Accident and Emergency Waiting Times

Bill Esterson Excerpts

Wednesday 5th June 2013 Commons Chamber

[Mr Hunt]

I will make some progress and then give way. I want to ask why the Opposition have chosen to call this debate. I am afraid it is nothing less than a smokescreen, because their objective is to try to dress up the pressures on A and E as a short-term crisis when, as every A and E department in the country will tell us, to deal with the pressures we need to address long-term structural problems that the previous Government either ignored or made worse.

[Bill Esterson (Sefton Central) (Lab)]

May we talk about one of the pressures on A and E, which is the pressure of social care? I hope that the Secretary of State will accept that significant cuts have been made in social care under this Government and that the role of social care is crucial in keeping people in their homes in the first place and in returning them to their homes after they have been in hospital. As a result of those cuts, it is very difficult for social care to perform that role. Will he examine the suggestion by my right hon. Friend the Member for Leigh (Andy Burnham) to use the underspend from the Department of Health to support social care to perform its essential role?

[Mr Hunt]

I will come to that suggestion, but I agree with the hon. Gentleman. If we are going to deal with bed blocking, which is one of the root causes of the problems that many A and E departments talk about, we have to have better integration between the health and social care systems—that is essential. I say to him that the problem of the underfunding of social care did not start in 2010; as my hon. Friend the Member for Stourbridge (Margot James) said, it is a problem that goes back many years, and the failure to integrate health and social care was a failure that happened over 13 long Labour years.

A and E Departments

Bill Esterson Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

I completely agree with that. I pay tribute to my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) for piloting those important reforms through the health service. I just hope that the Labour party, which claimed to support practice-based, clinically led commissioning, will see the error of its ways and understand that proper clinical commissioning holds the key to solving many of these problems.

[Bill Esterson (Sefton Central) (Lab)]

One of the concerns raised with me is about the lack of commissioning of community services to help patients to be discharged from hospital, which has a knock-on effect on A and E and queuing ambulances. Is not the reality that, as health professionals tell me, the lack of community services, which is what causes the problem in A and E, is a direct result of this Government’s reorganisation?

[Mr Hunt]

Quite the opposite: the changes introduced by my predecessor make it possible to have truly joint commissioning between clinical commissioning groups and local authorities, which are responsible for social care. I hope that will deal precisely with the problems the hon. Gentleman talks about. That is what we have to encourage and facilitate in every way we can.

NHS Commissioning Board

Bill Esterson Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

I repeat that we will be publishing amended regulations within days and that the Government’s reforms are about putting the clinician centre stage in decisions about how money is spent, rather than unaccountable bureaucrats, as happened in primary care trusts up and down the country. The reforms are also about ensuring that the patient’s interests and patient care are always uppermost in the minds of everyone making decisions about the use of money in the NHS.

[Bill Esterson (Sefton Central) (Lab)]

As my constituent Terry Eastham told me, the regulations, as they stand, make privatisation of the NHS swift and inevitable. The Minister says that he is confident that his changes will guarantee that private companies will not be able to challenge CCGs to demand full and open competition. Will he give that assurance now and explain how the changes he is proposing will make absolutely certain of that?

[Norman Lamb]

It is absolutely not the case that the regulations, as currently drafted, drive the privatisation of the NHS. As the hon. Gentleman will discover in the next few days, the amended regulations will make it abundantly clear that CCGs will be in the driving seat—the letter from the former Secretary of State made that clear back in 2012. They will take into account the importance of co-operation, integration and putting the patient’s interest first.

Mobile Technology (Health Care)

Bill Esterson Excerpts

Wednesday 21st November 2012 Westminster Hall

[Bill Esterson (Sefton Central) (Lab)]

I congratulate my hon. Friend on securing this important debate. She is making a point about the importance of technology in preventing health care problems. As she will know, the preventive public health role is being transferred to local government. Does she agree that it is vital for the technology to have the funding needed when the preventive role is transferred, and that it is not left to local government, given the scale of the cuts that local government has suffered?

[Rosie Cooper]

A serious point is being made here: public health is being transferred to local government, and the funds that go with it need to be spent on public health and preventive means. I am worried that councils might use some of the money to do work to which they are already committed. So, yes, they do need support, and we need to ensure that the money they get is spent correctly and wisely. Mobile technology can help to improve public health.

One of the perennial challenges of modern health care is to keep accurate, comprehensive records without detracting from the care-giving process, which is quite difficult. Too often the supposed solutions feel burdensome. As a result, clinicians can sometimes be difficult to engage—in fact, there is a view that sometimes clinicians rarely engage—and the accuracy and completeness of records suffers as a result.

We can show that there are tried and tested solutions developed by and in partnership with NHS organisations that have been shown to work. For example, digital pen-and-paper technology, supported by mobile connectivity, can be used to complete patient records. In turn, that can improve patient safety, care quality and efficiency. That technology is pioneered by Portsmouth Hospitals NHS Trust and allows mums-to-be to keep their paper records as normal, and because the records are made using a mobile-enabled digital pen and paper, the maternity department instantly receives an easily accessible electronic copy of the expectant mum’s paper records. That happens while the midwife is still with the expectant mum in her home. As well as improving safety when mums arrive at the hospital without their notes, the technology’s deployment has brought about real efficiency by halving the time that midwives spend on administration.

As well as solutions that can help health care professionals in the community, we need to recognise that most acute hospitals are large complex buildings that, all too sadly, often span several sites. There is strong evidence that the accuracy of patient records and the quality of clinical decision making may be improved if clinicians record information themselves and have access to it when they are with their patients, rather than leaving the process to administrators who are removed from the care. Realistically, that can be achieved only by making it easier for clinicians to record and access information wherever they are.

I am told that organisations such as University Hospitals Birmingham NHS Foundation Trust are making real progress in mobilising information so that clinicians have real-time, secure access to patient records. The foundation trust is using tablet devices and smartphones to achieve such improvements. As the NHS looks to implement new solutions, we need to encourage people to focus on secure approaches that patients and clinicians trust, which means designing privacy into the entire system, with security measures built into mobile devices. We also need reliable connectivity, which is fundamental for effective mobile working. Even in areas with the most advanced mobile infrastructures, bandwidth can sometimes be limited, so it is essential to choose hardware that can switch seamlessly between different mobile protocols and wi-fi connections. Such functionality would minimise bandwidth-related costs. We need to focus on approaches that complement patient-clinician interactions and that make the most of existing technology. Mobile solutions that can be rapidly deployed and that integrate with existing infrastructure would ensure investments that have already been made can be enhanced rather than discarded.

As the former chair of Liverpool Women’s hospital, I know there are now solutions to some of the problems in enabling midwives to spend the maximum amount of time out on the front line. Such improvements are a godsend and enable our professionals to deal with patients efficiently and effectively. I am aware of the Government’s plan to introduce a fund for technology to improve midwifery and nursing care, and I very much welcome that. As the plans for the fund are developed, it is essential to learn from those trusts that have already pioneered new approaches. I ask the Minister, therefore, to meet me and some of the professionals who have been involved in developing the examples I have cited so that he can hear about their experiences. That might help future implementation. The truth is that mobile communication technology will be a core strand in the 21st-century health service. We very much need it, and working together we can deliver for all the people who depend on the health service to deliver their care.

Care and Support

Bill Esterson Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Lansley]

I completely understand my hon. Friend’s point. We very much reflect the need for care and health care in the allocation of resources to local authorities through the formula grant, and the allocation of resources to the NHS through the NHS resource allocation.

[Bill Esterson (Sefton Central) (Lab)]

Councils have faced a £1 billion cut in their funding for care of the disabled and elderly since the right hon. Gentleman’s Government came to power. Without the cash, the White Paper will be meaningless. How confident can he and everybody else in the country be that the Treasury will cough up, given the track record so far of a £1 billion cut to councils?

[Mr Lansley]

I am sorry, but I simply do not recognise the figures that the hon. Gentleman is using. The Association of Directors of Adult Social Services has suggested—these are not my figures—that this year the service reduction in adult social care budgets on a monetary basis was £113 million and last year it was £226 million. The great majority of the figures he is quoting are actually not cuts at all; rather, they are service efficiencies, which are being reinvested for the benefit of maintaining eligibility.

NHS Annual Report and Care Objectives

Bill Esterson Excerpts

Wednesday 4th July 2012 Commons Chamber

[Mr Lansley]

My hon. Friend makes an important point. Part of the measurement of the performance of ambulance trusts, together with their hospitals, is to record the number of occasions when ambulances wait more than 15 minutes before discharging their patients into the service. The Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), is very concerned and pursues precisely those issues, so I will ask him to look into the matter further and respond to my hon. Friend.

[Bill Esterson (Sefton Central) (Lab)]

The Secretary of State told us earlier that every ambulance trust was meeting core response times, but I have to tell him that that is not the experience of my constituents, including Mrs Taylor, who had to wait 90 minutes after falling down stairs. Is not the truth that this is the result of reorganisation and the resulting cuts are making it impossible for ambulance trusts up and down the country to hit the times he says they are hitting, because they are not actually doing it?

[Mr Lansley]

No, and I do not think that the staff of ambulance trusts will appreciate the hon. Gentleman generalising from the particular. I have not said that ambulance trusts reach every case in the time we intend, but the figures show that all ambulance trusts across England have met the category A target for responding consistently at a level they have not previously achieved.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Lansley]

I entirely understand my hon. Friend’s concern, and I applaud the way in which she has expressed it. The BMA’s proposed action could result in up to 30,000 operations being cancelled, as many as 58,000 diagnostic tests being postponed, and more than 200,000 out-patient appointments being rescheduled. I do not think that the House will understand why the BMA would risk patient safety in that way, when it knows perfectly well that its action will have no benefit and that we cannot now go beyond the basis for pension reform that has been agreed with the majority of the NHS trade unions, especially in circumstances in which doctors will continue to receive an extremely generous pension worth up to £68,000 a year at the end of their working lives. I think that the right hon. Member for Leigh (Andy Burnham) and I share the view that this is not a justified position for the NHS to take. The pension is intended to be a generous one. Through the negotiations with the BMA and the other trade unions, we arrived at a very generous pension scheme.

[Bill Esterson (Sefton Central) (Lab)]

T3. Thanks to the staff at St Thomas’ hospital in London, and at Aintree in Liverpool, I have had excellent health care myself in the past three weeks, but, in order to build the morale of staff across the NHS, will the Secretary of State instruct all NHS trusts not to cut anyone’s pay?

[Mr Lansley]

I am glad that the hon. Gentleman has had excellent care; he might like to tell those on his own Front Bench about it, as they are constantly denigrating the NHS. I will simply reiterate what he will have heard me say previously, which is that I have made no proposals to cut anybody’s pay in the NHS.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 27th March 2012 Commons Chamber

[Mr Simon Burns]

I hope I can reassure my hon. Friend. PCTs carrying legacy debt into 2012-13 must clear it. Clinical commissioning groups will not be responsible for resolving primary care trust legacy debt that arose prior to 2011-12. It is expected that aspirant CCGs will continue to work closely with primary care trusts and primary care trust clusters in 2012-13 to ensure that no PCT ends 2012-13 in a deficit position.

[Bill Esterson (Sefton Central) (Lab)]

One NHS consultant told me that

“NHS reorganisation could mean that you are forced to spend around 10% of your income on private health care insurance.”

Does the Secretary of State accept that the doctor is right to say that people will either wait longer for care or they will have to pay for it?

[Mr Lansley]

That is complete rubbish. The legislation is absolutely clear that it does not lead to privatisation, it does not promote privatisation, it does not permit privatisation and it does not allow any increase in charges in the NHS. It simply creates a level playing field so that NHS providers will not be disadvantaged compared to the private sector, as they were under a Labour Government.

Health and Social Care Bill

Bill Esterson Excerpts

Tuesday 13th March 2012 Commons Chamber

[Andy Burnham]

I agree with the hon. Lady. It is that ideology that the NHS and health professionals are rejecting. They want to work in an essentially collaborative health service. They do not accept the vision that pits hospital against hospital and doctor against doctor.

Barely anybody has a good word to say about this busted flush of a Bill, which has lurched from one disaster to another. The unprecedented pause did not address the real concerns, but simply added bureaucracy and complexity. The 1,000-plus amendments are not a sign of improvement, but of confusion, complexity and contradiction. They have left a mess of a Bill that even the Health Secretary cannot recognise as his own. If that was not bad enough, an unfolding communications disaster has alienated the very people the Government are depending on to implement their Bill. A Downing street summit was called to discuss the implementation of a reform that is about clinical leadership, but doctors’ and nurses’ leaders were shut out of Downing street. It was hard to see how the situation could get any worse, but it just has.

First, on Friday, the Information Tribunal ruled against the Government and in favour of my right hon. Friend the Member for Wentworth and Dearne (John Healey). I pay tribute to the assiduous way in which he has pursued his principled case. The tribunal ruled against the publication of the strategic risk register, but in favour of the publication of the transition risk register, vindicating our position and dismissing the Prime Minister’s claims against my actions as Health Secretary.

Let us be clear about what that ruling represents. It is an incredible state of affairs for any Government to suffer such a serious legal reversal at this stage of a protracted parliamentary process. It is an indictment of the judgment, or lack of it, of the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) and others in the Department, in their handling of the Bill. Where is the Minister’s good grace in defeat? It is simple: my right hon. Friend the Member for Wentworth and Dearne won and the Government lost. What are they waiting for? They must publish the risk register today and give Parliament the courtesy of knowing all the relevant information on Ministers’ plans before they ask us to approve them. Instead, what do we get? Silence and playing for time. They are hoping to string it out until after 20 March. That is simply not good enough.

[Bill Esterson (Sefton Central) (Lab)]

My right hon. Friend is, as ever, making the case for the NHS, not for the privatisation that the Tories and their Lib Dem friends are pursuing. We are talking about the future of the NHS, so let me quote Victoria Roberts, a student nurse from Merseyside, who starts her training in two weeks. She says:

“I am a student nurse due to start my training in 2 weeks. This is not the NHS I want to serve or work in, but rather will help only those who can pay the most.”

Does my right hon. Friend agree with that assessment of where the Tories are taking the NHS?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We must have shorter interventions. A lot of people want to speak and we have got to get on with it.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

I want to speak in support of the motion, which notes the e-petition and declines to support the Bill in its current form. As has been said but deserves repeating, the Conservative-led Government have no democratic mandate for the Bill; quite the opposite, given the Prime Minister’s promise that

“with the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures”

of the NHS. Yet this reckless and unnecessary top-down reorganisation will cost £3.5 billion, which could be spent on patient care.

Already in my local area and many others, patients are losing services, waiting longer and receiving poorer treatment than before. Salford primary care trust has ended its active case management service for people with long-term conditions—the service had been both popular and effective. NHS budget cuts have meant that a community matron service was ended in a local area.

The Select Committee on Health recently dealt with the impact of the NHS reorganisation in its report on public expenditure—my right hon. Friend the Member for South Shields (David Miliband) quoted it. The report concluded:

“The reorganisation process continues to complicate the push for efficiency gains...it more often creates disruption and distraction that hinders the ability of organisations to consider…effective ways of reforming service delivery and releasing savings.”

Cuts are having a direct effect on treatment. A staff member of the local branch of the Parkinson’s Disease Society told me recently that NHS cuts mean that GPs and pharmacists are switching to cheaper brands of drugs for patients with Parkinson’s, many of which are much less effective. One person was admitted to hospital. She became ill following a switch to a cheaper, less effective medicine. The hospital staff told her that she should be “firm with her GP” and insist on the more expensive brand.

The Bill brings competition into the NHS at a level that is unhealthy and unwanted. The PIP breast implants saga showed us the dangers for the NHS of a vast increase in private provision when regulation of medical products for use in surgery is so poor. In January, 14 consultants, GPs and public health experts wrote a letter to The Times about the expansion of private provision and the issues arising from PIP implants. They warned that the Health and Social Care Bill

“provides much less protection for patients should their provider fail than is available to people booking package holidays”.

With PIP implants and private surgery, there was a strong marketing sell to patients of the benefits of surgery but little information about risks, and little or no interest in aftercare. That is an important warning. We know that there are potential health issues with metal-on-metal hip implants, yet there will be pressure on patients waiting for a hip or knee replacement to go for private surgery to avoid the waiting lists that we know are building up.

The Bill risks creating a two-tier NHS and a return to the long waiting lists experienced under Conservative Governments in the 1990s—the Government have already watered down guarantees on NHS waiting times. I recall meeting a patient in 1997 who had been waiting up to two years for vital heart surgery, yet more recently in my constituency I have met people whose lives have been saved in a matter of days by the rapid diagnosis and treatment of cancers.

A number of local GPs have written to me calling on the Government to drop the Bill because they feel it undermines the bond of trust between doctor and patient. One GP told me:

“The reforms are being made on the cheap. GPs are being asked to do the work of the PCTs with half of the funding and all of the blame when problems arise. The Bill drives a wedge between primary and secondary care.”

That GP actually supports the theory of clinicians being given more input and supports a reduction in bureaucracy, but says that the Bill “does the exact opposite” because it introduces new layers of bureaucracy such as the clinical senate. He says that people coming in

“are doing so at different levels of understanding…leading to confusion.”

He feels that, ultimately,

“it will be the patients who will suffer…no one has asked the patients what they want.”

[Bill Esterson]

My hon. Friend describes a GP in her constituency, but a GP in mine described his concern to me. He said that he is there to be a doctor and wants to care for patients, and that he does not have the expertise to be a manager. That is the overwhelming concern of his colleagues around the country. Does she agree that that is the danger of that part of the Bill?

[Barbara Keeley]

I very much agree. Only quite recently have GPs expressed such concern. I have never known GPs to come to their MPs in numbers, as they are doing, to complain about the implementation issues they are already finding. As I said, the GP I quoted supported the idea of GPs being more involved with decisions about patients, but he now thinks that the Bill is

“simply a mask for a cost cutting exercise…a way to deal with the NHS on the cheap. A way of farming out support systems…e.g. clinical support, into the private sector.”

He says:

“More money will be taken out of the NHS and put into the private sector.”

The hon. Member for South West Bedfordshire (Andrew Selous) asked us to trust the wisdom of our GPs. That is a damning indictment by a Salford GP, and one that I believe is echoed by GPs up and down the country. Trusting the wisdom of my local GP, I urge hon. Members to support the motion.

--- Later in debate ---

[Grahame M. Morris]

That is precisely our fear, and I hope to develop that argument in a moment.

The national health service was established in 1948, against the background of the devastation following a world war. Men and women with a vision for a better, fairer society set in law the guiding principles and values of our NHS. Let us not forget that, during the post-war period, this country faced a bigger deficit as a proportion of our national wealth than we are facing today.

[Bill Esterson]

Will my hon. Friend give way?

[Grahame M. Morris]

I am afraid not, as I have very little time.

Those people knew that the value of money would be worthless if it did nothing for ordinary people. Nye Bevan stated:

“No longer will wealth be an advantage, nor poverty a disadvantage. Healthcare will be provided free of charge, based upon clinical need and not on ability to pay”.

In contrast, this Government seem to see any money spent by public sector providers as somehow wasteful unless it is trickled through their friends in the private sector who can turn a profit. I am concerned that their whole philosophy is antagonistic towards the public sector. I was outside the Lib Dem conference on Saturday, lobbying the delegates. I hope that Lib Dem MPs will support the motion tonight.

Southern Cross Care Homes

Bill Esterson Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

What I have told the House is that the process in hand, following the statement made yesterday by Southern Cross, will ensure a smooth transition of every home to a new operator over the next four months.

[Bill Esterson (Sefton Central) (Lab)]

This will be of great concern to many people who live and work in homes that are not run by Southern Cross. Many other people will be affected. The Minister has spoken about regulation and care home standards. Will he bring forward proposals to consider the business regulation, and can he tell us when he will do that? That is the way to provide reassurance and security for many people who live and work in homes other than the 31,000 in Southern Cross.

[Paul Burstow]

My right hon. Friend the Secretary of State for Business, Innovation and Skills has already made statements and commitments about looking at the business model and at why it was thought to be appropriate for this sector.