Covid-19

Bernard Jenkin Excerpts

Tuesday 1st September 2020 Commons Chamber

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I thank the Secretary of State for the written ministerial statement he published after my last question to him in July. May I ask a bit more about the National Institute for Health Protection? Who was consulted before the decision was made? What is the legal basis for its present operation? Does it require legislation? What kind of public body is it intended to be: a non-ministerial department, an executive agency or a part of the Department of Health and Social Care? How will it be funded? When will there be a proper White Paper or Green Paper on the subject? Will the political appointee put in as interim head be replaced by a properly appointed public appointments-approved person? I could go on—there are plenty of unanswered questions.

[Matt Hancock]

I counted eight questions. Let me try to answer them. The National Institute for Health Protection does not require a legal basis; these PHE duties were not done on a legal basis. It will take on some UK-wide responsibilities, but also have responsibilities for England only. It is funded from the Department of Health and Social Care. It will be an executive agency of the Department. There is a global search under way for long-term, permanent leadership. As I said in response to the previous question, it will bring together the leadership of several different parts of the response. It was imperative, as far as I could see, to try to make sure we have that single unified leadership for the next stage of our response to the crisis. I pay tribute to the work of Public Health England. It has done an enormous amount, especially through its scientific work, which has truly been among the best in the world and has helped us to respond as well as we possibly could. I think that the new National Institute for Health Protection, established on the basis that I have set out, will make sure that we are constantly learning to have the best response, in terms of both the science and the scale, and to deliver for this country.

Covid-19 Update

Bernard Jenkin Excerpts

Thursday 16th July 2020 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

Before turning to Leicester, will the Secretary of State update the House and comment on Sir Patrick Vallance’s remarks at the Science and Technology Committee, where he said that SAGE had advised the Government to implement lockdown measures as soon as possible on 16 March? Why did it take a further seven days for the Government to implement lockdown if SAGE was advising to do so on 16 March?

I start by putting on record my thanks to the city council and all the health officials, particularly our director of public health, Ivan Browne, for all the work they are doing to drive our infection rates down in Leicester. I welcome the extra testing capacity we have received as a city, including the door-to-door testing, and I put on record my tribute to the people of Leicester, the city where I live, for their fortitude in doing all they can to drive this infection down through 17 weeks of lockdown.

If we still have to make further personal sacrifice to keep people safe and hunt this virus down with the lockdown, so be it, but there is no question but that there will be a degree of dismay across the city in response to the Secretary of State’s remarks. We welcome the opening of non-essential retail, but many businesses were preparing to open their doors for the beginning of July and still cannot open their doors, and they will want to know whether they will get any specific extra business support. The Secretary of State suggested in a previous statement that they would, but the Under-Secretary of State for Business, Energy and Industrial Strategy, the hon. Member for Stratford-on-Avon (Nadhim Zahawi) ruled it out.

The continued lockdown coincides with the traditional Leicester fortnight. I do not know whether the Secretary of State is familiar with the Leicester fortnight. It is the two weeks in July where our schools break up earlier than other schools across the country. It is a time when many Leicester families will have booked holidays, but they cannot go on holiday because they are not allowed to, and many travel companies are refusing to pay them compensation. Will he guarantee that families will not be out of pocket because they are not allowed to go on a holiday they have saved up for all year round? Will the Government step in, or can he force those travel companies to reimburse those Leicester families?

As the Secretary of State knows, Leicester is a city that suffers from high levels of child poverty, insecure work, low pay and a lack of decent sick pay. We have many deep-rooted economic problems and the spike or larger outbreak in the city appears to coincide with the inner-city areas where we know there are high levels of deprivation and overcrowding. We also have a large ethnic minority community, so will he explain why he has not yet implemented the recommendations of the Public Health England report on protecting those from minority ethnic backgrounds?

There has been widespread speculation about the garment industry. Can the Secretary of State tell us how many inspections by the Health and Safety Executive and Her Majesty's Revenue and Customs have now taken place in Leicester’s textile factories, particularly since the Home Secretary a couple of weeks ago promised us that she would stamp out any illegal exploitation?

We note that the Secretary of State has rejected the advice of the city mayor of Leicester to partially ease restrictions in parts of the city, although he has taken advice from the leader of Leicestershire County Council to ease restrictions in part of the county. Can he explain what the public health evidence is behind that decision? If the public health advice is to maintain, for example, the lockdown in the west of the city, when we know that the infection rates are at their highest in the east of the city, why does not that advice also apply to the neighbourhoods that border the city boundaries? This is one greater urban area. What is the public health reason why someone living on one side of Gilmortin Avenue—I do not expect him to know Gilmorton Avenue in my constituency, but it illustrates the point—is subject to restrictions because they fall under Leicester City Council, but they are not allowed to cross the road to speak to their neighbour, who lives opposite them, because they fall under Blaby District Council? There are other examples across the city as well. If he could offer us that advice, we would appreciate it.

Leicester went into lockdown because of the infection rate and because it took so long to get us the specific data. Local authorities are still complaining that they are not getting patient identifiable data, they are not getting data on a daily basis and they are not getting contact tracing data. Yesterday, at Prime Minister’s questions, the Prime Minister said that we have a world-leading system—the best system in the world—for testing and tracing and it will avoid a second spike this winter, but we know that there have been problems with testing and tracing throughout. Last week, Sky News revealed that he has been overstating the test numbers by 200,000. Today, the Health Secretary has come to the House—we are grateful to him for updating the House—to explain what is happening with Randox. I believe that the £133 million contract was given to Randox without any competitive tender. Can he explain what is exactly wrong with these kits? How many of these presumably faulty kits have been used? Is there a health risk to anyone who has been tested with these kits?

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

He said there wasn’t.

[Jonathan Ashworth]

The hon. Gentleman says from a sedentary position that there is not a health risk, but the Government are withdrawing these kits. And how many people have these unsafe kits been used on and why were the certifications not checked before these kits were used? These kits tend to be used in many care homes. We want care home residents to be tested regularly. We want care home staff to be tested regularly. Can the Secretary of State guarantee that those care homes will now get alternative kits rapidly?

Today we have seen more testing data come out. The Prime Minister promised that tests would be delivered within 24 hours by the end of June. I think the figures today show that only 66.9% of them are. On the tracing data, we see that only 71% of people are being contacted, not the 80% that we were promised. Is not it the truth that we now have swabs being recalled, contact tracing not meeting the targets and Serco call centres with people not doing anything? It is all costing £10 billion and the Health Secretary is now bringing in McKinsey. Why is he throwing good money after bad? Why does he not invest in public health services, primary care and local health teams instead to do this testing?

--- Later in debate ---

[Matt Hancock]

Absolutely. Our approach is that the vaccines developed in the UK—supported by UK Government and, ultimately, UK taxpayers’ money—are of course there, should they come off, to provide protection to the UK population, but so too to the population around the world. We are using our official development assistance money to help ensure that there is broad global access, should they work. On the question about cyber-security and potential hacking, the hon. Member will understand why I cannot go into the full details, but I can reassure him that the National Cyber Security Centre is taking this very seriously.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

May I return to the question of public confidence? I thank my right hon. Friend for the tireless way that he submits himself to scrutiny by parliamentarians and the press, but will he accept that the public do want to understand more clearly what mistakes were made and what lessons have been learned? Can I perhaps invite him at least to table a written ministerial statement, before the rising of the House next week, that sets out the key lessons learned and how they are being implemented as we go into the autumn, which could be another very testing time for our country?

[Matt Hancock]

I am very happy to do that—I would not deny the Chair of the Liaison Committee his wishes on that—and I am very much looking forward to appearing before the Science and Technology Committee next week to answer any questions it might have.

Covid-19

Bernard Jenkin Excerpts

Monday 16th March 2020 Commons Chamber

[Matt Hancock]

My hon. Friend the Economic Secretary to the Treasury tells me that undoubtedly the devolved nations will very rapidly get the information they need. After all, this is a UK-wide effort.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

Will my right hon. Friend join me in thanking the thousands of local community groups that are already mobilising in order to deal with what may be a very serious situation in their communities, involving looking after vulnerable people and even nursing the sick? Will he, with the Prime Minister and others, make sure that we mobilise these people and empower them to take decisions without having to wait for instructions?

NHS Funding Bill

Bernard Jenkin Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Matt Hancock]

We absolutely will be looking at doing that where we can. Unfortunately, that is difficult to do, because, over time, and especially during the time that the hon. Member for Leicester South was in the Treasury, the legals on these PFI deals got tighter and tighter. There are 106 PFI deals in hospitals and we are going through them. We will work towards making them work better for patients, and if that means coming out of them completely, I will be thrilled.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

My right hon. Friend might know that I am a vice-president of Combat Stress, the charity for the mental welfare of our armed servicemen and veterans. Until recently it had a very tiny contract compared to the vast sums he has just announced—£3.1 million a year—and was treating some 250 patients a year with PTSD and other mental illnesses related to combat stress. Combat Stress is now having to discontinue taking referrals because the contract has come to an end. What prospect is there that there will be a new contract as soon as possible so Combat Stress can carry on its brilliant work?

[Matt Hancock]

I am very glad that my hon. Friend has raised this matter, because I was concerned to read the reports in the newspapers and have had a briefing this morning. There is work on a new contract to replace the old one, and I very much hope that that is settled and agreed as soon as possible.

The National Health Service

Bernard Jenkin Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Matt Hancock]

The hon. Gentleman is saying yes, which I am grateful for. I am open-minded to changes and improvements, and to listening to the experts and those with constituency cases that they can bring to bear, to make sure that the Bill is the best it possibly can be.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I hope very much to address the Health Service Safety Investigations Bill in my remarks later, but my right hon. Friend did not include one important element among the characteristics of the investigations, which is that they are to find the causes of clinical incidents without blame. It is not about satisfying a complaint; it is about finding without blame so that we can talk about things that have gone wrong without blaming people. It is about understanding the clinical, human factors that lead people to make perfectly understandable mistakes.

[Matt Hancock]

My hon. Friend is quite right. I was trying to shorten my speech, Madam Deputy Speaker, so I missed out a paragraph. I should have said that the purpose of the Bill is to enable staff to speak openly and honestly about errors without fear of blame or liability. That is exactly the point that my hon. Friend made and to which he paid an awful lot of attention in the drafting and prelegislative scrutiny of the Bill.

Finally, let me turn to the proposals on mental health. This country has been on a journey, over a generation, towards recognising that mental health is as important as physical health. There have been contributions to this change in mindset from all sides of the political debate—from Labour Members; especially from the right hon. Member for North Norfolk (Norman Lamb), to whom I pay tribute; and very much from Government Members, too.

I would like to take a moment to say how much I value the enormous contribution that the Duke and Duchess of Cambridge and the Duke and Duchess of Sussex have made to changing attitudes towards mental health on this journey. The Mental Health Act 1983 is nearly 40 years old and some of our law is still shaped by 19th century Acts and, indeed, their views of mental illness, and that is completely out of place in the 21st century.

The National Health Service

Bernard Jenkin Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I join the hon. Member for Totnes (Dr Wollaston) on that last point. We pay tribute to all those who are serving in the NHS and our emergency services. In particular, if I may, I pay tribute to those serving in North East Essex.

Recent years have seen a significant turnaround in the health service in my constituency. Colchester General Hospital was for years in some considerable difficulties, but it is now commanding the confidence of the Care Quality Commission. It has newly merged with Ipswich Hospital in the East Suffolk and North Essex NHS Foundation Trust. It exemplifies the importance of the inspirational and strong leadership that we have in Nick Hulme, who is the chief executive of that trust.

I also commend the strategic transformation plan, which was greeted with great suspicion when such plans were first talked about. It is looking strategically at things such as GP capacity—for example, we need a new surgery on Mersea island—and at providing more services locally, such as at the Fryatt Hospital in Harwich, where we are maintaining and developing the excellent minor injuries unit and developing local access to other satellite services that would otherwise have to be at Colchester General Hospital.

All this underlines the importance of leadership, and I do hope the Secretary of State and his Ministers will continue emphasising the importance of leadership and staff engagement. I have to say to the colleague who served with me on the Joint Committee, the hon. Member for Central Ayrshire (Dr Whitford), that all this is much harder to achieve in Essex on 40% less funding per head than is available to the NHS in Scotland.

I want to concentrate on the Health Service Safety Investigations Bill, which originates from a report that my Committee—the Public Administration and Constitutional Affairs Committee—produced in 2015. We were dealing with the aftermath of all the problems of Mid Staffordshire, with 80% of the complaints coming through from the Parliamentary and Health Service Ombudsman, in an atmosphere where we were asking how complaints could be better handled and how incidents could be better investigated.

People such as Martin Bromiley, whose wife died on the operating table in 2005 and who set up the Clinical Human Factors Group, inspired me, as did papers by people such as Carl Macrae and Charles Vincent—they published a paper in the Journal of the Royal Society of Medicine in 2014, called “Learning from failure: the need for independent safety investigation in healthcare”—and that led my Committee to establishing our inquiry.

In a context of the then Secretary of State telling us there were 12,000 avoidable hospital deaths, 10,000 serious incidents, 338 “never” incidents and 170,000 written complaints about healthcare in the NHS every year, and with the NHS Litigation Authority reporting a potential liability for clinical negligence of £26 billion—the figure today is much larger—we were determined to find a better way to investigate clinical incidents so that there could be learning and no blame. The fundamental conclusion we published was that there is

“a need for a new, permanent, simplified, functioning, trusted system for swift and effective local clinical incident investigation conducted by trained staff, so that facts and evidence are established early, without the need to find blame, and regardless of whether a complaint has been raised.”

With the Bill that the Government introduced in the House of Lords last week, we are now progressing towards legislation for a safe space, so that the conversations can happen, without fear of litigation, through a properly independent body that is not a regulator, is not part of the political apparatus and is not beholden to the spending and politics of the NHS, much like safety bodies in other industries such as the air accidents investigation branch.

The Joint Committee considered the legislation last week, and the Select Committee produced another report in August 2018, “Draft Health Service Safety Investigations Bill: A new capability for investigating patient safety incidents.” I look forward to its being one of the Government’s most important achievements when they set up this body under statutory authority.

NHS Long-Term Plan: Implementation

Bernard Jenkin Excerpts

Monday 1st July 2019 Commons Chamber

[Matt Hancock]

I completely agree with the hon. Gentleman. The whole plan—the whole NHS long-term plan—is about prevention as well as cure. The focus of the NHS needs to switch more towards prevention as well as, of course, helping people get better when they get ill. Taking the example of stroke, there is a lot on the prevention of stroke in the draft prevention Green Paper—just to give him a bit of a teaser for that. At the core of improving prevention of stroke is both behaviour change but also better use of data, because being able to spot people who have symptoms that are likely to lead to stroke can then help much more targeted interventions. I find it striking that with the big stroke charities, as with the big heart charities, their big ask is for better and more access to data.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

May I thank my right hon. Friend for his statement and his commitment to this implementation plan, alongside the commitment to increase clinical standards? That is not a criticism of the medical professions; it is just a determination to make sure that the NHS is an infinite learning organisation and can learn from its mistakes. In that respect, will he recommit to HSIB—the healthcare safety investigation branch of his Department—which is devoted to doing clinical investigations without finding blame, so that these problems can be surfaced and the learning can be implemented across the NHS? In particular, will he recommit to the legislation, which has been through prelegislative scrutiny and is still waiting to be introduced?

[Matt Hancock]

Yes, I am looking forward to that legislation being introduced. The work that my hon. Friend’s Select Committee—the Joint Committee on the Draft Health Service Safety Investigations Bill—did in the prelegislative scrutiny was incredibly important. The HSIB Bill promises to improve patient safety, which is an important part of the agenda, and I look forward to its being brought forward to the House.

Gosport Independent Panel: Publication of Report

Bernard Jenkin Excerpts

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

I am happy to do that. All the families who think they had a relative affected have been part of the panel process, and they were all invited for a briefing by Bishop Jones this morning in Portsmouth. We will provide ongoing support and counselling if necessary through the Department of Health and Social Care, which was a specific request of Bishop Jones. We are also conscious that when people read the news, they may suddenly decide that they or a loved one were affected by this. We have set up a helpline so that people can contact us and we can help them to trace whether they too have been affected.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

Does not every instance of people being scared to speak out and relatives finding it too difficult to complain underline the importance of the Healthcare Safety Investigation Branch, which the Secretary of State has established? I remind him that I am chairing the Joint Committee of both Houses that is carrying out prelegislative scrutiny of the draft Health Service Safety Investigations Bill. When we report on 24 July, will my right hon. Friend undertake to bring that into law as quickly as possible? That will afford the safe space that people need to report such matters without fear or favour.

[Mr Hunt]

Absolutely. I commend my hon. Friend for his work and for being one of the colleagues in this place who have thought and talked about the importance of getting the right safety culture in the NHS. The Healthcare Safety Investigation Branch matters because in situations such as this, it could have been called in, done a totally independent investigation, got to the truth of what was happening quickly and prevented a recurrence of the problem. That is one of a number of things that we need to think about.

Primary Care: North Essex

Bernard Jenkin Excerpts

Tuesday 14th March 2017 Westminster Hall

[Mr Carswell]

My hon. Friend, as so often, is absolutely spot on. His judgment is impeccable. The failure to provide people with the primary care they need when they need it means that more people then tend to go to A&E departments. The people who run the ambulance service tell me that that then causes a bottleneck in A&E, which has a knock-on effect on ambulance response times. Many of the problems we are grappling with are a consequence of the failure to provide accessible, customer-focused primary care where it is needed.

The consultation on the minor injuries unit and walk-in centre is irresponsible. I share the view that it would clearly be absurd to shut that facility. A lot of angst and worry could be addressed if the option was ruled out now, and I hope it is.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I am most grateful to the hon. Gentleman for inviting us to take part in his debate, and I commend him for securing it. We are now in the throes of the so-called sustainability and transformation plans, which are being constructed on the acknowledgment, confirmed by the Boston Consulting Group, that there has been underinvestment in primary care in Essex for 20 or 30 years. If the STPs are to address the demand on the primary care units and deal with the shortage of GP facilities, there has got to be a programme, supported by Ministers, of investment in primary care in Essex so that the GPs can do far more for their patients without sending them off to hospital.

[Mr Carswell]

The hon. Gentleman is absolutely spot on. This is a cumulative problem that has been allowed to get worse over decades—perhaps a generation or more. I am often struck by how some of the GP surgeries in my constituency are located in what started out as residential houses built in the 1930s. There has simply not been the investment that was needed over a long period of time. That is also part of the problem. To be fair to GPs, if we do not provide attractive surroundings and surgeries, people are not going to want to work in those 1930s houses. If anyone in the district council is listening, I urge them to take that into account when talking about new planning for the area. Some top-quality, first-rate surgeries in which GPs are happy to work would go some way to addressing the problem.

I am incredibly grateful to the Minister for coming along to respond, and to the hon. Members for Harwich and North Essex (Mr Jenkin) and for Colchester (Will Quince), who are committed to this issue and have done a lot of work for their constituents. I hope to hear from the Minister not only about how we can get more GPs in our area but about the reforms we need to change the way people obtain primary care, so that they are no longer supplicants standing in a queue to receive care on the system’s terms but valued patients who get the care they need when they need it.

--- Later in debate ---

[David Mowat]

My hon. Friend may be relieved to hear that Colchester general hospital is not in my portfolio, but I will speak to my ministerial colleagues about it being a pilot and write to him.

[Mr Jenkin]

A moment ago the Minister mentioned some extra money for primary care. Who is responsible for investing that money? Does it come from NHS England and not from the CCG? How do we influence how that money is spent, so that there is some accountability in the process?

[David Mowat]

All money goes into the health service through NHS England, which used to be called the NHS Commissioning Board. The money is then given to the CCGs around the country to spend. In terms of a funding formula and so on, there are some specific primary care initiatives, including infrastructure-based ones for new premises and things of that type, and specific ones, which I am about to talk about, such as recruiting more GPs. We absolutely need more GPs, not only in Essex but across the country, although we do need them in particular in parts of Essex. The responsibility for that lies with NHS England, through the CCG. It is the CCG that has the accountability—to answer the earlier question, “Who do we blame for this situation?”—and I want to make that quite clear.

As for what all that means, we have workforce issues in primary care, and the Government and NHS England are committed to having 5,000 more doctors working in primary care by 2020, which should mean more availability and vacant jobs in Clacton being filled. We are determined to meet that commitment with progress made this year, with more medical students going into GP training than has ever been the case before in the history of the NHS—just over 3,000 of them. The hon. Member for Clacton was right to talk about pharmacists, and we also need to make progress with them. We aim to have 2,000 pharmacists working in primary care by 2020, as well as 3,000 mental health therapists.

All of that matters, but in addition we have to allow people to work in a different way from how they have up to now, and some of that is happening across the CCG in Essex. Broadly speaking, however, we find that a GP hub of 30,000 to 40,000 patients enables more scale. That would let us employ physios, pharmacists, mental health therapists and, indeed, social workers—in terms of the relationship with hospitals and the transfer of patients—and to have longer opening hours. I therefore completely accept the hon. Gentleman’s points about working and being open on a Saturday. We are determined to achieve that by 2020, although we are starting from a difficult position in Essex, given the lack of GPs generally. Only by collaboration and working across practices will we make progress. The model of a single GP practice—and such practices still exist—is self-evidently not viable and does not allow us to do some of the things that we need to in primary care, such as employing pharmacists and other such disciplines.

Those are my general comments, but I completely agree that unless all that lands in Essex, it is just words. Judge and jury on it will be the extent to which we are successful in landing some of that stuff in Essex. To address the specific issues, I will now talk about a number of things that have gone on in the hon. Gentleman’s local CCG. Of the nine practices in Clacton, a number have been closed to new patients, as he said. I am informed that the East Lynne practice, the Ranworth practice and the St James practice all closed to new patients in 2015, but two of those are now completely opened. The other has temporarily closed again but is expected to reopen soon. On the statistic he cited at the start, my understanding is that only one practice in Clacton now has no immediate opening in its list. The CCG has worked hard on that.

There are clearly specific issues with getting people with a GP background to move into the area. The CCG has put in place a workforce plan to address matters of recruitment and retention of GPs principally, but also of pharmacists, nurses and allied health professionals. Again, the judging of that will be in something actually happening and the vacancies in Clacton being filled. The plan exists and is being managed, and I understand that the CCG expects to make progress with it.

The practices in the CCG have come together in three collaborative groups, covering about 80% of the total number of patients seen, although the patient who sees the same GPs from the same practice and goes to the same clinic might not realise that. GPs are working collaboratively in a way that should enable better leverage of their time—I return to that point made in connection with pharmacists. We have to get away from every patient’s principal contact in the primary care system having to be a GP, rather than other professionals who could help a great deal. For example, I was recently in a practice where a pharmacist was conducting a diabetes clinic. Diabetes clinics are routine, happening perhaps every month or so, with a set of standard questions to be asked, and there is absolutely no reason why they need to be conducted by a GP, as opposed to a pharmacist. That applies in Essex, too.

I draw the attention of hon. Members from Essex to a couple of grants lately given to practices in their area. A £46,000 resilience funding grant has gone to the Clacton GP Alliance and, in a specific effort, almost £400,000 of capital funding to three GP practices that are coming together I think in Clacton hospital. The CCG understands that the standard of premises and infrastructure in Clacton is generally weaker than in other parts of the country—certainly weaker than is needed to attract the sort of talent necessary.

I have a “jam tomorrow” point to make, but it is worth putting it on the record. There is a plan to have a medical school in Essex, in Chelmsford, I think in 2018. That will obviously help, because people who train as doctors in that part of Essex will be more likely to live there, enjoy living there and, in time, make their careers and lives there. We have found that to be so in other parts of the country; I hope it works for Essex.

In connection with the minor injuries and walk-in centres, I want to speak briefly about the consultation. Members have pointed out that it would be absolutely ridiculous if, by closing those centres or doing anything to affect patient flows, more patients were to go to Colchester hospital. That is self-evidently true, and the CCG believes so too. Interested Members will know that the consultation, which set out four options, has received more than 3,500 replies. In all fairness, I do not believe that the CCG was consulting in order to close; it was consulting because contracts were up, and it wanted to look at the options and how to do better. One view given to me was it was more confusing than it ought to be for patients to know where they ought to be.

I cannot say anything today about the outcome of the consultation, other than that the CCG board will consider the recommendations received in the 3,500 responses and the various other pressures that have been discussed today. Frankly, people in the CCG will also be listening to our debate today. I would be surprised if closure of the centres was top of the list, given the other pressures on GP practices, the hospital and so on. The decision will be made by the CCG at the board meeting on 30 May.

I will finish as I started, by saying that there is a problem with the number of GPs in Clacton and North Essex. The problem is understood and action is being taken that I hope does not all amount to “jam tomorrow”, to use the phrase of the hon. Member for Clacton. Although progress has been made in getting lists open and so on, clearly a lot more needs to be done. I am happy to continue to meet the hon. Gentleman in the months ahead if we are not making progress and getting things better.

Question put and agreed to.

Public Administration and Constitutional Affairs Committee

Bernard Jenkin Excerpts

Thursday 2nd February 2017 Commons Chamber

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I am grateful for the opportunity to present to the House the seventh report of PACAC this Session, “Will the NHS Never Learn?”, a follow-up to the Parliamentary and Health Service Ombudsman report on the NHS in England, “Learning from Mistakes”.

Over the past decade, written complaints regarding NHS services have doubled, from just over 95,000 in 2005-06 to more than 198,000 in 2015-16. Investigations into such complaints have frequently failed to identify the root causes of any mistakes that occurred. Even more frustrating is that they have failed to prevent the same mistakes from being repeated over and over again, despite multiple reports highlighting that as a critical issue from both the Parliamentary and Health Service Ombudsman and the Public Administration and Constitutional Affairs Committee, which I chair.

In its report “Learning from Mistakes”, which was published last year, the PHSO highlighted the fear of blame that is pervasive throughout the NHS. That fear drives defensive responses and inhibits open investigations, which in turn prevents NHS organisations from understanding what went wrong and why. That also undermines public trust and confidence, because the public can see that NHS organisations are failing to learn from mistakes—if they did, that would drive improvement. A combination of a reluctance on the part of citizens to express their concerns or to make complaints, and a defensiveness on the part of services to hear and address concerns, has been described by the PHSO herself, Dame Julie Mellor, as a “toxic cocktail” that is poisoning efforts to deliver excellent public services.

To further understand the issues and what more needs to be done to tackle them, PACAC recently undertook its inquiry, which followed up on the PHSO’s “Learning from Mistakes” report. In PACAC’s report, which was published earlier this week, we conclude that if the Department of Health is to achieve its policy of turning the NHS into a learning organisation, it must integrate its various initiatives to tackle the issue and come up with a long-term and co-ordinated strategy. That strategy must include a clear plan for building up local investigative capability, as the vast majority of investigations take place locally. We will hold the Secretary of State for Health accountable for delivering the plan.

PACAC’s report also considered the potential impact of the new healthcare safety investigation branch, which is in the process of being set up. The creation of HSIB, as it is known, originates from our recommendations as the Public Administration Committee in 2015. The Government accepted our recommendation, and HSIB is due to be launched in April. It will conduct investigations into the most serious clinical incidents, and is intended to offer a safe space to allow those involved in such incidents to speak openly and frankly about what happened. In so doing, it is hoped that HSIB will play a crucial role in transforming the expectation and culture in the NHS from one that is focused on blame to one that emphasises learning. It should be a key part, albeit only a part, of the wider strategy that we want the Government to adopt.

Unfortunately, there is still a long way to go if the Department of Health’s aim of turning the NHS into a learning organisation is to be achieved. Most importantly, HSIB is being asked to begin operations without the legislation necessary to secure its independence and ensure that the safe space for its investigations is indeed safe. That undermines the whole purpose of HSIB. It is essential that the Government introduce the necessary legislation as soon as possible.

To ensure that the learning produced from HSIB’s investigations leads to an improvement in standards, PACAC also reiterates its previous recommendations, made in our 2016 report, “PHSO review: Quality of NHS complaints investigations”, that the Government should stipulate in the HSIB legislation: first, that HSIB has the responsibility to set the national standards by which all clinical investigations are conducted; secondly, that local NHS providers are responsible for implementing those standards according to the serious incident framework; and, thirdly, that the Care Quality Commission should continue to be responsible, as the regulator, for assessing the quality of clinical investigations at local level according to those standards.

The purpose of complaints is not just the redress of grievances—which I must say is extremely unsatisfactory in the NHS anyway—although that is clearly important; complaints are a tool by which public services can learn and improve. When medical professionals are forced primarily to be concerned with avoiding liability and responsibility and are trapped in a culture of blame, there can be no learning. There is an acute need for the Government to follow through on their commitment to promote a culture in which staff feel able to speak out and in which the emphasis is placed on learning, not blame. I very much hope that they will implement PACAC’s recommendations as a step towards achieving that as soon as possible.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate my hon. Friend for his work, and that of his Committee, on producing the report. He is absolutely right about HSIB and the need to underpin it properly. The Government have said that they would cap litigation costs at £100,000. I think my hon. Friend would accept that there will always be litigation, even if we get a more satisfactory means of redressing grievance, in the way he has suggested. Does he think that that cap would be appropriate, particularly since motor costs, for example, are capped at that level? Would that mean that people with grievances would be properly compensated while, sadly, their lawyers would not be?

[Mr Jenkin]

I confess I am not sighted on the proposal to cap litigation costs, but people resort to litigation only because they feel that their complaints are not being heard and that the problems they have identified in the service are not being addressed. People resort to litigation because they do not feel they are being told the truth. We know from our surgeries that most people who complain come in and say, “I only want to make sure this doesn’t happen to somebody else. I don’t want compensation.” Nevertheless, because that public-spirited attitude to complaining is so often rebuffed in the health service, people resort to litigation because they feel there is a cover-up.

In other fields, such as aviation and marine investigations, where this kind of investigative process is already established and is designed to find the causes of accidents without blame, there is far less resort to litigation at the outset. That does not preclude litigation in the final analysis, but discovering the truth without blame is the first step towards reconciliation.

[Glyn Davies (Montgomeryshire) (Con)]

I, too, greatly welcome this report, as do my constituents. That may seem surprising to some of my colleagues, as, of course, my constituency is in Wales, but all my constituents use hospitals in England for elective care and specialist care, so this is as important to the people of Wales as it is to the people of England. I have also been involved in many of the complaints. Does the Chair of the Committee acknowledge that, in the debates that he has had and in any follow-up debate that he might have, the position of Welsh constituents is key, because, although they are in another Administration as far as health is concerned, they depend on hospitals in England for treatment?

[Mr Jenkin]

I am most grateful to my Welsh hon. Friend for his question. It gives me an opportunity to highlight not only my agreement with the point that he makes, but that this is just about healthcare safety investigations in England. By pursuing this policy to set up HSIB, the Government have embarked on a very, very major and significant reform, which the health services in Scotland, Wales and Northern Ireland are certainly watching. I can assure my hon. Friend that they are being watched all over the world. Different countries in different jurisdictions have tried using various bodies to deal with this question. I do not think that any country before England has embarked on a reform of this scale and nature that has the capacity to transform safety investigation in a health system. I very much hope that Wales, Scotland and Northern Ireland will either set up their own equivalent of HSIB, or employ HSIB as the pinnacle of their investigation system as well. This matter is not something that necessarily needs to be devolved any more than the Air Accidents Investigation Branch of the Department for Transport.

[Sir Peter Bottomley (Worthing West) (Con)]

Does the Chairman agree that each of us receives from our constituents many more golden letters about their treatment in the health service than letters of complaint? When there are complaints or questions, openness and responsiveness matter most, and most of our constituents are satisfied with that. HSIB will be for the pinnacle of the hardest cases, but most cases should be resolved locally by the GPs or the hospitals.

[Mr Jenkin]

I certainly agree that the vast majority of our constituents who experience the care of hospitals or GP practices are extremely grateful for the quality of care that they receive. However, we cannot underestimate how corrosive the blame culture has been throughout our health system. Crises such as those at Mid Staffordshire and at the Morecambe Bay maternity unit arise from the defensive culture that exists in the NHS. If we are to change that into a much more open and collaborative system of learning from mistakes, we need HSIB to set the tone throughout the entire organisation. It is not just about dealing with a few complaints, but about setting a whole new standard for a whole new profession in the NHS about how complaints and clinical incidents are investigated. I am most grateful to have the opportunity to present this report.

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

Labour welcomes this constructive report and thank all of those involved in producing it. It highlights some worrying statistics, including the fact that the most recent NHS staff survey found that 43% of staff thought that their organisations treat staff involved in near misses, errors and incidents fairly. Clearly, from the Chairman’s candid contribution today, there is a long way to go before we eradicate the culture of defensiveness that he has described. To give HSIB the strongest start, it was the clear view of the Committee, HSIB, the Expert Advisory Group, HSIB’s chief investigator and even the Minister himself that legislation is needed, but, as of today, no legislation has been forthcoming. Given that, does the Chair of the Committee agree that it might be better to delay implementation to allow time for legislation?

[Mr Jenkin]

I am most grateful to the hon. Gentleman for his question and for his support. I am also extremely grateful to my Committee for its work on this report.

I hesitate to lose the progress that we have made. We have approved the appointment of the chief investigator of HSIB, who spent 25 years as chief investigator of the Air Accidents Investigation Branch of the Department for Transport. He brings with him that wealth of experience and perspective about how this organisation should work. The answer is, as the hon. Gentleman suggests, for the Government to bring forward the legislation as quickly as possible. I know that efforts are being made in that direction, but perhaps the Minister will have something to tell us.

[The Minister of State, Department of Health (Mr Philip Dunne)]

I wish to add my thanks to my hon. Friend and members of the Committee for their considered report. He has succinctly described to the House what more needs to be done systematically to transform the way in which the NHS learns from errors to improve patient safety. We support the main thrust of the Committee’s recommendations and will offer a detailed response to the report in due course. Like the Committee, we put this matter right at the top of our agenda to change the culture within the NHS, of which he has spoken so eloquently today.

We are committed to making our hospitals and GP surgeries the safest in the world, supported by the NHS as the world’s largest learning organisation. The only way in which we will achieve that is through a learning rather than a blame culture characterised by openness, honesty and candour; listening to patients, families and staff; finding and facing the truth; and learning from errors and failures in care.

As my hon. Friend has indicated, the Government have accepted the recommendation of PACAC’s predecessor Committee to establish an independent healthcare safety investigation service. The Healthcare Safety Investigation Branch will be up and running from April. I join him in welcoming the appointment of Keith Conradi, the former chief inspector of the Air Accidents Investigation Branch, who has a strong track record of delivering high-quality investigations in aviation.

The hon. Gentleman’s Committee has again called for HSIB to be statutorily independent, and we agree that it should be as independent as possible if it is to discharge its functions fully and effectively, and we would not rule out the option of legislation. His Committee has also raised, in this week’s report, various suggestions for HSIB and its potential role in setting standards. We will be responding to that formally in due course.

We are committed to ensuring that the NHS becomes an organisation that learns from its mistakes. In response to the Care Quality Commission’s report, “Learning, Accountability and Candour”, from April this year all NHS trusts will be required to publish how many deaths they could have avoided had care been better, along with the lessons that they have learned.

Before I pose my question, I should like to thank the Committee for its response to the Government’s recent consultation, “Providing a Safe Space in Healthcare Safety Investigations”, and we will be responding to it shortly.

Improvements in safety, incident handling and learning in the NHS will not happen overnight, but does my hon. Friend agree that the shared programme of work demonstrates a commitment, across the care system, to improve the way in which all serious patient safety incidents are viewed and treated, and is that not a crucial foundation for lasting change?

[Mr Jenkin]

I am most grateful to the Minister for his question and for the fact that he has personally appeared at the Dispatch Box today with his opposite number from Her Majesty’s Official Opposition. I know that his presence here underlines the commitment of the Secretary of State to this programme of change.

I very much welcome the shared programme of work to which my hon. Friend refers, but, in taking evidence for this particular report, we found that there was some dislocation between the various bodies involved in it. We conclude that it is only Ministers, and probably only the Secretary of State, who can draw this together to ensure that there is a coherent strategy and a plan, which is what we emphasise in this report.

Finally, my hon. Friend refers to legislation in passing, but I hope that valiant efforts are being made in that regard. Perhaps something can be included in Her Majesty’s Loyal Address later this year. I must point out that it is not just about statutorily underpinning the independence of HSIB, but the safe space to which he refers and on which he thanks the Committee for its contribution. The safe space has to be legislated for. Without legislation, there is no safe space. The AAIB, the Marine Accident Investigation Branch of the Department for Transport and equivalent bodies could not possibly function unless they can provide people with protection, so that those people can come and talk openly and off the record about what has happened. That has transformed the safety culture in other areas, and it is the transformation that we need in the health service. I leave with the Minister the word “legislation” echoing in his ears, and I very much look forward to making further progress with him on these matters.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The House is grateful to the Chair of the Public Administration and Constitutional Affairs Committee for bringing his report before the House this afternoon and for taking questions.