Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Adam Holloway (Gravesham) (Con)]

1. What progress his Department has made on improving primary care for frail older people.

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

It is a particular pleasure to be here this morning, although I appreciate that that feeling may not be reciprocated on all sides of the House.

Our NHS will not be sustainable unless we totally transform out-of-hospital care. That is why we have introduced the £3.9 billion merger of the health and social care systems, and reforms to the GP contract. We are encouraging clinical commissioners to be responsible for all out-of-hospital commissioning.

[Mr Holloway]

I am delighted that my right hon. Friend is answering questions today. Will he confirm that the changes announced will mean that frail elderly patients in Gravesham will have a single person to co-ordinate their care?

[Mr Hunt]

There is agreement across the House that we need a focus on frail elderly patients and a system in which everybody knows, for their mum, dad or grandparents, that there is someone in the NHS where the buck stops in relation to complex, long-term conditions. That is a condition of the better care fund, so I hope that that will make a big difference in my hon. Friend’s constituency.

[Alison McGovern (Wirral South) (Lab)]

The Secretary of State mentioned integration. Good care and support for older people in their own homes are vital, yet a constituent visited me recently to say that she simply could not find a decent trustworthy care company to look after her relative. Will the Secretary of State join me in calling for all local authorities to sign up to the ethical care charter?

[Mr Hunt]

I do not know what the charter says, but I am happy to have a look at it. I agree with the hon. Lady’s sentiments. The important change we need to make is to understand that it is a false economy not to look after people who are vulnerable—those who need help washing, getting out of bed and feeding every day. Scrimping on such care is incredibly dangerous: it costs the NHS more, but most of all it means that those people are not treated with the dignity and respect that they should be.

[Greg Mulholland (Leeds North West) (LD)]

A recent Age UK report shows that older people are many times more likely to be moved multiple times in hospital, and that there is an attitude that they should not be using up hospital beds. What does my right hon. Friend suggest to tackle the problem, for example through improved guidance?

[Mr Hunt]

The attitude to which my hon. Friend refers is totally unacceptable. It is not specifically an NHS problem; we need to change the way of thinking across our society. In particular, I worry about people with dementia who are sometimes in hospital wards where they are not able to speak up for themselves. That is why we have introduced probably the toughest inspection regime of any hospital system anywhere in the world, and I hope it will make a real difference.

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

In view of the fact that there are currently 10 million people in the UK over 65, and the latest projections are for a further 5.5 million elderly people in 20 years’ time, what plans have the Government made to allocate and prioritise resources for the future care of older people with complex needs?

[Mr Hunt]

The hon. Lady is absolutely right. The figure always in my mind is that by the end of the next Parliament we will have more than 1 million additional over-70s. We need to totally change the way we look after those people, through the single point of contact and a different attitude to continuity of care. One of the things that matters most to those people is the feeling that there is someone in the NHS who knows about their particular needs, their family and their carers. That is the big challenge for the NHS in the next few years.

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

The Health Secretary does not seem to realise that continuity of care is actually getting worse under him. The GP patient survey shows that the proportion of people who cannot regularly see their preferred GP has risen from 34% in 2012 to 39% in 2014, an increase equivalent to 1.2 million people. Experts say that that is one of the reasons why A and E is under so much pressure. Will he confirm that on Friday it will be precisely one year since hospital A and E departments last met his Government’s own A and E target?

[Mr Hunt]

What I will confirm is that the worst possible thing for continuity of care was Labour’s scrapping of named GPs in 2004. The single thing that makes the biggest difference is to have, for every frail and elderly person in our NHS, someone who is responsible. That is what we are bringing back.

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[Sir Edward Leigh (Gainsborough) (Con)]

5. What steps he plans to take to improve standards in general practice.

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

We are working hard to improve standards of care in general practice. We have brought back named GPs for those aged 75 and over, introduced a new inspection regime and are doing everything we can to recruit more GPs to improve capacity.

[Sir Edward Leigh]

When will both political parties be honest about the massive looming black hole in health funding, with an ageing population demanding ever better care? We cannot afford to pay for it out of general taxation, so are we going to be honest and have an open debate about moving to the French system of social insurance in which people are charged and repaid if they do not have the means, giving them an infinitely better health service?

[Mr Hunt]

I do not agree with my hon. Friend; let me explain why. The first and important point is that independent studies, such as that which was done last month by the Commonwealth Fund, have ranked the NHS top out of 11 major health economies, including the French example. Money is, of course, tight throughout the NHS, but we have been able to find efficiency savings of £20 billion over the last five years, and we will continue to find them. What I would not support, however, is any system of charging that would make it harder to access NHS services, particularly for older people whom we need to access more services more quickly if the NHS is to be sustainable.

[Lucy Powell (Manchester Central) (Lab/Co-op)]

Let me reassure the Secretary of State that Opposition Members are pleased to see him still in his post today, but if I were him, I would not take that as a compliment. On GP access, what is he actually doing? Survey after survey shows that patient satisfaction with access to their GP is getting worse and worse. That has been borne out in my constituency surgery in a significant number of cases. One constituent recently came to see me who had been discharged from hospital with significant care needs and he was told that he would have to wait three and a half weeks to see his GP. What is the Secretary of State actually doing about it?

[Mr Hunt]

I am delighted that the hon. Lady is delighted that I am in my position here today—we can all be delighted about that wonderful piece of news. Let me tell her that we are doing a lot to improve access to GPs. We have recruited 1,000 more GPs over the course of this Parliament. Let me gently say to her that we can afford those 1,000 GPs only because we pushed on with difficult reforms, getting rid of the PCT bureaucracy and removing 19,000 managers. We would not have been able to afford them if we had listened to her party and continued to spend money on bureaucracy and management.

[Mr Philip Hollobone (Kettering) (Con)]

In every area, there are some very good GPs and some less good ones. How does my right hon. Friend think that clinical commissioning groups should celebrate those GPs who go the extra mile and provide an example for others to follow?

[Mr Hunt]

My hon. Friend has made a very good point. We have learnt from the big efforts to improve standards of care in hospitals—of which I think everyone in the House should be proud—that the best way in which to improve those standards is to be transparent about how well people are doing. What the new chief inspector of hospitals has done is identify not just the failing hospitals that have been put into special measures, but the good and outstanding hospitals, so that they know what they should and can aspire to. I think that we shall hear shortly how the chief inspector of general practice intends to implement the same regime in general practice.

[Mr Speaker]

Order. If the right hon. Gentleman would face the House, it would greatly avail us. I understand the natural temptation to look backwards—[Laughter.]—as in, behind him! But he must face the House.

[Mr Jamie Reed (Copeland) (Lab)]

On 20 June, I wrote to the Secretary of State informing him of the claims of doctors in Cumbria that unless drastic action were taken to reduce the pressures on GPs’ work loads, patients could die. I have not even received a response. Why, having being given such a stark warning, is the Secretary of State sitting on his hands? There are fewer GPs today than there were during Labour’s last year in office. How can standards in general practice be improved when surgeries are dealing with a recruitment crisis?

[Mr Hunt]

Let me give the hon. Gentleman his answer now. According to the Royal College of General Practitioners, 40 million more appointments with GPs are being made in every single year than were made when Labour was in office, and we have 1,000 more GPs than we had when his party was in power.

Let me say very clearly that the way in which we will deal with this problem is by increasing the capacity of general practice and the capacity of primary care. The hon. Gentleman should be supporting that—and he might just think about the 48-hour target that Labour has been talking about. If a new target for GPs is introduced, they will simply cut the amount of time that is available for them to deal with the most frail and vulnerable patients, and that would be wrong.

[Sir Tony Baldry (Banbury) (Con)]

6. What steps his Department is taking to support carers.

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[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

11. What progress his Department is making on improving the performance of failing hospitals.

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

The new special measures regime for failing hospitals is designed to introduce honesty and transparency for hospitals in difficulty. The new chief inspector of hospitals will report later this week on progress in the first year. I am sure that the whole House will welcome the fact that the new regime has made really encouraging progress.

[Gordon Henderson]

Medway NHS Foundation Trust is not in my constituency, but is used by many of my constituents. It was announced last week that Medway is to remain in special measures because of the inadequacies of its A and E department. What steps can my right hon. Friend take to ensure that Medway receives the help needed to improve the service it provides to my constituents?

[Mr Hunt]

I thank my hon. Friend for his question. He is right that the chief inspector raised concerns about some issues that persist at Medway. It is important to praise the staff for the progress that they have made in the past year. We have put in place 113 more nurses, the Bernard dementia unit, which has made some really good progress, and a twinning arrangement with University Hospitals Birmingham, which is one of the best in the country. There are some encouraging signs. I wish to reassure him and his constituents that we will stop at nothing to ensure that we turn that hospital around

[Diana Johnson (Kingston upon Hull North) (Lab)]

The former chief executive of Hull and East Yorkshire Hospitals NHS Trust, Phil Morley, left his post suddenly just before the publication of a very poor Care Quality Commission report, leaving behind a culture of bullying in the trust. Is the Secretary of State as surprised as I am that he has now been appointed chief executive of a hospital in Essex?

[Mr Hunt]

I do not know the details of the individual case, and it would not be right for me to comment. However, what I will say is that we have changed the rules to prevent people who are responsible for poor care from popping up in another part of the system. From now on, when trusts appoint people to boards, they can check their prior records on a central database administered by the CQC. Let me tell the hon. Lady that we are absolutely determined to change the culture in the NHS so that we stamp out the bullying and intimidation that were such a factor for so many doctors and nurses for many years.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

23. Will the Secretary of State join me in congratulating the management and staff of Basildon hospital who have worked hard to turn the hospital around so that it is now rated as good? Will he confirm that his Department will continue to support it so that the hospital can carry on making progress?

[Mr Hunt]

I am delighted with the progress that has been made under Clare Panniker’s leadership. The hospital now has 241 more nurses, and the first maternity unit in the country to be rated as outstanding. My hon. Friend will want to know why it is that when there was a CQC report under the previous Government, it was sat on for six months and nothing was done.

[Mr Nick Gibb (Bognor Regis and Littlehampton) (Con)]

19. In 2005, Littlehampton’s community hospital was demolished to make way for a new community hospital. Weeks later, the plans were put on hold because community hospitals went out of vogue. Sussex Community NHS Trust now wants to increase the number of in-patient beds at community hospitals. Will the Secretary of State ensure that NHS Property Services rebuilds Littlehampton community hospital to deliver those beds where they are needed?

[Mr Hunt]

That is not actually a matter for NHS Property Services Ltd; it has to be locally driven. However, my hon. Friend is absolutely right that we need to enhance community care services, whether in community hospitals or through services delivered at home. My hon. Friend has a high proportion of older people in his constituency and the transformation will be incredibly important for all his constituents.

[Andrew George (St Ives) (LD)]

Will my right hon. Friend join me in welcoming the National Institute for Health and Care Excellence’s statement today on the establishment of safe staffing levels on hospital wards? He will be aware that I have been campaigning on the matter for many years. The 1:8 ratio is certainly not a target but a baseline against which safe staffing and patient care can now be measured.

[Mr Hunt]

I welcome what NICE has done today, because it is incredibly important that we end the scandal of short-staffed wards in our NHS, which was a feature for many years under Governments of both parties. The lesson of Mid Staffs is that the oldest and most vulnerable patients, such as people with dementia, can be forgotten when a hospital is under pressure, so NICE’s guidance will be welcomed and useful. It is important to say that it can save money, because nothing is more expensive than unsafe care.

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[Paul Burstow (Sutton and Cheam) (LD)]

14. What the timetable is for publication of a successor to the current national dementia strategy.

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

Dementia is one of the most important issues we face at the moment and we are having detailed discussions with stakeholders about the best way to ensure that the very successful Prime Minister’s challenge on dementia continues into the next Parliament.

[Paul Burstow]

I am grateful for that answer and have no doubt that the continuation of the challenge is very important, but both the Prime Minister and the Secretary of State have told the House from the Dispatch Box that there will be a successor to the national dementia strategy. My question was very straightforward. Is there a timetable for delivering that strategy, given that the current strategy ends this year?

[Mr Hunt]

I should clarify for my right hon. Friend that the Prime Minister’s challenge was a successor to the national dementia strategy. The Prime Minister’s challenge finishes at the end of this Parliament and that is why we are having discussions about what should succeed it, because we all have an interest in ensuring that we maintain the tremendous momentum of the past few years.

[Mr Speaker]

I call Michael Connarty—he is not here.

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[James Duddridge (Rochford and Southend East) (Con)]

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

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

I am pleased to tell the House that on 19 June the Prime Minister hosted a very successful global dementia summit as a follow-up to the G8 dementia summit. We are currently diagnosing and treating 70,000 more people every year with dementia, but the big challenge is, as he set out at the G8 summit, finding a cure or disease-modifying therapy by 2025. We had useful discussions on what barriers need to be eliminated to ensure that the research happens to find such a cure.

[James Duddridge]

What assessment has the Secretary of State made of the need for a single hyper-acute stroke unit in south Essex?

[Mr Hunt]

I know that discussions are going on on that very topic and the CCGs are very interested in putting a hyper-acute stroke service at Southend hospital, which I know has excellent stroke services. We still need further improvements in the ambulance services for the east of England if we are going to do that and that is what we are currently discussing.

[Andy Burnham (Leigh) (Lab)]

I shall begin by congratulating the Health Secretary on surviving the massacre of the moderates. This was no real surprise for those of us on the Opposition Benches, however, because we know that his real views on the NHS are anything but moderate. On his watch, there has been more privatisation and now there is an accelerating postcode lottery. Today, the Royal College of Surgeons has revealed that some people waiting for hip replacements are being denied treatment that is available elsewhere because of arbitrary pain thresholds that are so harsh in places that people must be in severe debilitating pain before they can be treated. This is in direct contravention of National Institute for Health and Care Excellence guidance. Will the Secretary of State today condemn the fact that people are being denied treatment in that way, and act immediately to end the practice?

[Mr Hunt]

Of course it is absolutely right that people should follow NICE guidance, including all clinical commissioning groups, but if the right hon. Gentleman looks at what has happened over the past four years, he will see that we are treating more people, not fewer, with 6,000 more people getting their knees replaced and 9,000 more getting their hips replaced every year. That is possible only because we have 7,000 more doctors in the NHS because we took the difficult decision to get rid of the primary care trusts. Will he now accept that he was wrong to oppose those reforms and wrong to put politics before patients?

[Andy Burnham]

The Secretary of State says that CCGs should be following NICE guidance, but they are not. Seven out of 10 are not following that guidance, and people who are waiting for operations today will be left in pain because he is not acting. The truth is that the reorganisation has resulted in a postcode lottery writ large, and it is worse than we thought, because there is now a proposal in one area to end the provision of hearing aids on the national health service. That is totally unacceptable. Action on Hearing Loss warns that that would set a dangerous national precedent, leaving millions unable to live their lives. So, no ifs, no buts—will he condemn that proposal now and guarantee that patients will not be forced to pay for hearing aids on his watch?

[Mr Hunt]

I make it absolutely clear that everyone should follow NICE guidance. As the right hon. Gentleman has talked about the reorganisation, will he please accept that we are now doing 850,000 more operations on the NHS every single year? That means that more people are getting help with their hearing, their hips and their knees, and with all the other things that they need. He bitterly opposed that reorganisation, but he must now realise that he was wrong to oppose it then and he is wrong to oppose it now.

[Stuart Andrew (Pudsey) (Con)]

T2. I recently had the pleasure of meeting my constituents Susan Childs and Doreen Smulders, who raised the issue of the inequalities that exist for men with prostate cancer. Will my right hon. Friend tell me what steps are being taken to address the shortfalls in care and support that such men are receiving across the country?

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

T3. Since 2010, the percentage of patients who say that they can see their GP within 48 hours has halved from 80% to 40%. Given the pressure on the NHS, and especially on accident and emergency services, will the Secretary of State explain why the Government’s reforms are threatening to close 98 surgeries around the country, including five in Tower Hamlets? Will he publish the full list today?

[Mr Jeremy Hunt]

Let me gently explain to the hon. Lady that she has excellent GP provision in Tower Hamlets, led by Dr Sam Everington. It is a model of what can happen under the Government’s reforms. The way in which we are going to make it easier for people to see their GP is with additional capacity. We have 1,000 more GPs during this Parliament, and we have achieved that only because we took the difficult decision to get rid of 19,000 managers, which was bitterly opposed by the hon. Lady and the Labour party.

[Margot James (Stourbridge) (Con)]

T4. Now that the Medicines and Healthcare Products Regulatory Agency has concluded its consultation on the use of generic asthma inhalers by schools in cases of emergency when a child does not have his or her own inhaler, will my hon. Friend update the House on the next steps? In particular, does she expect schools to be allowed to keep these inhalers in the new school year?

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

T6. On nurse-patient staffing ratios, it has been reported in the Health Service Journal that out of 139 trusts surveyed, 119 failed to fill their registered day nurse hours, 112 failed to fill their registered night nurse hours and 105 failed to fill their registered nurse hours across day and night. Is it not time for Ministers and NICE to state straightforwardly that a ratio of one nurse to eight patients or better is the only way for patient safety?

[Mr Jeremy Hunt]

NICE has taken the sensible decision to issue its guidance. It does so independently, but we are not making it mandatory on the advice of the chief nursing officer and many other chief nurses across the country for the simple reason that if we have a mandatory minimum, that can become the maximum that trusts invest in and many wards need more than 1:8. That is why NICE’s guidance was so important today.

[Andrew Selous (South West Bedfordshire) (Con)]

T5. The Chavasse report on improving care for members of the armed services and veterans builds on the improvements that we have already made and has been welcomed by the Department of Health and indeed the Ministry of Defence. We owe it to our armed services to carry on making improvements to their care, so will the Minister encourage NHS England to look favourably on its recommendations?

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[Mr Jim Cunningham (Coventry South) (Lab)]

May I remind the Secretary of State that it takes seven years to train a doctor and most of the doctors he boasts about were trained under a Labour Government? What is he doing about the disparity between GPs surgeries and the service that they offer? Some months ago I made some visits in Coventry and I was amazed by the difference in the levels of service.

[Mr Jeremy Hunt]

It does take seven years to train a GP, but we also have to have an NHS that is able to pay for GPs when they are trained. That is why it was so important to take the difficult decision to reduce the amount of money that we spend on back-office and management costs. The hon. Gentleman is right to say that there is too much disparity in the services offered by different GPs. That is something that the chief inspector of general practice is thinking about, and he will publish his plans shortly.

[Mr Robert Buckland (South Swindon) (Con)]

T8. From my regular discussions with local GPs in Swindon, I know that the reasons behind recruitment issues are often complex and localised. Will my right hon. Friend assure me that those responsible for commissioning GP services will place daily access to general practitioners at the heart of their considerations?

[Mr Hunt]

I know that they do that, and I know that people recognise that access is a critical issue. That is why the Prime Minister introduced a £50 million fund last year that has been taken up by 1,100 of the 8,000 surgeries across the country to improve access in evenings, at weekends and by e-mail and Skype. I hope that those will benefit his constituents.

[Bill Esterson (Sefton Central) (Lab)]

SSP Health runs a number of GP practices in my constituency and across Merseyside. When it took over, it promised full-time GPs and an improvement in services, yet after well over a year several of the practices are still run by locums. We have seen vulnerable, elderly people unable to get appointments for many days, if not weeks, and those who can have gone to other practices. Will the Secretary of State look at what is going on with SSP Health in and around Merseyside and give me and other hon. Members an answer?

[Mr Hunt]

I am happy to do so, because the service that he describes—I have not seen the details—sounds totally unacceptable.

[Paul Burstow (Sutton and Cheam) (LD)]

T9. Given that last year, more than 7,500 people with a mental health crisis found themselves in police cells rather than anywhere appropriate such as a hospital, given that 263 of those people were children and young people, and given that they stayed for 10 and a half hours in a police cell, is it not time that we took the evidence of street triage, which we know works, and rolled it out across the country?

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

I welcome the Secretary of State’s commitment to getting rid of as much bureaucracy as possible, so will he look into what is happening with NHS England in south Yorkshire that is delaying approval for a much-needed GP surgery in my constituency? Given that it is in partnership with the local authority, the delay risks us losing the surgery altogether.

[Mr Jeremy Hunt]

I am happy to look into the details of that case and be as much of a bureaucracy buster as I can.

[Robert Halfon (Harlow) (Con)]

T10. Is my hon. Friend aware that nurses are paying an extra £200 a month and patients an extra £40 a week for ever-increasing hospital car parking charges? Will he look into the problem, meet me and do everything he can to end the great hospital car parking rip-off?

[Mr Hunt]

I share my hon. Friend’s concerns that the car park charges in some hospitals are just too high. I understand that hospitals have financial pressures, as do many parts of the system, but I am happy to talk to him on another occasion about what specifically can be done on this issue.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Annually 30,000 applications for funeral payments are rejected, leaving families committed to expensive funerals that they cannot afford. People who are approaching end of life are not advised, as part of their palliative care, about planning for funeral costs or their eligibility for support. What is the Secretary of State going to do to remedy this?

[Iain Stewart (Milton Keynes South) (Con)]

The Secretary of State will be aware of the campaign run by the Milton Keynes Citizen, my hon. Friend the Member for Milton Keynes North (Mark Lancaster) and myself for an expanded A and E department at Milton Keynes hospital. What assurances can he give me that A and E services at the hospital will be able to meet the needs of an expanding population?

[Mr Jeremy Hunt]

No one could have campaigned harder than my hon. Friend and his hon. Friend the Member for Milton Keynes North (Mark Lancaster) for improving the services at their local A and E department. A consultation is currently taking place. There is no question of closing both A and Es in that area, and I understand that a very good capital bid for £2 million for his local A and E has been put in which, subject to the usual value-for-money requirements, looks like it is very strong.

[Julie Hilling (Bolton West) (Lab)]

My constituent, 81-year-old Rita, was taken seriously ill on holiday and had to spend two weeks in hospital. She was discharged with a letter saying that she needed very urgent surgery, but has had to wait five weeks before she even sees a consultant, let alone getting any treatment. What can the Secretary of State do for Rita and others like her?

[Mr Hunt]

We are working extremely hard to make sure that people do not have those long waits. We are doing about 3.5 million more diagnostic tests, for example, every year in the NHS than four years ago. I am happy to look into the individual case and see what lessons can be learned and to see whether we can help the hon. Lady’s constituent.

[Duncan Hames (Chippenham) (LD)]

Is it ever acceptable, as reported to me in my constituency surgery last week, for a GP to tell their patient, “There is nothing I can do, so I don’t want to hear any more about your mental health”?