Oral Answers to Questions

Debate between Ben Gummer and Justin Madders

Tuesday 5th July 2016 Commons Chamber

[Ben Gummer]

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

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

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

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

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

[Ben Gummer]

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

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

[Justin Madders]

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

[Ben Gummer]

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

Oral Answers to Questions

Debate between Ben Gummer and Justin Madders

Tuesday 10th May 2016 Commons Chamber

[Ben Gummer]

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

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

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

On NHS bursaries, last week the Minister said that

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

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

[Ben Gummer]

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

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

NHS Bursaries

Debate between Ben Gummer and Justin Madders

Wednesday 4th May 2016 Commons Chamber

[Ben Gummer]

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

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

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

[Ben Gummer]

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

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

BMA (Contract Negotiations)

Debate between Ben Gummer and Justin Madders

Monday 21st March 2016 Westminster Hall

[Justin Madders]

Will the Minister give way?

[Ben Gummer]

I will in a second; I will just answer this point.

From that point, as many Members have pointed out, considerable progress was made through the negotiations that we had under ACAS from December 2015 to February 2016—far more progress than in the previous negotiating period, partly because the BMA knew that an imposition would have to come if there could be no agreement. As the shadow Minister will understand, at some point an employer needs to move both on issues where there is agreement and on those where there might not be.

The fact that the Secretary of State chose Sir David Dalton to lead negotiations undermines the argument that somehow he was not trying to come to a negotiated settlement. He asked one of the very best chief executives in the NHS to lead the negotiations on his behalf. Even Sir David Dalton was unable to come to a final conclusion of the negotiations with the BMA, because the BMA refused to discuss the last remaining substantive issue—the rates of Saturday pay.

Herein lies the rub: in the heads of terms of the talks it began through ACAS, the BMA had agreed to discuss Saturday pay rates, yet it withdrew that agreement at the end. Sir David Dalton was therefore forced to write to the Secretary of State saying that in his judgment, there was no prospect of agreement on the remaining matters because the BMA was refusing to discuss them. When the Secretary of State or any negotiator has no counterparty with whom to negotiate, it is impossible to negotiate.

Far from the title of the e-petition, which suggests that the Secretary of State has somehow been unwilling, he has been negotiating in good faith all through the period since 2013. It was the BMA, right at the last minute and at previous moments that has refused to do that. I myself have called on it a number of times, both personally and in public, to come back to the negotiating table.

[Ben Gummer]

I will not, because I know that the hon. Gentleman needs to go. I said that I would give way to the shadow Minister.

[Justin Madders]

The Minister is correct that considerable progress has been made in negotiations since the start of this year. The consensus seems to be that 90% of the contract was agreed. Does he not agree that it was therefore a great shame that a decision was made to impose the contract when just 10% of the issues were outstanding?

[Ben Gummer]

It is a great shame that we were unable to discuss those final things with the BMA, but as I have just explained, the BMA did not wish to discuss that final portion, even though it had agreed to do so in the heads of terms that were in front of ACAS at the end of November 2015. It was impossible to have that final discussion. That was not of the Secretary of State’s volition; it was a decision of the BMA’s junior doctors committee.

I turn to the point that my hon. Friend the Member for Morley and Outwood made, which Opposition Members discounted so quickly. At no point has the Secretary of State ever claimed that there is militancy among junior doctors as a whole, nor has he said that the BMA as a body has sought to wind up the dispute. In fact, if he had said that, it would have been entirely wrong. It is, however, true that the junior doctors committee, which is a small portion of the BMA—it is not the whole body, and we have just come to an agreement with the BMA on the general practitioners’ contract—has become radicalised in the past few years.

We know that the committee did not wish to discuss Saturday pay rates, not because of any inherent merit or otherwise in the arguments but because of the tantalisingly close prospect of an agreement with the Secretary of State—one that the committee had been fighting against. We know that that dispute existed, because even when we made a revised offer just after Christmas, the committee refused to discuss it before talking to its members and committing to a strike. There has been an impelling force within the junior doctors committee to take action, which, I am afraid, has disrupted the course of the negotiations and made it far harder to have an open and honest discussion with junior doctors.

We come to the issue of junior doctors being misled. They are very bright people who I know take an interest in the news and in the contract under which they will be working. I have no doubt about that. However, the British Medical Association—a trusted body—has claimed to its members that they are going to have a pay cut of 20% or 30%. Despite the fact that the NHS and we in this House have rejected that claim numerous times, it has been repeated. The hon. Member for Hornsey and Wood Green (Catherine West) repeated it today. That claim is untrue. It was made in the summer, and it is no wonder that BMA members were worried. If I were a junior doctor and someone told me I was going to have a 20% or 30% pay cut and would have to work longer hours, I would be extremely worried, and of course I would be angry. The fact is, however, that the claim was not true. The gravity of that untruth is such that it can still be repeated in this Chamber as if it were true.

Junior doctors, who no doubt informed the hon. Lady—I know she is not willingly misleading the House—still think they are going to have a pay cut of 20%. If we are still in an atmosphere where people believe they are going to have something that they are not, and that they will have to work more hours than they will, it will of course be difficult to come to a resolution until we allow things to calm down. That is why it is important to move to a point where junior doctors have the contract in front of them, so that they can see the effect on their working patterns and see that much of what they have been told is simply not true. We can then, I hope, move to a much better position in individual trusts where we can start discussing the existing problems that the hon. Member for Central Ayrshire mentioned, such as rotas, training schedules and the like.

I will address some of the individual points that hon. Members have made during this interesting debate. Apart from misrepresenting the shape of the negotiations as if somehow the Secretary of State had broken off talks, which he did not, the hon. Member for Warrington North questioned the research that led to the various statements that the Secretary of State and others—many of them clinicians—have made about the so-called weekend effect, or avoidable excess mortality attributable to weekend admissions. I should make absolutely clear where the link is. Almost any clinician in the NHS will recognise that we do not yet have the same consistency of care over the weekends that we do during the week in every hospital or every setting where we need it. We know that, and the hon. Member for Central Ayrshire made a similar point herself.

Our manifesto pledge was translated into the mandate that is reflected in all the contract negotiations that are going on, and it concerns one particular issue—the need to standardise urgent and emergency care—and nothing more. It is not about elective care; I have made that point several times to the hon. Lady. People who are admitted at weekends—including, to some extent, those admitted at the shoulder periods at the end of Fridays and especially on Monday mornings, because of inconsistency of care over the weekends—will then be able to expect the same standard of care, which will contribute to lower mortality rates as part of a wider package to reduce mortality attributable to weekends.

The drive for that comes from clinicians. It comes from the seven days a week forum convened by the Academy of Medical Royal Colleges, which reported at the end of 2012 and gave the Secretary of State and the whole service 10 clinical standards that it believed would help to reduce variation in weekend clinical standards. It is those standards that we seek to bring in across the service. The academy has said that four of them in particular are the most important for reducing variation. They relate to urgent and emergency care, and it is those standards that we seek to fulfil across the service.

--- Later in debate ---

[Justin Madders]

I am grateful to the Minister for giving way; I could tell that he was about to reach a crescendo. He has set out what he intends to do to reduce the temperature and avoid further industrial action. I have to say that I think his response was inadequate, but his central contention was that he hopes to persuade the majority of the BMA’s membership that the new contract is beneficial for them. To that end, can he confirm when the full details will be publicly available?

[Ben Gummer]

I expect the full details to be available shortly. The Secretary of State is studying, and will continue to study, the draft final terms, together with the equality impact assessment. It is important that when he has studied that assessment, he can make a judgment about whether any changes are necessary. Once that process has concluded, the final offer will be made, and that will be the point at which we proceed with the implementation of the contract. I hope very shortly to be able to give the hon. Gentleman a timetable for that. It is in my interests as well as his to see it happen as soon as possible, and I hope to be able to provide junior doctors with the reassurance that the contract will provide—that this is not the tragedy that they have been led to believe it is.

This has, none the less, been a difficult period for the service and, in particular, for junior doctors, who have been led to have unnecessary worry as a result of a series of misrepresentations by their union. I hope that in the next few weeks and months we can allay their concerns, and I hope that we can then get on with the job that we are all mindful of the need to achieve, which is better quality of care whatever the day of the week, a reduction in avoidable mortality whatever the cause, and an improvement in our national health service.

Draft General Dental Council (Fitness to Practise etc.) Order 2015

Debate between Ben Gummer and Justin Madders

Tuesday 19th January 2016 General Committees

[Justin Madders]

I am grateful to the Minister for his explanation, and I agree that the processes are similar to those of other regulatory bodies. We certainly hope that efficiencies will result from the order. The point that the hon. Member for Lichfield and I were making is that it is about the perception of the investigators’ independence. That is critical, particularly given the history of this particular body.

[Ben Gummer]

On the hon. Gentleman’s wider point about the reform of healthcare regulation and why it is happening through section 60 orders at this stage, I understand his frustration. I hope I can reassure him by referring to my written ministerial statement just before Christmas, in which I outlined that we are hoping to take forward the Law Commission’s report and look at the work that the Professional Standards Authority for Health and Social Care has put together on the reform of professional regulation, to see whether there is an ideal combination of the two pieces of work.

I have discussed the order at length with the regulators. They are content with the way we are going, and we will enter a period of extensive consultation, which I hope will lead to substantial reforms. However, that can be done only on a consensual basis. I very much hope to involve the Opposition in that work, because it is clearly important that healthcare regulation remains a non-partisan issue.

That takes me to another point that the hon. Gentleman raised: how we will guarantee the independence of the case examiners. I understand, especially given the recent history of the GDC, that he wants to ensure that independence in the first years. The Professional Standards Authority for Health and Social Care has proved itself a worthy guardian of healthcare regulation in the past few years. Its reports, one of which he quoted in his speech, give an accurate picture of the state of healthcare regulation. It will audit the new system with assiduity and report back in its annual review about whether it is working.

My hon. Friend the Member for Lichfield referred to the fees gathered by the General Dental Council, which have increased in several of the past few years. I understand from the PSA’s last report that the GDC’s performance has improved somewhat over the past year, but it certainly has a great distance to make up. It is not for me to determine fee levels for healthcare regulators. However, with a number of fees having gone up recently, I made clear to all the regulators when we met last that I expected them to do everything within their powers to either freeze fees or, where they find can efficiencies, pass them back to their members if possible.

[Ben Gummer]

I can assure my hon. Friend that the order will be cost-saving for the General Dental Council—the estimated savings are £2.5 million. It depends slightly on whether the increase in referrals to the GDC continues. If it does, that saving will be eaten up in the increased resources required to process claims. However, if the number of incidents stays the same or reduces, I agree: the logic would be that the GDC might find space to reduce the fees it charges to its members. That is exactly what I have encouraged all the regulators to look at—how can they make justice quicker, which is good for everyone? If they save money in the process, which should only be a secondary consideration, it should be passed on to their members. In some regulated professions, many people, such as nurses or associated healthcare professionals, are not on high wages, and the fee levels make a difference. The regulators are aware of my views, and I put them as strongly as I can without infringing on their independence.

I hope I have answered every one of the shadow Minister’s points.

[Justin Madders]

indicated assent.

[Ben Gummer]

I think that is a yes. If there are no more questions, I will sit down. I hope that the Committee will endorse this section 60 order.

Question put and agreed to.

Oral Answers to Questions

Debate between Ben Gummer and Justin Madders

Tuesday 5th January 2016 Commons Chamber

[Ben Gummer]

The hon. Lady should look at the facts. March 2015 saw a record number of nurses in the NHS—319,595. We are increasing the number of nurse training places. We are able to increase them by considerably more than we could have done otherwise, as a result of the reforms to student finance that bring nurses into line with teachers and other public sector professionals.

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

It would be good to hear the Minister concede that it was a bad idea back in 2010 to cut the number of nurse training places. Even today we are still training fewer nurses than we were in 2009. Not only have this Government failed to recruit enough nurses, they have failed to retain them too: last year there was a 12% increase in the number of nurses leaving hospitals. With staff morale already at an all-time low, why does the Minister think it is right that nurses should be burdened with a lifetime of debt to pay for his Government’s mistakes?

[Ben Gummer]

The hon. Gentleman raises a reasonable point about attrition rates: they have remained too high for too long. One of the things we are undertaking at the moment is to talk intensively with universities to see how we can reduce attrition rates. We have had some success in some areas, but I want to see far more. It is important that students stay on their courses as much as possible. Of course, many go into community nursing. I would be prepared to write to the hon. Gentleman about further actions we are taking on attrition rates.

Draft National Health Service (Licensing and Pricing) (Amendment) Regulations 2015

Debate between Ben Gummer and Justin Madders

Monday 30th November 2015 General Committees

[Ben Gummer]

That is not entirely the gloss I would give to my comments.

There is no veto to all providers, because we are talking about 66% of providers in total meeting the objection threshold. This means that one particular bloc in the healthcare system as a whole that uses the tariff—it is not just used by NHS providers—will not be able to block the proposed tariff. Currently a smaller proportion of NHS providers—it is not even the full number—can block the tariff. It is not a scientific process, but in trying to balance the interests of commissioners and a healthy provider sector, which incidentally we will fund considerably more in years to come, we feel it is not right to give an objection threshold of 51%, and that we need to show a more significant number. That is why 66% of all providers would have to meet the objection threshold.

I would not like to speak for Earl Howe, who I know spent many hours explaining this matter and going through it in detail during the passage of the 2012 Act, but I think it was understood at the time—this was why the Bill developed as it did during its gestation—that, as with any health economy, the regulations would need to be finessed as issues emerged. To be blunt, we are at a time when NHS spending has gone up over the past few years, although it has been under significant pressure, as the hon. Member for Ellesmere Port and Neston said, because of changing demographics, and the way in which the tariff system and the changes made in the 2012 Act have enabled the tariff and the whole health economy to operate has allowed us to manage funds in an efficient manner.

I am conscious that others may want to speak, so I want to cover some of the other issues that the hon. Gentleman raised. He mentioned patient safety. I hope that I can place the issue in the larger context of all our reforms around the Care Quality Commission, introducing a simple grading system that gives complete transparency, and our additional funding to the commission over the past five years. By everyone’s estimation, the commission has improved its performance significantly, although we all want to it to improve still further.

We believe that patient safety is ensured by a raft of measures, not just by increasing NHS funding, but by increasing transparency on outcomes, by better regulation and inspection, and by giving a voice to NHS workers—giving them freedom to speak out through the whistleblowing champions that we have introduced and the efforts we are making to bring in a learning culture in the NHS. We are making those efforts in order to develop an NHS that learns from mistakes, can point out and shout about failures in patient safety, and can improve patient care in an iterative process.

That cannot, and can never be, about just pumping money in at one end and expecting to get improved care out at the other. We know that increased resources are one component, but to characterise tariff as a patient safety alarm is itself a little alarmist. It is one part of a health economy. As I explained, it is set by clinicians and economists, and the whole architecture that the Government have tried to reinforce and in parts introduce is there to underpin patient safety in the round. This is merely one component of that.

The hon. Gentleman raised specialised services. He could also have raised the issue of emergency admittances. Both those things are being looked at in the current tariff proposals. I understand the concerns that he raised, and I know that officials and Monitor will have heard them.

I must finally address the consultation process itself. I am not sure that the hon. Gentleman’s characterisation is fair on this. The consultation lasted a month. I do not think we can count a Spanish summer as happening in the NHS in the way he might suggest, as if everyone had vanished and was unable to respond. We received a significant number of responses. Given the fact that there are roughly 147 NHS acute trusts and a significantly larger number of commissioners—we are not talking about thousands, however—receiving 221 responses is good. They were full responses and I was completely open about their nature and the fact that, frankly, they were split, if not 50:50, about as close to 50:50 as a public consultation gets, on the quality of the Government’s proposals. The Lords sits in the summer months in a way that the House of Commons does not when we are back in our constituencies, but the 20-day scrutiny period is significant, and their lordships will have looked over it with due care and attention.

I understand the hon. Gentleman’s concerns about the nature of the changes, and it is understandable that he wishes to raise them. In part, they are the objections of some providers, and I am glad that he has brought them to the Committee’s attention, but I hope that, after this discussion, he understands that the regulations are part of a larger balance between different parts of the NHS to ensure that the additional money that we are putting into the NHS—the NHS budget will exceed half a trillion pounds over the course of this Parliament—goes towards reforming the system, new models of care and the primary, social, community and mental healthcare that all our constituents want improved on the ground. This tariff reform will help the process by ensuring that a bloc of providers cannot obstruct that change without significant enough numbers.

[Justin Madders]

I am grateful to the Minister for his gracious comments at the start of his speech. Does he accept that, under the regulations, if all NHS providers objected, they still would not reach the objection threshold? Can he explain why NHS providers are being put on an equal footing with non-NHS providers?

[Ben Gummer]

I hope the hon. Gentleman understands that the tariff, because it is a set price across the entire sector, has to treat every provider with equality. We cannot have a tariff of one price that accounts for one provider differently from another. All providers operate under the same tariff system, which means that no single bloc in the NHS or the healthcare system can obstruct tariff reform.

In summary, I hope that the Committee understands why these changes are necessary. They have been consulted upon in full, which is why I continue to commend these regulations to the House.

Question put,

Oral Answers to Questions

Debate between Ben Gummer and Justin Madders

Tuesday 13th October 2015 Commons Chamber

[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.