Oral Answers to Questions Debate
Full Debate: Read Full DebateJeremy Hunt
Main Page: Jeremy Hunt (Conservative - Godalming and Ash)Department Debates - View all Jeremy Hunt's debates with the Department of Health and Social Care
(6 years, 6 months ago)
Commons ChamberThe NHS needs more nurses, which is why we are making big changes for new entries into the profession, including the new nurse associate role and new nurse degree apprenticeships.
I am glad to hear that the Secretary of State values the degree apprenticeship as a way to provide further routes into nursing, but will he consider working with the Treasury and across the Government to increase the funding that educational establishments receive from the Institute for Apprenticeships for nursing courses, to further incentivise universities and colleges to offer more places on those courses?
I thank my hon. Friend for his excellent question. It will strengthen my hand with the Department for Education, which decides what levels of funding are made available from the Institute for Apprenticeships. It has actually given us the highest level of funding, at £27,000, but we never say no to more.
But will the Secretary of State admit that he made a basic error by scrapping nurse bursaries, which has led to a 23% fall in the number of people applying to nurse courses? Why does he not look at that if he wants to widen the entrance into nursing?
I am most grateful. That is a very rare compliment, so I shall savour it. I would gently say to her that the point about nurse degree apprenticeships is that it is possible to transition into nursing from being a healthcare assistant without any fees being paid at all. That is why it is a huge and highly significant change.
As the hon. Member for Wallasey (Ms Eagle) is sporting what appears to me to be a very fetching suffragette rosette, it is perhaps timely to record that in the great success our national health service has been under successive Governments, I think I am right in saying, as things stand, that well over 70% of the people who make it great are women.
Following the recent inquiry by the Select Committee on Health into the nursing workforce, we absolutely welcome the new routes into nursing, including the new role of nursing associate. However, one of the issues highlighted strongly was the need to retain our existing nursing workforce as well as to recruit into it. Will the Secretary of State comment on that?
My hon. Friend speaks very wisely—we do need to be better at retaining our existing workforce. I think that is why the Treasury has given me extra latitude in negotiations on the pay rise—those discussions are currently happening—but we also need to be much better at flexible working and at recognising the challenges people have in their ordinary working lives.
Unlike in Scotland, where student nurses receive free tuition and a nursing bursary of over £6,500 a year, nurses in England now face debts of £50,000 on graduation. Owing to that, training applications in England have dropped by a third since 2015, and the new nursing apprenticeship attracted only 30 trainees against a target of 1,000. Will the Secretary of State not accept that he got it wrong, and reinstate the nursing bursary?
I am interested to hear the hon. Gentleman say that, because we have published a draft of a workforce strategy in this country, but I notice that Audit Scotland says that in Scotland there is a lack of a long-term strategic plan for the workforce. I gently say to him that there are workforce pressures across the United Kingdom. We have a plan to dramatically increase the number of nurses that we employ in the NHS, and I am sure many people in Scotland would like to see the same there.
The Secretary of State has claimed that the removal of the bursary would fund 10,000 extra training places, but the first 5,000 will start only this autumn and the nurses will qualify only in 2021. With more than 36,000 nursing vacancies in England, more nurses leaving than joining and a 90% drop in EU nurses coming to the UK because of Brexit, exactly who does he expect to care for patients in the meantime?
As we discussed earlier, we are broadening the routes into nursing from just traditional higher education courses, including nurse apprenticeships and people being able to train on the job over four years in a hospital. We hope that a whole group of healthcare assistants who currently find it difficult to get into nursing can become nurses. I think that would be very welcome in Scotland as well.
Will the Secretary of State update the House on progress made in reducing the cost of agency nurses so that the money can be reinvested in full-time nursing?
I am happy to do that. It is one of the great successes of NHS Improvement, which should be celebrated, that it has brought down the amount spent on agency nursing by £1 billion in the last couple of years. That is a huge achievement. Every penny of that goes back into frontline care.
The Government cut the number of nurse training places in 2010, and when they scrapped bursaries applications from mature students suffered particularly. What is the point of blaming trusts for hiring agency staff when the Government simply do not train enough nurses to fill the vacancies?
Perhaps I should set the record straight for the hon. Lady. We have 52,000 nurses in training—more than was ever the case under the last Labour Government, who were planning to cut nurse training places by 6%. We are planning to increase them by 25%. That shows our commitment to nursing.
Yesterday, the Royal College of Nursing reported on the total failure of Government policies to increase the nursing workforce. As we have just heard, the Government hoped to recruit 1,000 trainees to the nursing apprenticeship, but ended up with just 30. This year, the number applying to university to study nursing has so far fallen by a staggering 33%. We have a workforce crisis exacerbated by badly thought out policies, so is it not time that the Secretary of State admitted that scrapping the bursary was a mistake?
I have a great deal of respect for the hon. Gentleman, but that is not the first time that he has presented a somewhat incomplete picture of what is actually happening. In the last five years, we have 15,700 more nurses, and the reason for those vacancies and for the pressure is that, as he knows very well, under the last Labour Government we had Mid Staffs, which was a crisis of short staffing that this Government are putting right. That is why we want to recruit those extra nurses.
This week is Children’s Mental Health Week, and still too many children and young people wait too long for their mental health provision in the NHS. That is why, by the end of next year, we will have invested an extra £1.4 billion, meaning that 70,000 extra children and young people are seen every year.
A constituent’s 14-year-old son suffers severe obsessive compulsive disorder, resulting in self-harm. Treatment options have failed and his doctor recommends an intensive residential programme, but as Ministers are aware, places are very limited. He has been waiting seven weeks and counting, with 24-hour parental support and supervision. What more can be done to ensure that that boy and other adolescents who are in desperate need of help get that help before it is too late?
I thank my hon. Friend for raising that issue, and I understand that in that particular case clinicians are meeting this week to resolve those issues. She is right: we need to expand the number of beds available for children and young people. They are at a record level—1,440, and that went up by another 81 last year—but more needs to be done, which is why we published our children and young people’s mental health Green Paper.
I have been approached by a number of my constituents in Leicestershire who are concerned about the wait between a referral to child and adolescent mental health services and the allocation of a named caseworker and formal treatment. Will my right hon. Friend enlarge on how the steps that he is taking, which he has set out, will help to reduce such waits in Leicestershire and across the country?
I am happy to do that. The simple truth is that it is a tragedy for every child who has to wait too long to access mental health care, because half of all mental health conditions become established before the age of 14. If we do not nip them in the bud, they can get a lot worse. What are we doing? We are setting up a whole new service inside schools to spot such problems earlier and we are going to introduce a waiting time target for CAMHS appointments.
In 2016-17, 65% of young people in England with eating disorders started urgent treatment within one week of referral. What has been done to ensure that the target of 95% by 2020 will be reached? Does the Secretary of State share my belief that waiting time targets are a vital tool for improving eating disorder treatment and should be in place in all parts of the United Kingdom?
I absolutely agree with that. I join my hon. Friend in supporting the introduction of waiting time targets in Scotland and other parts of the United Kingdom. How are we doing so far? In terms of the need for urgent treatment for eating disorders, we are hitting 79%, so we are on our way to the 95% target and we want to get there as soon as we can.
I listened very carefully to what the Secretary of State said about the additional funding that is supposed to be reaching the frontline, but the Young Person’s Advisory Service, which is the main service for young people’s mental health in Liverpool, has seen a £757,000 cut—a cut of 43%—in this financial year. There are now 412 children in Liverpool waiting more than 28 weeks for an assessment—not even for treatment. It is absolutely shocking. How can he stand there in young people and children’s mental health week and say that everything is rosy?
I did not; I said the opposite. I said that we need to do a lot more and I told the House what we are doing. If the hon. Lady looks at what is happening in her own clinical commissioning group, she will see that the proportion that is spent on mental health has gone up from 12.3% to 13%. She will see that this Government have done a huge amount on mental health. In 13 years, Labour did not have any waiting time targets for mental health and did not introduce parity of esteem—a whole range of things that are now happening and that she should support.
Will the Government commission more extensive research into the causes of mental ill health among children and young people, both pre and post-natal, with a view to preventing as much ill health as possible?
Specialist mental health crisis care for young people in south Cumbria is available only between the hours of 9 and 5 from Monday to Friday. Does the Secretary of State agree that in the light of the Care Quality Commission’s recent damning report of the partnership trust, that is not acceptable? Will he join me in asking the Morecambe Bay CCG to ensure that there is out-of-hours and weekend care for all people?
I am happy to look into that issue. The hon. Gentleman’s colleague, the right hon. Member for North Norfolk (Norman Lamb), did a huge amount to set up crisis care provision around the country. We need to build on that for the simple reason that, if we are to have parity of esteem, people need to be able to get help in a mental health crisis, just as they are if something goes wrong with their physical health.
Does my right hon. Friend agree that, as well as improving the treatment of adolescent ill health, everything possible needs to be done to prevent crisis from occurring in the first place? Does he agree that we need more research into why we are seeing a surge in Cheltenham and elsewhere in the world, so that clinicians can best tailor their response?
This is something that my hon. Friend has thought a lot about. A particular area of concern is the growth in mental health problems in young women between the ages of 18 and 24. We are looking carefully at whether that relates to social media use, which is an additional pressure that many of us did not face when we were that age. I thank him for his campaigning on this issue.
With respect, we are taking action. Last year, spending on mental health went up by £575 million and four out of five CCGs increased their mental health spend by more than their overall spend. This year, all CCGs will do that. That will apply in Lewisham, as it will everywhere else in the country.
Under plans announced by NHS England, child victims of sexual assault in Stoke-on-Trent would have to travel as far as Birmingham to receive the vital support that they need. Will the Secretary of State agree to look urgently into the proposals to remove child sexual assault referral services from the city?
Research by the Children’s Commissioner revealed that the spend on children and young people’s mental health services varied by CCG from 0.2% to 9%, resulting in services in some areas being described as “shockingly poor”. Can the Secretary of State therefore explain the reason for the variation, and will he commit today to matching Labour’s pledge to increase the proportion of the mental health budget spend on CAMHS services?
The hon. Lady is right to shine a light on that variation, and that is why this Government have introduced Ofsted ratings for all CCGs—to make sure that we understand. It is not just in children and young people’s mental health, but in all mental health where we see that variation. Specifically when it comes to children and young people’s mental health, she will be pleased to know that last year overall spending went up by 20%, and the Green Paper that we published announced an additional £300 million in investment.
Our ambition was to halve the number of maternal deaths, neonatal deaths, neonatal injuries and stillbirths by 2030, but because of the progress we have made with our maternity safety programme, we have brought that forward to 2025.
I am glad to hear that progress is being made. The World Breastfeeding Trends Initiative’s 2016 report highlighted several gaps in access to breastfeeding support, including deficiencies in clinical training and a lack of integration between the NHS and voluntary sector services. What can be done through the maternity transformation programme to ensure that women can access, and health professionals can provide, the best-quality infant feeding advice right across the country?
It is five years today since the landmark publication of the Francis report on the Mid Staffordshire Foundation NHS Trust. Since then the NHS has made a huge number of changes, not the least being that 34 trusts have gone into special measures and 19 have come out. I particularly congratulate the West Hertfordshire Hospitals NHS Trust on coming out of special measures in January and securing a “good” score for its caring: that was a fantastic achievement by its staff.
Given that York’s local health service is in special measures, the additional funds in the Budget to deal with winter health pressures were very welcome. I am pleased to say that York NHS has already received a tranche of those funds, but the remainder of its share has not been released, although discussions with NHS Improvement are ongoing. Will the Secretary of State undertake to look into the situation, as a matter of urgency?
The Secretary of State will be aware of the importance of King’s College Hospital to my constituents. In 2009, it was rated “excellent” and one of the top hospitals in the country; now it is missing its A&E waiting time targets and a key cancer treatment target, there has been a fourfold increase in the number of cancelled operations, and it is in special measures. The Government must take some responsibility for that. They must not wash their hands of it. Will they step up to the plate and help King’s by, for instance, giving it the resources that it needs?
Let me reassure the right hon. and learned Lady that we do not wash our hands of any trusts that go into special measures. The point of the special measures regime is to highlight where Government intervention is necessary. I know the right hon. and learned Lady will agree that a huge amount of very fine treatment happens at King’s every single day, but it is having profound issues in relation to the management of its finances and some of its waiting times, which is why we are doing everything we can to support it.
With a high delayed-discharge rate of 10%, Kettering General Hospital, which is in special measures, has 60 patients on any one day who have completed their treatment and await their transfer into the community. Northamptonshire County Council has been given millions of pounds, via the better care fund, but it is simply not up to the job. What can be done in those circumstances?
I am well aware of the pressures at Kettering. It is a very busy hospital, and it has undergone a number of changes of management. However, I can reassure my hon. Friend that a big improvement package is there to support it and that we want to take it out of special measures as soon as possible.
The previous chair of King's College Hospital NHS Foundation Trust resigned because he had concluded that the funding provided for King’s had placed the trust in an impossible position. The current interim chair has said that the proportion of GDP spent on health and social care needs to rise to match that in other European countries if our NHS is to be sustainable. When will the Secretary of State heed the warning cries and commit the funding that King’s and, more widely, our NHS need in order to deliver care to our constituents?
I do not know whether the right hon. Lady is referring to my age, a proposition on which I think the House would have to divide, or the rosette. [Interruption.] Yes, I thought she meant the rosette.
On the day that we mark the 100th anniversary of giving a voice to women, I want to update the House on concerns in the medical profession that we may not be giving a voice to doctors and other clinicians who want the freedom to be able to learn from mistakes. The House will know that, as a Government Minister, I cannot comment on a court ruling, but it is fair to say that the recent Dr Bawa-Garba case has caused huge concern, so today I can announce that I have asked Professor Sir Norman Williams, former president of the Royal College of Surgeons and my senior clinical adviser, to conduct a rapid review into the application of gross negligence manslaughter in healthcare.
Working with senior lawyers, Sir Norman will review how we ensure the vital role of reflective learning, openness and transparency is protected so that mistakes are learned from and not covered up, how we ensure that there is clarity about where the line is drawn between gross negligence manslaughter and ordinary human error in medical practice so that doctors and other health professionals know where they stand in respect of criminal liability or professional misconduct, and any lessons that need to be learned by the General Medical Council and other professional regulators. I will engage the devolved Administrations, the Justice Secretary and the Professional Standards Authority for Health and Social Care in this vital review, which will report to me before the end of April 2018.
I thank the Secretary of State for that answer—or rather, for that statement—and also for the robust tweets that he makes on that and many other issues. Would he be amenable to the idea of following on Twitter the Oliver King Foundation? On the foundation’s advice, I have written to all the schools in Broxtowe urging them to install defibrillators. This is an important project. What assistance is the Department of Health giving to such an admirable charity and such an excellent project?
I welcome the review that the Health and Social Care Secretary has just announced. I also welcome the addition of social care to his role and the Government’s belated realisation that social care should be a Cabinet-level role, as Labour recognised with its shadow Cabinet in 2010. Yesterday, the Alzheimer’s Society reported that care homes were turning away people with advanced dementia—or even evicting them, sadly—because care providers do not get enough money from local authorities to cover the cost of their care. Will the Health and Social Care Secretary now be arguing with Treasury colleagues for the funding that is so badly needed to ensure that people with dementia are not evicted from care homes due to a lack of funding?
The hon. Lady always speaks powerfully about the social care system. One of the key parts of the social care Green Paper that we are currently working through is on market stabilisation. We have seen a number of care homes go under, although the number of beds overall has remained broadly stable, but our particular concern is, as she rightly points out, people in the advanced stages of dementia who might not be able to get the care that they want. This is a key focus of our work.
Will the Secretary of State give an assurance that any accountable care organisations that he establishes will not be able to use commercial confidentiality excuses to evade scrutiny under freedom of information legislation?
As the Secretary of State carries out his social care funding review, I urge him to look carefully at whether we should look again at implementing the Dilnot commission’s proposals. Given that we legislated for them, they are the only way that we are going to tackle the issue with the sufficient urgency.
At the heart of the Dilnot proposals was the idea of risk pooling—that there is a randomness in the illnesses that affect us in the later years of our life that we would want, as a society, to do something about. I will confirm what the Prime Minister said in the election campaign: we will consult on a cap on social care costs.
For the first time ever in Devon and Plymouth, GP practices are struggling to recruit new doctors and new partners in particular and are spending a fortune on locums as a result. The Government have a plan to fix the situation by 2020, but what more can be done in the meantime to ensure that my constituents can access primary care services?
There are two things. First, we have succeeded in increasing the number of medical school graduates who go into general practice—a record 3,157 this year. Secondly—I know this from my conversations with GPs in my hon. Friend’s constituency—we are doing what we can to reinvigorate the partnership model. Since meeting those GPs, I have agreed with the Royal College of General Practitioners and the BMA that we will carry out a formal review of how the partnership model needs to evolve in the modern NHS.
I point the hon. Gentleman to what the King’s Fund says, which is that accountable care organisations and integrated care systems make a “massive difference” in care to patients. The King’s Fund is not a pro-Government organisation; it regularly holds the Government to account at election time and throughout the year. Not just the King’s Fund but Polly Toynbee and many other people are saying that.
It is very positive that Corby clinical commissioning group has announced that core urgent care services will be protected in Corby, along with the announced new GP access and new primary care facilities, but will the Minister join me in keeping a close eye on the CCG as it designs the new access arrangements? People need to be able to access those urgent care services at the right place, at the right time and without delay.
At the weekend, NHS England, as my colleagues have pointed out, gave up on the key A&E waiting time target. Does the Minister agree that it is very important that when people go to A&E they do not have to wait longer than four hours, as more than 2.5 million did last year? Whose responsibility is this delivery failure?
I have great respect for the right hon. Gentleman, but he is saying something that is a big exaggeration. What the NHS has committed to is that by the end of the year coming up more than half of the trusts in the country will meet the A&E target and that we will go back to meeting it across the whole country in the following year. So we are absolutely committed to this target. We recognise there are real pressures, which is why it is going to take time to get back to it, but we will get there.
I congratulate the Secretary of State on securing the £10 billion capital commitment in the Budget at the end of the last year to spend on the NHS. May I take advantage of my position on these Benches to urge him for the next allocation of STP funding to adopt the advice of my hon. Friend the Member for Telford (Lucy Allan) and ensure that the Shrewsbury and Telford Hospital NHS Trust gets the Future Fit funding it needs?
The Secretary of State will be aware of the huge disruption at the Manchester hospitals this week because of problems with water supplies and a big water leak. He might also be aware that Emmeline Pankhurst’s home is on the site of the Manchester hospitals. What conversations has he had with United Utilities and other water companies to ensure that we have safe, constant supplies of water to our hospitals, so that these disruptions do not happen?
Child suicide calls to Childline are at a record high among girls—it is at 68%. Despite that, the NHS spends only 11% of its budget on mental health issues. Will the Minister indicate what he is going to do to prevent child suicides?
We are very focused on reducing all suicides. As the hon. Gentleman will know, we have a plan to reduce suicide rates by 10%, and last week we announced a plan to reduce in-patient suicides to zero, which is a big aspiration to which the NHS in England is certainly committed. We are very committed to this agenda.