Baby Loss

Jamie Reed Excerpts

Thursday 13th October 2016 Commons Chamber

[Antoinette Sandbach]

I most certainly do. That is exactly the kind of bureaucratic barrier that needs to be broken down. My hon. Friend’s example powerfully demonstrates the need to have a proper bereavement care pathway in place in every region. It should not matter where someone lives; everyone who needs such support should be able to access it.

[Mr Jamie Reed (Copeland) (Lab)]

In relation to the integrated bereavement care pathway, does the hon. Lady envisage the same level of service for parents who have suffered bereavement post-hospital discharge as the service that parents would receive following a bereavement in their own home?

[Antoinette Sandbach]

I agree with the hon. Gentleman. It should not matter what kind of loss a person suffers; they should be able to access that bereavement care pathway whether it is inside or outside hospital.

NHS Sustainability and Transformation Plans

Jamie Reed Excerpts

Wednesday 14th September 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

In the six minutes available to me, it will not be possible to respond to the 40 or so speeches that we have heard today. I shall just pick out two contributions for special mention. First, so far as I can see, the shadow Secretary of State genuinely believes that an organisation that provides care to 45 million people on a budget of £100 billion should not do planning. That really appears to be the view of the hon. Member for Hackney North and Stoke Newington (Ms Abbott). Secondly, the hon. Member for Central Ayrshire (Dr Whitford) made an excellent speech, in which she used the word “opportunity” in connection with STPs, which is what they provide. She also said usefully that healthcare systems were about “more than buildings.” As we go forward with this process, it is important that we all think about what that means.

The health service is not static. Technology is changing; drugs are changing; expectations are changing; and, as we have heard, demography is changing. It is right to try to make it evolve and help it to change. The STP process is the planning mechanism to do so. It is a planning mechanism to put in place a five-year view—this was in the manifesto—that NHS England has developed. If it is to work, it must have three things: it has to be care driven; it has to be properly funded; and it has to be locally driven. It is all those things.

[Mr Jamie Reed (Copeland) (Lab)]

rose—

[David Mowat]

I shall not take interventions; I now have only five minutes left.

When it comes to funding, we have put in an extra £10 billion, and it is real money. If that money had been available in Wales, some of the points raised in the debate about the interface between us and Wales would have been quite different. This year, the increase in health funding is 4% in real terms—three times the rate of inflation. The real point, however, is not to do with money—however much the Conservatives put in and however much Labour says it might put in, although we have not heard that yet. But however much is put in, it does not detract from the need for the health service to be managed effectively and properly so that it can improve and innovate.

There is a prize from these STPs. At the end of the process, we will have a health service that is more oriented towards primary and community care where people live. The health service will provide better access to GPs, emphasise prevention more than ad hoc responses, properly address long-term conditions such as diabetes and begin to address more quickly our mental health and dementia commitments. I say again that if STPs do not address those things, they will not go forward. Perhaps the most important of all the advantages is that the unacceptable gap that currently exists between healthcare and social care will be breached. That is at the centre of the whole process.

NHS Spending

Jamie Reed Excerpts

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

The point that many of us made in the referendum campaign is that even the net figure—the more like £100 million net contribution that we make to the EU—is not a figure that we can bank on with any certainty because, even if it did materialise after an exit from the EU, it would be negated by the very smallest of contractions in the economy, which would itself reduce the tax base and the amount of public spending available. The Institute for Fiscal Studies said that that £100 million a week would be negated by a contraction in the economy as small as 0.6%. I do not think any of the economic forecasts said that the contraction would be as small as that; all of them said that it would be much bigger than that.

[Mr Jamie Reed (Copeland) (Lab)]

I share the right hon. Gentleman’s concerns about—with your permission, Mr Speaker—the lie on the side of the bus. As Secretary of State for Health, will he now, on behalf of the whole country, and particularly on behalf of people who were deceived and let down by that claim, take up with the Electoral Commission why that lie was allowed to stand for so long?

[Mr Hunt]

I understand the hon. Gentleman’s concerns. Let me give him a challenging reply. The trouble that we have—those of us who disagree with the outcome—is that that issue was exhaustively debated and, for whatever reason, people chose to disbelieve our concerns or decided that they were not worried about it.

I understand why the shadow Health Secretary has brought the motion before the House, but the reason it is a difficult one to debate is that essentially the argument about the £350 million, or the £120 million, or the £100 million is dependent on the state of the economy. That is something that we cannot know now, only 12 days after the Brexit vote result. However worried we are about the impact of that vote, in discussions about the economy we have to be careful not to talk it down, because in the end we have a responsibility to recognise that there may be opportunities and we need to make the most of the ones that exist.

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[Mr Jamie Reed]

On the point my hon. Friend the Member for Harrow West (Mr Thomas) has just made about having an assessment if we do end up, essentially, forcibly repatriating EU citizens in the United Kingdom, there will of course be a flip side: something like 3 million British expats in the EU would have to return to the UK as well. Many of them are, to put it politely, of pensionable age, with challenging health demands in many regards. Will the Secretary of State also provide an assessment of what effect that would have on the national health service?

[Mr Hunt]

I am sure that that is analysis we can do, but I cannot do it at the Dispatch Box as a direct response to the hon. Gentleman. However, as I am sure he is well aware—we made this point during the whole Brexit referendum debate—we have reciprocal health arrangements with other EU countries at the moment. Those are immensely convenient to people travelling to and visiting other European countries, because they mean those people can access healthcare completely free of charge. The bill is actually sent to the Government, and that arrangement includes pensioners who have retired to Spain and France and Italy as well. It would be very sad if, as a result of the new relationship with the EU, we lost that convenience. That is one of the reasons why I am confident that other EU countries will be happy for British pensioners to remain in them. As long as those countries are able to charge us for the healthcare costs, the burden to them should be minimal.

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[Joan Ryan]

If the hon. Lady looks at my constituency she will see a perfect storm when it comes to health funding. We are underfunded in public health, in social care, in primary care and in acute care. She can come up with whatever figure she likes, but the experience on the ground is that we are suffering very badly.

I will come on to talk about the Care Quality Commission report, out today, on our hospital. I do not know whether the hon. Lady has seen it, but if she wants to talk about increased spending, I suggest she look at that report. What it says about what is going on in an acute care hospital is unprecedented.

[Mr Jamie Reed]

Two of the prominent leave campaigners who endorsed the £350 million figure are now running to be leader of the Conservative party and our future Prime Minister. Does my right hon. Friend agree that those two people should be brought to this House and made to explain to the country just where they will get the £350 million from?

[Joan Ryan]

I absolutely agree. Nothing makes the public feel more disillusioned and separated from the political and democratic process than to be given promises by politicians who, once the public have given their vote to them, walk away from those promises. That is not acceptable.

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[Mr Jamie Reed (Copeland) (Lab)]

Before I begin, may I apologise to you, Madam Deputy Speaker, and the House authorities for posting a picture of this Chamber on the popular social media and networking site Twitter? Its purpose—it has now been removed—was purely to demonstrate that, at the point of taking the picture, only two Conservative MPs were in the Chamber and both were Ministers. The other point I would like to make before moving on is how much, as a bereft supporter of the English national football side, I am looking forward to cheering on Wales in what I hope will be a victory against Portugal this evening.

The Cumbrian health economy is experiencing the most prolonged period of intense pressure, strain and threat that it has ever faced.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Before the hon. Gentleman gets into the body of his speech—I do not want to interrupt his argument—I want to thank him for the point he made and for his immediate action in removing the picture that he had tweeted. For the avoidance of doubt, it is simply not allowed, but as soon as he realised that he had done something that was not allowed, he acted immediately, and I thank him for doing so.

[Mr Reed]

That is greatly appreciated, Madam Deputy Speaker.

Despite the dedicated and incredible efforts of local NHS staff in my constituency, I see health inequalities on a daily basis, and many of my constituents experience profound access challenges to health services in my constituency and elsewhere across Cumbria, caused in part by our inadequate transport infrastructure, but also by a clearly insufficient profile of investment in local services. So far, I am afraid to say, my calls for improvement have fallen upon deaf ears.

In north and west as well as east Cumbria, we are currently subject to the ongoing success regime process. Funding for the important second phase of the West Cumberland hospital has not yet been released by the Government, and the communities I represent are gravely concerned about the uncertain future facing our local health services, including beds not just at the West Cumberland, but at our local community hospitals in Keswick, Millom, Maryport and elsewhere—and that is before we even consider the profound challenges to primary care, too.

In spite of the challenges that we face and the strength of feeling in my constituency, the Health Secretary, who is no longer in his place, has paid not one visit to the West Cumberland hospital, or any of our community hospitals on whose behalf I speak tonight, in the four years in which he has held his position. Moreover, he has refused my invitation to visit West Cumbria to see for himself the unique challenges that we face in our part of the world. Without visiting the hospital, experiencing the transport inadequacies and seeing the vital work of consultant-led accident and emergency, maternity and paediatric services that the West Cumberland hospital provides, the Health Secretary cannot and does not understand the necessity for his immediate intervention in our troubled health economy.

Most recently, owing to the fact that the Health Secretary would not come to us, my constituents and I—health campaigners from across the piece—decided to go to him. West Cumbrian health campaigners, including Mike Bulman, Mahesh Dhebar, Rachel Holliday, Siobhan Gearing and the fantastic Pamela McGowan from the News & Star newspaper, planned to make a 700 mile round trip to London to meet the Health Secretary, to outline the challenges that our health economy faces and to put our case to him. However, at short notice, but coincidentally on the day after he announced his ambition to stand as leader of the Conservative party, the Health Secretary cancelled the meeting. The decision to cancel that meeting was seen by my community as the calculated insult that I am afraid it surely was.

I led the local campaigners instead to the Department of Health to meet the gracious and approachable Under-Secretary responsible for care quality—the Minister in his place today. The delegation handed to him a confidential document containing the cases given to local campaigners by local mothers about babies who were likely to have suffered fatalities—and maternal fatalities, too—if consultant-led maternity services had been unavailable at the West Cumberland hospital in Whitehaven. The Government are well aware that consultant-led maternity services at that hospital are non-negotiable and absolutely essential—whatever the successor regime that comes forward in the immediate future. Any other option would compromise the safety of local mothers and their babies.

It is clear to me, to my community and to Simon Stevens, the chief executive of the NHS, who visited my constituency only a few months ago, that consultant-led services must be retained and improved at West Cumberland hospital. Removing those services from Whitehaven would be dangerous—

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Question agreed to.

[Mr Reed]

As I was saying, the removal of those consultant-led maternity services would actively undermine the principle of a truly national health service, and will never be accepted by me or by my community. I am therefore deeply concerned by a recent report, based on a leaked e-mail, which suggests that the success regime is indeed considering the removal of maternity services from Whitehaven as one of the options on which it wishes to consult. That is appalling. If the success regime turns out to be a Trojan horse initiated by the Government to slash budgets and remove services, I have just one message to send to the Government today: my community will never accept that, and cannot and will never forgive it.

There is no doubt that consultant-led maternity services are what west Cumbrian women and their families need, want and deserve. Removing those services from the remotest constituency from Westminster in England, in terms of accessibility, would be not only unsafe, but without precedent in our country. It is clear that this move is being driven by the Government’s determination to cut costs, and not by the safety of mothers and babies.

My community now calls on the Government and those responsible for the success regime to make the immediate, clear and unequivocal commitment to consultant-led maternity services at West Cumberland hospital—and other services—that communities in west Cumbria deserve. Without a clear commitment to our consultant-led services, including a fully functioning consultant-led maternity service at West Cumberland hospital, it will be impossible for us to support the work of the success regime in the future.

I have since urged the entire community of west Cumbria to join me, and our local campaigners, in fighting any proposals to remove essential consultant-led services from West Cumberland hospital. We are a community of campaigners, patients, families and NHS staff, united in our commitment to our local national health service, and we are determined to build a 21st century health economy, equipped to overcome the challenges that we face in my incredibly rural constituency. We will not allow the Government, by any means, to strip away our services, leaving a threadbare health service, unfit for purpose, to future generations in the community of west Cumbria. My community is determined; what we are missing is the immediate commitment, support and investment from the Government that we so clearly require.

Just two weeks ago the country voted to leave the European Union, and I regret that. Many of those voters, including a large number of my constituents, voted on the basis of their belief that a Brexit vote would result in an extra £350 million per week for the NHS. Since that vote, prominent members of the leave campaign have been quick to renege on a key promise that swung so many people behind their prospectus. As we observe the Conservative leadership contest, it appears likely that those prominent campaigners will wash their hands of the responsibility of delivering on the commitments that they made. In communities like mine, where people voted in the belief that their vote would help to fund the investments that we need in our health services, that is an unforgivable betrayal.

Now is the time for the Government to fulfil their responsibility to provide a truly national health service. My community needs and deserves no less than an immediate intervention to ensure the release of funding for the second phase of the redevelopment of West Cumberland hospital and a commitment to the retention and improvement of consultant-led services, including accident and emergency, maternity and paediatric services. We also require a commitment to the retention of beds at our community hospitals. Brexit campaigners in the Government, especially those who aspire to be not just the next leader of the Conservative party but the next leader of our country, have a particular responsibility to stand before the House and the country, and explain to all the people whom they knowingly deceived why they did it, where the money is coming from, and what they are going to do about it.

Diabetes-related Complications

Jamie Reed Excerpts

Tuesday 7th June 2016 Westminster Hall

[Paula Sherriff]

I thank the hon. Gentleman for that intervention; once again, I agree with those points.

It makes sense both clinically and financially to improve access to diabetes self-management education. Managing diabetes well is time-consuming and can be complicated, but 69% of diabetics said they did not fully understand their condition. On average, people with diabetes spend only three hours a year with a healthcare professional. For the remaining 8,757 hours they manage their diabetes themselves, for which they need the right skills and knowledge—not to mention confidence. Diabetes self-management courses empower people with diabetes to take charge of their own care. Nine out of 10 people with diabetes who attended a course stated that they felt more confident about managing their diabetes afterwards.

Evidence collated by Diabetes UK shows that diabetes education courses reduce an individual’s risk of developing serious and costly complications and prove very cost-effective. However, more than a third of CCGs do not currently commission specific courses for people with type 1 and type 2 diabetes, despite national guidance, and less than 2% of people newly diagnosed with type 1 diabetes—and just 5.9% with type 2 diabetes—attend a diabetes education course. Investing in diabetes education is the big missed opportunity in diabetes care. Will the Minister agree to look at what can be done to ensure that we do not continue to miss it?

[Mr Jamie Reed (Copeland) (Lab)]

My hon. Friend is making a fantastic case. I speak as somebody who is a type 1 diabetic, the father of a type 1 diabetic and the uncle of a type 1 diabetic. Does she agree that when we look at providing the education that she has talked about, we also need to give regard to the fact that such courses require a basic level of numeracy and literacy, so provision needs to be made for people accessing those courses to be given help in those disciplines in some cases?

[Paula Sherriff]

I thank my hon. Friend for his contribution; he speaks with a great deal of experience, having experienced diabetes himself. That is an incredibly interesting point, and I hope that the Minister will give her views on that issue.

Finally, we must tackle the significant variations in the care and support received by people living with diabetes. The postcode lottery is exacerbated by additional differences according to age and the type of diabetes. People of working age with type 1 diabetes receive considerably worse routine care than other people with diabetes. For example, although 41% of people with type 2 diabetes achieve the three treatment targets—on blood pressure, HbA1C, or haemoglobin A1c, and cholesterol—less than 20% of people with type 1 diabetes achieved them in 2014-15. Because of that variation, far too many people are experiencing short and long-term complications that have a huge impact on their health and quality of life and prove incredibly costly to our NHS.

The universal provision of healthcare is one of the founding principles of the NHS, and we have warned of the impact of wider Government policies on that, but there is also a specific issue in the case of diabetes. We should acknowledge that the Government have recently made some steps to improve care and address wider problems through the new improvement and assessment framework, but those measures will require sustained resources and national leadership. I hope that the Minister will outline not just a commitment, but some detail on how she will ensure that those intentions result in long-term action. In particular, will she tell us more about what support will be provided to CCGs that are identified as poor performers as part of the new improvement and assessment framework?

As well as better care to reduce complications and enable people with diabetes to live long and fulfilling lives, urgent action is needed to tackle the rise in type 2 diabetes. Nearly 12 million people are currently at increased risk of developing it. As obesity accounts for 80% to 85% of the risk for type 2 diabetes, the main strategy for reducing the rising prevalence of type 2 diabetes must be to tackle the rise in obesity. I welcome the NHS diabetes prevention programme—a joint commitment from NHS England, Public Health England and Diabetes UK—which will identify those at high risk of developing type 2 diabetes and refer them to evidence-based behaviour change programmes to help reduce that risk.

The first wave of 27 areas in that programme covers 45% of England’s population, with the aim of supporting 20,000 individuals to reduce their risk of type 2 diabetes. Can the Minister give us any assessment of the programme’s record to date? Will she confirm that it is due to cover the whole country by 2020 and that she still expects a full 100,000 places to be available on the programme each year?

The Obesity Health Alliance identifies three other priority areas for action that should be fundamental components of the forthcoming governmental childhood obesity strategy. They are restrictions on unhealthy food marketing, including a 9 pm watershed for TV advertising of junk food; the implementation of independent and mandatory reformulation targets to reduce the sugar, saturated fat and salt content in our foods; and the implementation of a levy on sugary drinks manufacturers. We have, of course, recently had some progress on the last of those, although the levy that the Chancellor of the Exchequer is implementing perhaps does not quite match up to that envisaged by public health campaigns. Perhaps the Minister can tell us more about that strategy and about the Government’s views on the other policies put forward by the alliance.

The Government have also promised to take action to reduce childhood obesity, with the aim of publishing a childhood obesity strategy. The strategy was initially due for publication in autumn 2015 but has been delayed. The latest indication is that it is to be released in summer 2016, but quite frankly, they have been holding off for far too long already. Can the Minister give us a specific date for exactly when the strategy will be published?

I know that other hon. Members are keen to speak, so I will conclude by saying that, both as a former NHS worker for many years and as a member of the Select Committee on Health, I see this issue as absolutely critical for the future of our health service as a whole, as well as for the many thousands of my constituents who live with diabetes. There are a disproportionate number of diabetics in my constituency, so this is a big issue for the people of Dewsbury, Mirfield, Denby Dale and Kirkburton. I hope that the Minister has some answers today for them and for everyone who relies on our NHS.

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[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to my hon. Friend the Member for Dewsbury (Paula Sherriff) for securing this important debate. We both have a background of working in healthcare and we share an interest in health issues, particularly when it comes to health inequalities and postcode lotteries of healthcare provision.

As my hon. Friend said, we recently visited the excellent diabetic foot clinic at King’s College hospital. I will be honest: when I received the invitation, it was only my interest in diabetes that led to my accepting it. I did not expect to come away from a diabetic foot clinic feeling inspired, but inspired I most certainly was. I spoke to the doctors, nurses, healthcare assistants, researchers and, most importantly, the patients. I heard from patients whose limbs had been saved from amputation by the amazingly skilled, dedicated and knowledgeable staff—patients who had arrived at the foot clinic clutching letters from their doctors that stated, “There is no alternative other than to amputate this limb.” Those patients were lucky because they had talked to people such as diabetes specialist nurses, who had suggested that they consult the diabetic foot clinic to get a second opinion.

We spoke to a farmer from Kent who had been kicked by one of his cows. He had a wound on his foot that would not heal and he had been advised by the hospital that a below-knee amputation was the only solution. The farmer talked to us about his family farm, about how he would have been unable to carry on working had the amputation gone ahead and about how grateful he was for his referral to the foot clinic. The staff there had been able to treat the wound and it was well on the way to recovery by the time we saw it. They had saved his limb and consequently his business and his family’s livelihood, with all the concomitant savings to the NHS. So many of the people we spoke to told us stories like that; he was just one of them.

I was absolutely blown away by the incredible work done by that clinic, but, as has been pointed out, the care provided there is not universal and there are currently no national drivers to lower amputation rates across the country. It has already been stated that four out of five of these amputations are avoidable. I particularly liked the comment by the hon. Member for St Ives (Derek Thomas) that we should aim to get to a point at which amputation is seen as a failure rather than as a form of treatment.

My hon. Friend the Member for Dewsbury has quoted quite a lot of my speech. [Laughter.] So I will be brief. She referred to this, but it deserves repetition. In 2013, the Health Secretary committed to reducing the rate of diabetes-related amputations by 50% over five years. The amputation rate has in fact remained steady. Little progress appears to have been made towards the commitment. I do not think it does any harm to repeat that point and to hope for a response.

[Mr Jamie Reed]

My hon. Friend is making an excellent point. Does she agree that there is a regional dimension? There is a GP shortfall of 40% across the north of England. If the gateway treatment for type 1 and type 2 diabetes is through primary care and accessibility is limited in certain parts of this country, clearly, we will get much worse outcomes.

[Liz McInnes]

I thank my hon. Friend for that intervention. He is absolutely right. In my own constituency of Heywood and Middleton, I have also come across the problem of people being unable to get access to GPs. I am a member of the all-party group on diabetes and we have come across the problem time and again.

Patients have told the APPG that, when they first went to see the GP with the full-blown symptoms of diabetes, the GP took weeks to diagnose them. We have a real problem with GPs’ awareness of the condition of diabetes, even though it is common. Perhaps it is just the patients who come to our APPGs, but they all seem to come with the same tale, so perhaps there is a job of work to be done to standardise GPs’ education on diabetes.

We have touched on the subject of variations in care around the country. Because of the regional variations, far too many people are experiencing short and long-term complications, which can have a huge impact on their and their family’s quality of life. It is also very costly to the NHS.

I want to talk about a major clinical audit that is going on at the moment, the national diabetes audit, which measures the effectiveness of diabetes healthcare against NICE clinical guidelines and NICE quality standards in England and Wales. That audit provides an overview of the quality of diabetes care at national, clinical commissioning group, acute trust and GP practice levels. Through the collection of the data, the national diabetes audit can produce reports for a range of stakeholders to drive changes and improve the quality of services and health outcomes for people with diabetes.

Again, we see regional variations in participation in the national diabetes audit. The latest NDA report produced in January this year showed that participation in the audit had dropped to 57%; it is thought that that can be attributed to a change from an opt-out to an opt-in system for GP practices, plus variations in the ease of use of the three different IT systems used by GP practices. I am very disappointed to say that, in my constituency, which is covered by the Heywood, Middleton and Rochdale CCG, not one GP practice is participating in the national diabetes audit. It is really important that participation be improved; better data help CCGs to more effectively set priorities and evaluate improvements. If we are not collecting the data, there is no way we can plan for improving the outcomes for people with diabetes. NHS England should make participation in the national diabetes audit mandatory as an important step towards improving diabetes care.

Several Members have already talked about the importance of education. An important aspect of avoidance and prevention of complications of diabetes lies in educating diabetics to help them to better understand and therefore manage their condition. With 69% of diabetics saying they do not fully understand their condition, there is clearly a need for education to be made available and accessible.

As has already been pointed out, more than a third of CCGs do not currently commission specific courses for people with type 1 and type 2 diabetes, despite national guidance. In my own constituency, only about 20% of people with diabetes are offered a course, and the take-up is alarmingly low, at around 6% to 7%. One reason that people give for not taking up the offer of a course is that their employer will not give them time off to attend. There is a real job of work to be done to persuade employers that supporting their employees to attend the courses will have all-round benefits for the employer and the employee in terms of reduced sickness absence and a healthier and more productive employee.

I know that the Minister shares my interest in promoting diabetes education, which is key to preventing the major complications of diabetes. I am interested to hear her views and whether she has any plans to improve access to education.

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[Justin Madders]

We could have been forgiven for making that error today, but we will talk more about pronunciation afterwards. My hon. Friend spoke with great sincerity about the benefits for children of taking part in sport, and about how once they get into it they can enjoy the physical activity. I know from experience that dragging kids off the Xbox can be a difficult challenge, but once they actually get out there they enjoy themselves, and that contributes to a healthier lifestyle. He also made a valuable point about the world of work, in that so many more jobs are now sedentary in their nature. Of course, a healthy workforce is a more productive one, and productivity is a challenge for the whole country.

My hon. Friend the Member for Heywood and Middleton spoke with great experience of health. It was great to hear that she had been inspired by her visit to King’s College. She spoke about the national diabetes audit, and the importance of using the data collected to drive improvements. Again, she highlighted the need for more education. It was interesting to hear that some of her constituents have difficulty attending some education courses because employers are not agreeing to give them the time off. It will be interesting to hear the Minister’s reflections on that and it comes back to the point about a healthy workforce being a more productive one. We really need to get that message across to employers.

The hon. Member for Inverclyde (Ronnie Cowan) spoke about his family’s experience and gave us a useful personal insight into the everyday challenges faced. We can all reel off the figures but hearing from someone who has had a close relationship with the condition for a considerable length of time brings home some of the practical challenges that people face.

There is a consensus, as the hon. Member for Linlithgow and East Falkirk (Martyn Day) said. All hon. Members acknowledge that diabetes is one of the most significant healthcare challenges, given the impact that it has on NHS resources and, more importantly, the impact it has on people. We heard very powerful details of that today.

To put the condition in perspective statistically, 45 people in the UK will have been diagnosed with diabetes in the time it takes to complete today’s debate. In that time, one person will have undergone a diabetes-related amputation and four people will have died prematurely due to diabetes-related complications. According to figures produced by Diabetes UK, there are currently 4 million people living with diabetes in the UK, of whom 549,000 are undiagnosed.

The number of people with diabetes is increasing, as various hon. Members have said, and it has more than doubled since 1996. More than doubling the number of people with any condition in 20 years is bound to lead to serious questions about how our society is operating. Indeed, several hon. Members have given some good examples of the challenges we face. Part of our role is to question and support, where possible, how the Government respond to those challenges, particularly when we are talking about something that can be preventable. The level of interest shown by hon. Members today shows that there is at least recognition and agreement that the issue demands significant attention.

The number of people with a diagnosis is huge, as is the cost to the health service. The NHS now spends about £10 billion on diabetes each year, which is equivalent to about 10% of its budget, and £8 billion of that is estimated to be spent on complications, which, as we have discussed, are largely avoidable. Diabetes is an important issue to tackle at any time but, when we have such financial pressures on the NHS, it becomes even more pressing to really get on top of trying to avoid the complications it can cause.

At the heart of the issue are the people involved. Although many are able to manage their diabetes effectively, it is still a life-changing condition that has an impact on those living with it on a daily basis. We heard from the hon. Member for Inverclyde about how it really has an impact not only on the individual, but on their family. For somebody with type 2 diabetes, managing their condition means learning how to treat it with diet and exercise, and possibility coming to terms with the need to take medication and insulin. For someone with type 1 diabetes, it means constant diet management and carefully working out the correct amount of insulin to take. However, for everyone living with diabetes, it means being aware of the potential complications that can occur, and keeping a careful watch not only on blood glucose levels, but on cholesterol, weight, blood pressure and the conditions of eyes and feet.

Put simply, living with diabetes means becoming an expert on the condition. Despite that, less than 2% of newly diagnosed individuals with type 1 diabetes, and just 5.9% of those newly diagnosed with type 2 diabetes, attend a diabetes education course, which is a theme that has been mentioned by various hon. Members. Those figures alone are disappointing, but they are even more so given that there is clear evidence that the courses reduce the risk of individuals developing complications, and given the fact that a worrying 69% of people say that they do not fully understand their diabetes. The very nature of the condition means that self-management is the only practical way to reduce the risk of complications.

We welcome the publication of the Government’s new improvement and assessment framework for CCGs, which will assess CCGs on the attendance of structured education schemes and on the NICE recommended treatment targets. Will the Minister tell us what steps the Government are taking to improve access to diabetes self-management education, what steps she envisages taking against CCGs that perform poorly in the improvement assessment framework, and what support will be available to those identified as poor performers in order to bring them up to what is considered best practice?

[Mr Jamie Reed]

Does the shadow Minister agree that some consideration ought to be given to the funding allocation for CCGs with particularly large concentrations of people with type 2 diabetes, which is, after all, linked to obesity and lifestyle, especially considering that obesity is increasingly statistically linked—there is a clear correlation—with the incidence of poverty and socioeconomic disadvantage? Does he agree that CCGs with those significant populations should have their funding allocation reviewed?

[Justin Madders]

I agree that that needs due consideration. In some written answers, the percentages of people with diabetes per constituency are shown, and there are some definite peaks and troughs. If we are to get the issue under control, we must think more strategically about where the resources are put.

At the moment, a third of CCGs do not commission specific courses, which is contrary to national guidance. I hope that the Minister will be able to tell us what she will do to try to end the current postcode lottery. One of the most convenient and effective sources of education for many people with diabetes is their local pharmacy. There is a need—possibly, a demand—for expanding the role that pharmacies play in supporting people with diabetes. What are the opportunities and possibilities for thinking again about the Government’s plans to slash the community pharmacy budget, which may lead to the closure of up to 3,000 sites?

More significant than the variation in education is the variation in the levels of care and support offered depending on location, the age of the patient and the type of diabetes. There is evidence of markedly different routine care throughout the country, which has a huge impact on the quality of life of diabetics, as well as being costly to the NHS. One in six people in hospital has diabetes, yet one in three hospitals has no diabetes specialist nurse. The national diabetes in-patient audit paints a worrying picture of the variations in the way in which the condition is managed by hospitals, and the unacceptable number of in-patients suffering avoidable complications.

Some of the most serious diabetes-related complications are avoidable amputations and foot ulcers. We have heard that £1 in every £150 that the NHS spends is in that area, and such action has a dramatic, life-changing impact on individuals and their families. As my hon. Friend the Member for Dewsbury said, in 2013 the Health Secretary committed to reducing the rate of amputations by 50% in five years. Will the Minister tell us what progress has been made towards achieving that goal, particularly given that Diabetes UK has said that no progress has really been made? Will she confirm that she still hopes to meet that target?

NICE recommends that all people with diabetes undergo an annual foot check but, in the worst performing CCGs, one in four people are not receiving a foot check at all. Part of the reason for that is the shortage in the number of podiatrists, particularly following a recent reduction in the number of students from 361 to 326. I am concerned that the plan to scrap bursaries for podiatry students and to push them into about £50,000 of debt will make the situation even worse. I ask the Minister to reconsider the direction of travel on this policy. Will she advise us what assessment has been made of the likely number of podiatrists who will be trained each year under the new funding regime?

I will close by making a few remarks about prevention. As I said at the beginning of my speech, the number of people suffering from diabetes continues to rise. The primary driver of that is, of course, lifestyle. Some 11.9 million people are currently at an increased risk of developing type 2 diabetes as a result of their waist circumference or weight. Two in every three people in the UK are now overweight or obese. As other Members have said, people might not necessarily feel that that relates to them, but we must reflect on those figures. Obesity accounts for 80% to 85% of the risk of developing type 2 diabetes, and therefore we need to focus on education and treating the condition. The main strategy to address the prevalence of type 2 diabetes has to be to address the rise in obesity, particularly at a young age, as the hon. Member for St Ives said.

We welcome the Government’s announcement of a sugar tax in the Budget, but that measure will only be effective as part of a wider strategy to address childhood obesity. I do not know whether the Minister will be able to tell us, but what is holding back the publication of the strategy? Is there disagreement on what will be in it? Is it at all possible for her to give us a date for when it will be published? [Interruption.] I suspect I have my answer from the grin on her face.

Both sides of the House are alert to, and supportive of, the need to get on top of this challenge but, as with all such matters, the Government will be judged by the results, on which we will keep a close eye in the coming years.

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

It is a pleasure to serve under your chairmanship, Mr Pritchard. What an excellent debate we have had, and I thank the hon. Member for Dewsbury (Paula Sherriff) for securing it. She is a passionate health campaigner and has made her mark in a very short time in the House. This is the second time I have seen her today, as I gave evidence to the Select Committee on Health this morning. It is excellent to see so many colleagues from both sides of the House in the Chamber today.

Diabetes-related complications are a vital issue and, sitting here, I agreed violently with much of what was said about the scale of the challenge, the need to step up and, indeed, some of the things that we need to do. I hope to use my time, as much as possible, to update the House on practical measures that the NHS and the Government are taking, as well as to hint, where I can, at policy yet to come. There is more to be said later in the summer on some areas. One reason why it is so important to have such debates is to keep up a drumbeat of discussion. One thing I have realised as a Minister is that momentum is a funny thing in politics.

[Mr Jamie Reed]

It certainly is.

[Jane Ellison]

I make no comment. Political momentum is important because it drives change in a way that is hard to pin down. We now have momentum on obesity and diabetes in a way that we did not a few years ago. The level of interest in this House is a good measure of that, so it is vital that we have such debates. It is also a measure of how seriously we take diabetes that we have included reducing diabetes care variation and preventing diabetes in the NHS’s mandate—it is right at the heart of our big asks of NHS England.

Before I continue, I take this opportunity to pay tribute to the many NHS staff who provide invaluable support to patients. Inevitably, in a debate where we are rightly stress-testing the system and asking where we can improve, it is easy to forget that masses of people out there are doing brilliant work. We have heard inspiring words today from two colleagues about their visit to see real specialists in action. Across the country there are people supporting patients with diabetes. There are also excellent third sector organisations such as Diabetes UK, with which we work closely, and JDRF, which does such great work on type 1. They both work with and independently challenge the Government, all with the aim of improving the lives of those with diabetes or at risk of it.

[Jane Ellison]

I sat here thinking how interesting the visit sounded. My team has made a note of that. We had heard about the visit and how it had gone well, so it is great to hear that first-hand from the hon. Lady.

I will not repeat the shocking facts on diabetes, which have been well rehearsed and explained by Members in this debate, but suffice it to say that the impact is huge. My hon. Friend the Member for St Ives (Derek Thomas) and others have made notable contributions drawing out the human cost of diabetes. People tend not to understand how devastating diabetes can be for patients and families, as well as the cost to the NHS, which in England we estimate to be £5.6 billion a year.

We have to work together to address diabetes. Before I talk about the action we are taking now and the progress we need to make, it is worth noting that we have come a long way. I have discussed that in some detail with our national clinical director, Dr Jonathan Valabhji, over the past year. The progress we have made through the quality and outcomes framework over the past decade has driven a step change in delivering better management and care for people in GP practices. Last year’s National Audit Office report showed that the relative risk of someone with type 1 or type 2 diabetes developing a diabetes-related complication has not changed, and indeed has fallen for most complications, despite the growing number of people with diabetes, so we have made progress. Clearly, the question now is how we can go much further. Diabetes is a key priority for us, and we want to see a measurable difference in the lifetime of this Parliament. There are four main areas in which we are taking action.

[Mr Jamie Reed]

Before the Minister moves on to the progress that is being made—she is right that we have come a long way over the past 10 years—will she undertake that the Department will consider not just the cost to the NHS of all diabetes-related complications, because we have been talking about this from a very NHS-centric point of view, but the cost to the economy of such complications?

[Jane Ellison]

We have been preparing and working on the childhood obesity strategy for some months, and I assure the hon. Gentleman that we have been looking at the wider cost to society and, obviously, projecting that forward, as has been done by many other economies in the developed world. There is an interesting piece by the McKinsey Global Institute on the cost to the developed world.

Specifically in the NHS, and going to the heart of the debate, there are four main areas in which we are taking action that we expect to deliver reductions in complications: reducing variation in the delivery of the three NICE treatment targets for blood pressure, blood glucose and cholesterol control; improving the take-up of structured education; improving foot care; and improving in-patient care. Reducing variation is always a theme of health debates and, frankly, it is a constant challenge in any system. The question is how we drive out variation, and Members have made a good point about how we support people to drive out variation. One of our goals for 2020 is a reduction in such variation in the management and care of people with diabetes.

The newly established CCG improvement and assessment framework has been mentioned by a number of Members. Diabetes is one of the clinical priorities in that framework, which will play a key role in delivering the challenge to variation. The chief executive of Diabetes UK is the chair of the panel of independent experts who are involved in the assurance process for that rating system. Diabetes is high on the IAF agenda. The framework will identify CCGs in need of improvement, and then NHS England will work with those CCGs to identify the nature of the changes needed and the type of support required to facilitate those changes.

To give some idea of the support available, we will be working with CCGs to consider the nature of the tasks they need to address. A key focus will be to help CCGs to map how their services compare with those in similar areas, to help them look at best practice from which they can learn and to introduce specific peer support through other programmes. CCGs will be supported in practical, hands-on ways. As we build the data picture of what is going on, we obviously need to support CCGs as they discover that they have variation, of which they may not even have been fully aware.

There are other areas not covered by the IAF that the Public Health England “Healthier Lives” website addresses. I encourage people to look at the vast amount of publicly available data for their local area. NHS Right Care is an important programme that has reducing variation at its core, and it is there to help CCGs and other partners to make step changes in the way they improve care. It will be very focused on diabetes care, and it has been improving services. It will be rolled out to all CCGs over the next 18 months, with practical support and sharing best practice at its heart.

The hon. Member for Heywood and Middleton (Liz McInnes) and I have discussed structured education, and I share her frustration. Essentially, we know that structured education works and that it is being offered to far more people, but that take-up is low. We cannot keep doing the same thing; we must look at things differently. For example, working people with diabetes straight away pose a challenge involving the amount of time that they can take to attend a course. We want to improve take-up. We know that structured education makes a difference to people’s quality of life and, importantly, reduces their risk of developing complications, but we also know that we are not where we need to be.

It is one of my personal priorities to change that. The Department is working with NHS England and Diabetes UK on ways to improve the take-up of structured education, particularly by considering more diversity of provision through digital and web-based approaches, as well as what can be done to improve access to more traditional forms of support. Again, the improvement and assessment framework includes an indicator for the number of newly diagnosed diabetes patients who attend a course. However, we have to make it possible for CCGs to refer people to a course that they think is likely to be taken up. There is something in why such courses are not commissioned as much as they should be: people are aware of low take-up and it is a vicious circle. We need to address that. Next week, an expert round table is taking place with the national clinical director. It will consider options to update structured education, potentially including working with employers, and practical actions that we can take to overcome barriers. I expect to be able to say more about it in due course.

We regularly discuss improving foot care. Particularly for people with late-stage diabetes, it is a challenge and a threat, for reasons that have been well explained. The number of amputations is unacceptably high, and we want to reduce it. NHS England is working with a number of key stakeholders to publish a new framework to improve the delivery of hospital-based diabetic foot services. The framework makes it clear that all patients with diabetic foot problems should have rapid and equal access to services, and describes for commissioners what key elements are in place that they need to commission. The new national diabetes foot care audit provides data on all diabetic foot care services so they can measure their performance against the NICE clinical guidelines.

I note the concern expressed about the survey and the lack of take-up. NHS England is taking action on the issue of GP participation, but I might ask NHS England to write directly to the hon. Member for Heywood and Middleton to say specifically what it is doing, because I share her concerns about having the fullest possible picture. Again, transparency of information, along with improvement support through initiatives such as Right Care, will drive improvement. Interestingly, the variation on amputations does not follow many of the traditional patterns in terms of the burden of disease that we see in some other areas. We need to be able to examine the information at quite a local level, as support for patients is variable even within local areas, and we must expose that.

On inpatient care, the NHS’s focus is on ensuring that all hospitals have inpatient specialist teams to assess and help to manage inpatients with diabetes. Again, if we get that right, it can lead to a significant reduction in complications.

I will say a few words about prevention, as it is at the heart of any public health Minister’s agenda. Preventing people from developing type 2 diabetes in the first place helps to take them off the conveyor belt that can lead ultimately to complications and all the burden of disease that we have been discussing. At all points along that conveyor belt, there are things that we can and must do, and are doing, to make life better for people with diabetes. For example, I welcome the increasing focus of our major charities on prevention and explaining the role of prevention in fending off some of the most serious diseases from which people suffer.

Healthier You, the NHS diabetes prevention programme, goes to the heart of tackling the rising prevalence of diabetes. Around 90% of adults with diabetes have type 2, and an estimated 80% of cases of type 2 are related to lifestyle; as Members have said, it is a huge factor. The national diabetes prevention programme is, we think, the first at-scale diabetes prevention programme to be delivered anywhere in the world. This year it will refer at least 10,000 people to an evidence-based behaviour change intervention that has been proven through randomised controlled trials to reduce the risk of type 2 diabetes.

I can confirm that the programme will be made available to up to 100,000 people by 2020. I know that there is great interest in it. We are learning from the seven demonstrator sites, which tested different approaches over the past year. Although the nature of the intervention is essentially common, there are different ways to deliver it, and we have learned a great deal. We are taking a phased approach, and the first wave of 27 areas covering 26 million people, or half the population, will open their doors to patients in the next few months and throughout 2016.

We are building up at pace. The interventions offer tailored, personalised help to reduce risk, including education on healthy eating and lifestyle and bespoke physical exercise programmes. If there is one thing that I ask of Members, it is to encourage their constituents to attend their NHS health check when invited to do so, as it is one of the gateways into the national diabetes prevention programme.

Of course, that is only part of a wider public health programme of preventing disease in the first place. Members have mentioned children. It is absolutely right that we should go way upstream to consider what we can do to tackle overweight and obesity in children. We will be launching our childhood obesity strategy in the summer. It will examine everything that contributes to children becoming overweight and obese and set out what can be done by all. We are looking at the entire environment around a child, so everything that Members have said that they hope will be considered as part of the strategy is being considered.

All parts of society, the public health system, Government and local government and industry have a part to play. The soft drinks industry levy announced by the Chancellor in the Budget is an important first step, and it has turbo-charged our discussions on the childhood obesity strategy. Its introduction in 2018 is driving reformulation of product, which every expert identifies as a key way to tackle obesity at population level. That is why there is a delay. I cannot comment in detail, but I assure hon. Members that we care about the same things that they do, and that all are being considered extensively.

[Mr Jamie Reed]

There are approximately 500,000 type 1 diabetics in the UK. Will the Minister undertake to ensure that continuous glucose monitors, flash glucose monitors and other emerging diabetic technologies are made available as a right on the NHS for people with type 1 diabetes?

[Jane Ellison]

Yes, I should say that many of my remarks have addressed type 2 diabetes, but that is not to say in any way that type 1 is less important. I will undertake to write to the hon. Gentleman on that, because there is work going on. As I said, many of my comments have dealt with type 2, but that is not to say that we are not also interested in addressing the challenges of type 1.

I am hugely heartened by the continuing parliamentary interest in this important subject. We will introduce the childhood obesity strategy and I have described all the other work on diabetes. It is good to know that there is so much parliamentary support from all parties for doing more, and particularly on investigating how to prevent diabetes from developing, to ensure that the next generation does not carry the same burden of disease as this one. It is a big challenge, but an unprecedented level of activity is taking place across our health system and the wider public health system, and in government at all levels. I look forward to updating Parliament further.

Question put and agreed to.

Resolved,

That this House has considered diabetes-related complications.

West Cumbria Health Services

Jamie Reed Excerpts

Wednesday 4th May 2016 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

I beg to move,

That this House has considered health services in West Cumbria.

I thank you, Mr Nuttall, for chairing this debate, which is on the particularly important subject of health services in west Cumbria and the ongoing work of the success regime process in my part of the world. I am pleased to see the Minister in his place. He responded to my debate concerning these matters in December last year, and he is well aware of the numerous difficult issues that I will raise with him today. He will know that any criticisms I make are not personal or even necessarily politically partisan. In all the years I have fought for this argument and this cause, I have represented thousands of constituents who do not vote for me or my party. I always have and always will place my constituency interests above any superficial party political interests. Most of all, I seek solutions in this debate for the ongoing problems facing the north, east and west Cumbrian health economy. The problems have persisted for too long. They have worsened and can no longer be allowed to defy resolution. The Minister has responded positively to my questions and requests in the past—I am exceptionally grateful for that—and I hope he can do so again today.

I will start by outlining the issues facing my constituents in accessing health services in west Cumbria. The problems facing the North Cumbria University Hospitals NHS Trust are well known. There is intense pressure on overworked and under-resourced staff. I am grateful for the work undertaken by The Cumberland News and the News and Star, particularly that of the journalists Emily Parsons and Pamela McGowan, in helping to illustrate the scale of the problems within the trust. I will return to those later.

In such a rural county with such dispersed areas of urban population, the pressures on ambulance services are enormous. There is unprecedented pressure on primary care and GP services as a result of doctor shortages and truly catastrophic cuts to adult social services as a result of the Government’s choice to cut Cumbria County Council’s budget. A new threat in the guise of the potential closure of beds in the area’s community hospitals has emerged to widespread anger and condemnation from every community that relies upon them.

Added to those problems are the problems—caused exclusively by Government, I fear—facing the success regime. In particular, I want to address the success regime and, despite the initial optimism, the manifest problems and difficulties the process has been presented with. Critically, I will talk about the consequences of the success regime’s failure, how we can avoid them and how we can solve the problems facing our health economy, which is undoubtedly the most challenged in Britain. I will also talk about the recent floods, the effects of which are still being keenly felt throughout the county. They have magnified the issues at the heart of the debate over health services in the area.

Finally, I will pose as many of the questions sent to me as I can before outlining the health needs of my community and those of neighbouring communities—those needs, after all, are what it comes down to. The key issue for decision makers, Government and Ministers is: what do the people of west Cumbria need from their health services and how can that be delivered? That is a very different question from, “What are the Government prepared to provide?” Make no mistake, at the heart of the issue is the question: is the national health service worthy of the name? When we answer those questions, we should have the humility and wisdom to recognise that the consequences of the decisions we take now will outlast the lifespan of this Government. They will certainly outlast my and the Minister’s political careers. That is the gravity, the reality and the privilege of the situation we find ourselves in.

The simple answer is that the people of west Cumbria need better access to health services, particularly the hospital services provided by the West Cumberland Hospital in Whitehaven. It serves a vast rural area with many tightly compacted urban communities, with all the attendant challenges that has. In that context, access can be defined in a number of ways. It means the actual services provided locally, ensuring that those services are staffed appropriately so that they are of a high quality, and empowering the community so that it is listened to when decisions about its services are taken. It also means proper planning for the significant population expansion forecast for the area. In west Cumbria, each area is immensely challenging and we must address that. It is what the success regime was meant to address.

At this point, I have to thank the hundreds of patients, medical professionals past and present and members of the public who responded to my request for questions or evidence relating to the success regime process and the condition of the local health service in general. Time limits mean that I will not be able to put every question to the Minister today, but those I cannot ask I will either table as parliamentary questions or I will write to the Secretary of State for Health expressing the concerns. I am particularly grateful to the Royal College of Nursing, the Joint League of Friends of Community Hospitals, West Cumbrians’ Voice for Health Care—it has undertaken phenomenal work—and healthcare campaigners in Millom, Keswick and right across Allerdale, Carlisle and Penrith and the Border. I hope the Minister will ensure that the Secretary of State replies honestly and at length.

The Minister will be well aware that in July 2013, Sir Bruce Keogh published his review into mortality rates at a number of hospital trusts around the country. North Cumbria University Hospitals NHS Trust was one of them. Along with 10 other trusts, it was placed in special measures. The trust had higher than average mortality rates and action to remedy that was obviously welcome and necessary. At the time, Ministers were unable to provide basic information about what special measures actually meant for the trust, but it was patently clear that the major reason for care failings at the trust was—it remains the case—a chronic staff shortage.

It is only right that I again take this opportunity to thank, on a personal level as a parent and on behalf of my constituents, the amazing staff who work tirelessly in trying conditions to provide high-quality care. Many work unpaid overtime because they care about their patients, their work and, by extension, the service they provide to my community. I and my constituents know that they work in extraordinary circumstances beyond their control, and we are so grateful for their work. I doubt that any community in the country prizes its medical professionals so highly.

The truth is that every part of the health economy in west, east and north Cumbria simply needs more staff in primary care, secondary care, acute care and across our preventive services. Government must intervene to ensure that the problem is resolved, assisting with local initiatives wherever possible. That request has fallen on deaf ears for too long. The most recent report on the North Cumbria University Hospitals NHS Trust by the Care Quality Commission, which was published in September 2015, illustrated the scale of the challenge. It stated:

“The recruitment of nursing staff also remained an on-going challenge. At the time of our inspection nurse staffing levels, although improved, were still of concern and there was a heavy reliance on staff working extra shifts and on bank and agency staff to maintain staffing levels. There were times when the wards were not appropriately staffed to meet the needs of patients.”

I am sure the Minister would agree that that simply is not acceptable. In 2013-14, the trust spent £16 million on agency staff. That is clearly a false economy. Agency staff are a short-term expensive solution to a long-term problem.

Stable, long-term recruitment is key to turning around the finances of the local health economy and the hospital trust in particular. If my local trust has to pay over the odds to secure services taken for granted in other parts of the country, it should be able to do that and be funded appropriately by the Department of Health. That must be accepted by the success regime and by Government. Sadly, that is not currently the case. Sadly, it is not a conflation of the issues to point out that the Secretary of State’s antagonistic and insulting behaviour towards junior doctors is severely worsening the recruitment problem in challenged health economies such as that in Cumbria.

In my constituency, I have been working with the trust and the University of Central Lancashire to bring a medical school to west Cumbria so that we can “grow our own medics”. It would be a long-term sustainable solution to one of the key problems we face. I am delighted to say that the new West Cumberland medical education campus now exists at the Westlakes science park, immediately adjacent to the new West Cumberland hospital in my constituency. So far that has succeeded without the support or involvement of Government, but I hope that the Government will be able to support the development, not just in spirit as I know the Minister does, but with practical assistance, including money.

In addition to growing our own medics in west Cumbria for the benefit of the entire Cumbrian health economy, we are providing the basis for policy solutions by becoming a rural health policy laboratory. The campus can and should become a crucible of innovation, providing solutions to the problems facing rural areas through the provision of high-quality, accessible, universal health services. The Minister has expressed support for that in the past, but the Government should now support it financially and in terms of policy. Will he request that Health Education England works with the University of Central Lancashire and the North Cumbria University Hospitals NHS Trust as a matter of urgency so that innovative models of healthcare training, such as earn-while-you-learn models, can be rolled out, not only in Cumbria but in other challenged health economies?

I hope that the Government will look again at nursing bursaries. The Chancellor’s decision to scrap those will only make it harder for us to train and recruit the medical staff that we need. The market will not deliver the workforce that the national health service requires; it will deliver only inefficiency and inequality. We need proper workforce planning right across the national health service.

On the subject of the local health workforce, will the Minister commit to looking into the morale issues affecting health professionals in the area covered by the success regime and undertake action to improve this?

In December, I told the Minister that sooner or later our luck would run out and that patients would pay the price. Tragically, as documented in the News and Star and The Cumberland News recently, the signs are that that is already happening. It was reported yesterday that in March a patient was transferred from the West Cumberland Hospital in Whitehaven to the Cumberland Infirmary in Carlisle, but died—according to the medics who have come forward—because specialist staff were not alerted to the patient’s arrival in Carlisle. The patient subsequently had a cardiac arrest and died. If that is true, it is not only a direct result and a damning indictment of policy, but the inevitable consequence of an overburdened, underfunded and understaffed system. I cannot imagine the despair that the family of the deceased must feel, and I cannot describe how angry I am that, in all likelihood, a constituent of mine has died as a result of being transferred from the West Cumberland Hospital to the Cumberland Infirmary.

The community has repeatedly warned of such an event. It has not been listened to and so I ask the Minister to commit as a matter of urgency to making a statement in the House about this and other so-called never events that occur across the North Cumbria University Hospitals NHS Trust. We need to solve these problems, and we need to determine accountability for them, too. I know that the medics and the new chief executive, Stephen Eames, are determined to get this right.

At the beginning of 2015, I wrote to the NHS chief executive, Simon Stevens, and asked him to visit Cumbria to see for himself the geographical challenges; to speak to patients and staff; and to work with me to develop a comprehensive recovery plan for the Cumbrian health economy. Nowhere in the country is quite like Cumbria. The health inequalities, the demographic differences, the challenging geography and the contrast between the affluent and those who are less well-off all present unique challenges with regard to providing services—right across the board, not just in the health service.

The national health service should ensure equality of standards and accessibility of services, but how that is delivered must be flexible enough to accommodate unique local circumstances such as those in Cumbria. The success regime is the response to my request for a comprehensive recovery plan. That new regime was intended to develop a locally tailored solution to the problems that we face. I was a shadow Health Minister at the time I made the request. Sadly, it is unusual for an Opposition spokesperson to ask Ministers in the Department that they cover to work together on an issue of joint concern for the greater good.

In December, I expressed my concerns about the then management team at the hospitals trust. I pointed out how it had attempted to defy the NHS chief executive and sabotage the work of the success regime. The appointment of Stephen Eames and his team has changed all that to date, but the public are still understandably worried about the prospect of key services being removed from the West Cumberland Hospital.

I was present at a meeting with Simon Stevens and the success regime when the trust management was told categorically that the continued “asset-stripping”—that was the precise phrase—of services from the West Cumberland Hospital should not continue. It was an uncomfortable meeting, but a welcome one in which the primacy of the success regime in determining what services would be provided where was asserted.

In December, I told the Minister that unless the previous trust management committed fully to the success regime process, it should have no part to play in the future of healthcare service design in west, north and east Cumbria. Information now coming from many people from within the success regime process is that the process is not working and that the reason for that is Government intransigence, a refusal to listen to the experts on the ground and a refusal to grant the additional resources that the process requires to succeed.

In the rest of the country, the Government and the NHS would be hard pushed to find more committed, willing, well-informed and passionate communities when it comes to health services than the communities of west, north and east Cumbria. We want the success regime to work and the people within the success regime want it to work, but right now the Government are stopping it working. I am told, from within the process, that the success regime and the people in it know what they need to do to put the health economy right, but that, as soon as ideas are put forward, they are knocked down.

I have been asked to ask the Minister whether the Government recognise that a premium is required to continue to enable the people of west Cumbria to access certain acute services at the West Cumberland Hospital. Do the Government recognise that centralising services in Carlisle is about service cost, not service quality, and that this will lead to worse outcomes for patients? Again, I am told from within the success regime that the exercise is now becoming one that is not as has been advertised. Rather than a process of investigation and improvement, it has become a cost-management tool and the people within the process do not want it to be that way, yet the Government insist that cuts, not quality, are king. I have been asked, again from within the success regime, what happened to the Prime Minister’s promise of a bare-knuckle fight for district general hospitals and maternity services, because it either has not materialised or was a knowing deception.

There are more questions, all of which I will forward to the Secretary of State, but the most incredible intervention in the work of the success regime was recently made by the Cumbria Partnership NHS Foundation Trust. In an open letter to the success regime, governors of the trust have given notice of their intention not to approve the work of the success regime, accusing its emerging options proposals of lacking logic, transparency, financial evidence and meaningful detail. The letter states:

“Our problem is that on every significant issue, the Success Regime appears to us to be shrouded in impenetrable fog.”

The letter adds that the success regime’s vision is

“woefully lacking in sensitivity to the health-related implications of geography and demography in Cumbria.”

Nowhere can this be seen more than in the unjustifiable proposals to remove beds from community hospitals. They deserve better in Millom, Keswick, Maryport, Workington, Brampton and Alston. This demonstrates precisely what we risk destroying here: a process that the people, public and medical professionals of Cumbria supported with optimism at the outset, but that now risks collapse and failure because the Government have changed the remit of the success regime as its work has progressed.

The point underpinning all of this is relatively simple: access to a full and comprehensive range of acute hospital services for the people of west Cumbria is non-negotiable, and the success regime requires freedom from Government interference to complete its work. The work requires additional funding. If the success regime is to succeed, it has to be funded to succeed. Let us not pretend that that is not the case.

The recent flooding in the county has shown that if services were transferred from the West Cumberland Hospital, in times of emergency patients simply would not be able to access them as they would not be able to get to the Cumberland Infirmary. Again, that is not acceptable. In times of emergency, the people of west Cumbria need to be able to access their services, and that can be assured only by retaining the services in their local hospital—the West Cumberland Hospital—a fantastic new facility that the Minister knows I have campaigned for for more than 10 years, and which should now become a model for how we provide care in non-metropolitan communities in the 21st century.

I have a specific request for the Minister. Will he move to unblock the funding for phase 2 of the West Cumberland Hospital new build programme? I have been told that the money has been allocated but is not accessible. I ask that this is done as soon as possible so as to provide confidence and help build trust. Will the Minister tell my constituents that this will be done soon as a central part of the success regime process, and will he confirm that this project is not included among those deferred capital spending programmes identified in the Health Service Journal this week? There can be no agreement of any kind without this money being unlocked.

West Cumbria is home to one of the most nationally and strategically important sites in the shape of Sellafield. Over the coming years, with new nuclear reactors at Moorside, thousands of jobs will be created, and my constituency will become one of the fastest growing regional economies in the country. This is due to the plan I developed in 2005: the plan that my community has worked towards ever since. As a result, the local population will grow significantly and quickly.

The people who live in west Cumbria now need better access to the health services they rely on, but it is simply mind-boggling that when a local population is growing, anyone should believe it is sensible to move services 40 miles along a road in need of serious upgrading and subject to frequent closure.

The local NHS must take into account strategic infrastructure and the local population of host communities when planning services. The Minister has been unequivocal about this in the past, and I thank him again for that. Will he ensure that the local population growth and the national obligation owed to my community as a result of its strategic importance is addressed prominently and clearly as part of the work of the success regime?

The fundamental principles in this debate are straightforward. Moving services 40 miles away from the West Cumberland Hospital is the antithesis of the principles that underpin a truly national health service. I said in December that unless the patients and taxpayers of my community can access the same level of healthcare routinely provided by the NHS in other communities, the NHS exists in name only. Forty miles is not a reasonable distance to ask people in need of medical care to travel, particularly when that 40 miles is served by such inadequate infrastructure. Mothers giving birth do not want to sit in an ambulance on the A595 hoping that they do not get stuck behind a tractor or encounter a road traffic accident.

A fully operational A&E department, supported by associated departments, consultant-led maternity services and paediatric services, must remain at West Cumberland hospital. If we need to adopt a flexible approach to achieve that, that is what we must do. Fully functioning community hospitals with the beds that they have provide an invaluable service in the communities of west, north and east Cumbria. Those services should be built upon, expanded and improved in the face of growing demand, not cut. The Government must allow the success regime the freedom and finances to make that happen.

The Government and local authority partners in Cumbria recently attempted to reach an agreement on a devolution deal. The deal was appalling, but local partners tried hard, on a cross-party basis, to make it work. Negotiations continued right up until the eve of the Budget, so keen was the Chancellor to include the deal in his Budget statement, but they collapsed because the Government refused to accommodate the wishes of local partners with regard to the NHS in Cumbria. Will the Minister tell me whether the Department was consulted, or whether the deal was driven purely by the Treasury?

I have today written to the Secretary of State to invite him to my constituency to listen to local people, hear their concerns and answer their questions. He will be accountable for this process, come hell or high water. To summarise, will the Minister commit to giving the success regime the freedom it needs, and the west, east and north Cumbrian health economy the additional resources it requires? Will he commit to making a statement to the House on the recent never events in the local hospitals trust, how they happened and who is responsible? Will he commit to retaining existing acute services at the West Cumberland hospital? Will he commit to supporting the west Cumbria medical campus with both funding and assistance from Health Education England? Will he commit to releasing the funds for phase 2 of the West Cumberland hospital new build?

I want the success regime process to work and the Minister wants it to work, but it will do so only if the Government work with my community, not against it. There is no doubt in my mind that we can solve the problems, but the Government have to want to solve them and they have to let the process work. The choice is clear: together, we can produce something truly special, groundbreaking and innovative, or we can watch a hollowed-out, under-funded, fraudulent process break the notion of a truly national health service. The NHS is our country’s religion; what happens next in Cumbria will demonstrate whether the Government believe in it.

Access to Health Services: West Cumbria

Jamie Reed Excerpts

Thursday 17th December 2015 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

Thank you, Madam Deputy Speaker, for presiding over this Adjournment debate, the last parliamentary business of 2015.

The issue at hand is one that my constituents and people living across west Cumbria care a great deal about. I know that the Minister is well aware of the challenges. He has responded positively to my questions and requests in the past, for which I am exceptionally grateful to him, and I hope that he will do so again today.

I will first outline the issues facing my constituents with regard to their ability to access health services in west Cumbria, particularly hospital services at the West Cumberland hospital. The issues facing the North Cumbria University Hospitals NHS Trust, the pressures on ambulance services and the intense pressure on overworked and under-resourced staff are well documented, but despite that, little, if any, progress towards solving the problems would appear to have been made. I will then address the success regime and the opportunity it represents for health services in west Cumbria and therefore for our communities. The recent floods, the effects of which are keenly felt throughout the county, have magnified the issues at the heart of the debate on health services in west Cumbria, and I will also talk about that. I will conclude by outlining what I believe are the needs of the west Cumbrian community. After all, the key decision for decision makers, the Government, Ministers and NHS executives comes down to this: what do the people of west Cumbria want from their health and hospital services, and how can that be delivered? It must be said at the outset that that is a very different question from: what is the North Cumbria University Hospitals NHS Trust prepared to provide? The simple answer is that the people of west Cumbria need better access to health services, particularly in relation to hospital services provided by the West Cumberland hospital in Whitehaven.

In this context, the term “access” has myriad meanings. It means the actual services provided locally, and it means that those services must be staffed appropriately so that they can be provided to a high quality. It also means empowering communities so that when decisions are made about their services, they are listened to during the decision-making process. Access also means proper planning for the significant population expansion that is forecast for the area. In west Cumbria, each of those points are immensely challenging, and that is what we must address.

In July 2013, Sir Bruce Keogh, with whom I have a very good and effective working relationship, published his review of mortality rates at several hospital trusts around the country. North Cumbria University Hospitals NHS Trust, which serves my constituents, was one of the trusts and, along with 10 others, it was placed in special measures. The trust had higher than average mortality rates, and action to remedy that was justified and was welcomed.

At the time, Ministers were unable to provide basic information about what “special measures” meant for the trust. It was patently clear, however, that a major reason for the care failings at the trust was a chronic staff shortage. It is only right that I use this opportunity to thank, personally and on behalf of my constituents, the tremendous staff who are working tirelessly in trying conditions to provide high-quality healthcare. I know that many work unpaid overtime because they care about their patients, about the community and about the care they provide. It will be a tough winter and there will be huge pressures, but I want them all to know that I and my constituents understand that they are working in extraordinary circumstances.

The trust simply needs more staff, and the Government must intervene to ensure that it has more staff. Such a request has fallen on deaf ears for too long. The most recent report by the Care Quality Commission, published in September, showed the scale of the challenge:

“The recruitment of nursing staff also remained an on-going challenge. At the time of our inspection nurse staffing levels, although improved, were still of concern and there was a heavy reliance on staff working extra shifts and on bank and agency staff to maintain staffing levels. There were times when the wards were not appropriately staffed to meet the needs of patients.”

This simply is not acceptable.

In 2013-14, the trust spent £16 million on agency staff. That cannot be sustainable, and it is clearly a false economy. Agency staff are a short-term, expensive solution, and in my view the Government should be empowering trusts to achieve long-term, efficient solutions. Capping agency costs is a small, tentative step in the right direction, but it would be better all round if the Government provided funding to enable trusts to train and recruit for the long term. That would surely save money in the long run and enable predictable, stable, secure service design for the long term. Will the Minister therefore commit to making relief funding available to allow the trust to be more competitive in the recruitment market? If my local trust has to pay over the odds to secure services that are taken for granted in other parts of the country, it ought to be funded appropriately to do so.

In my constituency, I have been working with the trust and the University of Central Lancashire to bring a medical school to west Cumbria so that we can grow our own medics. That is a long-term sustainable solution to one of the key problems we are facing. I am delighted to say that the new West Cumberland medical education campus now exists at the Westlakes science park in my constituency, immediately adjacent to the new West Cumberland hospital. So far, it has succeeded without the support or involvement of the Government, but I hope that they will support the development not just in spirit, but through practical assistance, including money.

In addition to growing our own medics in west Cumbria for the benefit of the entire Cumbrian health economy, every part of which faces similar challenges, we are providing the basis for policy solutions by becoming a rural health policy laboratory. The campus can and should become the crucible of innovation that provides the solutions to the problems facing rural areas in respect of the provision of high-quality, accessible, universal health services. I hope that the Minister will express the support of the Government and the Department for that today.

I hope that the Government will look again at nursing bursaries, as I fear that their new policy will make it harder to train and recruit the medical staff that we all know we need. On 14 December, the chief executive of the Royal College of Nursing said that the decision to cut bursaries that was announced in the Chancellor’s autumn statement is having a negative impact on people who are considering a career in the profession. It is all well and good pledging to increase the number of training places, but the impact is wasted if the mechanism that we adopt turns people away.

The NHS staff survey shows the current strain on medical staff in north and west Cumbria. There has been a big increase in the proportion of staff who suffer work-related stress and, unforgivably, the prevalence of staff experiencing bullying from other staff is increasing. Staff are working extra hours unpaid. The people in west Cumbria rely on the services provided by those hard-working people. Much like the expensive agency bills, overworking staff simply is not sustainable. Will the Minister commit to seeing what action the Department can take to improve the situation? Sooner or later, our luck will run out. The good will of the medical professionals, who are exhausted and demoralised in so many ways, will run out too. It is patients who will pay the price.

At the beginning of the year, I wrote to the NHS’s chief executive, Simon Stevens. I asked him to visit Cumbria to see for himself the geographical challenges and to speak with patients and staff. I asked him to work with me and other stakeholders to develop a comprehensive recovery plan for the Cumbrian health economy. Nowhere in the country is quite like our county. The health inequalities, the demographic differences, the challenging geography and the contrast between the affluent and those who are less well-off all present unique challenges in designing and providing hospital services and health services in the round.

What is provided should be broadly the same in every community in the country. A national health service should ensure that there is equality of standards and accessibility in the health service, but how that is delivered must be flexible enough to accommodate unique local circumstances.

The success regime is the response to my request for a comprehensive recovery plan. The new regime is intended to develop a locally tailored solution to the problems we face. I support the success regime fully, but I have doubts about the support of the North Cumbria University Hospitals NHS Trust for the process.

Over recent years, actions by the trust’s executive team have led to the public being understandably worried about the prospect of key services being removed from West Cumberland hospital without a rationale. In September 2013, the trust moved some out-of-hours surgery services from the West Cumberland to the Cumberland infirmary in Carlisle, over 40 miles away. The public were not consulted on the change. Crucially, the modelling and assumptions underpinning the move were flawed. Much greater numbers of patients have had to travel than was either anticipated by the trust or told to the public. Either it was a lamentable failure properly to model the effects of service change or it was a lie. That raises serious questions about either the honesty or competence of the trust.

The trust’s attitude on a number of other issues since then has done little to reassure those who are concerned about its intentions with regard to the provision of services at the new West Cumberland hospital. I was present at a meeting—I think it was in October—with Simon Stevens on the success regime, in which the local hospital trust was told categorically that the “asset stripping” of services from West Cumberland hospital must not continue. It was an exceptionally uncomfortable meeting. Days later it was reported that senior managers at the trust had told staff that the accident and emergency department would be downgraded. That is unacceptable. The trust must abandon any preconceived plans to strip services. Those services must be provided at West Cumberland hospital, and the success regime must be allowed to complete its work.

I welcome the recent statement from the NHS in Cumbria, which set out in a public letter that the accident and emergency department, and other services, must remain at the West Cumberland hospital. That is the bare minimum that my community would expect, yet the trust had to be shamed into making such a basic commitment.

With regret, if the trust does not abandon its preconceived ideas about service reconfiguration and reduction, and if it tries to ride roughshod over the work of the success regime programme before it has a chance to develop its plan, I will be left with no option but to pursue the removal of the current trust management. I would be grateful if the Government would support what is clearly an effort of last resort. I take no pleasure in that, but unless the trust management can commit fully to the terms of reference of the success regime, it should have no part in the future of healthcare service design in north and west Cumbria.

The attitude displayed by the trust, whether deliberate or not, has meant that many in the local community simply do not believe a word it says. Its lack of willingness to engage with the public who use or rely on the services provided at our hospital means that many feel disconnected from a key service—the key service—in their community. The service reconfiguration of September 2013 was done without public engagement, and the development of the trust’s future clinical options did little to assuage legitimate concerns. The document showed the stripping of key services from West Cumberland hospital which, I repeat, is unacceptable.

Last year, in front of a crowd of almost 5,000 people at the recreation ground—the home of Whitehaven rugby league football club—trust representatives assured an anxious crowd that no decision on service reconfiguration would be made. However, the publication of the future clinical options appraisal in October 2014 showed that the plans had been in development for a year. It is easier to deal with Iran!

The duplicitous nature of the trust’s public statements, the covert actions that seek to pursue in private the opposite of what it states it wishes to do in public, and the public distrust that it has singularly managed to establish is staggering. It is truly breathtaking. Too often, the trust acts as a rogue trust, seemingly beyond any accountability to anyone and beyond the influence of the Cumbrian public. Will the Minister commit to examine the behaviour of the trust? Senior local medics, patients, local civic society, trade unions, and local representatives of all parties all doubt that any eventual consultation designed by the trust will be genuine or honest. Progress will not be possible within that climate of distrust.

Hopefully, many of the trust’s preconceived ideas about service reconfiguration will be superseded by the work of the success regime. In the rest of the country the Government and NHS would be hard pushed to find a more committed, willing, well-informed and passionate community when it comes to health services than the community of west Cumbria. A campaign group set up to fight for services, “We Need West Cumberland Hospital”, has garnered much public support and I pay tribute to its work, as I do to the fantastic work of Siobhan Gearing, Carol Woodman, Lee Butterworth, Rachel Holliday, my hon. Friend the Member for Workington (Sue Hayman) and so many others.

Does the Minister agree that if the trust was committed to rebuilding trust within the community, it should involve the local public in open and transparent discussions about local services, instead of defying the NHS chief executive, deliberately undermining staff, raising doubts about services about which there should be no doubt, and acting like thieves in the night?

The recent local floods did not cause the underlying issues inherent in the north and west Cumbrian health economy. Nor did they cause lasting damage to the ability of the NHS in Cumbria to deliver services. What the recent floods did, among many other things, is prove beyond doubt the sheer folly of removing services from the West Cumberland hospital and putting them in the Cumberland infirmary in Carlisle, more than 40 miles away.

The floods meant that roads were impassable. Ambulances and other emergency services, which were already struggling more in Cumbria than anywhere else in the north-west, were under intense pressure. Power was cut to the Cumberland infirmary, which had to rely on back-up generators. I am told that there were no clean sheets or bedding. The laundry service failed and doctors and nurses could not get to work. The impact on patients was severe.

Getting from west Cumbria to Carlisle at the best of times is difficult. If the weather does not beat you, the tractors or the sadly routine road traffic accidents and diversions will. I am campaigning for serious improvements to the A595, but because of the floods over that weekend and the following days it was simply impossible to get from west Cumbria to Carlisle—not difficult, not unlikely, but impossible. The levels of the flooding could not be anticipated, but there are things that we can do to ensure access to, and the resilience of, our key services. Rain in the Lake district should never come as a surprise—it should never lead international news bulletins—but severe weather should not create a health emergency because access to services has been cut off.

I have been inundated with numerous examples of the situations people found themselves in, but the underpinning point is relatively simple: access to a full and comprehensive range of hospital service is, for the people of west Cumbria, essentially non-negotiable. The recent flooding showed that, if services are transferred from the West Cumberland hospital, in times of emergency, patients simply would not be able to access them because they would not be able to get to the Cumberland infirmary in Carlisle.

I repeat that that cannot be acceptable. In times of emergency, the people of west Cumbria need to be able to access their services. That can be assured only by retaining their services in their local hospital—the West Cumberland hospital—which is a fantastic new facility for which I have campaigned for more than 10 years. I make two specific requests of the Minister with regard to the hospital. Will he please move to unblock the funding for phase 2 of the hospital new build programme? The money has been allocated but is not yet accessible. I ask that that be done as soon as possible so as to provide confidence and help to build public trust. If, as is suggested by some, Monitor will shortly be able to allocate a fund £1.8 billion to the most challenged health economies in the country, will the Minister ensure that north Cumbria is at the top of that list?

The last point I should like to address is the short-sightedness of the trust’s desire to move services. West Cumbria is home to one of the most nationally strategic points in the shape of Sellafield. Over the coming years, with new nuclear reactors at Moorside, which is adjacent to Sellafield, thousands of jobs will be created, and my constituency will become one of the fastest-growing regional economies anywhere in the United Kingdom. As a result, the local population will grow significantly and quickly. The people who live in west Cumbria need better access to the health services on which they rely, but it is simply mind-boggling that, when the local population is growing, the trust thinks it is possible and perhaps even desirable to move services more than 40 miles up the road. The Minister has been unequivocal about that in the past and I thank him once again for that. The local NHS must take into account strategic infrastructure and the local population of host communities when planning services, so will he commit to write to North Cumbria University Hospitals NHS Trust to ensure that it publicly acknowledges that? Will he today, at the Dispatch Box, urge the trust to factor that population growth and strategic need into its future plans?

The fundamental principle in the debate is absolutely straightforward. Moving services more than 40 miles away from the West Cumberland hospital is the antithesis of the principles that underpin a truly national health service. I would go as far to say that, unless patients and taxpayers in my community can access the same level of healthcare routinely provided by the NHS in other communities, the national health service exists in name only. Forty miles is not a reasonable distance to ask people who are in need of medical care to travel, particularly when that 40 miles is served by such inadequate infrastructure. Mothers giving birth do not want to sit in an ambulance on the A595 hoping beyond hope that they do not get stuck behind a tractor.

A fully operational accident and emergency department supported by associated departments, consultant-led maternity services and paediatric services must remain at the West Cumberland hospital, for which I have much to be grateful for, both as an individual and as a recent parent. If we need to adopt a flexible approach in order to achieve that, that is what we must do. It must be accompanied by what will in many ways be nothing short of a new model of healthcare. The trust should know that the people of west Cumbria will stand for nothing less. The trust may be a provider of services but, after all, the NHS belongs to all of us.

I fully support the success regime, but I ask the Minister today to tell the trust in unequivocal terms that, unless it listens and responds to the west Cumbrian community, it will face a fight the likes of which it has never seen.

Hospital Services (South Manchester)

Jamie Reed Excerpts

Tuesday 8th September 2015 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. It is a pleasure, too, to be the shadow Minister in the Labour health team not running for the leadership of his party. That is a genuine pleasure, let me assure you.

I congratulate my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) on securing this timely and important debate, which is of huge importance to his constituents and those of many colleagues from across the House who are in the Chamber today. However, I will be brief, Mr Hollobone.

Hon. Members on both sides of the House will appreciate that changes to local NHS services can often be difficult and cause our constituents major concern. It is entirely appropriate, therefore, that when changes are being proposed, hon. Members speak up for their constituents and express any concerns that their constituents may have. I have been doing that with regard to services in my own local hospital for the past 10 years. The Minister is aware of that, and we are working together to try to resolve the issues.

We all know that the NHS will have to make major changes over the coming years. One of the big challenges facing health and care systems around the world is how to do more for less; that is as true in the UK as it is anywhere else. The ageing society and the need to move services out of the hospital and into the community mean that difficult decisions will have to be taken in the course of this Parliament. If done properly—if done rightly—those decisions could and should lead to a better standard of care for our constituents and a more sustainable future for local health services right across the country. Where that is the case, hon. Members have a responsibility to support the changes, but where the clinical case has not been made, hon. Members are right to be questioning and to seek reassurance that any changes are focused on the quality and safety of services.

It is vital when any changes to hospital services are being proposed that a number of basic principles should apply, and I shall outline some of those. First, the public should be involved at the very outset of any proposal for change. The proposals should not be designed behind closed doors, and the clinical case must be presented to the public at the earliest opportunity; I struggle to count how many well intentioned reconfigurations have fallen foul of that test.

Secondly, there must be a proper, meaningful consultation. Too often, proposals for change are presented as a fait accompli and the consultations that follow are little more than box-ticking exercises. My party has previously proposed that the formal responsibility for consultation should be given to an independent body, such as the health and wellbeing board, instead of being a responsibility of clinical commissioning groups. That could go some way towards improving the consultation process and would certainly restore faith in the independence of the consultation process. Thirdly, and perhaps most importantly, the process should be as open and transparent as possible. The public should be entitled to the full range of information and data required for them to have an informed view on any proposals put forward.

Today’s debate has focused on the Healthier Together review and, as we have heard from several colleagues, the review appears to have fallen short on a number of factors. My hon. Friend the Member for Wythenshawe and Sale East spoke in particular about the decision not to choose Wythenshawe hospital as the fourth site to provide emergency abdominal surgery, as part of the single service model proposed by Healthier Together. He made a compelling case as to why Wythenshawe hospital should be recognised as one of the “fixed site” specialist hospitals. I do not want to take up too much time, as I am conscious that hon. Members have raised specific concerns to which the Minister will want to respond in as much detail as he can, but I would like to press him on a couple of points to which my hon. Friend referred.

First, it appears that the decision to allocate the fourth specialist site was made largely on the grounds of travel and access. The strapline for the review includes the phrase “helping to save more lives”, but it seems clear, not just in Manchester but across the NHS, that access to services and the quality and safety of those services are too often presented as a binary trade-off. We must improve on that way of configuring services, so will the Minister tell us what more can be done to resolve what appears to be an invidious choice facing people right across Manchester?

Secondly, I understand that during the public consultation 33% of respondents gave Wythenshawe as their choice for the final specialist site, while Stepping Hill was backed by 26%. The Minister will appreciate that that has led some to question the point of the consultation and, understandably, has led to concerns that the views of the public are not adequately being taken into account. Wythenshawe hospital’s medical staff committee said that the decision was “irrational” and, as we have heard, there were reports last week of a plan to apply for judicial review. That is in no one’s interests. No one wants their hospital or services caught up in legal disputes.

I hope that the Minister appreciates that there is genuine frustration among hon. Members across the political spectrum—he has seen that for himself here today—about the Healthier Together process and that there are important questions that require answers. More broadly, I hope he will ensure that the NHS reflects on what lessons can be learned from this process to ensure that the public can have confidence that future proposals for change are focused on improving the quality and safety of local NHS services, and also that access to safe and high-quality—indeed, world-class—services remains equitable for all service users and taxpayers.

My final point is about Manchester airport and the nearest adjacent hospital. As a country, we need to address the needs of those communities that host nationally significant, strategic pieces of infrastructure. That might be Manchester airport or Sellafield nuclear reprocessing plant in my constituency. The communities that house such infrastructure require special regard to be paid to them when it comes to the configuration and supply of services at their local hospital. We should do that as a nation. It is done in other countries. I hope that the Minister will reflect on such an approach. I look forward to working with him on precisely that approach and to hearing his response to the points that I have made.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 7th July 2015 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for raising this issue. It was a terrible tragedy—I had constituents who died—and I can confirm that we will be meeting the commitments made by the Prime Minister to bring forward a solution very shortly.

[Mr Jamie Reed (Copeland) (Lab)]

The House will have seen that the pitch is being carefully rolled by the Secretary of State today for future service closures around the country. Last week, a former care Minister was reported as saying that the £22 billion of efficiency savings the Government had signed up to were “virtually impossible” to achieve and that everyone knew it. Given that he is one of the few people to have seen the detail of the efficiency savings, this does not fill anybody with confidence. Will the Secretary of State now commit to publishing the details of the efficiency savings so that Members, the public at large, patient groups and medical professionals can have a proper and open debate about what it means?

[Mr Hunt]

We will of course publish how we are going to make these efficiency savings. We have already started with a crackdown on agency spend and a crackdown on consultancy spend, and with the work that Lord Carter, a Labour peer, has done to improve hospital procurement and rostering.

Let me gently say to the hon. Gentleman, however, that he went into the election promising £2.5 billion more for the NHS—£5.5 billion less than we did—and most of that was from the mansion tax that Labour now says was a bad idea. So there would have been nearly £8 billion more of efficiency savings under Labour’s plans than under this Government’s plans, and he should recognise the progress we are making.

A&E Services

Jamie Reed Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

I beg to move,

That this House notes that hospital A&E departments have now missed the four-hour A&E target for 100 weeks in a row; further notes that trusts are predicting record deficits this year; believes the pressures on hospitals are a consequence of declining access to out-of-hospital services under this Government, including fewer older people receiving social care and more people waiting a week or more for a GP appointment; further believes the increasing bill for agency staff is also adding to the pressure on hospitals; notes that the Government plans to stop the weekly reporting of A&E data; believes this decision will make the NHS less transparent and make it harder for patients to judge the performance of their local hospital; and calls on the Government to reinstate the publication of weekly A&E data and to set out how it will tackle hospital deficits in 2015 in order to protect services.

I want hon. Members from all parts of the House to cast their minds back to the week commencing 14 July 2013: the country was still basking in Andy Murray’s historic win at Wimbledon; England had just embarked on a successful Ashes series against Australia; and hospital A&E departments achieved their target to see 95% of patients within four hours. Since then a number of unlikely things have happened: the then reigning world champions, Spain, have crashed out of the World cup in the first round; a group of scientists remotely have landed a probe on a comet hundreds of millions of kilometres from earth; and Cuba and the United States have begun to repair diplomatic relations. But in the same period some sadly predictable things have occurred: England have crashed out of the World cup in Brazil; they have been whitewashed by Australia in the cricket; and under a Conservative Government hospitals in England have now missed their A&E target for 100 weeks in a row.

I start this debate by paying tribute to the hard-working staff at every level of our national health service. They work tirelessly in trying circumstances, and without them there would be no NHS. Ministers have in this place adopted the practice of attempting to pretend that any criticism of Government policy is a criticism of the health service or its staff, so let us make clear one thing right at the start of this debate: NHS staff are remarkable and we are all in their debt. The achievements of NHS staff are despite Government policy, not because of it.

[John Redwood (Wokingham) (Con)]

What have the Opposition learned from the Mid Staffs disaster and tragedy, where they were hitting the targets but missing the point? What should they learn about how one drives quality forward in the health service?

[Mr Reed]

I thank the right hon. Gentleman for that question. If he paid attention to the Francis report, he would learn that it was not the targets themselves that were to blame for the Mid Staffs tragedy, but the way they were applied in that hospital. That is clearly stated in both the first and second Francis inquiries; indeed, it was a point that the Prime Minister made on the Floor of this House when he reported to Members.

In the past 100 weeks, nearly 2.4 million patients have waited more than four hours in hospital accident and emergency units in England.

[Gareth Johnson (Dartford) (Con)]

Why does the hon. Gentleman think that in my constituency A&E targets have been met for 97% of patients, that in his own hospital in his constituency in England they have been met for 93% of patients, but that in Wales they have been met for only 83%?

[Mr Reed]

I am grateful to the hon. Gentleman for that question. Had he been in this House longer and paid more attention to these issues, he would know that the datasets comparable between England and Wales are not actually the same. He would know also that the last time we had a Conservative Government people in Wales were waiting two years for operations, and that nobody campaigns more than I do on behalf of hospitals in my area on the waiting times there.

In the past 100 weeks nearly 2.4 million patients have waited more than four hours in hospital accident and emergency units in England; almost half a million people have spent more than four hours on a trolley waiting to be admitted; and more than 1,500 have waited more than 12 hours to be admitted.

Those figures offer a stark analysis of the difficulties facing accident and emergency. Even in this week of the summer solstice, this Government’s A&E winter crisis shows no signs of abating. In a debate in January the Secretary of State for Health said that the NHS had just been through a tough winter, but the evidence from NHS England shows that accident and emergency departments have had two tough winters and are well on their way to a third tough summer. Under this Government accident and emergency is experiencing a permanent winter.

[Barry Gardiner (Brent North) (Lab)]

My hon. Friend will know that Northwick Park hospital in my constituency has had some of the worst waiting times in the country over the past year. Does he understand, and will he address in his remarks, the fact that the ageing population—those over the age of 80—in Brent has increased by 50%, yet the funding available to cope with that increase has been reduced by 25%? It means that, of the 250 people who attend A&E each day, 100 are dementia patients who become bed blockers because the integrated care package is not in place and is not working.

[Mr Reed]

My hon. Friend makes an excellent point. He is right to mention those issues, which I will come to later. I pay tribute to him for doing so.

The reason for those pressures on A&E, in addition to the issues that my hon. Friend raises, is the sharp increase in people attending A&E since 2010. In the past the Secretary of State has tried to claim that the increase is the fault of the previous Labour Government, but that is patently nonsense. Annual attendances at hospital accident and emergency units increased by 60,000 in the four years before 2010, whereas in the four years after they increased by nearly 600,000—10 times faster. The reality is that A&E dramatically improved between 2004 and 2010, when 98% of patients were seen within four hours. This is a crisis that only started on the Tories’ watch—after they made it harder to see a GP, after they started stripping back social care services and after they launched their damaging top-down reorganisation.

[Henry Smith (Crawley) (Con)]

Does the hon. Gentleman not think that the closure of A&E at Crawley hospital in 2005, under a Labour Government, was distinctly unhelpful to A&E waiting times?

[Mr Reed]

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

[Clive Efford (Eltham) (Lab)]

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

[Mr Reed]

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

[Dawn Butler (Brent Central) (Lab)]

My hon. Friend the Member for Brent North (Barry Gardiner) mentioned the distressing figures at Northwick Park hospital, but the Government’s solution was to close Central Middlesex hospital’s A&E. Does my hon. Friend the Member for Copeland (Mr Reed) think that that added to the crisis or made it better?

[Mr Reed]

Everything that transpired in my hon. Friend’s constituency made the situation much worse, as many medical professionals have said.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Is there not an extra pressure, with many trusts ending the year with deficits? Wythenshawe hospital, which is looking at a £3 million deficit, has decided to try to cut 33 district nursing posts, yet when the Health Committee looked at winter A&E pressures we found that it was important to hang on to district, community support and hospice nurses. Is it not just madness to force hospitals with deficits to cut district nurse posts?

[Mr Reed]

My hon. Friend puts her finger on the problem precisely. It is absolute madness, and it is happening at trusts throughout England, as their deficits edge up towards £1 billion for this financial year.

The number of patients waiting more than four hours each year has rocketed by more than 1 million, meaning that there are now almost four times as many people as there were five years ago waiting more than four hours. That is a damning record, and based on the performance over the previous Parliament five more years of the same will see almost 2.5 million patients each year waiting more than four hours by 2020. For the benefit of patients, medical professionals and the healthcare system as a whole, that cannot be allowed to continue.

[Andrew Percy (Brigg and Goole) (Con)]

The hon. Gentleman may know that I spend my weekends working in the NHS, attending seriously ill patients. We are seeing more patients who are elderly, who have a higher acuity and who need admission to hospital; hospital is the only place for them. On his suggestion that the situation has arisen on the Government’s watch, how does he account for the Royal College of Nursing’s telling the Health Committee that the decisions that needed to be taken to deal with this demographic shift should have been taken a decade or more before my party entered government?

[Mr Reed]

If the hon. Gentleman wants to compare the records of this Government and the previous one, we will do that all day long and he will come out on the wrong side of that debate. On the ageing society, we would think from listening to Ministers and Government Back Benchers that this has just been sprung upon us. He is right to say that it has been coming for a long time, but we did an awful lot more to address it than this Government are doing. I will go on to explain why in just a moment.

A real worry for the NHS, and for those of us who use it or work within it every day, is the Government’s plan to suspend the work of the National Institute for Health and Care Excellence on its safe staffing programme. That move is a rejection of a key recommendation made by the Francis report, and in response to the move, Sir Robert Francis said:

“I specifically recommended the work which NICE has been undertaking for a reason…I would not be surprised if this news generates a significant level of concern, and it seems a shame that the work of NICE has been stopped.”

Dr Clifford Mann, president of the Royal College of Emergency Medicine, has said:

“There are real pressures on nursing levels in Emergency Departments.”

He has also said:

“We are concerned about patient safety and staff welfare.”

I would be grateful if the Minister could explain to me, and to Sir Robert Francis, why on earth the Government have suspended this crucial work.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I read the hon. Gentleman’s motion carefully and I was left slightly bewildered, as he seems to be suggesting that the solution to this problem is more resources for A&E and for primary care, yet I seem to recall that just a few weeks ago I was standing in an election campaign where my party pledged £8 billion more for the NHS and his party failed to back that. Can he explain where he will find the resources?

[Mr Reed]

That is the kind of magical thinking that afflicts Conservative thinking. The hon. Gentleman will be aware that at the last general election we talked about a specific £2.5 billion fund to train 20,000 more nurses, 8,000 more GPs and so on. What we always said was that the NHS would get the money it deserves, quite separately from that £2.5 billion, from a Labour Government. That remains the case and he knows that that is the truth. It is true that certain societal changes, including the ageing society, pose new challenges and offer new pressures for the NHS, but the service is also under increasing financial pressure as a direct result of Government policy.

[Joan Ryan (Enfield North) (Lab)]

May I tell my hon. Friend that we should not recommend to anybody that they rely upon the promises of the Conservative party, because it promised to keep Chase Farm’s A&E unit open—the Prime Minister himself promised that at the 2010 election—but then he closed it? Every A&E department in the surrounding area that now serves the people of Enfield—those of the Royal Free, Barnet and North Middlesex hospitals—continually miss their A&E waiting time targets.

[Mr Reed]

I thank my right hon. Friend for that intervention, and may I say what a pleasure it is to see her again in the House of Commons? She is entirely right in what she says. We all remember the pictures, and we remember the Prime Minister’s promises and those from the previous Secretary of State. My right hon. Friend is right to say that nobody should ever take any lessons from Conservative Members or believe what they are being told by them—not one bit.

[Mr Steve Baker (Wycombe) (Con)]

Why is it that when an A&E department is lost from a Labour constituency it is the Government’s fault, but when one was lost in a Conservative constituency under the previous Government that was “clinically led”? Can the hon. Gentleman explain the contradiction?

[Mr Reed]

I am afraid the hon. Gentleman is not listening; the rules have changed. The system whereby these processes are undertaken has comprehensively changed. If he were to draw a golden thread through Conservative health policy over the past five years, it would be that the public do not matter and are not listened to, and that change is driven from the centre, irrespective of what local clinicians say.

[Tom Pursglove (Corby) (Con)]

This is all a little ironic, given that in my constituency the Labour party went around petrifying local people by saying that the A&E unit at Kettering general hospital was going to close, but it is still open and it is performing better. Would the hon. Gentleman like to apologise?

[Mr Reed]

If the hon. Gentleman is seeking an apology, would he like to apologise for the fact that A&Es in England have missed their waiting time targets for the past 100 weeks? I do not see any trace of an apology or any scintilla of embarrassment on his face.

It is true that certain societal changes, including the ageing society, pose new challenges and offer new pressures for the NHS, but the service is also under increasing financial pressure as a direct result of Government policy. First, the declining access to social care and the squeeze on primary care have forced people to turn to A&E in increasing numbers and have also meant an increasing number of admissions that could have been avoided if people had received better care outside hospital. Secondly, the Government wasted £3 billion, at least, on a damaging top-down reorganisation that nobody wanted and nobody voted for, and which was hidden from the electorate. That reorganisation sucked resources from front-line patient care. We know that senior members of the Cabinet believe that the reorganisation was a catastrophic mistake. We know that, in the words of British Medical Association chair Mark Porter,

“the damage done to the NHS has been profound and intense”,

and we know that the reorganisation has not made the NHS more productive or more efficient.

Thirdly, the effect of that wastage has been compounded by the short-sighted cuts to nurse training places at the beginning of the previous Parliament. That means that there are not enough staff working in hospitals—that was a key criticism by the Keogh review. In addition to compromising patient safety and clinical outcomes, this Government’s decision has left trusts over-reliant on expensive agency staff.

[Mrs Madeleine Moon (Bridgend) (Lab)]

When I worked in hospitals and was responsible for arranging community-based discharge, two major problems created a delay in discharge—I hate the expression “bed-blocking” as it is such an insult to elderly people. One was access to community care facilities—home care support—and the other was ensuring that we had community equipment, such as hospital beds, hoists or bathing equipment. If we do not have all the pieces in place, which often come not from NHS funding but from local authority funding, it will not happen. That is exacerbating the problem in A&E.

[Mr Reed]

My hon. Friend makes a prescient point. The Government talk the talk but do not want the walk, and she has detailed precisely why that is the case.

[Sir Simon Burns (Chelmsford) (Con)]

I am grateful to the hon. Gentleman for giving way, particularly as he has just responded to the intervention by the hon. Member for Bridgend (Mrs Moon), who is from Wales. Does he accept that in every financial year since 2010 the NHS in England has had a real-terms increase in funding, albeit a modest one, but that there has been a cut of 8% by the Labour Government in Wales and the A&E target in Wales has not been met since 2008?

[Mr Reed]

I congratulate the right hon. Gentleman on his knighthood—it is remiss of me not to have done that. He will know that real-terms increases and cash increases are not the same. He will also know, because he voted for it, that the budget in Wales has been cut by this Government by more than £2 billion. Let us compare like with like.

The Royal College of Nursing has calculated that almost £1 billion—£980 million—was spent on agency staff in the last year alone. Those and other choices made by this Government have meant that, collectively, trusts in England reported a total deficit of £822 million in 2014-15. That is simply unsustainable. A recent survey by the King’s Fund found that 90% of trust financial directors and 85% of commissioners are concerned about the financial state of their local health economies, and that view will be shared by many Members on both sides of the House. An investigation by Pulse revealed that clinical commissioning groups were being forced to use their 2015-16 winter pressures allocations just to maintain regular services.

Questions must also be asked about this week’s revelations that thousands of foreign nurses working in our NHS could be forced to leave the country as a result of the Government’s immigration rules. The RCN points out that this would cause chaos for the NHS and waste tens of millions of pounds—the Secretary of State laughs as I mention that. It would make matters much worse for patients and for front-line clinicians. Will the Minister tell us how many nurses will be lost from A&E and how many will be lost in total as a result of this move? Where in the country will they be lost? How will the vacancies be filled? What will this cost? Has he or any Minister in his Department made representations to the Prime Minister about the effects of this policy? If so, will he share those with the House? When did Health Ministers know that this policy might cause so much damage?

[Robert Flello (Stoke-on-Trent South) (Lab)]

When the Minister replies it will also be interesting to hear him say exactly how that cut and restriction on nurses will impact on the Royal Stoke university hospital, which had the great misfortune, for patients and the public more generally, of topping the list for the longest waits last winter of more than 12 hours on trolleys.

[Mr Reed]

My hon. Friend is absolutely right. Stoke deserves better, and no one has worked harder than him to ensure that it gets something better. Let us ensure that the Minister answers those points.

The understaffing crisis represents a dire situation that will only get worse unless the Government demonstrate an understanding of these issues and give them the attention that they deserve. We know that, as well as deficits this year, the“Five Year Forward View” is based on assumptions that the NHS can save £22 million by 2020. Will the Minister assure us that this will not result in any fewer medical staff or cuts to hospital or community services? Will he also commit to placing the analysis and the assumptions behind the efficiency plans in the public domain so that we can have an informed and honest debate about NHS funding? We do not want a programme of services being set up to fail and then being cut by stealth.

[Maria Caulfield (Lewes) (Con)]

I worked as a nurse under the previous Labour Government. That Government may have kept numbers the same, but they reduced the skill mix, which greatly affected the safety of patients both on wards and in out-patient facilities. Can the hon. Gentleman explain that?

[Mr Reed]

It is a matter of fact that we increased nursing numbers. The hon. Lady will be well aware that when we came into office in 1997, we were training 15,000 nurses a year, and when we left office in 2010, we were training 20,000 nurses a year.

On social care, under this Government, 300,000 fewer older people are getting the care they need, with more and more people being forced to stay in hospital. But that is only part of the story. When someone who needs care cannot get the help they need, it increases the risk that they will struggle or fall ill and have to go to accident and emergency. That is clearly demonstrated in the increasing number of older people arriving at A&E by ambulance. Almost 100,000 extra patients over the age of 90 were brought to accident and emergency by ambulance last year. That is an indictment of Government policy towards older people, and the problem is further exacerbated when the true scale of the damage to social care is revealed.

Before the election, the National Audit Office published its report on the impact of Government cuts on local council budgets. The report found that 40% of the total savings between 2013-14 and 2014-15 were made through reducing adult social care services.

The Association of Directors of Adult Social Services has calculated that a further £1.1 billion will be cut from adult social care over this financial year, and the president of the association said:

“Short-changing social care is short-sighted and short-term.”

The number of patients ending up in A&E because they cannot get the care they need to help them stay healthy outside hospital is clear evidence of this short-termism.

Cutting the social care budget is clearly a false economy, as thousands turn to A&E as a result. That is bad not only for the patient, but for the taxpayer. If a patient is not getting the care they need, their condition will deteriorate, which means that more complex interventions will be needed. A recent poll commissioned by the Care and Support Alliance found that nine out of 10 GPs believe that deep social care cuts are responsible for the overcrowding in our accident and emergency departments. The Government need to get a grip and address the crisis in social care in order to relieve the pressure on A&E departments and GP surgeries. Instead, they have chosen to risk putting more pressure on the heath system at all levels by announcing further cuts of £200 million to the public health budgets of local authorities without any idea of whether they can be made without harming vital services—services that potentially save money.

[Mr Peter Bone (Wellingborough) (Con)]

Will the shadow Minister recognise the initiative that is happening in north Northamptonshire? Kettering general hospital will have not only an A&E, but urgent care, social care and mental health facilities and GPs all on the same site. People can go to the hospital and be dealt with there and then, correctly. I will also have an urgent care centre in my constituency. Is that not the way forward?

[Mr Reed]

I am grateful to the hon. Gentleman for his intervention. I absolutely agree that models such as that and local best practice can exist in pockets all over the country. It is just a shame that so many health economies are getting cut to the bone, because that stops them developing such care models. He is right that it is precisely that kind of integration that points the way to the future. Have the effects of these public health budget cuts on primary care and accident and emergency been modelled by the Department, and will the Minister share that work with the House? If that work has not been done, will he explain why? Has the Department consulted on these latest cuts, and what was the response?

I now wish to turn to the situation in general practice. In the previous Parliament, we saw a marked increase in the number of people waiting longer for a GP appointment. By 2013-14, almost 6 million people could not get a GP appointment. If the trend continues, that figure could be around 10 million by the end of this Parliament. Those people are often left with little option but to turn to accident and emergency. The GP patient survey suggests that almost 1 million patients went to A&E last year because they could not get a convenient GP appointment. It is clear that the GP workforce crisis is a major driver of the issues under discussion today.

[Robert Flello]

My hon. Friend is making an extremely good speech and is being very generous in giving way. On that point, Stoke-on-Trent has traditionally had far more patients per GP than the national average, and the age of that population is rapidly approaching, and often way past, retirement age. What we are seeing is not that people cannot get an appointment when it is convenient, but that they cannot get an appointment for days on end.

[Mr Reed]

My hon. Friend makes the case. What is happening in Stoke, I regret to say, appears to be something of a canary in a coal mine for the NHS around the country, and its issues will increasingly be seen in areas all over the country.

It is clear that the GP workforce crisis is a major driver of the problems. The number of full-time equivalent GPs per head has fallen over the past five years, even as demand has increased.

[Henry Smith]

rose—

[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.

[Several hon. Members]

rose—

--- Later in debate ---

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

May I take this opportunity to congratulate you on your election, Madam Deputy Speaker? It is a great pleasure to speak for the first time with you in the Chair. You will have noted that the subject for debate on the Order Paper is A&E services—an important matter that everyone in this House cares much about. You will also have noted that there are several proposers of the motion, including the Leader of the Opposition, the shadow Secretary of State and the shadow Minister for care and older people. My first question is why, on this important issue, which the Opposition seem to think is critical to their programme for the NHS, the shadow Secretary of State for Health cannot be here to make the argument himself. Further, we understand that the shadow Minister for care will not be wrapping up the debate.

[Mr Jamie Reed]

I can tell the Minister where they are not: they are not hiding behind trees, and they are not meeting Rupert Murdoch in an underground car park.

[Ben Gummer]

I am not sure I get the gist of the hon. Gentleman’s point, but I do think that the shadow Secretary of State for Health should propose the motion in an Opposition day debate on health matters. I hazard a guess that there has been a disagreement between the two shadow Ministers—perhaps a suggestion that one of them is using health debates as opportunities to grandstand. I hope that that is not the case.

I am slightly concerned that we are about to see another episode of the ongoing psychodrama which is the Labour party. We had the TB-GBs and then, when that very happily came to an end, we had the Miliband “Band of Brothers”—a disaster for that family but happily not for the country.

--- Later in debate ---

[Ben Gummer]

The shadow Secretary of State cut the number of training places for nurses; it was increased under the last Government and is now at a record level.

We were on the subject of performance, which is at the heart of the motion. The shadow Minister can speak warm words about the workforce, but he failed to congratulate them on their exceptional performance under unprecedented pressures. At no point in his speech did he acknowledge the real increase in pressure on A&E services in the NHS. Some 3,000 additional patients a day are being seen, treated and discharged in accordance with the 95% target; that is being delivered by NHS staff across the service. He fails to point out the places where we have seen remarkable successes. He fails to give the example of Barking, Havering and Redbridge University Hospitals NHS Trust, which saw a 16% improvement in A&E performance times in the last year. That is front-line staff delivering better outcomes as a result of changes made by the Secretary of State over the past five years.

[Mr Jamie Reed]

I am grateful to the Minister for giving way, but he gives an absolutely fictional account of my remarks to the House. If he is so confident in his description of what is happening in the health service, can he explain why a comedy document produced by the Conservative research department says:

“New polling by Conservative peer Lord Ashcroft found that 47 per cent of voters believe Labour has the best approach to the health service while just 29 per cent picked the Tories”?

[Ben Gummer]

As Madam Deputy Speaker pointed out, we have just had an election, and the voters’ voice on the NHS was loud and clear. There is a simple point to make about the performance of this nation’s NHS: an independent think-tank—one of the most respected in the field—has rated it the best performing national health service in the world. It is better than that of Scotland, Northern Ireland or Labour-run Wales. A&E, as measured by countries across the world, performs no better in any country than in this. If we wish to go to international comparisons, the shadow Minister would do well to accept the extraordinary work that NHS staff are already delivering to make this the best health service in the world.

[Mr Reed]

I wish the Minister was right. I genuinely wish ours was the best A&E provision in the world. However, I have to draw his attention to an article in the International Business Times in January this year. When a journalist contacted the Department of Health to learn the basis for that claim by the Secretary of State, they were told that there was

“no concrete research on which Hunt had made the statement”.

This is a complete fabrication. Will the Minister set the record straight?

[Ben Gummer]

The shadow Minister should know that we in this country perform best of all countries that measure A&E, and that is the only way that we can judge this. The trouble is that by talking down that remarkable fact, all we do is denigrate the work of the people who deliver that every day.

I move on to the financial performance of the NHS, the second point that the shadow Minister raised, which lies at the heart of his motion. Let me set the financial context. [Interruption.] While Opposition Members are giggling, they might like to remember that they went into the last election not willing to commit to the NHS’s own plan for the next five years. Only one major party pledged to give the NHS the funding that it requested for the next five years: the Conservative party. The history on delivery is clear: we are talking about an additional £12.9 billion of cash in the last five years; a contribution of £2 billion this financial year, and a further £8 billion to fulfil the five-year plan. That is the financial background to this debate—a background that the Opposition refused to match at the last election. Money on its own does not get to the root of the problem, which I am afraid is not recognised in the motion, namely the relationship between quality, standards and money.

--- Later in debate ---

[Ben Gummer]

I am not going to take any more interventions, if my hon. Friend does not mind, because I want to cover the additional issues raised by the shadow Minister. Before I do so, I would like to know whether the shadow Minister agrees with our target for 5,000 additional GPs, which can be afforded only because of the £8 billion that we have committed to the NHS—a commitment that, again, he has been unable to sign up to.

[Mr Jamie Reed]

The Minister has touched repeatedly on issues of finance. He has not given an accurate reflection of the Labour party’s position going into the general election with regard to NHS funding. Let me ask him again: will he explain how the £22 billion of efficiency savings is going to be made, and will he give a guarantee that it will not affect hospital services, A&E services, staff numbers, or any front-line services in any community in this country?

[Ben Gummer]

I find it difficult to have to repeat to the hon. Gentleman, as I have to the shadow Secretary of State on a previous occasion, that this is a plan by NHS England. It is a plan that we supported before the election and afterwards, and a plan that the Opposition failed to support. The details of the plan have been worked out by NHS England and will be revealed in due course. Our part of the deal is that we provide the money that it has requested, which is £8 billion. We will see the plan as it is revealed by NHS England. It is an ambitious plan but one that we will fund from our side of the bargain.

The shadow Minister reveals in his comments and in the motion to which he has put his name that his motives are not pure. He speaks about the reporting targets for A&E departments around the country, but does not mention that the decision to change the reporting standard was made not by the Government but on the basis of a recommendation made by Professor Sir Bruce Keogh, who did so as part of a general review of reporting standards. When the shadow Minister talks about reporting standards, he does not mention that we are bringing those for cancer waiting times forward from a quarterly to a monthly basis, which I would hope he would have welcomed.

The shadow Minister does not mention that, for the first time, we are introducing mental health waiting times, as well as putting into the NHS constitution parity of esteem, which was not in the original constitution written and instituted by the shadow Secretary of State. Those are two matters of vital concern to our constituents which we are correcting on the recommendation of Professor Sir Bruce Keogh. Nor does the shadow Minister mention that Sir Bruce recommends that the A&E targets are brought on to a monthly reporting basis so that they can have clinical parity with all other standards and produce a better quality of statistical reporting.

In this debate, the shadow Minister finds himself on the wrong side of the clinical evidence given by Sir Bruce; the Patients Association, which welcomed the change; and the Royal College of Emergency Medicine, which said:

“The move from weekly to monthly reporting better reflects meaningful trends and will in fact increase the validity of this key metric, by reducing the effect of short term and unforeseeable events”.

The Nuffield Trust said that

“the replacement of weekly A&E figures with a monthly publication of indicators for many targets should help us understand changes in performance in a more meaningful way”.

The hon. Gentleman is on the wrong side of clinicians, academics, the Patients Association and the Royal College of Emergency Medicine—and on the wrong side of the argument.

The reason why is that the hon. Gentleman has made a choice. I appeal to the new Opposition Members who are sitting behind him: they can go through the next five years, motion by motion, vote by vote, opposing everything that is done on the basis of clinical evidence, just for the purpose of making political gain. If they do that, I, in turn, will remind the Opposition of the scandal of mixed-sex wards; the scandal of the highest hospital infection rate in the developed world; the scandal of a doubled pay bill for managers; the scandal of Morecambe Bay; the scandal of Mid Staffs; and the scandal of some of the worst cancer outcomes in the world. I will remind them of those every time they seek to oppose us for political reasons. The choice is theirs—or they can take the other tack and try to listen to clinicians, to be constructive and to de-weaponise the NHS.

I will seek to do what the shadow Secretary of State claimed to want to do, which is to come together and allow the NHS to get on with the job of building 21st-century services. However, if the Opposition make the wrong choice, all they will do is confirm in the minds of the British people that they put politics before the NHS, and that for the Labour party, the party comes first—always—whereas for Conservative Members, the NHS and patients always come first.

NHS Success Regime

Jamie Reed Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

The urgent question was submitted this morning.

Coming from a shadow Secretary of State who is, one might suspect, using urgent questions and the subject of the NHS not to address issues relating to the quality of care, but for his own political reasons—as he always has—this was a shameless attack. It reflected rather badly on the right hon. Gentleman himself, rather than reflecting on the cause that he should seek to pursue: the better care of patients, which lies at the heart of what NHS England is attempting to do. If he had read what Simon Stevens said when he announced the plans yesterday to the NHS Confederation, he would have noted that they are being drawn up, co-ordinated and, in part, led by local commissioners rather than—as was the case before—by monolithic centralised bodies headed by bureaucrats. This process is being led, locally, by clinicians, who are being supported and helped by NHS England and professional regulators.

The right hon. Gentleman asked about staff shortages. I am surprised that he mentions that, given that he was in part the author of the staff shortages that hobbled the NHS at the end of the previous Administration and that led in part to the problems at Mid Staffordshire that we have been seeking to address. Only this Government, in their previous incarnation, promised to correct that situation, in part through our pledges on GP numbers over the next five years.

The right hon. Gentleman asked about plans for accident and emergency departments and about job losses. I would say to him that it is different this time. These plans are being drawn up by local commissioners, who are now beginning the process of working out how to improve their local health economy. This is not a plan that will be devised centrally in Whitehall, imposed on local areas and announced as a done deal for local people. I know that that is what the right hon. Gentleman is used to, but in this instance it is a genuine conversation between local patients and local commissioners with the aim of improving their local health economies, and it will be supported by national bodies.

The right hon. Gentleman asked about south London and about consultation. I was a candidate in a constituency that had a solution imposed on it, during his tenure as Minister for Health, without any decent consultation. That proposal was eventually thrown out. The previous Government never consulted local people properly when he was in control, but we have changed that. These local plans will involve local people, patient bodies and health and wellbeing boards from the outset.

The shadow Secretary of State asked about the powers of NHS England, about localisation and about the co-ordination of local services. I ask him once again to go back and read Simon Stevens’s speech. He will see how things have changed. This is not about decisions being made by politicians in Whitehall. I dare say that the right hon. Gentleman does not know the solution to the problems in the local health economies in Devon, Essex and Cumbria—

[Mr Jamie Reed (Copeland) (Lab)]

I do.

[Ben Gummer]

I am so glad that the shadow Minister is such an augur of knowledge. I will tell him who knows the solution: it is the patients and the local clinicians. They will provide the answers and make the changes. We want patient care to be improved for local people to provide excellence in the local NHS—excellence delivered and excellence for patients—and we were supported at the general election in that mission to create a world-class NHS.