Primary Care: North Essex

Douglas Carswell Excerpts

Tuesday 14th March 2017 Westminster Hall

[Mr Douglas Carswell (Clacton) (UKIP)]

I beg to move,

That this House has considered primary care in North Essex.

I am grateful for the opportunity to have this debate. We face a serious problem of primary care provision in our corner of Essex. To put it bluntly, there are not enough GPs. In my part of Essex, there are three local GP surgeries, which are not taking on any new patients at all. Those fortunate enough to be registered with a surgery often struggle to get an appointment.

Here are some of my constituents’ experiences, pulled out from my postbag in the past three weeks, to give a flavour of what they are having to put up with. An elderly lady from Little Clacton wrote to me a couple of weeks ago:

“On attending the practice, I realised that there was an average of three weeks waiting time to see a GP. … When I did finally get seen, the practice nurse said, and I quote, ‘You have to be at death’s door to get an urgent appointment on the NHS now.’”

This is a woman who has spent decades paying into the system, unable to see a doctor for three weeks.

Then there is a lovely lady from Kirby near Frinton who emailed me, saying:

“I’m writing to say how abysmal the doctor’s surgery is now. I waited two weeks for an appointment, only to be told to go to a different surgery if I wasn’t any better in two weeks.”

There is not much sign of customer service there, is there?

Finally, a man from Clacton wrote:

“I am my mother’s carer. I’m not a doctor. I just do my best and feel abandoned by my medical practice. I am having great trouble making appointments for my mother to see a doctor so that we can control her pain.”

Those are not isolated cases. My postbag is full of examples—it is fair to say that something is badly wrong with primary care in our part of Essex. What concerns me is that it was possible to see the problem coming. Back in September 2013, I led a delegation of GPs to see the Health Secretary to flag it up, precisely because GPs said the problems were going to happen.

To be fair to Ministers, we in this room all know—I hope people outside know it too—how disastrous the 2004 GP contracts were. They were certainly disastrous for those who are meant to be provided with primary care—but that is now more than a decade ago. We also recognise that a Minister cannot, as I think Nye Bevan put it, be held responsible for the “sound of every dropped bedpan” in every NHS surgery and waiting room. In fairness, I do not think we can blame Ministers for the failure of individual surgeries to get their appointment systems sorted out. But the question is, who does take responsibility? Who will answer to my constituents for these failings?

It is clear there has been a failure to provide the level of primary care that is needed in our part of Essex. What is less clear is who we hold to account. We have an alphabet soup of different agencies and quangos in charge, but none of them seem to be properly responsible. There is something called the CCG—the clinical commissioning group. It allocates the money and the patient is then expected to follow. The technocrats commission and the patient is expected to follow. Then there is the CQC—the Care Quality Commission. It inspects the GP surgeries. Would it not be better if surgeries had to satisfy customers and not simply comply with CQC assessments? Then, of course, there is NHS England, and in our part of Essex, something called ACE—Anglian Community Enterprise—which provides certain primary care services.

I have raised concerns with all those different branches of NHS officialdom on behalf of constituents and I have done so repeatedly. Promises are invariably made. I am told that we will get more GPs, that new contracts and a new kind of contract will be sorted out—always tomorrow. Not much ever actually seems to change on the ground.

Sometimes I am told, or it is implied—they do not dare tell me this any more because I react very strongly to it—that all of this is to be expected. There is, they say, an elderly population in our part of Essex. The profile of the patient group, I was once told, means that there is all this extra pressure.

Those sentiments are excuses for failure; they are not credible reasons. We should not be in the business of blaming people for being elderly. After all, if someone is elderly, it means they have paid more into the system. In what other walk of life or area of activity is a surfeit of customers regarded as a problem? In Clacton, it is possible—I speak as a father—to go shopping for the family 24 hours a day, seven days a week, so why is it not possible to see a GP on a Saturday if a child is ill?

At the root of the problem is a system of state rationing—it is probably one of the last vestiges of the mid-20th century system of state rationing—in which the patient is expected to stand in line and wait. The patient is made to follow the money. We need a system of primary care in which the money—for a taxpayer-funded service, free at the point of access—follows the patient.

Ministers are absolutely right to want to see surgeries open on a Saturday, at weekends and in the evenings. Heaven forbid, if we really had a system of primary care that responded to my constituents’ needs, there might even be GP surgeries in railway stations, where quite a large number of my constituents tend to congregate in the early morning and late evening. If we are to have a more accessible, customer-focused service, it means making the patient king. It is not something that can be done by top-down design or by ministerial decree. Good customer service comes from the need to please customers, not from on high.

GPs tell me that the burden they face could be alleviated in part if more people were willing to use and made better use of pharmacists. There is a lot of truth in that. Pharmacists are highly qualified and often very experienced, and we are right to look into that. I say this in the week when we have finally passed the legislation to get us out of the EU, but perhaps we could learn from some of our European neighbours who seem much better at making good use of pharmacists, particularly Italy and France. I gather that in Germany people do not have to depend on the equivalent of a GP acting as a gatekeeper in the way that we do in this country. I would be very grateful if the Minister could elaborate and talk about not just what we can do to alleviate the problems in our part of Essex but the far-reaching reform that is needed if we are to make sure that people who have spent all those years paying into the system can be seen by a doctor when they need to.

[Will Quince (Colchester) (Con)]

I recognise the issues that my hon. Friend rightly raises. Does he agree that a direct result is the considerable pressure placed on the general hospital in Colchester, which serves his constituents and mine, and that the foolhardy decision to consult on the closure of minor injuries units and the walk-in centre in Colchester should be dropped immediately, because it is such a ridiculous idea? It will just put additional pressure on Colchester general hospital.

[Mr Carswell]

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

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

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

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

[Mr Carswell]

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

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

Oral Answers to Questions

Douglas Carswell Excerpts

Tuesday 10th May 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Sussex CCGs are responsible for monitoring Coperforma’s performance, and High Weald Lewes Havens CCG acknowledges that, as my hon. Friend said, the early performance of the new non-emergency patient transport service has not been acceptable. For that reason, the CCG, on behalf of all Sussex CCGs, has begun an inquiry, with the aim of making a report available by June, and with interim progress reports. We will of course monitor the issue carefully.

[Mr Douglas Carswell (Clacton) (UKIP)]

T5. In my corner of Essex, there is a primary care crisis: demand for GP services is rising, the supply of GPs is falling and many surgeries are simply no longer accepting new patients. What assurance can the Minister give me that we will definitely get more GPs, and when will we get them?

[Alistair Burt]

The concerns the hon. Gentleman raises are very real, and they are shared by GPs around the country, which is why we put so much work into analysing them. The recently published “GP Five Year Forward View” addresses a number of concerns brought to us by GPs, but the determination to have 5,000 more doctors working in general practice by 2020 is a reflection of the fact that making sure there are enough doctors physically to work in general practice is an important aim of the Government’s.

Oral Answers to Questions

Douglas Carswell Excerpts

Tuesday 7th July 2015 Commons Chamber

[Jane Ellison]

I congratulate my hon. Friend on securing so many Adjournment debates. Our most recent debate took place only a couple of weeks ago. He is right to continue to remind us of the contribution that the Porton Down site makes to the UK economy. I can assure him that the outline business case has been and is being scrutinised by Ministers, and that that includes an economic assessment. However, as I have said on previous occasions when we have debated the matter, Public Health England will remain committed to the site even if research staff are relocated.

[Mr Douglas Carswell (Clacton) (UKIP)]

T6. What concrete steps is the Secretary of State taking to increase the number of GPs and ensure my constituents can be seen by one when they need to be?

[Alistair Burt]

As has been discussed extensively during this Question Time, the Secretary of State has announced a programme that will include increasing the numbers training to be GPs, improving not only the recruitment but the retention of GPs, and work to make general practice more attractive to those who are worried about that. With all these measures, we will do our best to boost the position of general practice within an expanded primary care system in future, and I hope we can meet the concerns of the hon. Gentleman and his constituents.

Health and Social Care

Douglas Carswell Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Douglas Carswell (Clacton) (UKIP)]

It is an honour to follow the hon. Member for Eastbourne (Caroline Ansell). I remember sharing a platform with her when I campaigned for her in her constituency about a year ago. She was clearly a worthy candidate and she is a winner now, so I am delighted to see her here.

I may be my party’s only voice in the House of Commons, but I shall speak on behalf of not only my constituents, but the millions who voted for my party. I may have only one vote in the Division Lobby, but I shall use it to support Ministers when they do sensible things, to oppose the Government when they are being daft, and, when I think it is possible to improve things, to try to amend things to make them better.

There is, in short, much in the Queen’s Speech with which I agree. This is ostensibly a debate about health and social care, and I will direct most of my comments to that, but it would be remiss of me if I did not touch on one subject that is central to the long-term health and wellbeing of our nation in its broader sense, and that is the Europe question. I am absolutely thrilled and delighted that there is a European Union Referendum Bill in the Queen’s Speech. That is truly magnificent.

I remember 111 hon. Members from both sides of the House voting in October 2011 for an in/out referendum Bill. We were opposed on that occasion by Members on both Front Benches, all the Whips and, indeed, many of the pet pundits. It is wonderful that the Front Benchers, including Labour Members, have changed their minds and converted to the case for a referendum.

We should be generous to Ministers as they bring the Bill before the House. This is not a time for bickering or semantics. The Government have got it right on the big issues in this Bill. I think they are right about the franchise and more or less right about the wording, and I think they are even right on the timing, too. The campaign to leave the European Union begins with this Bill, and we are only going to win it if we are relentlessly upbeat, optimistic and generous. We should begin today by being generous to the Government.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I am interested in what the hon. Gentleman is saying. Does he therefore agree that the worst possible scenario would have been the policy articulated and advocated by UKIP, which was to hold a referendum now, without any reform of the European Union, when all the polls suggested that the result would be staying in an unreformed EU?

[Mr Carswell]

I am pleased that the hon. Gentleman is being generous, but he is also being a little unfair. My party’s position was to get the legislation on the statute book. Those of us who want to maximise the chances of the out campaign winning recognise that it would be helpful if the Prime Minister tried to negotiate a new deal and failed to bring back anything significantly different. If the Prime Minister wants to take his time to conjure up this fictitious new deal, let him do so. The more he is seen as being Harold Wilson mark 2, the greater the chances of the undecideds going into the no column.

During the referendum debate that will follow, we also need to be generous to those who will be pro-Brussels, including perhaps the hon. Gentleman. We must seek to convince them that Brussels is not a seat of high-minded internationalism, but a nexus of vested interests and a den of crony capitalism.

I hope also to be able to support the education and adoption Bill—something is wrong with some of the adoption process in this country—and I hope we will use it as a chance to look at what other countries do when it comes to adoption, particularly Scandinavian countries such as Denmark.

I want to support the childcare Bill and will study the small print. The issue of affordable childcare is very important in my constituency. I will look with interest at the detail of the housing Bill, too. It is a very good idea to support self-build and, indeed, a brownfield register.

The Health Secretary outlined ideas to change and improve our national health service, including the importance of putting more money into healthcare. Given the advances in medical technology, the ageing population and rising expectations, my party supports that. As nations become richer, it is natural that we should want to spend more on health. The Health Secretary seems to be talking about championing the patient’s interest, as opposed to that of the producer. He seems to be talking about seven-day surgeries and using innovation to allow people to access better care, and my instinct is very much to support that agenda.

The Health Secretary also touched on the challenges we face as a country when it comes to healthcare, including coping with dementia and social care and the need to do more for mental healthcare. There is clearly a shortage of GPs, there are clearly problems at A&E departments, and ambulance response times are not good enough. There needs to be a culture change in the health service. Those challenges and problems are very real, certainly at Colchester hospital, which serves many of my constituents, as Members on both sides of the House will recognise.

We should not forget, however, that we are living in an age of unprecedented progress. There will be 1 million more people over the age of 70 at the end of this Parliament, because we are living longer, healthier lives. Excessive alcohol consumption, particularly among younger people, is falling. Cigarette-related deaths are falling: e-cigarettes are providing a modern, cheap solution to the age-old tobacco problem. Diseases that were once terminal are in retreat. A whole new generation of tailor-made drugs are on the horizon. The public policy choices that any Minister will have to grapple with are difficult, yet they are choices borne of rising expectations, greater medical capability and greater scrutiny.

I imagine I will oppose much of what this Government do. I regret what is not in the Queen’s Speech as much as I support what is in it. There is a failure to introduce meaningful political reform. There is nothing in it that will make Government more properly accountable to Parliament and Parliament more properly answerable to the people. There is little in it to disperse power outward and downward, or to personalise public services in the way I think they need to be.

When I challenge the Government’s shortcomings, however, I will do so cheerfully and in the belief that, yes, things are not good enough, but that is because they could and should be better. I will be optimistic and cheerful in opposing the Government when I need to do so, and I will support them when I think they are doing the right thing.

Oral Answers to Questions

Douglas Carswell Excerpts

Tuesday 24th February 2015 Commons Chamber

[Dr Poulter]

Our NHS has always benefited from overseas staff bringing their skills and coming to work here, and we can all welcome that as long as they have a good standard of spoken English, which is something that we are putting right through the legislation that we are introducing. As I outlined earlier, there are now around 7,500 more nurses, midwives and health visitors working in the NHS than there were under the previous Government.

[Douglas Carswell (Clacton) (UKIP)]

2. What contingency plans his Department has formulated to cope with the expected increase in the number of GPs retiring before 2020.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

In addition to the extra 1,000 GPs working in our NHS since 2010, our mandate to Health Education England will ensure that 50% of trainee doctors enter GP training programmes by 2016. This will enable the delivery of 5,000 additional newly qualified GPs by 2020.

[Douglas Carswell]

I am told that many young doctors are choosing not to go into general practice. That, coupled with the number of retiring GPs, is leading to real shortages in places such as Clacton. What more can be done to make general practice more attractive to young doctors, in order to offset the number of GPs who are retiring?

GP Services

Douglas Carswell Excerpts

Thursday 5th February 2015 Commons Chamber

[Stella Creasy]

I apologise for using shorthand. My right hon. Friend is completely right. I am talking about type 2 diabetes. For example, many people from the south Asian community in my constituency have type 2 diabetes.

We are told that our local GP work force needs to grow by 40% by the end of the next Parliament if it is to serve the community I represent. However, I can already see very real problems with our local community service, and that is bad for the patients and for the rest of the NHS. We know how difficult it is to recruit and retain doctors, but in my part of town, with the high cost of living in London, it will get even harder.

Since 2011, complaints about GP access have rolled into my constituency office. Let me give the Minister some examples. Just the other day, a resident rang me and said: “Look, the receptionists were perfectly polite. They said call at 9 o’clock or queue up before the surgery opens to get an appointment, but the line was constantly engaged from 9 o’clock. My phone shows I called 28 times between 9 am and 9.30 am, and I could not get through. When I did get through, it was only to be told that there were no more appointments left.” That is not unusual in my community.

Little wonder that residents in Walthamstow routinely report that it takes two weeks to get an appointment with a doctor. Nationally, we know that one in four people wait a week or more. The problem—this is why I disagree with the hon. Gentleman—is that it is very hard for people to know whether or not they need to see a doctor, especially if they are worried about a child.

Let me give another example of a complaint I received just the other day: “I have had constant problems trying to get a GP appointment for my 13-month-old daughter since she was born. A couple of times, even only last week, I was asked by reception staff at the doctors why I hadn’t gone to A and E.” That is the constant question for residents in my local community when they cannot get through to the surgery—should they wait or should they go to A and E?

I agree with the hon. Gentleman that not everybody needs to see a doctor, but another resident told me: “I fell and cut my hand deeply on glass. I went to the doctors to ask if a nurse could check that there was no glass left in. They told me to go to hospital. The cut was really not that bad. But they said they don’t have any nurses on a Friday and I would have to make an appointment to see a nurse—two weeks as usual, no doubt—so I just left it, as I do with most pains, coughs or small lumps, and hoped it would sort itself out. My hand is healing now and seems to be glass-free. I hope so anyway.” That is not unusual in my area. At least that elderly lady could have seen a nurse, but many constituents tell me that they do not bother to see a doctor because of how long that takes, and they take the risk of waiting.

[Douglas Carswell (Clacton) (UKIP)]

I am very interested in what the hon. Lady is saying, because it sounds ominously like the situation in Clacton. Indeed, in one Frinton surgery in my constituency, one doctor was trying to serve 8,000 patients. She is absolutely right to avoid the temptation to blame the patients or to suggest that they are the problem. Does she agree that part of the answer is to ensure there are far more attractive terms for would-be GPs? That does not necessarily mean higher salaries—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Mr Carswell, interventions are meant to be short, not speeches. I am sure you have got to the point.

A and E and Ambulance Services

Douglas Carswell Excerpts

Thursday 18th December 2014 Commons Chamber

[Mr Hunt]

What my right hon. Friend has said about what is happening in Oxfordshire is very important. I commend the efforts that are being made there, as well as those that are being made in so many other parts of the country. It is interesting to note that all the questions that are being asked by those on the Government Benches are about the details of how we can help the NHS to get through the winter, while on the Opposition Benches it is all about politics. I think we know which side cares about patients the most.

[Douglas Carswell (Clacton) (UKIP)]

There have been serious problems with ambulance response times in Clacton. I recognise that the ambulance trust is addressing some of them, and I recognise that the Secretary of State is taking genuine steps, not least in establishing proper inspection systems, which is fantastic. However, many of the problems have been connected with turnaround times at Colchester hospital’s A and E department. Would it not be helpful if patients could access primary care via GPs in the first place rather than being forced to go to A and E departments? Emergency care would be then accessible in emergencies.

[Mr Hunt]

The long-term solution is to provide more GPs and GP capacity, which is why we plan to train 5,000 more GPs over the course of the next Parliament, but that will take time, so we need to find shorter-term solutions. We are working with the Royal College of General Practitioners to establish what can be done in the short and medium term.

Oral Answers to Questions

Douglas Carswell Excerpts

Tuesday 25th November 2014 Commons Chamber

[Dr Poulter]

It is very important that the NHS faces up to the situation when things have gone wrong so that it can put them right for the benefit of patients in future. If the right hon. Gentleman has concerns about his local NHS not investigating complaints that he has raised with it on behalf of his constituents who are patients of the local trust, I am very happy to investigate those issues for him if he would like to write to me about them, and see what I can do to ensure that he gets the answers that he and his local patients deserve.

[Douglas Carswell (Clacton) (UKIP)]

I understand that pretty much every hospital in Essex faces a yawning deficit, including Colchester hospital. Can the Minister guarantee that we can address the deficit without having to dramatically and radically reconfigure local services in Essex?

[Dr Poulter]

It is important to outline that for the first time this Government have put in place, via section 42 financial agreements with trusts where there is a requirement for interim financial support, measures that will ensure that trusts are held to account for delivering efficiencies—for example, reducing agency staffing costs, improving procurement practice, more efficient estate use and land disposal, and pay restraint of very senior managers. I am therefore confident that the local NHS can continue to deliver efficiencies to direct money to front-line care.

Oral Answers to Questions

Douglas Carswell Excerpts

Tuesday 1st April 2014 Commons Chamber

[Mr Jeremy Hunt]

Unfortunately, a third of Welsh patients do not get things such as urgent scans within six weeks, compared with just 1% of patients in England. The Welsh NHS is struggling badly. I urge Labour, if it is to be consistent, to work closely with its colleagues in Cardiff to give a better standard of care to people in Wales, because they deserve a good NHS as well.

[Mr Douglas Carswell (Clacton) (Con)]

There is due to be a consultation on the future of maternity units at Clacton and Harwich hospitals. Last week, however, the management team at the already troubled Colchester trust decided to shut the units anyway. That has caused great anger and concern locally. Will my hon. Friend write to the board to ensure that it does not prejudice the outcome of the consultation and that decisions are made on the basis of fact, not muddled management?

[Dr Poulter]

I will certainly be happy to look into the issue. My hon. Friend will be aware that the closure decisions were made on clinical safety grounds, for the safety of women. It is a temporary issue. One of the outstanding problems in my hon. Friend’s part of the world and elsewhere when we came into government was a historical shortage of midwives. That is why we are investing in more midwives. There are already 1,500 more in the NHS and I believe that six more will be recruited to the local NHS in his area.

East of England Ambulance Service

Douglas Carswell Excerpts

Tuesday 25th June 2013 Westminster Hall

[Priti Patel]

My right hon. Friend is right. The issue is the turnaround of the trust and a key thing is to learn from successful ambulance trusts. That means looking at skills and capabilities as well as at times, both in urban centres and rural parts of constituencies. The east of England is a big region, and we must consider how resources can be correctly allocated to ensure that patients are not left waiting as they have been in the past.

Most of the executive directors at the trust have moved on, and the former chair, Maria Ball, resigned recently after the CQC report earlier this year. However, it is deeply alarming and thoroughly disgraceful that five non-executive directors who have presided over the mismanagement of the trust still sit on the board. They are Paul Remington, Phil Barlow, Margaret Stockham, Anne Osborn and Caroline Bailes. They all seem to refuse to take any responsibility for the failure that they have presided over, and they continue to receive funds from the taxpayer to continue in their role. By choosing to remain in post they are putting their own interests above those of the public, patients and front-line staff.

[Mr Douglas Carswell (Clacton) (Con)]

I congratulate my hon. Friend on bringing the issue up for discussion. There has been a series of appalling incidents in my part of Essex as well, in Tendring. Are not all the failures further evidence that the ambulance trust is run for the convenience of the senior management on the payroll, and not that of the taxpayer who pays taxes to be provided with an ambulance? Surely we need proper accountability, which means examining the regional structure, which is too cumbersome, and perhaps adopting a system of local accountability, putting it at county level as it once was. We should also make sure that the service is not stuffed full of quangocrats, and that the people who are there to speak for the taxpayer are accountable to the taxpayer, rather than having CVs full of parasiting off the taxpayer.

[Priti Patel]

My hon. Friend makes some pertinent and valid points. Transparency and accountability are key things. I have touched on the issue of the revolving door in the NHS, but cronyism is another issue. We must stop the same people being placed on and recycled around various boards in the NHS. NHS board members should put patients first, but, as the governance review by Dr Marsh concluded,

“there is a lack of focus and grip from the Board which has contributed towards the deterioration of performance across the Trust.”

The question, as we have already heard, is whose interests the board is serving. It should be putting patients first.

The Minister will know that the review is full of many other statements about the board, each of which is a damning indictment of each non-executive director and of the board. As to the quality risk profile showing that a number of outcomes relating to patient care and welfare were not being achieved, the review states at page 13:

“The Board should be taking leadership decisions and actions on these Outcomes and holding others to account,”

but of course there has been collective failure and

“this doesn’t appear to be happening.”

On page 14 the review refers to the current trust board and senior management team appearing to have developed “a sense of ‘helplessness’” and states that

“the Board have not been taking both the responsibility collectively as well as they could or should have and that Board members have not been held to account”.

On page 18 the report highlights

“a lack of confidence and trust that the Board has the expertise, experience or gravitas to respond to the substantial challenges facing the organisation.”

Page 22 contains the conclusion that

“the overall Governance arrangements cannot have been adequate for the Trust to get into this much difficulty.”

The non-executive directors’ fingerprints are, to be frank, all over the crisis. The trust is experiencing major failures, and every day that the individuals remain on the board they are being financially rewarded for blatant failure. Their poor leadership and inability to acknowledge and deal with the challenges facing the trust have led to patients’ lives being put at substantial risk. The trust’s staff survey results have demonstrated the lowest morale in the country.

My hon. Friend the Member for Suffolk Coastal and I wrote to Paul Remington while he was acting chair, to ask him and his fellow non-executive directors to explain their actions and what they had done about improving the trust. We wanted to give them a fair and proper chance to explain themselves in the aftermath of the CQC’s report earlier in the year. We received a substantive reply from Mr Remington two months later, on the eve of the publication of the Government’s review, and it was light on information and did not acknowledge the mess that the trust was in. It was thoroughly unconvincing. In view of those poor responses I hope that the Minister will appreciate that the presence of those non-executive directors on the board is undermining public and staff confidence in the trust. It is scandalous that they have not already been dismissed, and shocking that, despite the publication of the Marsh review, board members whose terms are due to expire this year are to be reappointed for the foreseeable future. The report of the chair and chief executive for tomorrow’s board meeting states that, during the recruitment process for the new non-executive directors,

“the TDA has agreed to extend Mr Remington’s period of service on an interim basis.”

That is utterly unacceptable. Why should Mr Remington and other non-executive directors be allowed to continue on their taxpayer-funded ride, when they have failed so miserably to fulfil their responsibilities? What will happen to the other non-executive directors, whose terms do not end this year? How much longer will they be permitted to remain in post? They refuse to do the right thing and step down, so I urge the Minister to recommend to the Secretary of State and the NHS Trust Development Authority that they should use their powers to remove them with immediate effect, before the board meets in Bedford tomorrow.

In addition to the board’s inability to lead the trust, its secretive and unaccountable handling of criticism by Members of Parliament is also disturbing.