Oral Answers to Questions

Helen Jones Excerpts

Tuesday 9th February 2016 Commons Chamber

[George Freeman]

My hon. Friend makes an important point. It is right that the crisis resolution and home treatment teams were criticised in the recent CQC report for not providing adequate home treatment. That is why the Prime Minister announced in January that we are providing an extra £400 million in funding for those teams. It is also why, in the mandate, we recently required that NHS England not only agree but implement a plan to improve crisis treatment in all areas.

[Helen Jones (Warrington North) (Lab)]

Does the Minister now accept that the Government’s decision to slash funding to local authorities was disastrous for adult social care, as the Government were warned at the time it would be? Does he also accept that the social care precept, which the Government are allowing councils to levy, will raise the most money in those councils with the highest council tax base, not necessarily in those with the greatest need?

[George Freeman]

I would be concerned if that were true. The point is that we are facing extraordinary, exploding demand in our system. At the risk of sounding like a Monty Python sketch, what have the Government done, apart from launching the £3.9 billion better care fund and a £2 billion social care precept; fully funding the NHS five year forward view, with a front load of £3.5 billion; driving health devolution; and providing £4 billion for health technology? We are funding the integration of health and care in a way the last Labour Government never did.

NHS Bursary

Helen Jones Excerpts

Monday 11th January 2016 Westminster Hall

[Paul Scully]

I do not believe so. There were similar predictions for students in general when the student fee loan system came in, but that did not happen. People thought that student numbers would decline. They have not; they have increased. I do not believe that diversity in university courses in general has declined and I do not see any reason why that should be the case with nursing, although I understand the concern. A number of people have raised that concern both in Twitter conversations that we and nurses have had and in a number of events that have been held in the lead-up to this petition debate, including the one immediately before the debate. I understand the concern but I do not see the evidence.

[Helen Jones (Warrington North) (Lab)]

The hon. Gentleman will have heard, as I did, in the discussion that we just had with many student nurses that many of those going into the profession are mature students. Sometimes they already have debts from previous degrees or they have families to keep. If we are to maintain diversity and encourage people with considerable life experience to enter the profession, we must incentivise them to do so and not load them with more debt.

[Paul Scully]

I will just complete my comments regarding student loans in general, but then I will come directly to the hon. Lady’s point because it is one of the issues particular to nurses that I mentioned a little while ago. Student loans in general do not go on credit files, so the only way that a loan, credit card or mortgage company will know if someone has a student loan is if they ask for it. Obviously, for bigger loans, they tend to ask. Student debt is not accounted for by mortgage lenders in terms of the total amount owed, although they will look at the affordability of the loan and at an applicant’s outgoings. When tuition fees and student loans were first introduced, the Council of Mortgage Lenders confirmed that lenders would not use that or add that total debt to the amount owed when they considered mortgages.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 5th January 2016 Commons Chamber

[Ben Gummer]

My hon. Friend is right to point out that there are different ways into nursing. Just a few weeks ago, we announced a massive expansion in apprenticeships across the NHS, and I anticipate that a significant number will be for those going into nursing. The new post of nursing associate is a vocational route into nursing via an apprenticeship. In addition, our reforms to bursaries will ensure that there is a 25% increase in funding to recipients, bringing it into line with the rest of the student cohort. That cohort has seen a considerable expansion in the number of students coming from disadvantaged backgrounds as a result of the reforms that we undertook in 2011 and 2012.

[Helen Jones (Warrington North) (Lab)]

Does the Minister accept that his Government’s decision to cut nurse training places by 3,000 a year since 2010 has led to the huge shortage of nursing staff in the NHS and an increased reliance on nurses recruited from abroad and expensive agency staff, and that that will get worse with the abolition of bursaries? Is not this a textbook example of a false economy from the Government?

[Ben Gummer]

The hon. Lady should look at the facts. March 2015 saw a record number of nurses in the NHS—319,595. We are increasing the number of nurse training places. We are able to increase them by considerably more than we could have done otherwise, as a result of the reforms to student finance that bring nurses into line with teachers and other public sector professionals.

Sugary Drinks Tax

Helen Jones Excerpts

Monday 30th November 2015 Westminster Hall

[Helen Jones (Warrington North) (Lab)]

I beg to move,

That this House has considered e-petition 106651 relating to a tax on sugary drinks.

The Petitions Committee has scheduled the debate to coincide with the publication of the report by the Select Committee on Health about childhood obesity. I did not have the advantage of seeing that report when I drafted my speech, but I am sure that the hon. Member for Totnes (Dr Wollaston) will enlighten us further if she catches your eye later, Mr Hamilton. It is a great pleasure to see many members of that Committee here.

The petition was prompted by real concern about the health problems that are being caused by rising levels of obesity, particularly among children. Having looked at the matter, there is no doubt in my mind that we face a very serious situation. I am lucky to be one of a fortunate generation that saw advances in housing and sanitation, and mass vaccination programmes that eradicated or reduced the incidence of many diseases from which children used to suffer. However, we are now in danger of raising a generation who will have a lower life expectancy than that of their parents. The reason for that is down to diet, with too much fat and too much sugar—combined with too little exercise, yes, but it is mostly about diet.

[Mark Field (Cities of London and Westminster) (Con)]

Will the hon. Lady give way?

[Helen Jones]

If the right hon. Gentleman is so eager to get in, I will give way.

[Mark Field]

I am eager to get in on that point, because I think it is rather facilely simplistic to suggest that any reduction in life expectancy is just down to diet. I accept that that could be one of the factors, but, in looking at this report and others like it, it is important that we take an evidence-based approach. Diet is a factor in reduced life expectancy in some parts of the country, but it is by no means the only factor.

[Helen Jones]

The right hon. Gentleman will learn that diet is actually the major factor. I will go on to say a little more about that later. He is right that it is difficult to talk about the subject without seeming like a killjoy, so I will fess up right at the beginning: I enjoy a glass of wine with my meals, although I try to restrict it to weekends; I am martyr to my cravings for chocolate; and, like many of us in this House, I could do with losing a bit of weight. However, we should not let our own frailties put us off tackling what I believe to be a real health emergency.

I have seen a huge change in diet, particularly in children’s diets, over my lifetime. When I was growing up, pop was a treat that we got occasionally, and we usually got a bottle of it between several of us. Sweets were bought by our dads on payday. If we were out playing—most children did play out in those days—and we came in hungry, we got bread and butter and a drink of water. Now, thanks to a huge change in lifestyle, the wider availability of products and some heavy marketing to children, the situation has changed. Many adults and most of our children are not meeting the proper dietary requirements. We eat too much saturated fat and too much sugar—both added sugar, and sugar in fruit juices, honey and similar products.

[Mark Field]

As the father of two young children aged seven and four, I entirely endorse what the hon. Lady has to say about the prevalence of treats for today’s youngsters compared with that which our generation grew up with. Does she accept, however, that the issues here are the responsibility of parents and of the companies who produce such goods? Many of those companies have shown a level of responsibility, and the average size of confectionery such as the Mars bar has fallen as time has gone by. There is more information on all such products about the amount of fat and sugar that they contain. In many ways, we are living in an age of more responsible and more informed consumers, both young and old. That is where the responsibility lies, and that responsibility has been put into place to a large extent—

[Fabian Hamilton (in the Chair)]

Order. I remind hon. Members that interventions should be kept brief, and that they should be questions.

[Helen Jones]

The right hon. Gentleman flatters me by saying that we are of the same generation; I think he is quite a bit younger than me. As I will come on to say, I do not think that the public health responsibility deal has delivered, and although it is true that there are responsibilities on parents and all of us, we have to look at the environment in which people operate. In this country, I think we face a real health emergency that is equivalent to an epidemic, and sugar is one of the worst culprits. Sugar is added to processed food, and that changes our tastes over time. A small can of drink can contain up to nine teaspoons of sugar. The result of that is that we are all growing bigger, particularly our children. Thirty per cent. of our children are overweight or obese. Many adults are too, and they often live in the poorest communities.

[Carol Monaghan (Glasgow North West) (SNP)]

Does the hon. Lady share my concerns about the new trend for having soft drink vending machines in schools? Schools may benefit from a slight increase in their budget, but the impact on children’s health and learning is significant.

[Helen Jones]

The hon. Lady makes a fair point, and I will come to what is happening in schools later in my speech.

[Emma Reynolds (Wolverhampton North East) (Lab)]

Does my hon. Friend agree that the voluntary approach to the food and drink industry is not working? Contrary to what the right hon. Member for Cities of London and Westminster (Mark Field) has suggested, the industry is not taking responsibility for reformulating sugary drinks, some of which contain as much as 14 teaspoons of sugar—double the daily recommended amount. That is why we need a regulatory approach.

[Helen Jones]

That is a reasonable approach, and I will come to that in a minute. The right hon. Member for Cities of London and Westminster (Mark Field) mentioned the shrinking size of Mars bars, but I think that has more to do with maximising profits than with concern for people’s health.

As a result of all that I have outlined, our risk of serious diseases is increasing. We are much more at risk than we used to be of cardiovascular disease, certain types of cancers and type 2 diabetes, which is increasing rapidly in this country. In fact, the British Medical Association has estimated that problems with our diet lead to 70,000 premature deaths a year. I put it to the right hon. Gentleman that if the Government were seeing 70,000 deaths a year from something such as a flu epidemic, they would act. This is just as serious.

Serious diseases are not the only problem. The biggest cause of childhood admissions to hospital is dental decay. If we talk to people who operate on those children, we hear horrific stories of young children having all their teeth removed because of decay.

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

A tax on sugary drinks has been Plaid Cymru policy for a number of years in Wales. The Labour party in Wales has responded in the media that such a policy

“is a not sensible way forward”,

and has called it “ill-thought” out, “economically illiterate gibberish”, “a disgraceful con trick” and “fantasy politics”. It has described the policy as “vacuous” and said that it has

“no chance of seeing the light of day”.

What is the hon. Lady’s message to her colleagues in Wales, especially as we are about to gain the powers to introduce a sugary drinks tax in our country?

[Helen Jones]

I never take what Plaid Cymru says about the Labour party in Wales at face value; I am used to its selective quotes.

Dealing with problems caused by poor diet is costing the NHS about £6 billion a year, which is more than the cost of dealing with problems that arise from smoking and alcohol combined. That figure is predicted to rise to £10 billion or £12 billion by 2020. The Government’s response to that, as has been said, was the public health responsibility deal. They have rejected direct intervention, which they refer to as “Whitehall diktat and nannying”. I think that is a profoundly mistaken approach, for this reason. Individuals do not make decisions in a vacuum, and they are making decisions about their diet in a situation where unhealthy foods are often heavily discounted or priced very low, where hundreds of millions is spent on marketing—particularly on marketing to children—and, in some cases, where there is a lack of availability of healthy alternatives. It is true that we need to take responsibility for our own health, but the Government also have a role in ensuring that we have the skills and facilities that we need.

[James Berry (Kingston and Surbiton) (Con)]

rose—

[John Glen (Salisbury) (Con)]

rose—

[Helen Jones]

I am not sure which of these defenders of the Government to take first. I will take the hon. Member for Kingston and Surbiton (James Berry).

[James Berry]

I am probably not the best qualified person to speak about this, having judged a cake competition in my constituency on Friday night. Does the hon. Lady agree that much clearer labelling would be an alternative to a tax—I do not form a view on whether that is right—in ensuring that people are not making decisions in a vacuum? For example, if a drink contains 14 teaspoons of sugar, 14 teaspoons should be clearly marked on the side of that drink so that people know exactly what is in it.

[Helen Jones]

Yes, the hon. Gentleman is right that we need much clearer labelling. As I will come on to say, the proposal in the petition is one avenue for tackling the problem, but not the only one and not a silver bullet.

I will take the intervention of the hon. Member for Salisbury (John Glen), but then I will make some progress.

[John Glen]

I am extremely grateful to the hon. Lady. She is making a powerful case, of which I am somewhat persuaded. However, does she not feel that it would be best if the Government were given an opportunity to develop the responsibility deal and to do a lot more to change public attitudes and consumption patterns before a sugar tax, the effects of which are not yet fully known, is implemented?

[Helen Jones]

The public health responsibility deal has had a fair trial over the past five years. The House of Lords Science and Technology Committee said of it that

“the current Public Health Responsibility Deal pledge on obesity is not a proportionate response to the scale of the problem.”

The reason for that, as the British Medical Association has pointed out, is that the deal does not set targets for individual food and drink products, or a timescale in which changes have to be made. That is why I have come to believe that there is a great deal of merit in what the petitioners are asking for, as one method among a whole lot of ways to tackle the problem.

A tax on sugary drinks would probably have to be at the level of 10% to 20% to make a change in behaviour, apparently—Public Health England suggests that range. There is evidence from Mexico and France that at that level, people’s behaviour starts to change and they start to choose sugar-free alternatives. However, that has to be part of a whole-Government effort to reduce obesity, which has to begin in schools.

Much work has been done on improving school meals, setting better nutritional standards for them and removing vending machines from schools. The problem is that those things do not apply to academies and free schools, and as more schools become academies we are putting more children at risk of poor nutrition. We should not tolerate that. It is good that food and nutritional education is compulsory at key stage 3, but we need to look at how that operates. Much more investment in equipment is needed. Schools need to be outward-facing and need to encourage local people to visit them to talk to children about food and how it is grown. The best schools do that, but often the curriculum is not appropriate for all children.

In my entire school career I did a term and a half of cookery, because it was considered that those who were academically inclined did not need to learn how to cook. The only thing I can remember being taught is how to make rock buns, something that I have not indulged in before or since. Another example is that my son specialised in Indian cooking. It was supposed to be brought home for the evening meal, but anyone who suggests that has never met a teenage boy. That was interesting, but expensive. What most of us need to know when we first set out in the world is how to eat healthily on a restricted budget. That is the sort of thing that we need to look at with our children.

In fact, all public institutions should be promoting healthy eating. Dare I suggest that we start with some of the vending machines in this place, so that I do not walk down the corridors thinking, “Get thee behind me, Satan”, every time I pass machines full of chocolate and fizzy drinks? That needs to be done in hospitals as well—there have been a number of articles about that recently.

I challenge people to walk into the foyer of many hospitals. There are machines selling chocolate and fizzy drinks, and the outlets often sell cake and biscuits quite cheaply but overcharge for a piece of fruit. If someone wanders in to buy a paper, they will be offered a big, discounted chocolate bar at the till. That makes it much harder for people to resist temptation. Of course, that is difficult to do, but the message that hospitals are giving their patients, staff and visitors is, “Don’t do as we say; do as we do.” The Government urgently need to negotiate with trusts and with NHS England to see how the issue can be remedied. It is nonsense to take an income from those sorts of outlets in one part of the hospital and then to deal with the effects of poor diet in another.

[Andrea Jenkyns (Morley and Outwood) (Con)]

Does the hon. Lady agree that it is also down to personal responsibility and choice, and that it should not be down to the state to tell people how to live their lives? Childhood obesity is more prevalent in deprived areas, so a sugary drinks tax will hit the poorest. Surely education, better labelling and personal responsibility are key.

[Helen Jones]

If we were dealing with a level playing field, the hon. Lady might be right, but we are not. We are dealing with goods that are heavily marketed, especially to children. I am sure she cannot really be arguing that it is great for hospitals to profit from unhealthy food and then for the other end of the hospital to deal with the consequences of that.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Will my hon. Friend give way?

--- Later in debate ---

[Helen Jones]

I will take one more intervention, then I am going to make some progress, because other Members need to speak.

[Geraint Davies]

On the issue of personal responsibility and consumer choice, as my hon. Friend will know, the World Health Organisation says that men should have up to nine teaspoons of sugar a day and that women should have up to six. Would it not be helpful if, in addition to the poison of sugar being taxed, all products were labelled in teaspoonfuls so that everybody knew what they were eating and could make empowered choices?

[Helen Jones]

That is right. I have already said that clearer labelling has a role to play, but the Government need to understand and recognise the link between obesity and food poverty, which is not—before anyone misquotes me—to say that all poor people are obese or that all obese people are poor. The children who are most at risk are concentrated in the most deprived areas of the country. The same is true of adults. Figures provided to me by the Library show that there is a stark division. For instance, 32.7% of adults in Hartlepool are obese; in the Chilterns, it is 17.7%. In Barnsley, 35% of people are obese; in Cambridge, it is 14.7%.

The noble Lord Prior recently said in the other place that he found it puzzling that obesity is growing while people are using food banks. Let me try to explain it simply to him. If people live in an area where shops do not sell reasonably priced food, fruit and veg, and they cannot afford the bus fare into town, they are more likely to buy cheap, fatty products. If people are fuel-poor, it is difficult to cook healthy meals, as it is if they are time-poor. I have just said at a public engagement event that there are women in my constituency who are working two or three part-time jobs, trying to make ends meet. Most poor families are good at managing their budgets, but if they do not have time to cook and are worried about waste, they are more likely to buy easy things that can be cooked quickly—we need to recognise that. I would do the same in that situation, and it is why we need to invest more in preventive measures and to subsidise healthy foods, rather than unhealthy foods.

If we look at the detail of the Chancellor’s autumn statement, however, the public health grant will continue to fall. Some 25% of the grant goes on sexual health services, and 30% goes on drug and alcohol services, which are demand-led statutory services that cannot be cut. If we add the child measurement programme, child medical examinations and health protection, there is not much left over. That is why the Local Government Association has said

“councils don’t have enough…to do the preventive work needed to tackle one of the biggest challenges we face.”

The Government also need to look carefully at what has happened to their obesity strategy. The strategy was launched with great fanfare in 2011, but since then, as the National Obesity Forum has said,

“little has been heard of the strategy”.

The National Obesity Forum has asked for a “much more determined approach”. Even the Change4Life programme, which does not address obesity but helps to prevent people from becoming obese in the first place, has found its budget cut. We have heard much about the public health responsibility deal, which is currently under review. I hope the Government will seriously look at the deal, because all the indications are that, as presently constituted, it is not working.

Simon Capewell, professor of public health and policy at Liverpool University, called the public health responsibility deal a “predictable failure” and

“a successful strategy for food companies who wanted to maximise profits.”

It is right to work with the industry as one strand of our approach, but it is not right to give industry the final say on what happens because, as the Health Committee said in the last Parliament,

“those with a financial interest must not be allowed to set the agenda for health improvement.”

We need a much tougher responsibility deal.

[Mark Field]

Will the hon. Lady give way?

[Helen Jones]

No, I will finish now if the right hon. Gentleman will forgive me. He has made several interventions, and he can make a speech later.

[Mark Field]

Do you want a debate?

[Fabian Hamilton (in the Chair)]

Order.

[Helen Jones]

I have said to the right hon. Gentleman that I will not give way again.

The Government need to introduce a much tougher responsibility deal, with targets for improvements in individual products. A cross-Government strategy is also needed. As well as looking at schools, the health service and other public services, Ministers need to come out of their silos—after a time, all Ministers get into silos in their Departments—and look at what is happening overall. We do not want to see a repeat of what happened in the previous Parliament, when the Department of Health urged us to take more exercise while the Department for Education was cutting funding for school sports partnerships.

We need to consider that seriously, because what the petition asks for has to be part of an overall strategy to ensure that we promote healthier diets and get people more active, and not just by playing sport—sport is important, but I speak as someone who spent more time avoiding games at school than I ever spent playing them. There are other ways of getting people active. We need to encourage more walking and cycling, which is a role not just for the Department for Transport but for the Department for Communities and Local Government and for local councils, too. There is no reason why we cannot design new developments better to encourage more walking and cycling. There is no reason why we cannot ensure that new developments have children’s play facilities, communal gardens or even allotments, which are in very short supply, to encourage people to take exercise out in the open air.

We cannot continue with the current hands-off attitude. The problems are too great for that. The Government need to accept that the things they have done so far are—[Interruption.] The Minister will have a chance to speak when she winds up; she need not chunter from a sedentary position. Ministers ought to be above that sort of thing.

We need to have a full look at the situation and to encourage a proper national conversation, because the only way that such initiatives can be successful is if we take people with us.

[Mark Pawsey (Rugby) (Con)]

Will the hon. Lady give way?

[Helen Jones]

No, I have said several times that I will not give way again. I will now wind up my speech. The hon. Gentleman can make a speech later.

We must take people with us. We must get people to understand the need for a healthy diet, we must get people to understand the risks that many of us are currently taking with our diets and, most of all, we must get people to understand the future risks to their children. As I have said, a sugar tax is one of the things that we need to have, but the Government need to go much further and introduce a proper, co-ordinated national strategy to ensure that, in future, our people are healthier than they are now.

[Fabian Hamilton (in the Chair)]

Owing to the number of Members who have requested to speak, I may have to impose a time limit on Back-Bench speeches after the Chair of the Health Committee has spoken.

--- Later in debate ---

[Helen Jones]

This has been an interesting debate, and I thank all who have spoken in it. We have heard the message clearly from all parts of the House that action on the matter is imperative. We have heard about the health problems, dental decay and loss of life that result from poor diet. The message has been clear today—even from those, such as the hon. Member for St Austell and Newquay (Steve Double), who started off as sceptics, as I confess I did—that the evidence all points to the need for serious action. That action should include the taxation of sugary drinks, not as a silver bullet, as we have all made clear, but as part of the overall strategy. I urge the Government to look again at the matter, because it is an area where gains can be made relatively quickly to improve people’s health.

There is plenty of evidence from the past that Government action can change people’s behaviour. It used to be the norm for people to go to the pub and have several pints before driving home, but it is not now. There used to be lots of smoking in public places, but there is not now, and smoking is reducing as a result of the action that has been taken. We now face a new emergency, which has to do with diet. Nearly everyone who has spoken in the debate—probably not the hon. Members for Nestlé and Britvic, who are no longer present—agreed that that was an urgent problem.

When the Government publish their strategy, I hope that we will see a concerted plan to tackle our poor diet and particularly our intake of sugar. I hope that plan will go across the public sector and involve local authorities and our health professionals, as well as tackling the food poverty and deprivation that lead to poor diet. It is not by accident that some foodbanks are now giving out packs of cold food only, because they know that some people cannot afford fuel or have had their fuel cut off.

I hope that the Government will also tackle the advertising industry. We like to think that children watch only children’s programmes, but peak viewing time for children is between 8 and 9 o’clock. We have also heard about the amount of advertising that is now online, which is impacting on our children.

I hope that we will soon hear a clear strategy from the Government to tackle the obesogenic environment in which people find themselves, to help people to make healthier choices in their lives. In particular, as far as the petition is concerned, I hope that the Government will revisit the idea of a tax on sugary drinks. The fact that it is only part of the overall strategy, as has been said, does not mean that it is not important. The strategy as a whole, in its many guises, is important. The Minister is constrained in what she can say today, but I know that she understands a lot of the issues. I say to her that the health of our children and adults demands action.

[Geraint Davies]

Will my hon. Friend give way?

[Helen Jones]

No, I am winding up; I am sorry. The health of our children demands action now. If we do not take such action, we will see much more illness in our society, much more drain on the NHS and a poorer life for all of us in the future.

Question put and agreed to,

Resolved,

That this House has considered e-petition 106651 relating to a tax on sugary drinks.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 13th October 2015 Commons Chamber

[Mr Hunt]

I welcome my hon. Friend to his post. I am not sure I have had a question from him before. I know quite a bit about the Dudley vanguard programme, because I shared a taxi to Manchester station with the entire Dudley team. They told me, at close quarters, about their exciting plans. What really struck me was how they are talking to different bits of the health and social care system in a way that has never happened before. It is really exciting and I think it really will be in the vanguard of what can happen in the NHS.

[Helen Jones (Warrington North) (Lab)]

Many people in my constituency are struggling to see a GP from Monday to Friday. Warrington has fewer GPs than it had in 2010, despite a rise in population. The number of unfilled GP vacancies quadrupled under the previous Government. How does the Secretary of State expect to produce a seven-day service when he cannot properly staff the service from Monday to Friday?

[Mr Hunt]

I shall tell the hon. Lady how I expect to do it. We are, in fact, making very good progress. By March next year, a third of the country will be able to access routine GP appointments at evenings and weekends. We do need more GPs. I agree with her that it takes too long to get a GP appointment, but we are doing something about it. That is why we have announced plans to recruit an estimated 5,000 more GPs. That will be a 15% increase in the number of GPs, the biggest increase in the history of the NHS.

NHS (Contracts and Conditions)

Helen Jones Excerpts

Monday 14th September 2015 Westminster Hall

[Valerie Vaz (in the Chair)]

A digital debate took place on Twitter, ahead of today’s debate. Mr Speaker has agreed that for this debate members of the public can use handheld electronic devices in the Public Gallery, provided that they are silent. Photos, however, must not be taken.

[Helen Jones (Warrington North) (Lab)]

I beg to move,

That this House has considered the e-petition relating to contracts and conditions in the NHS.

It is a pleasure to serve under your chairmanship, Ms Vaz, and, in particular, to be debating the first petition to reach the debate stage under the new system for dealing with e-petitions. The original petition on the joint Government and Parliament website called for a vote of no confidence in the Secretary of State for Health. Fortunately for him—or unfortunately, depending on how people want to look at it—the Petitions Committee does not have the power to initiate a vote of no confidence, and so we decided that the debate should be on the issue underlying the petition, which was the contracts and conditions of NHS staff.

I might be joking about motions of no confidence in the Secretary of State, but the morale of NHS staff is not a joke. It is a long time since I last saw dedicated doctors, nurses and ancillary staff so demoralised and, sometimes, despairing. If we look at the current state of the NHS we can see why. A&E departments are in crisis and missed waiting time targets for the whole of last winter. GP services are struggling to cope, and patients find it harder and harder to get appointments. Last year, the deficit across trusts was nearly £1 billion; this year, that is predicted to double.

Yet despite all that, NHS staff work miracles every day. Who could not be proud of some of the achievements of our surgeons? Who could sit in an A&E department, as I unfortunately had to during the election, seeing the endless patience of NHS staff, and not be grateful to them? Who could watch paramedics dealing with an accident or reassuring a frail and confused elderly patient and not be ever grateful for the NHS? After the Olympic opening ceremony, I remember one American reporter said, “Oh, it’s just like praising UnitedHealthcare.” No, it is not. The NHS is not like UnitedHealthcare, thankfully, and that is why we value it.

NHS staff have been badly treated by this Government. Since 2010 pay increases have been deliberately kept low and last year we saw some staff being told that they could not have even a 1% increase if they were due to get an increment as well. The Government often talk about public services as if they were a drain on the economy, but they are not. Services such as the NHS are a huge contributor to our economy. It is completely wrong that, under this Government, tax is cut for millionaires but dedicated NHS staff are not even entitled to a decent pay rise.

Indeed, in the previous Parliament the NHS was told to make £20 billion of what the Government call efficiency savings but the rest of us call cuts. That is due to rise to £30 billion by the end of this Parliament. The NHS is struggling to cope with fewer and fewer resources but more and more patients. Many of the difficulties being encountered are of the Government’s own making. Ministers criticise spending on agency staff, but the Government’s first act on coming into office in 2010 was to cut nurse training places by over 3,000 a year.

[Michael Tomlinson (Mid Dorset and North Poole) (Con)]

I of course recognise the great work that NHS staff do, not least in Dorset, but is the official policy of the official Opposition now to lift pay restraint in the NHS?

[Helen Jones]

We made our policy quite clear in the last Parliament. In particular, we opposed the Government’s decision to curb 1% pay increases for NHS staff who were gaining increments. The hon. Gentleman really has to think about this: if there are fewer and fewer nurses in our hospitals—in particular, employment in the most senior grades is down by 3%—and we are spending millions on agency staff, something is going badly wrong. Hospitals are being forced to recruit nurses from abroad or spend on agency staff when we have thousands of people in this country who want to train as nurses but simply cannot get the training places that are available.

[Maria Caulfield (Lewes) (Con)]

Will the hon. Lady give way?

[Helen Jones]

In a moment. I want to make a little progress and finish this point.

That is a false economy. I make no criticism of the skills of the nurses we recruit from abroad, but it—

[Helen Whately (Faversham and Mid Kent) (Con)]

Will the hon. Lady give way?

[Helen Jones]

In a moment. The hon. Lady will have to curb her impatience for a little while.

I make no criticism at all of those nurses’ skills, but it is much better to be employing people here in this country. The only people benefiting from the current situation are the companies that supply agency staff. Indeed, one, Independent Clinical Services, saw its profits more than double, from £6.2 million in 2010 to £16.5 million in 2013. In other words, what the Government have done is a textbook example of a false economy.

[Helen Whately]

Does the hon. Lady acknowledge that between May 2010 and May 2015 the number of qualified nursing, midwifery and health visiting staff increased by 2.1%, at 6,622 additional staff?

[Helen Jones]

I am grateful to the hon. Lady for reading that out, but I referred to nurses in hospitals. The number of nurses working in hospitals has fallen under this Government, particularly in the top grades. The failure to train and recruit enough permanent staff is putting a great strain on those staff already in post, who are having to deal with agency staff all the time to make sure that they know how things work in a particular hospital or ward. That does not offer continuity of care for patients.

[Maria Caulfield]

I declare an interest as a former NHS nurse—in fact, I still work as a nurse. I do not want to be political about this, because I want progress to be made on supporting the NHS, and particularly staff, but one of the single biggest factors in demoralising nurses and leading many skilled nurses to leave the practice was the last Labour Government’s change to the skill mix. That was crucial, because we were forced to cut our budgets, particularly on the wards, and junior nurses were left in charge of wards, instead of experienced senior staff nurses and sisters—

[Maria Caulfield]

Can I just say that it is the change to the skill mix that has demoralised nurses, and that did not happen under this Government?

[Helen Jones]

I am afraid that I do not agree with the hon. Lady. What has demoralised most of the nurses I see is the cuts they have to cope with day in, day out, as well as the shortage of sometimes even basic equipment and the—

[Mary Robinson (Cheadle) (Con)]

Will the hon. Lady give way?

[Helen Jones]

In a moment. I need to make a little progress, because other people want to speak.

There is also the fact that this Government, rather than valuing NHS staff, consistently appear to undervalue them. The Government are now introducing further ideas. They want seven-day working in the NHS. I will come in a moment to what that means for hospitals, but let me look first at what is happening with general practitioners. In principle, everyone agrees that more out-of-hours care is a good idea—not least NHS staff themselves. The question is how the Government will fund and staff the extra working hours. Currently, we are increasingly short of GPs. In Warrington—on the Government’s own figures, before the hon. Member for Faversham and Mid Kent (Helen Whately) jumps up to read out her brief again—we have fewer GPs than we had—

[Mary Robinson]

Will the hon. Lady give way?

[Helen Jones]

No. I need to make a little progress, because other people want to speak.

In Warrington, we have fewer GPs than we had in 2010—those are the Government’s own figures, not mine. Nationally, the number of unfilled GP posts quadrupled in the three years from 2010 to 2013. The Royal College of General Practitioners says there are severe shortages in some parts of the country and that in some areas—it quotes Kent, Yorkshire and the east midlands—we need at least 50% more GPs over the next five years just to cope with population increases. Now, when there are not enough GPs to ensure timely access to appointments on weekdays, it is difficult to see how the Government are going to extend GPs’ working hours without recruiting more staff.

Of course, the cost is also an issue. It is estimated that the costs of extending services beyond the current contract, with one in four surgeries opening late in the evening and at weekends, would be £749 million. That would rise to £1.2 billion if one in two practices were open longer. That is far in excess of the money currently in the GP challenge fund. If the Government intend to proceed without recruiting more staff, that will simply increase the pressures on the staff working already, leading to more burn-out, and it will be a downward spiral. We already know that many GPs are thinking of retiring early.

The Secretary of State has now turned his attention to not only GPs, but hospital doctors and consultants, who he says do not work weekends. Well, I have two consultants in my family, and that is news to me, because they certainly do work weekends. In fact, the Secretary of State so provoked hospital doctors that they took to Twitter under the #iminworkJeremy, posting pictures of themselves working at weekends, often after a 70-hour, five-day week.

Now, I reiterate that everybody accepts that out-of-hours care has to improve, but the Secretary of State needs to achieve that through consultation and by showing respect for the staff we already have. At the moment, he is guilty of muddled thinking; he has deliberately confused emergency care with elective care. Specialists in emergency care do work weekends; in fact, very few consultants opt out altogether—the figure is about 0.3%. Yet, the Government tell us that there are 6,000 extra deaths among people admitted at weekends. The Minister needs to publish the research on that and to go further, because correlation and causation are not the same thing.

[Dr Sarah Wollaston (Totnes) (Con)]

May I recommend that the hon. Lady read last week’s edition of the British Medical Journal, where the issue is set out very well by Professor Freemantle?

[Helen Jones]

Yes. I thank the hon. Lady for that useful suggestion. I will do so.

People who are admitted to hospitals at the weekend are much sicker than those admitted on weekdays, because we do not have elective admissions at the weekend.

[Maria Caulfield]

Does the hon. Lady have any suggestion as to why people are sicker at the weekend? Is it perhaps because they have been unable to get hold of their GP in the evenings or on previous weekends?

[Helen Jones]

I have just said the Government should publish their research and delve deeper into the figures. [Interruption.] Look, the hon. Lady knows that people admitted at weekend are, overwhelmingly, emergencies. That is the point. Their death rates cannot be compared with death rates on weekdays, when there is elective surgery—that is a basic point, which she needs to grasp.

If the Government really believe these things are happening, they need to find out why. As I understand it, death rates are taken over 30 days, so someone can be admitted on a Sunday and die 28 days later, on a Thursday. The Government need to prove cause and effect before they can make the link between admissions at the weekend and death rates. So far, however, we have not seen that from them.

[Helen Whately]

Will the hon. Lady give way?

[Helen Jones]

No, I need to make some progress.

What, exactly, is the Secretary of State trying to do? If he is trying to bring about a seven-day fully elective service, he needs to say so. As far as I am aware, no major health system in the world has managed to do that. If he is not trying to do that, he needs to tell us clearly—perhaps the Minister will do so when he winds up—which services he thinks should operate at the weekend.

The Secretary of State also needs to recognise that, to have the service he proposes, he needs not only more doctors, consultants and nurses on the wards, but back-up staff. Doctors operate by leading teams. If they do not have the ancillary staff—the people to do the MRI scans, the radiology and the lab tests—they cannot operate properly. We need to hear how the Secretary of State will implement his proposals. Will he recruit more staff, or will he worsen the terms and conditions of staff who are already not well paid, to introduce weekend working?

It might help to improve morale in the NHS if the Secretary of State refrained from attacking staff for not working at weekends, when they do, and actually negotiated with them sensibly. Staff know what is happening at the frontline, and they can best suggest the changes that need to be made.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

We are discussing contracts and conditions. Does my hon. Friend agree that whistleblowing is another issue over which there tends to be silence? The last time there was a full debate on it in this place was 2009. It came up tangentially in 2013, in a debate on accountability and transparency, and it has appeared in statements—I think there was one last July and one earlier this year—but is it not time that we had a full and proper debate?

[Helen Jones]

Whistleblowing in the NHS, as in other areas, is an important issue. It is important to protect staff who blow the whistle to protect their patients, which is their duty. Perhaps my hon. Friend will initiate a debate on that; I am sure we would welcome that.

When the Secretary of State talks about NHS staff and doctors, let us remember that the starting salary for a junior hospital doctor is £22,636. It is not a huge amount when someone has spent years in medical school and works many hours, and often has to deal with seriously ill patients. However, the Secretary of State proposes to change their contracts to take away the extra payments for weekend working, which will effectively mean a huge pay cut. The Scottish Executive will not do that, and that will lead to the ridiculous situation in which two doctors doing exactly the same jobs in different hospitals either side of the border will be on two rates of pay.

As for consultants, I have heard complaints from the Government that Labour raised their pay rates. Yes, we did, and I am proud that we did. I will give the Minister the reason, which was set out very clearly by Frank Dobson, who was formerly my right hon. Friend the Member for Holborn and St. Pancras. In the City there are people who probably messed about for most of their time at school and played noughts and crosses at the back of the class, and who can make millions. Across the road there will be someone who was probably the cleverest kid in their class and has worked for years in training—often someone who is at the cutting edge of medical development. Yes, those people deserve a decent rate of pay for their skills, training and responsibility.

The Government also forget that consultants’ time is allocated in two blocks: direct clinical care and supporting professional activities. Those two together make up the 40-hour week. SPA time is for such things as mentoring, quality improvement and teaching. Some consultants go on to do more teaching and research, perhaps, but they are doing extra work on top of the 40-hour week, which increases their pay. Consultants’ basic pay ranges from £70,249 to £101,451, so the Secretary of State needs to explain how he can tell us that consultants are paid £118,000 a year. How does he calculate that figure, and what is included in it?

If the Government really want more consultant time on the ward, they could look at some of the things that do not need to be done by doctors, but which doctors currently do because of lack of back-up staff. The Government always talk as if non-clinical staff in hospitals are somehow superfluous and an extravagance. That is not correct. Without the right staff, doctors and nurses are forced to take time from clinical care to do some of their jobs. For example, many doctors whom I have spoken to now collect their own data for audit and input it themselves. That is a job that a competent clerk should be doing—not a consultant. I found one hospital where there is one secretary to a group of 25 consultants. Writing letters takes consultants away from clinical care.

I found one place where the IT equipment is so old that it takes six minutes to boot up, and often collapses, with the loss of the data. If the Government really want more doctor time on the wards they should consider those issues as well, and think about the other staff. As an example, if an operating theatre does not have a full complement of staff, there is no one to send out with the patient who is in recovery, and a doctor must go with them. That slows the turnaround time for theatres, and staff are told that their turnaround time is not good enough.

I say again that it takes a team of people to run the NHS, not just doctors. Let us also remember that the NHS depends on many staff who earn very low salaries. As doctors would be the first to say, those people are an essential part of the team. The NHS Pay Review Body could see a case for some adjustments to unsocial hours pay—and I have not met any staff who do not see a case for that; but it noted that both the Department of Health and NHS employers said that the cost of unsocial hours premiums makes the delivery of seven-day services prohibitive. The Minister must tell us whether the Government will try to deliver seven-day services by cutting the pay of staff again. The review body said that that could risk the morale and motivation of staff.

Recently we have had a few soundbites from the Government, but no clear mechanism showing how they will set out to do what they say they will do. They have pledged an £8 billion increase in NHS funding by 2020. Even taking them at their word—and some of us are rather sceptical—that is the bare minimum to keep existing services going. [Interruption.] If the Minister’s Parliamentary Private Secretary, the hon. Member for Winchester (Steve Brine), will stop chuntering from behind the Minister, I will wind up my remarks. [Interruption.] PPSs, as I told someone once before, are meant to be seen, not heard.

The Minister needs to make it clear what services the Government will run and what staffing arrangements they will put in place. They can put more doctors on the ward, but that will be useless without the back-up staff. It is not surprising that one surgeon in the #iminworkJeremy campaign posted a picture of himself mopping out his operating theatre at the end of the day. That was very good of him, but is it the best use of a consultant surgeon’s time? Above all, the Secretary of State and his Ministers need to stop attacking the people who work in the NHS, and to try to work with them in a climate of mutual respect. It is not hospital doctors, GPs, nurses, lab technicians or cleaners who have caused staff shortages in the NHS; it is the Government. Those staff members did not introduce the disastrous Health and Social Care Act 2012. They are not the people requiring huge cuts in our hospitals and other services. Unless the Government are prepared to recruit more nurses, doctors and ancillary staff, more and more pressure will be put on existing staff, who will suffer burnout. It will be a downward spiral.

When I worked in teaching, a wise old head teacher said to me, “People say that the first thing you have to do in a school is ensure that the children are happy; but no—the first thing you should do is ensure the staff are happy. If the staff are happy the children will be well taught.” That is something that can be applied in many areas. I tell the Minister honestly that he needs to take note of the anger among staff that generated the petition, take it on board, stop denigrating them, and deal with them properly and sensibly, to achieve what the Government have set out to achieve.

--- Later in debate ---

[Helen Jones]

What I said, if the hon. Lady was listening, was that the Government have to dig behind those figures and find out the reason for them. Correlation is not causation. That is a very basic principle when we are looking at things such as that, and I would be grateful if she did not attribute to me words that I have not said.

[Helen Whately]

The hon. Lady is correct to distinguish clearly between correlation and causation, but I did feel that the tone of her remarks seemed to question the evidence of increased mortality over weekends and out of hours. I will say that I agree with her on the need for increased investment in IT to enable the clinical workforce to spend more time on clinical work. I agree with her on that point.

I have observed over recent years that the Secretary of State has championed the NHS. He has fought for its budget to be protected at a time when many other budgets have been cut. He has secured the Chancellor’s commitment to an extra £8 billion of annual funding by 2020, and he has truly focused on patients and clinical quality over finances and structures. I wonder whether any other Secretary of State has spent as much time with his sleeves rolled up in hospitals, not just listening to the sound of bedpans but actually emptying them.

I am a supporter of the Care Quality Commission and observe that three years ago it was close to collapse, but it is now widely praised, particularly by the acute sector. I know that GPs are unhappy about the inspections, but 70% of providers say that the CQC’s inspections have given them information that has helped to improve their service. That has been supported by the Secretary of State.

Along with that focus on quality and transparency, the Secretary of State is to be applauded for trying to improve the culture of the NHS—to make it more open, supportive and connected and to ensure that NHS leaders are in touch with patients and staff.

--- Later in debate ---

[Jo Churchill]

It is a very good idea. The lack of pharmacy provision in hospitals is often cited as one obstacle to patient discharge. The cost of not discharging someone on a Friday, meaning that they use a bed on Friday, Saturday and Sunday, is £2,700, which is a lot of money.

[Helen Jones]

The hon. Lady was not in the House when we debated this Government’s change to local government finance, but at the time, many of us warned that it would hit social care and impact on our hospitals. Does she accept that hospitals are having great difficulty discharging patients, not only at weekends but during the week, because social care is not available for them?

[Jo Churchill]

I would say that it is a mixed picture. What I am picking up from care homes in my constituency is that some wards do it more effectively than others, with better services and things better locked together. Although I accept that there may be a problem, again, I look to the leadership.

I gave birth to some of my children on a Saturday and Sunday. Their entrance did not appear any less special to the obstetrician than those of my children who appeared midweek. I am not consultant-bashing; this is reality. The NHS has been delivering consultants and staff who provide outstanding service, but one cannot deny the statistic that patients’ chance of survival is less if they are admitted to a hospital at the weekend. Even if we extrapolate from those figures to account for the fact that the people admitted at the weekend are often very poorly, and often very elderly, they tell us that there is a problem. It would be remiss of this or any Government not to ask why or to investigate the situation and consider how to provide solutions.

I will not talk about people’s pay or anything else; we have done that. Instead, I shall focus on the petition, which in my view is neither constructive nor helpful. I would like the Government to learn from the best practice of consultants and their teams. Brilliant ideas are out there if we can only harness that best practice. For example, at the virtual fracture clinic at my West Suffolk hospital, a consultant told me that he has cut the number of times that patients must visit the hospital. Work can be done remotely; even discharges can be done on the phone, and those who need further specialist help can be sent on. We need to have honest conversations about the NHS. We need to use its finite resources, including staff, more sensibly if we are to survive.

We have 1.4 million great people working in our NHS, and 1.6 million people working in our social care sector. That is one tenth of this country’s population. We all agree that a seamless pathway between the two is the best future, but I leave Members with this question. If we cannot discuss a way forward that allows us to accept change, understand and develop new ways of working, we may struggle to look after the burgeoning health population, and there may be more than contracts to think about.

[Maria Caulfield (Lewes) (Con)]

Thank you, Ms Vaz, for giving me the opportunity to speak in this debate. I am a passionate supporter of a seven-day-a-week national health service. That might take many formats; it is not a one-size-fits-all situation, so what works in my constituency might be different from what works in someone else’s.

I will not repeat what many of my colleagues have already said, but I think that we need an honest debate. There are difficulties to get over; my hon. Friend the Member for Totnes (Dr Wollaston) in particular has described them. We will have to work together and compromise on certain things, but if we do not debate the issue and find a resolution, patients will die from lack of access to good out-of-hours care. We need to tackle it. To be 16% more likely to die just because of the day of the week one is admitted to hospital is not good enough in this day and age.

However, it is not just about the impact on patients and their relatives; it is also about the impact on staff. Tribute has rightly been paid in this debate to staff, senior consultants and doctors who work long hours and come in at weekends. Many of them do so unofficially because they are dedicated, but I want to represent staff who work out of hours because it is part of their contract. I have been a nurse for more than 20 years. I have worked in the community on weekends, when patients without access to a GP have needed painkillers or an urgent dressing and it is difficult to get hold of a doctor. I have been in charge of wards on weekends and nights, when patients tend to be sicker because as medicine has progressed, patients who are well are often discharged earlier, so those left in hospital are often sicker than they would have been a decade ago.

Along with the reduced skill mix that I highlighted earlier, the pressure on nurses, healthcare assistants and other ancillary staff is huge. Two or three staff on night duty with a poorly patient who is septic might have one doctor on call handling four or five other wards, who might have 10 admissions that night to see to first. The staff will have expanded their skills so that they can cannulate the patient, take their bloods and send them off to the labs, but that is the limit of what they can do. It is hugely stressful. I know from having been in charge of a team of nurses on nights how difficult it can be.

That cannot continue. It is not good for patients—we know that their mortality and morbidity rates get worse—and it is not good for staff or for their morale. I have seen nurses in tears after a busy night shift during which we could not care for a patient the way we should have, because we had no access to senior medical advice. Yes, it is possible to phone the consultant on call and have a chat with them, but nothing beats having the advice of an expert who can interpret an X-ray or blood results and who can help junior medical staff prescribe the right antibiotics.

A great example introduced in the past couple of years is the acute oncology service, which has transformed out-of-hours care for cancer patients. As a sister in a research unit not far down the road, I know what a difference that has made to my patients. For some reason, patients tend to get really poorly at half-past 4 on a Friday afternoon, come what may. I have been so pleased with that service, which is now available up and down the country and offers trained senior nurses, doctors and a whole team of people who can assess a patient and get treatment going. For conditions such as sepsis, it is life-saving. Those with spinal cord compression can have a scan urgently and be started on steroids straight away. That is the difference between a patient being able to walk during the last six months of their life and being bed-bound.

That is out-of-hours care at its best, but of course difficulties and contentious issues will arise when renegotiating contracts. It is not just about consultants and senior staff. Proper out-of-hours care will require support services such as radiologists, radiographers and pharmacists. My hon. Friend the Member for Banbury (Victoria Prentis) spoke about the perfect week; I could talk to hon. Members day in, day out about how many patients we kept in hospital over the weekend because we could not access drugs to send them home. That is not a great use of hospital resources, but more importantly that is not a great experience for patients and their relatives.

Support services make a huge difference, but my plea is that we do not use the debate as an opportunity to score political goals. We have to work together. If we do not work cross-party on this, we will be here in 10 years’ time. Patients will lose out and their families will lose loved ones if we do not make a difference. It will not be easy. Nobody will be happy about working different hours. We are not asking people to work more than 40 hours a week; we are just asking people to work differently. We are not even just talking about how we work, but about a systems change in the culture of the NHS, so that the patient at half-past 4 on a Friday afternoon does not think, “What lies ahead for me this weekend?” I urge hon. Members on both sides of the House to be as constructive as possible.

[Helen Jones]

I am grateful to the hon. Lady; she has been most generous in giving way. She says that she is not expecting NHS staff to work more than 40 hours a week; did she mean to say that? Many of them already work more than 40 hours a week. Is it now Government policy that no one in the NHS should work more than 40 hours a week?

[Maria Caulfield]

The hon. Lady is being disingenuous.

[Helen Jones]

Answer the question.

[Maria Caulfield]

Of course. I have worked more than 40 hours a week; many staff do. We are not asking staff to work more hours—we have been very clear—but we are asking staff to work differently. I do not think that there is anything wrong with that if it provides a better service for the patient and takes the pressure off those front-line staff who are without radiology support, laboratory support and senior cover support. I ask the hon. Lady to support the measures and work with us, so that we can work with healthcare professionals to achieve that. They need senior support out of hours, because they need someone to interpret test results, make decisions to discharge a patient and break bad news when results are not good, and they need senior expertise to refer to others to move the process forward. My plea is that is we all work together.

I welcome the debate this afternoon. It is good to have it. I am pleased that healthcare professionals flag up issues, because I do not want policies to be steamrollered in, as they have been in the past, and for us to sit here 10 years later reaping the results. I welcome the seven-day-a-week initiative and the move to change the culture and the system, so that ultimately patients see improvement in patient care.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a great pleasure to serve under your chairmanship for the first time, Mrs Gillan, as it was to serve under the previous Chair, Ms Vaz.

This is an important and exciting day because we are responding to the first e-petition under the new system. The hon. Member for Denton and Reddish (Andrew Gwynne) is quite right that it should have happened some time earlier. I hope that through what are pretty modest forays into social media we can make more popular the debates that take place in Westminster Hall, because they are often far more thoughtful and certainly more nuanced than some of the debates that one hears just a few hundred yards away.

I am grateful to the Chairman of the Petitions Committee, the hon. Member for Warrington North (Helen Jones), for her introduction. Hers was a vigorous opening argument and certainly did what it should have done, which was to spur a good and, at many points, enlightening debate. There is much to which I would like to respond, but at times the debate turned into a general critique of the NHS, so if I tried to answer every point, Mrs Gillan, I think we would be here beyond the 7.30 pm cut-off that you and, I imagine, other Members would not like me to reach.

The debate encompassed many of the issues and problems that confront the NHS, as do all discussions of seven-day services because they touch on contract reform and how we manage the NHS workforce. At the core of the debate was what we are trying to do: deliver exceptional, world-class care to every patient coming to an NHS institution, hospital, GP or community service in England and, by extension, the other nations of this country.

I, too, pay tribute to some shadow Front Benchers. I am grateful for the words of the hon. Member for Denton and Reddish. I almost wish he had not said what he did, because I wanted to say that I hope he keeps his Front-Bench position. He has always been a very reasonable defender of the Labour party’s point of view and a strong interrogator of the Government’s policies. That is exactly what opposition should provide. I should take the opportunity to say how much I will miss his colleague, the hon. Member for Copeland (Mr Reed), with whom I sat in this Chamber a couple of days ago for his last debate as a shadow Minister. I did not have the opportunity then—the moment escaped me, and I did not have knowledge or foresight about where he would be on Saturday—to wish him well and say how much I had, in my short time as a Minister, enjoyed debating important issues in the Chamber with him.

It is also entirely right to say that the right hon. Member for Leigh (Andy Burnham) has been Secretary of State for Health, a Health Minister before that, and a shadow Secretary of State for a long time. His contribution to debates about the NHS has been very important. It is clear from how he speaks that he cares passionately about the health service, and I very much hope that he delivers the same kind of force of argument in his new position as shadow Home Secretary.

It will be good to see what the new shadow Minister, the hon. Member for Lewisham East (Heidi Alexander), brings to her role. I hope that she will enter into arguments and debates on NHS reform with the spirit of openness and decency shown by the hon. Member for Central Ayrshire (Dr Whitford), who often attends these debates, bringing a great deal of personal experience from both this country and abroad, and who makes sure—no doubt because we often feel chastised if it goes any other way—that the debate is continued with a sense of decorum and a remembrance that our discussions are held in public. We must be aware of the fact that what turns people off political discourse more than anything is a silly repetition of party political positions with no meeting in the middle or discussion of the issues at hand.

It is in that spirit that I hope to address the central point of the presentation of the petition by the hon. Member for Warrington North. I am glad that we have these petitions, although perhaps a little less glad that this particular petition contains such stridency of language. Nevertheless, at the core, what concerns me is the point made very well by the hon. Lady: words matter. That was echoed by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately). We must be very careful about the words we use—not only the manner in which we say them but how they might or might not be construed.

Hon. Members may not be surprised to hear that I have read—several times, as it happens—the Secretary of State’s speech on this matter. I have also seen the coverage on it, and there is dissonance between the two. At no point did he attack NHS staff or suggest that they are not working in conditions that are often heroic, and at no point did he suggest that we have ended up at this impasse because of a wilful wish on the part of NHS staff not to work at weekends. What was construed from that speech has unfortunately meant that our debate has been about a number of words and phrases that were not used, intended or even suggested.

Turning to the core of the speech, the Secretary of State began by saying that talking about seven-day services is not news to a large number of NHS staff, because nurses, porters, cleaners and many of those working under the “Agenda for Change” contract have, for the entirety of their professional lives, been working in seven-day services. His main contention was that, given the weight of evidence on excess mortality that can be attributed to differential working patterns at weekends and on weekdays, it is at least reasonable to ask what we are doing to ensure that if someone is admitted on a Saturday or a Sunday they can expect the same quality treatment and intensity of consultant and diagnostic support as they would receive on a Wednesday. That suggestion was not plucked out of the blue.

I have two points to make. Given that the petition is an ad hominem attack on the Secretary of State, it is right to say that I have never encountered anyone in a ministerial post who has acquitted himself with as much passion about a point on which he wishes to concentrate—patient safety—as the Secretary of State. The right hon. Member for Leigh recognised that when he was shadow Secretary of State, and it is recognised even by those who often oppose the Secretary of State in the BMA and other professional representation bodies. The fact is that the Secretary of State is passionate about patient safety. He cares deeply about it, which is why he takes an intense interest in gathering evidence about differential mortality rates.

I want to run through in detail where NHS England’s thinking comes from and why the Government have decided to act as they have. As the hon. Member for Central Ayrshire knows, there have been various academic papers from the United States and some from the United Kingdom on differential mortality, and they contain many of the questions and answers that have been alluded to today. It is certainly true that people are admitted sicker at weekends, which points in part to the need to do something about community and GP services at weekends. That is part of the reason why people are being admitted sicker. If somebody with a serious acute illness is seen on a Wednesday, they will receive a level of service—both diagnostic and consultant support—that they are unlikely to receive in many hospitals on a Saturday or Sunday.

[Helen Jones]

The Minister is making a sensible point, but could he enlighten us about exactly which services the Government foresee working seven days a week? Has the Department for Health assessed how many extra staff will be required to ensure that happens? NHS staff have got to have days off sometimes, so if they are working at the weekend they will have to have a day off in the middle of the week. How many more staff will we need?

[Ben Gummer]

Those are very reasonable questions. If the hon. Lady will allow me to continue with what I was setting out, I will certainly answer them.

That assortment of academic research, together with the wide anecdotal evidence from people who have experienced poor care in good hospitals, either for themselves or for their relatives, led NHS England to conduct the Seven Days a Week forum in 2013, which gathered together clinicians to look at the challenge. It produced a clear strategy for dealing with differences in care quality at weekends, compared with the week, and set out 10 clinical standards that it believes hospitals must meet to eradicate the difference between weekday and weekend working. Many hospitals are implementing the 10 clinical standards on a variable basis during weekdays, so the work done for weekends was helpful in determining a standard clinical approach for maximising the ability to reduce avoidable deaths for weekend and weekday admittances. The product of that forum was taken forward by NHS England and incorporated into its five-year forward view, in which the NHS, separately from the Government, made a commitment to seven-day services. It did so not because of the benefits to patients—as my hon. Friend the Member for Sutton and Cheam (Paul Scully) said, that is a secondary reason for pursuing the agenda—but purely because of the need to reduce excess mortality where possible.

This is a challenge on the scale of infections in hospitals. It is our duty not only to find out precisely why excess deaths are happening—as the hon. Member for Central Ayrshire correctly said, further work is needed and the data must be understood—but to do what we can as quickly as possible to reduce them where we think they are preventable. That is why NHS England incorporated the seven-day service into its five-year forward view. NHS England asked for an additional £30 billion of spending between 2015 and 2020, of which it said £22 billion can be achieved through efficiencies within the service. It is important to point out to the hon. Member for Warrington North, who made that point, that they are not cuts but genuine efficiencies within the organisation. On top of the £22 billion of internal efficiencies though a better use of IT, to which she alluded, and better job rostering—I will turn to that in a minute—there will need to be an injection of £8 billion to make up the rest of the £30 billion. That package will implement the five-year forward view, which includes seven-day services and many other things of great importance and about which all parties agree, such as shifting resources from providers to primary care, social care and the community sector.

This programme was not invented by the Secretary of State in a speech given to annoy doctors and consultants, much as that might be the impression given by some people on Twitter. It is the policy response of a Government taking seriously the clinical evidence and advice of NHS England, led by Professor Sir Bruce Keogh. We are responding to give NHS England and the providers tools with which they can deliver a seven-day NHS service in hospitals and GP practices.

I turn to the changes in the contracts, which are at the heart of the petition and the speech of the hon. Member for Warrington North. The contract terms are based on a review by the doctors and dentists pay review body, which identified a number of areas where contract reform is needed, including the systems of opt-out and on call. It asked a completely reasonable question: why should it be that some members of the workforce, who are expected to work at weekends as part of their normal shift patterns, do not have the option of an opt-out from their contract, while others—who tend, as it happens, to be far more highly paid than those who do not have the option of an opt-out—do? It proposed a series of changes, which in our view make up a far better contract for both junior doctors and consultants. On balance, we feel that it presents a real opportunity for consultants and doctors to improve not only their working conditions but, in some cases, their pay.

To take some salient examples from the consultants’ contract, we want a far more equitable and reasonable distribution of clinical excellence awards—many consultants are privately critical of how they are awarded—within not a cut to the total consultant budget, but exactly the same existing pay framework.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 7th July 2015 Commons Chamber

[Mr Hunt]

We will not take any lessons from the Labour party about what needs to be learned from Mid Staffs. Labour Members should be ashamed of the state of hospital care they left behind. There are 8,000 more nurses in our hospitals as a result of the changes that this Government have made. They should welcome that, not criticise it.

[Helen Jones (Warrington North) (Lab)]

9. What recent discussions he has had with NHS England on the future of district general hospitals; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

The NHS was launched in a district general hospital. The continuing commitment of NHS England to DGHs is shown in their serial mentions in the “Five Year Forward View”. I recommend that the hon. Lady reads that to see the future for district general hospitals and the important role they will play.

[Helen Jones]

I am grateful to the Minister for that answer, but it ignores the reality on the ground. In opposition, the Prime Minister promised a bare-knuckle fight to save district general hospitals. Since he came to power, Warrington has lost its vascular services and some of its spinal services, maternity services are under review, and a £15 million deficit threatens the future of the trust. Did that bare-knuckle fighter get knocked out, or did he not even bother to enter the ring?

[Ben Gummer]

I gently remind the hon. Lady that the difference is that changes to services provided at hospitals are now made on the recommendation of clinicians, rather than of bureaucrats and Ministers, as it was under the previous Government, in which she served. In respect of her own hospital, the number of diagnostic tests for cancer are up by 22,000 since 2010, the number of MRI scans by 6,000, the number of CT scans by 7,000 and the number of operations by 1,800. That is a record of which to be proud.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Jane Ellison]

I welcome the hon. Lady back to her place. It is good to see her back in that job and not on the Government Benches. It is far from the case that we took a passive approach—far from it. Some important things were learned from the way we have worked with industry and we are looking to build on those, but as I have said, there is no silver bullet. There is not a single academic study in the world that says that the way to respond to obesity in the developed world is through a single mechanism. We have to look at a whole-system approach, and that is what we are doing.

[Helen Jones (Warrington North) (Lab)]

12. What estimate he has made of the anticipated levels of deficits in hospital trusts for the current financial year.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The NHS faces significant financial challenges this year and beyond. That is why we have now committed £10 billion extra for the NHS—£2 billion for this year and at least £8 billion more by 2020. Individual trust plans for 2015-16 are still being worked up but, with concerted financial control from providers, we expect to deliver financial balance in 2015-16.

[Helen Jones]

But does the Secretary of State accept that in trusts such as mine, which anticipates a £15 million deficit this year, that cannot be done without cuts to staff, beds and services? What happened to the Prime Minister’s pledge on a bare-knuckle fight to protect district general hospitals, when trusts such as mine are facing such circumstances?

National Health Service

Helen Jones Excerpts

Wednesday 21st January 2015 Commons Chamber

[Andy Burnham]

I will make some progress.

I mentioned record numbers of delayed discharges. There are also record numbers of people visiting A and E, record numbers of frail people being admitted through A and E, record numbers of people waiting on trolleys and record numbers of people trapped in acute hospital beds. This is the simple question that has not yet been answered by this Government: why is there this unprecedented pressure in accident and emergency? Until there are proper answers to that simple question—and agreement about the true causes of the A and E crisis—we will not be able to move forward with a proper solution, and that is the point of today’s debate.

When the Secretary of State came here to answer the urgent question two weeks ago, he was asked by my hon. Friend the Member for Halton (Derek Twigg) what he saw as the causes of the increased attendances at A and E. Let me remind the House of what he said:

“We have looked into that matter in huge detail. There are probably three broad factors that are behind the increase in demand. One is the ageing population...The second factor is changing consumer expectation among younger people who want faster health care…The third factor is a refusal by NHS trusts to do what they were pressurised to do in the past, which is to cut corners to hit targets.—[Official Report, 7 January 2015; Vol. 590, c. 280.]

In other words, “Nothing to do with us, Guv.” It is the same old story with this Secretary of State. It is always someone else’s fault: older people’s fault, younger people’s fault, the previous Government’s fault—anyone but him.

[Helen Jones (Warrington North) (Lab)]

My right hon. Friend knows Warrington well. As well as increasing ambulance response time and having fewer GPs than we had in 2010, we are now seeing one of the last specialisms—spinal services—moved from Warrington to Walton with no public consultation whatever. Does he agree that this is exactly the result of the Government’s reorganisation in which no one is accountable for any decisions and the future of hospitals such as Warrington is at risk?

[Andy Burnham]

My hon. Friend is right; I do know Warrington well. Speaking up for my own family who live in Warrington, I will not accept a situation in which their services are taken away without them having the democratic right to challenge those decisions. But that is what has been growing under this Secretary of State. We had the decision on Lewisham—the most outrageous example—in which he tried to close a successful A and E that was serving a very deprived part of London, without any proper process, and he lost in the High Court. Then we had a clause brought before the House that tried to close hospitals anyway. That is what the Government want to do; they want to ride roughshod over local people and close services where they want to, and we will not let it happen.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

What is so disappointing about the health debate is that Labour Members tour TV studios trying to whip up a sense of crisis in the NHS in England, and then deny that things are even worse in Wales. Services are better in England because we have put more money on to the front line and less into management.

[Helen Jones (Warrington North) (Lab)]

Prior to Christmas, a motorcyclist in my constituency with serious leg injuries was left lying on the ground in the rain for an hour and 40 minutes waiting for an ambulance. Local people had to bring out blankets and hot water bottles to try to keep him warm, but because no ambulance arrived, the police had to commandeer a council minibus to take him to hospital. Is the Secretary of State ashamed to stand at the Dispatch Box and tell the House that the NHS is not in crisis, when that is what is happening on the ground?

[Mr Hunt]

Let me tell the hon. Lady what we are doing—[Interruption.] This is what I think is so shocking: Labour Members are not actually interested in what is happening to avoid precisely the kind of things that the hon. Lady mentioned. We are putting £4.6 million of extra support into the North West ambulance service this winter, and that money is being used to employ more paramedics, to train people so that they can see and treat patients on the spot, and to help more people on the phone so that they do not need an ambulance. The hon. Lady should perhaps have listened to the earlier question, because where Labour is running the ambulance services, results are even worse.