Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

1. What recent discussions he has had with the Home Secretary on ensuring that the NHS has the workforce it needs after the UK leaves the EU.

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

The 150,000 EU nationals working in our health and care services do a brilliant job and we want them to continue doing it. I am in regular talks with Cabinet colleagues to inform both domestic workforce plans and the Government’s negotiations with the EU.

[Mr Carmichael]

The Secretary of State will be aware that that figure represents in excess of 5% of the total workforce in the NHS. This matter will have to be addressed, engaging with the recruitment sector, the employment sector and, indeed, the devolved Administrations. Is that how he will handle it?

[Mr Hunt]

We absolutely will be taking a UK-wide approach. The numbers for England are actually slightly higher than those the right hon. Gentleman talks about—about 9% of doctors and about 19% of nurses are EU nationals. However, we are still seeing doctors and nurses coming to the UK, and we need to do everything in all parts of this House to reassure them that we see them as having a bright and vital future in the NHS.

[Sir Desmond Swayne (New Forest West) (Con)]

If students with four As at A-level continue to find it very difficult to get into a medical degree in this country, is it any wonder that we have to import them from Europe?

[Mr Hunt]

My right hon. Friend makes a very important point. That is precisely why last year we increased the number of medical school places with, I think, the second biggest hike in the history of the NHS—a 25% increase. We absolutely do believe that this country should be training all the doctors and nurses that we need.

[Heidi Alexander (Lewisham East) (Lab)]

The truth is that EU staff no longer want to come here. Doctors and nurses are leaving in their droves, and thanks to the abolition of the NHS bursary, our nurses of tomorrow are going to have to pay to train. When will the Secretary of State understand that this staffing crisis has not materialised out of thin air but is directly attributable to his actions and the actions of his Government over the past seven years?

[Mr Hunt]

The hon. Lady may have noticed a little thing called Brexit that happened last year, which is the cause of understandable concern. If she looks at the facts about how many doctors came from the EU to the NHS in the year ending this March, in other words, post-Brexit, she will see that 2,200—[Interruption.] Someone asked about nurses. I happen to have that information here: 4,000 nurses joined the NHS from the EU in the year ending in March.

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

One of the consequences of free movement in the European Union is that proportionately we take in rather fewer doctors, in particular, and fewer nurses from the Indian subcontinent and other places. What assessment has the Secretary of State made of the capacity to revisit the strong relationship we had with those workforces in the immediate post-war years?

[Mr Hunt]

My hon. Friend makes an important point. We want to attract the brightest and best into the NHS from all over the world, wherever they come from, if there is a need. The only caveat I would make is that we have imported a number of doctors from very, very poor countries that actually need those skills back home. We have to recognise that we have international responsibilities to make sure that we train the number of doctors and nurses we need ourselves.

[Mr Chris Leslie (Nottingham East) (Lab/Co-op)]

The Secretary of State should know that staff shortages are not just bad for patients—they are also costing a lot more, in Nottingham and elsewhere, because of locum and agency costs. Is it not clear that if we start restricting access from the EU for staffing purposes, it will cost the NHS an absolute fortune more?

[Mr Hunt]

Let me reassure the hon. Gentleman that there is no intention to restrict access to vital professions such as the clinical professions in the NHS post-Brexit. We have said many times that we will have a pragmatic immigration policy. The long-term solution is not to depend on being able to import doctors and nurses from anywhere, because the World Health Organisation says that there is a worldwide shortage of about 2 million clinical professionals; we are not the only people facing the challenge of an ageing population.

[Mrs Maria Miller (Basingstoke) (Con)]

I welcome the Secretary of State’s words and his deeds in terms of recruiting more doctors and nurses domestically, but as he said, hospitals such as mine in Basingstoke rely on the best and the brightest from around the world. What can he do to make sure that when we need to recruit nurses, in particular, we have the travel permits and work permits available to enable them to move in swiftly rather than having to wait for long periods of time?

[Mr Hunt]

My right hon. Friend is absolutely right to make that point. Nurses are, in fact, on the Home Office’s tier 2 shortage occupation list, and they will remain so for as long as we need them to do so. The bigger issue is that for a long time we have relied on being able to import as many doctors and nurses from the EU as we need to, and that has meant that we have not trained enough people ourselves. That is bad for EU countries and for our own young people.

[Justin Tomlinson (North Swindon) (Con)]

2. What steps are being taken to increase the supply of doctors and nurses in the NHS.

[Mr William Wragg (Hazel Grove) (Con)]

12. What steps his Department is taking to increase the number of doctors and nurses working in the NHS.

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

Last year this Government announced one of the biggest expansions of medical training places in the history of the NHS, involving funding 1,500 additional medical school places every year—of which 500 start this September—and reforms that will enable universities to offer up to 10,000 additional nurse training places every year.

[Justin Tomlinson]

Swindon clinical commissioning group secured pilot funding for its successful video campaign to recruit additional GPs to fill vacancies in our local community. Will the Secretary of State commit to exploring further innovative ways to match newly qualified staff to vacancies that they might not have considered?

[Mr Hunt]

My hon. Friend makes a really important point. In parts of the country, GP shortages have been successfully addressed as the CCG has done in Swindon. An important part of this is persuading people who go into medicine that general practice is one of the most exciting and rapidly changing parts of medicine today. We have seen a 9% increase in the number of medical students choosing to go into general practice since 2015.

[Mr Wragg]

Further to my hon. Friend’s question, may I ask the Secretary of State what he is doing to ensure that enough doctors are recruited, developed and retained at my local hospital, Stepping Hill?

[Mr Hunt]

I heard a lot about Stepping Hill when I went to visit my hon. Friend; I think it was last year. I had the privilege of visiting the hospital more recently after the horrific terrorist attacks, and I commend the hospital for the brilliant work that it did in the wake of the bomb. The hospital has done a good job of recruiting; I think it has recruited 93 more doctors and nearly 300 more nurses since 2010. A national programme to help all trusts to retain their nursing staff has been launched by NHS Improvement in the last week.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

In this country, we are short of approximately 40,000 nurses, and applications for nursing places have gone down by 23%. Can the Secretary of State tell us why he and his Government think that that is the case?

[Mr Hunt]

The hon. Lady happens to work in an NHS hospital in which there has been a big increase in the number of nurses. Across the country, there are actually 13,000 more nurses working on our wards than there were in 2010, but she is right: we need more nurses and nursing staff, and that is why we are expanding the number of nurse associates. This year we are, for the first time, opening up an apprenticeship route into nursing, which means that people from non-traditional backgrounds—particularly band 3 healthcare assistants—will find it much easier to get into nursing. That is how we will expand the workforce.

[Derek Twigg (Halton) (Lab)]

According to the latest NHS indicators published by the House of Commons Library last week, the number of GPs is estimated to have fallen over the past 12 months, and the figures for March 2017 are expected to show a further fall. Why is that?

[Mr Hunt]

We have had a big increase in the number of medical students choosing to go into general practice, but we have also had an increase in the number of GPs retiring early. That is a problem that we are urgently addressing.

[David Tredinnick (Bosworth) (Con)]

May I congratulate my right hon. Friend on serving as Health Secretary for three Parliaments, and say to him that besides doctors and nurses, he should look to increase the use of properly regulated acupuncturists, herbalists, homeopaths, chiropractors and osteopaths, who would reduce the burden on doctors and nurses in the health service.

[Mr Hunt]

Over those three Parliaments, I have learned to expect questions from my hon. Friend in a similar vein, and I commend him for his persistence in championing that cause. As he knows, I think the most important thing, with all such issues, is to follow the scientific advice.

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

When the Government removed the nursing bursary and introduced tuition fees, the Secretary of State said that it was being done, as he has repeated this morning, to fund 10,000 extra student nurse places. The universities are saying that no extra places have been commissioned, however, so when will we see an expansion of student nurse training?

[Mr Hunt]

I always welcome the hon. Lady’s forensic interest in matters south of the border, but given that Scotland has just seen its first fall in life expectancy for over 100 years, she might want to think about her own constituents. With respect to the number of nurses, we now have more than 50,000 nurses in training, and we are confident that we will deliver a big increase in the supply of nurses to the NHS.

[Dr Whitford]

We still have a nursing bursary and we have no tuition charges, so the Secretary of State may want to explain why universities claim there are no additional places. In addition, we are losing almost half of junior doctors at the end of their foundation years. What action is the Secretary of State taking to find out why?

[Mr Hunt]

At the heart of this is the need to open up avenues for more flexible working for both doctors and nurses. If the hon. Lady followed what we have done in England—by successfully pioneering such working, we have reduced agency spend by 19% in a year, whereas it is still going up in Scotland—she might find the NHS in Scotland has more money to spend on her own constituents.

[Rachel Maclean (Redditch) (Con)]

Will the Secretary of State confirm what specific actions he is taking to help trusts, such as the Worcestershire Acute Hospitals NHS Trust that runs the Alex hospital in my constituency of Redditch, which are in special measures? Such trusts face special pressures in recruiting and retaining staff.

[Mr Hunt]

I welcome my hon. Friend’s first question to me. I am very aware of the issues faced by the Worcestershire Acute Hospitals NHS Trust, which I visited during the difficult winter period that it has just come through. It now has a new chief executive and leadership team, who have made a very promising start. From the experience of many other hospitals that have been through difficult patches, we have found that it is usually never about the commitment of staff, but about getting the right leadership in place. I can assure her that I saw outstanding commitment from the staff of the trust.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

The number of nurses has fallen for the first time in a decade, which is why we need fair pay now. I read in the newspapers that the Health Secretary now supports the Labour party policy of scrapping the cap, although he did not vote with us last week. Given that he supports our policy, when he soon sets the remit for the NHS Pay Review Body, will he tell it to scrap the cap, and will he publish his instructions before the summer recess?

[Mr Hunt]

I did not vote for the hon. Gentleman’s amendment, because—as usual—Labour Members have told us a lot about how they want to spend the money, without having the faintest idea of where it will come from. He is ignoring an elephant in the room: if we had followed the spending plans he campaigned for in 2015, the NHS would have £2.6 billion less this year, which is the equivalent of 85,000 fewer nurses.

[Jonathan Ashworth]

I want to talk about the spending plans for 2017, in which the Secretary of State can find £1 billion for Northern Ireland, but nothing for nurses in England. Would it not be fairer not to go ahead with further cuts to corporation tax, and to put that money towards giving our doctors and nurses a fair pay rise?

[Mr Hunt]

Let me tell the hon. Gentleman what extra money is going into the NHS: three years ago, £1.8 billion, which was not asked for by Labour; two years ago, £3.8 billion, which is nearly £1 billion more than Labour was promising; and this year, £1.3 billion. That is a lot of extra money. Why is it going in? Because, under this Government, we have created nearly 3 million jobs, and that strong economy is funding an improving NHS.

[Rebecca Pow (Taunton Deane) (Con)]

3. What steps he is taking to increase the number of dermatologists in the NHS.

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[Jeremy Lefroy (Stafford) (Con)]

7. What steps he has to secure the future of accident and emergency departments.

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

Last year our A&Es saw 1,800 more people every day within the four-hour target than they did in 2010. We also have nearly 1,500 more emergency care doctors and over 600 more emergency care consultants.

[Jeremy Lefroy]

A&E departments and associated acute care services at district hospitals such as Stafford and Burton are a critical part of the regional emergency infrastructure, enabling the large city-based departments to deal with major trauma specialist cases as well as day-to-day emergencies. Will my right hon. Friend ensure that that vital emergency infrastructure is protected, enhanced and funded?

[Mr Hunt]

I absolutely agree with my hon. Friend that an emergency care network that works well for his constituents is essential. As he fully understands, that will mean relying on a network of hospitals. I recognise the concern at his own local hospital, for which he campaigns extremely vigorously, and I assure him that I shall be watching very carefully what happens there.

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

Will the Secretary of State now confirm what the Prime Minister said when she visited west Yorkshire, namely that it was scaremongering to talk of the closure of Huddersfield A&E? Will he also confirm that we should have a real plan with a gold-standard university for a new medical school in Huddersfield, so that we can really attract talent? That would do a great deal for morale, which would lead to the recruitment of good doctors and nurses everywhere.

[Mr Hunt]

The hon. Gentleman is right to say that it is time we had more medical schools, given that health and social care will be one of the fastest-expanding areas of the economy in the coming years. I think the Prime Minister was absolutely right to say that there should be no scaremongering about important local plans that will improve services for patients.

[Victoria Prentis (Banbury) (Con)]

Will the Secretary of State reassure my constituents that the component parts of the NHS can communicate with each other sufficiently to ensure that decisions such as the one by a medical dean to remove accreditation for anaesthetic training will not lead to the closure of A&E departments in hospitals such as Houghton general, where my father was treated so well last Friday?

[Mr Speaker]

The hon. Lady’s father is a splendid fellow, and he is now in another place. [Laughter.] I was referring to another House of Parliament.

[Mr Hunt]

I was concerned about the general laughter following that comment, Mr Speaker.

I am delighted that my hon. Friend’s father was treated so well, and I very much enjoyed my visit to the hospital recently. She is right: where there are changes in the patterns of training, we need to be very careful to ensure that they do not interrupt the delivery of local services in a disadvantageous way.

[Tim Farron (Westmorland and Lonsdale) (LD)]

The boundaries of the sustainability and transformation partnerships are bound to cause concern about the future of A&E and other acute departments given the nature of them. My area, south Cumbria—relatively sparsely populated and rural—is lumped in with Lancashire, which is largely urban. Will the Secretary of State confirm that the voices of rural communities will not be dwarfed by those of the larger urban ones, and in this week, as we celebrate the 25th anniversary of Westmorland general hospital, will he give guarantees that it will not be closed and will indeed not receive any downgrading as a result of the STP process?

[Mr Hunt]

Westmorland general hospital has a very important future in the NHS and I am happy to give the hon. Gentleman that assurance. I do not think he should be concerned about STP footprints covering both rural and urban areas. However, where there is an issue in his constituency, and many others, it is the response times for ambulances in the most remote areas, and we are looking at that.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Another threat to A&E units is the capped expenditure process, which will mean hundreds of millions of pounds cut from NHS budgets. That was sneaked out during the election, but so far we have had nothing but silence from this Government. It is time that we had the truth: when did the Secretary of State sign off these plans and when is he going to publish them?

[Mr Hunt]

The capped expenditure process is an NHS England initiative to meet its statutory duty to live within its budget, and I support the principle that in a period where real expenditure on the NHS is going up by £5 billion, those benefits should be spread fairly among patients in all parts of the country.

[Maria Caulfield (Lewes) (Con)]

8. What progress is being made on improving end-of-life care.

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[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

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

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

Yesterday I updated the House on the action that we are taking to address delayed discharges from hospitals in advance of the winter. Since February, there has been a record decrease in delayed discharges, but faster progress is still needed to free up beds for the sickest patients and to reduce pressure on A&Es. Yesterday we therefore set out further measures to support the NHS and local government to reduce delays, including specific reductions required in all local areas, a prospective review of next year’s social care funding for poorly performing local authorities, and immediate CQC reviews in the worst-performing areas.

[Bridget Phillipson]

The latest figures from the British Medical Association show a huge rise in the number of patients with mental health conditions who are being sent hundreds of miles away from home for treatment. Is not any talk of parity of esteem meaningless unless and until patients can access the support they need close to home?

[Mr Hunt]

I completely agree with the hon. Lady that that is a very important issue. It is particularly important because people with mental health conditions need regular visits from their friends and family to help them to get over a crisis. Indeed, their chances of getting discharged and being able to go home are much higher when they are nearer home. She will be aware that we have a commitment to eliminate all out-of-area placements for children by 2020, and we are making big efforts with adults as well.

[Edward Argar (Charnwood) (Con)]

T4. Leicester and Leicestershire MPs, irrespective of party and led by the hon. Member for Leicester West (Liz Kendall), are united with local people, patients and medical professionals in opposition to NHS England’s badly thought out and, frankly, wrong proposals to close Glenfield hospital’s children’s heart unit. Can my right hon. Friend reassure me that he continues to appreciate the strength of feeling on this issue and that he will ensure that the eventual decision reflects the responses received to the consultation?

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

Today is the sixth anniversary of the publication of the Dilnot commission’s report on the funding of social care. In those six years, Ministers have legislated for a cap and a floor on care costs, and then abandoned those measures. They brought forward disastrous proposals in their manifesto for what became known as the “dementia tax”, and they appear to have abandoned those measures, too. Will the Secretary of State confirm that those policies have indeed been abandoned? Will he tell me, and more than 1 million people with unmet care needs, when he expects to have some new proposals for reform?

[Mr Hunt]

I have great respect for the hon. Lady, because she campaigns consistently on this issue, but I do not think that what she says is a fair reflection of what has happened. In the last year of the previous Labour Government, 45,000 people had to sell their home to pay for their care costs, whereas this Government have made it the law that no one has to sell their home. There is more work to do, but we have made important progress and will continue to do so.

[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

T5. Nothing is more important than that people can access a GP when they need one. With that in mind, will the Minister join me in welcoming the move made by South Tees clinical commissioning group to enable 90,000 more appointments a year to be generated for people in Middlesbrough, Redcar and Cleveland by ensuring that appointments are available on evenings, weekends and bank holidays?

[Ronnie Cowan (Inverclyde) (SNP)]

T2. With the Scottish Government now committed to a soft opt-out system for organ donation similar to that implemented in Wales in 2015, is it not time that the UK Government followed the lead of the Welsh and Scottish Governments by introducing a similar system south of the border?

[Mr Hunt]

There is a lot of merit in the opt-out system that has been developed in Wales for some time and is now happening in Scotland. We are looking closely at the evidence, but we have a lot of sympathy with this. If the system does lead to an increase in organ donations, it is certainly something we would want to pursue here.

[Matt Warman (Boston and Skegness) (Con)]

T6. One-year cancer survival rates are now at a record high of 70%, but does the Minister agree that we should and can go further by improving early diagnosis and screening?

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[Matthew Pennycook (Greenwich and Woolwich) (Lab)]

T7. At the height of the recent election campaign, NHS England took forward plans to merge, in effect, six south London CCGs, including Greenwich CCG, under one single chief officer. Does the Minister agree that that would be a retrograde step, not only in terms of local accountability, but at a time when primary care has been devolved downwards and all the emphasis is on collaboration and integration at a local borough level?

[Mr Hunt]

I think the answer is that this varies from area to area. The CCGs grew up organically following the Health and Social Care Act 2012. Some parts of the country are discovering that the groups can be more effective if they combine forces, but these things have to be decided locally.

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

In addition to the Government’s welcome focus on mental health first aid, may we have equal focus on mental health keep fit, looking particularly at the Mental Health Foundation’s 10 pointers, so that we can all keep our mental health in good condition?

[Mr Hunt]

As ever, my hon. Friend makes an important point. I think that every child should leave school as knowledgeable about how to remain mentally resilient as about how to be physically healthy.

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

T9. What recent assessment has the Secretary of State made of the financial sustainability of Coventry and Rugby clinical commissioning group?

[Mr Hunt]

Like all clinical commissioning groups, Coventry and Rugby CCG is under a great deal of pressure, but our view is that, given the recent funding increases, it should be entirely possible for it to be sustainable.

[Martin Vickers (Cleethorpes) (Con)]

May I return the Minister’s attention to the issues facing Northern Lincolnshire and Goole NHS Foundation Trust? My constituents are worried that both Grimsby and Scunthorpe hospitals are in special measures for the second time in as many years. Will he meet me and neighbouring MPs to discuss the situation?

[Mr Hunt]

I am more than happy to meet my hon. Friend, but he should be confident that we have put in place a substantial support package, including a buddy relationship with another trust and special teams from NHS Improvement, to turn the situation around.

[Liz Twist (Blaydon) (Lab)]

T10. What action does the Secretary of State intend to take to address the link between suicide and socioeconomic deprivation highlighted in the Samaritans’ “Dying from inequality” report as he seeks to reduce the suicide rate by 10% by 2020?

[Mr Hunt]

We will look carefully at the Samaritans’ report, as we always do with what the Samaritans say. I think the signs are that our policies are having an impact and reducing suicide rates significantly, but suicide remains the biggest cause of death among men under 50.

[Andrew Bridgen (North West Leicestershire) (Con)]

Funding our national health service to meet the needs of UK residents is one proposition; funding an international health service open to the world is another proposition entirely. Are there any indications that advance charging for non-emergency treatment for overseas patients is putting more money into our NHS?

[Karin Smyth (Bristol South) (Lab)]

NHS Property Services has just signed a £1 million lease on a central London location. May I suggest that other properties were available? Would the Secretary of State like me to inquire in my constituency, where NHS Property Services increased Knowle West Health Park’s rent threefold? Better value for the taxpayer is available.

[Mr Hunt]

I will be happy to look into the matter if the hon. Lady sends me the details.

[Will Quince (Colchester) (Con)]

I know that Ministers share my passion for ensuring that a bereavement suite is attached to every maternity unit in the country. What steps can the Government take to make that a reality?

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[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

During the election campaign, a lady in my constituency told me that she had had to wait nearly four hours for an ambulance to arrive at her home to help her off the floor. Does the Secretary of State have confidence in the ambulance service in London and other regions where targets have been consistently missed? Will he now look at extra resources for the ambulance service across the country, which is so urgently needed by all of our constituents?

[Mr Hunt]

If I may say so, that was a brilliant recovery. The hon. Lady is absolutely right to focus her attention on the performance of ambulance services. They are under pressure. They are hitting around 71% for their category A calls, and the target is to hit 75%. However, there are some bigger issues with the way those targets work, which we are looking at. Her ambulance service has just had a Care Quality Commission inspection.

[Dr Sarah Wollaston (Totnes) (Con)]

As a result of the capped expenditure process, the wider Devon sustainability and transformation plan is being asked to make £78 million of savings at short notice—within the next nine months. Does the Secretary of State share my concern about the impact on patients, the short timeframe and the undermining of savings already agreed by the STP? Will he meet me to discuss this matter and the wider CEP?

[Mr Hunt]

I am more than happy to meet my hon. Friend. The principle behind the capped expenditure process is that we should have fairness between patients in different parts of the country. We should not see patients in one part of the country disadvantaged because the NHS has overspent in their neighbouring area, but the way in which we implement the process must be sensitive and fair. We must ensure that we get it right.

[Rosie Cooper (West Lancashire) (Lab)]

What advice would the Secretary of State give to my constituents who receive their urgent care from Virgin Care, and are told that wounds should be dressed only once and that, in the event that they need to re-attend, they should purchase further dressings from the local chemist? Free at the point of delivery?

[Mr Hunt]

I suggest that the hon. Lady gets in touch with the details. What I would say is that when care is not satisfactory—whether it is delivered by the public sector or the independent sector—we have an independent inspection regime to root out the problems.

[Maggie Throup (Erewash) (Con)]

I was delighted to hear that, in answer to my hon. Friend the Member for Boston and Skegness (Matt Warman), the Minister was positive about the progress of genome screening. On a recent visit to Nottingham University, I saw similar techniques applied to Alzheimer’s research. Will he back using the process for that, as well as for cancer diagnosis and treatment?