warning.

[Ben Gummer]

Ideally, if things are going wrong and that has been noted within the hospital, the hospital chief executive or commissioners should inform local people, but in the past—and over the two and a half to three years since we instituted the special measures regime—it has taken a Care Quality Commission investigation to highlight poor standards of care so inadequate that the hospital needs to be placed under special measures. At that point, before the public are informed, Members of Parliament are informed by the CQC and what was Monitor and the Trust Development Authority, but is now NHS Improvement.

[Joan Ryan]

rose—

[Ben Gummer]

Before I take the right hon. Lady’s intervention, I will explain why Members were not informed, and it is by no means an excuse. The core problem around emergency medicine and paediatrics was to do with the training places and the relationship between the General Medical Council, which looks at and regulates the quality of training, Health Education England and NHS Improvement. Because this case did not go through the traditional special measures route, which is governed by the CQC and NHS Improvement, things did not happen at the pace I would have expected and nor were Members talked to when they should have been.

The first thing I want to ensure, once we have receipt of the review I asked for this morning, is that we have a similar standard approach, were this to happen again. We have to assume that it might, because things in a large system do go wrong. We need to learn from this scenario over the past year, where Members have been let down, and ensure that it does not happen again. We can move with greater celerity and ensure that Members are informed at the earliest possible opportunity.

--- Later in debate ---

[Valerie Vaz (in the Chair)]

Before the Minister responds, there is a Division.

[Ben Gummer]

May I respond to the right hon. Lady before we suspend?

[Valerie Vaz (in the Chair)]

I do not know how long the Minister wants.

[Ben Gummer]

I will be 20 seconds, and then we can come back for part 2.

[Valerie Vaz (in the Chair)]

Okay.

[Ben Gummer]

I will answer the right hon. Lady directly. Of course there is more to do, but we are much further ahead than 10 years ago. There is no blame on any particular Government—we are further ahead than 20 or 30 years ago. The Care Quality Commission is a respected regulator that comes down with tough judgments and makes Members aware. When we come back after the Division, I will explain what we will do.

--- Later in debate ---

On resuming—

[Ben Gummer]

I promised to explain to the House what we will do to correct the situation. There are two parts to this. First, the short-term rescue plan has been put in place by Health Education England, NHS England and NHS Improvement, with the approval of the General Medical Council, to ensure resilience in the A&E department and for paediatric services. Two consultants have gone on secondment to the department, and a further five are coming this month. The GMC is happy that that will provide the rota resilience we need in the short term.

If we think that will fix things, however, we will quickly end up in the same situation. That is why we need to look at a far more robust plan for the next few years, so that the North Middlesex can become the centre of excellence that hon. Members and I certainly want it to be. A new improvement director will be in place to deliver an improvement plan, which I will ensure is shared with hon. Members. So the plan that the right hon. Member for Tottenham (Mr Lammy) requested will be available for other hon. Members to see. It will have the transparency that has been lacking so far.

I must answer a particular point made by the right hon. Gentleman about the General Medical Council. I do not think that it was silenced in any way. Genuinely, this is more muck-up than conspiracy, and I hope that it will not be repeated, as I have already assured hon. Members.

On the long-term plan, the hon. Member for Hackney North and Stoke Newington was entirely right: the North Middlesex is like many hospitals on the periphery of London, which not only are seeing rapid demographic change, but suffer from the fact that they are not the attractive training places that the central London hospitals are—we have to be blunt about that. I think that is wrong, because many of the challenges that aspiring doctors want are in those hospitals, which are diverse with an extraordinary range of clinical conditions. However, because of the history of the NHS, which I cannot change, a glamour is attached to the central metropolitan hospitals, and that causes challenges for district general hospitals throughout the country, as well as those on the periphery of London.

I want to change that, but we cannot do it by fiddling around. That is why I am excited by the link-up with the Royal Free. That kind of branding, which the right hon. Member for Enfield North pointed to, the strong leadership, which will provide stability, and, I hope, the ability to move consultants and senior nursing points around—some people recruited already into the Royal London and Barts will also work at the North Middlesex—will result in the diversity of career opportunities necessary to attract the kind of clinicians that the right hon. Lady and her colleagues have requested for their hospital.

[Mr Lammy]

To press the Minister on a bit of detail, the CQC’s press release stated:

“We have strongly encouraged the trust to engage with other organisations across the local health and social care system to resolve this challenging issue...there are moves to appoint more senior doctors—and I note that the trust is calling on consultants from other departments within the hospital to provide the routine daily support to A and E which is so badly needed.”

That was on 6 July and, clearly, the CQC did not feel that the hospital had got there. Will the Minister therefore confirm what the required number is? If he cannot tell us that, it would be helpful for him to come back to us. What is the golden number that should comfort us? Will he also confirm, because this is important, that nurses are not still reviewing patients who arrive by ambulance, because that is seriously inadequate, and we want to ensure that patients are seen by doctors?

[Ben Gummer]

I reassure the right hon. Gentleman that NHS England has a live rota stream from the hospital to give it the reassurance that every single junior doctor has a consultant supervisor in place at all times—precisely to ensure that the reported lapses of supervision do not recur. When the right hon. Gentleman meets the chief inspector at the CQC tomorrow, I hope that he hears something similar to what I have heard: things are not good, but they are better than they were, and the trajectory is in the right direction.

Nevertheless, we will not fix this without looking at fundamental reform of local health services, which requires changes to primary care, of the kind that we discussed when I met local Members of Parliament last week. I hope to meet them again, in a few weeks or months, and to be able to talk about progress and the plans for the future, so that right hon. and hon. Members will be satisfied that things are getting better at the North Middlesex.

[Mr Charles Walker (in the Chair)]

I thank the Minister—my constituents in Broxbourne will be following the outcome of this debate closely.

Question put and agreed to.

Resolved,

That this House has considered the performance of North Middlesex University Hospital NHS Trust.

NHS Spending

Ben Gummer Excerpts

Wednesday 6th July 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

First, may I apologise to the House for not being here at the beginning of the debate? I did, however, see the contributions of the hon. Member for Hackney North and Stoke Newington (Ms Abbott), who set up a powerful case in support of the Opposition’s motion, and of the hon. Member for Central Ayrshire (Dr Whitford).

I would not dispute the motion’s central contention. We have just had an enormous public debate—as the hon. Member for Ellesmere Port and Neston (Justin Madders) made clear, a debate of a magnitude that this nation has not seen for decades. A central claim in that debate—a claim on which the referendum hinged—was that there would be an additional £350 million for the NHS to spend every week, were we to withdraw from the European Union. To be very clear about that claim, it is not one that any Member who supported Vote Leave can run away from. It was emblazoned not just on the bus, but in even more explicit language on a poster, which said:

“Let’s give our NHS the £350 million”—

not “some of” or “a part of”, but “the” £350 million—

“the EU takes every week”.

Members will know my position in this debate. It is not my purpose to revisit the arguments for one side or the other, but Members on both sides of the House, of this great debate and of the referendum campaign have a duty to hold to account the people who made those claims, because the referendum was won partly on the basis of them, and people will expect results.

I would like to put on record the nature of our contribution to the European Union every week, so we can be clear not about the claims, but about the facts. The simple fact is that it is wrong to take one year’s contribution as typical, because our contribution varies from year to year. Over the past four years, our gross contribution has in fact been £313 million a week. If we were to deduct the rebate, which is £69 million a week, and public and private sector receipts, which are a further £108 million a week, our net contribution per week is actually £136 million, worked out on a rolling average from 2010 to 2014. I would therefore suggest to those on both sides of the House, and on both sides of the campaign, that the figure needs to be challenged and challenged again.

Any money that might or might not be coming to the NHS needs to be seen within the framework of that claim. It is important for us at this stage not to move away from the claims made in the great referendum campaign. It is important that we bring the country together, but that does not mean that we should not bring some sort of scrutiny to those claims over the next few years, when the effects of Brexit will be played out and when our constituents will feel those effects in their pockets and in the security of their families, although some will say that that will be to the positive and others to the negative.

In the next few years, we will have to take consistent measures to bring scrutiny to the claims that were made. However, it is not just the money that is important in terms of Brexit. I, too, am concerned that we bring scrutiny to bear on the other issues facing healthcare, whether the regulation of medicines, research funding—universities have expressed real concern about that in just the past couple of days—or workforce supply. In that respect, I would like to reiterate the support that my right hon. Friend the Secretary of State for Health expressed for the migrant workers who have come to this country to serve our NHS. Many of them provide skills we cannot provide in our own country, and their dedication to our national health service is equal to that shown by those serving it who were born in this country, and I would like to personally thank them for their contribution and service.

On that issue, I think we can have some agreement across the House. Where, I am afraid, I part company from Opposition Members, however, is on their comments about the claim that was made by Vote Leave—as the hon. Member for Aberdeen North (Kirsty Blackman) made clear, it was also made by Labour Members of Parliament. That claim has not been made by Her Majesty’s Government; nor is it one that can be attached to the Department of Health.

In addition, it has been said that the money released by Brexit, even if it were to materialise, would be backfilling what the Opposition claim to be a deficit in NHS funding. That description could not be further from the truth, and I would advise Opposition Members to look at the OECD’s latest figures, which were released earlier this week. They clearly demonstrate that healthcare funding in this country is now just above the average for the EU15. It has moved up from being below average, and we are now achieving parity with countries such as Spain, which has a fantastic healthcare system that is much admired around the world, and indeed Finland. Given that position, we should surely praise this Government and the previous coalition Government, who protected healthcare funding, even when the Labour party suggested we do the opposite.

In 2010, the Prime Minister said healthcare funding would be protected, even though the Labour Chancellor of the Exchequer before the 2010 election suggested it should be cut. Under this Secretary of State and this Prime Minister, NHS spending has undergone its sixth biggest rise in the history of the NHS, despite the fact that we have been contending with the biggest financial crisis this country has faced in its peacetime history since the great depression in the 1930s. The financial environment of the NHS therefore bears positive scrutiny, compared with the situation in other leading countries in the European Union and with the history of Government funding for the NHS. Of that, the Conservative party is justly proud.

That does not mean, however, that there are no pressures within the NHS. I would like to pick up on some of the comments made by hon. Members, which I know they have made earnestly because they care very much for their local health systems. The hon. Member for Copeland (Mr Reed), who is a doughty campaigner for West Cumberland hospital and for healthcare provision in his area, knows that I will meet him again and again—I hope, soon, in Cumbria—to discuss the issues that he has in his locality. We are a receptive ear, but we must always pay attention to clinical advice as it pertains to his local area and not to the political exigencies that might exist. Rightly, we have removed political decision making from the disposition of services. That is precisely why the reconfigurations in the constituency of the right hon. Member for Enfield North (Joan Ryan) took place. It is always easy in government to try to make political decisions on matters that should be the preserve of clinicians, but that is the wrong thing to do, because one makes decisions for reasons of political expediency rather than clinical reasons. That is why we rely on the success regime in the hon. Gentleman’s constituency and in the whole of Cumbria, as we do in other parts of the country, to provide a clinical consensus and the arguments for change that local clinicians will wish to see.

The hon. Member for Bristol South (Karin Smyth) has an expertise unrivalled in this House in the management of finances at a local area level. She is right to say that Brexit poses particular problems for staffing of NHS and social care services, procurement and medicines. As a member of the Public Accounts Committee, she has provided very good criticism of how the NHS has been running its finances, which has not been good enough over the past five, 10 or 15 years—indeed, for many years. This Secretary of State and this team are doing a great deal to correct that. She is right, for instance, to point out that NHS Property Services has not worked as well as it should have done in the past. I hope that in the months and years ahead she will see reforms that give her greater pleasure than dealing with NHS Property Services gave her in her previous role.

The hon. Member for Harrow West (Mr Thomas) described the problems at his local hospital, as did the right hon. Member for Enfield North in relation to North Middlesex hospital, which I have discussed with her. Both hospitals suffer similar problems to other hospitals on the outside rim of London—discernible and discrete problems that we are endeavouring to correct and to provide solutions to. I hope that the right hon. Lady has seen, in the movement over the past few days, our determination to sort out the problems at North Middlesex. As the Minister responsible for hospitals, I do not want to leave this job without having given stability and certainty to the hospitals outside London that they have not had for many years.

[Mr Gareth Thomas]

I intervene merely to underline the request for a meeting with the Minister to discuss the finances of Northwick Park and, crucially, of the clinical commissioning group in my area.

[Ben Gummer]

Of course I will give the hon. Gentleman a meeting. If the issue is about general practitioners, I will refer him, if he does not mind, to my right hon. Friend the Minister for Community and Social Care. However, I will certainly meet him to discuss finances and hospitals. I will arrange both meetings on behalf of his constituents.

I thank hon. Members for this short but constructive debate. It is the first stage in the necessary scrutiny of the claims that were made by both sides in the EU referendum. We are now going to see, in the months and years ahead, who was right. I hope very much that I and the people on my side were wrong, because if so, it will be easier to deliver the spending commitments made by Vote Leave. I fear not, however, in which case we will have some very difficult years ahead. However, people can be sure that in this Government they have a Secretary of State, a ministerial team, a Prime Minister and a party that will continue to commit the funds that are necessary to the NHS, so that we improve on our position in the European averages. We will continue to fund it better than any previous Government to provide for the ambitious designs for this, our national health service, which we all care so much about.

Question put and agreed to.

Resolved,

That this House notes that the Vote Leave group during the EU referendum campaign claimed that an extra £350 million a week could be spent on the NHS in lieu of the UK’s EU membership contribution; further notes that senior figures who campaigned, including the hon. Member for South Northamptonshire, the hon. Member for Uxbridge and South Ruislip and the Rt hon. Member for Surrey Heath have subsequently distanced themselves from that claim; and calls on the Government to set out proposals for additional NHS funding, as suggested by the hon. Member for South Northamptonshire on 4 July 2016.

Oral Answers to Questions

Ben Gummer Excerpts

Tuesday 5th July 2016 Commons Chamber

[Fiona Mactaggart (Slough) (Lab)]

8. How many staff working in the NHS have been recruited from other European countries in the last 12 months; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

There are no centrally held data on the countries from which NHS staff are recruited, but self-reported nationality data suggest that 15,723 non-UK European nationals joined the NHS in England and that 7,900 left, leaving a net increase of 7,800. As the Minister responsible for the NHS workforce, may I say that every single one of them is very welcome in, and provides an invaluable contribution to, our NHS?

[Fiona Mactaggart]

The problem is that the Immigration Minister’s waffle yesterday and Ministers’ warm words today are not giving confidence to these vital NHS employees. Has the Minister spoken to the Immigration Minister to request that he guarantee permanent residence to every EU national working in the NHS so that they can have the security that they—and we, their patients—need?

[Ben Gummer]

The Home Secretary is well aware of the enormous contribution that EU nationals make to the NHS. We all have a duty to undo the damage done during the referendum campaign and the poisonous atmosphere that exists in some parts of our communities and to thank personally—I will be doing so myself—EU nationals working in the NHS for their hard work and dedication so that they feel valued by each and every one of us.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

There has been a 27% surge in trainee applications to NHS Scotland because of the conflict around the junior doctors contract in England, and now doctors and academics from the EU are not taking up posts here because of the Brexit vote. With a one-in-four rota gap in many specialties, how does the Minister plan to sustain the current service, let alone extend it?

[Ben Gummer]

As much as I admire and like the hon. Lady, my opposite number on the Scottish National party Benches, I think that the behaviour of some of her colleagues in Scotland during the junior doctors dispute was not in the spirit of concord by which we try to establish relations with the devolved Administrations. I do not recognise the figures she quoted about junior doctors—I am glad that we have recruited well in this country during this difficult period—but I know that she will want to thank the British Medical Association for its work in bringing the dispute to an end. I hope that in the next few days we will come to a conclusion suitable for everyone.

[Dr Whitford]

I thank the Minister for that and for his welcome to EU nationals here, but with the Secretary of State merely repeating what the Immigration Minister said yesterday and given what the Home Secretary has said, does he not understand the urgent situation facing EU nationals working here? With more than 100,000 of them, do we not want to give them security of residency now to avoid haemorrhaging vital staff from the NHS?

[Ben Gummer]

The Home Secretary said she was confident we could get a deal ensuring that they could stay, but we need a new Prime Minister able to start the negotiations caused by the decision of the British people on 23 June. I say in my capacity as a Health Minister— the House has heard from other Members, including the Secretary of State—that we have full confidence in the EU nationals working in the NHS and wish to praise their contribution, which makes the NHS a better organisation.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The head of the NHS, Simon Stevens, has strongly defended the role of immigrants in the NHS, saying that there has never been a time in its 68-year history when the NHS has not

“relied on committed employees from around the world”.

One of these employees was my own mother, who migrated from Jamaica to the UK in the 1950s to be a pupil nurse. Workers from the EU and other countries are the backbone not just of the NHS but of our social care system, which is facing many challenges. Does the Minister agree that we should be thanking these hard-working individuals for their service, not leaving them with questions about their status and job security?

[Ben Gummer]

I agree entirely with the hon. Lady that we should be thanking EU nationals working in the NHS and social care system. She herself is evidence of the enormous contribution of migrant labourers, not just in the first generation but in subsequent ones. We, as a nation and a House, should be grateful for it. This is a difficult time for many EU nationals in this country, and we should be thanking them not just for the numbers but for the special qualities they bring. In my constituency, the amazing Portuguese nurses in Ipswich hospital bring qualities and skills that some of our own nurses in our own country do not possess in our own hospitals.

[David T. C. Davies (Monmouth) (Con)]

9. What the cost to the public purse was in 2015-16 of providing interpreters for people using the NHS who did not speak English.

--- Later in debate ---

[Dr Rosena Allin-Khan (Tooting) (Lab)]

12. What assessment he has made of the potential effect of the proposed removal of NHS bursaries on the number of applications from mature students for nurse training places.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

Mature students represent a significant proportion of the nursing, midwifery and allied health professions’ workforce. Looking at what happened following the introduction of the maximum £9,000 per annum tuition fees in 2012, the latest UCAS data for last year show that full-time mature student numbers have now significantly exceeded previous levels.

[Dr Allin-Khan]

I am proud to have served on the front line of our national health service for the last 10 years, and to ask my first question on its 68th birthday.

St George’s hospital in my constituency is operating at a significant deficit, partly owing to expensive agency staff costs. Does the Minister agree that cutting NHS bursaries for nurses, midwives, radiographers and other allied health professionals will prevent the recruitment and retention of high-quality trained staff and make the problem worse?

[Ben Gummer]

I welcome the hon. Lady to her seat. She fought a courageous campaign, and it is good to see her in the Chamber. She brings expertise to the House, which is also very welcome.

I agree with the first part of the hon. Lady’s question—the deficit at her local hospital is indeed partly caused by the excessive costs of agency nurses, and we are trying to put a cap on those costs—but I am afraid I disagree with the second part. I believe that changes in nurse bursaries will enable us to get more nurses and healthcare professionals into the NHS. There has been a similar development in the rest of the higher education sector, and I want to replicate that success in the NHS so that we can provide it with the workers that it requires.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I, too, am delighted to welcome my hon. Friend the Member for Tooting (Dr Allin-Khan) to her seat. Her recent experience on the front line of the NHS will be of great value, and we in the Labour party pride ourselves on listening to NHS staff. Let me also put on record my thanks to my hon. Friend the Member for Lewisham East (Heidi Alexander) for the excellent job that she did as shadow Secretary of State.

I must challenge the Minister again about the impact of this policy on mature students. According to an answer given to me by his colleague the Minister for Universities and Science, in 2010-11 there were 740,000 enrolments in higher education among people aged 21 or over. Let me ask a simple question: in 2014-15, after tuition fees trebled, was the number of enrolments among mature students higher or lower?

[Ben Gummer]

I echo the hon. Gentleman’s remarks about the hon. Member for Lewisham East (Heidi Alexander). She gave the House admirable assistance in challenging the Government, and I regret her loss from the Opposition Front Bench.

The latest figure from UCAS, for 2015, shows that the number of mature student applications has risen since the introduction of £9,000 tuition fees, but the hon. Gentleman is right to identify that factor as a challenge in relation to our new plans. That is why we asked open questions during the consultation, and I hope that, now that it has closed, we shall be able to respond to those questions to ensure that we can give the best possible assistance to mature students who want to become nurses.

[Justin Madders]

According to the universities Minister, the number of mature students enrolling in universities has fallen by 22%. If that were repeated in the health sector, what is already a staffing crisis would become a catastrophe. The Minister has said that an extra 10,000 training places will be created during the current Parliament, but everything I have heard from the Government suggests that that figure was plucked out of thin air. What is the baseline figure for the Minister’s claim—10,000 more places compared to when?

[Ben Gummer]

There will be 10,000 additional places over the five years from when the policy was announced last year, and that will give NHS organisations throughout the country the assistance that will enable them to bring down their agency costs. It is only through such bold initiatives that we can reform the NHS for the betterment of patient care throughout the country.

[Margaret Greenwood (Wirral West) (Lab)]

13. What assessment his Department has made of the potential effect of measures to reduce the size of NHS deficits on NHS staff numbers.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

Trusts and foundation trusts are responsible for ensuring that their workforces are affordable, given the financial control totals that have been set for this financial year. We are clear about the fact that the first priority in the reduction of provider deficits will be to reduce unsustainable spending on high-cost temporary staff.

[Margaret Greenwood]

Five per cent. of NHS workers in England come from the European Union. What steps is the Minister taking to ensure that every effort is made to retain those skilled workers, and will he provide them with the confirmation of their permanent employment status that they so urgently need?

[Ben Gummer]

At the risk of repeating what the Secretary of State and I have said previously, we very much welcome the contribution of all EU nationals working in the NHS. It is for the process of the negotiations to establish the precise status of everyone, both EU nationals and British nationals working abroad. That was not my choice at the referendum, but the decision has been made by the British people. I hope that the hon. Lady will take comfort from what the Home Secretary has been clear about: that she hopes to be able to secure a deal so that we can retain EU nationals in this country.

[Mr David Burrowes (Enfield, Southgate) (Con)]

Can the Minister confirm that the challenge to NHS budgets will not compromise in any way the provision of sufficient consultants and middle-grade doctors to not only keep North Middlesex hospital open, but to provide sufficient care to patients and proper quality training to trainee doctors?

[Ben Gummer]

The problems at my hon. Friend’s hospital are a result of management issues and long-running troubles that the hospital has encountered. I hope we will be able to fix them in the short term and provide long-term solutions, which I will be briefing about in the days to come.

[Several hon. Members rose—]

--- Later in debate ---

[Sir Edward Leigh (Gainsborough) (Con)]

T8. Community hospitals such as John Coupland in Gainsborough are very popular, yet health authorities seem intent on centralising services. Will the Secretary of State today make clear his absolute commitment to supporting local community hospitals and giving them work, and state that there will be no closures without his personal authorisation?

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

Community hospitals form an important part of the NHS landscape and are valued by local communities, many of which have contributed to them through their fundraising efforts. The Secretary of State has to abide by the decisions of the Independent Reconfiguration Panel and the advice of clinicians, but it is clear that community hospitals that evolve and modernise will have a place in the NHS in the future.

[Margaret Greenwood (Wirral West) (Lab)]

T6. The cancer drugs fund is due to be handed back to NICE later this month. In May, 15 leading UK cancer charities published an open letter detailing their concern that that would see patients missing out on clinically proven cancer drugs because the NICE system is outdated and no longer fit for purpose. Will the Secretary of State agree to carry out a wide-ranging review of NICE’s health technology appraisal process for cancer drugs to ensure that all cancer patients can access the drugs they need?

Bedford Hospital

Ben Gummer Excerpts

Tuesday 28th June 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank my hon. Friend the Member for Bedford (Richard Fuller). As a fellow Member of Parliament for a county town with distinct and important interests, I recognise his campaigning work. I know the pleasures and vicissitudes of representing a town such as Ipswich or Bedford and can see why he feels so passionately about this subject and why he continues to fight for the good of his hospital.

It is no wonder that Bedford hospital is held in such affection and high regard by the people of that town. It was founded in 1803 by Samuel Whitbread with a bequest of £8,000, which was not inconsiderable at the time, and three physicians—if only we could provide healthcare on such limited means now. That long history has clearly placed the hospital at the heart of the community. I can quite see why the charitable and community efforts that go into the hospital are so considerable.

My hon. Friend is right to point out that Bedford hospital is classed as requiring improvement by the Care Quality Commission. Although the CQC recognised that there were areas that were good and, most importantly, that the hospital was good at caring for patients, significant areas required improvement. I know that puts it with the majority of hospitals in this country, but it does not put it in a good place. The point of having these scorings by the CQC is to ensure that we can measure progress, so that hospitals across the country improve and become better at what they do.

All of us agree that the current quality of care provided at Bedford, as with other hospitals that require improvement, is not good enough and that something needs to be done about it. I know that my hon. Friend has not shirked that responsibility. In his speech, he made it clear that there are areas of clinical care, which are currently provided outside the county, that need to be provided because of the nature of the change in medical technology. They are provided outside the county because of the need to have clinicians doing work on a regular basis, which they cannot given the relatively limited population base. My hon. Friend’s hospital serves about 280,000 people, which is a small population for a district general hospital. Therefore, it is impossible for it, as it is for my own hospital, to provide the full panoply of services. That means that, in the future, the kind of services it provides will change. I hope—and this is the intention of NHS England—that, in some areas, it will increasingly do more of the work that was otherwise done at a regional level and that we will begin to see services in Bedford hospital that have not been provided there before.

By the same token—to take one particular clinical example—I imagine that the advance of stroke medicine will mean the establishment of major stroke centres, as we are seeing in London. The new technologies, which are currently very little used in the NHS, will require investment of a kind that we have never before had in stroke medicine, and that will have implications across the country. We must be honest about that, because it will require moving services so that people can have access to better treatment and therefore a higher likelihood of their lives being saved.

My hon. Friend is also right to say that the hospital has a deficit. Many hospitals in the NHS do so. Some manage their finances better than others, and there is a close correlation across the NHS between those hospitals that run their services well and those that run their finances well. The hospitals that are scoring outstanding ratings from the CQC are the ones that run their finances best. Those that cannot run their hospital well and are classed inadequate are those with the biggest financial problems. Given the fact that there is a standard formula across the country, that is to do with the internal management both by clinicians and managers, and not to do with differences in funding.

Clearly, there are issues with the quality of care at Bedford, and the future will be secured at that hospital only if, like other district general hospitals across the country, it can evolve, change and respond to changing medical technology and best practice. It also needs to provide new and additional services and to play to its strengths. One particular strength that I wish to highlight, because it is fantastically provided in Bedfordshire as a whole, is end-of-life care. It is noticeable that it was rated good by the CQC and clearly plays a part in the system-wide approach to end-of-life care, which I have held up to people across the country as a symbol of how to get it right, rather than wrong.

I will have to disappoint my hon. Friend in this regard: I cannot comment on the specifics of the reviews. There are two reasons. First, reconfigurations do not concern the Department. They are to be done locally; that is the point of reconfigurations. I will talk about the generality of that later, but I cannot direct one way or the other how that reconfiguration should happen.

I completely understand my hon. Friend’s frustration. He has been let down, and his community has been let down. This has been going on for far too long—its current phase goes back to the mid-2000s. That is not acceptable. There is one thing worse than making a bad decision or a mediocre decision, and that is putting off making a bad or mediocre decision and putting everything into chaos in the meantime—something on which we can reflect on a larger scale at the moment. If we do not move forward with proposals, we are not changing the hospital in the way that it might need to be changed or responding to changing circumstances. That means that in the end we create greater instability, and instability itself is a bigger problem for the hospital that might or might not remove one or two services.

That is not to say that I endorse whatever plan comes out from the joint committee, or to say anything otherwise, but I am absolutely determined that reconfigurations, as they happen around the country—and continue to happen through the NHS—should abide by the principles of reconfiguration. They should be independent, they should be clinically led and they should reflect the full gamut of clinical opinion across any area. They should be cognisant of the wider interests of the NHS; it is not right to be able to reconfigure something that has detrimental effects on neighbours. That is how our system works. They should also be expeditious, and this is where we have singularly failed over the whole history of the NHS. People hang around, they do not make decisions, they vacillate, and consequently when decisions are made they are often out of date, even if they are right.

This is where I hope that the STP process correctly identified by my hon. Friend will help. The chief executive of the NHS, Simon Stevens, has made it absolutely clear that we need to ensure that we have consistent, rigorous plans that have the agreement of the central bodies but are locally driven, that have the buy-in of all the local organisations involved in healthcare and that actually happen, so that they will happen within the period of the five year forward view, into which we are 18 months advanced already. That is why, whatever happens, the joint committee’s report needs to work with the STP when it is eventually published and agreed. The two need to work together; we cannot have two separate plans. It will be impossible to do that, and that goes for the situation across the country. We cannot have one plan that is not reflected in the STP.

I would encourage my hon. Friend to continue his hard work and that of his council to influence how the STP is formed and to bring maximum pressure to bear to ensure that it reflects the wishes of local people, so that the STP is something into which everyone can buy and so that it is realisable.

I want to reflect quickly on the generality of mergers. My hon. Friend spoke about the relationship with Milton Keynes. Again, it is not for me to make a determination on whether that is the right or wrong thing, but the whole NHS needs to get out of the rut of feeling that mergers can happen only between two neighbouring places. Often, it is the right thing to do, but being neighbours does not always make it the right thing to do. I would be as happy to see a relationship between Bedford hospital and another outstanding hospital elsewhere in the country if that was the right thing for Bedford.

Realistically—this is the same for my hospital as for others—we will have to see scale, not only so that we can better manage overhead costs but so that we can spread good practice, which is something that the NHS has been terrible at doing throughout its history. Some of the experience of the emerging chains elsewhere in the country—I point my hon. Friend to the work of Sir David Dalton at Salford royal hospital and the remarkable work done by Jim Mackey at Northumbria NHS trust—shows the advantage of creating partnerships, which would secure Bedford’s future and ensure that Samuel Whitbread’s original vision lives on into this century and therefore into the third century of the hospital’s foundation.

I thank my hon. Friend for bringing these important local issues to the attention of the House. I share his frustration. He is right in his analysis that this has taken too long. None of us in the House is able to determine the clinical adequacy, or not, of the plan as it emerges, but I impress on local commissioners and NHS England that we must ensure that a plan is agreed locally as quickly as possible and just to get on and do it, so that we stop this indecision and vacillation, which has clearly caused local people in Bedford such concern over so many years.



Question put and agreed to.

Oral Answers to Questions

Ben Gummer Excerpts

Tuesday 10th May 2016 Commons Chamber

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

10. What assessment he has made of the potential effect of his proposals to reform the NHS bursary on future levels of recruitment into the medical professions.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

The reform to the NHS bursary will lift the cap currently placed on university places for nurses, midwives and allied health professions. Universities will be able to train up to 10,000 extra students by the end of this Parliament. This increase in UK graduates will reduce NHS reliance on expensive agency staff and staff from overseas.

[Stuart C. McDonald]

I am certain that the Minister will want to congratulate the SNP on sweeping spectacularly to a historic third successive term, all on a manifesto pledge to protect rather than abolish the nursing bursary in Scotland. The serious question is this: how does the Secretary of State plan to monitor the impact that the removal of the bursary might have on students from poorer backgrounds who are training as nurses in England?

[Ben Gummer]

I would like to congratulate my friend the leader of the Scottish Conservative party, who has led the extraordinary resurgence of Conservatism and Unionism north of the border.

I regret very much that the SNP is not endorsing our plan to give opportunity to thousands more people who want to become nurses, especially those from under-privileged backgrounds. We will of course monitor the reform, not only as we continue our process towards making a decision, taking account of all the equalities analysis that will be done in the interim, but after the final decision has been made.

[Carol Monaghan]

It is recognised that there is a high proportion of mature students of nursing and other health professions. How does the Secretary of State plan to mitigate the effects of the removal of the bursary and provide support to students who have family commitments or who already have a student loan from a previous degree?

[Ben Gummer]

The NHS benefits enormously from mature students entering the service, and that is why we have already said that we will be looking at offering second-degree bursaries in the scheme. The consultation is clear: it asks a number of open questions, inviting responses from nurses and nurse trainees about how best to support mature students. We will be looking at those carefully as we formulate our conclusions.

[Martyn Day]

With the increased cost of training as a nurse and a 1% pay freeze throughout this Parliament, how does the Secretary of State plan to recruit and retain sufficient nurses in permanent posts in the short term, so that patient care and staff wellbeing are not negatively affected?

[Ben Gummer]

South of the border we have been able over the past six years to increase the number of nurses, both in training and in the service, which has been made possible by the stronger economy and the stewardship of the NHS, in such contrast to the developing picture in Scotland. We are able to expand the numbers in training by up to 10,000 between now and 2020 as a result of that innovative policy, and that is why it should also be adopted in Scotland.

[Michael Fabricant (Lichfield) (Con)]

What lessons has the Minister learned from the experience in higher education, where bursaries or grants were removed and replaced with student loans, and we have seen an increased number of students from all backgrounds?

[Ben Gummer]

We have indeed, and it is remarkable that south of the border we have seen a university that would equate to the fourth largest in the country filled every year as a result of the reforms to higher education funding, and a university the size of the University of Leicester filled with those who would not previously have gone to university as a result of the reforms that we introduced in 2011. I want to see those benefits extended across the range including to those who have not so far had them—namely, student nurses.

[Ms Margaret Ritchie (South Down) (SDLP)]

Considering the importance and the central role of nurses in the medical profession and in helping people when they are ill, how long does the Minister expect it will take on average for a nurse working in the NHS to pay back the total debt that would be accrued under the Government’s proposed replacement for the bursary scheme?

[Ben Gummer]

It depends of course on the career progression of that particular nurse, but the repayment terms will be precisely those for students of other degrees. Newly qualified nurses will not pay any more than they do currently, and the exact rates at which they will pay back—9% above £21,000—are outlined carefully in the consultation document. I recommend that the hon. Lady looks at it and sees the benefits that will come from the reform that, were it to be adopted in Scotland, would provide an enormous benefit to the service north of the border.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I start by congratulating the Secretary of State on becoming the longest serving Health Secretary in history. It is an important-landmark, not least because it is the first target that he has managed to hit.

On NHS bursaries, last week the Minister said that

“more mature students are applying now than in 2010.”—[Official Report, 4 May 2016; Vol. 609, c. 197.]

However, a written answer given to me yesterday by the Minister for Universities and Science appears to contradict this. Indeed, it shows that numbers of mature students have fallen in the past five years by almost 200,000. Given that the average age of a student nurse is 28, and in the light of the clear evidence from his own Government, will the Minister correct the record and commit to looking again at the impact of these proposals on mature students, who form a significant part of the student nurse intake?

[Ben Gummer]

I, too, as I know will all my ministerial colleagues, congratulate my right hon. Friend the Secretary of State on a remarkable tenure in his post.

It is clear that mature student numbers dropped immediately after the higher education reforms, but they then started rising and have now exceeded the rate before the reforms. I am happy to give the hon. Gentleman the details of that. We are also clear that we need to nurture mature students, which is why the consultation asked the specific question that it did. We want to invite answers from the service about how best we can do that because we are clear that the current system is not working as well as it should.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

2. What recent assessment he has made of the effectiveness of specialist nurses in supporting disabled people.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

Specialist nurses make a valuable contribution to the care of disabled people. They have specialist post-registration qualifications, which are attained through additional training. There are now 3,000 more nurses working in the NHS than in May 2010, ensuring that disabled people continue to receive the highest possible quality care.

[Debbie Abrahams]

In May 2010 there were 5,360 learning disability nurses. In January 2016 there were 3,619. The Government promised to protect the NHS frontline. Why does this protection not extend to people with learning disabilities?

[Ben Gummer]

It is true that the skills mix and the way in which specialist nurses have changed over the past six years may well account for the variation that the hon. Lady has noticed—I am willing to write to her with the detail—but the total number of nurses has increased, and we are giving better and more varied training to nurses across the board so that they can deal with the specialist problems that are increasingly the core part of their work.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his response. Specialist nurses are vital for the care and support that they provide for patients and families, not just for the elderly but for the disabled. What is his Department doing to ensure that funding for specialist nurses is maintained and that we do not end up in the situation that we have in Northern Ireland with Four Seasons, which is responsible for 62 homes in Northern Ireland and 450 across the whole of the United Kingdom of Great Britain and Northern Ireland?

[Ben Gummer]

Funding for nurses has increased over the past six years. It is because of the sixth largest increase in the NHS budget that we can guarantee that nursing numbers will remain in that strong position for the remainder of this Parliament. That will include specialist nurses. My role is to make sure that as many nurses as possible get additional training so that we have a wider and richer skills mix, specifically so that nurses can develop their careers—something that I am afraid was often made more difficult rather than easier under the previous career structure.

[Dr Tania Mathias (Twickenham) (Con)]

3. What steps he is taking to encourage the use of biosimilar medicines in NHS treatment.

--- Later in debate ---

[Peter Heaton-Jones (North Devon) (Con)]

The success regime review in Devon is causing real concern about the future of acute services at North Devon District Hospital. Does the Minister recognise that the unique geographical circumstances of Barnstaple mean that the reduction of any of those services will, for some of my constituents, mean a round journey of more than 120 miles to access them?

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I do recognise the unique geographical circumstances in my hon. Friend’s constituency. That is precisely why the success regime is being led by local clinicians. I hope and expect that in formulating plans they take account of all the views and all the clinical needs of his constituents and his own views.

[Norman Lamb (North Norfolk) (LD)]

There is growing concern that the additional investment in children’s mental health services committed last year is not getting through to where it is intended. What will the Secretary of State do to guarantee that that money gets through to help children with mental health needs? It would be scandalous if it did not get through. Transparency is not enough.

West Cumbria Health Services

Ben Gummer Excerpts

Wednesday 4th May 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is very kind of you to oversee this debate, Mr Nuttall. I thank the hon. Member for Copeland (Mr Reed) for his kind words and I of course accept the fact that he speaks on behalf of all his constituents—he has a fine track record of doing so. It is good to see the hon. Member for Workington (Sue Hayman) by his side, and to see here present my hon. Friend the Member for Carlisle (John Stevenson), who has also taken a profound interest in this intractable and difficult matter. I do not have much time, so I will address the points that the hon. Member for Copeland raised in turn.

The hon. Gentleman said that the NHS is our national religion. One of his great forebears, the creator of the NHS, Nye Bevan, said that socialism is the religion of priorities. I know that the hon. Gentleman understands the nonconformist antecedents of the British Labour party, perhaps better than some of the party’s current leadership. He will also know that we need to get priorities right in Cumbria. That is something that neither we nor our predecessors in Government have achieved for many years.

I hope that the hon. Gentleman does not mind if I start by refuting his central contention that the success regime has been perverted in its course. That is absolutely not the case. The success regime has had no further instruction from its co-sponsors, NHS England and NHS Improvement, since its foundation. I have certainly made no intervention, other than to listen carefully to Sir Neil McKay when he came to see me a few weeks ago so that I could understand the challenges that he has in bringing the success regime to a conclusion.

I am as frustrated as the hon. Gentleman is about the time the success regime is taking to formulate a plan, and I expressed that frustration to Sir Neil. He is going through the proper consultation process, which in Cumbria above all places needs to be done properly, given the failure of previous consultations either to be done properly or to result in a conclusion. That is why I understand why he feels he needs to go through the process as rigorously as possible, but I do want to see a conclusion. We need to see a proper clinical resolution to the problems. It is not for me to say what that clinical resolution will be, so I cannot comment on the hon. Gentleman’s specific questions about service delivery at West Cumberland hospital and its relationship with Carlisle, or, for that matter—he did not mention this—with other partners in the north, be they the Northumbria NHS Foundation Trust or other possible partners for the trusts in Cumbria.

We will give Cumbria all the means to be able to achieve what it needs to achieve, whether they be financial or representative. I hope the hon. Gentleman will understand that the 3% funding increase for the clinical commissioning group in Cumbria this year alone shows our commitment to ensuring that Cumbria has the funds it requires to achieve the changes it needs to make. Nevertheless, those changes will not come just from more money; there will need to be reform, which is why I urge him to look at the success regime’s emerging thoughts on integrated care communities. Those thoughts have been brought together not by me, NHS England or NHS Improvement bureaucrats—I count myself as a bureaucrat in that sense—but by local clinicians who understand the problems on the ground.

I cannot comment on the devolution deal, which is a matter for the Treasury, but I can assure the hon. Gentleman that I will ensure that he has an answer from the correct person on the recent never events, of which I was informed. He should know that the Secretary of State keeps in his office a board of never events throughout the NHS. He takes a keen interest in them and in their reduction. I hope that I can ensure that the hon. Gentleman gets a proper answer to those questions.

I have previously endorsed the moves by the University of Central Lancashire that the hon. Gentleman mentioned, and I will of course ask Health Education England to engage with that process as fully as possible. I disagree with him about the impact of nurse bursaries. It is exactly by reforming health education funding that we can release 10,000 additional places in nurse training school. Those places will mean that we can staff areas of the country that have been difficult to staff in the past. We cannot provide such massive expansion by the traditional means, and nor could the Labour party have promised to do so, because the costs involved are so considerable. It is by that reform that we will achieve the ends he wants to see. I want to be outlining more items of medical education reform in the next few months, and I hope that they will be to the advantage of places such as the University of Central Lancashire. In the meantime, I shall ensure that Health Education England takes a keen interest in that work—I know that it already is.

On the second phase of funding for the West Cumberland hospital A&E department, it is incumbent on me to say that £90 million has already been spent. That shows our commitment to ensuring that services in West Cumberland are of a consistent and proper level. Nevertheless, I will find out what the blockage is. I know there is a problem with increased costs and the fact that, as anticipated, the budget has been broken. We cannot have a situation anywhere in the NHS where, just because a budget is broken, we pay for capital increases, but I shall ensure that that particular matter is addressed as quickly as possible and that that is not part of the success regime reasoning, as it is part of a phased deal for that hospital.

Finally, the hon. Gentleman raised the issue of GPs. I know that he will have noted NHS England’s announcement last week about the improved deal for GPs: there will be in excess of £2 billion over the Parliament to increase support for GPs. A lot of that will be going into under-doctor areas and those areas into which it is hard to recruit. Those are subtly different things, but both apply to Cumbria. I hope that, over the next few years, he will see the impact as the 5,000 additional GPs that the Government have committed to providing feed through to improved services on the ground.

West Cumbria and Cumbria as a whole are indeed a mark of whether we get the NHS to be a national service. Bevan coined the term “universalise the best”, but that also means universalising the best that we learn from elsewhere in the world. We must learn from elsewhere in the world about how to deal with scarcely populated areas and make sure that we have specific solutions for places such as Cumbria. We have not yet done that successfully, which is why I want the success regime to be concluded as quickly as possible, and with community buy-in, so that we can have the results that Members present want to see.

Motion lapsed (Standing Order No. 10(6)).

NHS Bursaries

Ben Gummer Excerpts

Wednesday 4th May 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a great pleasure to respond to the motion, not least because I think that this is potentially one of the most exciting things that we will do in the NHS in the next five years to increase opportunity and quality, and the presence of nursing staff on wards. We will be able to do that because of the reform that has helped so many other students throughout the country in the last five years.

The hon. Member for Lewisham East (Heidi Alexander) entered the House at the same time as I did. In November 2010, we sat on opposite sides of the House and contributed to a debate; many of us expressed anxiety about the outcome, not least because of the enormous pressures that we were experiencing from our constituents. Members who have been here for many years will know that that was the first occasion on which a riot taking place outside the House could be heard from the Chamber. The rioters were complaining that we were going to destroy people’s ability to go to university. We were going to make it impossible for people from disadvantaged backgrounds to go there, and we were going to set back years of progress in the closing of the inequality gap in this country.

Members on both sides of the House who spoke in that debate felt very passionately about the issue. We believed that it could be resolved by different means, but over the last five years we have been able to see the effect—and, as posited by the hon. Member for Lewisham East, the evidence—of the changes that were made. That evidence is quite clear. This year, 394,380 people were given university places in this country, 35,000 more than were given places in 2010, the year of the debate. If those 35,000 were to make up a single university, it would be the fourth largest in the country: one university, the fourth largest in one year, following the expansion of opportunity that resulted from the reforms that the House passed in 2010.

The hon. Lady made the most important point, however, when she asked how the reforms extended opportunity to the people who most needed to go to university. I regret the tone that she adopted in that portion of her speech; it was, I am afraid, beneath her. It was indeed wrong that when I was at university my fees were paid for in part by nurses paying tax on low wages. That was wrong, and we accepted that it was wrong. We also accepted that the system was not helping the people who most needed to go to university in order to escape their backgrounds.

The result that we should be looking for now is the number of people from disadvantaged backgrounds who have been helped to get into university in the last five years, and I can tell the hon. Lady that it has increased by 10,150. That is a massive increase. Had someone said back in 2010 that that would be possible, I doubt whether anyone would have given 5,000:1 odds on it, but I can also tell the hon. Lady that 10,150 is the number of people at the University of Leicester. That is the number of people whom we have brought into the university sector as a result of the changes that we have made. We have the equivalent of one more university, full of people from disadvantaged backgrounds, as a result of the reforms that we enacted in 2010.

I know that the hon. Lady’s motivations back then were entirely honest and commendable. I also know that many Conservative Members felt likewise. But we have to accept when we get things wrong, and it is in that regard, I am afraid, that the hon. Lady, rather than us, is failing to learn from history. During the 2010 debate, in an intervention on one of my hon. Friends, she said that the proposed changes would force on students a “huge debt”, and that

“the huge debt that they could now face will act as a greater disincentive to go to university than it will for students from more affluent backgrounds”.—[Official Report, 9 December 2010; Vol. 520, c. 579.]

The hon. Lady has made exactly the same point in today’s debate. She was wrong then, and I humbly suggest that she is wrong on this occasion. She should listen very carefully to the evidence that has been presented, not by me but by so many institutions, about the progress that has been made in reducing inequalities, and the reasons why we need to press ahead. In this instance, for one reason alone—and I will come on to others—we need to bring about the reforms to nursing bursaries.

[Heidi Alexander]

Does the Minister not accept, though, that healthcare students have very different characteristics from other students, and that their behaviour will not necessarily be same as that of students affected by the reforms in the last Parliament?

[Ben Gummer]

I accept that there are differences—I will come to them in a second—but implied in the hon. Lady’s point is an acceptance that she was wrong in 2010, and she should therefore be more measured in her proposals, or lack of them.

[Wes Streeting (Ilford North) (Lab)]

It has not all been plain sailing since the reforms, not least as regards the impact on applications from mature students, who make up a significant proportion of the nursing cohort. Does the Minister not accept that there is no proposal in the consultation on how to mitigate the risk to good recruits from mature student backgrounds, who make up a significant proportion of the nursing workforce?

[Ben Gummer]

I am afraid that the hon. Gentleman is wrong on both points: more mature students are applying now than in 2010; and there are specific recommendations in the consultation to deal with mature students.

[Mark Spencer (Sherwood) (Con)]

Does this not demonstrate the Minister’s point? We have a choice: we either inspire people to aspire and give them the opportunity to enter the NHS by talking it up, or we take the opposite view, talk the NHS down by being negative, and put people off.

[Ben Gummer]

I do believe that. The Opposition were wrong back in 2010, and had we followed their advice, fewer people from disadvantaged backgrounds—precisely the people Labour was elected to represent and support—would be going to university. As a result of our taking forward brave proposals, in the teeth of much opposition, we have done more for the prospects of people from disadvantaged backgrounds than any Government dealing with this matter since higher education was reformed after the second world war.

I come now, I am afraid, to the motion tabled by the hon. Member for Lewisham East. It implicitly accepts that we have made progress. The fact that it is so anaemic in offering an alternative makes it clear that there is no alternative suggestion that she thinks would achieve the aims that she and I want: an increase in the number of students going into nursing and training, and of those coming from a diverse background. It also implies that she accepts, like me, that workforce planning over the last 10, 15, 20, 30 or 40 years has failed. I can say that, whereas she is not willing to, because everything we are doing now to correct workforce numbers—for example, the 5,000 additional GPs my right hon. Friend the Health Secretary fought the last election campaign on and will be delivering in the next few years—is the result of poor commissioning decisions made not under the coalition Government, or even in the latter years of the Labour Government, but under Governments 20 and 30 years ago.

The failure to predict the number of GPs needed, and the number and types of other professionals needed, lands us perpetually in this perverse situation where we are not accepting British students on to training courses at British universities and, as a result, are not creating the numbers of domestically trained nurses we need. In response to the inadequacies in care uncovered as a result of the Mid Staffordshire NHS Foundation Trust scandal and the failure of the Labour Government to provide the number of nurses needed in hospitals across the country, we are having to import nurses from abroad and to fill nurse places with expensive agency posts. That is something we are putting right now.

[John Glen (Salisbury) (Con)]

One of the main pieces of feedback I have had from Salisbury NHS Foundation Trust is its frustration at the reliance on agency nurses, so I welcome the Government’s moves, because they will open up supply and reduce that reliance and the significant additional costs we have seen over the last few years.

[Ben Gummer]

It is precisely to help my hon. Friend’s hospital that we are introducing these reforms.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The Minister said there was no alternative to these proposals. Which of the royal colleges did he consult before coming to that decision?

[Ben Gummer]

Contrary to what the hon. Member for Lewisham East said, I did consult the royal colleges. I have spoken at length with the Royal College of Nursing and with Unison. As I would expect, we differ on key parts—though not every part—of the plan, but the royal college’s initial response accepted that the premise on which we were proceeding was, in significant part, correct. In the consultation, I want to find areas we can agree on and improve the proposals we have put before the public. We were open about the consultation and offered the full 12 weeks—many people said we would not do so, but we did—precisely so that we could listen to the concerns, proposals and exciting challenges from people across the sectors, and thereby improve the proposals we have put before the NHS.

The motion suggests a series of things, but not a proposal from the Opposition to do anything different. They are not offering the NHS any new money—they offered £4.5 billion less than we did at the last election—so I can only presume that the money would have to be found from cuts elsewhere in the service. The hon. Lady will have no credibility unless she tells the House that she will pay for the 10,000 additional training places out of taxpayers’ money, rather than by finding an alternative funding mechanism. I will not offer the House a series of suggestions that might or might not be better, or merely criticise proposals, rather than offering constructive improvements.

[Heidi Alexander]

Whenever I make suggestions, they’re just ignored.

[Ben Gummer]

The hon. Lady is welcome to contribute to the consultation. She is doing so now, although sadly we heard no solutions or alternative proposals. I intend to set out not suggestions, but a clear announcement of our plans, the reasons for them, and how we will enact them over the year to come.

[Peter Kyle (Hove) (Lab)]

The Opposition have proffered many solutions to the Government. Just last week, we suggested a cross-party solution to the doctors crisis, but it was thrown back in our Front-Bench team’s face. Here is another solution: will the Minister speak to colleagues in the Department for Business, Innovation and Skills to see whether the apprenticeship levy, which the Government are taking from all large employers, could be spent on subsidising nurses to tackle the funding challenges?

[Ben Gummer]

The hon. Member for Ilford North (Wes Streeting), who has concerns about the proposals, has discussed the matter with me several times and offered some useful suggestions about the detail. I have accepted his points and incorporated them into our thinking. I am very willing to listen to people from across the House when they come with helpful suggestions, and I am sure that the Minister for Skills, my hon. Friend the Member for Grantham and Stamford (Nick Boles), would be interested in the hon. Gentleman’s contribution about the apprenticeship levy. The way not to do it, however, is to come to the House with a series of criticisms but not one suggestion, nor any money to provide for the increased number of training places in the plan.

We should make these changes not only for reasons of social equity, though that is the foremost reason; not only to produce 10,000 additional training places in our university system; and not only because we have a broken planning system, which otherwise would remain broken—even people as intelligent as the hon. Member for Lewisham East cannot predict how many nurses, doctors and allied health professionals we will need in 20 or 30 years, or the skills they will need. Even were it not for all those things, it would still be important to do this, because of the changes it will make to the quality of training we can provide to nursing graduates. Across the rest of undergraduate training, universities have been released to innovate and improve their courses. Satisfaction levels have gone up and drop-out rates have fallen; consequently, people are getting a better experience.

We have not, however, been able to spread those advantages to nurses, who, I am afraid, remain trapped in a system that is prescriptive and does not take account of the skills that they and their future employers will need. By releasing universities from their straitjacket, we can make significant improvements to the quality of the training they provide.

[Heidi Alexander]

That’s just an assertion.

[Ben Gummer]

It is an assertion that is backed up by the evidence of the past five years, and which has received the recommendation of Professor Dame Jessica Corner, the chancellor of the Council of Deans of Health. I can tell the hon. Member for Lewisham East, in answer to her barracking, that Professor Dame Jessica Corner said:

“We recognise that this has been a difficult decision for the government but are pleased that the government has found a way forward. Carefully implemented, this should allow universities in partnership with the NHS to increase the number of training places and also improve day to day financial support for students while they are studying. The plan means that students will have access to more day to day maintenance support through the loans system and recognises that these disciplines are higher cost, science-based subjects.”

Likewise, Universities UK has said:

“We support increasing health professional student numbers and will work with Government and the NHS to secure the sustainable funding system”

that the Government have provided. It is particularly pleased about the impact that this will have on placement training. These are the people who are providing training in our NHS, and they support our proposals because they will release the same kind of innovation that we have seen elsewhere in the university sector.

[Richard Graham]

I want to reinforce a point that the Minister has made. I think—he will know this—the evidence shows that far more people from deprived backgrounds have gone to university since the changes we made five years ago, at a time when Opposition Members were saying that they would have precisely the opposite effect. So the evidence is even more conclusive than my hon. Friend suggests. Can he confirm that the maintenance grants will go up by about 25%, which will help in regard to the specific point being made by Universities UK and the other lady?

[Ben Gummer]

I thank my hon. Friend for that intervention. It brings me neatly on to my next point, which is that the great virtue of these reforms to student finance is that we will be able to increase student finance support—maintenance support—by 25%.

The hon. Member for Lewisham East made some clear and sensible points. She suggested that training as a student nurse was different from being a history undergraduate, because student nurses have less time to take on a second job. There is therefore even more reason to provide better maintenance support for them. However, she has not come to tell the House that she will provide 25% additional maintenance support for students who do not have time to do a second job. She has not made that commitment, yet she has criticised our efforts to increase maintenance support by 25% precisely to help those people who would not otherwise be able to take time out to take on a university course. She cannot have it both ways. She cannot criticise us for the reforms we are undertaking while at the same time saying that students need greater support. It is precisely through these reforms that we are producing the support that so many students require.

[Liz McInnes (Heywood and Middleton) (Lab)]

The Minister talks about maintenance support, but can he clarify that that support will no longer be in the form of a grant, and will now be in the form of a loan? Does he acknowledge that that will land students in even more debt when they finally qualify?

[Ben Gummer]

By reforming the system so that this becomes a loan rather than a grant, we are able to produce 25% extra support for these students while they are training, much as with the rest of the student population.

The results relating to newly qualified nurses are not as the hon. Member for Lewisham East suggests. She should be very clear in the way she addresses this question, because all of us, whatever our views on this subject, have a duty to inform the public properly. It would be remiss of all of us, even those who disagree with the policy as she does, to mislead potential students into thinking that they will have to pay more than they would otherwise. She said that students would have to pay hundreds of pounds more in repayments once they had qualified. That is just not the case. We anticipate that a newly qualified nurse will pay roughly £90 a year more; that will be about the same as they are currently paying, because of the way in which student payment finance is gradated. The impact on newly qualified nurses will therefore not be anywhere near the impact that she has suggested. She should be very careful about how she addresses her points; otherwise, people could receive an impression about these loans that is not actually a fact.

[Nic Dakin]

What calculation has the Minister made of how much of the loan will not be paid back over a period of time? Can we have that information in the public domain as well?

[Ben Gummer]

The economic impact assessment is part of the consultation, and the hon. Gentleman should consult that. It will obviously depend on the way in which the student workforce develops over the next 20 or 30 years, but this has been fully costed within the Treasury’s assumptions, and we anticipate that people working beneath the current limits will not be paying back more than they are doing at the moment. That is in the nature of the way in which student finance repayments are calculated. These measures will not land newly qualified nurses with new payments that they might otherwise not have expected.

[Heidi Alexander]

The Minister has urged me to be careful with my words, which I was, and I recognise that he is being careful with his, too. He is talking about newly qualified nurses. Can he confirm what the average repayment would be for the average nurse?

[Ben Gummer]

We do not currently have a figure for the average nurse, as the hon. Lady puts it. I cannot project where a nurse’s career path will take them 50 years into the future, for precisely the reasons that we have been discussing. The actual repayments—[Interruption.] I will come to the hon. Member for Kingston upon Hull North (Diana Johnson) in a second. The actual repayments are clearly listed in the consultation document. They are clear about the amount that will be paid back over and above what existing students would be expected to pay.

The only way in which we will be able to square the circle that the hon. Member for Kingston upon Hull North mentioned is by reforming student finance. Rather than shouting from a sedentary position, she might like to know that, contrary to her suggestion that many people in her constituency were none the wiser about this reform, I talked about the reforms to nurses in her constituency a few months ago. I also talked to them about the introduction of apprenticeships and of nursing associate grades, all of which are part of the reforms that I am outlining, and they were very excited about the changes that we are making to the nursing profession. All of this is possible only within a budget that is being carefully controlled, and in which priorities are placed on where the money is spent.

[Diana Johnson]

I am sorry; perhaps I should not have been shouting at the Minister from a sedentary position, but I am surprised that he has come to this House and been unable to answer a basic question about the amount of money that will be lost through the scheme that he wants to introduce. Surely he ought to have those facts at his fingertips when he is standing at the Dispatch Box.

[Ben Gummer]

I do have those facts at my fingertips. A newly qualified nurse will not be paying any more than he or she is paying under the current system. For those on higher pay rates, the figures are in the consultation document, and if the hon. Lady is not willing to go and look at that herself, I will write to her with the details for her ease and comfort. Opposition Members, rather than picking at points because they refuse to face the fact that they have to fund their commitments with additional money, should listen carefully to the entirety of the reforms that we are proposing.

[Diana Johnson]

rose—

[Ben Gummer]

I will make some progress now, if the hon. Lady does not mind.

We are introducing a new nursing associate grade. This will present an extraordinary opportunity to eradicate one of the great unfairnesses in the NHS, which is that there are brilliant people working as healthcare assistants who are unable to become registered nurses because they were let down by the schools they went to. I am afraid that this is a consequence of the failure of school reform under the previous Government. Under previous Governments, people were failed to the extent that they have not been given the opportunities that they deserve.

We are going to reverse that situation by providing an apprenticeship ladder to a nursing associate role, and from there to a registered nursing position. A degree apprenticeship will be available to those who are able and competent to reach that grade. That will provide a route of opportunity that was not available under the previous Labour Government. It is being brought in by this Conservative Government—a one nation party for all.

By bringing in these reforms, creating a nursing associate role and creating 100,000 apprentices in the NHS, many of whom will be healthcare assistants working their way towards a nursing associate position and from there to a registered nursing grade, we will give people multiple opportunities to become nurses. That will include those who are already in the service and who want to earn while they are learning. It will take them between four and a half and six years to get to a registered nursing position from a healthcare assistant role. It will also include those who are able to take time out and do a degree to become a registered nurse, for whom we will provide additional support in the form of increased maintenance grants. Opposition Members are shaking their heads, but at what, I do not know. Are they shaking their heads at the 100,000 NHS apprentices that we are creating? Are they shaking their heads at the nursing associate roles? Are they shaking their heads at the increased maintenance support? None of those issues was addressed in the speech of the hon. Member for Lewisham East.

[Richard Graham]

Will the Minister give way?

[Ben Gummer]

I hope that my hon. Friend will not mind if I just conclude my remarks, because I know that Members from across the House want to contribute to the debate.

In my remaining minutes, I want to state why the reform is important not only for the individuals who want to become nurses, and not just for social equality and opportunity, but for the NHS. The NHS is unable to innovate like other parts of our public sector and our private sector because of the long lead times for training people. We do not have the instruments within the NHS to reflect the dramatic changes in demography and technology that change the NHS not year by year, but month by month. The great benefit of bringing in apprenticeship routes and nursing associate roles, of diversifying the skill mix and of creating quicker, more numerous routes into the nursing profession is that we can create a more diverse, flexible and agile trained workforce.

All that will be possible as a result of the changes, of which this bursary reform is part. None of it would have been possible with the reduction in funding promised by the Labour party, or a failure to wish reform upon the system. That is why I hope the House will reject the motion, which is full of suggestions and implications rather than firm plans. It says nothing about the future of the people on whom the NHS depends, and does nothing to suggest how we will increase numbers, provide additional maintenance support or, most importantly, provide opportunities for those who have not yet had any. We will do that by reforming the system, just as we did in 2010. We will ensure that we do not listen to the well-intentioned but erroneous voices of the Labour party. Had we listened to them back in 2010, tens of thousands of people would have been denied an opportunity. We are determined not to do that. We will be the party of opportunity, presenting it to people who want to be nurses or hold any other position in the NHS. This NHS will be truly national only if it provides opportunity to the many, not the few.

Ambulatory Care

Ben Gummer Excerpts

Wednesday 27th April 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank my hon. Friends the Member for Henley (John Howell) and for Banbury (Victoria Prentis), both of whom have spoken with great expertise about the place that ambulatory care has within a developing and modernising national health service. I cannot better the description that my hon. Friend the Member for Henley gave of the purpose of ambulatory care and the place it holds in his constituency, which I will turn to at the end of my speech.

For the benefit of the House and the record, I will add some examples of what ambulatory care entails for patients around the country. There is a clinical decision unit in the Royal Free hospital that provides an alternative to admission to an emergency department for patients who may benefit from an extended observation period. The James Cook University hospital has an ambulatory emergency care unit that handles nearly a quarter of all emergency admissions and manages a whole range of medical emergencies, including cardiac failure, cellulitis, diabetes and low-risk gastrointestinal bleeds.

The university hospital of Leicester has a frailty unit, which supports patients who are over 70 and need treatment for conditions such as delirium, dementia and fractures. The rapid assessment and treatment unit at Queen’s hospital in Romford has greatly reduced the time between a patient being assessed and a care plan being implemented. Those examples are in addition to the example that my hon. Friend the Member for Henley gave of Townlands in Henley.

Where ambulatory units are collocated with an emergency department, patients arriving at A&E by ambulance or as walk-ins are triaged according to clinical need and directed to the unit for treatment or tests, effectively bypassing the main emergency department. Patients identified as needing specialist treatment, tests or monitoring at the hospital, but who do not need to stay overnight, can also be referred to ambulatory units by a general practitioner. Patients with long-term conditions can be booked in for regular treatments such as dialysis.

Ambulatory care units can also focus on returning patients to their homes after treatment as quickly and safely as possible, as my hon. Friend outlined. As a result, patients are more likely to have good health outcomes because they avoid unnecessary overnight stays. He outlined beautifully the principle behind ensuring that people do not stay in bed any longer than they need to. The statistics on that developing area of academic study are stark, and he put them plainly to the House for its attention, but at their core they encompass something rather encouraging for many, although not all, patients. The best principle is to keep on going. We have all seen that with our elderly relatives: the minute one stops prematurely or unnecessarily, one precipitates a decline in condition, rather than an improvement.

Ambulatory care is an exciting and important approach to providing patient care, just as my hon. Friend outlined, and it will be central to the development of the national health service in the years to come. It has not come about by accident. It is based on good science and academic study. We in the Department are led by the Royal College of Physicians’ acute care toolkit and NHS England’s “Safer, faster, better”, which is based on the royal college’s advice.

While ambulatory care units may vary between trusts, both the royal college and NHS England have provided guidance on what a good unit looks like, so the underlying principles that all units are built on are the same. The principles fall into three main categories. First, the units must be patient-focused, meeting the needs of patients through timely treatment and discharge, and bringing together secondary and primary care services to avoid admission where beneficial. Secondly, effective clinical decision making is key, ensuring not only that patients in ambulatory units receive the high standards of care we expect from the NHS, but that the patients who would benefit from an ambulatory setting are identified early and directed to the service. Finally, ambulatory care needs to form a coherent part of the hospital-wide health system and structure to improve the patient’s journey flow through the hospital. Gaining support from other parts of the system, including clinical commissioning groups, as in my hon. Friend’s constituency, and primary care more generally is key to ensuring that the potential benefits are realised.

Ambulatory care units work well as independent units within acute trusts, but they work best when they are part of an integrated system. That is why I am pleased to see that there is an ambulatory emergency care network, which allows trusts to share best practice and to understand how to improve their services further. The Royal College of Physicians estimates that more than 30% of patients admitted for medical, as opposed to surgical, reasons could be treated in an ambulatory setting. By treating and discharging patients on the same day, emergency admissions are reduced, leaving hospital beds available for those patients who need them the most. There is therefore an advantage not only to the patient but to the system as a whole, because we are freeing up capacity for people who really do need the beds.

Increasing the numbers of patients seen in ambulatory care also has the potential to reduce waits for patients in A&E, which in turn decreases pressure on wards and increases bed availability, providing benefits to patients in other parts of the system. A whole number of benefits therefore come from ambulatory care. My hon. Friend mentioned the urgent and emergency care review and the place that ambulatory care has in that. I turn quickly to his experience of it at Townlands, where some features are particularly impressive. The first is the way in which the service has been brought together in the rapid access care unit—I imagine it is called a RACU, but I am sure the people of Henley pronounce it with a soft C. I found the integration of that with the Orders of St John Care Trust next door exciting.

It is clear that the clinical commissioning group in my hon. Friend’s constituency has been thoughtful about commissioning the care needed, involving other providers of care and using beds only when absolutely necessary. It is an ambulatory care setting without beds, but if beds are needed, it has 11 beds on a three-year contract, purchased from the trust next door, and if that number needs to increase still further, it can procure such beds through the CCG’s usual spot purchasing arrangements. For people who are admitted to an ambulatory setting, beds are available if needed for step-up care—or for step-down care for people coming from the John Radcliffe or from other acute trusts that serve my hon. Friend’s constituency.

Ambulatory care allows for a far more subtle approach to people needing care. As my hon. Friend outlined, it provides much better patient outcomes, is better for the health system as a whole and is much more flexible, ensuring that resources go precisely where they are needed. That opens out a much wider point, which he alluded to elegantly—I will say it rather more vulgarly than he did—namely the serious question of how we frame community services in the future. In parts of the country, we have a far older model of community service provision based on large bed capacity in community hospitals, which are much loved by their local communities, often funded in part by the local communities and in almost every instance founded by the local communities. We know, however, that in many cases they are not providing the best care for patients. It will often be a difficult transition to a better standard of care for patients, providing them with better outcomes and releasing resources for better outcomes for all patients across the health system.

By bringing the experience of Townlands hospital to the House’s attention, my hon. Friend has shown that we can be thoughtful and direct with constituents about the implications of change, and can explain carefully how improvements that might be challenging on the face of it, because it might seem that a benefit is being lost, can produce a whole series of additional benefits that enable better patient outcomes and a better distribution of resources within the system. He has allowed the House to understand how the benefits could be more widely spread across the NHS.

I turn finally to NHS England’s plans for ambulatory care. My hon. Friend will know about the vanguard sites in place across the country. Many of them involve the use of ambulatory care systems. There are many different kinds of ambulatory care settings involved in the vanguard sites, but the principle remains broadly the same: to try to identify those areas and experiences that replicate the positive experience that he, with the co-operation of his clinical commissioning group and primary care and acute trusts, has brought to Henley, and to ensure that that is tested on a system-wide basis. We can then roll that out across the rest of the country. We have 50 vanguard sites involved in one way or another in community care settings across the country, and I hope that that will inform a far wider transformation by the end of the five year forward view period, which concludes at the end of the Parliament.

[Mr Andrew Smith (Oxford East) (Lab)]

I am sorry to come in at the end of the debate, but I was delayed by traffic. I congratulate my colleague from Oxfordshire, the hon. Member for Henley (John Howell), on securing this important debate. Does the Minister agree that in the roll-out it is important that the ability, training and qualification of home careworkers is raised, so that they can complement the changes in services?

[Ben Gummer]

The right hon. Gentleman makes an interesting and subtle point. That is absolutely the case, and that is partly why, as part of the workforce review that I instigated, we are looking at apprenticeship and nursing associate models that will help to upskill nurses and care practitioners in not just acute but community settings. The result will be an ability to provide a far better, more holistic service to patients when they turn up at an ambulatory care setting, or indeed at the John Radcliffe, or, hopefully, when they are looked after at home before that happens, and when they return from either of those places. All that taken together provides a far better service to constituents.

I welcome the approach that Members have taken in this little but important debate. If we are positive about these changes and have a will to explain them to constituents, they will quickly understand why this system is better for them. Those Members who wish to pursue a cruder campaigning method that looks purely at the number of beds provided in any one setting, based on the model inherited from 1948 rather than one relevant to 2018, will be doing their constituents a disservice. In being brave and direct with his constituents and in explaining clearly the benefits that he has endeavoured to get, my hon. Friend the Member for Henley has delivered a far better service for the people of Henley than the one they had last year. It will continue to improve throughout the course of the Parliament.

Question put and agreed to.

Upper Gastrointestinal Haemorrhage

Ben Gummer Excerpts

Monday 11th April 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank my hon. Friend the Member for South West Wiltshire (Dr Murrison) for his wide-ranging introduction to this important matter, and for his ability to make this difficult medical subject relevant using the important context of “Downton Abbey”. Lord Grantham’s ulcer is, indeed, a filmic representation of a dangerous clinical event that can happen to people. Mercifully, its incidence in this country is relatively low when compared with that of our European partners and colleagues, although the mortality rates associated with GI bleeding are higher than we would wish. The data are not as robust as I would like them to be, and comparisons can therefore not be nice ones, but none the less mortality rates are not as low as they should be when compared with European comparators.

My hon. Friend points out a number of reasons why that should not be the case. He speaks wisely about the need for on-site site endoscopy, on-site radiology, on-site surgery and on-site critical care, all of which were recommended by the NCEPOD report. That tallies closely with the most recent National Institute for Health and Care Excellence guidelines. The guidelines specify that endoscopy should be offered to unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and offered within 24 hours of admission to all other patients with upper GI bleeding.

Reports from NHS Improving Quality and the National Confidential Enquiry into Patient Outcome and Death, to which my hon. Friend referred, go further and state that that will require the appropriate structures to be in place at all hours of the day and on all days of the week. As he reflected, that tallies well with the aims of the Government in producing a seven-day NHS, although I will, if I may, take issue with certain aspects of his comments in a few moments.

The audit of endoscopy services for acute upper gastrointestinal bleeding in 2007 found that only half of all acute trusts in England were compliant with NICE guidelines in this area. The most recent survey has shown some improvement. In 2013, 62% of services are able to provide a formal 24/7 rota for endoscopy specialists, and 56% of services can offer acute admissions for endoscopy within 24 hours of admission. While this is an improvement, there is clearly a long way to go if only 62% and 56% of services respectively provide the kind of provision we expect. Our aim, therefore, is to ensure that every patient has 24/7 access to safe, high-quality GI endoscopy services with facilities to perform an interventional procedure linked to other essential interventions, such as interventional radiology and surgery. High-quality care will not only reduce mortality and complications but increase early discharge, through the use of formal risk assessment scores, and reduce lengths of stays.

It is therefore important that those services are available to those patients at all hours of the day, and on all days of the week. That is why we have made clear our commitment that, by the end of this Parliament, patients with urgent and emergency hospital care needs will have access to the same level of consultant review, diagnostic tests and treatment seven days a week; patients with upper GI bleeds will be one of many cohorts of patients to benefit from that.

At this point I should be very clear in my response to my hon. Friend. He restated the position, often quoted by Opposition Members, that somehow there is a lack of definition about our intentions for 24/7 services. I say to him gently that we have been very clear indeed about how we believe the seven-day NHS will be delivered. In secondary and tertiary care, it will be based entirely on the needs of urgent and emergency care pathways. Those pathways have been outlined in 10 clinical standards brought together by the Academy of Royal Medical Colleges, under the chairmanship of Sir Bruce Keogh. Those 10 clinical standards have informed the policy we have developed on urgent emergency care, which will be announced and rolled out in the weeks and months to come.

We could not have been more clear, both in this place—I believe we have been clear to my hon. Friend—and to the public at large, that our intentions for a seven-day NHS are rooted in the provision of a consistent urgent and emergency care pathway for patients. We have never intended to mandate from the centre non-acute dermatological services, as he suggested, or any other service like that.

Clearly, to support good 24/7 services in hospitals we have to be able to provide exceptional diagnostic services. Whatever the lacunae in the current evidence base around particular specialties in the NHS—we are never going to have a full picture in the way we might wish—we can draw general conclusions. One, which my hon. Friend rightly drew, is that the quality of diagnostics needs to be consistent, people need to have access to those diagnostic services on a regular, rigorous, robust and consistent basis, and those services need to be available on a Saturday night much as they would be on a Monday morning. That is why the Government’s intentions on 24/7 services involve consistent diagnostic services, as we have made clear since the beginning of the policy.

It is important to explain how those services will become priorities for trusts. In the roll-out of a consistent 24/7 service in diagnostics, we want to be clear to trusts about exactly what is expected of them. Patients admitted as an emergency should be seen as soon as possible by a consultant for review, but at least within 14 hours of arrival at hospital. In-patients must have scheduled seven-day access to the full range of diagnostic services, including endoscopy, with reporting of results within one hour for critical patients and 12 hours for urgent patients. In-patients must also have timely 24-hour in-patient access to consultant-directed interventions such as critical care, interventional radiology, interventional endoscopy and emergency general surgery, either on-site or through formally agreed network arrangements. Finally, all acutely ill patients in high dependency hospital areas, such as the acute medical unit and the intensive care unit, must be seen and reviewed by a consultant twice daily.

I hope my hon. Friend will see that we are already encapsulating his principal demands about upper gastrointestinal bleeding in the general outline of the clinical standards that we plan to roll out to ensure consistent quality of care for urgent and emergency care pathways.

We will monitor the implementation of those clinical standards through transparent metrics, and I hope that in a year, if my hon. Friend is successful in securing a further Adjournment debate—I would happy to brief him privately on this issue both then and in the interim—he will see that through the transparent metrics that we will publish on mortality, length of stay, emergency readmissions and whole series of other measures, there will be trust compliance across clinical standards.

[Jim Shannon]

I understand that mortality rates for hospitalised conditions can be as much as 35%. That worries me, and I am not sure whether the Minister has addressed that issue. He referred to 10% mortality, but some hospitalised conditions have a 35% mortality rate. We must address that.

[Ben Gummer]

There is variation in mortality, and I hope we will make progress in that area over the next period. We must understand comparisons of mortality across the country, and as the hon. Gentleman knows, the Secretary of State is interested in discovering and understanding that issue. We must also understand variations across the European Union, and in the United Kingdom where there are apparent variations between practice in England and that in Scotland, Wales and Northern Ireland. Some of that comes down to data collection, but we must understand where it comes down to practice and consider how we can improve in accordance with our most neighbourly health systems.

[Dr Tania Mathias (Twickenham) (Con)]

I appreciate the Government’s intention, but I do not know whether my local hospital is accredited. I am highly concerned about the current postcode lottery. What is the Minister’s plan right now, tonight, for people who are going to a hospital that does not have an adequate rota system and is not accredited?

[Ben Gummer]

The principles that inform the policy of creating a sustainable seven-day NHS are being announced in stages. The clinical standards to which I referred have been explained in this place and outside several times, and I expect that in the next few weeks and months, further details will be given on the pace at which units around the country will comply. My hon. Friend will know that in the autumn the Prime Minister made it clear that 25% of the population will be covered by 24/7 urgent emergency care services by March 2017, 50% by March 2018, and the entire service by 2020. Precisely how that happens will be made clear in short order, and I hope that my hon. Friend will be satisfied that her hospital will form part of the programme to provide the coverage she expects.

The fact that we are having this discussion is testament to the fact that we are willing to be open about variation and failure, and to do something about it. I thank my hon. Friend the Member for South West Wiltshire for bringing this issue before the House because, just as Lord Grantham popularised it for the nation at large, my hon. Friend has explained in a particular clinical area how the introduction of robust, sustainable 24/7 services will provide the improvements in clinical care that the Government seek. That is why the challenges and difficulties that face us in introducing 24/7 services require attention across the board—not just in hospital estates, but in the configuration of services, the way that services are commissioned and procured, and the contracts that ensure that rotas can be properly manned across the service. We must attack this problem on all fronts and ensure that we provide consistency of care to our constituents. They do not choose when they fall ill, but they should expect the same quality of care whether they go to one unit or another, or on a day not of their choosing.

Question put and agreed to.