Capsticks Report and NHS Whistleblowing

Debate between Ben Gummer and Philippa Whitford

Wednesday 13th July 2016 Westminster Hall

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

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

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

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

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

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

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

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

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

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

[Dr Philippa Whitford]

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

[Ben Gummer]

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

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

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

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

Oral Answers to Questions

Debate between Ben Gummer and Philippa Whitford

Tuesday 5th July 2016 Commons Chamber

[Ben Gummer]

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

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

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

[Ben Gummer]

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

[Dr Whitford]

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

[Ben Gummer]

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

BMA (Contract Negotiations)

Debate between Ben Gummer and Philippa Whitford

Monday 21st March 2016 Westminster Hall

[Ben Gummer]

I will, and by way of return I hope that the hon. Lady will consider what the Secretary of State has actually said on a number of occasions, which—I am sure completely unintentionally—she misrepresented at numerous points. The hon. Lady said that the existing contract had moments of imperfection—I cannot remember her exact words. However, it had rather more imperfections than that, which is why the BMA recognised many years ago there was a need for significant change, and why the coalition Government entered into negotiations with the BMA early in 2013. The heads of terms were agreed between early 2013 and July 2013. The negotiations began in October 2013 and broke down a year later, with no notice to the Government. The BMA just walked out, and it took some time to explain why. It claimed, generically, that it was to do with patient safety, which was an odd thing to say given that there were doctors negotiating on the management side who were also concerned about patient safety. The negotiations were not rejoined until we involved ACAS in November last year.

[Dr Whitford]

When we had a debate about the issue in October, the Secretary of State was reluctant to go to ACAS, yet only when the negotiations went to ACAS was some progress made. The BMA wanted the contract changed to include recognition of quality training. The junior doctors are future consultants and leaders, and at the moment, while they hold multiple pagers and cover rota gaps, they feel that they are getting no training at all.

[Ben Gummer]

I will come on to the hon. Lady’s sensible points about rota gaps, which have persisted for many years and need to be addressed as a separate issue, and about training. However, the negotiations have been going on for more than two years. There is an idea that the Secretary of State somehow ended them peremptorily, but throughout the period of the negotiations there was a serious attempt to engage with the BMA. Progress was very slow, and the BMA unilaterally broke off the negotiations in October 2014. It did not come back to the table until the offer was made to go to ACAS.

On why the Secretary of State took the stance that he did, I have a different interpretation from the hon. Lady, because I was with him through that whole process. We were very keen to return to negotiations via ACAS, but we needed to ensure that the BMA would give its representatives full negotiating powers.

--- Later in debate ---

[Ben Gummer]

I will happily arrange for the hon. Lady to have a clinical explanation of the various studies that she has cited, because I think she will then understand why the part that she has quoted needs to be understood in context—[Interruption.] I am asking her a direct question: does she—and do other hon. Members, who are tittering about this on the Opposition Benches—really propose that there is no weekend effect? If they are saying that is the case, or if they are saying that there are 500 or 1,000 deaths and that somehow is acceptable and the Secretary of State should not address himself to it, that is a worrying statement of intent.

[Dr Whitford]

rose—

[Helen Jones]

rose—

[Ben Gummer]

I will not give way to the hon. Member for Warrington North. I give way to the hon. Member for Central Ayrshire.

[Dr Whitford]

The problem here is about exactly what it is the paper shows. What do any of these papers show? They show a statistical excess of deaths. We know that 25% more of the people are in the sickest category. We know that 15% more of them die on a Sunday. Maybe the NHS did an absolutely amazing job in saving the other 10%. We do not know the answer, so we do not know how many are avoidable. However, I would point out to the Minister, who referred to the standards, that the only mention of junior doctors in the 10 standards is with regard to review of outcome and focus on training. Not one of the 10 standards says there should be a change in how junior doctors work.

[Ben Gummer]

One of the studies that the hon. Lady cites does a control for acuity, which she has raised. I know that there is an understandable change in the acuity of patients and one of the studies allows for that.

As for the point about the 10 clinical standards—and here I will just move on from the points that the hon. Member for Warrington North was making—

--- Later in debate ---

[Dr Whitford]

Will the Minister clarify whether the protection for GP registrars has been re-established? We obviously do not have access to the terms and conditions that have been agreed, because they have not been published. However, one of their concerns was that they had pay protection when they became GP registrars, and that was going to be taken away.

[Ben Gummer]

All trainees working within legal hours will have pay protection and that includes GP registrars. That was one of the bottom lines of our negotiations all the way through the process and precisely why we are so disappointed that the BMA consistently misrepresented our position.

I have addressed the point the hon. Member for Hornsey and Wood Green raised about the 20% fall in income. She asked me to say expressly whether that is right or wrong. It is wrong. No one will see a fall in their income if they are working the legal hours. Indeed, we think that 75% of doctors will see an increase through the course of this pay contract.

The hon. Lady raised the issue of maternity and cited a doctor who claimed that they were earning £22,600. I would be interested to know the detail of that because the foundation year one minimum pay rate is £23,768, which is slightly above the figure she quoted. She made an entirely valid point about the need to make sure that women especially, but I hope under shared parental arrangements, women and men in the service have the flexibility to be able to take time out of the service to bring up children. That is why the increased base rate of pay is particularly good because it will increase the parental pay, as we should now call maternity pay, under shared parental leave when people take time out to look after children.

The hon. Member for York Central (Rachael Maskell), who is no longer in her seat, talked about guardians, but was factually wrong to claim that there would be no payment to junior doctors. They will be able to get one and a half times their salary as part of the payment fines made to guardians. The guardians will not, as the hon. Lady suggested, just respond to complaints. They will have an overall duty to maintain the wellbeing of junior doctors. Theirs will be a critical position in trusts and I hope it will grow into being a substantial one, making sure juniors have the opportunities for training they wish for and the levels of welfare to which they are entitled.

The hon. Lady spoke about whistleblowing, and her comments concerned me because this is precisely an area where we should be asking juniors to speak up. If working longer hours is dangerous—we all agree with that—like any other patient safety issue, not only should they morally speak up to their guardian, but they are under a duty to do so under GMC guidelines.

[Dr Whitford]

Does the Minister recognise that if someone is the most junior person in a very hierarchical system, it is difficult and harder for them to complain about something they perceive is being done to them as opposed to something they see concerning a patient?

[Ben Gummer]

I recognise that speaking up is difficult in the current NHS culture. It is precisely what lies at the heart of Sir Robert Francis’s second report. That is why we need to change that culture. It is also the reason why we said that guardians, in receiving proactive complaints from juniors, should have an overall duty of care for the juniors in their trust and make sure they are treated properly. That is why this is an exciting role. It is a tutorial role in sense with a responsibility, especially for the youngest trainees, to make sure they are in the right place and supported in what can be difficult times.

[Dr Whitford]

May I ask the Minister again about not having the chance to see the details? One concern of junior doctors is that they would not have a voice or a role within the guardianship. They asked to have a representative as part of that function. Has that changed, or are they still excluded from that?

[Ben Gummer]

They are not excluded. It is important that that person does not become a BMA nominee, but we want the guardian to make sure they command the respect not only of the junior doctor workforce, but the trust itself. It is important to make sure that person gets that degree of buy-in from both sides, and I hope that the final solution we arrive at will satisfy that.

[Ben Gummer]

There has been a problem for decades with whistleblowers being listened to. That is what gave rise in part to the tragedy at Mid Staffs and the Secretary of State is trying desperately to do something about it. He cares passionately about it and his recent speech, which the hon. Member for Lewisham East (Heidi Alexander) welcomed, was about trying to create those safe spaces within trusts so that people feel they can speak openly. Indeed, recently at the social partnership forum, which I chair and where we hear contributions from trade unions, I heard of a very effective scheme recently developed in Somerset which showed a good way of getting people of all grades in a trust able to speak up.

I, too, am delighted that the hon. Member for Bristol West (Thangam Debbonaire) has been able to take her seat again. She has come back at an exciting time in politics—one that may be more exciting for her than the last six months. She asked about the funding for seven-day services. All I would say is that within the five-year forward view are two parts that are connected. The first is the commitment to have seven-day services in urgent and emergency care, which is reflected in our mandate for the service, our manifesto pledge at the last election and the request for £8 billion of cash funding connected with the £22 billion of efficiency savings in the service. That is the funding that is being provided to achieve not only that commitment, but everything else in the five-year forward view. Hon. Members have questioned whether that money is sufficient and I point them to the statement by NHS England today in which it was very clear that that is the amount that was asked for and that is the amount that they were glad to get.

The hon. Member for Central Ayrshire spoke about the opt-out, and I want to give clarification for the record to ensure that we are clear about it. In parts of the emergency care pathway, the opt-out has an effective impact and indeed affects part of the urgent care pathway. Ensuring the opt-out is removed is one of the areas we are keen to progress and was the origin of the Secretary of State’s statement, which related to that and not to junior doctors at the beginning of this process. It is important that we do that specifically around urgent and emergency care, and other hospital services, but we have never, ever wanted to extend by the process of our negotiations elective care at weekends. That is not part of our commitment, which has always been squarely about ensuring consistency of standards in urgent and emergency care.

[Dr Whitford]

I am afraid that I have sat in the House and listened to the Secretary of State talking about having elective services across seven days and how great that would be for patients. Of course it would be great, but we would need thousands more doctors whom we have absolutely no chance of finding. It has not been clear. In Salford Royal today, Sir David Dalton again said one crucial thing is for the Government to define exactly what they mean by seven days. Doctors have not objected to strengthening urgent and emergency care.

[Ben Gummer]

The hon. Lady, in repeating that, as have other hon. Members, makes it harder for us to state again—she knows I have done so on numerous occasions—that this is to do with urgent and emergency care. It is true that some hospitals—Salford Royal is one—do elective work at weekends. I have no doubt her hospital might do some elective work at weekends. That is part of the trust’s decision-making. It is for the hospital to make that decision. Our key in changing these contracts has been to concentrate on urgent and emergency care. That is the focus of the contract changes.

The hon. Lady also spoke about the tenor of the language that has been used and I know that she cares deeply about this, for understandable reasons. I, too, enormously regret the way this has been portrayed. Although to a lesser degree than the Secretary of State, I have been on the other end of language that one would hope professional doctors would not wish to use.

The whole debate has become intemperate in an extremely unfortunate way, but I have sat through every single speech that the Secretary of State has made on this matter and every single press utterance—I have also made a number myself—and never once has he attacked junior doctors as a body. He has only the utmost respect for them, not least because, like everyone else in this Chamber, he has been the beneficiary of their care. But it is true that they have been let down by their trade union.

I repeat—I know that the Opposition Front Benchers know this—that the BMA has let down its members, because first, it has allowed a series of statements to persist that it knows to be untrue, and secondly, the junior doctors committee has not engaged in meaningful negotiations in the way that it should have done and in the way that other parts of the BMA have been happy to do, and they have concluded better contracts as a result.

That brings me to the points that the shadow Minister, the hon. Member for Ellesmere Port and Neston, made. He asked quite a lot of questions, and I commit to giving a full answer later to the ones that I do not answer today.

The hon. Gentleman asks whether there will be any further steps to avoid industrial action. We will do whatever we can to ensure that junior doctors understand the nature of the contract, and we hope that they will therefore not feel the need to go on strike. We have contended all the way through that that is a needless endangering of patient safety. It is certainly a massive inconvenience to patients, many thousands of whom have now seen their operations cancelled as a result. The contract dispute does not have anything to do with safety, as the BMA itself has implicitly accepted. It is to do with Saturday pay rates. The BMA and its members really have to think about whether they wish to take the dispute about Saturday pay on to the street time and time again.

The hon. Gentleman asked whether there has been a risk assessment on patient safety. We have risk-assessed that at every single stage, and the way in which we have dealt with the industrial action has been concentrated solely on the effect that it has on patient safety, but the best way of ensuring patient safety is for the BMA to cease its unnecessary action.

In relation to an assessment of recruitment and retention, the whole contract has been framed to try to ensure that doctors have a better work-life balance. That is precisely why we have reduced the number of consecutive long days, consecutive long nights and consecutive weekends, and it is why the contract is better for junior doctors and why we hope that it will aid recruitment and retention in the long term. However, we are conscious of the fact that there are ongoing morale issues that go all the way back to 1999 and beyond. In fact, when the previous contract was negotiated, precisely the same points were made about morale as are being made now, so clearly the old contract did not fix those issues. That is why we have asked Professor Dame Sue Bailey to look at wider issues of training and morale in the service as they pertain to junior doctors, to see what else needs to be done to ensure that they are getting the training opportunities that they require, the welfare standards that they expect and the quality of work-life balance that they rightly wish to have.

The hon. Gentleman asked about the BMA’s proposal that it claimed was cost-neutral. Our judgment was that it was not cost-neutral, and given that the BMA was refusing to negotiate on the contract that was on the table and had been worked on for several years, it was rather odd—and, one might think, a political gesture—to throw an entirely new idea on to the table, knowing it not to be cost-neutral. I would say that that was more for effect than to actually try to further the aims with which everyone approached the contract renegotiation.

In short, I am afraid that I reject the premise of the petition, because the Secretary of State has attempted at every stage in the process, over a period of nearly three years, to have meaningful contract negotiations with the BMA. At every point at which contract negotiations have broken down, it has been the instigator of that breakdown, so the petition would better serve itself by being addressed to the junior doctors committee of the British Medical Association, which has broken off meaningful contract negotiations not just once but three times. It is with that committee that the responsibility lies for the failure to find a solution to the final 10% of the contract negotiation, as Sir David Dalton concluded.

Junior Doctors’ Contract Negotiations

Debate between Ben Gummer and Philippa Whitford

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

My hon. Friend is right that new measures have been introduced in the proposed contract. A new guardian role, which was proposed by NHS Employers, will help to protect the hours of junior doctors in individual trusts. That has been a point of success in the negotiation between the BMA and NHS Employers. A new fines system, which is not currently in place, will penalise trusts and ensure that the moneys that are generated by the fines go towards enhancing the general wellbeing and training of doctors within those trusts.

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

Obviously, I am disappointed that it is not the Secretary of State we are speaking to today. The Minister referred again to weekend deaths. I gently point out that if one studies the evidence from Freemantle, one sees that there is a lower level of deaths at weekends. Perhaps we might be a bit more precise and say that we are talking about people admitted at weekends who die within the next 30 days.

I welcome the commitment to increase diagnostics and social care, as I think will everyone in the NHS, but junior doctors already work seven days and seven nights a week, so I really do not see how they can be the barrier to the safety of patients.

I do think that, on looking back, the Secretary of State and the Minister may regret how this matter has been handled. Right from last summer, it has been so combative. In October, when we debated the junior doctors, the Secretary of State was still refusing to go to ACAS, so this cannot all be put on the BMA. Doctors are not stupid; they are capable of reading what has been offered. Many of the junior doctors who have written to me have talked about the fear of hours getting out of control. When I was a junior doctor, the hours were ridiculous and it was the automatic financial penalty on trusts that changed things. It is important that their concerns are listened to and that they are not patronised, as they were on the Marr show yesterday. That has aggravated things further, and the way in which this process has been dealt with from beginning to end has been really disappointing.

We are facing the second day of strike for the first time in 40 years—that is my entire career. What does the Minister feel will be brought to the table by the Department of Health in the next few days to try to get out of this and to try a different approach? We do not have junior doctors on the streets in Scotland. He has to ask himself why we have them on the streets here.

[Ben Gummer]

The hon. Lady speaks from experience, and rightly points to the fact that avoidable mortality that is attributable to weekends is different from mortality at weekends—the Secretary of State has been clear about that in his public statements. However that gap does exist, as the hon. Lady knows, and Professor Sir Bruce Keogh was clear in his statements that there is an avoidable rate of mortality. He stated:

“There is an avoidable ‘weekend effect’ which if addressed could save lives. This is something that we as clinicians should collectively seek to solve. It also strengthens the moral and professional case for concerted action.”

The way in which the hon. Lady characterised the discussions in September, October and November is not quite right. We implored the BMA to come and talk; I personally had those discussions with leaders of the BMA, and they refused to do so. It was only when they came and talked to us that we made substantive progress.

The hon. Lady is right to raise these issues, and we wanted to discuss such matters with the BMA. One issue was protection against excess hours, but we had no counterparty with whom to negotiate. Since we have had that counterparty, we have made good moments of progress, and the result is the guardian position, which she welcomed in another place. The guardian will be able to levy fines, and those fines will be remitted to the guardian. I hope—and indeed expect—that process to reduce the excess hours that we still see in a small minority of positions. We must get away from the perverse incentives for trusts and a small minority of doctors that mean that unsafe working hours are perpetuated.

Of course we all regret the course that this dispute has taken, but it would not have done so had the BMA taken a responsible position from the beginning. If people lie to their members and say that they will have their pay cut and their hours raised, of course doctors will be angry—all of us would be. The fact is that that was never true, but it has inflamed the situation. We could have had the kind of productive talks that we have had over the past three or four weeks back in August, September and October had we not had all the mess beforehand because of untruthful statements issued by the BMA.

NHS Trusts: Finances

Debate between Ben Gummer and Philippa Whitford

Monday 1st February 2016 Commons Chamber

[Ben Gummer]

My hon. Friend will be aware of the increase in the better care fund that this Government have introduced and the 2% precept on council tax bills that will deliver increases for social care. She will also be aware that “Five Year Forward View” is a holistic understanding of the healthcare system that includes transformation of the NHS and social care towards that point. That is why we are proud to fund “Five Year Forward View” in the manner that Simon Stevens requested —front-loaded, with £3.8 billion in the next year. The manner of that bottom-up integration over the next few years will ensure that the challenge around social care that my hon. Friend identifies will be addressed in years to come.

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

With almost 80% of trusts running a deficit, I am not sure that we can say that it is just failing hospitals that are having problems. The Government talk about giving £10 billion upfront, but £2.2 billion of that is already written off in the deficit, and usually budgets are ascribed across the Department of Health, whereas Public Health England and Health Education England are losing money. With the £3 billion that is being clawed back from the areas that are not specifically under NHS England, it is actually £4.5 billion, not £8 billion, that is being put in. “Five Year Forward View” identified public health and prevention as crucial. The Government have a plan to recruit 5,000 extra GPs, but I am not sure how that can be done without Health Education England. The one thing that has so far been shown in evidence to impact on unnecessary deaths is a good, strong ratio of registered nurses to patients, so it is important that we look at how that will be funded. If trusts are not allowed agency or immigrant nurses, how are they going to do this? Why do we not get the National Institute for Health and Care Excellence to finish the piece of work on safe nursing levels throughout hospitals?

[Ben Gummer]

I thank the hon. Lady, who asked some salient questions that I will address. She asked about the deficits across the system. It is true that there are some particularly challenged providers where the heaviest deficits fall, and they account for the larger part of the accumulated deficit, but it has been a very challenging time across the system, not only because of the demographic challenges facing the NHS that have got worse in every year of this and the previous Parliaments, but because of the effect of the excessive charges of agencies levied after the increase in staffing levels in the wake of Mid Staffs. To seek to address that area, which makes up the majority of the cost of the deficit, we have brought in the controls not only on agency spend—on locums—but on very high salaries and on consultancy spend. Taken together, that will make a significant difference to hospital trust finances.

The hon. Lady talked about public health. We accept that that is a very important part of achieving “Five Year Forward View”. That is why, over the course of this Parliament, we will invest £16 billion in public health across England, to ensure that we can achieve the kind of transformation that she wishes to see.

On GP recruitment, we intend to have 5,000 additional GPs by the end of this Parliament. I am glad to say that Health Education England is so far meeting its targets in filling those training places. I congratulate its chief executive, Professor Ian Cumming, on the work he has done in that regard.

The hon. Lady mentioned safe staffing and the NICE guidelines. During the process of NICE looking at safe staffing levels, it became clear, as the chief nurse identified, that we need to look more broadly at team staffing levels, not just at individual positions on wards. I think that the hon. Lady in particular will understand that. That is why the chief nurse and Dr Mike Durkin were commissioned together to look at and build on the advice of NICE. The safe staffing guidance, which will be released in the next few months, will show a broader and more complex understanding of staffing levels, which I know the hon. Lady will appreciate from her time on the wards.

I want to be clear that that staffing guidance will be signed off only once it has the approval of NICE, Professor Sir Mike Richards, the Care Quality Commission and Dr Mike Durkin, the head of safety and quality at NHS England. It will require their imprimatur.

Hand Hygiene: NHS

Debate between Ben Gummer and Philippa Whitford

Wednesday 13th January 2016 Westminster Hall

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

I thank my hon. Friend the Member for Amber Valley (Nigel Mills) for bringing this important matter to the notice of the House, and I thank hon. Members on both sides of the Chamber for their speeches and contributions.

Hand-washing is an interesting thing, is it not? For the majority of human history, from Pontius Pilate to Lady Macbeth, it was associated with a bad act. Hand-washing was what someone did after they had done something wrong. It was only through the transformation in clinical knowledge in the 19th century that the understanding of hand-washing and its criticality in reducing infection rates became commonplace, but it was a long fight. It is worth remembering that Ignaz Semmelweis, the man who made people understand that washing their hands in obstetric and maternity settings reduced the risk of infection, was so criticised by his colleagues that it drove him to insanity, and eventually to death in an asylum. This was a hard-won victory, and I utterly endorse the wise comments made by the hon. Member for Central Ayrshire (Dr Whitford): perhaps it is because it has become such a commonplace part of our modern understanding of hygiene that we have forgotten its central importance in reducing infection.

My hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) came to the Department of Health a few months ago and sat in on one of the Secretary of State’s Monday morning care meetings to discuss her Handz campaign and the fact that she wanted to set up an all-party parliamentary group on hand hygiene. I know that her personal testimony brought acuity to our understanding of why this is important. It is all too easy to see MRSA, E. coli and C. diff rates plotted on a chart and to forget that, actually, the result of those infections can lead to the tragic and completely unnecessary loss of life. However, even if it does not lead to that, it can often mean a very extended stay in hospital, with serious injury sometimes incurred as a result of infection.

The overall story of infection caused by poor hand-washing has been good over the last decade. Rates of MRSA, MSSA, C. diff and E. coli have all come down— very considerably in some circumstances—but, as the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), rightly noted, we have plateaued in almost all of those, and worryingly so. In fact, in the case of MRSA, there has been a worrying, albeit slight, increase in rates in hospitals. That has now been consistent enough to constitute a trend.

We have to be clear that, from the Government’s perspective, we are still not entirely sure in each case why the reductions have not continued. To some extent, it is clear that an increasing role is played by community infection and community onset, or expression, of infection. We do not yet have a full understanding of the relationship between community settings and hospitals, and the chief medical officer is working very hard to try and understand it. Therefore, this is a pressing moment, not least because of the problems of antimicrobial resistance, which the hon. Member for Central Ayrshire mentioned, and which is why we have to be particularly vigilant.

Overall, the one thing that will guarantee that we do not make more progress is if I make a central directive from Richmond House and then ensure compliance through a massive, bureaucratic reporting mechanism. The only point on which I differed from anyone in their observations was when the shadow Minister, in his generally very wise comments, talked about the relationship to staff retention. That was because, although general infection control should be part of how teams work, it should be part of the personal, professional responsibility of a clinician, no matter where they work—whether in the community or between hospitals as a bank nurse or clinician—to take infection control very seriously.

How do we improve matters? How do we make sure that, as in so much of the NHS—to copy Bevan’s words, which I do not tire of using—we are “universalising the best” and lifting poor performers, of which there are several, up to the best standards in the country, some of which can be found with our neighbours in Scotland?

[Dr Philippa Whitford]

I have not worked in a hospital in England, but the poster campaign that the hon. Member for Morley and Outwood (Andrea Jenkyns) referred to involved massive posters that were in the lifts and targeted at visitors, porters, nurses and doctors. The five points of contact were above every sink and in every room. If we are trying to change a culture, I wonder whether the first thing is actually just to try to get the campaign out there among staff and visitors.

[Ben Gummer]

I take the hon. Lady’s point, and I agree that we have to re-educate the public that we have not won the battle and that we have to re-engage. I will take her comments to the chief medical officer and talk to her about what more we can do to re-engage the public in the debate on hospital-acquired infections.

NHS Bursary

Debate between Ben Gummer and Philippa Whitford

Monday 11th January 2016 Westminster Hall

[Ben Gummer]

The numbers do relate to full-time students. I concede that, in the case of part-time students, there have been, for a longer period than the time since 2011, problems in maintaining a rise consistent with that across the population. The Chancellor has accepted that fact, which is why he devoted specific attention and funds in the spending review to supporting part-time mature students. However, in this case we are talking about a nursing degree that is, for the vast majority, a full-time one. For the majority of nurses—I believe the figures are not quite those given by the hon. Member for Central Ayrshire, although I do not have them to hand—their degree is a normal undergraduate degree, taken before maturity. For all those people, I want the same benefits that have been provided across the rest of the university sector. The hon. Member for Sheffield Central was a Member in the previous Parliament, as was the hon. Member for Lewisham East, and they made exactly the same claims then as they do now about a reduction in opportunity, a reduction in number of applicants and a reduction in all the areas where we want universities to perform. I am afraid they have been proved wrong and the Government have been proved right, and that is why it is important that we extend those benefits to nursing.

I will address in terms the process by which we have come to this decision, about which the hon. Member for Ilford North raised some detailed questions, and our intention for the wider reform of training routes into nursing. It is important that hon. Members should see the changes that we are making to university training as part of a wider reform enabling us to increase both numbers and the quality of courses, as well as improving the student experience for nurses entering nurse registration by whatever route. The policy has been worked through in considerable detail in the Department of Health. There has been consultation with leading nursing professionals. The Department of Health is advised by a number of chief nurses. All were consulted and involved in working up policy in this area, which is entirely how it should be.

We have been very open about the fact that we want a full and detailed consultation about how the proposals should be implemented. We want that to be thorough and to involve everyone, whether they oppose or are in favour of the changes, so that we get the detail right. While I will maintain that the overall policy direction is correct for the reasons I have given, it is important to make sure we implement the detail correctly. If we do not get it right, it could have a perverse impact. If we do, this could be an important moment for the nursing profession, because we will be able to do something that previous Governments have not been able to do. Even in the wildest spending realms of the imaginations of some colleagues of the hon. Member for Lewisham East, it would not be possible to commit the resources to expand the training places that the route we have decided on will make possible.

The Opposition must answer a central point when they set out their opposition to the proposal. The fact is that we want to give more training places to people who want to become nurses. Last year, there were 57,000 applicants for 20,000 places. We want to expand the number of places so that people get the chance to become a nurse, but within the current spending envelope—even if we were to increase it more significantly than we propose to over the next five years, and certainly far more significantly than the Opposition propose—it is not possible to do that.

[Dr Whitford]

Does the Minister not accept, on the basis of invest to save, that if agency nurses are costing the NHS £2 billion, such an investment in future nursing would, in actual fact, save money in the long term?

[Ben Gummer]

I agree with the hon. Lady that one key thing we have to do is ensure we have a permanent workforce and do not depend across the service on agency and locum nurses and doctors. However, part of that is ensuring we have the workforce numbers trained to be able to fill places. In the past, we have failed to predict workforce numbers with any accuracy, which is something all Governments are guilty of.

No matter what happened to training places, the changes required across the service because of the impact of Mid Staffs on our understanding of safe staffing ratios has meant an increase in the requirement for nurses. At the moment, in the very short term, that requirement has to be plugged by agency and locum nurses, but we want to replace them with a full-time permanent staff that is sustainable. I hope the Opposition are able to bring an alternative view—I would be interested to hear it—but if we are to increase the number of training places, we have, simply put, to be able to afford to do so. The surest way of expanding places is to repeat exactly what we did for all other university degrees back in 2011, which has seen a massive expansion in training places.

The other point that the hon. Member for Lewisham East and her colleagues must address if they wish to oppose this reform is how they would afford not only the expansion in training places, but the maintenance support for nurses going through training. I completely agree with the hon. Member for Central Ayrshire and my hon. Friend the Member for Lewes (Maria Caulfield): the current bursary funding is not generous. It is certainly not sufficient for many, especially those with caring duties, to maintain themselves, but how can we find the increase while ensuring we expand places at the same time?

Through reforming bursaries, we are ensuring that we can increase the cash amount by 25%—something that, again, could not be funded out of the existing envelope, even though we are increasing NHS spending more than any other major party promised at the last election. We are therefore able to provide the support that people going through nurse training are rightly asking for.

--- Later in debate ---

[Ben Gummer]

I will write to the hon. Lady with year-by-year figures, where available—pass rates change every year. The nursing training course is one of the most over-subscribed of all undergraduate courses. Compared with other undergraduate courses, whatever metric we use, it is a significantly over-subscribed course. We know that a significant number will not receive a place on a course, even though they have met the criteria.

[Dr Whitford]

If the cap is completely removed, the Government will lose any ability to plan a workforce for the future. If all 47,000 applicants are given a place, what will happen when they come out at the other end? There will not be the placements to train them, and there will certainly not be the jobs. Is this just a way of having a flood of cannon fodder nurses, so that their pay can be frozen?

[Ben Gummer]

The hon. Lady mentioned in her speech, as did the hon. Member for Ilford North, the need by some trusts to recruit from abroad and to use locum and agency nurses. I hope she will understand therefore the internal logic of our argument: even at the moment, we are not able to fill places from the domestic supply of nursing graduates. It is precisely our wish to expand that supply. Planning the workforce will, in large part, be controlled through the placements that Health Education England buys from universities on behalf of the taxpayer and the NHS.

Several hon. Members raised the issue of clinical placements, on which we are now in deep discussions with Universities UK. The hon. Member for Ilford North raised that issue, as did my hon. Friend the Member for Lewes. I urge them both to look at the example of the University of Central Lancashire, and its relationship with Central Manchester University Hospitals NHS Foundation Trust and Bolton NHS Foundation Trust. They are delivering innovative and exciting ways of providing new placements outside the scope of the existing placement scheme, even without any Government support or change in the rules.

There is an appetite for delivering additional clinical placements, and we will see how that progresses in our discussions with Universities UK. All the while, it is important to point out that the Nursing and Midwifery Council has to register nurses at the end and ensure that the degrees are satisfactory. All of this will have to abide by the NMC’s recommendation that the placements are up to scratch, so we are constrained, quite rightly, in anything we might want to do by what it decides in that regard.

[Ben Gummer]

In the course of taking interventions, I am skipping around the points that hon. Members have raised, which I want to address. The hon. Lady is right that the University of Central Lancashire has worked up a really good course, which is partly about job security at the end of it. It is exactly the kind of scheme we are looking at to improve attrition rates, which were another point that my hon. Friend the Member for Lewes raised. We have to do better to help nurses complete their courses, and again, that metric has improved across the rest of the university sector since 2012. I hope that in freeing up nurse training a little through our reforms, we will be able to provide better incentives for foundation trusts and NHS trusts to have an end-to-end training offer for student nurses—if not modelling the one that the University of Central Lancashire has brought in, then a variant on it.

There is a lot of exciting thinking out there in universities, foundation trusts and NHS trusts about how we can implement the reforms to make nurse training better, expand the number of places and solve their workforce problems. My job is to release that thinking. I cannot do it within the straitjacket of the existing system, but I can through the reforms I am able to make.

[Dr Whitford]

Is the pilot in Lancashire that has been described not an argument for better manpower and workforce planning, rather than for simply throwing things open to the winds, which is what is proposed?

[Ben Gummer]

I was merely making the point that there is a lot of exciting thinking out there, outside the workforce planning that we are doing. Through our reforms, I hope to be able to encourage more of that. I know that there is some very innovative thinking in my part of the country. People want to get on with it in the NHS and university sectors, but at the moment they cannot, because of the constraints on how nurses are trained and recruited.

I turn to the issues raised by my hon. Friend the Member for Sutton and Cheam, who introduced the debate on the petition. He asked four specific questions. One was on specialist courses, and the shadow Minister repeated that point. Some specialist courses have suffered shortages for many years. For several years, the Higher Education Funding Council for England has been dealing with the wider attribution of training funds and university tuition funds across the sector, and it will take on responsibility for making sure that very small and specialist courses are properly funded and promoted. In liberating the universities sector a little, I hope that we will be able to excite interest in some of the more specialist courses, which have been suffering for several years, and better match foundation trusts’ workforce requirements with universities’ ability to deliver.

My hon. Friend asked whether foundation trusts will be able to pay back loans as an inducement. I do not know whether that will be possible for foundation trusts specifically, but they are free to offer pay premiums to aid their recruitment—they have been able to do so for many years. I imagine that will continue.

My hon. Friend asked about the number of placements and the financing of them. That will be determined by the consultation and in discussions with Universities UK. He also asked about the arrangement for placement expenses, and I have heard his point. I know it is a unique problem that is specific to student nurses—although to some extent, it also applies to student teachers—and again, we want to look at that in detail in the consultation to ensure that we get the implementation right. That is why it is not just a matter of pure detail; it is about how the policy works as implemented.

The hon. Member for Ilford North raised a number of points in addition to the ones he raised in his Adjournment debate. I apologise for not having answered all of them previously; I had a short time and he raised a huge number, with his usual eloquence. However, I hope I can answer some of his specific points on this occasion.

The hon. Gentleman asked about the problems of recruiting into community-based settings. There is a shortage in that specialty, which has traditionally suffered from problems in recruiting. I am well aware, just as he is, of the need to improve recruitment into community settings and primary care settings if we are to get the proper integration of primary and secondary care, and more importantly, of social care and the NHS. That is one of the key challenges facing us in the years ahead. Health Education England has a scheme under way called “Transforming nursing for community and primary care”, which it launched just over a year ago, precisely to incentivise nursing applicants into that specialty. Again, I hope that universities will respond positively, as they have in the case of other courses, so that they step up to the workforce demands placed on them as a result of the reforms that we are making.

The hon. Gentleman asked what the amount of debt to be written off was. The long-term loan subsidy—he will understand the phraseology—remains at 30%. That is the figure that the Treasury has set. As a consequence of that and because of, as he put it, reliable reports from newspapers, which he imputed to be fact, he asked whether there would be an increase in student fees above inflation. I can say to him that there are no plans at all to increase student tuition fees above inflation.

The hon. Gentleman asked whether I would be willing to meet those who disagree with my point of view and that of the Government on this matter. I would, of course, and I have done already. I would be delighted to meet anyone whom he wishes to bring to me, including the demonstrators he mentioned.

The hon. Gentleman began his speech, however, by talking about a burden of debt. It is important for all of us here to remember that the loan is an attachment against earnings, which is time-limited and limited according to the ability to earn, so it is not like debt such as a mortgage. We made the same argument back in 2011 and 2012, and it is important that we use language correctly in this place. We saw an uptake in university courses after the 2012 reforms. Once prospective students understood how the financing worked, how they would pay back the tuition fees and that it was not a debt that would saddle them in the same way that a mortgage or hire purchase agreement might, as was suggested at the time, university applications increased significantly. We all have an interest in this place in making sure that the number of people going into nursing increases. It is important, therefore, that even if we disagree with the policy, we do not misrepresent it.

NHS: Financial Performance

Debate between Ben Gummer and Philippa Whitford

Monday 12th October 2015 Commons Chamber

[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.

NHS (Contracts and Conditions)

Debate between Ben Gummer and Philippa Whitford

Monday 14th September 2015 Westminster Hall

[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.

Contaminated Blood

Debate between Ben Gummer and Philippa Whitford

Monday 20th July 2015 Commons Chamber

[Ben Gummer]

My hon. Friend is entirely right to say there are some exciting medicinal prospects on the horizon. The demands, especially on those for hepatitis C, have to be seen in the round of all sufferers of hepatitis C, but this is an additional factor to be played in. We hope the particular group affected by hepatitis C will be considered by NHS England as part of its discussions on how to take forward future cures.

Penrose reported just before the election. There is an enormous amount of work going on in the Department at the moment, and this is a priority for the Department. We know we need to move quickly. I want to reassure my hon. Friend ‘s constituents that we want to have this matter settled before the end of the year.

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

The problem of contaminated blood products was an international one, but Penrose was a Scotland-only inquiry. It could not compel witnesses from elsewhere in the UK and that needs to be borne in mind. The victims and their families are key. Many families were infected because patients were not warned, and families have been bereaved. What consultation has there been with the Scottish Government, who held the inquiry and apologised on the same day, about this apparent delay? How much of the £25 million will be spent? We must ensure access to treatment, whether that is the new antivirals or transplants. We hurt these people; we must not let them down.

[Ben Gummer]

I thank the hon. Lady. It is a good example of the new mode of working between our Governments that officials in the Department of Health have been working very closely with their counterparts in the Scottish Government. Of course, most of the events that the Penrose report refers to were pre-devolution. It is therefore entirely right that the recommendation is adopted across the United Kingdom, not just in Scotland. I expect that cross and close working will continue through the course of the settlement process.

NHS Success Regime

Debate between Ben Gummer and Philippa Whitford

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

My right hon. Friend will be aware of the hospitals in Essex that have been placed in special measures. He will also be aware that focusing on one or several particular institutions is not sufficient to sort out the problems in the wider local health economy. That is why the success regime is being brought in—to try and deal with those systemic issues. Once the success regime has been concluded, I hope that his constituents will rapidly see an improvement in the service that they receive and that they deserve, wherever they are in the county.

On his second point about funding per head, he will know that NHS England has already started to look at that and, in some instances, address it. I have the same problem in my constituency in Suffolk, and it needs sorting out in the medium term across the country.

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

The Minister talks about consulting commissioning groups locally, but why is he not willing to listen to groups of doctors across the country who talk about the point I made on Tuesday—fragmentation? We need integration. Local authorities are having their budget taken away, which means cuts to social care. Social care companies are one thread away from bankruptcy. We need to fund both sides of that, yet we are running round looking at structure. We need to move and look at outcomes. I have heard the Minister talk about “Five Year Forward View”. In Scotland we are already doing that as part of 2020 Vision: look at the patients, as the Minister says.

[Ben Gummer]

I take this opportunity to congratulate the hon. Lady on her entry into the House and on her maiden speech, which I enjoyed listening to in the Queen’s Speech debate. In England we are addressing the issues surrounding social care and its integration with the health service. That is why we have introduced the £5 billion better care fund. Under the success regime, far from looking at structure, we are trying to see how we can better link up services. That is why local councils will be a key partner at the table in the discussions.