New Cancer Strategy

Ben Gummer Excerpts

Thursday 19th November 2015 Commons Chamber

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

It is a great pleasure to respond to the excellent speeches that have formed this interesting and remarkably well-informed debate. I echo the thanks given by the shadow Minister and others to my hon. Friends the Members for Basildon and Billericay (Mr Baron), for Bury St Edmunds (Jo Churchill) and for Bosworth (David Tredinnick) for securing the debate in such a timely manner. I do not think that even they would have anticipated it coinciding with today’s launch of the consultation.

The debate touches on the lives not only of everyone in this House but of everyone in the country. The frustrating regularity of cancer diagnosis—in the past week, two of my friends have had a cancer diagnosis confirmed—is shared by Members and by people watching this debate across the country. That is why this is such an important and salient issue for all our constituents. I am therefore very grateful to hon. Members for both speaking on this matter and for bringing it to the attention of the House.

At the start of my speech, it is worth reflecting that we are able to speak about this issue from a position of celebrating the success of the past few years. There have been quantum leaps in the treatment, diagnosis and survival rates of cancer. More than half of people receiving a cancer diagnosis now live 10 years or more, a remarkable statistic that would scarcely have been believed 20 or 30 years ago. The fact that we are able to speak frankly about this at all, with the very personal speeches hon. Members have given today, marks the end of the dangerous taboo surrounding talking about cancer. Happily, we are now able to replicate that fight in relation to mental health and end-of-life care. The work done by cancer charities over many years, to talk about cancer and to make it a live issue in the public imagination, is now reflected in other important areas of care.

[Mr Baron]

The Minister is absolutely right to say that we have made great strides, and the Government are to be congratulated on playing their full part in that, but may I gently remind him that as we have made great strides, other countries have also made great strides? The debate is largely about the fact that we are still well behind European averages on survival rates. The first year survival rate in this country is 69%, whereas in Sweden it is 81%. That apparently small difference accounts for about 10,000 lives a year in this country being needlessly lost because we diagnose too late. I am sure the Minister will agree that there is still a lot to improve on.

[Ben Gummer]

I could not agree more with my hon. Friend. I was not trying to offer mere bromides. Indeed, I was about to say that although we perform well in many clinical areas, we perform badly on cancer compared with other countries. We have made significant progress over the past few years, but we are still not where we should be: at the top of the pack. There are many reasons for that, some of which we understand and some of which we do not, but it behoves us all to do something about it, which is why the taskforce was set up. In that regard, I add my thanks to Harpal Kumar and the many people who contributed to the taskforce’s conclusions.

I am speaking to an expert audience here—I am conscious that almost everyone who has spoken has considerably greater expertise in this area than I do—so I will not rehearse the history of the taskforce or its recommendations. Importantly, there is now a consensus about what needs to happen. Various things have to happen if we are to deliver on the aims of the taskforce.

[Mark Tami]

Does the Minister agree we should be talking about people living with cancer and the associated issues? A lot of people talk about “a cure” as if everything goes back to how it was before the diagnosis.

[Ben Gummer]

We should indeed. I found the hon. Gentleman’s remarks extremely interesting; I learned a lot from them.

I want to answer hon. Members’ questions as well as I can, although I am conscious that I am answering them on behalf of the public health Minister, who has responsibility for cancer and has considerable expertise in this area. She is sorry she cannot be here. My hon. Friend the Member for Basildon and Billericay (Mr Baron) asked some salient questions. The first was: when will the taskforce conclusions be implemented? He will know that the new national director for cancer has just been appointed, and I met her yesterday. As he knows, she is an immensely impressive women, having run one of the foremost cancer institutes in the world, and she is aware that one of her initial tasks is rapidly to set out an implementation plan. In doing that, I know she will want to speak to the all-party group on cancer as soon as she develops her plans in order to keep its members abreast of developments and to hear their views about the pace of implementation. I will ensure that officials write to Members with any further details about implementation.

My hon. Friend asked about the CCG scorecards. I understand the nervousness—I detected it in his voice—about the complex measurements and the dashboard being translated into apparently simple measurements in the scorecard. I want to give him some reassurance. The scorecards used for hospitals are immensely complex and have behind them a huge amount of data that are then distilled into simple scorings, the point of which is to provide clear accountability and transparency to patients and people living in CCG areas, who, at the moment, have no grip, because we do not give them any, on how well a CCG is performing. The expert panel looking at the operation of the scorecards will be out for consultation next month and will report back before the scorecards are put in place in April. I know it will listen carefully to his comments about one-year survival rates and the detail of how the scorecards are put together, but I am clear that the oncological experts on the panel will not want to undermine the work done on the various metrics and the dashboard.

My hon. Friend spoke with eloquence about genomics. It is of course true that the reason we are able to make increasingly rapid progress is that cancer is a genetic disease, and genetics and genomics are the great new frontier in medical innovation. In a sense, therefore, dealing with cancer and drugs for cancer will be the tip of the spear when it comes to developing all new drugs in the decades ahead. It is very exciting, but presents massive challenges to funded healthcare systems around the world. It is in trying to find a way of affording the new drugs that are coming online, but also releasing the unique possibilities that the NHS offers, that we think we are in such a strong position to offer opportunities both to those wanting to research cancer from an academic point of view and to those businesses and companies doing so in order to develop drugs.

The point of saying that is that the cancer drugs fund, which many Members referred to in their speeches, will necessarily have to change in response to the significant changes of the last few years. To the shadow Minister’s point about the cancer drugs fund, I would gently say that it was an innovation personally promoted by the Prime Minister in 2010. He has made a personal commitment to it, so all Members should take solace from the fact that he will be watching carefully how the fund develops. It has risen from a few hundred million pounds to over £1.2 billion. That demonstrates a commitment that was not present before the cancer drugs fund was invented. Its size is such that it now makes up a considerable part of the overall drugs spending of the NHS.

I hope hon. Members will take comfort from the fact that the consultation announced today by NHS England aims to build on the success of the cancer drugs fund, to incorporate the new structures that need to come about as a result of the significant changes in genomic research over the last five years and to align the general research, licensing and funding of drugs through NICE with the principles of the cancer drugs fund, so that we have a far more integrated system in future. I would encourage all hon. Members present to contribute to the consultation on the cancer drugs fund and thereby help to inform the second stage of its existence, when that comes about—I imagine at some point next year.

[David Tredinnick]

I may be pre-empting what my hon. Friend is about to say, but on the point about widening the scope of drugs, which he has alluded to, will he take note of the remarks about broadening the scope of patient choice and the range of therapies available, and perhaps using Professional Standards Authority-regulated professionals rather more?

[Ben Gummer]

I will, and I was about to move on to my hon. Friend’s remarks. He made a similar point—that great progress had been made but there was still much to be done. He spoke with eloquence and detail about complementary treatments, in which I have absolutely no expertise—I shall have to disappoint him on that. I know that he has written to me about the regulation of herbal medicines. I have today spoken to the Minister for Life Sciences, and I know that my hon. Friend will be receiving a full response about the various issues he has raised.

In response to my hon. Friend’s points about complementary treatments, I would say that it is very important when spending taxpayers’ money on cancer treatments that there is a solid evidence base for what we do. However, his point is well made—that the entire person needs to be taken into account when considering treatment. That can also involve people living with cancer, not just the treatment of it.

It was very nice to hear the hon. Member for Alyn and Deeside (Mark Tami) speak. It was also good to hear him speak from a personal point of view—it was good of him to share his sorrow regarding his son. On the stem cell transplantation issue that he raised, I can tell him that the recovery package as part of the taskforce’s recommendations that the Government have already moved on will apply to blood cancer patients who have undergone stem cell transplantation. The Government are very supportive of the work by the Anthony Nolan trust and other charities, but I will make sure that the hon. Gentleman gets a fuller response on the specific issues that he raised, so he can be satisfied that we have taken into account the particular difficulties and challenges facing those who have undergone stem cell transplantation.

It was a great pleasure to hear from the hon. Member for Scunthorpe (Nic Dakin). I have a particular affection for him, not only because he helped me on the way through King’s Cross the other day, but because he spoke just before me in my maiden speech—we made ours at the same time. This is a good point at which to reflect that the Member who spoke after me was the former right hon. Member for Oldham West and Royton, who is much missed in this place.

The hon. Member for Scunthorpe brought to our attention the issue of rare cancers—specifically pancreatic and blood cancers. I would like to reassure him about research. He will know that Cancer Research UK has looked specifically at the rare cancers and has prioritised work in the areas where it feels additional research funding and effort need to go, which include blood and pancreatic cancers—and, indeed, brain cancers, which my hon. Friend the Member for Castle Point (Rebecca Harris) mentioned. The hon. Member for Scunthorpe also raised the issue of GP imaging capacity, and I would like to reassure him that, as part of the ACE programme—Accelerate, Co-ordinate, Evaluate—by NHS England, imaging will be expanded within primary care. I hope that I will be able to write to him with further details.

I thank my hon. Friend the Member for Castle Point for her fascinating speech and for bringing to our attention the very sad story of her constituent Danny Green. Her point about a national register for off-label drugs was well made, and I know it is an issue that the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), is looking at actively. My hon. Friend the Member for Castle Point made a point about research,. She will be aware that it is always difficult to try to divvy up research funding, but I will make sure that her point is reflected back to my hon. Friend the Under-Secretary.

My hon. Friend the Member for Bury St Edmunds (Jo Churchill) made some very good points about joined-up care. It is certainly the case that we need to see such care across the NHS.

The hon. Member for Foyle (Mark Durkan) spoke about the cancer drugs fund, and made an interesting point about a UK-wide set of arrangements. I shall certainly pass on his comments to the Minister responsible for cancer. He also spoke about molecular diagnostics, and I would like to reassure him that, in England at least, we will significantly roll out molecular diagnostics as a result of our acceptance of the principles of the taskforce recommendations.

Finally, the hon. Member for Ellesmere Port and Neston (Justin Madders), the shadow Minister, rightly made some points about public health strategy. It is, of course, difficult to make sure that we balance the books, while keeping to our manifesto pledges. His points about tobacco and obesity were well made, and I know that the Government will be coming forward with obesity plans in short order.

With no more time available to me, I would like to thank Members for their full, excellent and expert contributions to this fascinating debate. I hope that the Government have shown the kind of progress and commitment to this important area that they are so keen to see.

[Madam Deputy Speaker (Natascha Engel)]

That leaves one minute for John Baron to conclude the debate.

Oral Answers to Questions

Ben Gummer Excerpts

Tuesday 17th November 2015 Commons Chamber

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

It is for NHS organisations locally to set the cost of car parking, but they should be informed by the principles and guidance set by the Department of Health.

[Jo Cox]

My local trust of Mid Yorks has just increased parking charges at Dewsbury and district hospital and has introduced charges for drivers with disabilities. The trust is clear that that is due to the financial settlement from Government. Does the Minister think it is acceptable that people who are ill or in need of medical attention, and their loved ones, are being penalised in this way?

[Ben Gummer]

The financial settlement from the Government is more generous than the one promised by the hon. Lady’s party at the last election. We are committing £10 billion over the next few years. I would ask her trust to look at the savings suggested by Lord Carter, who has identified considerable savings that can be made within hospitals. If it feels that it needs to increase car parking charges, it should refer to the Department of Health guidance, which makes it clear that there should be concessions for blue badge holders.

[Ben Howlett (Bath) (Con)]

Hospital car parking charges are clearly too high in the UK. I am sure that my hon. Friend agrees that the Minister without Portfolio, my right hon. Friend the Member for Harlow (Robert Halfon), led an amazing campaign during the previous Parliament to reduce the charges. Will my hon. Friend confirm that he is pursuing his commitment to reduce hospital car parking charges and explain how that will help patients and visitors to the Royal United hospital in my constituency?

[Ben Gummer]

The principles that the Department publishes are clear that charges, if they are set, should be proportionate and fair and should be set at a level that assures people of a car parking space. One of the problems of free car parking is that it often means there are no spaces for carers and for the sick when they turn up. Clearly, hospitals should exercise judgment in making sure that carers and people making frequent visits get a heavily discounted rate so that such charges do not become an impediment to free access to healthcare.

[Paula Sherriff (Dewsbury) (Lab)]

Mid Yorkshire Hospitals NHS Trust has recent imposed charges for blue badge holders. Many constituents have told me that, as a result, they will struggle to attend their appointments. The trust admitted to me that it had not considered the impact on the DNA—did not attend—rate. Does the Minister agree that not only does this place an extra financial burden on the vulnerable, but could lead to their being denied access to the healthcare that they desperately need?

[Ben Gummer]

The hon. Lady raises the surprising point that the hospitals did not consider the impact on their operations, which they should have done. The principles make it quite clear that disabled drivers should get concessionary rates, although charges sometimes need to be applied so that there are spaces for disabled drivers. The hospitals should have thought that through, and should look for savings elsewhere in their operations before they look at car parking charges.

[Helen Whately (Faversham and Mid Kent) (Con)]

6. What steps his Department is taking to improve clinical outcomes for people treated by the NHS.

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

On a number of fronts, the Department is looking at how it can improve clinical outcomes. Indeed, that is the entire focus of the Department. With reference to hospitals, we can improve clinical outcomes across the service through introducing a seven-day NHS, by increasing transparency and by looking at the cover provided by consultants and doctors.

[Helen Whately]

I welcome the Government’s commitments to improving outcomes for patients admitted at weekends, but seven-day services are needed not just in hospitals but in primary care, community care, social care and mental health services. What steps are the Government taking to make sure that seven-day services are available in all settings where patients need care urgently?

[Ben Gummer]

My hon. Friend makes her point extremely well. A seven-day NHS will operate only if it works across all areas of care. That is why the local integration of care and health services is part of our wider vision for the NHS. I urge her to look, when it is published, at Professor Sir Bruce Keogh’s report on urgent and emergency care, which envisages precisely the sort of joined-up care that will ensure people receive the correct attention at the correct level and do not therefore go to hospital when they can be dealt with in primary care settings.

[Nick Thomas-Symonds (Torfaen) (Lab)]

On the Friday before last, a Minister stood at the Dispatch Box and talked out my private Member’s Bill, the Off-patent Drugs Bill, which would have provided a mechanism for improved clinical outcomes by making repurposed drugs more consistently available across the country. The Minister for Community and Social Care said that the Government would consider an alternative pathway. What is that pathway and when will it be implemented?

[Ben Gummer]

As I am sure the hon. Gentleman knows, my hon. Friend the Under-Secretary of State for Life Sciences is fully committed to the ambition expressed in the hon. Gentleman’s Bill. My hon. Friend feels that the mechanisms do not work, but has set up a working party to ensure that that ambition can be taken forward. I know that he would welcome full engagement with the hon. Gentleman to make sure that that happens.

[David Tredinnick (Bosworth) (Con)]

If we are to improve patients’ clinical outcomes, surely we need to look more at patient experiences. According to The BMJ, only 11% of the 3,000 treatments looked at in clinical trials proved to be beneficial, with 50% being of unknown effectiveness. Now that the Society of Homeopaths is regulated by the Professional Standards Authority, should we not spend more than a paltry £100,000 a year on homeopathic medicine in the health service?

[Ben Gummer]

The Department’s position, despite repeated questioning from my hon. Friend, is consistent on this matter and remains the same.

[Mr Philip Hollobone (Kettering) (Con)]

In Northamptonshire, 80% of end-of-life patients die in hospital, whereas 80% of end-of-life patients want to die at home, assisted by the hospice movement. I have discovered that GPs are ticking the end-of-life box on the quality outcomes framework form, but that that information is not being passed automatically to local hospices. What can the Department do about that?

[Ben Gummer]

My hon. Friend raises a terribly important matter. Clinical outcomes can be assessed in a complete sense only if they include end-of-life care for those for whom there is no clinical outcome in the commonly received understanding of the term. If that is what is happening in his clinical commissioning group area, it is unacceptable. I point him to the work that the Government are doing on a paperless NHS to ensure that the kind of bureaucratic muddle he has identified no longer occurs.

[Jo Churchill (Bury St Edmunds) (Con)]

7. What progress has been made by Genomics England in making the UK the world leader in genomic medicine.

--- Later in debate ---

[Seema Kennedy (South Ribble) (Con)]

T6. St Catherine’s hospice provides outstanding end-of-life care, but receives only 26% funding compared with 34% nationally. Will the Minister confirm whether he has any plans to encourage clinical commissioning groups to pay their fair share for hospice care?

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

I thank my hon. Friend, who is right to raise the issue of end-of-life care, which is central to our plans to provide better care across the NHS. Indeed, it was a manifesto commitment of ours at the general election. NHS England is looking at a more transparent, fairer and clearer funding advice formulae for CCGs. I encourage her CCG to look very carefully at that and to copy the example of some CCGs such as Airedale, which have put this at the centre of the work they do looking after local patients.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

T2. I strongly associate myself and my colleagues with the remarks of the Secretary of State about the atrocities in France this weekend. What assessment has the right hon. Gentleman made of the impact of housing problems on the difficult task of recruiting and retaining clinical staff, particularly nurses in London and London’s NHS?

--- Later in debate ---

[Chloe Smith (Norwich North) (Con)]

What support will be available to hospitals over the winter? Norfolk and Norwich University hospital declared a black alert last week.

[Ben Gummer]

We are preparing for the winter on an unprecedented scale, having learnt from the experience of last winter. Specific support has already been provided for Norfolk and Norwich University hospital, and support will be provided consistently throughout the winter to enable us to deal with the additional challenges that are, I am afraid, being thrown in the way of hospitals throughout the country by the junior doctors and their industrial action.

[Norman Lamb (North Norfolk) (LD)]

Is the Secretary of State doing everything he can to ensure that we secure extra dedicated investment in mental health in the spending review? He will know that introducing the access rights that everyone else already enjoys requires hard cash. I am sure he will agree that we must end the outrageous discrimination against those who suffer from mental ill health.

Palliative Care

Ben Gummer Excerpts

Wednesday 4th November 2015 Commons Chamber

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

I thank my hon. Friend the Member for Lewes (Maria Caulfield) for bringing this very important subject to the attention of the House and for doing so with her characteristic passion and verve. It has been a pleasure to answer her points in several previous debates. She has made her points with great clarity and it is with great pleasure that I will respond to every single one.

I will start where I finished on Monday night. This debate is timely, because it follows closely on that evening’s Adjournment debate, which was brought to the House by my hon. Friend the Member for Colchester (Will Quince) and to which other Members contributed with such great passion, interest and detailed knowledge. I firmly believe that, unless the NHS understands that the basis of care is not the end point of healthcare but a good in and of itself, we will not build a satisfactory foundation for the medical care that we hope is the experience of the majority in the NHS. For people for whom the end point is not recovery, but good and decent care, we must ensure that such care is embedded in the foundations of the NHS. If we do not, we will not provide a suitable foundation for good care throughout the system. That is why I see palliative care not as something that is nice to have—an added extra or a bonus within the NHS—but as something that is crucial to the delivery of good care throughout the system, whether or not people are likely to survive at the end of their care in hospital, in the community or at home.

I share my hon. Friend’s judgment of the debate on the Assisted Dying Bill, which I found fascinating. No matter where Members came from in that debate, what was clear was their wish to cherish, support and improve the palliative care services in our country and to ensure that people had access to the very best services not only in the UK, but in the world. That is where I will start my general remarks.

My hon. Friend is right to point out that the provision of palliative care is variable across the country, and I will turn to that in a second, but it is one of the areas that we should be very proud of, not least because of the dedicated work that people like her provide across the system in specialist settings and because of the unique gift that we have in this country of the hospice movement.

That is why the Economist Intelligence Unit, only a few weeks ago, judged that this country had the finest palliative care in the world in terms of access to services and the quality of those services. I do not say that in order to say that there is nothing to do—quite the opposite. The Economist Intelligence Unit pointed out that there are examples of extraordinarily good care across the country. I want to ensure that the experience is not variable, and that no matter where one is in the country, one receives the finest care.

Where should one look? I will point to a few examples of where exceptional care is being provided. In Bedfordshire, Sue Ryder has brought together palliative care services across the county. There is a brilliant linking up of services, whether they be in the community, in hospital or at home. As my hon. Friend knows well, home can encompass care home settings and private homes. That is a beacon of good practice that has been brought together by an expert charitable institution.

The Airedale, Wharfedale and Craven clinical commissioning group has blazed a trail with its expertise in palliative care, particularly through its adoption of the gold line telephone number, which is used not just by clinicians, but by families. People are lucky if they need palliative care and live in the Airedale clinical commissioning group area, because they are likely to receive the very finest palliative care available anywhere in the world.

I know that my hon. Friend has experience of hospital palliative care as a cancer nurse at the Royal Marsden, where exceptional care is provided that is comparable to the best care anywhere in the world. She will also be familiar with the work that is done at Frimley Park, where there is a comprehensive palliative care programme that goes across the hospital and is not seen as a bolt-on extra. The John Radcliffe hospital in Oxford has a similar approach with similar ends.

[Sarah Champion]

The Minister is citing excellent examples, but does he agree with me—I think that this is the intention behind the debate—that we should not just have exceptional examples, but 24/7 care wherever people are and whatever their condition is?

[Ben Gummer]

I agree completely with the hon. Lady. I was just about to turn to the very useful intervention that she made earlier, in which she said that palliative care is a mark of the integration of the health and social care sectors. It is no coincidence that one often sees good palliative care where there is good integration of health and social care. In a sense, the state of palliative care is a proxy for where care is well integrated and where it is not. That is why it should be seen as part of the larger challenge of achieving successful integration, on which there is a good deal of cross-party agreement.

My hon. Friend the Member for Lewes mentioned the fact that many people do not die where they would choose. She will be aware of the Choices survey, which was launched by my predecessor in the coalition Government, the right hon. Member for North Norfolk (Norman Lamb). It has reported, and the Government have committed to replying to it. She can take that as an indication that there is policy to come, and that we will study carefully the things we have set up. We intend to ensure that people have greater access to the services they require to ensure that they can die where they wish. We made that commitment in our manifesto—we were very clear about it—and we intend to deliver on it, as we intend to deliver on the rest of our manifesto.

My hon. Friend was entirely right to point out that that will require changes in services where they are not good. That will require commitments on palliative care nurses and the spreading of training. They have been achieved in Airedale, but have not been achieved in other clinical commissioning groups, where care is sometimes significantly lacking. There is much to do in some areas of the country. If I may use Bevan’s words, it is about universalising the best. We know what the best looks like. We now need to ensure that we spread it across the rest of the country.

My hon. Friend was right that palliative care has, unfortunately, in some cases been associated with cancer care. That is not how it should be seen. She will be aware in great detail of the European Partnership for Action Against Cancer system, which is being used to ensure that cancer patients can indicate their wishes for the end of life. It can also help clinicians to manage that end-of-life period. The EPAAC system was originated and developed specifically for cancer patients, but we intend to roll it out for patients no matter what the cause of their death.

My hon. Friend mentioned the need to provide services 24 hours a day, seven days a week. Without wanting to state the obvious, that is one reason why we want to get a seven-day NHS working. When people need the NHS—whether they need medical attention that will save their life or pain relief that will mean that the end of their life is bearable—it cannot be right if treatment is deferred to a Monday because we do not have services available on Saturday and Sunday. That is the crux of what the Government are trying to achieve across our NHS reforms: we want to achieve a truly seven-day NHS.

Briefly, on the Bill introduced by Baroness Finlay in another place, I cannot disagree with the general sentiments of the proposal. The degree of variability that we have is obviously wrong and we must put it right. It should be right, in a sense, to say, “Let us legislate in order to make it so.” I have reservations about the Bill—I have made them clear to Baroness Finlay—but I should like to outline them to explain why I believe it may not achieve what it wants to achieve, and why, on a wider point, it might be counterproductive.

If enacted, the Bill would be the first instance in the history of the NHS that means we would make specific clinical demands on clinical commissioning groups about a specific clinical area. To take an analogy, we have not had a cancer services Bill that demands things of CCGs on cancer services. The Bill would therefore set a precedent, which requires very careful consideration. My current judgment, and that of the Secretary of State, is that we do not want to determine that demand from the centre in the manner in which Baroness Finlay wishes.

There are other instruments for achieving what Baroness Finlay wishes to do, such as the mandates to CCGs and to Health Education England. There are ways to achieve by similar means the same ends that she wishes to achieve, which is putting certain obligations on CCGs to ensure that they commission care in a way that we expect. We need to be careful about how we do it. Airedale is so good because it has come to that point by itself and developed its approach organically. Other CCGs around the country have come to equally good solutions in a different way.

I would not want to impose a solution from the centre that squashes the local innovation of good leaders. I think we can all agree that the NHS in the past has not been good at allowing staff locally to celebrate leadership and innovation. There are lots of brilliant people in the NHS who have great ideas, but they do not feel empowered to bring them forward. We need to be careful, therefore, about imposing solutions from the centre, either from the Department, NHS England or this place, that do not recognise the ability of local people to come up with local solutions. I have told Baroness Finlay that I want to develop policies that do what she wants to do but not by the means she proposes. I hope to empower local people to get to where she wishes to go, and I hope to do so in a manner that celebrates success and exposes failure, so that we can put it right, and universalises the best as quickly as possible, without taking a top-down approach, which might have the contrary effect.

We are in a better position than other countries because of the remarkable work of charities and voluntary bodies over the last few years, and we have now accumulated a mountain of evidence from charitable groups and Government. My hon. Friend pointed to the 2011 NICE guidelines, but there were also the five priorities outlined last year in “Priorities of Care for the Dying Person”, and we now have the NHS Choices review, to which the Government will respond. We have enough paper evidence. We know what looks good, how to make it happen and that it needs to happen, and we know that many people die in circumstances that leave much to be desired. I point in particular to those who die in hospital. It is clear from the VOICES survey, which tracks the experience of families and individuals at the end of life, that people’s experience of dying at home and in community settings, especially in hospices, is generally much higher than in hospitals. Broadly—I generalise—half of people in hospital do not have an optimum experience of death.

We can change some things quite quickly, but we have got to this point because of the sustained effort over many years and the accumulation of evidence in a clinical area where Britain leads the world. I pay tribute to my hon. Friend and other colleagues with expertise in this area, to the many academics who have worked hard on this, and to the hard work of NHS England and its director of palliative care, Professor Bee Wee, who is a remarkable clinician. Over the next few years, as we fulfil our manifesto pledge, I hope that all parties can work together on this, calling on the experience of people from every part of the country—it was great to hear from the hon. Members for Torfaen (Nick Thomas-Symonds) and for Strangford (Jim Shannon), who shared their experience from other parts of the UK. If we can bring all this together, I think we can do something rather remarkable for people with no medical hope at the end of their life but to whom we should give the absolute guarantee that their care will be exceptional and will make what is never going to be a happy moment at least bearable and full of meaning for them, their families and their loved ones.

Question put and agreed to.

Maternity Units: Bereavement Care

Ben Gummer Excerpts

Monday 2nd November 2015 Commons Chamber

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

I thank my hon. Friends the Members for Colchester (Will Quince) and for Eddisbury (Antoinette Sandbach) for coming to the House and raising this important matter in an abnormally well-attended Adjournment debate. They are very brave to have shared their personal experiences, and not only the House but the nation will benefit from that. They have raised the issue just at the right time, and I hope we will be able to incorporate the larger part of what they have said in our policy formulation pretty quickly.

My hon. Friend the Member for Colchester said that he was no expert in this field, and I would beg to differ only with that part of his speech, as he surely is, as are his wife and my hon. Friend the Member for Eddisbury. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) brought his clinical experience to bear. It is clear from all their comments that there is much to do in this important area. I give an initial commitment that I will try to address all those things in the months ahead.

The description given by my hon. Friend the Member for Colchester of the care at Colchester general hospital is important in two ways. First, he described how care, when it goes well, can completely change what is a traumatic, horrifying experience not into one that is any better but into one that is manageable. Secondly, in relation specifically to that hospital, which has had very serious problems over the past few years, he described how committed and caring the staff are, and how that has shown through in an individual way. Indeed, the experience of Sister Liz Barnes and the rest of the staff at the Rosemary suite should be copied around the country by hospitals that on the face of it, and in other parts of their operations, are performing better than Colchester general hospital. I hope that my hon. Friend will be able to pass back to his hospital and to his constituents the very considerable thanks of the Department and others.

I read the British Medical Journal article, at my hon. Friend’s suggestion. It is a harrowing read. All the stories in it are, by turns, profoundly depressing, shocking and, to someone who is a new father, viscerally arresting, and also uplifting and very beautiful. It contains some very sensible advice about the need for time, for a culture of care, and for careful consideration of parents’ wishes, some distance after the death of a baby, to help us understand how better to look after those who are just entering that most awful place.

My hon. Friend’s first wish was that we look carefully again at the number of bereavement suites around the country. I have already asked officials to look at that. The numbers have increased somewhat since the 2010 survey, so we are now at well over half, but that is nowhere near enough. I will now, as a consequence of his raising this issue, ensure that we get a proper assessment of the number of bereavement suites. Already, all new-build maternity units will have a bereavement suite in the right place. In fact, I intend to toughen up the guidelines so that they are not so much a suggestion, specifically about proximity to the rest of the maternity unit, but something rather more forceful than that. I hope that in finding out how great is the extent of the lack of provision in other hospitals, we can do something to address this in the months ahead.

My hon. Friend raised commissioning and the work of NHS England and local CCGs. My constituency neighbour, my hon. Friend the Member for Central Suffolk and North Ipswich, made a point about the mandate. I will look at this carefully in the next few months. The date for the reassessment of the mandate is coming up shortly. However, the Government are undertaking a whole series of other policy initiatives in maternity and in end-of-life care, and this is the right moment to look at many of the issues that my hon. Friend the Member for Colchester and others raised so that we can get a response that is universal but also respects a lot of the different good work that is going on around the country. In producing a national set of guidelines and policy instruments, I want to make sure that we respect the fact that in different parts of the country organic solutions to these terrible challenges have grown out of local will. Those solutions must be respected and, indeed, spread. I would not want to stamp on that by issuing guidance that was too demanding.

My hon. Friend’s points about guidelines on maternity bereavement were expanded on by my hon. Friend the Member for Eddisbury in terms of counselling. She spoke powerfully of the need to provide equality of care at a distance after the event of a stillbirth or the death of a baby, which is not very usual in the national health service. She highlighted the fact that in some parts of the country this is being done well and in others it is not. That is precisely the kind of variation that we need to eradicate in dealing with the issues which both my hon. Friends raised. My hon. Friend the Member for Eddisbury correctly pointed to the study undertaken by the national perinatal epidemiology unit in 2014, “Listening to parents after stillbirth or the death of a baby after birth”, and I hope to be able to draw on the conclusions of that, which broadly support the point that she made, to see how we can eradicate that variation as quickly as possible.

Both my hon. Friends spoke of the contribution of Bliss, Sands, Tommy’s and other sometimes local charities that do remarkable work. In drawing up policy and guidelines, we need to respect that so that we maximise the enormous good will that there is in trying to help people through stillbirth and the death of a baby. The Minister for Small Business, Industry and Enterprise told me of a constituent of hers who had suffered a stillbirth and had started a fundraising campaign which, within weeks, had surpassed by 10 times the amount that she had expected to raise. That is the power of local bodies which, if we can energise and use it, will enable us to do so much more at a national level. In bringing all this together in the months ahead, I hope we will be able to release that energy, passion and commitment, so much of which is born out of personal tragedy, and that we will be able to do far more than I would be able to achieve in Whitehall or all of us would be able to achieve in this place.

Finally, the vocation of bereavement midwives was mentioned by both my hon. Friends. We are increasing the number of midwives. The mandate has been written in such a way—in part by my hon. Friend the Member for Central Suffolk and North Ipswich—and I hope that will lead to an increase in the number of midwives who have specialist training in bereavement. I will ensure that I get back to my hon. Friends the Members for Colchester and for Eddisbury with details of how that might be achieved.

Our efforts should go further than that. I spoke today to the chief executive of Health Education England about ensuring that there is training in all clinical areas on dealing with bereavement and providing palliative care. I hope we can do far more for all trainee clinicians, especially those dealing with maternity, so that there is a widespread understanding of the issues and it is not left to a specialist group, but is part of the general training in care that should lie right at the heart of our NHS.

The national health service does not mean anything unless we care for those for whom health is not the end point. It is the selflessness of care that should lie at the heart of our national health service because that is the foundation on which we build medical help. That is no more so than in this case where, at the point of greatest expectation of hope and joy, people experience the deepest sense of tragedy. Once again I thank my hon. Friends for making that plain to all of us in the House this evening, and I hope this might be an Adjournment debate with a difference—that it will produce a real outcome, from which they will hopefully draw some encouragement from what is otherwise an unspeakably terrible experience.

Question put and agreed to.

Junior Doctors’ Contracts

Ben Gummer Excerpts

Wednesday 28th October 2015 Commons Chamber

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

Junior doctors form a critical work force in our national health service. They are critical in the truest sense of the word: they are indispensable to the care of NHS patients. They work around the clock, and they are crucial to the cure of millions of people every year. That was recognised in the powerful speeches that have been made today, not least the very personal speeches made by my hon. Friend the Member for Boston and Skegness (Matt Warman) and the hon. Member for Wakefield (Mary Creagh). It is clear that every Member appreciates the central importance of junior doctors, and the extent of their training was made plain by the hon. Member for Central Ayrshire (Dr Whitford).

The critical importance of junior doctors makes their career unique. Few professions are so rewarding, but few are so challenging. I know from my own experience in hospital and from listening to junior doctors how many strive to provide the very best care, how they devote themselves to advancing their knowledge and level of training, and how they frequently make sacrifices in their private lives that others in comparable professions are not asked to make. That is why I understand why there is such a sense of frustration and anger when junior doctors are told by a trusted source that they will soon be asked to work more hours for less money. I know it will be of small consolation to them, but we on this side of the House are as frustrated because we have always recognised in the contract negotiations that we have initiated with the BMA that no such situation would arise.

The assurances that my right hon. Friend has made in a series of letters over the past few weeks, and the assurance he has given today that no junior doctor working within the legal limits in their current contract will lose money as a result of these changes—

[Heidi Alexander]

Will the Minister give way?

[Ben Gummer]

I cannot because I have to conclude.

They are precisely the offers that were made privately both by the Secretary of State and negotiators in their discussions with the BMA. Our frustration is compounded by the fact that right from the beginning of this process, we have sought in the new contract to eradicate the slew of injustices in the current contract which make life unfair, and in some cases unbearable, for junior doctors.

Let me give a few examples raised by hon. Members, including my hon. Friend the Member for Finchley and Golders Green (Mike Freer). It is unfair that doctors who take time out for valuable medical research receive precisely the same increments as colleagues who might take time out to do something completely unconnected with their training and with service to the NHS, and the same increments as those who take time out altogether from the health service, working only part-time perhaps to develop a career in business or another field. They retain the same increments and basic pay through their career as the doctor who works diligently five, six, sometimes seven days a week, progressing through their training, passing their exams—yet getting exactly the same level of pay as the doctors who do not.

The greatest injustice arises for doctors from the perverse incentives in this contract—for example, hospital management choosing to use the current contract to avoid difficult decisions in rostering staff, paying doctors to work unsafe hours rather than getting to grips with the roster they should be putting in place to ensure safe care for patients.

Let me make it clear to the hon. Member for Denton and Reddish (Andrew Gwynne), who spoke for the Labour party, that the reductions so far since the 2000 contract are a result not of the penalty payments put in place as part of that contract, but of the working time regulations which have made a significant impact on the working hours of doctors, and quite rightly so. Does he not see the logic of his own argument? There are still doctors in the national health service who are working dangerous hours despite the fact that there are penalties in place to stop them doing so. By extension, the only way we can ensure that we have a proper, safe working environment in the NHS is to ensure, once and for all, that in contract and through review, and by exposure to regulatory bodies, junior doctors are not permitted to work unsafe hours. When we are asked whether we back the mis-statements by some of the people involved in this debate, or whether we encourage people to—

[Ms Rosie Winterton (Doncaster Central) (Lab)]

claimed to move the closure (Standing Order No.36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question put accordingly (Standing Order No. 31(2)), That the original words stand part of the Question.

Cosmetic Surgery

Ben Gummer Excerpts

Tuesday 20th October 2015 Commons Chamber

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

I thank the hon. Member for North Durham (Mr Jones)for securing this debate on what is clearly an extremely distressing case for his constituent and an unfortunate one more generally. I want to pick up on the specific issues he raised to do with his constituent’s case before talking about the generality of the regulation of cosmetic surgery.

The hon. Gentleman pointed out the failure of his constituent’s doctor to have insurance and he will be pleased to know that, as of July 2014, new legislation required all surgeons providing cosmetic interventions to provide insurance and proper cover. A failure to do so would render them liable to undergo the fitness to practise tests conducted by the GMC. Those doctors operating outside the UK but in the EU who would have a temporary ability to operate in this country under the directive on mutual recognition of professional qualifications would still, under GMC regulations, be required to provide evidence of insurance cover. That legislation was brought into effect in August, which was clearly too late in the case of his constituent.

[Mr Kevan Jones]

Will the Minister look specifically into the case of Dr Paganelli, as I understand that he is still practising in this country?

[Ben Gummer]

I will certainly look into that case, as it does not sound right. I cannot trespass on the realms of the GMC, but I will inquire into the specific case outlined by the hon. Gentleman.

The hon. Gentleman makes a valid point about the cost to the NHS and this is not the only area in which we have considered and continue to consider cost recovery for the NHS. It can be difficult as sometimes the cost of legal action outweighs the cost of recovery and it is not something that the service is used to doing. I am keen to explore it further, but in the context of the action we are taking, which I shall come on to, I hope that the hon. Gentleman will understand the need to take this bit by bit so that we get the process right. In principle, I certainly agree that if organisations cause a cost to fall on the NHS, as in this case, there is a good argument for seeing whether that cost can be recovered.

That takes me on to another part of the hon. Gentleman’s speech that was particularly striking, about the celebrity endorsements in this case. It is not for me to make policy announcements in an Adjournment debate, nor would I want to in the case of celebrity endorsements, but I agree with the hon. Gentleman that people should think carefully about how they endorse cosmetic surgery. It is a serious intervention and if anyone seeks to glamorise something to which careful thought should be given, people and the organisations using those endorsements should treat them with extreme care.

I would point the organisation that the hon. Gentleman is dealing with and everyone else towards the code of conduct in advertising, the Committee of Advertising Practice and the Broadcast Committee of Advertising Practice, which drew up guidance in October 2013, especially on protecting children and young people. I think it would be appropriate to make sure the organisation of which he speaks is complying with the spirit as well as the letter of that guidance, and if not I will certainly help him to ask whether anything more can be done on that.

The hon. Gentleman raises the issue of counselling. Any reputable organisation should seek to ensure that people undertake procedures only when they need to do so and have been properly counselled on the consequences of their actions so that they can make an informed decision. The Government believe that that should happen in every case for cosmetic surgery. There should be an informed decision, taken with serious thought.

Finally, on the issues to do with The Hospital Group the hon. Gentleman raised, I cannot speak without further advice, but there clearly seem to be questions about trading standards, which he raised. I hope that I and my officials will be able to meet him to look carefully at this case, to make sure if The Hospital Group is misrepresenting its position apropos its surgeons and those it seeks to represent, it is not besmirching an industry which more widely does take its duties and the way it represents itself seriously.

[Jim Shannon]

The hon. Member for North Durham (Mr Jones) has raised a topical issue of which we are all aware. Many people have had botched operations. Has the Minister’s Department been able to quantify how many? Optimax was one of the groups involved with a lot of the operations for laser surgery. People thought that was safe, but it was obviously not safe for all. Has the Department been able to quantify the numbers and therefore take action?

[Ben Gummer]

I am afraid I do not have an answer to the hon. Gentleman’s question, but I will make sure we write to him if such figures exist, although I suspect they may not. Let me inquire, and then I shall reply to his question.

Let me turn to the broader policy issues to which the hon. Member for North Durham referred. He referred to Sir Bruce Keogh’s review. It began in January 2012 after the PIP breast implant scandal. It covered the rapidly growing non-surgical cosmetic market. He published that review in 2013 and it highlighted the rapid growth of cosmetic interventions, and suggested safeguards among 40 recommendations to protect patients. The aim of those was to improve how surgical and non-surgical interventions were done, to set standards for training practitioners and surgeons and for how supervision from regulated healthcare professionals can support self-regulation of the industry, and to improve the quality of the information clients have to ensure they are able to make informed decisions about their treatment. The Government published their response in 2014.

By the time of the publication the Government had already started work on a number of the recommendations. To address the issue of proper training for cosmetic practitioners, the Royal College of Surgeons set up an inter- specialty committee with representation from the relevant specialty associations and professional organisations including plastic surgery, ear nose and throat, oral and maxillofacial surgery, breast surgery, urology, the Royal College of Obstetricians and Gynaecologists, the Royal College of Ophthalmologists, the General Medical Council and the Care Quality Commission. The committee also includes patient and provider representation, and representatives from the devolved Administrations are invited as observers.

The committee established three sub-groups which are taking forward the work to implement the recommendations. They cover standards for training and certification, clinical quality and outcomes, and patient information. The committee is also in the process of developing an overarching framework for certification to improve the safety and delivery of cosmetic surgery. Individuals performing cosmetic surgery will be expected to practise within their field of specialty training. The framework for certification takes into account equivalence for non-UK-based surgeons.

[Holly Lynch (Halifax) (Lab)]

I thank the Minister for giving way, and I thank my hon. Friend the Member for North Durham (Mr Jones) for bringing this important debate to the Chamber. PIP has been mentioned, along with the regulations that are in place in this country. I want to ask how we need to work with our European neighbours to ensure that we get the regulation right. We have heard about doctors coming from Italy to practise in this country, for example, and we know how PIP, which started in France, has impacted on patients in the UK. What work is the Minister doing to ensure that we co-operate across Europe to close any loopholes in this area?

[Ben Gummer]

The hon. Lady has touched on a complicated and diverse subject. I will happily talk to her when we have more time about what the Department is doing and what we are doing within the European Union to ensure the transferability of qualifications. A considerable amount of work is being done, and the GMC has tightened up a whole number of areas to ensure that we allow only the highest quality of practice in this country, while allowing people to travel through the European Union to practise using their qualifications.

I want to turn now to training for non-surgical interventions. We asked Health Education England to develop a new qualification framework for providers of non-surgical cosmetic interventions, and for those required to be responsible prescribers, that could apply to all practitioners regardless of previous training and professional background. Health Education England has now completed its review of the qualification requirements and will publish its recommendations shortly.

The issue of breast implants initiated the review by Sir Bruce Keogh. The review placed particular importance on systems that can precisely identify the complete cohort of patients in which a specific implant has been used. It recognised that being able to monitor the device implementation and performance for clinical outcomes and tracing of patients at risk of device failure was an important safety issue. There has been a range of responses, involving the Medicines and Healthcare Products Regulatory Agency, the Health and Social Care Information Centre, the Committee of Advertising Practice and the Broadcast Committee of Advertising Practice, and a whole series of recommendations has been enacted following the review.

Turning to legislation, we know that there are examples of high-quality surgical and non-surgical intervention, as I am sure the hon. Member for North Durham would agree, and it is those standards that we must make universal. I am aware of the arguments in favour of legislation as a way of reaching those standards—for example, through the statutory regulation of the non-surgical sector or new powers for the GMC. However, it does not follow that we must depend on legislation alone to meet the fundamental objectives of the Keogh review. Much has been achieved already and there is much more to do.

I know that the hon. Gentleman understands the pressure of competing priorities on parliamentary time. The calendar for legislation is full at the moment, as he knows, but we now have an opportunity to review and monitor the impact of non-legislative action before confirming whether new legislation would add significant value to safeguards for people choosing cosmetic procedures. We will continue to be advised on that by Sir Bruce and others as the safeguarding framework continues to develop. I can give the hon. Gentleman a personal assurance that I will ensure that the review of the non-legislative remedies is thorough, and that if it is found wanting, we will immediately look again at the subject with a view to taking further action.

We are grateful for the support of the Royal College of Surgeons and its partners and for the extremely thorough work that they have done so far. We are also grateful to the General Medical Council and the Care Quality Commission. In the light of the continuing work that I have outlined, I hope that the hon. Gentleman will agree that we are in a far better position now than we were before Sir Bruce’s review to help to protect the public and ensure proper training and oversight of non-surgical as well as surgical cosmetic interventions.

On the specific questions that the hon. Gentleman raised about his constituent, I commit to returning to him with an answer on the doctor he mentioned and the insurance that he will be required to have. I will also give him a specific answer on the cost to the NHS and any work that we might do on cost recovery, and on the specific guidance on the advertising of surgical procedures. I hope also to be able to get to the bottom of the nature of the sales techniques and the claims made by the hospital that he has mentioned, to ensure that it is practising in accordance with the standards that would be expected of a decent, reasonable organisation doing what it purports to do. I thank the hon. Gentleman very much for bringing this case to the Government’s attention.

Oral Answers to Questions

Ben Gummer Excerpts

Tuesday 13th October 2015 Commons Chamber

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

I am pleased to refer my hon. Friend to the recent appointments of Ruth Carnall to the role of programme chair and Judith Dean to the role of programme director for the success regime in Northern, Eastern and Western Devon. Together, they will lead an intensive diagnostic exercise within the local health economy, which will develop options for change to be implemented in the new year.

[Johnny Mercer]

Given the news last week that the Northern, Eastern and Western Devon clinical commissioning group that covers my constituency has appointed a special team to ensure the projected £430 million funding shortfall does not become a reality, what can my hon. Friend do to assure my constituents that an already challenged constituency can retain confidence in its health care provision?

[Ben Gummer]

My hon. Friend rightly points out that there are specific challenges in Northern, Eastern and Western Devon and that is precisely why NHS England has instituted the success regime and why it has moved quickly to appoint a programme director and team. I hope that with the engagement that I know he will lead with his colleagues they will come to a resolution that will ensure that the challenges cease.

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

9. What additional financial support he is making available to the NHS to help it deal with winter pressures.

--- Later in debate ---

[Mr Robin Walker (Worcester) (Con)]

12. What steps his Department is taking to manage and meet demand for A&E services in Worcester.

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

Last month, the Department approved a £4 million capital improvement loan for the expansion of the A&E department at Worcestershire Royal hospital and the development of a dedicated discharge lounge. Worcestershire Acute Hospitals NHS Trust and the local health system will also receive practical support via the emergency care improvement programme to help the trust to address the challenges it has faced in meeting the four-hour A&E waiting time standard.

[Mr Walker]

I thank the Minister for his reply. I warmly welcome his recent decision to approve the £4 million interim investment in A&E capacity and a new discharge suite at the Worcestershire Royal. As he knows, demand remains very high, and the number of patients being admitted to hospital is close to record levels. May I urge him and his colleagues to look very carefully and urgently at plans for further upgrades, which could deliver much-needed capacity over the coming years?

[Ben Gummer]

I assure my hon. Friend that we will do so, but he will be conscious that capital plans are the responsibility of individual trusts. I urge his trust to take part fully in the Worcestershire acute review and in other reviews of the west midlands health service. There are challenges, and we will fix the problems only if there are locally sourced solutions, which we will then seek to support.

[Drew Hendry (Inverness, Nairn, Badenoch and Strathspey) (SNP)]

13. What estimate his Department has made of the change in the number of nurse training places since 2010.

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

The number of available nurse training places in England in 2015-16 is consistent with those filled in 2010-11. There are 20,033 nurse training places available in England in 2015-16, compared with 20,092 in 2010-11.

[Drew Hendry]

Simon Stevens, the head of the NHS in England, has already highlighted the devastating impact that new immigration earnings thresholds will have on nursing numbers—it is estimated that up to 29,755 nurses will be affected, and that the recruitment cost will be more than £178.5 million by 2020. What representations will the Minister be making to the Home Secretary to put a stop to this irresponsible and illogical change in policy that defines ballet dancers but not nurses as a shortage occupation?

[Ben Gummer]

The hon. Gentleman will be reassured to know that there are continuing and cordial relations between the Department of Health and the Home Office. Trusts have had three years to prepare for this moment. There is a bigger issue at play here, which is that there are five applicants for every nursing place in the United Kingdom; that is the position for people wishing to train as a nurse. Our first responsibility is to ensure that we are getting as many people who want to be nurses in this country into a nurse training place.

[Mary Creagh (Wakefield) (Lab)]

The Mid Yorkshire Hospitals NHS Trust, which covers the Wakefield constituency, has been forced to recruit nurses from both Spain and India. Following on from the previous question, what representations has the Minister made to the Home Office, because these changes could affect nurses who have come to Britain, bought mortgages here and plan to make their lives here? Will they be affected?

[Ben Gummer]

The hon. Lady knows that the Immigration Advisory Committee is independent and it makes its recommendations on that basis. There are trusts—I have visited some myself—that had previously relied on agency and migrant labour that have now managed to change the way they are hiring staff so that they can better source sustainable staffing from the domestic staffing pool.

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

In December 2009, Lord Lansley, as the then shadow Health Secretary, described the amount spent by the NHS on agency staff as “unforgiveable”. Since he made that statement, agency spending has spiralled out of control, rising by 83% in the past three years. Ministers are in denial about the root causes of that increase. The cuts to nursing training places have created a shortage of nurses and forced hospitals to spend vast amounts on expensive agency staff. Will the Minister now come clean and admit that it was the Government’s mismanagement that caused this financial crisis?

[Ben Gummer]

The hon. Gentleman should know that the unforgiveable thing was the dereliction of care by a Department of Health under a previous regime. It contributed to short staffing—a significant part of the scandal at Mid Staffs—that we needed to put right in short order. That required an emergency response and agency labour to be employed. We are now putting staffing on a sustainable basis; we were left with short staffing in 2010.

[Tom Pursglove (Corby) (Con)]

14. What steps he is taking to ensure consistency in services and treatment throughout the NHS.

--- Later in debate ---

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

T9. Patients in England wait 18 weeks for an operation, but in Wales, where Labour has run the NHS for the past 16 years, they wait 26 weeks. Does that not prove that only the Conservative party can be trusted to run the national health service?

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

My hon. Friend is right. A further cause of distress for the people of Wales is the fact they do not have the funding that the NHS requires in their country, just as England would not had a Labour Government been elected in 2015, because we would not have the funding that this Conservative Government have promised to ensure top care for patients.

[Ian C. Lucas (Wrexham) (Lab)]

T5. The all- party spinal cord injury group, which I chair, recently reported that very vulnerable patients are being prejudiced by delayed discharges, taking up lots of public money in hospital expenses that should be used to treat more patients. Will the Secretary of State carry out an urgent service review to address this real problem in England, Wales, Scotland and Northern Ireland?

--- Later in debate ---

[Caroline Flint (Don Valley) (Lab)]

T8. The Royal College of Nursing reports that it is becoming clear that for the first time since the early 2000s there is a critical shortage of registered nurses in the UK. Both the UK and global nursing labour markets are changing, and our increasing reliance on alternative sources is not sustainable. In 2014, 37,645 students across the UK were turned away from nursing courses. Is it not time the Minister admitted that the situation is not good enough and that the Government need drastically to scale up those places to reduce dependency on overseas nursing staff?

[Ben Gummer]

The thrust of the right hon. Lady’s question is correct. That is why we have near-record numbers of nurses in training and a record number of nurses in practice, and we will continue to see growth over the next five years.

[David Mowat (Warrington South) (Con)]

Last year the NHS paid £300 million to claimants’ lawyers. Indeed, for small and medium claims, the lawyers made two to three times as much as the claimants themselves. Is there more we can do to stop this abusive behaviour?

--- Later in debate ---

[Mims Davies (Eastleigh) (Con)]

Given this Government’s continued excellent commitment to investing in our NHS and reducing preventable mortality, does the Minister agree that keeping healthcare provision as local as possible is very important for Moorgreen hospital in my constituency?

[Ben Gummer]

The core purpose of the Vanguard programme is to ensure that we get local solutions to local healthcare problems. Only by making sure that we release the potential of local healthcare staff and providers, doctors and nurses, do we get the solutions we require rather than things being determined from Whitehall, as was the wont of previous Administrations that we will not follow.

[Jenny Chapman (Darlington) (Lab)]

I can think of few things more frightening than being in labour and being turned away from a maternity unit that someone has visited, become familiar with, and got to know the staff. Over a third of units closed their doors to women in labour last year. What is the Minister going to do about this, and why does he think it has been happening?

NHS: Financial Performance

Ben Gummer Excerpts

Monday 12th October 2015 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the financial performance of the NHS.

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

I thank the hon. Lady for giving me this opportunity to come to the House and make a statement on the financial performance of the NHS.

On 9 October, Monitor, the regulator of NHS foundation trusts, reported that foundation trusts ended the first three months of the financial year with an estimated net deficit of £445 million. Monitor’s publication noted that performance in the first quarter of the financial year is usually worse than it is over the rest of the year. The NHS Trust Development Authority also published that day the financial position of NHS trusts for the first quarter of 2015-16, which showed that the NHS trusts sector ended the first quarter of the year £485 million in deficit.

The financial position of the NHS is undoubtedly challenging. It is important to recognise that, despite the difficult decisions we have had to make as a result of the calamitous deficit we inherited, it is the Conservative party that has chosen to prioritise funding for the NHS. That is why we are committing an additional £10 billion over the lifetime of this Parliament, starting with £2 billion this year.

However, additional Government spending is not the only answer to the challenges faced by the NHS. The Government have taken action with our arm’s length bodies to support local organisations to make efficiency savings and reduce their deficits. In the first three months of this year NHS trusts spent £380 million on agency staff, while foundation trusts spent £515 million. That is nearly £10 million a day across the NHS. We need to reduce that spending and challenge the agencies that are charging, frankly, outrageous amounts for their staff. To that end, a package of measures, including a ceiling on the amount each trust can spend on agency nurses and mandatory central framework agreements, was announced by my right hon. Friend the Secretary of State in June.

The Government and NHS leaders have taken national action to support local leaders in managing down those deficits. I very much welcome a constructive discussion with the Opposition on where we might be able to go further in driving the efficiency savings that the NHS must find if it is to provide the exceptional standard of patient care that we all, on both sides of the House, wish to see.

[Heidi Alexander]

I thank the Minister for that response. Where possible, I hope that we can have a mature and constructive relationship. However, he should make no mistake that when responses are as poor and lacking in detail as the one we have just heard, I will provide strong and robust opposition.

Ministers are accountable to patients, and their silence on the growing black hole in NHS finances has been deeply disappointing, as is the absence of the Health Secretary today. Not a single Minister was available to be interviewed about the NHS on Friday: it is not good enough. The deficit for the first three months of this financial year was larger than the deficit for the whole of 2014-15.

So, first things first: what advice has the Minister issued to hospital chief executives and finance directors about managing these pressures? Does he honestly think it is still possible for hospitals to balance the books, maintain current services, and deliver safe patient care? Given that the figures relate to quarter 1 and we are now in quarter 3, will he provide his latest assessment of the NHS financial outlook?

There is clearly not enough money in the current budget to cover existing costs. How on earth does the Minister plan to fund more services spread over seven days? The Conservatives’ election promises of more money have yet to materialise, and now their commitment to transparency in the NHS is looking decidedly shaky. For someone who prides himself on being open, the Health Secretary has been suspiciously silent about the delayed publication of these reports. Let me quote what a senior official in Monitor said just over a week ago:

“We are being leaned on to delay them and I have a suspicion that the sensitivity would be less after the Tory party conference”.

Will the Minister say whether these allegations have been investigated? The figures were presented to the board of Monitor on 30 September, so when was he told? Was it before the Tory party conference?

It may be an inconvenient truth for the Health Secretary and his Ministers, but the public have the right to know what is going on and what the Government plan to do. People across the country depend on NHS services, and Labour Members will stand up for them.

[Ben Gummer]

First, I welcome the hon. Lady to her place. Although he is not in the Chamber, I pay tribute to her predecessor, the right hon. Member for Leigh (Andy Burnham), who occupied her position, both as shadow Secretary of State and as Secretary of State, for a considerable period. I hope we can develop our relationship as constructively as possible in the months and years ahead.

The hon. Lady rightly said that Ministers are accountable to patients. That is precisely why we will not make the same mistakes as her predecessors in trying to trade off patient care and patient safety with the finances of the NHS. That is why we have been entirely open not only about the size of the deficit but, in a manner that the previous Administration were not, the failings of care in the NHS when they occur.

The hon. Lady said that the deficit is larger than it was in the whole of last year. That is not accurate. The deficit is traditionally larger in the first quarter of any one year. [Interruption.] She questions that, but it is a statement of fact.

We took action as soon as we came into office to give providers the opportunity and ability to bear down on deficits: it was one of my right hon. Friend’s first actions in coming into government. In three specific areas—agency staff required because of our need to take urgent action following the calamitous and scandalous events at Mid Staffs, the high and excessive pay of NHS managers and consultancy spend, and NHS property—we have given trusts the ability to bear down on deficits. We expect to see the use of those new tools in the past few months bear fruit in the months to come.

The hon. Lady asked if it is possible to balance books and deliver safe patient care. I point her in the direction of the trusts that are, and have been, successfully balancing their books and providing exceptional patient care. Indeed, it has been observed not only by me and other Ministers, but by those outside the Department of Health, that the trusts that best manage their finances and the efficiency of their hospitals also tend to provide the best patient care.

The hon. Lady made an interesting statement about there clearly not being enough money, but she will be aware that the NHS itself asked for £1.7 billion in this financial year and that we responded not with £1.7 billion, but with £2 billion. We have met the NHS’s own funding requests with more than it has anticipated. For the remainder of this Parliament the NHS itself has requested £8 billion of funding, and we have pledged to give it every single billion—a pledge that was not matched by the Opposition and that they tried to undermine at the last election. They pledged to give only £2.5 billion, as opposed to the £8 billion we promised the electorate. The hon. Lady says that promises have yet to materialise, but the money that we promised, not at the last election but in the previous autumn statement, is already flowing through the system.

The hon. Lady asked specifically about the relationship and the nature of the release of the figures. I completely refute her suggestion and I am certainly looking at investigating why such comments were made. I speak for the ministerial team when I say that we did not put on pressure as she might have suggested.

Finally, the hon. Lady says that the public have a right to know what is going on. We have been completely straight, and I have been direct, about the financial challenges facing the service. The reason for those financial challenges is the extraordinarily challenging situation resulting from the demographic changes in our country. On the Government’s part, that requires making very big decisions about the transformation of the service. We best do that not by making the NHS a political plaything, but by working together to deliver precisely the plan that the NHS has delivered for this Government and that we intend to deliver for the patients and people of this country.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the Minister’s statement, particularly the confirmation that the £8 billion will be forthcoming. He says that the money is already in the system, but what the NHS really needs is to be reassured about how much of that £8 billion will be front-loaded in the spending review. Will he reassure the House that he will set out in the clearest possible terms that it needs to be delivered as early as possible?

[Ben Gummer]

When my right hon. Friend the Chancellor made his commitment in the autumn statement on this year’s spending, he said it was a down payment on the five-year forward view and expressed his determination to ensure that the NHS is protected and promoted in all areas of Government.

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

The Minister mentioned successful trusts, but fewer than one in five predict reaching the end of this financial year in balance. That does not leave an awful lot of successful trusts. I echo the call for the funding to be front-loaded. Where are trusts meant to find staff if they are not allowed to use agency staff or nurses from overseas? Given that the deficit started to appear only in 2013—after the Health and Social Care Act 2012—does the Minister not feel that the Conservative party should review the direction of travel? The NHS was in balance from 2009 to 2013 and it has been on a downward slope ever since.

[Ben Gummer]

I will address the hon. Lady’s final point first, if I may. The previous coalition Government’s 2012 Act has saved considerable numbers—billions of pounds—which we would now have to make up if we had not made difficult decisions.

That allows me to address the hon. Lady’s first point. We have a choice: we can take the traditional view of politicians, which is to try to paper over the cracks and pour money into an unreformed system, or we can take the difficult decisions that will mean that we deliver patient care in the long term. That is what the Conservative party is willing to do: we are not only providing the commitment to funding, but taking the necessary, difficult decisions.

On the specific issue of agency nurses—one such example of difficult decisions—it is not so much the number of nurses available as the scandalous rates at which they were hired out to NHS trusts. We have taken action on that to ensure that NHS providers can procure agency staff when and how they need them at a reasonable rate.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

Will my hon. Friend confirm that there have been no cuts in expenditure on the health service and that there have been no cuts in the total level of service? The problems at the moment are caused by the extraordinary pressures of an ageing population, clinical advances and rising public expectations. Will he continue to get the right balance between the needs of greater efficiency and responsible public financing, putting patient interests first and resisting short-term lobbying from trouble spots, which is a permanent feature of the politics of the NHS? In particular, will he resist any attempts by organisations such as the British Medical Association to turn controversy into yet another pay claim?

[Ben Gummer]

I thank my right hon. and learned Friend for his assurances on what needs to be done: he, more than anyone in the House, knows how to do it. Had the Government taken the Opposition’s advice and cut the money going into the NHS, we would not have achieved record numbers of doctors and nurses; we would not have halved MRSA and clostridium difficile rates; we would not have eliminated mixed-sex wards; and we would not have achieved record high cancer survival rates. All that has been made possible because of the funding commitments that the Government have made, to which the Opposition failed to commit at the election.

[Norman Lamb (North Norfolk) (LD)]

The Minister will be aware that failure to finance social care adequately has a significant knock-on effect on NHS finances. He will also be aware that the finances of NHS organisations are deteriorating rapidly, and that senior people across the system do not believe that the system can achieve the £20 billion of efficiency savings that are required. Before the election, I proposed a non-partisan commission engaging with the public, burying our political differences and working together to safeguard the NHS. I welcome the fact that he has indicated the need for that sort of approach, but will he now commit to it? The Secretary of State agreed to it in the election campaign, so will the Minister commit to work with all parties to come up with a new settlement making the necessary changes but also coming up with the necessary finances?

[Ben Gummer]

I thank the right hon. Gentleman, who was an exceptional care Minister in the coalition Government, but I am a little confused by his question. He was in post when the five-year forward view was delivered by the chief executive. Within that five-year forward view is a commitment to £22 billion of efficiency savings, and he did not raise his concerns at that stage. It is precisely those efficiency savings, presented by the NHS itself and on which we have embarked, that will allow the transformation to better care that we know is possible within the service.

[Richard Drax (South Dorset) (Con)]

We all have huge admiration for all the staff who work in the national health service. Visiting two community hospitals in my constituency in the past week, I saw that work at first hand. However, we are baffled by the bureaucracy that still exists in the NHS. Does my hon. Friend agree that we can go much further and be far more radical in cutting bureaucracy, not least, for example, by cutting the number of trusts? Is that going to be looked at as a whole to see if we can provide more money for front-line services?

[Ben Gummer]

My hon. Friend is entirely right. Every penny that we can save in bureaucracy and administration is a penny that we can spend on patient care, which is why the Secretary of State commissioned Lord Carter to look at the administration and bureaucracy that surrounds hospitals especially. Lord Carter has identified many billions of savings that can be made, and I anticipate that there will be more to come.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

The university hospitals trust in Birmingham, Edgbaston is balancing its books, but the neighbouring hospital, Heartlands, ran up a deficit of £5.6 million last year. In the first five months of this year, the deficit has reached £29.4 million. GPs in Worcestershire recommend that their patients are not referred to Worcestershire hospitals but to University Hospitals Birmingham NHS Foundation Trust. What action has the Minister taken to prevent those few hospitals that are balancing their books from being pushed over the edge?

[Ben Gummer]

The right hon. Lady makes the important point that exceptional hospitals such as her own not only balance their books, but have a management culture that allows them to deliver some of the best care in the country. She is right that there is a continuing challenge for all trusts, whether they are well managed or poorly managed. The measures that we have brought in, especially those on agency nurses, are designed to enable the chief executive of her trust to continue with that exceptional management in the years to come.

[Henry Smith (Crawley) (Con)]

I note with interest that the new Leader of the Opposition has said that the Welsh model for the NHS should be expanded to encompass the whole of Great Britain. I am interested to hear my hon. Friend’s views on that, seeing as Labour has significantly cut funding to the NHS in Wales.

[Ben Gummer]

My hon. Friend is entirely right that the new Leader of Her Majesty’s Opposition made that point. It is surprising because, as a representative, I would not like our A&E targets to be missed for seven years in a row, as has happened in Wales. If we replicate what has happened in Wales here in England, we will see worse care for patients. I am sure that Members from all parts of the House would not wish to see that happen.

[Kelvin Hopkins (Luton North) (Lab)]

Comparable developed countries spend a substantially higher proportion of GDP on health than we do. In my view, that means that our health service is substantially underfunded. Will the Minister report back to the House on those comparisons and explain why we spend so much less than those countries on health?

[Ben Gummer]

The hon. Gentleman is right that, in the past, the NHS has not had the funding that it requires. That is exactly why the Government have committed £10 billion to the NHS at a time when efficiency savings are being made across all other Departments. That is the mark of a party that believes in the NHS and the reason why only this party can fairly claim to be the party of the NHS.

[David Tredinnick (Bosworth) (Con)]

I suggest to my hon. Friend that one way to reduce the pressures on the service would be to make greater use of health professionals who are regulated by the Professional Standards Authority, which covers 13 mental health and wellbeing professions. What is the point of people getting statutory oversight, regulation and registration if the health service does not employ them to reduce the demand for its services?

[Ben Gummer]

My hon. Friend is right to point to this area of health policy as one that is of interest. That is why the Law Commission reported on professional regulation before the last election. It is being kept under close review within the Department.

[Mr Speaker]

We are straying a tad from the relatively narrow terms of the urgent question, to which I know colleagues will be eager to return, and none more so than the hon. Member for Strangford (Jim Shannon).

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his statement. This is a question for Members across the whole of the United Kingdom of Great Britain and Northern Ireland, where there are pressures on the NHS, because while we all have passion and love for the NHS, we must ensure that there is enough money for it. Will the Minister confirm the amount of money that will be there for accident and emergency departments and say what will be done on waiting lists?

[Ben Gummer]

The hon. Gentleman will know that funding for the NHS in Northern Ireland is not within my bailiwick. I therefore point him in the direction of the Northern Ireland Office and his Assembly. As far as England is concerned, I confirm that we will deliver not the £8 billion that the NHS has asked for, but £10 billion over the course of this Parliament.

[Tom Pursglove (Corby) (Con)]

The policy of advancing a new urgent care hub at Kettering general hospital has united politicians of all parties in north Northamptonshire, as well as the public. Does the Minister agree that we need more of that in our country—rather than petty bickering, people getting together to find solutions to these problems?

[Ben Gummer]

Conservative Members disagreed with my hon. Friend’s predecessor on many points, but he did great cross-party work with Members who were not of his political persuasion to find a good solution for urgent care in his area. I hope that we will follow that model on a larger scale across the country. If we can do that, there will be a much better resolution to the challenges facing the NHS. Patients and people want us to address those challenges without turning the whole thing into a political circus.

[Marie Rimmer (St Helens South and Whiston) (Lab)]

I agree that the use of agency staff places a great cost on the national health service, and I am sure the Minister will accept that cutting the number of training places for nurses and doctors at the beginning of the previous Government will have had an impact on that. St Helens and Knowsley teaching hospital is currently recruiting in Spain because it cannot recruit here. Recruitment and retention are crucial, and more than 50% of doctors now apply to practise abroad. Does the Minister think it sensible to further punish trusts that are in financial deficit—there are many across the country—by reducing their quality pay if they do not balance the books this year?

[Ben Gummer]

The hon. Lady asks about nurse training places, and this year the number of places is consistent with the number in 2010. The key point is not just the number of nurses in training, which is determined by NHS providers, but the number of nurses in hospitals serving patients and the public. The number of nurses is currently at a record high thanks to this Government’s actions.

[Simon Hoare (North Dorset) (Con)]

My hon. Friend may have missed the speech to the Labour party conference by the hon. Member for Lewisham East (Heidi Alexander). He may therefore be interested to know that she said that the Labour party would not be enforcing any efficiency savings in the NHS, including the £22 billion that the NHS itself has identified. Will he confirm that efficiency savings must be a concomitant part of NHS funding?

[Ben Gummer]

I saw the comments by the hon. Member for Lewisham East (Heidi Alexander), and the thing that confused me most is that she imagines that efficiency savings are a creation of this Government. They are not; they are the product of the “Five Year Forward View” that identifies the need to create £22 billion of efficiency savings over the next five years. Had she read the “Five Year Forward View” she would be aware that those efficiency savings are essential if we are to get the patient care and quality that Simon Stevens identified as a necessity for the service.

[Wes Streeting (Ilford North) (Lab)]

The House of Commons Library estimates the cost to the NHS from falls this year at around £2.45 billion. At a round table that I chaired last week with our local NHS trust it was clear that although the will is there to tackle the cost of falls, the resources are not. Is that a good example of how the under-resourcing of the NHS is harming patient outcomes and undermining the efficiencies that the Minister hopes to achieve? How will he address that and wider inefficiency in the NHS?

[Ben Gummer]

I point the hon. Gentleman to parts of the country such as Torbay, Greenwich and the soon-to-be-devolved Greater Manchester authority where the relationship and integration between social care and hospitals is producing exactly the kind of linked up action that he identifies for falls. If we can achieve that at local level we will have a truly integrated health and social care system that is not imposed from above but created by those who deliver care on the front line.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I welcome the Minister’s statement. A comprehensive economic evaluation conducted last year by the London School of Economics and the Centre for Mental Health calculated that the annual cost of perinatal mental illness to the NHS is £1.2 billion, and the total cost to society is £8.1 billion. The Minister will know that on Wednesday I will introduce a private Member’s Bill that is supported by the Royal College of Psychiatrists and will save lives and costs. Will the Minister ensure that that is fully considered?

[Ben Gummer]

My hon. Friend raises an important matter that has also been raised by my hon. Friend the Member for South Northamptonshire (Andrea Leadsom). Given my responsibility for maternity services, I am particularly focused on the need to do better in perinatal mental health and maternity care, and I hope to say something about that in the not-too-distant future.

[Teresa Pearce (Erith and Thamesmead) (Lab)]

As far as I am aware, the Minister has not answered the question about the delay in issuing the report. If he cannot answer now, will he put a note in the Library and explain the reason for that delay?

[Ben Gummer]

I answered that point entirely accurately and categorically, and on behalf of the ministerial team I refute the allegation.

[Robert Jenrick (Newark) (Con)]

My local trust in Nottinghamshire, Sherwood Forest, is in a very bad financial position—one of the worst in the country. The primary reason is the appalling private finance initiative deal we inherited from the previous Labour Government, which consumes 17% of the trust’s annual budget. Would a new Parliament be an opportunity for the Government to look again at those appalling PFI contracts, particularly those that affect trusts such as mine that are in special measures?

[Ben Gummer]

Across the country, trusts are struggling under the load of poorly negotiated PFI contracts. It is worth remembering that when the Labour party speaks about all the money it put into the NHS, a large part of it was borrowed via PFI—that part which was not borrowed as part of Government debt. The important point about PFI is to try to address each contract in turn. The Department is looking at this on an ongoing basis, not only as it concerns old contracts but in the letting of new ones.

[John Glen (Salisbury) (Con)]

Salisbury hospital enjoys an excellent reputation across the constituency. On a recent visit, having completed a number of easily found cost reduction programmes, the management expressed their determination to continue with patient-level costing service by service and to pursue electronic patient records reform. They asked me to raise their concern about obtaining visas for specialist scientists at the hospital and the need to have a better joined-up service between primary, secondary and tertiary elements of the NHS.

[Ben Gummer]

I thank my hon. Friend for bringing the attention of the House to innovation at a local level. This kind of innovation, which will allow us to transform the service into an even better NHS in the years to come, is being repeated in many trusts across the country. If I may, I will reply to him by letter on the specific issue of scientists after I have investigated the points he has made.

[Helen Whately (Faversham and Mid Kent) (Con)]

In addition to needing extra funding, which the Government have rightly committed to provide, the NHS could and should make better use of its resources through better procurement, the use of technology and the employment of permanent rather than temporary staff. The challenge is how to do this at the necessary pace and scale. Will my hon. Friend advise what steps the Government are taking to drive the pace and scale of the changes that are important not only to improve productivity but for better outcomes and patient experience?

[Ben Gummer]

My hon. Friend identifies precisely the action we in the Department need to take. It would be a dereliction of duty to pour money into an unreformed system, as it would mean money being spent on administration, bureaucracy and waste, and not on the changes we need to improve patient care. We need to move at pace to bring in the changes necessary to transform the system if we are to get the NHS we all want to see.

[Mr Peter Bone (Wellingborough) (Con)]

I congratulate the shadow Secretary of State on an excellent urgent question and the Minister on how he has responded. It is interesting that there are more Government Members who want to ask questions. With regard to deficits, we have very expensive and highly paid management and accountants. They set their budgets and then a deficit develops. What action can be taken against these highly paid individuals for not keeping to their budgets?

[Ben Gummer]

My hon. Friend raises an important point. There are trusts that are being managed exceptionally well which hit the budgets they set at the beginning of the year. That is the normal course of business for other organisations. This is why my right hon. Friend the Secretary of State introduced the clawback on new chief executive contracts, which mean that if they do not perform according to plan then a proportion of their salary will be docked at the end of the year. That is an important reform, one not introduced by the previous Administration but by us, the party of the NHS.

[Andrew Stephenson (Pendle) (Con)]

May I echo the comments made by my hon. Friend the Member for Newark (Robert Jenrick)? Parts of the Royal Blackburn hospital and Burnley general hospital were rebuilt by private companies in 2006, under the previous Labour Government, at a combined cost of about £140 million. East Lancashire Hospitals NHS Trust will have to pay back almost £1 billion by 2041 because of the PFI contracts signed at that time. Does the Minister agree that the toxic PFI legacy is one of the biggest challenges facing most of our NHS trusts?

[Ben Gummer]

A considerable number of PFI contracts were poorly negotiated under the previous Labour Administration. They need to be looked at one by one, and the Department is committed to doing that again to see whether we can reduce the burden on trusts. My right hon. Friend the Secretary of State will have more to say about that in the course of the transformational changes that we are helping the NHS to make.

NHS (Contracts and Conditions)

Ben Gummer Excerpts

Monday 14th September 2015 Westminster Hall

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

It is a great pleasure to serve under your chairmanship for the first time, Mrs Gillan, as it was to serve under the previous Chair, Ms Vaz.

This is an important and exciting day because we are responding to the first e-petition under the new system. The hon. Member for Denton and Reddish (Andrew Gwynne) is quite right that it should have happened some time earlier. I hope that through what are pretty modest forays into social media we can make more popular the debates that take place in Westminster Hall, because they are often far more thoughtful and certainly more nuanced than some of the debates that one hears just a few hundred yards away.

I am grateful to the Chairman of the Petitions Committee, the hon. Member for Warrington North (Helen Jones), for her introduction. Hers was a vigorous opening argument and certainly did what it should have done, which was to spur a good and, at many points, enlightening debate. There is much to which I would like to respond, but at times the debate turned into a general critique of the NHS, so if I tried to answer every point, Mrs Gillan, I think we would be here beyond the 7.30 pm cut-off that you and, I imagine, other Members would not like me to reach.

The debate encompassed many of the issues and problems that confront the NHS, as do all discussions of seven-day services because they touch on contract reform and how we manage the NHS workforce. At the core of the debate was what we are trying to do: deliver exceptional, world-class care to every patient coming to an NHS institution, hospital, GP or community service in England and, by extension, the other nations of this country.

I, too, pay tribute to some shadow Front Benchers. I am grateful for the words of the hon. Member for Denton and Reddish. I almost wish he had not said what he did, because I wanted to say that I hope he keeps his Front-Bench position. He has always been a very reasonable defender of the Labour party’s point of view and a strong interrogator of the Government’s policies. That is exactly what opposition should provide. I should take the opportunity to say how much I will miss his colleague, the hon. Member for Copeland (Mr Reed), with whom I sat in this Chamber a couple of days ago for his last debate as a shadow Minister. I did not have the opportunity then—the moment escaped me, and I did not have knowledge or foresight about where he would be on Saturday—to wish him well and say how much I had, in my short time as a Minister, enjoyed debating important issues in the Chamber with him.

It is also entirely right to say that the right hon. Member for Leigh (Andy Burnham) has been Secretary of State for Health, a Health Minister before that, and a shadow Secretary of State for a long time. His contribution to debates about the NHS has been very important. It is clear from how he speaks that he cares passionately about the health service, and I very much hope that he delivers the same kind of force of argument in his new position as shadow Home Secretary.

It will be good to see what the new shadow Minister, the hon. Member for Lewisham East (Heidi Alexander), brings to her role. I hope that she will enter into arguments and debates on NHS reform with the spirit of openness and decency shown by the hon. Member for Central Ayrshire (Dr Whitford), who often attends these debates, bringing a great deal of personal experience from both this country and abroad, and who makes sure—no doubt because we often feel chastised if it goes any other way—that the debate is continued with a sense of decorum and a remembrance that our discussions are held in public. We must be aware of the fact that what turns people off political discourse more than anything is a silly repetition of party political positions with no meeting in the middle or discussion of the issues at hand.

It is in that spirit that I hope to address the central point of the presentation of the petition by the hon. Member for Warrington North. I am glad that we have these petitions, although perhaps a little less glad that this particular petition contains such stridency of language. Nevertheless, at the core, what concerns me is the point made very well by the hon. Lady: words matter. That was echoed by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately). We must be very careful about the words we use—not only the manner in which we say them but how they might or might not be construed.

Hon. Members may not be surprised to hear that I have read—several times, as it happens—the Secretary of State’s speech on this matter. I have also seen the coverage on it, and there is dissonance between the two. At no point did he attack NHS staff or suggest that they are not working in conditions that are often heroic, and at no point did he suggest that we have ended up at this impasse because of a wilful wish on the part of NHS staff not to work at weekends. What was construed from that speech has unfortunately meant that our debate has been about a number of words and phrases that were not used, intended or even suggested.

Turning to the core of the speech, the Secretary of State began by saying that talking about seven-day services is not news to a large number of NHS staff, because nurses, porters, cleaners and many of those working under the “Agenda for Change” contract have, for the entirety of their professional lives, been working in seven-day services. His main contention was that, given the weight of evidence on excess mortality that can be attributed to differential working patterns at weekends and on weekdays, it is at least reasonable to ask what we are doing to ensure that if someone is admitted on a Saturday or a Sunday they can expect the same quality treatment and intensity of consultant and diagnostic support as they would receive on a Wednesday. That suggestion was not plucked out of the blue.

I have two points to make. Given that the petition is an ad hominem attack on the Secretary of State, it is right to say that I have never encountered anyone in a ministerial post who has acquitted himself with as much passion about a point on which he wishes to concentrate—patient safety—as the Secretary of State. The right hon. Member for Leigh recognised that when he was shadow Secretary of State, and it is recognised even by those who often oppose the Secretary of State in the BMA and other professional representation bodies. The fact is that the Secretary of State is passionate about patient safety. He cares deeply about it, which is why he takes an intense interest in gathering evidence about differential mortality rates.

I want to run through in detail where NHS England’s thinking comes from and why the Government have decided to act as they have. As the hon. Member for Central Ayrshire knows, there have been various academic papers from the United States and some from the United Kingdom on differential mortality, and they contain many of the questions and answers that have been alluded to today. It is certainly true that people are admitted sicker at weekends, which points in part to the need to do something about community and GP services at weekends. That is part of the reason why people are being admitted sicker. If somebody with a serious acute illness is seen on a Wednesday, they will receive a level of service—both diagnostic and consultant support—that they are unlikely to receive in many hospitals on a Saturday or Sunday.

[Helen Jones]

The Minister is making a sensible point, but could he enlighten us about exactly which services the Government foresee working seven days a week? Has the Department for Health assessed how many extra staff will be required to ensure that happens? NHS staff have got to have days off sometimes, so if they are working at the weekend they will have to have a day off in the middle of the week. How many more staff will we need?

[Ben Gummer]

Those are very reasonable questions. If the hon. Lady will allow me to continue with what I was setting out, I will certainly answer them.

That assortment of academic research, together with the wide anecdotal evidence from people who have experienced poor care in good hospitals, either for themselves or for their relatives, led NHS England to conduct the Seven Days a Week forum in 2013, which gathered together clinicians to look at the challenge. It produced a clear strategy for dealing with differences in care quality at weekends, compared with the week, and set out 10 clinical standards that it believes hospitals must meet to eradicate the difference between weekday and weekend working. Many hospitals are implementing the 10 clinical standards on a variable basis during weekdays, so the work done for weekends was helpful in determining a standard clinical approach for maximising the ability to reduce avoidable deaths for weekend and weekday admittances. The product of that forum was taken forward by NHS England and incorporated into its five-year forward view, in which the NHS, separately from the Government, made a commitment to seven-day services. It did so not because of the benefits to patients—as my hon. Friend the Member for Sutton and Cheam (Paul Scully) said, that is a secondary reason for pursuing the agenda—but purely because of the need to reduce excess mortality where possible.

This is a challenge on the scale of infections in hospitals. It is our duty not only to find out precisely why excess deaths are happening—as the hon. Member for Central Ayrshire correctly said, further work is needed and the data must be understood—but to do what we can as quickly as possible to reduce them where we think they are preventable. That is why NHS England incorporated the seven-day service into its five-year forward view. NHS England asked for an additional £30 billion of spending between 2015 and 2020, of which it said £22 billion can be achieved through efficiencies within the service. It is important to point out to the hon. Member for Warrington North, who made that point, that they are not cuts but genuine efficiencies within the organisation. On top of the £22 billion of internal efficiencies though a better use of IT, to which she alluded, and better job rostering—I will turn to that in a minute—there will need to be an injection of £8 billion to make up the rest of the £30 billion. That package will implement the five-year forward view, which includes seven-day services and many other things of great importance and about which all parties agree, such as shifting resources from providers to primary care, social care and the community sector.

This programme was not invented by the Secretary of State in a speech given to annoy doctors and consultants, much as that might be the impression given by some people on Twitter. It is the policy response of a Government taking seriously the clinical evidence and advice of NHS England, led by Professor Sir Bruce Keogh. We are responding to give NHS England and the providers tools with which they can deliver a seven-day NHS service in hospitals and GP practices.

I turn to the changes in the contracts, which are at the heart of the petition and the speech of the hon. Member for Warrington North. The contract terms are based on a review by the doctors and dentists pay review body, which identified a number of areas where contract reform is needed, including the systems of opt-out and on call. It asked a completely reasonable question: why should it be that some members of the workforce, who are expected to work at weekends as part of their normal shift patterns, do not have the option of an opt-out from their contract, while others—who tend, as it happens, to be far more highly paid than those who do not have the option of an opt-out—do? It proposed a series of changes, which in our view make up a far better contract for both junior doctors and consultants. On balance, we feel that it presents a real opportunity for consultants and doctors to improve not only their working conditions but, in some cases, their pay.

To take some salient examples from the consultants’ contract, we want a far more equitable and reasonable distribution of clinical excellence awards—many consultants are privately critical of how they are awarded—within not a cut to the total consultant budget, but exactly the same existing pay framework.

[Dr Philippa Whitford]

To point out a slight difference, we do not have those awards in Scotland. We have local discretionary points, but the national clinical awards have been done away with for quite some time. Much as we also struggle with staff, we have not been haemorrhaging them south on that basis.

[Ben Gummer]

The hon. Lady points out that contractual differences already exist between NHS Scotland and NHS England. Officials have looked with interest at the experience of NHS Scotland—one of the pleasures of the devolved NHS system is that we can all learn things from one another. I hope that the new replacement of the clinical excellence award will be perceived as far fairer by clinicians and will reward those surgeons who are giving their utmost in academic research and the professional development of others. That is a tangible improvement to consultants’ terms.

It is important to point out, as several of my hon. Friends have done, that we are talking about ensuring that, at most, consultants work no more than one weekend in every four. That is the basis on which they will be contracted to work in a seven-day NHS. We are not talking about seven days at a time, but about shift rotas and patterns, as many people in professional life already recognise, not least some of those who have spoken in this Chamber. We need to get to a situation in which NHS professionals at the top, as well as those at the bottom, are trusted to organise their life and work patterns according to the professionalism they hold so dear. Many consultants in the NHS want to move to contract reform so that they may express their professionalism in that way, and we need to ensure that it happens so as to bring them with us, rather than its being forced on them.

For that reason, I am delighted that the consultants committee of the BMA has agreed to rejoin negotiations. It has seen that there is a basis for reaching an agreement, which suggests—contrary to some of what has been said by Opposition Members—that things are being done with a sense of collaboration. We have wanted to enter the negotiations for some time. The BMA, for reasons no doubt connected with the election—probably understandably—decided to withdraw from negotiations, but it has now come back. We and the consultants committee can reach a good position on the proposed contract.

The junior doctors’ contract is a proposal of great strength, not least because we include a significant increase in basic pay rates, which should be welcomed across the board. The contract addresses one of the points made by the hon. Member for Warrington North and does something important for the way in which junior doctors are perceived by their management. Instead of offering, in effect, danger money for excess hours, which is surely not the way to manage a workforce, it gives junior doctors a right to a review of their hours, so that they may properly manage their work rotas and patterns. For the first time, that will be enshrined in their contract. They will have far more predictable work patterns; providers—employers—will be forced to think seriously about work-life balance when constructing the roster; and, on pay and on the offer to juniors for their working life, the proposed contract will produce a far happier outcome.

I had hoped that the juniors committee would already have agreed to come back to the table, and I remain hopeful. The committee is meeting imminently—in six minutes’ time, in fact—and I hope that it is listening to the words in this Chamber, because hon. Members and others listening have heard nothing from both Government and Opposition Members but unalloyed praise for NHS staff and a real desire to work cross-party to secure the kinds of advances in quality that everyone wishes to see. With the juniors at the table, we could reach a constructive and reasonable resolution to the need to change their contract. That need was impressed on Ministers not only by the DDRB—the review body on doctors and dentists remuneration, but by the NHS’s own independent pay review body. Many in the service, perhaps more quietly than those who have been most exercised on Twitter, know that it is necessary.

[Helen Whately]

Is the Minister aware that if we compare the number of staff in a particular NHS service with the demand for that service over time, we can see that demand is sometimes highest when staff numbers are at their lowest? Demand and staff numbers do not match well. Is there not an opportunity to look at changing staff shifts and rotas to ensure that there is the greatest number of staff when demand is greatest?

[Ben Gummer]

My hon. Friend is entirely right. The whole purpose of what we are doing through contract reform is to match the professionalism of doctors, consultants and those working on agenda for change contracts—nurses and so forth—with the demands of any particular hospital. That cannot be decided by me or NHS England, but has to be decided in each setting, because of the differences—sometimes subtle and sometimes wild—between hospitals. In a study of some 15 hospitals released a couple of years ago, it was noticeable that there was 3.6 times more consultant cover for acutely ill people on a Wednesday than on a Saturday, even though 3.6 times more people were not acutely ill on a Saturday. The comparison is roughly drawn, but it points to a mismatch between rostered staff and peak patient flows. Most hospital managers would not only accept that point, but offer it to you.

All that suggests that somehow no seven-day NHS working is going on at the moment. As the shadow Minister and other hon. Members have said, however, some hospitals are already delivering an exceptional seven-day service—sometimes at no extra cost at all, and sometimes with only a minimal cost increase. What is most noticeable is that care quality has improved. In some cases that is now measurable, which is very exciting, and we can see reductions in mortality attributed to changes to staff working patterns. The staff, when asked, “What difference has this made to your lives?” point, as the key difference, to the fact that this was led by enthusiastic members of the staff themselves. There we have a pointer as to where we need to go: we need to get staff buy-in at the beginning. When the change is done well, it gives staff far greater control over their working life, which has led in a couple of hospitals to appreciable improvements in staff satisfaction.

Those settings have achieved the trick that we want to see throughout the NHS, which is for contract reform to empower and help staff to deliver care with the professionalism that I and everyone in this Chamber know that they wish to, while delivering better, higher quality care and decreased mortality—all within tight spending constraints, despite the increases to the cash budget that the Government have pledged to the NHS. If we can achieve that, we will have done something very special: we will have dealt with the lack of a link that has existed for too long between patient quality and care, and restrictive contracts that do not reflect how many staff want to work, and certainly do not reflect how patients admit themselves to hospital.

There is one final thing that I would like to add—in fact, it is the penultimate thing, because I must answer the point made by the hon. Member for Warrington North about staff. She is right to say that, of course, seven-day services will, in some disciplines, have an effect on the staff numbers that might or might not be required. That is part of the plan being developed by NHS England, in close association with Health Education England. We are recruiting close to record numbers of nurses, doctors and consultants, and we are doing so in many of the diagnostic specialties as well.

However, this is a question of not just staff numbers, as the hon. Lady recognises, but much smarter rostering and rota-ing, so that we use staff and their time as effectively as they would like us to. It is also a question of the productive use of staff time. She rightly pointed to the bureaucracy that ties people down. In some hospitals—some quite near her constituency—that bureaucracy has been reduced to a very minimum, as a result of which staff have patient contact time of an order of magnitude different from that in hospitals just 50 or 60 miles away. If we can bring all levels of staff exposure to patients—the patients they want to care for, for the maximum period of time—up to the best level in the NHS, we will already have the productivity gains in the workforce that will make possible not just seven-day working but a whole series of other improvements in care quality.

My final point about the opportunity that contract reform gives us was touched on by the hon. Member for Ealing Central and Acton (Dr Huq), who spoke about whistleblowing. It is an important point. When people attack the Secretary of State they should remember that he brought in freedom to speak up and the duty of candour, is bringing whistleblowing champions into the NHS, and has acted on some of the most difficult recommendations of the Francis report. It is this Secretary of State who said for the first time, “If you are employed by the NHS and feel that care is not being delivered in a way that is good for patients, we will prize your voice and listen to you above those who might stop you being heard.”

That kind of message to the system is new. It is so radical that I think many still do not quite believe it could be true, but I hope that the instigation, at some considerable cost, of whistleblowing champions, along with the framework for whistleblowing and the independent national officer, demonstrates to Members and the outside workforce that we are deadly serious about listening to staff, no matter where they work or who manages them, to make sure that we improve patient care wherever possible. We know that improving staff’s experience in their working lives is a crucial part of that.

Although this was not mentioned in the debate, I am conscious that far too many staff in the NHS suffer bullying and harassment. The numbers are almost unheard of in any other walk of life, including the Army and the police. NHS workers unfortunately can expect abuse from members of the public and bullying within management chains to a degree that is unique in the public sector and close to being so across the entire workforce. That is an historical problem that has led to the very high levels of staff sickness that the NHS has carried for decades. It will not be an easy problem to crack, but I have to tell Members that I and the Secretary of State are absolutely committed to doing something about it. NHS staff go to their place of work because they care about patients and about their vocation, but too often can get pushed back by poor management, abusive patients and poor performance management processes, and often feel belittled in what they are doing. If we can do something about their working conditions and improve their working lives, that will be very important, not just for staff but for patients. If we can improve the working practices and the working lives of the 1.3 million people devoted to our nation’s healthcare, we will do so much to help them produce even better care for the patients they serve.

I hope that Members on both sides of the House have come to a broad understanding that the changes anticipated by the contract reform are necessary. It is certainly true that we must take account of the data and listen carefully to the arguments of everyone involved in the provision of NHS services seven days a week, to make sure that changes are made as collaboratively as possible, so long as collaboration is made possible by all parties. We must also bind ourselves to the promise that we should all reflect correctly the words of politicians on both sides of the House, lest their misconstruction cause worry and fear in the outside world. In all that, we must ensure that the changes we make improve the quality of patient care and reduce the excess rate of mortality, which I know everyone, including all Members, would like to come down when and if possible.

Question put and agreed to.

Resolved,

That this House has considered the e-petition relating to contracts and conditions in the NHS.

Hospital Services (South Manchester)

Ben Gummer Excerpts

Tuesday 8th September 2015 Westminster Hall

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

First, I thank and congratulate the hon. Member for Wythenshawe and Sale East (Mike Kane) on bringing this debate to the House. It is a particular pleasure to be answering him. His predecessor became something of a friend, and I know that he had a similar admiration for him and certainly a far closer friendship with him, so I feel honoured now to be answering, as one of my first clutch of Westminster Hall debates, a debate brought here by him.

As is so often the case with Westminster Hall debates, it is frustrating that the debate will not be more widely seen and understood by members of the public, because they would see Members of Parliament fighting hard for their constituents and constituencies, and speaking with great eloquence and detailed knowledge and understanding of complicated things. Those things are not necessarily within their professional expertise, but they have done the research and acquired the knowledge to be able to speak about them. And, most important, Members are speaking on a cross-party basis. If more people were to see that, they would see the value that they were getting from their representatives. I value very much the passion and the detail that the hon. Member for Wythenshawe and Sale East has brought to the debate, as I do that of other hon. Members who have spoken and the measured response that the shadow Minister, the hon. Member for Copeland (Mr Reed), has given.

I should say at the outset that I am rather more restrained from giving an expansive answer to the hon. Member for Wythenshawe and Sale East than I would normally be, because a letter before action has been issued and, although the Department of Health is not a party to any legal action, I would not like to prejudice something that did come about. I hope that the hon. Gentleman will not mind if I comment on those areas on which I can comment and then on the general principles that were raised. The hon. Member for Stretford and Urmston (Kate Green) specifically raised the general policy of reconfiguration. I can give her more detail about that and give, I hope, a narrative explanation of how I and the Department understand the process as it has gone on so far.

In the round, it is welcome that the hon. Gentleman and other hon. Members understand the importance of devolution. I agree completely with him that the turn of events in Manchester is of serious significance; it is of a generation-changing nature. It was good to hear my hon. Friend the Member for Altrincham and Sale West (Mr Brady) saying exactly the same thing. It is important that decisions that are taken at any stage by devolved administrations, whether they be clinical commissioning groups, local councils or health and wellbeing boards—or indeed the overview and scrutiny committees in the way they look at these decisions—inspire confidence in devolved decision making, rather than acting against it. Of course, reconfiguration and change normally cause some disruption and disquiet in areas not chosen as sites for new or increased activities. He spoke powerfully of the need for devolved powers, but I hope that he accepts that it is in the nature of such decisions that people will sometimes be disappointed.

I understand entirely why Wythenshawe, with the extraordinary range of specialisms, both secondary and tertiary, which the hon. Member for Wythenshawe and Sale East pointed to, and with a history famous not only in the north-west but across the country, should feel aggrieved that it was not one of the four centres chosen to be part of Healthier Together. It would be unusual if the world-respected clinicians and management at the hospital did not fight their corner, and it is appropriate that he should represent their concerns. I agree with everyone who has said that it would be extremely sad for the matter to go to judicial review. We certainly do not want that to come to pass, either in this consultation or elsewhere.

Before I talk in general about consultations, I want to bring the hon. Gentleman up to date on events in the past couple of days. I understand that there have been some constructive conversations between commissioners and clinicians at the hospital, and that discussions will continue about the relationship between tertiary specialties and the general surgery that, it is proposed, will be moved to one of the four sites. A conversation has begun and is continuing, so there is a glimmer of hope that the parties involved will not go to the courts on this matter, which is so important for patient safety and healthcare in Manchester.

I want to speak about the nature of consultations, and to respond to the shadow Minister’s entirely correct points about how a consultation should be conducted. As a constituency Member of Parliament, I, too, have been through a number of health consultations. Some are good, and some are bad, but I hope that we are generally getting better at them. I remember several, under the previous Administration—this is not a party political point, but I think that the process is generally iterative within government—which were particularly poorly conducted. To their credit, the previous Administration reversed some of the decisions.

Some consultations are well run, however, and have the support of large numbers of people in the community. I can only report on the information that I have received, but I am impressed by the support from local councils, from clinicians, from the clinical senate, from doctors and from management across Manchester for the Healthier Together programme, and for the size and scope of the consultation. As the shadow Minister and Opposition Members know, a consultation is not a plebiscite, so we cannot take the raw number of responses in favour of any particular solution as a “correct” response. It is important that all consultation responses are taken into account, and I have been assiduous in trying to make sure that the Healthier Together team—the commissioners—have listened to all consultation responses. I have urged them to engage as profoundly as possible with Wythenshawe to show that the responses have been listened to with care.

At the core of the proposal is a noble ambition: to save in excess of 1,000 lives over a five-year period. If Manchester were to match the best mortality rates achieved elsewhere in the country, 300 lives a year would be saved, which is nearly a life a day. The decisions being taken are difficult, but they will produce a considerable dividend not only for hundreds of potential victims of currently substandard care but for their families, extended families and friends. The prize is considerable, and it is worth striving after.

I agree with the shadow Minister that consultations need to demonstrate wide public engagement. I am impressed by the number of people involved in this consultation, which received some 29,000 written responses. There has been 18 months of consultation, and 23,500 people were involved in this specific part of the consultation. There are conflicting answers to the question of how to reduce mortality in Manchester; that has been clear even from hon. Members’ contributions. To mangle St Augustine, we are almost saying, “Let us have service reconfiguration and service improvement, but not yet.”

I do not fully agree with the suggestion made by my hon. Friend the Member for Altrincham and Sale West that consultations and service changes should happen sequentially. It would be impossible to run anything as complex as the health service, or, indeed, anything in government, if one were to take that approach. We must in this instance, as elsewhere, rely on the clinical judgment of commissioners. That lies at the very heart of the changes that the Government have made—both in our coalition iteration and in this new Conservative Government—towards relying entirely on the clinical basis for service reconfiguration. I must, therefore, bow to the judgment of clinicians in this and other instances, and I know that most Members here will want to do the same.

Although the shadow Minister has said that the proposal comes within the global need to try to do more with less—I do not want to rehearse the arguments about healthcare spending—I think that everyone has agreed that, in this instance, finance does not play a part. The chairman of the Manchester local councils made that explicit in his response to the consultation. This is actually about doing more better. There will always be a trade-off between travel times and sites, and clinical excellence. We would all like to have, right next to our house, a hospital with the full suite of tertiary expertise, but as we all know, a high throughput of patients would be required to maintain the necessary skills within clinical teams. Clearly, that would not be possible, so there has to be a balance between the number of sites and the distance that people must travel to them. That is the balance that the consultation and the proposal have sought to strike. In the majority of Manchester, it is believed that they have struck that balance correctly.

[Kate Green]

The Minister spoke a moment ago about the decision being taken by clinical commissioning groups—by clinicians. The problem is that a different group of clinicians, namely the consultants at Wythenshawe hospital, are offering a different opinion about patient safety from that of the commissioners. As politicians, I believe that we must take account of the fact that safety is being flagged up by clinicians. How does the Department reconcile the difference of opinion about patient safety between commissioners and consultants?

[Ben Gummer]

The hon. Lady is right to say that there are concerns from some clinicians at Wythenshawe hospital, and we should listen to those. There is an established process by which those concerns should be brought to bear. If she does not mind me running through the detail of how reconfiguration policy works, I am sure that she will find answers to some of the questions in her speech.

Our first principle is that the service changes should be led by clinicians, which is the point of the process. In this instance, the service changes are being led by 12 clinical commissioning groups coming together to discuss the future of 10 hospitals. The service changes will affect just under 1% of in-patients, and just under 20% of patients receiving general surgery, at Wythenshawe hospital. Within the context of Wythenshawe hospital as a whole, we are talking about a very small number of patients. I appreciate the hon. Lady’s concerns about the interrelationship with other specialties, but let us keep it in mind that this is a small number of patients.

Once the commissioners have come to their decision, there are two ways of resolving complaints from one party or another. The first is by a recommendation from the joint overview and scrutiny committee to the Secretary of State for Health—such a recommendation has not been made in this case—or by a referral to the Independent Reconfiguration Panel, which the hon. Lady mentioned in her speech. The Independent Reconfiguration Panel has made a number of recommendations in the past. That is no predictor of future performance, but at no point in the past, under any Administration, has a Secretary of State gone against the Independent Reconfiguration Panel’s recommendations. The point of both those exercises is to retain clinical ownership of decisions, albeit by different clinicians from those who made the original decision. If we go back to the bad old days, when decisions were made for political purposes following a clinical recommendation, we would not listen to clinicians in the round and, therefore, would make decisions on the wrong basis, possibly putting lives in jeopardy.

The hon. Lady has raised clinicians’ concerns about the effect on tertiary services, which are impressive at Wythenshawe hospital. All I can say is that NHS England has undertaken a thorough clinically-led review of all tertiary services at the hospital and has concluded that the changes to general surgery for stomach and bowel accidents will not adversely impact on the tertiary specialties available at Wythenshawe hospital. That is the advice that the Department has received from clinicians at NHS England. I have described the other options open to parties in Manchester, and I reaffirm that, even if it might suit some Members present to take that decision-making process out of clinical hands at whatever level and to vest it in the Department, it is not a direction that anyone on either side of the House ultimately wishes to take. We must therefore trust the opinion of clinicians in the bodies that have made those decisions so far.

[Mr Graham Brady]

My hon. Friend, for obvious and very good reasons, is valiantly treading a tightrope between discussing the specific case and addressing the general points, but I must counter the suggestion that any of us is here to try to overturn clinically-led decisions. On the contrary, our concern is that very senior clinicians feel that they have had no voice in this process. As the hon. Member for Stretford and Urmston (Kate Green) said, they are now raising very serious concerns about patient safety. As I said earlier, the consultants I have dealt with at Wythenshawe hospital are serious professionals who do not say that lightly. I also suggest that the three local Members here today do not have a record of hysteria on such things, and we are united in our concerns. We are perfectly capable, and we have shown that we are capable, of making reasonable judgments about reconfiguration when that reconfiguration is reasonable.

[Ben Gummer]

I am acutely aware of the huge spread of sensibleness on both sides of the Chamber, and I would not want any of my remarks to be construed as suggesting otherwise. On the contrary, I restate that it is not only reasonable but right that local Members respond to the views expressed by very experienced clinicians in their local hospital.

In my short discussions so far with local commissioners —I am sure there will be more discussions—I have impressed on them the need to engage fully with all clinicians. I understand that they began the process afresh before I made that request and that they will continue that engagement. We will only get good reconfigurations across the country if we have the general buy-in of clinicians and the public. We are now doing that better than we were five, 10 or 15 years ago, when every reconfiguration of every kind was fought tooth and nail by everyone. There is now a general move to an understanding that we need to make some changes to some areas. Indeed, the shadow Secretary of State for Health, the right hon. Member for Leigh (Andy Burnham), has made clear his desire to see some services centralised:

“If local hospitals are to grow into integrated providers of Whole-Person Care, then it will make sense to continue to separate general care from specialist care, and continue to centralise the latter. So hospitals will need to change and we shouldn’t fear that.”

I could not agree with him more on that general principle, but it does not change the fact that commissioners need to engage with every single party.

My hon. Friend the Member for Altrincham and Sale West, and every other Member, can be sure that I will pass back to commissioners their specific concerns about that engagement. In the discussions, which I am sure will continue between all of us, I hope that he and other Members will notice continued engagement between commissioners and clinicians at the hospital, and I hope that there will be a happier outcome than the one that might come about through judicial action.

The hon. Member for Blackley and Broughton (Graham Stringer) and the shadow Minister both spoke about Manchester airport and made interesting and valid points about the need for a stated relationship between important national infrastructure and centres of major trauma care. I will respond to the shadow Minister in writing on that specific question, if he does not mind sharing that response with his colleagues. This is an important matter, and I want to ensure that I can answer it in detail and in full.

If I interpreted his remarks correctly, the shadow Minister also said that consultations had been taken out of the hands of clinical commissioning groups specifically to be conducted by a third party, such as health and wellbeing boards. Again, I have not previously heard that idea, but I am happy to respond to that specific point once I have been able to give it greater thought, with no implication for the current consultation.

I will now close in order to give the hon. Member for Wythenshawe and Sale East time to reply to my comments. We all agree that reconfiguration needs to happen. In this instance, there has clearly been support from those Members who have been the beneficiaries of the reconfiguration in their constituencies, but the most important beneficiaries will be the people of Manchester, who I expect will see world-leading trauma care connected to emergency stomach and bowel surgery as a result of these changes. We must be proud that clinicians are leading the review, we must be proud that clinicians have been prepared to make bold and difficult decisions and we must be proud that Members present have come forward to represent the concerns of some that clinicians have not made those decisions in the right way. Members have made those points with lucidity, care and passion.

I hope that in the next few weeks we will resolve this matter in a rather happier way than it might otherwise have been resolved, and I pledge to continue my discussions with Members on both sides of the House to ensure that that is the case.

[Mr Philip Hollobone (in the Chair)]

I will call Mike Kane to give a winding-up speech of two or three minutes. Members who are here for the next debate should get ready, because we will go straight on to that debate rather than waiting till 11 o’clock.