Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 26th February 2013 Commons Chamber

[Angie Bray (Ealing Central and Acton) (Con)]

1. What assessment he has made of the benefits of comparative performance data in raising standards in the NHS.

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

Comparative performance data are essential to raise standards in the NHS. I have therefore commissioned a review from the Nuffield Trust to consider whether aggregate ratings of provider performance should be used in health and social care, and if so, how best this should be done.

[Angie Bray]

My right hon. Friend will be aware that NHS North West London has made considerable use of comparative performance data to justify closing four A and E departments in one concentrated part of its area. Charing Cross, Ealing, Hammersmith and Central Middlesex are the four A and E departments closest to my constituents, who will be wondering how their closure will raise standards of health care provision locally. Does my right hon. Friend appreciate that there will be strong support among my constituents for any calls to review the decision and the use of comparative performance data?

[Mr Hunt]

I first congratulate my hon. Friend on campaigning extremely hard on behalf of the views and concerns of her constituents throughout the process of the decision that was finally made by NHS North West London last Tuesday. Comparative performance data have a very important role to play, particularly with regard to excess mortality of people who use A and E on weekends. I am, however, aware of my hon. Friend’s concerns and will consider them carefully if, as is likely, the decision is reviewed by Ealing council.

[Grahame M. Morris (Easington) (Lab)]

I thank the Secretary of State for his previous answer. Comparative data are essential in compiling an evidence base on which to plan effective health interventions. Will he use the radiotherapy data sets that his Department publishes as a basis to inform planned investments in advanced radiotherapy systems, particularly in regions like mine which lack such equipment?

[Mr Hunt]

I know that the hon. Gentleman asks a lot of questions about radiotherapy. We use a strict evidence base before we make any investments. We also want to embrace innovation, but our absolute priority is to save as many lives as possible from cancer. He will know that we are in the lower half of the European league tables when it comes to cancer survival rates, and that is something that we are determined to put right.

[John Pugh (Southport) (LD)]

On collecting performance data, has the Secretary of State seen the NHS Confederation publication “Information overload: tackling bureaucracy in the NHS”, which points to a great deal of duplication in information? What is his reaction to it?

[Mr Hunt]

There is far too much bureaucracy in the NHS, which is why I have asked the chief executive of the NHS Confederation to report to me on how we could reduce the bureaucratic burden on hospitals by a third. If there is a lesson from the Francis report on the tragedy at Mid Staffs, it is that we need to free up the time of people on the front line to care, which is what they went into the NHS to do.

[Mr Jamie Reed (Copeland) (Lab)]

The hon. Member for Ealing Central and Acton (Angie Bray) asked a key question. Under the secondary legislation being introduced by the Secretary of State under section 75 of the Health and Social Care Act 2012, local commissioning groups will be forced to allow private providers into the NHS. These private providers will be exempt from the Freedom of Information Act, which will make it harder for patients to compare data between providers. It cannot benefit NHS patients for core clinical services to be given to private providers that do not have to conform to the same standards of transparency as those in the NHS. Will the Secretary of State see reason, ensure a level playing field for the NHS and withdraw the section 75 regulations without delay?

[Mr Hunt]

Who exactly are the section-75 bogeymen that the hon. Gentleman hates: Whizz-Kidz who are supplying services to disabled children in Tower Hamlets, or Mind, which is supplying psychological therapy to people in Middlesbrough? The reality is that those regulations are completely consistent with the procurement guidelines that his Government sent to primary care trusts. He needs to stop trying to pretend that we are doing something different from what his Government were doing when in fact we are doing exactly the same.

[Rehman Chishti (Gillingham and Rainham) (Con)]

2. What support his Department has given to local authorities in respect of their new public health responsibilities.

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[Simon Hughes (Bermondsey and Old Southwark) (LD)]

3. What recent assessment he has made of the future demand for accident and emergency and maternity services at (a) Guy’s and St Thomas’ NHS Foundation Trust and (b) King’s College Hospital NHS Foundation Trust.

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

I have accepted the trust special administrator’s broad recommendations on the future of A and E and maternity services in south-east London. Appendix E of the administrator’s final report outlines the forecast A and E activity and births in south-east London, and the methodology used to determine that information. That includes activity at Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospital NHS Foundation Trust.

[Simon Hughes]

I am grateful for the Secretary of State’s answer. Following his statement and decision, does he recognise that there are still two significant concerns? The first is that any downgrade of A and E and maternity services in Lewisham will put pressure on the other trusts which they cannot cope with. The second is that there is not yet support among all GPs and clinicians, including in Lewisham, for the current plan. Will he assure me that he will seek their support before anything is implemented, and that he will give us the assurances that we need?

[Mr Hunt]

I recognise the concerns that the right hon. Gentleman outlines. As he knows, we have allocated £37 million to help the other four A and E departments that will take the 25% of cases that will no longer go to Lewisham to deal with that extra capacity. He is right to say that the way in which the plan is implemented will be critical. We need to do it properly and extremely carefully to ensure that we meet the concerns that he talks about.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

When the Secretary of State announced his decision to downgrade Lewisham’s A and E services and transfer the patients to St Thomas’ and King’s, he said that Sir Bruce Keogh, the medical director of the NHS, had reviewed those proposals and that:

“He believes that…these proposals…could save up to 100 lives every year”. —[Official Report, 31 January 2013; Vol. 557, c. 1075.]

Having read Sir Bruce Keogh’s review, I can tell the House that he makes no mention whatsoever of saving 100 lives each year. Will the Secretary of State now apologise for misleading the House?

[Mr Hunt]

No. What Sir Bruce Keogh did—

[Mr Speaker]

Order. Just before the Secretary of State replies, I ought to say to the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) that she is perhaps suggesting that the Secretary of State may have inadvertently, rather than deliberately, misled the House. Could she just confirm that? A nod of the head would suffice.

[Mr Speaker]

That is the right hon. Lady’s suggestion, and it is for the Secretary of State to respond as he thinks fit.

[Mr Hunt]

Thank you, Mr Speaker.

Sir Bruce Keogh accepts the calculations that were made in the proposals put forward by the trust special administrator that the plans would be likely to save about 100 lives a year, because they would allow the hospitals in south-east London to move towards the London quality standard, which would mean reducing excess mortality at weekends. Sir Bruce Keogh accepted that, and I accepted his view of it.

[Patrick Mercer (Newark) (Con)]

rose—

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[Heidi Alexander (Lewisham East) (Lab)]

Demand for A and E services at Guy’s and St Thomas’ and at King’s will go through the roof if Lewisham’s full A and E closes. The Secretary of State may claim that he is keeping a smaller A and E at Lewisham, but that is nothing more than dangerous spin. No blue-light ambulances will call at Lewisham under his plans, and even the College of Emergency Medicine says that they do not meet its definition of an emergency department. How on earth can the Secretary of State be so confident that other hospitals in south-east London will be able to cope once he has taken the axe to Lewisham?

[Mr Hunt]

I recognise that the hon. Lady has been campaigning hard for her constituents, but she massively overstates her case. The reality of the proposals is that 25% of the people who go to Lewisham A and E will no longer go there—the most complex cases among her constituents, who will get better treatment as a result. Those 25% will be spread among four other A and E departments, and we are allocating £37 million to help them upgrade their capacity. That is a sensible proposal that will save the lives of her constituents.

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

Local Members of Parliament are right to raise concerns about future capacity at Guy’s and St Thomas’ and at King’s. The recent King’s Fund report showed that between October and December 2012, many A and E departments in England faced their worst winter in almost a decade. Standards of care are deteriorating, with too many people waiting too long to be seen and many being left on trolleys in corridors or waiting in ambulances stuck outside A and E. Does the Secretary of State now accept that the NHS is struggling to cope with the toxic mix of cuts and reorganisation, and that patients in south-east London and elsewhere are paying the price for this Government’s mismanagement of the NHS?

[Mr Hunt]

Really, from a party that closed or downgraded 12 A and E departments when in office, I would expect a slightly more mature attitude to an extremely difficult and complex problem. We will not take any lessons in meeting A and E targets from that lot. The reality is that we met our A and E targets last year, but in Wales, where Labour cut the NHS budget by 8%, they have not met their A and E targets since 2009.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

4. What the reason is for the time taken to produce the Government’s sexual health policy document; and when he now expects it to be published.

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[Mrs Madeleine Moon (Bridgend) (Lab)]

7. What funding his Department has allocated to research into pre-senile dementia.

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

The National Institute for Health Research supports a wide range of research, including a number of studies of pre-senile dementias, more commonly known as early-onset dementias. This includes 85 studies recruiting patients with dementia and a further 17 in the set-up phase.

[Mrs Moon]

I declare an interest.

Dementia in the ageing population is beginning to be better understood and recognised—I appreciate the Government’s efforts on this—but there are also the frontotemporal dementias, such as Pick’s, corticobasal degeneration, Lewy body, progressive supranuclear palsy, Parkinson’s and stroke-related dementias, which are early onset. There is less understanding and awareness of these dementias. I welcome the Government’s commitment to research in this area, but we also need to extend understanding among nurses, general practitioners and care providers. Will the Government ensure that this wider understanding is available and extended?

[Mr Hunt]

I thank the hon. Lady for her interest in early-onset dementia. She is absolutely right: there is a widespread lack of understanding of dementia in general, and of early-onset dementia in particular. In addition to the research that I mentioned in my earlier answer, we are also looking at a major programme to engage GPs. Sadly, some GPs still think that it is not worth diagnosing someone with dementia, and there is a lack of understanding that we absolutely have to put right.

[Jason McCartney (Colne Valley) (Con)]

Government and charitable spending on dementia research is 12 times lower than spending on cancer research, with £590 million a year being spent on cancer research and only £50 million being invested in dementia research. What steps can we all, including the Government, take to increase the amount of investment in dementia research?

[Mr Hunt]

My hon. Friend makes an important point, and he will be pleased to learn that the Government are more than doubling the amount of money that we put into dementia research. We need to catalyse the private sector companies because although they know that the size of their potential market of people with dementia is huge, they have been frustrated in their attempts to find the breakthrough medicine that we urgently need. We need to use the research to excite their interest and keep them focused on this truly tragic disease.

[Julian Sturdy (York Outer) (Con)]

8. What steps his Department plans to take to improve dementia diagnosis rates and to reduce regional variations in such diagnoses.

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

There are unacceptable variations in the level of dementia diagnosis across the country, and we are committed to driving significant improvements. We have asked local areas, through the NHS mandate, to make measurable progress in improving dementia diagnosis over the next two years.

[Julian Sturdy]

In North Yorkshire and York, only 43% of those suffering from dementia receive a diagnosis. Given the ageing population in the county, that means that about 7,000 people with dementia remain undiagnosed. Does my right hon. Friend agree that the clinical commissioning groups have a large role to play in the delivery of dementia services, and will he tell us what support those groups will get?

[Mr Hunt]

My hon. Friend is absolutely right. It is a tragedy for those 7,000 people and their families that they are not getting a diagnosis. With a diagnosis, medicines and drugs could have a big impact and stave off the condition for between one in three and one in four people, and support services could also be put in place for carers. We need a massive transformation, and we need to make it much easier for people to get a diagnosis. We need much better understanding among GPs, as I mentioned earlier, and among hospitals as well, given that 25% of all in-patients have dementia.

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[Henry Smith (Crawley) (Con)]

13. What steps he has taken to support research on the most common causes of premature mortality.

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

We are still far too low in the European league tables for premature mortality, particularly in respect of cancer, liver disease and respiratory diseases. I have therefore made improving our performance a key priority.

[Henry Smith]

Can the Minister say a little more about what is being done to prevent early mortality as a result of heart disease?

[Mr Hunt]

We are investing £34 million in cardiovascular research. Much excellent work is being done at, in particular, the Oxford Biomedical Research Centre, which will help us to make great strides.

[Mr John Baron (Basildon and Billericay) (Con)]

19. It is widely accepted that late diagnosis of cancer makes for premature mortality. Will the Government recommend the inclusion of proxy measures such as staging and accident and emergency admissions in the outcomes indicator set, as a way of complementing the one and five-year survival measures? That would give us a more complete picture of how CCGs are performing in encouraging earlier diagnosis.

[Mr Hunt]

I congratulate my hon. Friend on his campaigning. No sooner do we agree to the inclusion of one indicator in relation to early cancer diagnosis than he finds another that should also be included.

I will certainly consider the issue that my hon. Friend has raised, but I think that there is a broader question about the role of GPs. They should see themselves as being in the front line when it comes to early diagnosis of not just people who walk through the doors of their surgeries, but people in their communities who are at high risk. That is a much more fundamental change that we need to think about.

[Paul Blomfield (Sheffield Central) (Lab)]

14. What was the change in the level of spending in real terms on adult mental health services in 2011-12.

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[Alun Cairns (Vale of Glamorgan) (Con)]

15. What recent estimate he has made of the potential savings to the NHS of making better use of technology.

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

PricewaterhouseCoopers estimates that the NHS could save £4.4 billion every year through proper investment in IT, which is one of the reasons I set the NHS the challenge of becoming fully paperless by 2018.

[Alun Cairns]

I am grateful to the Secretary of State for his answer, but can he assure me that investment in new technology will release resources for patient care, rather than follow the pattern over the past 15 years, when investment in new technology has detracted from the available resources?

[Mr Hunt]

My hon. Friend makes an important point. In encouraging such investment, we are thinking about the nurse who recently reported that in order to admit someone to trauma she had to fill out a 22-page admission form and another 10 forms after that. The whole point of this move is to free up the time of professionals on the front line so that they can spend more time with patients.

[Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)]

The Secretary of State will be aware that the general practice extraction service contract has recently been awarded to French IT firm Atos Healthcare. Given the concerns expressed by the Public Accounts Committee and the National Audit Office about the way in which Atos has performed in respect of other contracts let by the Government, what has the Secretary of State got in mind to ensure that there are safeguards for patient data under the general practice extraction service contract?

[Mr Hunt]

With respect to all IT contracts, all I will say is that we have learned a great deal from the mistakes made by the previous Government.

[Ms Margaret Ritchie (South Down) (SDLP)]

T1. If he will make a statement on his departmental responsibilities.

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

The last month has seen the Government take two radical steps that will fundamentally improve the quality of health care in this country. First, in our response to the Francis report on the appalling tragedy at Mid Staffs, we announced the setting up of a chief inspectorate of hospitals based at the Care Quality Commission. That will introduce compassionate care, patient feedback and expert peer review into a system that has been too long dominated by targets and box-ticking. Secondly, in response to the Dilnot report, the Government announced a long-term solution to the funding of social care, which will both help thousands of low-income pensioners avoid having to sell their homes and make us one of the first countries in the world where it is as normal to save for social care costs as it is to save for a pension.

[Ms Ritchie]

This week I will meet my constituents Neal and Rita Denvir, whose son, Fionn, made a miraculous recovery from meningitis. Many are not so fortunate, however, so will the Secretary of State pledge his support to the Meningitis UK “Beat it now” campaign, and include the newly licensed vaccine for meningitis B in the NHS childhood immunisation programme, so that no family has to live with the terror of that terrifying disease?

[Mr Hunt]

As the father of two young children, I completely share the hon. Lady’s passion for this issue and I am happy to give my support to Meningitis UK. The decision on whether to include a meningitis jab in the immunisation campaign is made by an independent expert panel, and I will always follow its advice.

[Nick Herbert (Arundel and South Downs) (Con)]

T2. We used to believe that tuberculosis was beaten in this country, but the number of instances of it is increasing, and there were more than 9,000 new cases last year. Does that not suggest, particularly when the incidence of drug-resistant TB is a concern, that a comprehensive public health strategy is needed to tackle the disease? What steps is the Department taking to lead that strategy?

[Andy Burnham (Leigh) (Lab)]

I am sure that, like me, the Secretary of State has spent recent weeks absorbing the Francis report and its recommendations; there are lessons for everyone at every level, particularly on staffing. New analysis to be published later today will show that the NHS is set to lose 12,000 nurses over the course of this Parliament, raising doubts about its ability to respond to Robert Francis’s recommendations on staffing. Will the Government say today whether they accept those recommendations and the principle of a minimum staff-to-patient ratio?

[Mr Jeremy Hunt]

If the right hon. Gentleman had read the Francis report carefully he would have, first, observed that the appalling tragedies covered in that report happened between 2005 and 2009, when nursing numbers were going up. So to say that this is an issue about nursing numbers is to miss the point completely. This is not an issue where there is a quick fix; it is an issue about the NHS having become dominated for far too long by a culture of targets at any cost. Unpicking that culture is the biggest challenge we face if we are to return a culture of compassionate care to the NHS.

[Andy Burnham]

I have read both Francis reports, and I think it is essential that everybody learns the lessons—that is what I said—including Labour Members. It is also important that we do not repeat the mistakes, and the first Francis report said that the problems were caused because the trust cut staff to dangerously low levels. The most worrying thing from the analysis that will be published today is that four in 10 of the jobs being lost come directly from services linked to the care of older people. Does the Secretary of State therefore agree that there is a danger that the NHS is already failing to learn the lessons of the recent past? Will he join me in sending a message to the NHS that care of older people should be a priority for improvement, not an easy target for cuts?

[Mr Hunt]

If we are to learn the lessons of the Francis report and admit to our mistakes, perhaps the right hon. Gentleman will reflect on the fact that, because we decided to protect the NHS budget, there are 8,000 more clinical staff in the NHS today, yet he still wants to cut the NHS budget from its current levels, as he confirmed only last December.

[Mr Christopher Chope (Christchurch) (Con)]

T3. In today’s edition of the Daily Express, the Prime Minister promises to prevent immigrants freeloading on our NHS. Words are one thing, but can the Secretary of State spell out exactly what actions will be taken to deliver on the Prime Minister’s pledge?

[Mr Jeremy Hunt]

I am happy to confirm to my hon. Friend that we intend to take some profound steps in this area, because we have a national health service, not an international health service. We have to ask whether it is appropriate for us to be giving free health care to short-term visitors, to students, to people on temporary visas. We will be saying more about that issue shortly.

[Paul Blomfield (Sheffield Central) (Lab)]

T6. On 13 March 2012, the former Secretary of State said of the Health and Social Care Bill:“There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector.”—[Official Report, 13 March 2012; Vol. 542, c. 169.]However, the new NHS competition regulations break those promises by creating a requirement for almost all commissioning to be carried out through competitive markets, forcing privatisation through the back door, regardless of local will. Will the Secretary of State agree to make the regulations subject to a full debate and vote of both Houses?

[Mr Jeremy Hunt]

If the hon. Gentleman had listened to my previous answer, he would have heard that the regulations are consistent with the procurement guidelines that his own Government sent out to PCTs. It is not our job to be a champion for the private sector or the NHS sector; we want to be there to do the best job for patients. That is the purpose of the regulations.

[Tessa Munt (Wells) (LD)]

T4. Two years ago, the Prime Minister welcomed the installation of CyberKnife, the latest in cancer radio surgery equipment at the world-leading Royal Marsden cancer centre, as an example of how the NHS has progressed. Since then, the Royal Marsden has invited successive Health Ministers to visit the cancer centre but no one has accepted the invitation, and I am aware that Ministers have been to see other cancer treatment systems. Will the Secretary of State follow the Prime Minister’s lead and visit the Royal Marsden to see for himself the great progress that has been made there?

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[Mr Andy Slaughter (Hammersmith) (Lab)]

Last week’s decision to close four north-west London A and Es, including Charing Cross and Hammersmith in my constituency, will shortly be on the Secretary of State’s desk, as he predicts. It was referred by Labour Ealing council because Tory Hammersmith and Fulham council supports the closures. Will the Secretary of State refer the matter for independent review? This is the biggest hospital closure programme in the history of the NHS. It will see a world-class hospital downgraded to 3% of its size.

[Mr Jeremy Hunt]

I am aware how concerned people are throughout north-west London about the proposals. If the matter is referred to me by Ealing council, I will indeed ask the independent reconfiguration panel for its independent view on the proposals.

[Mr John Baron (Basildon and Billericay) (Con)]

T9. The cancer drugs fund has been a huge success and has helped up to 25,000 patients, but the negotiations between the Government and the pharmaceutical companies on its replacement—value-based pricing—is causing real uncertainty for cancer patients and clinicians alike. For example, will new medicines be available to new patients under the new system and what guidance is being given to local cancer drugs funds as they wind down? Can we please have clarity urgently?