Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 13th October 2015 Commons Chamber

[Mike Wood (Dudley South) (Con)]

6. What plans his Department has to increase capacity in general practice and primary care.

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

It is a pleasure to be back, Mr Speaker. By 2020, we will increase the primary and community care workforce by at least 10,000, including an estimated 5,000 doctors working in general practice, as well as more practice nurses, district nurses and pharmacists.

[Suella Fernandes]

Fareham community hospital is an example of Labour’s expensive PFI gone wrong. At a cost of £28 million, it remains underused, half-built and subject to complex governance structures. What will my right hon. Friend do to enable better use of this facility to allow provision for minor injuries, a GP practice and more primary care?

[Mr Hunt]

My hon. Friend is right, regrettably, that the PFI projects under the previous Labour Government created a lot of unsustainable debt. I know her local clinical commissioning group is meeting GP practices and working with community health partnerships to see if they can progress the idea she is campaigning for. I hope to visit her in the near future to discuss it myself.

[Mike Wood]

Will my right hon. Friend join me in welcoming the £2.7 million in vanguard funding given to Dudley to provide primary care services out in the community? This will not only improve the level of clinical and social services provided to people in Dudley South, but relieve pressures on Russells Hall hospital.

[Mr Hunt]

I welcome my hon. Friend to his post. I am not sure I have had a question from him before. I know quite a bit about the Dudley vanguard programme, because I shared a taxi to Manchester station with the entire Dudley team. They told me, at close quarters, about their exciting plans. What really struck me was how they are talking to different bits of the health and social care system in a way that has never happened before. It is really exciting and I think it really will be in the vanguard of what can happen in the NHS.

[Helen Jones (Warrington North) (Lab)]

Many people in my constituency are struggling to see a GP from Monday to Friday. Warrington has fewer GPs than it had in 2010, despite a rise in population. The number of unfilled GP vacancies quadrupled under the previous Government. How does the Secretary of State expect to produce a seven-day service when he cannot properly staff the service from Monday to Friday?

[Mr Hunt]

I shall tell the hon. Lady how I expect to do it. We are, in fact, making very good progress. By March next year, a third of the country will be able to access routine GP appointments at evenings and weekends. We do need more GPs. I agree with her that it takes too long to get a GP appointment, but we are doing something about it. That is why we have announced plans to recruit an estimated 5,000 more GPs. That will be a 15% increase in the number of GPs, the biggest increase in the history of the NHS.

[John Cryer (Leyton and Wanstead) (Lab)]

It is widely known that there is a serious lack of doctors who want to go into general practice. At the same time, the Secretary of State is guilty of an abject failure to engage with the British Medical Association in negotiations on junior doctors’ practices. On that basis, how the hell can he promise to increase general practice?

[Mr Hunt]

Just look at our track record in the previous Parliament: we increased the number of GPs by 1,700—a 5% increase. We are, on the back of a strong economy, putting in funding that will make it possible to increase that number even more. The hon. Gentleman talks about the BMA. I simply say that the people refusing to negotiate are not the Government, but the BMA.

[Several hon. Members rose—]

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

Unfortunately, every time I open a page of my local newspaper these days I am met with the beaming face of yet another general practitioner in his mid-50s who has decided to throw in his hand after many, many years of serving his community. These doctors are best placed to manage patients in primary care and ensure that they do not have to go to secondary care or A&E. What analysis has my right hon. Friend made of the reasons these experienced professionals are leaving the profession prematurely, and what will his reforms do to stem the tide?

[Mr Hunt]

My hon. Friend makes a very important point. We have done extensive analysis, because of our commitment to transform the role of general practice, of the issues. They include too much bureaucracy and form-filling, which means that doctors do not spend enough time with patients, and a sense that successive Governments have not invested in general practice and primary care. That is exactly what we seek to turn around with the “Five Year Forward View”.

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

What discussions have taken place with the devolved Administrations regarding the introduction of the new GP contract, particularly the junior doctor contract, given the exodus of junior doctors to Australia?

[Mr Hunt]

We also have Australian paramedics working in the UK, particularly London, so that traffic goes both ways, but, as the hon. Lady will know, health is a devolved matter, and people follow their own paths. For England, we are determined to eliminate the weekend effect. Every year, there are 11,000 excess deaths as a result of inadequate cover at weekends, and we do not want that to continue.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

2. How much additional investment there will be in children and young people’s mental health services in 2015-16.

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[Chris Philp (Croydon South) (Con)]

3. What progress his Department has made in delivering seven-day-a-week NHS services.

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

Eighteen million patients will benefit from seven-day GP appointments by March next year, and seven-day hospital services will reach a quarter of the country by then.

[Chris Philp]

In my borough of Croydon, the clinical commissioning group is currently consulting on the possibility of having three seven-day-a-week, 12-hour-a-day combined minor injury and GP centres, with one at Purley hospital in my constituency. Can the Secretary of State confirm whether any additional funding is available from central Government to facilitate this seven-day-a-week service?

[Mr Hunt]

Yes, I can. I should have said that seven-day hospital services will be available to a quarter of the country by March 2017. We are putting an extra £10 billion into the NHS in the course of this Parliament, which will help in the roll-out of seven-day services—I hope in Croydon, as well. I commend my hon. Friend for his efforts in that respect.

[Alison McGovern (Wirral South) (Lab)]

I met a large group of junior doctors in my constituency on Friday, and we talked a lot about seven-day working. They asked me to put two things straight with the Health Secretary: first, the vast majority of junior doctors are already working seven days a week; and, secondly, on their contract, it was not terms and conditions that they were worried about, as I thought they were, but safety. In respect of those new contracts for junior doctors, what assessment has the Secretary of State’s Government made about patient safety?

[Mr Hunt]

I am very happy to do that, and to correct some of the misleading impressions given by the BMA about what the changes are. The changes are about patient safety. They are about the fact that someone is 15% more likely to die if admitted on a Sunday than on a Wednesday because we do not have as many doctors in our hospitals at the weekends as we have mid-week. I want to give better support to the doctors who work weekends by making sure that they have more of their colleagues and more consultants there, as well as proper safeguards, which I do not believe we have at the moment. I will be getting that message out, and I hope that the hon. Lady will, too, when she next meets her junior doctors.

[Sir Simon Burns (Chelmsford) (Con)]

I urge my right hon. Friend to continue on his drive to improve patient safety and to reduce avoidable harm in our NHS because that is crucial for patients and the professions.

[Mr Hunt]

I thank my right hon. Friend for his question, and for the interest that he showed in these issues when he was a Minister.

The reality is that about we have about 200 avoidable deaths every week in our hospitals. It is the same in other countries—this is not just an NHS issue—but it is a global scandal in healthcare, and I want England and our NHS to be the first to put it right. I think that that is consistent with NHS values, and consistent with what doctors and nurses all want.

[Heidi Alexander (Lewisham East) (Lab)]

It is good of the Secretary of State to join us today. If he had been here yesterday to discuss the small issue of the £2 billion NHS deficit, he would have heard me say that I hoped we could have a mature and constructive relationship.

As has already been said, junior doctors are key to the delivery of a seven-day NHS. The Secretary of State said recently:

“I don’t want to see any junior doctor have their pay cut.”

Can he now guarantee that no junior doctor will be paid less as a result of his proposed new contract? Yes or no?

[Mr Hunt]

I welcome the hon. Lady to her post. I hope that, just occasionally, we might agree on some things, although I suspect that today may not be one of those occasions.

Let me be absolutely clear about the commitment that we have made to junior doctors. We will not cut the junior doctor pay bill, but what we do need to change are the excessive overtime rates that are paid at weekends. They give hospitals a disincentive to roster as many doctors as they need at weekends, and that leads to those 11,000 excessive deaths. Let me gently say that that was a change to the doctors’ contracts made in 2003, so for members of the Labour party to say that this is nothing to do with them is not accurate, and they should help us to sort out the problem.

[Heidi Alexander]

I think it is fair to say that junior doctors will make up their own minds about that response.

Last week I received an e-mail about a seriously ill woman who had needed to be admitted to hospital over the weekend, but had stayed at home for two days because of recent interviews given by the Department of Health that had made her think

“that the NHS was not staffed at weekends.”

Her doctor went on to say:

“This delayed her operation, put her life in danger and ultimately will have cost the NHS more”.

Does the Secretary of State feel any responsibility for that?

[Mr Hunt]

Let me give the hon. Lady the facts. According to an independent study conducted by The BMJ, there are 11,000 excess deaths because we do not staff our hospitals properly at weekends. I think it is my job, and the Government’s job, to deal with that, and to stand up for patients.

The hon. Lady talked about being constructive. There is something constructive that she can do, which is to join the Royal College of Surgeons, the Royal College of Physicians and the Royal College of Nursing, and urge members of the British Medical Association not to strike but to negotiate, which is the sensible, constructive thing to do. Will the hon. Lady tell them to do that?

[Mr Peter Bone (Wellingborough) (Con)]

The question is about the seven-day NHS, but there is no point in our having a seven-day NHS if it is not an NHS across the country. I have a constituent with advanced prostate cancer who, as his oncologist says, needs docetaxel chemotherapy. In fact, all east midlands oncologists say that it is needed, but it is not provided by the NHS in my constituency, although it is provided in Birmingham. If we are to have a seven-day NHS, we need treatment across the board. Will the Secretary of State step in and do something about this?

[Mr Hunt]

I will look into the individual case that my hon. Friend has raised, but I think patients recognise that sometimes they need to travel further for the most specialist care, and can receive better care if they do so. However, the way in which what we are doing will help my hon. Friend’s constituents, and other people with cancer, is not just about consultants and junior doctors working at the weekends; it is about seven-day diagnostic tests, which will enable us to get the answers back much more quickly and catch cancers earlier.

[Catherine West (Hornsey and Wood Green) (Lab)]

4. What progress his Department has made in introducing a cap on care costs.

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[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

17. What additional financial support he is making available to the NHS to help it deal with winter pressures.

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

Some £400 million in resilience money has been invested in the NHS for this winter. Learning from previous years, we have put this money into the NHS baseline for 2015-16 so that the NHS can plan effectively at an earlier stage.

[Liz McInnes]

I thank the Secretary of State for his response. In my constituency we have an excellent and much-used facility—a walk-in centre in Middleton town centre—which is now threatened with closure. Will he support our campaign to keep it open? Does he agree that its closure would create more A&E attendances and increase winter pressures on our acute services?

[Mr Hunt]

I welcome the question and understand the hon. Lady’s concerns about the changes. She will understand that we do not direct these changes centrally and they are decided locally. One of the things we have to try to do is deal with the confusion a lot of people have at a local level as to what they should do when they have, for instance, a child with fever at the weekends and whether they require a GP, an urgent care centre or an A&E department. I would ask all CCGs to be very careful to make sure they sort out that confusion so NHS patients know exactly what they should do.

[Tulip Siddiq]

The Royal Free hospital in my constituency is at the cutting edge of medical research and is currently treating Ebola patient Pauline Cafferkey. I am sure the Secretary of State will join me in wishing her a speedy recovery, yet the hospital faced considerable winter pressures last year. Will the Secretary of State work with the fantastic nurses and doctors at the Royal Free to ensure these winter pressures do not happen again this year?

[Mr Hunt]

I thank the hon. Lady for her excellent question. I know that the whole House is thinking of Pauline Cafferkey and her family and that it is proud that, under Dr Mike Jacobs and his team, she is getting the most outstanding care that it is possible to get anywhere in the world. We all wish her a speedy recovery. With respect to winter pressures, I know that the Royal Free had a difficult winter but I also know that it has a very good management team and made heroic efforts. I know that the whole team of doctors and nurses will do an excellent job, and we will want to support them in any way we can.

[David Tredinnick (Bosworth) (Con)]

As part of my right hon. Friend’s plans for dealing with winter pressures, will he look at making greater use of the 63,000 practitioners on the Professional Standards Authority’s 17 accredited registers covering 25 occupations? Has he found time yet to read the authority’s report, “Accredited Registers—Ensuring that health and care practitioners are competent and safe”?

[Mr Hunt]

I must confess that I have not yet read that report, but my hon. Friend has reminded me of how important it is that I should do so. I will read it carefully while thinking about whether it could help us to get through the winter pressures this year.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering general hospital, the local clinical commissioning group and the Government are all agreed that the best way to help the NHS in north Northamptonshire to cope with pressures all year round, including in the winter, would be to develop a £30 million urgent care hub at Kettering general hospital. That project is with Monitor. What can the Secretary of State do to encourage Monitor to speed up its deliberations?

[Mr Hunt]

Once again, I thank my hon. Friend for his persistent campaigning on behalf of Kettering general hospital. It is a very busy hospital under a great deal of pressure, and I know that people work very hard there. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who has responsibility for hospitals, met campaigners from Kettering recently to discuss this issue, and I will bring the matter up with Monitor as well.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The Department of Health’s own figures show a dramatic change, from a £500 million surplus to a £100 million deficit in 2013, following the introduction of the Health and Social Care Act 2012. That deficit moved to £800 million last year and we have heard in the past week that it stood at more than £900 million from the first quarter of this year. Does the Secretary of State recognise that this situation has been exacerbated by the outsourcing and fragmentation of the NHS, which involves spending money on shareholder profits and tendering bureaucracy, rather than on patients?

[Mr Hunt]

I do not. That Act meant that we reduced the number of managers and administrators in the NHS in England by 19,000, saving the NHS £1.5 billion a year. The reason for the deficits that the hon. Lady talks about is that, around the same time, we had the Francis report on Mid Staffs, and hospitals in England were absolutely determined to end the scandal of short-staffing. However, agency staffing is not a sustainable way of doing that, which is why we are taking measures today to change that.

[Dr Whitford]

The Francis report recognised the problems of nursing levels. As hospitals will not be able to use agency staff or immigrant staff, how does the Secretary of State suggest they tackle the nursing ratios in hospitals?

[Mr Hunt]

If the hon. Lady looks at what has happened with permanent full-time nursing staff, she will see that the numbers have gone up in our hospitals by 8,000 over the past two years, so there are alternatives. We need to do more to help the NHS in this respect, and I will be announcing something about that shortly.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

10. What plans he has to review renewal arrangements for the issuing of NHS medical exemption certificates.

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[Chris Skidmore (Kingswood) (Con)]

16. What steps his Department has taken to improve transparency in the NHS.

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

Last year I launched My NHS, where patients can see how safe their local hospital is and many other things. From next May, there will be overall information on the quality of mental health and cancer care.

[Chris Skidmore]

Does the Secretary of State share my view that driving up standards in the NHS is better achieved through a culture whereby providers can learn from their peers? For example the excellent maternity department at my local Cossham hospital recently received an outstanding rating from the Care Quality Commission. That is better than the old ways of doing things through targets driven by Whitehall.

[Mr Hunt]

I agree, and I congratulate the doctors and nurses working in the Cossham maternity unit. Southmead hospital in Bristol has some of the best maternity survival rates in Europe, so there is a lot of very good practice. The way to get the word out is through transparency of outcomes, not endless new targets, so my hon. Friend is absolutely right.

[Paula Sherriff (Dewsbury) (Lab)]

T2. If he will make a statement on his departmental responsibilities.

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

I would like to make a statement on measures the Government are taking to help NHS organisations tackle the deficits by reducing the cost of agency staff. Building on previously announced controls, from the end of November we will introduce maximum shift rates for all clinical staff employed through agencies, which will gradually decrease over time as the measures take effect and demand for agency staff reduces. In addition, we will work with each trust to limit or reduce the overall agency spend. Exceptional breaches of the limits will require advance agreement. Taken together, these measures are expected to improve patient care and reduce NHS agency staff spend by £1 billion over three years. The chief inspector of hospitals has confirmed that he believes this is the right thing to do.

[Paula Sherriff]

Like many Members across this House, I have been inundated with letters and emails from junior doctors who feel completely undervalued and undermined by the actions of this Government, so much so that thousands of them are leaving the UK. This weekend over 2,000 medics and students wrote to the Secretary of State, condemning him for his proposed unfair and unsafe changes to the junior doctors contract. What further evidence does he need to see that he has lost the confidence of the future leaders of the NHS, and does he think he can win it back?

[Mr Hunt]

Yes, I do. Let us be clear: this is about patient safety, about which every single doctor and nurse in the NHS is passionate. The problem is that the doctors whom the hon. Lady has met have been misled by their own union. This is not about cutting the pay bill for junior doctors, as the BMA has suggested. This is about safer care at weekends, reducing unsafe hours and doing the right thing for patients, and that is the right thing for doctors as well.

[Martin Vickers (Cleethorpes) (Con)]

T4. It emerged earlier this month that North East Lincolnshire CCG was operating a primary care incentive scheme intended to reduce outpatient referrals. Understandably, this has met with a hostile reception from my constituents, who fear it may affect decisions on their care. Will Ministers look into this scheme and either offer some reassurance or instruct the CCG to reconsider?

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

Last week senior officials at Monitor reported being leaned on by the Department of Health to suppress the publication of financial figures ahead of the Conservative party conference. This week the Health Secretary has been accused of vetoing the release of impartial independent reports on measures that could reduce our consumption of sugar. Does he not understand that leadership on transparency must come from the very top? Will he now commit to practising what he preaches on NHS transparency and release this report immediately?

[Mr Jeremy Hunt]

I will take no lessons on transparency from the Opposition. Professor Sir Brian Jarman said that the Department of Health under Labour was a “denial machine” when it came to the problems of Mid Staffs. We have made the NHS more transparent than ever before, and we will continue to practise transparency.

[Mr Steve Baker (Wycombe) (Con)]

T6. What progress has been made towards the implementation of the Keogh review of urgent and emergency care?

[Mr Hunt]

We are making good progress and we expect to make a substantive announcement on that before the end of the year. That will be about improving the standard and the quality of care in A and E departments, which I know my hon. Friend has a great interest in, and removing the confusion that people feel about what precisely the NHS offer is in their area. It is looking good and I hope to have something to announce to the House before too long.

[Teresa Pearce (Erith and Thamesmead) (Lab)]

T3. A recent whistleblower revealed that the 111 helpline is in meltdown and at least two babies have died after staff failed to recommend treatment that may have saved them. Two weeks ago my own three-week-old premature granddaughter was very ill. Her parents called 111 and were promised that the duty doctor would call. He did not. They waited the whole long night and the next morning took her to A and E, and she was diagnosed with meningitis. What exactly is the Minister doing to fix the crisis in the 111 service?

[Mr Hunt]

This is a very serious issue and I will happily look into it personally to make sure that a full investigation is taking place into the incident the hon. Lady mentions, which clearly should not have happened. The 111 service has been an improvement on what we had before. It has taken nearly three times as many calls as the service it replaced, and around a quarter of those are referred to a clinician, but it is clearly not perfect, given the hon. Lady’s story, so I will look into the case that she raised.

[David T. C. Davies (Monmouth) (Con)]

T9. Patients in England wait 18 weeks for an operation, but in Wales, where Labour has run the NHS for the past 16 years, they wait 26 weeks. Does that not prove that only the Conservative party can be trusted to run the national health service?

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[Andrea Jenkyns (Morley and Outwood) (Con)]

To continue on the same theme—hopefully I am coming in at the right time, Mr Speaker—I chair the all-party group on patient safety, in collaboration with the Patients Association. We are about to look into hospital infections, and in Parliament in November I will launch a hand washing campaign. What is the Department of Health doing to promote infection control outside hospital settings?

[Mr Jeremy Hunt]

I thank my hon. Friend for her great interest in this issue and for the campaigning she did before entering Parliament, which I know stemmed from personal tragedy. This is an incredibly important issue. We face a crisis in global healthcare as a result of anti-microbial resistance, which means the current generation of antibiotics is no longer as effective as it needs to be. Proper hygiene in hospitals is therefore vital, and we have a lot of plans that I will be happy to share with her.

[Owen Thompson (Midlothian) (SNP)]

T7. What measures is the Secretary of State putting in place to recruit and retain GPs? Given that he has indicated recruiting 5,000, where does he plan to find them?

[Dr Sarah Wollaston (Totnes) (Con)]

Delayed publication of evidence is as damaging as non-publication, which is why we rightly expect clinicians, researchers and managers to publish their evidence and data in a timely and transparent manner. It is a matter of great regret to the Health Committee that we started our inquiry today without access to the detailed and impartial review of the evidence that we need to make a contribution to this inquiry. Will the Secretary of State please set out when he will publish it?

[Mr Jeremy Hunt]

I agree with my hon. Friend about the importance of transparency and publishing in a timely manner. I will look again at the planned publication date for the report she wants to see, which will be published so that Parliament can debate it properly. The normal practice is for advice to Ministers to be published at the same time as policy decisions are made, as happened with the Chantler review and the Francis report.

[Caroline Flint (Don Valley) (Lab)]

T8. The Royal College of Nursing reports that it is becoming clear that for the first time since the early 2000s there is a critical shortage of registered nurses in the UK. Both the UK and global nursing labour markets are changing, and our increasing reliance on alternative sources is not sustainable. In 2014, 37,645 students across the UK were turned away from nursing courses. Is it not time the Minister admitted that the situation is not good enough and that the Government need drastically to scale up those places to reduce dependency on overseas nursing staff?

[David Mowat (Warrington South) (Con)]

Last year the NHS paid £300 million to claimants’ lawyers. Indeed, for small and medium claims, the lawyers made two to three times as much as the claimants themselves. Is there more we can do to stop this abusive behaviour?

[Mr Jeremy Hunt]

There certainly is. We spend £1.3 billion every year on litigation claims—money that could be used to look after patients on the front line. The way to avoid spending that money is to have safer care, and that is why it is so important that we have a seven-day service.

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

T10. As the Secretary of State will know, the Scottish Government are once again in the vanguard in introducing crucial legislation—the Smoking Prohibition (Children in Motor Vehicles) (Scotland) Bill, which will eradicate more than 60,000 journeys per week where children are exposed to dangerous second-hand smoke. Will he advise on what plans are in place for the rest of the UK to follow Scotland’s example?

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[Mr Jeremy Hunt]

The hon. Lady is absolutely right; we need more midwives. We recruited more midwives in the previous Parliament, and we do need to expand maternity provision as we have a growing birth rate. I am happy to look at the problems in her area. However, we also have a maternity review coming up early next year, led by Baroness Cumberlege, that will help us to address this problem sustainably.

[Philip Davies (Shipley) (Con)]

What health problems are caused by first-cousin marriages, and how much does dealing with those problems cost the NHS each year?