Musculoskeletal Services: Greenwich

Clive Efford Excerpts

Wednesday 11th January 2017 Westminster Hall

[Clive Efford (Eltham) (Lab)]

I beg to move,

That this House has considered musculoskeletal services in Greenwich.

What a great pleasure it is to serve under your chairmanship for the first time, Mr Hanson.

In 2016, Greenwich clinical commissioning group decided at an inquorate meeting to allocate a £73 million contract for musculoskeletal services to Circle Holdings plc. There were two rival bids at that time: one from Circle and one from a consortium of local providers led by Lewisham and Greenwich NHS Trust and involving local GPs and Oxleas NHS Foundation Trust.

A freedom of information request has exposed the fact that neither NHS England nor Greenwich CCG undertook an impact assessment prior to making requests for tenders or when allocating the contract to Circle. The purpose of an impact assessment is to ensure that no minority or vulnerable group is disadvantaged as a consequence of a decision to let a contract, and it is legally binding. How did Greenwich CCG satisfy itself that no one would be disadvantaged? Responses to the FOI requests to the CCG and NHS England have confirmed that neither party had answers to those questions at that time. As a result of local campaigning, which was led by the local authority, local Members of Parliament and the local community, we now have a review and an impact assessment being carried out subsequent to the contract being let.

The Minister was told by NHS England that it had reviewed the process by which the contract was let, but that is not satisfactory. She may have received assurances that the contract process had been reviewed, but what has not been reviewed is the impact on vital services that had nothing to do with the contract. They may be undermined by the fact that the NHS is so heavily cross-subsidised for providing vital services.

Because members of one of the rival bids were members of the clinical commissioning group, they were required to leave the meeting. That is custom and practice and happens in many fields, but it made the meeting inquorate. In order to allocate a £73 million contract, people who remained in the room were allowed to be double-counted in order to make the meeting quorate. I happen to have a friend who is a lawyer and an expert in health law, and I asked him whether what happened was within the rules. His answer was simple: “No, it is illegal.” At a subsequent health scrutiny panel meeting at Greenwich Borough Council, which was held to investigate the circumstances surrounding the allocation of the contract to a private provider, a representative of NHS England passed the procedure off as common practice. Can the Minister tell me whether it is common practice? Is it acceptable procedure? Is the advice that I have been given—that it is illegal—correct? Does she believe it to be a satisfactory way for such contracts to be allocated? If she is not satisfied, what do the Government intend to do?

The Minister will be aware that it is not permissible to pay anything other than the NHS tariff for services. Circle promised savings of £12 million as part of its successful bid for the contract. We do not know how much Circle intends to take out of the £73 million for its profits, but she will be aware that it is required to be paid the national tariff. If that is the case, will Circle be treating the same volume of patients as are currently being treated under the MSK process? If not, where are the savings and the profit for Circle going to come from?

I asked the Minster some questions to satisfy myself that the Government were happy with the procedure that had been followed. Were NHS England or the Minister informed of how Greenwich CCG achieved its quorum and the fact that the required number of GPs were not present? It was the GPs who were part of the consortium that was bidding who were required to leave the room. When the White Paper was launched by Andrew Lansley, he made it clear that local clinicians should be at the heart of decision making. In this case, we see that local clinicians were anything but at the heart of decision making.

I asked whether the local healthcare trust had been consulted at all in the process, and the Minister told me in an answer that it had been discussed at a meeting in March 2016 and as part of an assurance procurement process in August. That did not happen. Lewisham and Greenwich NHS Trust managers have no recollection of a meeting in August where the matter was discussed. Who told the Minister that the meeting had taken place when it clearly had not? It was not possible for anyone to give that assertion to the Government when the meeting simply had not taken place.

The Minister was also told that Circle was engaging with Lewisham and Greenwich NHS Trust, but the trust says there is no clarity around the clinical model and no commercial offer. That was still the case in November at the council’s scrutiny meeting, with the contract then due to begin on 1 December. The trust had no idea of the money or business that would come its way as a result of the Circle contract.

The Circle contract is a prime contractor model. That means that all patients will be directed to Circle, which will triage them and direct them to whichever services. Lewisham and Greenwich NHS Trust receives something in the region of £10 million for MSK services. It has nothing in its future budget for that service, because it is simply unaware of what it can expect from the contract that will be managed by Circle. How is that acceptable? The trust has to plan ahead for other services, and it is finding that impossible.

The trust has been through a couple of scenarios of what would happen if it was forced to cut its services as a result of losing elements of the MSK contract. It currently has a team of surgeons and some 45% of their surgical workload comes through the MSK contract. Those surgeons are vital to the support of other services, such as A&E. If those surgeons are lost, it will have an impact on other services in the trust. Activity could be reduced in consultant trauma services at Queen Elizabeth hospital which support the A&E. There would be an impact on doctors’ training and rotas; on the quality of training provided to junior doctors and other staff; on related professional services and posts such as nursing and physiotherapy; and, in the longer term, on recruitment at Queen Elizabeth hospital and specifically to its trauma service, including the emergency department, which is a designated trauma unit. It is disgraceful that no impact assessment was carried out to assess these impacts on other services.

The new Eltham community hospital was very much welcomed by my local community. Lots of lobbying has gone on. The local community watched the much loved and admired local building, the Eltham and Mottingham community hospital, being knocked down because they had been told they were going to get a walk-in GP service and a new hospital in the heart of their community, which they could attend for blood transfusions, X-rays and other diagnostics; more importantly, there were to be 40 rehabilitation beds for people leaving hospital and returning to the community. The community were very supportive of that scheme, which started in 2007. I and others in the local community lobbied very hard to make sure that the project stayed on track, and it finally opened in 2014.

Within 18 months of the opening, 20 beds were closed temporarily, to save money during the summer period when there was allegedly a low level of demand, but they were due to open again when winter came along. Now we are told that the beds are not opening. Lewisham and Greenwich NHS Trust is lobbying very hard because it desperately needs the beds back—it is now running at more than 100% occupancy for beds in its hospitals. We are now told that the space available for those 20 beds is part of the MSK project. That is not what my local community signed up for. It is not acceptable that the whole business plan for that hospital and the services to be provided there has been completely changed without any consideration of the local community.

I accept that there is a need for change in the NHS. I do not accept that we need the private sector to do it. If we continue to privatise services like this on the pretext of saving money, we will see a lot of money that should be being spent on patients going out in private profit. It is time to call a halt to the drip, drip of privatisation in our national health service.

If we want to modernise the NHS we need to find ways of doing that, but I wonder how someone could come to the conclusion that Circle is the organisation to take us forward. We know what happened at Hinchingbrooke hospital—Circle walked away the day before the Care Quality Commission was to put the hospital in special measures. At the Nottingham NHS treatment centre, a dermatological national centre of excellence, the consultants walked out. Chris Clough, who was appointed to investigate what was going on there, described it as “an unmitigated disaster”. To keep that service going, Circle brought in locums from overseas costing £300,000 a year. Today, the centre is no longer a centre of excellence.

The Government and NHS England did not learn a single lesson from what happened with the Cambridgeshire and Peterborough social care contract, where the private provider handed the contract back after eight months, saying that it was not viable. They ignored warnings from the National Audit Office about that in July 2016. It seems that the Government are happy to see any process go forward as long as the services are being privatised.

The process is completely and utterly flawed and is completely unsafe. The meeting in June last year was inquorate. It let a £73 million contract without any consideration of the knock-on effects on other vital health services, particularly A&E. The illegality of the process was disregarded and Ministers were given false assurances about the process and the consultation with Lewisham and Greenwich NHS Trust. There was no proper assessment of the suitability of Circle as a health provider. It provides not one clinician in the process—it is purely a management operation and another tier of bureaucracy. We hear endlessly from the Government about the need to cut back bureaucracy, but Circle is simply a signposter in the process, and for the pleasure of doing that it will take private profit out. It contracts with existing private services. In Bedford, there has been a 30% reduction in its contracting with the local Bedford hospital for MSK services and the private services in that area are brimming with profitable elective MSK surgery.

The process for awarding the contract is unsafe and has put patients at risk. Worse still, it has put at risk patients who are not in need of MSK services, due to the knock-on effect on other services. It cannot be that patients will unwittingly attend their local hospital and find that services have been cut because another service in the local health economy has been privatised. It is time to call a halt to this process. I hope that the Minister will step in, stop the process and stop the contract being let to Circle plc, because it is clearly flawed and not in the interests of patients in Greenwich.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a great pleasure to serve under your chairmanship, Mr Hanson. I congratulate the hon. Member for Eltham (Clive Efford) on securing this debate. I know that the subject is extremely important to him and his constituents. He has very eloquently raised the different concerns, which is no less than I would expect of him from our shared days on home affairs matters. I would warn him, however, that I doubt whether I will be able to answer every single one of his questions in detail. I will endeavour to get through the best I can and then reply with further detail in writing.

First, I would like to pay tribute to the many staff who work exceptionally hard every day for our NHS and deliver high-quality care for patients. As the daughter of an NHS doctor and nurse, who are now retired, I have seen at first hand how much personal sacrifice that involves from both NHS workers and their families, who often have to spend a lot of time apart from their dedicated NHS family members. It is a sacrifice that I am sure all of us here today would like to honour, especially during this busy time.

It is important to say at the outset—I know the hon. Gentleman is aware of this—that procurement of local health services by means of competitive tendering is a matter for the local NHS. Greenwich clinical commissioning group, which is the deciding body in this case, is a clinically-led independent statutory organisation. We believe it is right that local NHS systems are best placed to understand the health needs of their local populations and to use that knowledge to commission services for local people, to ensure the best clinical outcomes for all patients at the highest quality and best value to the taxpayer.

I know the hon. Gentleman knows that musculoskeletal services are currently provided to about 9,500 Greenwich patients by the four NHS trusts and one private provider, but despite the hard work of local health workers, the latest data show that Greenwich CCG’s referral rate to treatment trauma and orthopaedics performance is only 80.8%, against a target of 92%. It also shows a high number of out-patient appointments—more than 50% higher than the national average—with many seeing a consultant surgeon and then not having surgery. That paints a clear picture of too many patients waiting for too long. Even when they do get an appointment, they do not always see the right health professional, which means another wait for physio or other interventions.

As someone who has a chronic, complex illness and was misdiagnosed for more than a decade, I understand how dispiriting it is to wait in pain only to endure the disappointment of inappropriate or unnecessary appointments or tests and to end up on a new waiting list still in pain, just more frustrated. I know that because I lived it. We have to do better to get the right care to the right patients in the first place.

Taking such steps not only improves patient care and their experience of the NHS, but cuts out wasted appointments and tests, and frees up hugely valuable consultant and technician time, saving money that can be spent on appropriate care instead. That is why the CCG identified the musculoskeletal hub model, which has been successfully implemented using a range of different kinds of providers, private and public—I am agnostic on that point—across the country. It concluded that it would secure better value for money from that more streamlined service model, especially at the point of referral.

Given the hon. Gentleman’s description, I think he knows this, but I will say it anyway: the hub model means identifying one healthcare provider to act as a single point of access for all Greenwich musculoskeletal patients. That healthcare provider then offers patients who need an in-patient operation a choice of where the operation takes place. It is also able to triage patients more effectively into physio and other non-surgical treatments sooner, which means that surgery can often be prevented because it is possible to intervene quicker, which is better for patients.

The hon. Gentleman expressed concern in his parliamentary questions about the procurement process. However, I am sure he welcomes the fact that there was some consultation prior to procurement. He questioned the information that has come to me, and I will double-check it, but I have been told that the draft specification was shared with the CCG patient reference group and the pensioners forum for their comments prior to finalisation. When the musculoskeletal service was put out to tender in April 2016 in an open procurement process, the prospective bidders were required to put forward a programme budget within the range of £14 million to £14.8 million a year.

[Clive Efford]

Lewisham and Greenwich NHS Trust made about 50 requests for information about the scope of the contract it was being asked to bid for during that process, and it received very few responses from Greenwich CCG. It is very difficult to say that there was adequate information or consultation about the impact of the service, because very little information came from the CCG.

[Nicola Blackwood]

I am sure more information could have been made available, but there certainly were attempts to engage with patients to ensure the contract was shaped to meet patient need.

In the end, two bids were received. They were anonymised and evaluated by a panel that included clinicians. According to the information I have received, the CCG had at least four GP members in attendance at the governing body meeting of 29 June, as well as three other voting members. The musculoskeletal specialist was from another area, specifically so that the panel could benefit from his experience without risk of conflict. Following the evaluation section of the meeting, all members with a conflict of interest were asked to leave the room, as the hon. Gentleman said. Those members’ votes were transferred to other governing body members, in line with the CCG’s constitution. I am not sure where the hon. Gentleman’s information about the numbers in the meeting comes from. According to the information I have received—which I will check—the remaining members of the CCG governing body then voted, and the meeting was quorate, in line with the actual numbers in the room. They voted on the still anonymised bids. Following that process, the five-year contract was awarded to Circle Health. The bid was assessed by NHS England to be according to the NHS standard procurement process, which is obviously legal.

As the hon. Gentleman said, under the proposed model, Circle will triage all patients registered with a Greenwich GP who require physiotherapy or planned orthopaedic surgery to ensure they receive the most appropriate medical professional support the first time to avoid inappropriate patient experiences. The aim is to reduce the number of first out-patient appointments, because many have been found clinically unnecessary. Further, if the trust experiences fewer unnecessary out-patient appointments, surgeons will have more time to carry out elective surgery, which will reduce waiting times for those who really need it. Over the lifetime of the contract, the CCG expects the average waiting time at Lewisham and Greenwich NHS Trust to reduce from 7.8 weeks to below 7 weeks.

As I said, regardless of the details of the procurement, which we will check, ensuring that patients are better served with the right care at the right time must be something that colleagues from across the House support. I heard the hon. Gentleman’s concerns about the impact on existing services and his view that the assessment should have been carried out further. At any rate, I am pleased it is being carried out now. As I understand it, Greenwich CCG discussed the procurement with Greenwich Council’s healthier communities and adult social care scrutiny panel—which is very snappily named —at a meeting on 3 November. The panel accepted that the process had been correct, but due to the level of public concern it requested that the CCG and the trust co-commission an independent assessment of the likely impact on orthopaedic activity at Lewisham and Greenwich NHS Trust and also that the outcome of that assessment be shared with the HCASC prior to the CCG’s signing the contract. That is what is happening, and it is clearly the right thing to do.

The main concern raised by the HCASC is that the trust may see a reduction in elective orthopaedic activity, as the hon. Gentleman said, which would affect trauma services. The impact assessment will review the likelihood of a range of impacts—from a minus 40% shift in elective orthopaedic surgery to a plus 40% shift—and the resulting effect on local trauma services, emergency department services and other interdependent services at Queen Elizabeth hospital, as well as the risk to the clinical and financial viability of the trust. It will also consider the potential impact, should there be such a shift in orthopaedic surgery, on sustaining undergraduate and postgraduate training, capacity plans and backlogs, interdependent clinical services, the delivery of the national constitution standards for referral to treatment, and the implications on future recruitment of orthopaedic clinicians and support staff. Those are the parameters that were requested by the trust and others, so I think we can be confident that it will achieve its purpose.

The impact assessment is due to be presented to the Greenwich CCG board on 22 February. The report will be shared with the healthier communities and adult social care scrutiny panel the following day and published on the CCG website. The outcome of the assessment remains to be seen, but I am sure the hon. Gentleman agrees that it is essential that the CCG proceeds with what has clearly become a highly politicised decision with the best interests of patients as its core priority. As I said, the data show that we need to work to improve care for musculoskeletal patients in Greenwich, to ensure that all patients are getting the right care at the right time.

Question put and agreed to.

NHS Funding

Clive Efford Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

Those plans come up from local areas. The NHS is not projecting that we will have significant reductions in the need for emergency care over the next few years. What matters is that we make sure that, yes, people can get to an A&E near them, but that when they get there, they get the right expert care, and that is what local areas are working on.

[Clive Efford (Eltham) (Lab)]

In my constituency, a nurse-led practitioner service has been closed because of a lack of resources. Similarly, stroke rehab has been cut because of a lack of resources. Our A&Es are not meeting waiting times, and are now under threat because their orthopaedic services have been privatised and handed out to Circle, which may not contract back to their local healthcare trust, thereby undermining the capacity to maintain those A&Es. Does the Secretary of State accept responsibility for any of that?

[Mr Hunt]

I accept responsibility for the fact that in the hon. Gentleman’s part of the country, as in every part of the country, we have more doctors, more nurses and more operations than there were when his party left office.

NHS in London

Clive Efford Excerpts

Thursday 24th March 2016 Westminster Hall

[Dr Huq]

I completely agree with the right hon. Gentleman.

[Clive Efford (Eltham) (Lab)]

On the issue of community services, to which the hon. Member for Kingston and Surbiton (James Berry) referred, my local clinical commissioning group is facing a 20% cut in its funding. It has to make savings of £20 million—a fifth of its income—so services that are meant to prevent people from going into tertiary healthcare are being depleted. The Minister said that we should not alarm people, but how do we hold the Government to account if not by bringing these issues to this House for debate?

[Dr Huq]

I completely agree with my hon. Friend. We are trying to have a serious debate, but we are pooh-poohed at every turn. When my hon. Friend the Member for Hammersmith (Andy Slaughter) asked a question about the Mansfield report, he was told that he was living in a bygone age. I cannot recall the exact remark, but it was something like, “You’re an old soldier fighting a war that’s concluded.” Dismissing people in that way does not inspire confidence.

--- Later in debate ---

[Paul Scully (Sutton and Cheam) (Con)]

It is a pleasure to serve under your chairmanship, Mr Turner. I start by congratulating the hon. Member for Ealing Central and Acton (Dr Huq) on securing the debate. I was delighted to support her bid to the Backbench Business Committee to have the opportunity to debate this incredibly important subject. The NHS is source of great pride. Londoners are particularly protective of healthcare in their area, and none more so than the people of Sutton. I shall speak about my local area, but I think the story and the issues are the same throughout London.

For many years, people in Sutton have talked about St Helier hospital as the focal point of the community and of local healthcare. I serve as a volunteer at the hospital—I go regularly to feed people on the stroke ward—and I try to continue doing that even now I have been elected to Parliament, as it gives me a great opportunity to go in and see people on the front line. My family have also used the hospital. Before the last election, the right hon. Member for Doncaster North (Edward Miliband) weaponised the NHS. I tend to weaponise my mum’s use of the NHS. She has been brought in from sheltered accommodation, having taken a couple of falls, and when she injured her hand and fractured her hip, St Helier treated her really well. The hospital has a particularly good hip fracture unit that is renowned across London and, indeed, across the country.

Epsom and St Helier University Hospitals NHS Trust is predicted to run a deficit this year, despite hard work to try and break even, as it did last year. Opposition Members may use that as a brickbat to throw at the Government in respect of funding, but they fail to look at some of the symptoms behind what is happening in St Helier hospital in particular. The building has been crumbling for many years and is getting beyond use. For as long as I have lived in Sutton, which is about 26 or 27 years, there has been a political campaign, primarily by the Liberal Democrats in my area but involving other parties too, trying to “Save St Helier”—scaring people into believing that the hospital is to close imminently. Using the hospital as a political football has resulted in a failure to get some sort of consensus or agreement on how we can protect healthcare and build a really effective healthcare system in Sutton.

The trust has that deficit and the chief executive will need to tackle it without compromising quality.

[Clive Efford]

On the threatened closure of St Helier hospital, perhaps I have been in this place for longer than I should have been—[Hon. Members: “No!”] Thanks, I was hoping to get that response. I seem to remember that a Minister resigned in order to fight the campaign to defend St Helier hospital. He should have known what he was talking about, because he was a Health Minister at that time.

[Paul Scully]

Obviously he did not, which is why I won the election against him—[Interruption.] It is funny. I think the tale was that he resigned, but I do not know a lot of Ministers who would resign to save a hospital when they were one of the Ministers in charge. Others have reported that he was sacked. I do not know the truth, and I am not sure we will ever know.

--- Later in debate ---

[Clive Efford (Eltham) (Lab)]

May I start by saying what a pleasure it is to serve under your chairmanship, Ms Buck? We have been colleagues here for nearly 20 years, and this is the first time I have spoken in a debate under your chairmanship. It really is a pleasure to see you in the Chair.

I was not going to contribute, but as we have some time before 4.30 pm, I thought I should take a little time to discuss one or two issues relating to my constituency and the situation in London. Most of London’s hospital trusts are facing serious deficits, and this is an extremely worrying time for our national health service. When the London group of MPs met Dr Anne Rainsberry the other day, we asked her what the major sources of stress on our hospital trusts’ budgets are. She said that there was a failure in planning for the number of nurses that the NHS was going to require, and that because not enough training places had been made available, not enough nurses were becoming available for employment in our hospital trusts, which in turn meant that the trusts were having to look to agency nurses.

I have spoken to a number of nurses who live in my constituency. They point out that, taking into account the stress they are working under in the NHS and the pressure that they come under from management, it is easier for them to work for an agency. As an agency nurse, they can manage their time more effectively, because they are not under direct management and pressure to work extremely long hours, and earn more money, because of the shortages. Meanwhile, our NHS bill for nurses—in some circumstances nurses who were formerly employed in the NHS but have chosen to work as agency nurses—is growing.

As my hon. Friend the Member for Ilford South (Mike Gapes) said, the trusts could not recruit from overseas because nurses were not on the list of people whose professions allow them to come to the UK to work. That exacerbated the shortage and added to the demand for agency staff, and it is a major source of the problem. The lack of foresight and planning has led to this situation. Deficits are growing, and as I pointed out earlier, my local CCG is having to find savings of up to £1 in every £5 of its income to balance its budget. The knock-on effect on partnership working, for example on long-term care in the community, is frightening.

I shall not take much longer, but I want to discuss a couple of local matters. I have been advised by a local councillors that one of my local GP practices was summarily closed over the weekend. There was no notice or advice; the Care Quality Commission went in and literally put a stop notice on the practice. There are 3,800 patients at that practice. I am the locally elected Member of Parliament; can the Minister tell me why no one has been in touch with me to explain what is going on? What on earth is going on? Why do I not know about it? Why has no one from the CCG been in touch with me? Why have I not had an explanation of what will happen to my constituents because the surgery has been closed? I am really angry about this. I accept that the Minister cannot answer me right now, but will she look into the matter? I would like to hear why Members of Parliament are being overlooked in such circumstances, because I am elected to represent my constituents.

The surgery has been closed. We are told that additional resources are being made available to a neighbouring surgery—I will not name it now, but I will talk to the Minister after the debate—but what does that mean? As I understand it, the surgery that has been closed has to turn its service around within six months. How does it do that if it has been closed? What does that mean for the patients? What services are being moved into the neighbouring surgery? There are all sorts of questions. Who is communicating with my constituents? Do I get a copy of any letters, so that I know what is going on? The Minister really should look into the situation.

We have a right to be kept informed in such circumstances, because we are talking about a public service. Some 3,800 people are affected, most of whom are probably my constituents, and I would really like to be kept informed and know what is going on. I would be grateful if the Minister told whoever has failed to keep me informed to keep me informed from now on, and to take that point on board, so that in future other Members are kept informed of such serious matters in their constituencies.

We can look at the consequences of the savings that my CCG has to make. I have been in my constituency for many years as a councillor and as an elected Member of Parliament—I am in my 30th year as an elected representative of one type or another in my local community. There is an estate in my constituency on the border with Lewisham. More than 20 years ago, the local district health authority closed the doctors’ surgery on that estate because it was a single practice, and it was moved in with another practice. That left the people there with no direct access to a GP surgery. A lot of the patients affected lived on the border, so they went to GP surgeries in Lewisham.

Later, in partnership with the health authority, a local regeneration programme paid for a nurse-led practice on that estate to provide support to elderly people and families. As part of the cuts, the Source, on the Horn Park estate, now faces closure, which will yet again leave the community with no health services on that estate. That is completely unacceptable. People will have to travel a long distance to the nearest service if the Source is closed.

The CCG says that a number of the patients affected are from Lewisham, but they are not; they are actually from Greenwich, but they are considered Lewisham NHS patients. It is madness that they are to be penalised for living too close to the border with the neighbouring borough. That is just another failure in the planning of our health services. I hope the Minister will take that issue on board.

William Mead: 111 Helpline

Clive Efford Excerpts

Tuesday 26th January 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is right to say that we are doing that for hospitals. When I talk about 200 avoidable deaths every week, that is hospital deaths, not deaths as a result of problems in the 111 service. It is much harder to quantify avoidable deaths outside hospital, but we are determined to do that, and we are going further and faster than any other country that I am aware of as part of our commitment to make the NHS the safest system anywhere in the world.

[Clive Efford (Eltham) (Lab)]

The Secretary of State said that the report was

“far-reaching, with national implications.”

I have to say that this should have been a statement, not an urgent question. The right hon. Gentleman did not answer the question about the number of misdiagnoses on the 111 system. He needs to give more detail. The report suggests that other deaths of young children may be associated with misdiagnosis by 111. How many other cases are under investigation?

[Mr Hunt]

No one could have done more than this Government to tackle the issue of avoidable deaths across the NHS. It is much harder to identify when a death was avoidable when it happens outside hospital. As part of our work on reducing the number of avoidable deaths in the wake of what happened at Mid Staffs, we are looking at how we could improve primary care generally. Our first priority is to reduce the number of avoidable deaths in hospital and to learn from reports such as this one when they point to improvements that need to be made in the 111 service.

Junior Doctors Contract

Clive Efford Excerpts

Monday 30th November 2015 Commons Chamber

[Mr Hunt]

I would like to reassure categorically those doctors that that is not the intention of the changes we are making. We have made it clear that we will protect the pay of anyone working within the legal contracted hours, and in fact three quarters of junior doctors will see their pay rise as a result of these changes. We want to deliver safer care. If we are able to go ahead with the negotiations with the BMA that I hope we can in the coming weeks, I hope we will be able to put in place very strong safeguards that all sides agree will reassure my hon. Friend’s constituents.

[Clive Efford (Eltham) (Lab)]

The Secretary of State has to accept his responsibility in bringing about the cancellation of operations, because if he had been prepared to go to ACAS at the outset, all this would have been avoided. Does he accept that he is going to have to change his attitude towards negotiating with these junior doctors if we are to get the satisfactory outcome that we all want?

[Mr Hunt]

My attitude is very straightforward: I need to do the things that will make patients in the NHS safer, and I want to negotiate reasonably with anyone where there is a contractual issue that needs to be resolved. I think that the Government’s position has been reasonable. The vast majority of doctors will see their pay go up, and the pay for everyone else working legal contracted hours will be protected. This is a very reasonable offer that does a better job for patients, but it has been difficult to get through to the BMA. I urge the hon. Gentleman to talk to his friends at the BMA and to urge them to be reasonable and talk to the Government, whereby we could have avoided some of the problems.

Junior Doctors Contract

Clive Efford Excerpts

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

My hon. Friend puts it very well. The people of Bury, Tottington and Ramsbottom have long experience of very good health services provided by excellent family doctors, as well as through good secondary medical care, not just in their own constituency but around and about. They will find it surprising that, with the guarantees given by the Secretary of State and mentioned by my hon. Friend, anyone should be contemplating strike action. Equally, they will find it incomprehensible that anyone from any political party is giving that strike action any support.

[Clive Efford (Eltham) (Lab)]

The Minister has just told us that the Secretary of State is across the road in his office and cannot be bothered to come here to account for an unprecedented strike by junior doctors in our national health service. That is an absolute disgrace! The Prime Minister has said that this is his miners’ strike. The doctors are prepared to go to arbitration. The public will know that if this strike goes ahead it will be because the Government will not go to arbitration. It will be the fault of the Secretary of State and the Prime Minister.

[Alistair Burt]

I think it is of primary importance for the Secretary of State to work on contingency plans this morning to make sure that we are all safe should there be a strike. That is the task he has been given by the action that has been taken. At the same time, he has repeated that he is open to negotiations to deal with the dispute. Rather than expressing anger, the hon. Gentleman should be expressing concern that a contract that makes an unsafe situation for doctors safer is not being backed more readily by those on the Opposition Front Bench, who should also be rejecting strike action.

A&E Services

Clive Efford Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Reed]

The hon. Gentleman has made that point on the Floor of the House on many occasions, and he has been a constant voice with regard to the hospital services used by his constituents. That was a decision made by clinicians in the area, and he will recognise that. He will recognise also how much the framework has changed and how much more difficult the Government have made it for communities such as his to have their say on health reconfiguration.

[Clive Efford (Eltham) (Lab)]

My hon. Friend is absolutely right. The point is not that there should never be any change in our national health service. When clinicians plan it and put it forward to improve services, we are right to support it. The difference is that the Conservative-led Government came in and attempted to close A&Es from the centre, such as Lewisham A&E, which they were going to close. They said they would not close Sidcup A&E, but they closed it within months of entering government. That is the difference: the Government dictated the closures, not local clinicians.

[Mr Reed]

My hon. Friend is absolutely right. The lesson that the Prime Minister and Secretary of State drew from those episodes was, “When you get beaten in the courts, change the law”—a completely different approach from that of the previous Labour Government.

--- Later in debate ---

[Ben Gummer]

I am sure that the shadow Minister has come to the House without reading the speech in which my right hon. Friend the Secretary of State directly addressed the issues caused, in some trusts, largely by agency spending, which took place because of the chronic understaffing created by the previous Government, and put right by us. That led in part to the catastrophe at Mid Staffs. The shadow Minister has not read my right hon. Friend’s comments about limiting the salaries of highly paid managers in the NHS, or his comments about cutting consultancy pay. It is precisely that kind of action—including enabling chief executives of NHS trusts to control their budgets—that this Government are taking to ensure that, nationally and locally, we are living within our means.

[Clive Efford]

The Minister says that the Government responded to Mid Staffs. Will he give us a guarantee that there will be no removal of the minimum staffing requirement that came in on the back of the Mid Staffs report?

[Ben Gummer]

I can guarantee that to the hon. Gentleman. On minimum staffing, it was in response to the Francis inquiry that this Government, in their previous incarnation, set the Care Quality Commission a specific target of doing something about minimum staffing. That did not happen before then. He understands that relationship between safe care and money. I just wish that he was able to explain it to his colleagues on the Front Bench, because if they went to the Salford Royal hospital, they would see how, through instigating safer care, it is saving £5 billion a year. It is by combining quality and efficiency that we get the double benefit of better care for patients and better returns for the taxpayer.

Mental Health and Well-being of Londoners

Clive Efford Excerpts

Thursday 12th February 2015 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I beg to move,

That this House has considered mental health and wellbeing of Londoners.

First, I would like to thank the Backbench Business Committee for giving me the opportunity to raise the important question of the mental health and well-being of Londoners. Mental health touches all classes and cultures in London. In consequence, it is important not just that it be viewed within the paradigm of health care but that we understand that all elements of London’s socio-economic development are deeply rooted in the well-being of our city’s residents. Unless we start seriously to tackle what I believe to be a rapidly unravelling crisis of service provision for mental illness, we will begin to see dire ramifications surfacing in all aspects of society, including education, family stability and public order.

As the House will be aware, I have thrown my hat into the ring to be Labour’s candidate for London Mayor. If anything, this has sharpened my interest in these matters. Fundamentally, however, my interest in this subject derives from the fact that my mother was a nurse, and in the latter half of her career, she was a dedicated mental health nurse. I saw the mental health system through her eyes—the problems, the challenges—but above all I saw that she loved her job and that she genuinely loved the people she nursed. Through her, I have always had an instinctive idea that people with mental health issues are human beings, too, and deserving of our love and care.

For three years, I was privileged to be shadow public health Minister, and I was able to meet and learn from many dedicated workers in both the public and voluntary sectors in the mental health field. The sad truth is that mental health provision has long been chronically underfunded, and now, during a time of unprecedented demand, the concern is that spending might be falling dramatically in real terms.

[Clive Efford (Eltham) (Lab)]

On the point that funding might be falling, we in London also face the problem that the cost of living is growing. Many people working in public services such as mental health nurses and workers in mental health care are often low-paid in comparison to others. People who come to see me are having difficulty finding places in London and some services are finding it difficult to recruit staff, which has a knock-on impact on the standard of services. I wonder whether my hon. Friend would comment on that.

[Ms Abbott]

I very much agree with my hon. Friend. As he says, there are cost of living issues. Then there are spiralling housing costs. Health care in London has some of the biggest turnover and some of the highest vacancy levels of any health care provision in the country. The pressures of the cost of living crisis and the housing crisis are making it increasingly difficult to provide permanent staff to meet the health care needs in general and the mental health needs of Londoners.

I shall focus in my speech on the cost to London of the mental health crisis and the importance of parity of esteem between mental and physical health, about which Members on both sides of the House have spoken. It is important to stress it, because we are nowhere near parity of esteem when it comes to the questions of finance and resources. I also want to talk about the mental health and well-being of London’s lesbian, gay, bisexual and transgender community, and about the growing crisis of mental illness among our children, adolescents and young adults. I shall also deal with something not often spoken about—mental health issues in our black and minority ethnic communities in London.

It is important, because mental health is sometimes a marginalised issue, to talk about the huge cost of the mental health challenges to London. Recent figures indicate that almost a million adults of working age in London—15.8% of the adult population—are affected by common mental disorders such as anxiety and depression. I was in the House about 18 months ago when Members of all parties bravely talked about their own experience of depression and how they felt a stigma and found it very difficult to get treatment.

It is estimated that 7% of London’s population have an eating disorder, that one in 20 adults has a personality disorder; that 1% of Londoners are registered with their GP as having a psychotic disorder such as schizophrenia, bipolar and other psychoses; and that nearly half of Londoners are anxious. London has the UK’s highest proportion of people with high levels of anxiety. In addition, almost a third of Londoners report low levels of happiness, which must clearly be exacerbated by the cost of living issues we have mentioned. The number of Londoners reporting low levels of happiness is well over 2.5 million. We London MPs see many of them in our surgeries week after week.

In basic economic terms, almost £7.5 billion is spent each year addressing mental health issues in London, while according to the Greater London Authority, the wider health, social and economic impact of mental illness costs the capital an estimated £26 billion. In social care costs alone, London boroughs spend around £550 million a year treating mental disorder, and another £960 million each year on benefits to support people with mental ill health. There are some concerns about the changes in welfare and the—

Francis Report: Update and Response

Clive Efford Excerpts

Wednesday 11th February 2015 Commons Chamber

[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.

[Clive Efford (Eltham) (Lab)]

It will take a great deal to change the culture. I have spoken to a senior hospital manager who would like to express his concern about the lack of qualified nurses, forcing him to advertise posts abroad. I have spoken to two A and E nurses who are concerned about the critical situations occurring at their unit every day. One of them has become an agency nurse so she can limit the number of hours she is forced to work. Then there is an ambulance worker who is concerned about the 12-hour shift and the lack of time he is given to clean his ambulance between dealing with patients. They would all like to come forward to express their concerns, but they do not feel that anyone above them would listen. What can the Secretary of State say today to reassure those people?

[Mr Hunt]

I can say that we are consulting on making a big change that would mean they would have someone independent in their organisations to whom they could talk and raise their concerns. They could say, “I want to say this, but no one is listening to me”. That is what Sir Robert Francis calls “freedom to speak up” guardians, whom he wants in every organisation. It is what Helene Donnelly is championing in her work. That is the way forward to address those concerns.

NHS Major Incidents

Clive Efford Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

It was not raised by NHS England on Monday because I did not know about this local guidance, as I had absolutely nothing to do with it.

[Clive Efford (Eltham) (Lab)]

Can the Secretary of State explain why in the incident response plan from NHS England there is an entire paragraph headed “Politics” under the principles for considering an escalation response? In the House on 7 January he said:

“The decision to declare a major incident is taken locally—there is no national definition”—[Official Report, 7 January 2015; Vol. 590, c. 273.]

However, the guidance issued in the middle of January says that major incidents

“should be agreed...with the Director on call for NHS England”.

If it is not political, the Secretary of State owes the House an explanation of NHS England’s involvement and the meaning of that paragraph.

[Mr Hunt]

The hon. Gentleman has quoted selectively; he has not quoted the whole guidance. If he looks at the whole guidance, he will see that it clearly states that a responsible trust, before it declares a major incident, which is its decision, must make sure that there is not going to be a negative impact on the rest of the economy, because patients must always come first. He is also not saying what Dame Barbara Hakin said this morning —that none of this guidance was anything to do with Ministers.