Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 26th November 2013 Commons Chamber

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

2. What steps he is taking to ensure that compassionate care is at the heart of the NHS.

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

Last week, we published a full response to the Mid-Staffs public inquiry and set out our ambition to transform the quality of compassionate care in the NHS. We have already put in place a robust new inspection regime and measures to make it easier for doctors and nurses to speak out when they are concerned about standards of care or safety.

[Alec Shelbrooke]

Compassionate care goes right through from surgeons to GPs. Will my right hon. Friend comment on evidence that epileptic women of child-bearing age are not being shown the compassion necessary during pregnancy from their GPs or neurologists and are not having the risks of taking their epilepsy medication outlined to them? To date, such medication has caused more than 20,000 birth defects.

[Mr Hunt]

I thank my hon. Friend for highlighting this important issue. The Medicines and Healthcare products Regulatory Agency regularly reviews the evidence relating to anti-epileptic drug use, particularly sodium valproate products, and we check what information is available to doctors so that it can be passed on to patients. I am concerned about the issue my hon. Friend raises, so I have asked NHS England’s national director of patient safety, Dr Mike Durkin, to look into it carefully and get back to me.

[Nick Smith (Blaenau Gwent) (Lab)]

New York has raised the age for buying tobacco products to 21. As a public health care policy, has the Department considered that matter?

[Mr Hunt]

As the hon. Gentleman will know, we are constantly reviewing all policies that could reduce tobacco use among young people. Smoking is the No. 1 killer, so dealing with it would be the best way of reducing this country’s premature mortality rates, which are far too high.

[Jonathan Lord (Woking) (Con)]

23. Does the Secretary of State agree that transparency is critical in improving hospital standards and that, following the Government’s latest measures in response to the Francis report, the health cover-ups by the previous Government will never be allowed to happen again?

[Mr Hunt]

The Labour party does not like to hear this, but the reality is that micro-managing the NHS through top-down targets failed to deal with the problems of compassionate care. My hon. Friend is absolutely right that the best way to deal with this is through total transparency, so that when we are sure there is a problem, the public find out about it quickly and it is dealt with quickly.

[Jim Shannon (Strangford) (DUP)]

Compassionate care must be central to the NHS. The Health Minister in Northern Ireland has launched “Quality 2020”, a strategy that is intended to improve care in Northern Ireland. What discussions has the Secretary of State had with the Northern Ireland Assembly and the Health Minister about this issue?

[Mr Hunt]

We are in close touch with all the devolved Administrations about the changes that we are making in the NHS in England, and, interestingly, we are experiencing different levels of engagement. We have had very good discussions with the Northern Ireland Health Minister about some of the changes, but those in Wales are still refusing to commission a Keogh report on excess deaths, which I think shows that Labour in Wales has not learnt the lessons of transparency.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

3. What steps he is taking to train and retain more accident and emergency health specialists in the UK.

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

I have asked Health Education England to consider how we can improve the structure and skill mix of the emergency medicine work force to deal with long-standing shortages in staff at both consultant and trainee levels. Along with the Emergency Medicine Taskforce, we are considering a number of options, such as increasing the non-doctor work force and the number of emergency nurse practitioners.

[Mr Sheerman]

Just what is going on in medical education in this country? We train doctors, but some never work as doctors, and others move abroad. Calderdale and Huddersfield NHS Foundation Trust has advertised and advertised again, but it cannot recruit accident and emergency staff. It certainly cannot recruit any who have been trained in this country, or who have been trained in paediatrics. What is going wrong with medical education here?

[Mr Hunt]

The hon. Gentleman has raised some important issues. We do face big challenges. We have increased the number of doctors in the NHS by 6,600 over the last three years, but it is still very difficult to attract as many people as we need to disciplines such as A and E.

I know that Calderdale and Huddersfield NHS Foundation Trust is especially concerned about A and E staffing. I had a very good meeting with representatives of the College of Emergency Medicine last week to discuss A and E consultants’ terms and conditions and, in particular, their antisocial working hours. We are giving the matter close consideration, but I agree with the hon. Gentleman that we need to do better in this regard.

[Mr Philip Hollobone (Kettering) (Con)]

While it is important to recruit and retain more A and E specialists, part of the problem is that a third of the patients who are dealt with in A and E departments could receive better treatment closer to their homes. What can the Secretary of State do to encourage that?

[Mr Hunt]

My hon. Friend is absolutely right. One of the biggest mistakes made in health care over the past decade was the introduction of the disastrous changes in the GP contract in 2004, which broke the personal link between GPs and their patients. Hard-pressed A and E departments, including the one at Kettering hospital, say that one of the things that will make the biggest difference to them is the provision of a named GP for the over-75s, so that they know that someone is responsible for those people when they are not in hospital.

[Fiona Mactaggart (Slough) (Lab)]

Is it not the chaotic and overstretched nature of many A and E departments that makes A and E an unattractive discipline for people to work in? Ever since the closure of the A and E department at Wycombe general hospital in my constituency, Wexham Park hospital has been unable to cope. What will the Secretary of State do about that?

[Mr Hunt]

We have gained more than 600 additional A and E doctors over the last three years, so the numbers are rising. However, the best thing that we can do for A and E staff is to give them a sense that we are addressing the long-term challenges that they face. The issues of integration with social care and delayed discharges are being addressed through the health and social care integration transformation fund, but we must also ensure that there are better primary care alternatives. The named GP for the over-75s will make a big difference in that regard.

[Margot James (Stourbridge) (Con)]

My local hospital, Russells Hall, is experiencing considerable difficulty in recruiting A and E consultants. Would not a good alternative approach be to train more paramedics to serve on ambulances and provide more effective and robust triage at emergency centres, so that patients can be redirected when necessary?

[Mr Hunt]

As ever, my hon. Friend speaks very wisely about this subject. In his review of A and E services, which was published a couple of weeks ago, Professor Keogh said that paramedics could deal with 50% of 999 calls on the spot, without taking people to hospital. I think that there is a big role for ambulance services that are prepared to upskill. It is also important for us to ensure that they have the necessary information. One of the main changes that we intend to make next year will ensure that they have access to the GP records of the people whom they pick up, so that they can give those people the care that they need in their own homes.

[Mr Jamie Reed (Copeland) (Lab)]

The president of the College of Emergency Medicine has said that the Government’s reorganisation has made A and E recruitment worse; the chief executive of the NHS Confederation has said that A and E pressures have been compounded by three years of structural reforms; yesterday, we learnt that the number of nurses choosing to leave their profession had jumped by more than one quarter under this Government; and the Health Secretary himself admits he is worried by the fall in nurse numbers on this Prime Minister’s watch. I hope he listens carefully so that he can answer precisely: will he today give the House a guarantee that every A and E in the country will have enough nurses this winter?

[Mr Hunt]

Will the hon. Gentleman think about what he has said? He said he was against a reorganisation that got rid of 8,000 managers and put 6,600 doctors on to the front line. That is why we are doing nearly a million more operations every year and why waiting times for longer waits are shorter than they were under Labour. We are recruiting more doctors because we are putting money into the front line.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

It takes seven years to train a doctor, but, for whatever reason, the new GP contract is looking to end seniority pay in six years. Is my right hon. Friend not concerned that that will lead to a mass retirement of doctors at the end of that six-year period in 2020?

[Mr Hunt]

We have to make the GP profession attractive to younger GPs as well. The money we save from getting rid of seniority pay will go back into practices, but it should not be given to people just for length of service; it should be related to quality of service too, which will make the GP profession much more attractive.

[Rosie Cooper (West Lancashire) (Lab)]

5. What recent assessment he has made of ambulance handover times at accident and emergency departments.

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[Nick de Bois (Enfield North) (Con)]

17. What progress his Department has made on improving out-of-hospital care for frail elderly people.

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

Improving the quality of out-of-hospital care is the biggest strategic long-term change that we need to make in the NHS. It will help to make the NHS sustainable. Reforming the GP contract is the first step, but we also need to make major progress on integrating the health and social care systems.

[Mark Menzies]

I welcome the Government’s announcement of named GPs for older people. What does the Secretary of State envisage that will mean for my older constituents?

[Mr Hunt]

My hon. Friend is not the only person to welcome that change. After months of telling the House that this was nothing to do with the A and E problems, the shadow Health Secretary said on the “Today” programme that he welcomed the change and that it would make a difference to A and E. So I welcome the return of the prodigal son with great pride and pleasure. For my hon. Friend’s constituents, this will mean that there will be someone in the NHS who is responsible for ensuring that they get the care package that they need. That is incredibly important, because when people are discharged from hospitals, the hospitals worry about whose care they will be under. This change will provide that crucial link and make a real difference.

[Sir Tony Baldry]

Does my right hon. Friend agree that the 2004 GP contract did enormous damage to the relationship between GPs and their patients, and that the recent changes agreed with GPs should ensure much more proactive care of our most vulnerable constituents and ease pressure on A and E departments?

[Mr Hunt]

I agree with my hon. Friend, and I am pleased that the shadow Health Secretary also agrees with him in welcoming the reversal of that disastrous contract. The personal relationship between doctor and patient is at the heart of what the NHS stands for, and at the heart of that is a responsibility to ensure that people get the care they need. That is what we need to get back, and I think that the change will make a big difference to my hon. Friend’s constituents.

[Nick de Bois]

Enfield CCG is working closely with Enfield council to try to deliver integrated health and social care, particularly for the elderly and the frail. Noting our higher-than-average elderly age demographic in the borough, will the Secretary of State take steps to ensure that those efforts are supported with extra funding?

[Mr Hunt]

My hon. Friend knows that the funding arrangements are decided independently of the Government, by NHS England, which will make its decision at a board meeting before Christmas. He is absolutely right to suggest that the funding formula should reflect not only social deprivation but the age profile of constituents, because the oldest people are of course the heaviest users of the NHS.

[Liz Kendall (Leicester West) (Lab)]

The Health Secretary claims that he wants the NHS to be the best in the world at looking after the elderly. Nice rhetoric, but the reality is that we now have the highest-ever number of elderly people trapped in hospitals because they cannot get the health and social care they need at home. We now have the equivalent of five hospitals full of elderly people who do not want to be there, and that is costing the taxpayer £20 million a month. Is not the truth that care of the elderly is getting worse, not better, on his watch?

[Mr Hunt]

The truth is that the previous Government had 13 years to integrate the health and social care systems, but they failed. We are doing that, and we are also providing named GPs to the most vulnerable people, so that, hopefully, they do not have to go to hospital in the first place. That is doing a lot more for older people than the hon. Lady’s Government ever did.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my right hon. Friend agree that successive Governments over 30 years have talked about the importance of joining up the different bits of the health care system and joining that up with social care? Is not the difference between this Government and their predecessors that, through health and wellbeing boards, the integrated care fund, named GPs and the pioneers programme that he has announced, this Government are actually doing it, rather than just talking about it?

[Mr Hunt]

I have to pay tribute to my right hon. Friend, because he has been talking about the integration of health and social care for a lot longer than I have, and he is absolutely right. I would add to his list one other really important thing we are doing: we are making sure that whatever part of the system someone is in, doctors can access their GP medical record—with their permission—because that information is vital in showing their allergies, medical history and previous admissions. Breaking down the barriers that prevent that from happening is one of the things that has not been picked up but is in the GP contract.

[Graham Evans (Weaver Vale) (Con)]

7. What steps his Department has taken to ease the short and long-term impact of winter pressures on NHS services.

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

In the short term, a record £400 million has been assigned to help the NHS cope with winter pressures this winter, with £250 million announced in August—much earlier than before. For the long term, we will provide better out-of-hospital care for the frail elderly, by restoring the link between GPs and older patients, and looking to integrate the health and social care systems.

[Graham Evans]

Will my right hon. Friend join me in praising the outstanding work of Age UK and, in particular, Age UK Cheshire, which serves my constituency? It is raising older people’s awareness of seasonal impacts on health and offering support to prevent unnecessary pressures on the health service.

[Mr Hunt]

I am delighted to do that. As these are the last Health questions before Christmas, all of us would want to pay tribute to the voluntary organisations that do an extraordinary job of making sure that vulnerable older people do not get lonely over the Christmas period. It is heroic what they do—when we are with our families, they are looking after other people—and we should salute them all.

[Valerie Vaz (Walsall South) (Lab)]

22. One way to ease the pressure on the NHS is by not handing the £2.2 billion underspend back to the Treasury. Will the Secretary of State consider using it for the NHS?

[Mr Hunt]

I wish the hon. Lady had been as diligent in asking that question of Labour Ministers, who also handed back underspends to the Treasury when they were in power.

[Steve Baker (Wycombe) (Con)]

Along with county colleagues, I wrote to the Secretary of State on this subject, because Buckinghamshire Healthcare NHS Trust is relatively underfunded compared with the rest of the country and it is in special measures following the Keogh review. Further to the answer that he gave to the earlier question, when can we expect the NHS England funding settlement to reflect more equitably the age of the public?

[Mr Hunt]

I commend my hon. Friend for the campaigning he does for high standards in his local trust. That has not been easy because, as he says, there have been a lot of problems there, although I hope he thinks that we are beginning to turn a corner. The decision on the funding allocations will be made by NHS England before Christmas, and the things that he says will, of course, be taken into account.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Yesterday we learned that the number of people suffering from hypothermia has soared by almost 40% on this Government’s watch. This morning the Office for National Statistics revealed that the number of older and vulnerable people who died unnecessarily last winter jumped by 29%. For every person who tragically loses their life over the winter months, eight more are admitted to hospital, putting huge strains on our crisis-ridden accident and emergency services. Will the Secretary of State please tell us what he is going to do about it?

[Mr Hunt]

I do not think I have yet answered a question across the Dispatch Box from the hon. Lady, so I welcome her to her post. I just say that she should be careful what she chooses to turn into a political football, because hypothermia admissions, as Public Health England said in August, are very closely linked to the number of cold days over a winter and the length of that winter. We had a particularly difficult winter last year, but the number of winter deaths was nearly 20% higher under the previous Government, when the right hon. Member for Leigh (Andy Burnham) was Health Secretary.

[Mrs Mary Glindon (North Tyneside) (Lab)]

8. What assessment he has made of the effects of social care budget changes on attendances at accident and emergency departments.

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[Simon Danczuk (Rochdale) (Lab)]

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

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

I need to correct the record. In the House on 30 October, I said that it took 21 minutes longer for the average person to be seen in A and E under the previous Government—a figure that was repeated by the Prime Minister in Prime Minister’s questions. My Department made a statistical mistake: it turns out that under Labour, the average person took not 21 but 44 minutes longer to be seen. I apologise for underestimating the improvements made under this Government.

[Simon Danczuk]

When people have mental health problems, waiting too long for talking therapies can lead to poor recovery, relationships falling apart, and job loss. What progress has the Minister made in establishing and delivering maximum waiting times for talking therapies?

[Mr Hunt]

The hon. Gentleman is absolutely right: this is a big priority for the Government. We are a big fan of talking therapies. We have taken huge strides in improving take-up, but there is still a long way to go, and we are looking at introducing access standards, so that there is a maximum time beyond which no one has to wait.

[John Pugh (Southport) (LD)]

T3. What measurable progress is being made in improving data sharing, not just between hospitals and general practitioners, but between the NHS and social services, to avoid bureaucracy and additional cost?

[Mr Hunt]

My hon. Friend has taken a great interest in this topic, and he is absolutely right to do so, because if we are to give integrated, joined-up care, in which people deal with NHS professionals who know about them, their medical history, their allergies and all the other important things, it is vital that, if they give their consent, their medical record can be accessed. That needs to be from GP surgery to hospital to social care system. Under the named GP policy that we have announced, there is a big opportunity for care homes to access GP records and keep them updated daily, so that GPs are kept in daily contact with how some of the most vulnerable people are doing.

[Andy Burnham (Leigh) (Lab)]

Today I want to put to the Secretary of State new evidence that the A and E crisis is deepening, and having a serious knock-on effect on ambulance services. Information from police forces reveals that cases in which police cars have to ferry patients to A and E are far more widespread than people realise; in some areas, it happens on a daily basis. One ambulance service is now using retained firefighters to attend calls, and—this is how bad things have got—another ambulance service has seen a 350% increase in the number of 999 calls attended by taxis. Does the Secretary of State think that it is ever acceptable that when a patient dials 999, a taxi turns up?

[Mr Hunt]

I am afraid that that is utterly irresponsible. We are hitting our A and E target, and we are hitting our ambulance standard. When the right hon. Gentleman was Health Secretary he missed the ambulance standard for October, November, December and January. He is trying to talk up a crisis that is not happening. He should think about people on the front line and, just for once, put patients before politics.

[Andy Burnham]

The country will have heard the complacency from the Secretary of State. He needs to explain why he spent Friday afternoon making panicked phone calls to hospitals up and down the country that were missing their A and E target. He did not condemn the use of taxis, which is unacceptable but is happening on his watch because ambulances are trapped at A and E, unable to hand over patients. That means that 999 response times have got worse and large swathes of the country, right now, are without adequate ambulance cover. Is it not time that the Secretary of State was honest with the public and admitted the scale of the crisis facing the NHS this winter, and took action now to prevent it from engulfing other emergency services?

[Mr Hunt]

We will take no lessons in complacency from the party that did so little to sort out excess deaths in hospitals such as Mid Staffordshire, Morecambe bay, Basildon and Colchester, and many other hospitals. The truth is that, compared with when he was Health Secretary, we see nearly 2,000 more people every single day within the four-hour standard. We are doing much, much better: we have more A and E doctors, and the NHS is doing extremely well. I know that for him it is always politics first and patients second but, for once, he should be responsible and think about the people on the front line.

[Neil Carmichael (Stroud) (Con)]

T4. In contrast to the previous Government’s lack of focus, what have this Government done about hospital infection control, with particular reference to data management systems?

[Rosie Cooper (West Lancashire) (Lab)]

T2. Following Francis and Keogh, and in creating a more open and accountable NHS, will the Secretary of State, in the spirit of total transparency that he favours, order foundation trusts to publish all their board papers, have exactly the same publishing requirements as non-FTs, and hold all their board meetings in public?

[Mr Jeremy Hunt]

I absolutely encourage that transparency. In fairness, the hon. Lady will accept that this Government have done more to improve transparency in the NHS than any Government have ever done. I would encourage all FTs to be transparent about their board meetings, but they are independent organisations, and we have learned—[Interruption.] Well, this was legislation that her Government introduced, and we have learned that it is important to give people autonomy and independence, because they deliver a better service for patients.

[Dr Julian Huppert (Cambridge) (LD)]

T6. Cambridgeshire and Peterborough clinical commissioning group receives one of the lowest amounts of funding per head in the country. The Government’s own fair shares formula, which takes account of factors such as population, age and deprivation, says that we should have £46.5 million more each year. I know that it is not his decision, but does the Minister think that the new formula should be implemented?

[Caroline Lucas (Brighton, Pavilion) (Green)]

T5. The last time I asked the Secretary of State about the £30 million-worth of cuts forced on hospitals in Brighton and Sussex, he said that it was all down to local discretion. Does he admit that behind his rhetoric about protecting the NHS budget there still lies a real 4% cut to the centrally dictated national tariff? Does he acknowledge, therefore, that hard-working nurses and doctors have to do more with less money while patients suffer? Will he reverse those cuts?

[Mr Jeremy Hunt]

Can I explain to the hon. Lady that the reason for the 4% efficiency savings is that, although we protected the budget in real terms, demand for NHS services has gone up by 4% year in, year out, so we need to find those efficiencies? Within that, it is incredibly important that we do not make false economies in relation to the number of nursing staff, which is why last week’s announcement on our response to the Francis report will make a big difference, and we have already begun to see more nurses.

[Jonathan Evans (Cardiff North) (Con)]

T7. Given the more than 30% increase in the past five years in the cost to the NHS of prescribing stoma appliances, what action is the Minister taking to promote training for stoma patients in alternative management techniques, such as colostomy irrigation?

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[John Healey (Wentworth and Dearne) (Lab)]

The European Union has just agreed a trade deal with Canada that excludes health care, so will the Secretary of State ensure that the proposed EU trade and investment agreement with the US also excludes health care?

[Mr Jeremy Hunt]

We are looking at that very closely. We are big supporters of having a free trade deal between the EU and the US, but we do not want to do anything that would affect the fundamental principles, values and practices of the NHS.

[Stuart Andrew (Pudsey) (Con)]

The new review into children’s heart units feels very different, and I am pleased that everything is on the table. However, I was concerned to learn that the task and finish group has decided to meet in private. Given the group’s importance in decision making, and remembering the experience of the Safe and Sustainable review, does my hon. Friend agree that, in the interests of openness and confidence, the group should meet in public?

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[Karen Lumley (Redditch) (Con)]

In the past two weeks I have had to visit accident and emergency units in Redditch and in north Wales, unfortunately with members of my family. Although health is a devolved matter in Wales, will my right hon. Friend the Secretary of State invite his counterpart in Wales to spend some time at the great A and E unit in Redditch to see for himself the stark differences between the two services?

[Mr Jeremy Hunt]

I would be delighted to do so. He will see the impact of not cutting the NHS by 8%, which is what Labour has done in Wales, which means that in this country we are hitting our A and E targets and in Wales they have not hit them since 2009.

[Mr Speaker]

I am sorry to disappoint colleagues, but we must move on. Demand usually outstrips supply.