Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 10th May 2016 Commons Chamber

[John Pugh (Southport) (LD)]

5. What plans he has to reduce agency staffing expenditure in the NHS.

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

We have taken tough measures to control unsustainable spending on agency staff, which cost the NHS more than £3 billion last year. Overall agency spend is now falling and we expect to save the NHS at least £1 billion this year as a result.

[John Pugh]

I thank the Secretary of State for his answer. I do not share his optimism. Is not the real problem the shortage of permanent staff and the budgetary constraints on the acute sector? Most of them are now below establishment.

[Mr Hunt]

I think the hon. Gentleman is right that we have historically not trained enough staff to work in the NHS and been over-optimistic about the staff needs. That is why, in this Parliament, we will be training over 11,000 more doctors as a result of the spending review, and 40,000 more nurses.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

In the Public Accounts Committee, which I sit on with the hon. Member for Southport (John Pugh), we have repeatedly come to this question about agency staffing. The key thing is, as he says, that the establishment level for acute hospitals is always under par, because the budget set from the centre is never enough to meet it. Will the Secretary of State go and take a serious look at this issue, and stop this myth that it is just down to the rates paid? That is part of the problem, but it is not the main problem.

[Mr Hunt]

Perhaps I can give the hon. Lady some comfort. I recognise that there is a big mountain to move, but the changes we made last year were not just about changing the rates paid to agencies. They were also about capping the amounts agencies can pay their own staff, because we think it is incredibly divisive inside hospitals to have two nurses doing exactly the same work, but one being paid dramatically more than the other. We are also capping the total amount hospitals can spend on agency staff. The result is that the monthly spend on agency staff is now falling and we are on track to reduce the agency bill by about £1 billion in this Parliament.

[Heidi Alexander (Lewisham East) (Lab)]

Spending on agency staff has gone through the roof under this Health Secretary, and the Secretary of State’s attempt to deal with the symptoms of the problem but not the cause has left hospitals struggling to get staff at rates they are allowed to pay. In the past few weeks we have seen reports of emergency surgery suspended in Doncaster, an A&E department downgraded in Chorley and two critical care units closed in Leeds, all because of staff shortages. The Health Secretary has admitted that this will be his last big job in politics. May I urge him before he goes to get a grip on the cause of the staffing crisis? Otherwise, it will be patients who will be facing the consequences long after he has gone.

[Mr Hunt]

May I start by thanking the hon. Member for Ellesmere Port and Neston (Justin Madders) for his generous congratulations earlier, and indeed for making history himself by being the first Opposition Member I can remember to congratulate the Government on hitting a target?

I say to the hon. Lady that, as a result of the measures we have taken to deal with the agency staff issue, we think we have saved £290 million compared with what we would have spent since last October, two thirds of trusts are reporting savings and the price paid for agency nurses is 10% lower than it was in October. The root cause of the problem is, as the hon. Member for Southport (John Pugh) said, our failure in the past to recruit enough staff. One of the reasons for that is that successive Governments failed to understand the needs of nursing in wards, which is why we had the problem at Mid Staffs. Because we are addressing that, we are now able to make sure that we do not pay excessive rates for agency staff.

[Heidi Alexander]

If I may turn to another part of the staffing crisis, all Opposition Members welcome the resumption of talks on the junior doctors contract. It is in no one’s interest—not the Government’s, not junior doctors’ and certainly not patients’—for this dispute to drag on any longer. May I implore the Health Secretary to do all he can to find a reasonable compromise this week that will keep doctors in the NHS and ensure that we have a motivated, well trained and fairly rewarded workforce to continue to deliver the excellent care we all want?

[Mr Hunt]

I thank the hon. Lady for her reasonable tone and absolutely give her that assurance. We have always wanted a negotiated outcome to this dispute. That is why we paused the introduction of the new contracts last November to give talks a chance to succeed, and it is why this week I have said we will further pause the introduction of the new contracts to see whether we can get a negotiated outcome. We want a motivated workforce and we are highly cognisant of the fact that hospitals that offer seven-day care and higher standards of care for patients are the very hospitals that have some of the highest levels of morale in the NHS. It takes two to tango, and I very much hope that the British Medical Association will play ball and its part this week in helping us to deliver a safer seven-day NHS.

[Mark Durkan (Foyle) (SDLP)]

6. What steps he is taking to improve the outcomes of people with rarer cancers.

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[Chris Green (Bolton West) (Con)]

9. What steps his Department is taking to ensure provision of good quality A&E services.

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

Although we are not currently hitting the national A&E target, hospital A&E departments continue to perform well under great pressure. Overall they are coping with 1.9 million more attendances annually compared with 2009-10, and the average wait to see a doctor remains just 38 minutes.

[Chris Green]

I thank my right hon. Friend for his answer. Many of my constituents are concerned about the temporary closure of the Chorley A&E department, which now only operates as an urgent care service. What assurance can he give my constituents on A&E cover in and around the Bolton West constituency?

[Mr Hunt]

May I reassure my hon. Friend that I am very aware of this issue, and I have had a number of meetings with hon. Members to discuss it? Patient safety has to be the utmost priority. We are working with the local trust, and we have been given an assurance that neighbouring hospitals will be able to absorb any extra activity, and that it is working hard to try to reopen the A&E department.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

The temporary closure of A&E services at Chorley hospital has had a knock-on effect on hospitals across Lancashire, and anecdotally I hear of many more people turning up at Preston Royal. What reassurances can the right hon. Gentleman give my constituents and residents across Lancashire that he is doing everything he can to make sure that the staffing issues at Chorley are fixed and that Chorley A&E is open again?

[Mr Hunt]

I can reassure the hon. Lady that we have been monitoring the situation closely and have provided extra capacity at the Royal Preston hospital. Her own Royal Lancaster infirmary has recently come out of special measures and done a really good job in turning round the quality of care after protracted difficulties. We continue to monitor the situation, and patient safety is our No. 1 priority.

[Mr Steve Baker (Wycombe) (Con)]

Following centralisation and specialisation processes to drive up the quality of clinical care, we now have patients presenting at minor injuries units and urgent care centres with conditions that need to be treated elsewhere. Will my right hon. Friend take steps to ensure that those centres own the patients’ experience once they have presented, so that we never again have a patient with a serious illness being sent out to make their own way to A&E?

[Mr Hunt]

As ever on health matters, my hon. Friend speaks wisely. The fundamental issue is a high level of confusion about what happens to patients when they are faced with a bewildering choice about what to do when they have an urgent health need that needs resolving. They can call 111, try to get an urgent GP appointment, go to a walk-in centre, go to A&E and many other alternatives. We need to resolve that and make it simpler for patients so that they go to the right place first time. Urgent work is happening to ensure that we do that.

[Christian Matheson (City of Chester) (Lab)]

The closure of the A&E unit at Chorley and South Ribble district general hospital has ramifications across the north-west. I am informed that North West Ambulance Service has taken on three private ambulances at a cost of £70,000 each a month to provide the extra cover that is required. Does the Secretary of State accept that it is a false economy when he allows A&E units to close on his watch? He simply passes on the costs to other parts of the fractured NHS over which he presides.

[Mr Hunt]

I recognise that we have a difficult situation in Chorley and that people in that trust are working very closely together. The chief executive of the trust pointed out that the reason for the closure was that neighbouring trusts were not respecting the caps on agency staff that she was respecting. It is incredibly important that, across the NHS, we have a concerted effort to bring down the prices paid for agency staff, which I think is the root problem here. However, we are monitoring the situation closely.

[Mr David Nuttall (Bury North) (Con)]

But how will my right hon. Friend’s powers to ensure good quality accident and emergency provision in hospitals across Greater Manchester be affected by the devolution of health and social care responsibilities to Greater Manchester councils?

[Mr Hunt]

I can reassure my hon. Friend that, although we are happy to put the local authorities in Greater Manchester in the driving seat for some major changes, including what I hope will be the first full-scale integration of health and social care across the NHS, we are monitoring the performance against national standards. We will be able to see exactly how well they do on patient safety, waiting times and so on, and whether they live up to the big promises that have been made.

[John Nicolson (East Dunbartonshire) (SNP)]

11. What steps he is taking to resolve the industrial dispute with junior doctors.

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

Talks are now taking place between NHS employers and the British Medical Association to try to resolve outstanding issues around the junior doctors’ contract.

[John Nicolson]

In his recent letter to the head of the BMA, the Secretary of State offered to discuss improving work-life balance, especially for people with family responsibilities. How exactly does he plan to do that with a contract that the Government’s own quality impact assessment has identified as especially disadvantaging women?

[Mr Hunt]

That is not correct. It is worth saying that the reason for the dispute is a manifesto commitment to a seven-day NHS that the Government made to the people of England and that the Scottish National party has not made to the people of Scotland. The weekend effect does not happen just in England. There are studies in Scotland, including the Handel study, which states:

“The excess of admissions ending in deaths at weekends compared with those during weekdays seen elsewhere were also found in Scotland.”

I gently say to the hon. Gentleman that yes, we want to improve the quality of life for junior doctors so that they can live and work in the same city as their partners, and we are looking at the solution to that problem, but that he might think about doing the same thing in Scotland.

[Sir Simon Burns (Chelmsford) (Con)]

Will my right hon. Friend bear it in mind that Secretary of State Dean Rusk always said that jaw-jaw was better than war-war, and that it is welcome that the negotiations have resumed with the BMA on this difficult problem? Does he also accept that everyone wishes the talks well so that we can get a meaningful agreement that ensures a seven-day NHS for the benefit of patients and their safety?

[Mr Hunt]

My right hon. Friend speaks very wisely. Indeed, I was thinking about the talks as I spoke on my mobile phone and he was having a cigarette just outside the House yesterday morning. He is absolutely right about jaw-jaw. That is why I think that across the whole House we wish the talks well. However, for them to succeed all sides need to recognise their objective, which is a safer seven-day service for patients. I hope that, on that basis, we will be able to make progress.

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

I too am glad that the Secretary of State has reopened talks with the junior doctors, but I am a little concerned by the claim that the only issue is Saturday pay, whereas the doctors tell me that they fear the danger of exhaustion. Has he seen the analysis by Cass Business School suggesting that it is impossible to avoid high levels of fatigue under the new contract?

[Mr Hunt]

What I have done in the new contract is precisely to try to address those issues by reducing the maximum number of hours that junior doctors can be asked to work every week from 91 to 72 and by stopping junior doctors being asked to work six nights in a row or seven long days in a row. These are important steps forward, and the hon Lady may want to look at Channel 4 FactCheck and other independent analysis of the safety aspects of the new contract which say that this contract is a safer contract.

[Dr Whitford]

I would just say that stating it does not make it happen. Junior doctors have looked at the rotas that have been put out as exemplars, and they will not be able to avoid high levels of fatigue. Does the Secretary of State not recognise that, now that we have more data suggesting that the weekend effect may just be statistical, we actually require clinical research because he does not know exactly what the problem is that he is trying to fix?

[Mr Hunt]

The new data that the hon. Lady has talked about have been heavily contested this week by some of the most distinguished experts on mortality rates in the country. Academics do sometimes disagree, but Ministers have to decide. The fact is that the overwhelming evidence—whether it is on cancer, cardiac arrests, maternity or emergency surgery, and whether it is in big studies, small studies, UK studies or international studies—is that there is a weekend effect. This Government are determined to do something about it, and I gently say to the hon. Lady that she might consider whether something similar should be done in Scotland.

[Mr Nigel Evans (Ribble Valley) (Con)]

18. I am fully signed up to the national health service, and that is why I want to see the reopening of Chorley A&E as soon as possible. Many of my constituents use it.In his compromising mood, will my right hon. Friend ensure that, as he talks to the junior doctors, whom I value greatly, the one thing that he will not compromise on is delivering a full service seven days a week?

[Mr Hunt]

My hon. Friend is absolutely right. In the end, the British people’s passion for, and commitment to, the NHS is based upon its offering the highest standard of care for patients. It is sometimes difficult to take these decisions and sometimes we have arguments around them. I want to reassure him that my compromising mood is not a temporary thing. We have always wanted a negotiated solution, but there is one bit that we will not compromise on: the moment that the Government start doing things that mean that we are not delivering safe care for patients is the moment that we will fundamentally shake confidence in the NHS. This Government will not allow that to happen.

[Several hon. Members rose—]

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[Helen Whately (Faversham and Mid Kent) (Con)]

14. What progress his Department has made on delivery of the NHS five year forward view.

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

We are making good progress in implementing the five year forward view, including £133 million invested in new models of care and 18 million people benefiting from extended GP access.

[Helen Whately]

It is estimated that a third of patients in acute hospitals could be better treated elsewhere, for instance at home, and in east Kent our vanguard aims to address this with new models of care, but it is early days. Will my right hon. Friend advise us of what he is doing to drive progress on new models of care, bringing together health and social care so that more people are cared for in the right place?

[Mr Hunt]

My hon. Friend is absolutely right to draw attention to what is, in a way, the most fundamental point of the five year forward view, which is getting care to people earlier to help them live healthily and happily at home. Perhaps the most significant announcement we have had in the past few weeks has been the extra £2.6 billion a year that will be invested by the end of the Parliament in general practice. That is a 14% increase that will allow us to recruit many more GPs and, I hope, dramatically improve care for her constituents and others.

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

Yesterday the Health Secretary admitted to the Health Committee that “we didn’t protect the entire health budget” in the last comprehensive spending review. I am pleased that he appears to have adopted a bit of straight-talking, honest politics, so in that spirit will he now admit that the very real cuts to public health budgets over the next few years will make it harder to deliver the “radical upgrade” in public health that his five year forward view called for?

[Mr Hunt]

In the spirit of straight talking and honesty, which I think is an excellent thing, perhaps the hon. Gentleman might concede that those cuts and efficiencies that he is talking about would have been a great deal more if we had followed Labour’s spending plans—that is, £5.5 billion less for the NHS than this Government promised, on the back of a strong economy.

[Chris Davies (Brecon and Radnorshire) (Con)]

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

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

Last week I agreed to pause the introduction of the new junior doctors contract for five days and return to talks with the junior doctors committee. I commend the junior doctors for their decision to return to talks. They have agreed to suspend the threat of further industrial action and those talks are now in their second day. We have always been clear that we want to see a negotiated solution to this dispute, and the resumption of these talks shows that the Government’s door is and always has been open to meaningful talks.

[Chris Davies]

Last Friday I met my constituent Lisa Cass whose son Ben was recently diagnosed with type 1 diabetes. Ben had been showing signs of the four T’s of type 1 diabetes—toilet, thirst, tired and thinner—and Lisa took him to her local GP for an appointment. No test was done on the day at the surgery and a blood test was booked for the following week. The following day Ben was back at his GP’s surgery after a rapid decline which could have been fatal, and the air ambulance was called. Thankfully—credit is due to the excellent medical professionals who treated Ben—he is now doing well and is managing his condition. However, this case shows the need for awareness of type 1 diabetes to be improved right across the country. Will my right hon. Friend meet me and my constituent to see what more we can do to raise awareness of type 1 diabetes and its symptoms among health professionals and the wider public?

[Mr Hunt]

Of course I am happy meet my hon. Friend and his constituents. A close friend of mine who wanted to take a place in this House ended up dying tragically early because he had type 1 diabetes and was not able to get the care that he needed, so I am very aware of those issues. What we are doing in England, which is different from Wales, is publishing transparent indicators of the quality of diabetes care CCG by CCG. Those data will be published before the summer recess and will enable us to look at the disparities in care. I am sure there is more we can do.

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

Research published yesterday by NHS Providers and the Healthcare Financial Management Association showed that half of mental health trusts had not had an increase in their budget in 2015-16 and just a quarter of providers are confident that they will receive a funding increase for this financial year, 2016-17. Will the Secretary of State finally admit that the supposed additional investment in mental health that he talks about so often has not materialised for the patients and services that need it most? What is he going to do about it?

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[Paula Sherriff (Dewsbury) (Lab)]

T2. During March, at one of my local trusts the A&E ambulance target was missed for 937 patients, and more than 4,000 patients waited for more than four hours in A&E. Staff and management agree that this is a trust in crisis, with many wards staffed to less than half the minimum safe staffing levels. Patient safety is being compromised every day. Will the Secretary of State please stop passing the buck and act to stop the downgrade of Dewsbury and Huddersfield hospitals, because it is clear that our local healthcare is in absolute crisis?

[Mr Jeremy Hunt]

The hon. Lady mentioned to me yesterday that she would raise this issue today. We are absolutely not passing the buck; the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), had a very productive meeting with her and local representatives to address these issues. She is right to have concerns about some of the safety indicators, but it is also true that summary hospital-level mortality for the trust has improved, and there are encouraging improvements in morale, as recorded through the NHS staff survey. However, there are worrying things, and we will continue to monitor them closely.

[Henry Smith (Crawley) (Con)]

T4. Last month, Coperforma took on the patient transport contract for Sussex. Unfortunately, since then there have been unacceptable and serious delays for some very sick and elderly patients. May I have assurances that the Department of Health will follow up this issue?

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[John Mann (Bassetlaw) (Lab)]

T6. Other EU countries charge us £650 million a year more for the health treatment of our citizens abroad than we do for the treatment of their citizens here. Is that because we cannot charge them, or because we have not got our act together?

[Mr Jeremy Hunt]

The answer, regrettably, is that for many years we have not got our act together. That is why I have changed the system of incentives for trusts to make sure that they get a premium for identifying EU nationals they treat and that we can then recharge the treatment to their home countries. We are, as a result, now seeing significant increases in the amount we are reclaiming from other countries.

[Dr Sarah Wollaston (Totnes) (Con)]

Community hospitals are immensely valued by the communities they serve. Will the Secretary of State meet me to discuss the proposals for south Devon, which will particularly affect my constituents living in Dartmouth and in Paignton?

[Mr Hunt]

Yes, I am happy to do that. I have a number of community hospitals in my own area. It is really important that even as the functions and jobs that community hospitals do inevitably change, we recognise that they have a very important long-term future in the NHS.

[Yvonne Fovargue (Makerfield) (Lab)]

T7. Wigan A&E is expected to take a third of the patients turned away from Chorley A&E owing to Chorley’s unplanned closure, yet it has a similar ratio of staffing vacancies. What extra resources are being given to Wrightington, Wigan and Leigh NHS Foundation Trust to help it to cope with this crisis?

[Mr Hunt]

We are making sure that neighbouring hospitals have the resources to deal with the temporary closure of Chorley A&E. The more patients that any hospital sees, the more resources it gets. This is none the less a very worrying situation that we are monitoring very closely.

[Peter Heaton-Jones (North Devon) (Con)]

The success regime review in Devon is causing real concern about the future of acute services at North Devon District Hospital. Does the Minister recognise that the unique geographical circumstances of Barnstaple mean that the reduction of any of those services will, for some of my constituents, mean a round journey of more than 120 miles to access them?

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[Bob Blackman (Harrow East) (Con)]

My right hon. Friend will be well aware that the business case for the rebuilding of the Royal National Orthopaedic Hospital has been dragging on within the NHS for more than six years. We now seem to have a decision for the Trust Development Authority to make. Will he put pressure on the TDA to approve this business case so that work can begin this summer?

[Mr Jeremy Hunt]

As my hon. Friend knows, I have done a shift as a porter in that hospital and seen for myself just how much it needs the extra investment to transform its facilities. I will happily look into the matter for him, and I am keen to see it progress as fast as possible.

[Ian Blackford (Ross, Skye and Lochaber) (SNP)]

The Minister will be aware that mortality rates in England and Wales have increased by 5.4% in 2015—the biggest increase in the death rate for decades. She will also be aware that mortality rates have been rising since 2011. Has she done any analysis of what has been behind those trends? Specifically, with the Cridland review starting, what will her Department do to negotiate with Cridland on the increase in the pensionable age to take account of the recent changes taking place?

[Lucy Allan (Telford) (Con)]

I thank the Secretary of State for working so tirelessly to get the BMA back to the negotiating table. Will he confirm that Saturday pay for junior doctors will be at a 30% premium, which is above that for any of the hard-working midwives, nurses, firefighters, paramedics and so on in my constituency?

[Mr Jeremy Hunt]

I thank my hon. Friend for her question. She makes the important point that the proposals on the table in the new contract are incredibly generous compared with the terms of the other people working in hospitals. That is why it is very important that we have some flexibility from the BMA on Saturday pay so that we can deliver the seven-day service that we all want. It is a very good deal for junior doctors, and I think that if they look at it objectively, we should be able to come to an agreement this week, but it will take flexibility on both sides.