Junior Doctors’ Contracts

Helen Whately Excerpts

Wednesday 28th October 2015 Commons Chamber

[Mr Hunt]

Let us look at some of the facts. What is the most important thing for people admitted to hospital at the weekend? It is that they are seen quickly by a consultant. Currently, across all key specialties, in only 10% of our hospitals are patients seen by a consultant within 14 hours of being admitted at the weekend. Only 10% of hospitals provide vital diagnostic services seven days a week. Clinical standards provide that patients should be reviewed twice a day by consultants in high-dependency areas but, at weekends, that happens in only one in 20 of our hospitals across all key services.

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

Is the Secretary of State shocked, as I am, that the shadow Health Secretary seemed to say that the NHS should continue as it is, and that she appears to deny the weekend effect, which means that people are dying unnecessarily?

[Mr Hunt]

Yes, I am shocked. I am really shocked about the suggestion that there is a difference between what is right for patients and what is right for doctors. The shadow Secretary of State spent a lot of time talking about morale. The worst possible thing for doctors’ morale is their being unable to give their patients the care they want to give.

--- Later in debate ---

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

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

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

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

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

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

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

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

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

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

[Helen Whately]

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

[Charlotte Leslie]

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

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

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

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

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

NHS: Financial Performance

Helen Whately Excerpts

Monday 12th October 2015 Commons Chamber

[Ben Gummer]

I thank my hon. Friend for bringing the attention of the House to innovation at a local level. This kind of innovation, which will allow us to transform the service into an even better NHS in the years to come, is being repeated in many trusts across the country. If I may, I will reply to him by letter on the specific issue of scientists after I have investigated the points he has made.

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

In addition to needing extra funding, which the Government have rightly committed to provide, the NHS could and should make better use of its resources through better procurement, the use of technology and the employment of permanent rather than temporary staff. The challenge is how to do this at the necessary pace and scale. Will my hon. Friend advise what steps the Government are taking to drive the pace and scale of the changes that are important not only to improve productivity but for better outcomes and patient experience?

[Ben Gummer]

My hon. Friend identifies precisely the action we in the Department need to take. It would be a dereliction of duty to pour money into an unreformed system, as it would mean money being spent on administration, bureaucracy and waste, and not on the changes we need to improve patient care. We need to move at pace to bring in the changes necessary to transform the system if we are to get the NHS we all want to see.

NHS (Contracts and Conditions)

Helen Whately Excerpts

Monday 14th September 2015 Westminster Hall

[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.

--- Later in debate ---

[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.

--- Later in debate ---

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

I welcome the fact that in this House we are talking about the NHS workforce, because that is one of my greatest concerns for the future of the NHS. In my role on the Health Committee, tomorrow and on other days I will be asking questions about the future of the workforce.

The hon. Member for Newport West (Paul Flynn) has just made a very important point: what is said in the House really matters; words matter. I want to talk briefly on the subject of confidence. What really matters for the NHS is patient confidence and public confidence in the NHS. I note that last year, public confidence in the NHS in England went up by 5%, and that is at a time when the NHS is more transparent than ever before about the standard of care. It is being incredibly open about things going wrong as well as things going right, so the public know that problems are no longer being swept under the carpet. In fact, that may be one reason why public confidence has gone up: problems are being investigated and sorted out.

I have to say that I was quite staggered that the hon. Member for Warrington North (Helen Jones) questioned the mortality figures so much and was questioning the value and importance of seven-day working. As we have heard and as the BMJ—

[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.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

If the Secretary of State is doing the marvellous job that the hon. Lady suggests, why did so many of the front-line staff in our NHS, who work so hard day in, day out, take to Twitter to express their lack of confidence in him?

[Helen Whately]

I believe that the Secretary of State has done a good job of driving the NHS in the right direction, and I know that a large proportion of the workforce have been very supportive of him.

We are all in this room because we value the NHS, but we must not be complacent. We have to recognise when it lets people down. It is intolerable that if someone has the misfortune to get ill and be admitted to hospital at the weekend, they may be more likely to die. I am not going to repeat the statistics on that, because my hon. Friend the Member for Totnes (Dr Wollaston) helpfully updated us, and I suspect that my figures are not as recent as hers. She made a strong case, as have others, for why the NHS needs to have proper seven-day care, which must include the support services mentioned by the hon. Member for Warrington North.

The Royal College of Surgeons strongly supports seven-day care. It has said that one reason why outcomes are worse at weekends is that patients are less likely to be seen by the right mix of junior and senior staff; that such patients experience reduced access to diagnostics; and that earlier senior consultant involvement is crucial. Research from the NHS National Health Research Institute shows that 3.6 more specialists attend acutely ill patients on Wednesdays than on Sundays. More senior doctors need to be available at weekends—not just on call, as many consultants are at the moment, but present in hospitals.

The changes should not be about getting doctors to work intolerable hours, and that is not what is being proposed. As has been mentioned, only a small proportion of consultants exercise their opt-out. One could argue that the changes to the workforce, and to the consultant contract in particular, are about bringing the contract into line with what is actually happening. Looking at the terms of the workforce gives us an opportunity to ensure that there is an appropriate package for doctors in A&E, where there are large numbers of vacancies. That is the case in hospitals in and around my constituency in Kent, which is an area with a high proportion of out-of-hours work. It also gives us an opportunity to ensure that clinicians are recognised and rewarded for taking on management and leadership responsibilities. We really need clinicians to step up and take on those responsibilities. It gives us an opportunity to make sure that consultants are treated as professionals who take responsibility for their patients, their team and the whole service that they provide.

The NHS faces an incredibly tough time over the next five years. It faces rising demand for its services and rising expectations, and even with an extra £8 billion on its way, things will have to change. Senior doctors, along with senior nurses and other health professionals, will have to lead those changes. When I worked in hospitals grappling with the challenges of transformation, ideas came from everyone: junior doctors, senior doctors and patients. When it comes down to it, consultants, matrons and senior staff have to lead from the front and make things happen. They often face opposition from colleagues, so they need to be courageous and put in extra hours.

To ensure that that happens, and to get the NHS from where it is now to where we want it to be in five years’ time, there has to be a sense that we are all in it together. We cannot have a situation in which doctors blame managers and politicians, while politicians and managers point fingers at doctors. We absolutely have to move on and focus on doing what is best for patients, and what will achieve the best clinical outcomes. We have to build trust among all who are involved in healthcare and work out how we can have, and how we can afford, excellent care seven days a week, day and night. We have to support the healthcare professionals—consultants, nurses, managers and everyone else who is going to make that happen.

[Dr Huq]

Will the hon. Lady give way?

[Helen Whately]

I was just finishing.

[Dr Huq]

I just wanted to ask where the hon. Lady would place management consultants in that. The NHS in north-west London has spent, I think, £13 million this year alone on Saatchi and Saatchi, and various other groups. I just wondered where she would place that in that trajectory. Hopefully, it will be something we can all agree on.

--- Later in debate ---

[Helen Whately]

I want to make the important point that we in this House need to support the NHS in doing what it needs to do to make the substantial changes that it faces over the next five years. That means supporting managers, supporting doctors and supporting nurses. Let us not try to be divisive.

[Mary Robinson]

Will my hon. Friend give way?

--- Later in debate ---

[Ben Gummer]

The hon. Lady points out that contractual differences already exist between NHS Scotland and NHS England. Officials have looked with interest at the experience of NHS Scotland—one of the pleasures of the devolved NHS system is that we can all learn things from one another. I hope that the new replacement of the clinical excellence award will be perceived as far fairer by clinicians and will reward those surgeons who are giving their utmost in academic research and the professional development of others. That is a tangible improvement to consultants’ terms.

It is important to point out, as several of my hon. Friends have done, that we are talking about ensuring that, at most, consultants work no more than one weekend in every four. That is the basis on which they will be contracted to work in a seven-day NHS. We are not talking about seven days at a time, but about shift rotas and patterns, as many people in professional life already recognise, not least some of those who have spoken in this Chamber. We need to get to a situation in which NHS professionals at the top, as well as those at the bottom, are trusted to organise their life and work patterns according to the professionalism they hold so dear. Many consultants in the NHS want to move to contract reform so that they may express their professionalism in that way, and we need to ensure that it happens so as to bring them with us, rather than its being forced on them.

For that reason, I am delighted that the consultants committee of the BMA has agreed to rejoin negotiations. It has seen that there is a basis for reaching an agreement, which suggests—contrary to some of what has been said by Opposition Members—that things are being done with a sense of collaboration. We have wanted to enter the negotiations for some time. The BMA, for reasons no doubt connected with the election—probably understandably—decided to withdraw from negotiations, but it has now come back. We and the consultants committee can reach a good position on the proposed contract.

The junior doctors’ contract is a proposal of great strength, not least because we include a significant increase in basic pay rates, which should be welcomed across the board. The contract addresses one of the points made by the hon. Member for Warrington North and does something important for the way in which junior doctors are perceived by their management. Instead of offering, in effect, danger money for excess hours, which is surely not the way to manage a workforce, it gives junior doctors a right to a review of their hours, so that they may properly manage their work rotas and patterns. For the first time, that will be enshrined in their contract. They will have far more predictable work patterns; providers—employers—will be forced to think seriously about work-life balance when constructing the roster; and, on pay and on the offer to juniors for their working life, the proposed contract will produce a far happier outcome.

I had hoped that the juniors committee would already have agreed to come back to the table, and I remain hopeful. The committee is meeting imminently—in six minutes’ time, in fact—and I hope that it is listening to the words in this Chamber, because hon. Members and others listening have heard nothing from both Government and Opposition Members but unalloyed praise for NHS staff and a real desire to work cross-party to secure the kinds of advances in quality that everyone wishes to see. With the juniors at the table, we could reach a constructive and reasonable resolution to the need to change their contract. That need was impressed on Ministers not only by the DDRB—the review body on doctors and dentists remuneration, but by the NHS’s own independent pay review body. Many in the service, perhaps more quietly than those who have been most exercised on Twitter, know that it is necessary.

[Helen Whately]

Is the Minister aware that if we compare the number of staff in a particular NHS service with the demand for that service over time, we can see that demand is sometimes highest when staff numbers are at their lowest? Demand and staff numbers do not match well. Is there not an opportunity to look at changing staff shifts and rotas to ensure that there is the greatest number of staff when demand is greatest?

[Ben Gummer]

My hon. Friend is entirely right. The whole purpose of what we are doing through contract reform is to match the professionalism of doctors, consultants and those working on agenda for change contracts—nurses and so forth—with the demands of any particular hospital. That cannot be decided by me or NHS England, but has to be decided in each setting, because of the differences—sometimes subtle and sometimes wild—between hospitals. In a study of some 15 hospitals released a couple of years ago, it was noticeable that there was 3.6 times more consultant cover for acutely ill people on a Wednesday than on a Saturday, even though 3.6 times more people were not acutely ill on a Saturday. The comparison is roughly drawn, but it points to a mismatch between rostered staff and peak patient flows. Most hospital managers would not only accept that point, but offer it to you.

All that suggests that somehow no seven-day NHS working is going on at the moment. As the shadow Minister and other hon. Members have said, however, some hospitals are already delivering an exceptional seven-day service—sometimes at no extra cost at all, and sometimes with only a minimal cost increase. What is most noticeable is that care quality has improved. In some cases that is now measurable, which is very exciting, and we can see reductions in mortality attributed to changes to staff working patterns. The staff, when asked, “What difference has this made to your lives?” point, as the key difference, to the fact that this was led by enthusiastic members of the staff themselves. There we have a pointer as to where we need to go: we need to get staff buy-in at the beginning. When the change is done well, it gives staff far greater control over their working life, which has led in a couple of hospitals to appreciable improvements in staff satisfaction.

Those settings have achieved the trick that we want to see throughout the NHS, which is for contract reform to empower and help staff to deliver care with the professionalism that I and everyone in this Chamber know that they wish to, while delivering better, higher quality care and decreased mortality—all within tight spending constraints, despite the increases to the cash budget that the Government have pledged to the NHS. If we can achieve that, we will have done something very special: we will have dealt with the lack of a link that has existed for too long between patient quality and care, and restrictive contracts that do not reflect how many staff want to work, and certainly do not reflect how patients admit themselves to hospital.

There is one final thing that I would like to add—in fact, it is the penultimate thing, because I must answer the point made by the hon. Member for Warrington North about staff. She is right to say that, of course, seven-day services will, in some disciplines, have an effect on the staff numbers that might or might not be required. That is part of the plan being developed by NHS England, in close association with Health Education England. We are recruiting close to record numbers of nurses, doctors and consultants, and we are doing so in many of the diagnostic specialties as well.

However, this is a question of not just staff numbers, as the hon. Lady recognises, but much smarter rostering and rota-ing, so that we use staff and their time as effectively as they would like us to. It is also a question of the productive use of staff time. She rightly pointed to the bureaucracy that ties people down. In some hospitals—some quite near her constituency—that bureaucracy has been reduced to a very minimum, as a result of which staff have patient contact time of an order of magnitude different from that in hospitals just 50 or 60 miles away. If we can bring all levels of staff exposure to patients—the patients they want to care for, for the maximum period of time—up to the best level in the NHS, we will already have the productivity gains in the workforce that will make possible not just seven-day working but a whole series of other improvements in care quality.

My final point about the opportunity that contract reform gives us was touched on by the hon. Member for Ealing Central and Acton (Dr Huq), who spoke about whistleblowing. It is an important point. When people attack the Secretary of State they should remember that he brought in freedom to speak up and the duty of candour, is bringing whistleblowing champions into the NHS, and has acted on some of the most difficult recommendations of the Francis report. It is this Secretary of State who said for the first time, “If you are employed by the NHS and feel that care is not being delivered in a way that is good for patients, we will prize your voice and listen to you above those who might stop you being heard.”

That kind of message to the system is new. It is so radical that I think many still do not quite believe it could be true, but I hope that the instigation, at some considerable cost, of whistleblowing champions, along with the framework for whistleblowing and the independent national officer, demonstrates to Members and the outside workforce that we are deadly serious about listening to staff, no matter where they work or who manages them, to make sure that we improve patient care wherever possible. We know that improving staff’s experience in their working lives is a crucial part of that.

Although this was not mentioned in the debate, I am conscious that far too many staff in the NHS suffer bullying and harassment. The numbers are almost unheard of in any other walk of life, including the Army and the police. NHS workers unfortunately can expect abuse from members of the public and bullying within management chains to a degree that is unique in the public sector and close to being so across the entire workforce. That is an historical problem that has led to the very high levels of staff sickness that the NHS has carried for decades. It will not be an easy problem to crack, but I have to tell Members that I and the Secretary of State are absolutely committed to doing something about it. NHS staff go to their place of work because they care about patients and about their vocation, but too often can get pushed back by poor management, abusive patients and poor performance management processes, and often feel belittled in what they are doing. If we can do something about their working conditions and improve their working lives, that will be very important, not just for staff but for patients. If we can improve the working practices and the working lives of the 1.3 million people devoted to our nation’s healthcare, we will do so much to help them produce even better care for the patients they serve.

I hope that Members on both sides of the House have come to a broad understanding that the changes anticipated by the contract reform are necessary. It is certainly true that we must take account of the data and listen carefully to the arguments of everyone involved in the provision of NHS services seven days a week, to make sure that changes are made as collaboratively as possible, so long as collaboration is made possible by all parties. We must also bind ourselves to the promise that we should all reflect correctly the words of politicians on both sides of the House, lest their misconstruction cause worry and fear in the outside world. In all that, we must ensure that the changes we make improve the quality of patient care and reduce the excess rate of mortality, which I know everyone, including all Members, would like to come down when and if possible.

Question put and agreed to.

Resolved,

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

NHS Reform

Helen Whately Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

I thank the hon. Lady for the responsible approach that she took to the changes at Trafford general. Of course, I will listen to her concerns carefully, alongside those of her colleagues, and take them up with the NHS. Perhaps if she comes to the meeting that I am organising for her colleagues, that will provide an opportunity for me to do that.

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

I welcome a huge amount of the statement, particularly about the balance between transparency and more autonomy and the combination of scrutiny and support. Does the Secretary of State agree that not only hospitals and GPs but community and social care services need to be 24/7?

[Mr Hunt]

My hon. Friend speaks with great knowledge about health matters, because of her previous job. [Hon. Members: “McKinsey.”] Yes, McKinsey, which does some important work for the NHS. She is absolutely right that we need to be able to discharge into the community on all seven days, and it is important that the primary care and social care systems are part of that change.

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 7th July 2015 Commons Chamber

[Alistair Burt]

I will indeed meet the hon. Lady. Access to NHS dental practices has been improving, but I am aware that there are some difficulties in some areas. The best thing we can do is meet and talk about it, and see what I can do.

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

In the last Parliament we made great strides using transparency to drive improvement in the quality of patient care. Does my right hon. Friend agree that we can and should go further, particularly on the transparency of performance in primary and community care?

[Mr Jeremy Hunt]

My hon. Friend is absolutely right and has great experience in this area. We are now having a lot of transparency at an institutional level, but individual doctors and nurses in primary and secondary care are still finding it too hard to speak out if they have concerns. Getting that culture right has to be a big priority for this Parliament.

A&E Services

Helen Whately Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Reed]

I have been generous with time, so I must press on.

In 2013, the Government announced a call to action to improve general practice access and experience for patients. They set out six key indicators to rate the quality of access and experience for patients. One year later, every single indicator had shown a deterioration in performance. Fewer people described the overall experience of their surgery as good and fewer people were able to get an appointment. The Government must address that finding. Only by addressing the crisis in general practice in addition to social care can the Government begin to relieve the pressures on A&E departments.

When the Secretary of State and the Prime Minister discuss the NHS in this House, they like to use words such as “openness” and “transparency”. Sadly, their actions betray that sentiment on a routine basis. I refer again to Professor Keogh’s seminal letter to the Secretary of State two years ago in which he refers to the use and principle of transparency in the NHS as representing

“a turning point for our health service from which there is no return.”

Except that, for this Government, it seems that there is a return.

Currently, NHS England publishes the performance measures for each A&E in England every week. Those figures contain a wealth of information for each trust and it makes that data available to the public. The data show how each A&E department is performing across a range of measures, and it can be used to target specific interventions at trusts that are struggling. This reporting time period also means that issues can be identified quickly and resolved promptly. Rather than taking action to ensure that hospitals in England meet this target, the Government are seeking to hide the performance data. We will not be able to see how A&Es are performing each week; we will have to wait until the end of each month. By publishing a significant number of performance measures from across the NHS on the same day, the Government appear to have found an innovative way of burying bad news—publishing even worse news at the same time. Patients deserve better than that. Clearly, Ministers find it more palatable to be reminded of their failings just once a month, rather than at the end of each week. This move is designed to make the red box lighter and the scathing headlines kinder. Will people not conclude that the monthly publication of A&E data—unlike other monthly data sets—has nothing to do with patient care and everything to do with political and media management?

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

rose—

[Mr Reed]

I must make some progress.

The issues facing A&E departments, GP surgeries and social care services will not be solved by amending the date on which performance indicators are published. The public will be rightly sceptical about the motivations behind the reduced publication of data that illustrate both good and bad performance. It is a move designed to take the pressure off Ministers as they turn a blind eye to the pressures that they are inflicting on our health service.

The pressures that the Government have introduced into the health service have built up until the system can no longer cope. A&E is full to bursting and social care has been cut to the bone, which means that patients cannot be discharged, wards are getting fuller, there are delays for admission and more people are waiting longer for treatment. That is indisputable. In England, the target for seeing 95% of patients within four hours has been missed for 100 weeks in a row. Instead of easing the pressures in A&E, this Government have decided to make it harder for patients to see the effects of Government policy on the services that they use by restricting the performance data that are available. Under this Government, it is getting harder to see a GP, harder to be seen at A&E and harder to see how the NHS is performing.

Not only is the record of this Government shameful, but their cynicism and complacency are, too. Professional bodies and Opposition Members have long warned the Government that the path they have placed the NHS on is damaging the service, working against patients’ best interests and causing unprecedented professional concern. Having done that, the Government are now trying to evade scrutiny. Today, Ministers must explain why they are seeking to make NHS performance less transparent and to hide the damage caused by their policies from patients and the public, and how they intend to protect services and tackle hospital deficits this year.

--- Later in debate ---

[Dr Wollaston]

Indeed. I was going to comment further on the issue of the skill mix. This is about not only those higher skill professionals, but the mix within the NHS. I do not think that we should talk that down. We simply will not be able to manage unless we broaden the skill mix. Healthcare assistants, for example, make an extraordinary contribution to the NHS and social care. One of the reasons we lose so many of them is the lack of access to higher professional development; it is not just about a low-wage economy. This is about how we can create more pathways to becoming, for example, assistant practitioners and physician assistants, how we can use them and how we can bring in more pharmacists, who train for five years in their specialty, into what we do across the NHS?

[Helen Whately]

Picking up on my hon. Friend’s point about healthcare assistants, does she agree that improving the opportunities for healthcare assistants is a huge opportunity for the NHS at the moment?

[Dr Wollaston]

It is a huge opportunity and we must go further with that, because continuing professional development across the NHS workforce is part of addressing the burnout that the hon. Member for Central Ayrshire talked about. We must do more to address the rotas and see what is causing our staff to leave the NHS, because it is not just about pay or the allure of working in a sunnier climate—we cannot do much about that. It is also often about the work-life balance they face and how that compares with abroad. We have got into a vicious circle of increasingly having to rely on locums to fill those gaps, and that money could be far better spent addressing why the NHS is haemorrhaging so many skilled staff abroad and to outside professions.

When we talk in this House about the challenges facing primary care and A&E departments, we must be careful not to talk them down. We know that medical students find going into A&E attractive, so let us not cut off the supply any further by talking about it in terms of doom and gloom. There are things we can do to improve the working lives of people in A&E, so we should get on and do the job, and I think that this House should do so in a far more constructive frame of mind. It is time to put aside the difference we have had in the election. We have five years to go until the next election. Let us show an example to those following this debate outside by looking at this in entirely constructive terms.

I want to return to an issue the hon. Member for Central Ayrshire touched on: seven-day working. Just as we should not be trapped by targets, let us not be trapped by political dogma. Let us look at what the unintended consequences sometimes can be if we are driven by the mantra that it must be 8 till 8 and seven days a week in every situation. I used to practise in a rural community. If we create a system in which we make it deeply unattractive to work in small, rural practices and in which we divert resources from the key priorities of seven-day working—which should be to reduce avoidable mortality and unnecessary hospital admissions—and if we take our eyes off that as the key priority and drive towards having to achieve 8 till 8 in every location, we could find that we have a further recruitment shortfall, as has happened in my constituency. That can translate into real unintended harms, such as the closure of many beds at Brixham hospital because the GPs could no longer safely man the in-patient beds. We could find ourselves in a spiral of unintended consequences. Let us listen to those on the front line and to our patients and keep them first and foremost in our minds when we consider what we are doing in the NHS.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a good debate. I pay tribute to hon. Members who made their maiden speeches. I particularly congratulate my hon. Friends the Members for Dewsbury (Paula Sherriff) and for Salford and Eccles (Rebecca Long Bailey). Having been a student at the University of Salford, I had not realised until now that I followed in the footsteps of Marx and Engels by supping in The Crescent; you learn something new every day. The hon. Member for Dumfries and Galloway (Richard Arkless) also made his maiden speech. I congratulate them on their contributions. It is clear that all three will make their presence felt in the House of Commons in the coming years.

I thank the other Members who have contributed, particularly my hon. Friends the Members for Birmingham, Edgbaston (Ms Stuart), for Hartlepool (Mr Wright), for Hammersmith (Andy Slaughter) and for Ealing Central and Acton (Dr Huq), and the hon. Member for Central Ayrshire (Dr Whitford), who leads on health issues for the SNP. On the Government Benches, we heard from the hon. Members for Totnes (Dr Wollaston), for Sittingbourne and Sheppey (Gordon Henderson), for Lewes (Maria Caulfield), for Crawley (Henry Smith), for Braintree (James Cleverly), for Bath (Ben Howlett), and for Morley and Outwood (Andrea Jenkyns). Many Conservative Members stuck very closely to their party’s policy research unit paper, a copy of which I was conveniently sent earlier today. I congratulate them on being so loyal to their Whips Office.

It would be very remiss of me not to place on record my own tribute to the doctors, nurses, healthcare assistants and other dedicated NHS staff who provide such extraordinary and professional care. Many Members of this House who have been here for a number of years will know that I had a run of bad health about five years ago. As a result, I became far more familiar with my own local hospitals, Tameside general and Stepping Hill, than I had hoped to, even given my position as a constituency Member of Parliament and a shadow Health Minister. I have experienced the very best of NHS care. If I am honest, I also experienced some care that did not meet the standards that we perhaps expect of our NHS. I know, however, that we have a workforce who are completely dedicated and caring.

The House should be in absolutely no doubt, though, that those staff are under a great deal of pressure—sustained pressure that has been building over the past five years. The facts need to be laid out in the open, and Ministers need to be challenged on their fictions. They made all sorts of desperate promises to get them through an election campaign, and now they need to show where the money is going to come from to pay for those promises and to set out exactly how they are going to deliver them. Yet what have Ministers been doing since the general election? I do not disagree with Professor Sir Bruce Keogh’s decision to improve the publication of data for mental health and for cancer—that is welcome—but I do disagree with what this Government intend to do in relation to A&E data. Instead of dealing with the pressure facing the NHS in England, they have decided to stop publishing weekly data about those pressures.

[Helen Whately]

Will the hon. Gentleman acknowledge that the NHS leads the world in transparency, and that an excessive focus on one data point—the four-hour target for A&E—is detrimental overall to patients?

[Andrew Gwynne]

We should remember, of course, that the last Labour Government started that transparency with heart and stroke data.

I think we all know what is going on here. There can be no clearer sign of the Tories’ failure on the NHS than the fact that hospital accident and emergency departments have now missed their own four-hour target for 100 weeks in a row. This is a landmark failure, to which the Prime Minister promised he would not return. The reality is that this Government caused the crisis by making it harder to see a GP and by stripping back social care services.

Let us be under no illusions—[Interruption.] The Secretary of State can chunter, but social care cuts are NHS cuts. The Government made damaging mistakes that have seen the number of people going into hospital soar. The best thing that they could do is to admit it and explain what they are going to do to fix the problem. It is stunning that their only solution is to spin their mistakes and to make the NHS less transparent.

Let me briefly come on to nurse staffing problems. Only this week, we have seen yet another example of poor policy coming out of the Department of Health. If it insists, along with the Home Office, that migrants not earning £35,000 after six years must go home, that will cut a hole right through the middle of our NHS. The Royal College of Nursing estimates that 6,620 nurses will have to leave the country by 2020. Because of the Government’s failure to train adequate numbers of nurses in the UK, those nurses will have cost almost £40 million to recruit from overseas. People coming from other countries to work in the NHS make a huge contribution and our health service would not be able to cope without them, but this is now a mess entirely of Ministers’ own making.

The short-sighted cuts to nurse training in the early years of the last Parliament left NHS hospitals with no option but to recruit from overseas or hire expensive agency nurses. That is also one of the main reasons why many hospital trusts are now in deficit. It was an absolutely profound error and I hope that the Minister will acknowledge that. As ever with this Government, patients and taxpayers will pay the price for the Prime Minister’s mismanagement of the health services.

There have been further mistakes. On GP access, it stands to reason that if it is made harder to see a GP, people will be more likely to end up in hospital. As we have heard, the reasons for the crisis are many, but the lack of access to GP services appears to account for much of the problem. No amount of obfuscation and massaging of figures can hide the fact that this Government have made it harder to get a GP appointment. All Members will know of constituents who have had to phone their doctors only to be told that no appointments are available and that they should ring back the next day—which they do, only to experience the same problem again. That they end up in frustration in A&E should not come as any shock.

The Prime Minister has now repeated his 2010 promise to provide access to GPs seven days a week, but he cannot even provide access to them five days a week. When patients want up-to-date information on how their local hospital is performing, this Government plan to publish the data less frequently. I hope that the Government will now see sense, and I commend our motion to the House.

NHS Success Regime

Helen Whately Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

I welcome the hon. Lady to her place. I only hope that she does not have the same contempt for her constituents that her predecessor seems to have expressed. It is interesting how it all comes out afterwards. I repeat to the hon. Lady that the decisions will be made locally by local people and local commissioners in response to local problems, and where they arise we will seek to address them.

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

I have heard that trusts in my constituency were potential candidates for this regime. Will the Minister please make it clear that, unlike some previous oversight regimes, this regime will enable local health care organisations to work together to solve their problems and will involve not just scrutiny but more support?

[Ben Gummer]

I thank my hon. Friend for her question. I am delighted to see her in her place. She has experience and expertise in this area. She will know that elsewhere in the country, before 2010, local commissioners, doctors and providers often came up with good solutions, but then strategic health authorities would come in with a completely different answer and override all of them. That is what we are seeking to avoid.

Health and Social Care

Helen Whately Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Andy Burnham]

I must point out to the hon. Lady that Labour had a 20-point lead on the NHS going into the general election, which suggests that the public believed what we were saying about the NHS rather than what the Conservatives were saying. We do support the five-year forward view, and I have said as much, but it needs money now. If that plan is to be made real, it needs investment now. The NHS will not be able to deliver it while it has a £2 billion deficit this year; instead, it will go backwards. It will be unable to make the progress it needs to make.

Let us look at why the grip has been lost. This all goes back to the disastrous decision during the last Parliament to ignore the pleas of patients and staff and to force through the biggest-ever reorganisation in the history of the NHS, which nobody wanted and nobody voted for. Back then, a financially solvent NHS was turned upside down and, just when the service should have been focusing on making savings, it was instead firing and rehiring staff, abolishing and recreating organisations and making front-line nursing staff redundant. That destabilised the NHS, and it has never recovered since.

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

I welcome the right hon. Gentleman’s support for the five-year forward view, but how can he make all these criticisms of the NHS and give that support in the light of Labour’s not supporting our election commitment to give the NHS the £8 billion of funding it needs?

[Andy Burnham]

I shall come to the £8 billion, which was the centrepiece of what the Conservatives were proposing during the election campaign. The simple question was: where is it coming from? They never answered that question. The other question they need to answer is: what are they going to do for the NHS now? The £8 billion was promised for five years’ time, but, as I have been saying, the NHS is facing a crisis this year and next year. An IOU for five years’ time is not much use to the NHS when it faces laying off staff and closing services.

--- Later in debate ---

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

Thank you, Mr Speaker, for giving me the chance to make my maiden speech in this debate, as it is on a subject about which I have strong feelings. I congratulate the other new Members on both sides of the House who have made their maiden speeches today. I particularly appreciated the prominence of mental health in several of the messages.

It is an immense honour to be speaking in this Chamber, and I do so with some trepidation, no doubt shared by others finding their feet here. There are many sources of courage in this House. My courage comes from my constituents; from the trust they have placed in me to represent them and give them a voice.

My wonderful constituency, Faversham and Mid Kent, stretches from the edge of Maidstone across the North Downs to Faversham, a historic port with a rich mercantile and maritime heritage, and on across fruit farms, marsh and ancient woodlands to Boughton-under-Blean and Hernhill.

Faversham is known as the market town of kings, and the constituency is proud of its royal heritage, although it has also imprisoned a couple of monarchs and the bones of another have been somehow misplaced. One of its treasures is Leeds Castle, and if I may make full use of the custom that I may speak without intervention, I shall say that Leeds is well known as the most beautiful castle in England. If you head south from Leeds, you rise up the Greensand Ridge to see a breathtaking view of the weald of Kent extending for miles into the distance, and then down in the weald itself you reach the lovely village of Headcorn, the southern tip of my constituency.

The area is renowned for agriculture—fruit farming as well as hop farming, which continues albeit on a much smaller scale than in the past. Britain’s oldest brewery, Shepherd Neame, thrives in the centre of Faversham. It is the constituency’s largest employer and provided a good reason regularly to seek refreshment during the election campaign.

My constituency is a truly great place to live and work, but all is not as it could and should be. While unemployment is low, some people cannot get jobs, and there are too many people on low wages. We have excellent schools, including outstanding grammar schools, but some children leave school without good qualifications. Most people get excellent healthcare most of the time, but local hospitals face serious problems, GPs are overwhelmed and the future of Faversham cottage hospital is an ongoing worry. Residents of villages earmarked for development are fearful of the impact of new houses on their communities, although everyone recognises that we need more homes. During the election campaign, I promised to tackle these problems, and I will keep that promise.

I am fortunate that two of the area’s past MPs, Sir Roger Moate and Sir Hugh Robertson, both live in the constituency and are great sources of wisdom, albeit sensitive to the fact that the job is now mine to do. I have lost count of the number of people who have told me how hard it will be to live up to the standard set by Sir Hugh, and that is just in his role as constituency MP. On top of that, he served as Minister of State for Foreign and Commonwealth Affairs, and Minister for Sport and the Olympics, an event which we can all agree was an outstanding triumph for this country.

Sir Hugh brought to this House his military experience and put it to good use. I hope that I, too, bring valuable experience. I come from a family of doctors, and I nearly followed in their footsteps, but time spent in hospitals as a teenager—not because I was ill; I just did lots of work experience—triggered a different ambition. I wanted to improve the national health service itself. After a stint in telecoms, I spent nearly a decade working in healthcare.

My work with the NHS has been about improving care—the quality of care for patients. The last few years have seen immense progress, especially in respect of improving safety and paying attention to patient experience, but I believe that the NHS must now focus more on the third dimension of quality, which is improving clinical outcomes. How well is the NHS actually doing in helping people to get better? We should all be able to answer that question about the hospitals that care for our constituents, so we need more transparency.

The NHS workforce must be set up to succeed. People talk a lot about doctors and nurses, and we certainly need to train and retain more of them, but I would particularly mention healthcare assistants, who are a vital but often undervalued part of the healthcare workforce.

As we hold the NHS to account, we must get the balance right between scrutiny and support. Aneurin Bevan famously said that the sound of a bedpan dropped in a hospital in his constituency would reverberate in Whitehall; the counterpart is that what is said here reverberates across the country. I have worked in hospitals under intense scrutiny, and I know what it is like. We should be mindful of the impact of what we say on staff morale.

Staff in the NHS hate to see it treated as a political football. In October last year, there was a moment when it seemed that we might have moved on. All three main parties—as they were then—signed up to NHS England’s own plan, the Five Year Forward View. The plan is ambitious, and putting it into practice will involve difficult decisions. I hope that when we in the House are faced with taking a position, we will all avoid the temptation of political opportunism, and will always be sure to pick the side of the patient.

Let me return briefly to my constituency. Faversham is one of 24 towns that own a rare official copy of Magna Carta dating from 1300. This 800th anniversary year of the original Magna Carta is a special time for the town. Looking at Faversham’s Magna Carta recently was, for me, a profound reminder of the history of the rights and freedoms that we enjoy today. I also read several updated charters written by local schools, which brought the concept of rights bang into the 21st century. They reminded me of my duty not just to serve my current constituents, but to do my utmost to ensure that Faversham and Mid Kent is a wonderful place to live for generations to come.