Oral Answers to Questions

Charlotte Leslie Excerpts

Tuesday 21st March 2017 Commons Chamber

[David Mowat]

It is not for the Government to direct clinicians regarding the efficacy of particular treatments; it is for clinicians to decide, based on guidance from the National Institute for Health and Care Excellence and others. In developing its recent motor neurone disease guidance, NICE found that the evidence base for the routine use of cough-assist machines was weak. However, the matter is kept under review, so that may change as and if new data emerge.

[Charlotte Leslie (Bristol North West) (Con)]

4. What assessment he has made of the effectiveness of the export of procedures developed by NHS professionals.

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

Many NHS bodies work with their international peers, and each makes its own assessment about the effectiveness of intended collaboration, rather than any determination being made at a national level. Trusts should only pursue opportunities that deliver value for money and do not impair their ability to deliver NHS services.

[Charlotte Leslie]

A team of clinicians at Southmead hospital in my constituency, led by Professor Tim Draycott, have developed and are now exporting internationally a system of maternity healthcare that is transforming maternity safety and childbirth. What is the Department doing to provide further support and ensure that the evidence base the team have developed is embedded and incorporated in policy making in this place?

[Mr Dunne]

My hon. Friend will be aware that the professor to whom she refers has presented his findings to the Secretary of State. Partly in response to that, we have set up an £8 million innovation fund to help to take such initiatives forward and to spread best practice throughout the country.

Junior Doctors’ Contracts

Charlotte Leslie Excerpts

Wednesday 28th October 2015 Commons Chamber

[Charlotte Leslie (Bristol North West) (Con)]

I welcome this debate brought by the hon. Member for Lewisham East (Heidi Alexander) as a chance to offer some light, as opposed to the heat that has sadly dominated so much of this debate.

The House has often heard me quote the thinker and poet T. S. Eliot when he warns of the folly of trying to devise

systems so perfect that no one will need to be good.

This speaks extraordinarily to the NHS. The NHS is not a system; it is the people who work in it. That is why it is so important that we nurture and value our NHS staff in the ways so brilliantly expounded by my hon. Friend the Member for Totnes (Dr Wollaston)—those staff who work day in, day out, and, as the daughter of a surgeon I can vouch, at weekends and on Christmas days, too.

I was extremely concerned to hear the British Medical Association’s claims that this modernisation of the junior doctor contract would lead to dangerously long working hours and less pay for our junior doctors—cuts of 30%, it said. I began to look into this more closely. I noticed that the pay calculator had been taken down, but when I looked at the detail I became very surprised. In the proposals I could not see the kind of longer hours and the less pay scenario I had heard from the BMA with such certainty and to which many junior doctors, completely understandably, have been reacting with such worry and concern. I could not see anything approaching the authoritarian and draconian measures the BMA had led me to believe my own Government were imposing.

At most, I think there are areas where we need very careful negotiation and clarity with a doctor membership body so that we can work with doctors—that is incredibly important. I would have thought the BMA junior doctors committee would be very concerned for that to happen.

I cannot find evidence that the Government are imposing longer hours on doctors. What I did note was the new absolute limit on overtime worked, which is preventing dangerously long hours and those awful weeks of nights, and the current situation where doctors routinely work over the 48-hour working time directive often slightly off the record to get in the training that they need. I would have thought measures to tackle that would have been welcomed.

I know that huge numbers of people work during Saturday daytimes, but there needs to be further discussion on the agreement of what constitutes antisocial hours for doctors on a Saturday. Again, I would have thought the junior doctors committee would have valuably contributed towards that, and in fact the Government say the same.

To read the BMA submission we would think that less pay was a key aim of the whole exercise, but the plans make clear that there will not be an overall pay cut and that average earnings will remain the same. Yes, the distribution will be different to overcome the obvious unfairnesses in the system where a doctor working normal hours will get paid more than a doctor working antisocial hours, but I am not sure that is something to complain about. Yes, there will be a reward for progress as opposed to the time the doctor has been in training, but that is in line with many professions and I am just not sure that someone who takes longer in training to reach the same standard as a high-flyer should get paid more.

[Helen Whately]

I support my hon. Friend on that point. It is uncomfortable but true that in almost any profession outside the NHS if someone takes time out for parental leave the clock stops on their career progression. They gain other skills; they do not just press on with their career, but they can go back to it afterwards.

[Charlotte Leslie]

My hon. Friend is absolutely right. In addition, I am just not sure it should be possible for supervisors with more responsibility to be paid less than those they are supervising. I am slightly confused about the BMA stance on this. When I spoke to it about the European working time directive, it assured me that it was not just time spent in training that mattered, but the quality of that training. Now in its submission it seems to have completely reversed that position and says that it is just time spent on the job that matters. That confuses me.

As the Government accept, there is a need for discussion on how doctors moving between different specialities can have their pay protected, but that is again something on which we must absolutely enter into discussion with junior doctors. I plead with the BMA to come to the table. The consultants committee in the BMA has done that and I applaud it for doing so. A part of the drive to get more consultants in at weekends is to improve the quality of junior doctor training which has suffered under the European working time directive.

I also note that one paragraph in the BMA’s submission states:

“Much of the subsequent detail that has been discussed in the news was never fully outlined as part of the previous negotiation process.”

That demonstrates that the Government are still completely open to talking about many things, yet the BMA almost seems to lament that fact. In the light of this, I simply do not understand why the BMA will not return to the table. I celebrated the BMA’s “No More Games” campaign. We do need to de-politicise the NHS, but I am really concerned that the junior doctors committee is bringing that laudable aim by the BMA, and the work on that which the BMA does, into disrepute.

Francis Report: Update and Response

Charlotte Leslie Excerpts

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

I remember the good meeting I had with the hon. Lady and the former Secretary of State about that issue, which we are looking into. I hope she will understand that it would not be right for me to comment on that individual case, but let me say that it seems to exemplify exactly how things have gone wrong. That is why we need to look into it very carefully. We need to create a culture through which the management actually want to listen to their staff. I do not want managers to do so because of something I say; I want them to feel that they want it happen. It is as much about making sure that organisational priorities are correctly set from the centre, as it is about changing the law.

[Charlotte Leslie (Bristol North West) (Con)]

Culture change is a big tanker to turn, and senior managers under pressure from targets and headlines need significant sanctions and incentives to reveal rather than smother or downplay difficult truths. Doctors have the General Medical Council, although it needs improvement, but managers have no regulatory body to make them accountable. Will the Secretary of State consider doing something about that?

[Mr Hunt]

I thank my hon. Friend, whom I know has thought extremely hard about this issue. Indeed, we talked yesterday about getting the fit and proper persons test to work properly. It is still in the early stages, so it is difficult to assess whether it is having the impact we want. We certainly hope it will have some impact. There is an unfairness about the fact that a clinician as a chief executive of a hospital is accountable to the GMC as a doctor, whereas a chief executive who is not a doctor is not accountable. We actually want more doctors to become chief executives. On the whole, they do a really good job, and we should give further consideration to that.

NHS (Five Year Forward View)

Charlotte Leslie Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

The reason we decided to give that decision to NHS England—it is now decided at arm’s length from Ministers—was to remove the worry people had that politicians might make these decisions for political purposes, rather than for what is right for the NHS. I encourage the hon. Lady to make representations to NHS England before its board meeting on 17 December.

[Charlotte Leslie (Bristol North West) (Con)]

I very much welcome the “Five Year Forward View” and the new investment, but does the Secretary of State agree that it is not so much a five-year forward view we need as a 20 or 50-year forward one, if we are to begin to meet the tsunami of demand we face? We will have to work together across the House as we face the tough questions on how to fund and manage the NHS. Otherwise, we will be accused by future generations of bickering while our NHS burns.

[Mr Hunt]

I hear what my hon. Friend says, but it is also important to have a clear plan of action to take us in the right direction over the next six years, which is what the plan from NHS England and Simon Stevens provides and what the Government have said we support. She is right that the demographic trends will get worse. By 2030 the number of over-80s will have doubled to 5 million. That is the sobering reality that we all have to face up to.

Oral Answers to Questions

Charlotte Leslie Excerpts

Tuesday 25th November 2014 Commons Chamber

[Jane Ellison]

The hon. Lady will know from the answer I gave to my hon. Friend the Member for Truro and Falmouth (Sarah Newton) that the Government published the first fuel poverty strategy for England, which aims to address that very issue. It is also really important that all Members do everything they can locally to publicise the Government’s cold weather plan. Members can really assist local public health officials and their local NHS to get the word out to all communities about the simple measures we can take to keep our constituents warm and safe this winter.

[Charlotte Leslie (Bristol North West) (Con)]

One of the key challenges in improving access to GPs is improving recruitment of GPs. Will the Secretary of State work with the Royal College of General Practitioners and other medical groups to see whether there might be merit in introducing a mandatory stint of working in a GP surgery for junior doctors?

[Dr Poulter]

I am sure that my hon. Friend will welcome the fact that there are now just over 1,000 more GPs working in the NHS and training than when we came into government, but there is more we need to do. We have committed to delivering 5,000 more GPs for the NHS, and part of that work will be working with the Royal College of General Practitioners to ensure that we can support return-to-practice initiatives for GPs who have taken career breaks.

Special Measures Regime

Charlotte Leslie Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

The examples of poor care I gave happened under this Government. I am therefore being absolutely clear that failures in care happened under both the previous Government and this one. The difference is that this Government are doing something about it. We are taking action and taking the difficult steps to get those trusts out of special measures. The public are beginning to have confidence that, when there are problems, they are not being swept under the carpet but being dealt with.

[Charlotte Leslie (Bristol North West) (Con)]

Bad care is unacceptable, but what turns bad care toxic is covering it up and denying that it is happening. I am pleased that we are beginning to get a consensus across the House that transparency and unearthing problems is the beginning of solving them. On that note, will my right hon. Friend the Secretary of State work on a cross-party basis with the right hon. Member for Leigh (Andy Burnham) and the Labour party on Wales, which was also targeted by Bruce Keogh’s expertise? He has suggested that it would be sensible to have a Keogh-style investigation in Wales, not only because of mortality statistics and diagnostic waiting times, but because tales coming to me and the right hon. Member for Cynon Valley (Ann Clwyd) are raising the alarm. I urge hon. Members on both sides of the House who are worried about patients in Wales to urge such an investigation there, because the investigation here unearthed problems.

[Mr Hunt]

I totally agree with my hon. Friend. It is an absolute tragedy for people who use the NHS in Wales and Welsh NHS workers that they are not getting the support that people in England get to deal with poor care. For some reason, the Labour Administration in Wales believe that it would be incredibly embarrassing to find problems, but that is what hospitals and hospital staff are crying out for. The staff did not go into those jobs to deliver poor care. They want the support to deliver the best care. It is time that Labour in Wales understood that and got the support of Labour in England to do so.

Patient Safety

Charlotte Leslie Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

I am afraid I will take no lessons in spin and game playing after what the hon. Gentleman wrote in local election leaflets in Hammersmith and Fulham, failing to tell his own constituents about the brand new hospitals, the opening of a seven-day GP surgery and the 800 out-of-hospital professionals. I think he behaved absolutely disgracefully.

[Charlotte Leslie (Bristol North West) (Con)]

I very much welcome the Francis review into whistleblowing, which does indeed focus on transparency, and I am bemused and depressed that we cannot get universal welcome for it across the House. In addressing the name, shame and blame argument, does my right hon. Friend recognise that many front-line staff will be relieved at what he has announced because it will force management priorities to be the same as their priorities, which are overwhelmingly about patient safety?

[Mr Hunt]

My hon. Friend speaks wisely, and I commend her for her work in championing whistleblowers. In her relatively brief time here, she has made a big difference on that issue. Personally, I do not like to use the term “naming and shaming” because I think identifying problems should always be the first step to sorting them out. What we are doing today by identifying trusts that do not have a proper open and honest reporting culture is also helping them to change that reporting culture while at the same time identifying trusts that have a good culture. It is all about changing the culture, so this is a positive move, and I think that NHS staff will really welcome it.

Oral Answers to Questions

Charlotte Leslie Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Hunt]

I hope so, but I want to be honest with the House. It takes time to change a culture, and that is the big change we have to make. Whistleblowers are now coming forward from Coventry, Cambridge, Ealing and all over the country. That is why I am afraid that I profoundly disagree with the shadow Health Secretary, who said that the lessons of the Francis report were about a local failure. This is about a systemic problem and we have to change it across the NHS.

[Charlotte Leslie (Bristol North West) (Con)]

Given there are so many emerging cases of whistleblowers—both current and historic—being treated with injustice, a precedent will not be set for accountability until these injustices are actually faced. Will the Secretary of State set up a truth and reconciliation committee to look at historic and current cases so that accountability becomes a reality?

[Mr Hunt]

First, I commend my hon. Friend for her campaigning on this issue in the House and on the Health Committee. We have not done everything we need to do to change the culture within the NHS, and we are looking at what more needs to be done to get a culture change profound enough to make it easier for people to speak out. This is not just about whistleblowing. If it is whistleblowing, we have failed because it means that someone has had to go to the press or outside their organisation when they were worried. We need an NHS where people within their own organisation are listened to when they have concerns, and we are looking at what we need to do to take that forward.

--- Later in debate ---

[Dr Poulter]

I am very happy to meet the hon. Lady to discuss this further and see what we can do because it is important that the vulnerable patient groups she highlighted are looked after in the right way.

[Charlotte Leslie (Bristol North West) (Con)]

As he heralds an era of transparency, can the Secretary of State update us on what steps he has taken to ensure that private providers in the NHS are every bit as transparent and accountable as public ones?

[Mr Jeremy Hunt]

I think they absolutely should be, and the changes that we introduced in the Care Act 2014 relating to the transparency of the inspection regimes apply to private providers supplying services to the NHS just as they do to NHS providers. Let us be absolutely clear: poor care is poor, whether it happens in the public sector or the private sector, and we must clamp down on it wherever it happens.

Oral Answers to Questions

Charlotte Leslie Excerpts

Tuesday 1st April 2014 Commons Chamber

[Dr Poulter]

As the hon. Gentleman will be aware, we are in negotiations with the British Medical Association and other health care unions about the future shape of the NHS consultant contract and junior doctors contract. We are determined to have a contract that remains fit for purpose in future and to reform the contract that we inherited from the previous Government, which was not fit for purpose. We will continue to work with the BMA to make sure that we protect the interests of patients and deliver better care.

[Charlotte Leslie (Bristol North West) (Con)]

I very much welcome the taskforce reviewing the effects of the working time directive; as my hon. Friend knows, I have campaigned long on the issue. Given the severity of the evidence, which shows that more than a quarter of a million hours of surgical time are lost per month because of the directive, will my hon. Friend assure me that he will not only listen to, but act bravely and robustly on, any recommendations to rid the NHS of this very dangerous directive?

[Dr Poulter]

My hon. Friend has campaigned with great vigour on the issue, and rightly so. The European working time directive, to which the previous Government signed up in a headlong and reckless way, has damaged continuity of patient care and the training of the consultants of tomorrow. That is why we set up the independent review. We look forward to its recommendations and we will make sure that we respond to those appropriately in due course.

Care Bill [Lords]

Charlotte Leslie Excerpts

Monday 10th March 2014 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

I thank the right hon. Member for Sutton and Cheam (Paul Burstow) for getting this extensive group of new clauses and amendments under way. I understand that he shares a lot of the concerns felt by Labour Members, and the concerns of the Chair of the Health Committee have also been illustrated, as have those of other Government Members. It is essential that the Government take action to address the issues before the House.

The main issue I wish to raise this evening is the ability of the Care Quality Commission to inspect the commissioning of adult care services by local authorities. A number of new clauses and amendments have been tabled, and rather than examine each in extensive detail, it will be better for colleagues if I speak to the principles at the heart of the issue. It is, however, crucial that we understand the background to this group of new clauses and amendments.

In 2010, the Government announced the cessation of annual performance assessments. On application that has resulted in the CQC no longer inspecting the commissioning practices of local authorities. One consequences of that has been for local authorities to peer review voluntarily the services provided by neighbouring local authorities, and that in turn has resulted in the creation of a kind of opacity, or a climate of perverse incentives. Local authorities are more likely to give a neighbouring authority the benefit of the doubt on such issues. Co-operation has become the default in the sector, and although that should be welcomed to a degree, there is a disincentive for any local authority to raise issues of poor care in an adjoining local authority on which it might rely for assistance and other services. Given the financial strain on local authorities as austerity bites, they are forced to merge functions—and more—with each other, meaning that the disincentive is likely to persist for the time being at least.

As was pointed out and discussed in some detail in Committee, a strong effective regulator is as essential in the health and social care system as in any other sector—perhaps even more so. Only through thorough and effective monitoring and enforcement can patients have confidence in the services they receive, or exercise an informed choice when choosing those services. That is why the previous Government legislated for the creation of the first ever independent regulation of the NHS, and what is today the Care Quality Commission.

Regulatory oversight is an iterative process that by its very nature tends to be more active in taking remedial action than preventive action. It is the responsibility of every Member of the House to ensure that the regulator is given the tools and resources it requires to be as proactive as possible in preventing problems not just in the future following care failures, but before any failures occur in the first place. In short, the best regulatory systems are intelligent and proactive. That is why it is essential that the Care Quality Commission should be allowed proactively to inspect and review the commissioning of adult social care undertaken by local authorities. It is one thing to inspect the service provided—clearly that is important—but more information could be revealed, and better regulation resulting in better services would be enabled, if the regulator could inspect the process of service commissioning.

When a service fails, we need to understand the root causes of such a failure. How has a poor service come to pass? Is it down to a poor operator, a poor service provider, or is the local authority not commissioning the right service in the right way? Under the Bill, only once a pattern of poor care is identified can the CQC apply to the Secretary of State for permission to undertake a special review. There are a number of issues with that. First, the quality of care would have to be extremely low for a consistent period to allow a pattern of poor care to be identified, and that does not provide the best level of protection for service users suffering from inadequate care services. Secondly, the CQC would have to bear a significant burden to prove such a pattern before undertaking a special review. Such a burden will consume time and resource, while again prolonging the time during which service users may be receiving inadequate levels of care.

When the Minister responds, will he outline what threshold of proof would be required for a Secretary of State to grant the CQC permission for such a review, and say whether that has been modelled within the Department at any stage? Surely such issues have been considered. What mitigation does the Bill contain to prevent poor levels of care from continuing to be provided while investigations into care standards are ongoing? How does the proposed model fit the Ofsted model? On the face of it, it does not appear to fit it at all, because Ofsted does not wait for schools to fail before stepping in. I think—the Minister knows my views on this—that such a comparison has never been accurate and that strained and unnatural is a more precise description. The whole House will appreciate hearing the defence of a regulatory system that regulates only once failure has occurred.

As the Bill stands, it would appear that current provisions are best suited for remedial action to address instances of failure. The Bill addresses only actions to be taken following poor care, but does not give the necessary freedom to the CQC to act to prevent poor care from occurring in the first instance. That puts a limit on the practices of the CQC, and on application would mean that the inspection of commissioning would take place only in special circumstances. My fear is that we are knowingly legislating for a leaden-footed regulatory regime—hence the need for amendment 19.

The roots of care failures could be lodged firmly in the process of commissioning, and it is right that an independent regulator has the ability and duty to inspect all issues relating to the quality of provision before failures occur. Amendment 19 seeks to address the Government’s clear oversight in that regard. It would give the CQC more freedom to explore all aspects of care provision, rather than just quality, at the point where care is administered, and it would provide the scope for whole-system inspection. Problems can manifest much earlier in the process of care provision than the point at which care is received, and as such those problems must be dealt with earlier. The only way that is possible is for the CQC to be able to assess the quality of local authority commissioning.

If the Government seek to oppose amendment 19, I would be grateful if the Minister would explain why he thinks that the rather fudged clause in the Bill should remain unamended. The commissioning of services is clearly linked to the quality of service provided, so to limit CQC oversight to just one aspect, as in the Bill, is a flawed approach that knowingly turns a blind eye to other parts of the system, which are ultimately responsible for the standard of care provided.

The consequence of refusing to address the issues surrounding commissioning clearly results in the problems illustrated earlier by my hon. Friend the Member for Leicester West (Liz Kendall). A lack of oversight has meant that 15-minute visits and zero-hours contracts are quickly becoming the default option for care, rather than being used in extreme circumstances—we must all surely hear complaints about the consequences and effects of such an approach in our surgeries; I certainly do so.

Amendment 19 would give the CQC oversight of commissioning practices and lead to an improvement in care, and new clause 8 would put a duty on the CQC to undertake a review into commissioning practices within a year of the commencement of part 1 of the proposed Act. While that would be worth while in the short to medium term, to be useful in the longer term the CQC must be able to repeat inspections when it deems appropriate, not just when the Secretary of State requires it.

Clause 89 is entitled:

“Independence of the Care Quality Commission”.

Everyone across the House agrees with that principle except, it would appear, the Government in relation to this part of the Bill. Rather than giving the CQC independence to inspect commissioning services routinely, they are placing a shackle of ministerial approval on inspections that the CQC may deem necessary. That cannot be right, and to my mind it contradicts everything that the Government have said over the past 12 months regarding the need for CQC independence.

New clause 27 is tabled in the name of my hon. Friend the Member for Blaenau Gwent (Nick Smith). It would create an offence of corporate responsibility for neglect, which could see directors of care providers face jail if their management of a service led to abuse or neglect. I pay tribute to my hon. Friend’s work on this issue, and I know he works tirelessly helping those who have suffered as a result of neglect in the adult social care system. He does superb work in the House and is a credit to his constituency and his illustrious predecessors. It is right that we do everything in our power to ensure that those who abuse or neglect people in care are held to account. We put an inordinate amount of trust and faith in care providers, and if that trust is betrayed by wilful neglect or mismanagement, the perpetrators should face real punishment. These services are provided for some of the most vulnerable people in our society, and harm brought about by neglect must be punished. I would be grateful if the Minister would speak more about those issues, and say how the Government intend to address them.

[Charlotte Leslie (Bristol North West) (Con)]

I shall speak to new clauses 28, 29, 30 and 33, which stand in my name and those of other hon. Members from both sides of the House.

There is a huge amount to welcome in the Bill, and on Second Reading I welcomed the steps in part 2 to implement many of the recommendations in the Francis report. I said at the time that although there has been good progress, there remains a lot more to do, which is the reason behind the new clauses. I have tabled four new clauses—two on whistleblowing and two on patient safety. Those are both vital areas that we must get right.

I welcome the measures that the Government have taken to improve protection for whistleblowers, including changes to the Public Interest Disclosure Act 1998 and the banning of gagging clauses. Whistleblowers are not only individuals who are able to see where things have gone wrong when others around them have perhaps gone native and begun to accept the unacceptable, but they are people with the moral backbone and courage to speak out when things are wrong. It is hugely important that we have a culture where people do not need to become whistleblowers, because their complaints are taken up far earlier and they do not need to go down routes outside the usual complaints process. We should have a culture where people are encouraged to speak out, and where raising concerns is seen as a good thing.