Coronavirus

Jeremy Hunt Excerpts

Wednesday 11th March 2020 Commons Chamber

[Jeremy Hunt (South West Surrey) (Con)]

I thank both Front Benchers for the highly responsible way in which they are approaching this crisis, which shows Parliament at its best. I also thank the Health Secretary for his role in getting those very generous words for the NHS into the Chancellor’s speech this afternoon; they have been widely welcomed across the NHS and were much needed.

The chief medical officer says that we would have to be “pretty optimistic” to think we could contain the virus in this country. The deputy chief medical officer says that she thinks we may hit the peak in the next fortnight. We now have more reported cases in this country than there were in Wuhan when it went into lockdown. We know that the Secretary of State will rightly follow the science, but could I ask him to give his judgment to the House as to whether he thinks we still can contain the virus in this country and, if not, whether he expects to move to the delay phase very soon so that families up and down the country can start to prepare their loved ones for any precautions they might want to take?

[Matt Hancock]

I want to make two comments in response to my right hon. Friend. First, I want slightly to correct the point about the deputy chief medical officer, who said that in the next couple of weeks we may see the numbers starting to rise fast to their peak. We do not expect numbers to peak in the next fortnight. We expect them to continue to rise after that. The peak would be in a matter of a couple of months, rather than a couple of weeks. This is a marathon, not a sprint. Secondly, the World Health Organisation declaring this afternoon that the virus is globally now regarded as a pandemic indicates that the WHO thinks it will spread right across the world, and that will have a significant impact on the way in which countries around the world will now take forward their plans. Of course, the expectation that this may well happen was all within the plan that we set out. We will be discussing that at the Cobra meeting tomorrow.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 10th March 2020 Commons Chamber

[Helen Whately]

Work has already been done by the regulating bodies. For instance, we are already speeding up the process for nurses from overseas who want to come here to work in the NHS. I would be very happy to have further correspondence with the right hon. Member about the specific problem, and would be delighted if he could send me an invitation to make the visit that he mentioned.

[Jeremy Hunt (South West Surrey) (Con)]

I congratulate the Department on securing the NHS visa but, as the Minister knows, it does not apply to nurses and care workers in the social care sector. What is the Department’s assessment of the gap there will be in the social care workforce as a result of this new immigration policy, and how are discussions going with the Home Office and No. 10 on that issue?

[Helen Whately]

I thank my right hon. Friend for his question. I am well aware of concerns in the social care sector, particularly in areas where there are higher vacancy rates. It is important that employers make sure that they are taking the steps they can take to make sure that social care jobs are attractive and, of course, well paid, as they should be. I recognise as well a role for Government in this, supporting the role of working in social care, and overall making sure that we come together and fix the social care crisis.

Coronavirus

Jeremy Hunt Excerpts

Monday 9th March 2020 Commons Chamber

[Matt Hancock]

Let me start by concurring with what the hon. Gentleman said about the legislation. It should be taken through on a cross-party basis. I should of course be happy to talk to him about the proposals in that legislation, and also to ensure that the clinicians are able to explain why they are necessary and proportionate. I am grateful for the tone that he has taken throughout, recognising that our responses are led and guided by the science.

The hon. Gentleman asked about the NHS and its preparedness. There are record numbers of nurses and doctors, as I said. The 8,700 increase in the number of nurses over the past year is welcome in this context. We are, as he said, scaling up intensive care beds, and making sure that we have as much availability of ventilation equipment and, crucially, the skilled and trained people to use it, because ventilation equipment, without trained people, is dangerous. On that subject, we are making sure that we have the oxygen needed to go into those ventilation kits, working with oxygen suppliers to make sure that that is available.

The hon. Gentleman also asked whether GPs would have access to the protective equipment that they need, and the answer is yes. We have stockpiles of protective equipment and, again, we will release it at the right time. I am working closely with NHS England to make sure that that happens.

The hon. Gentleman asked about social care. He is absolutely right to draw attention to the importance of making sure that the staff in social care are well enough supported, including if they are sick and, critically, because many people in residential social care are some of the most vulnerable. Those living in the community in receipt of social care are likely to be vulnerable, whether because of prior health conditions or because they are elderly, or both. That is an area of significant attention, and we will update the existing guidance this week with further information for social care providers.

The hon. Gentleman asked about public health budgets which, of course, are going up. He also asked about home working and the cancellation of large events. We are not at this stage proposing the cancellation of mass events, because we are following the scientific advice that that is not what is proposed at this stage. Home working and flexible working are things that, in many cases, are advocated anyway. People will make their own decisions as to when that is appropriate. What we are saying from the Government point of view is that people should follow the public health advice so that, for instance, if they are returning from an affected area and they have symptoms they should stay at home, and that means home working. Over the weekend we added northern Italy to the list of places to which the Foreign Office does not recommend travel except in exceptional circumstances. We recommend that people returning from northern Italy self-isolate if they are symptomatic.

The hon. Gentleman asked about the food supply. We are confident that food supply will continue, even in our reasonable worst-case scenario. We have been talking to the supermarkets for some time about this scenario. I appreciate that on Friday there was discussion about whether every single supermarket executive had been involved in those talks. If any further supermarket executive wants to be involved in those conversations they should get in contact, but those conversations have been ongoing, and it is important, especially as we ask more people to self-isolate and stay at home, that we can ensure that we get supplies that are needed to the people we are asking to stay at home.

The hon. Gentleman asked about statutory sick pay, and I can confirm that we are proposing to put changes to statutory sick pay in the legislation, and I am happy to go through the details with him in the talks that I mentioned at the beginning of my response.

Finally, on Parliament, of course, this is a matter for the whole House. I know that the Commission met this morning, and I think that parliamentary scrutiny of decisions of the magnitude that we are having to take in response to coronavirus and their novel nature is incredibly important, and I will do all that I can to ensure that Parliament remains open.

[Jeremy Hunt (South West Surrey) (Con)]

I commend the Health Secretary for the way in which he is handling the crisis and ask him to reflect on what we now feel we have learned from the situation in China, given that yesterday was the first day when reported new cases in the UK exceeded reported new cases in China. The chief medical officer told the Select Committee that he hoped that a smaller proportion of the population in the UK would get the virus, given what we can learn from what happened in China, but one of the reasons for growing concern among our constituents is that the only number out there is the 80% reasonable worst-case scenario. Is it not time for the Health Secretary to share his central estimate of what proportion of the UK population he thinks will get the virus, even though we would all understand that that estimate might change over the passage of time?

[Matt Hancock]

I pay tribute to the Chair of the Select Committee for the way in which he has handled this—for instance, in demonstrating the need for transparency in the questioning of the chief medical officer last week. I will take away his point on the need for a central estimate. The figures out there relating to the proportion of people who will get the virus are a reasonable worst-case scenario. On the central estimate, there are still things that we do not know about the spread of the virus through China—in particular, whether the degree to which the slowing of the increase in cases in China is because the virus has reached a large proportion of the population and there is a large proportion who are not symptomatic, which would mean that the mortality rate was lower than otherwise thought; or whether the significant measures that the Chinese have taken are having a significant effect, and that therefore, as and when they are lifted, the virus will continue to spread. Either of those options is possible, and we do not know which one it is, but whichever it is, the approach that we are taking in the UK is the right response to both of those scenarios.

Coronavirus

Jeremy Hunt Excerpts

Tuesday 3rd March 2020 Commons Chamber

[Matt Hancock]

I am grateful to the hon. Gentleman for the constructive approach he has taken from the start, and I will seek to address all the questions that he has raised. His first point was about statutory sick pay. For those who need to self-isolate for medical reasons to protect others, that counts as being off sick. They do not need to go to a GP, because there is a seven-day allowance for self-declaration. I hope that that addresses that point directly—[Interruption.] We keep all matters on this under review because, broadly, I agree with him on the principle that he has set out. On the NHS, he asked about resources. We have already increased resources to the NHS and we stand ready to do so if that is necessary.

The hon. Gentleman asked about doctors and revalidation. In legislation, we are proposing to make revalidation simpler. We will bring forward those measures, and of course we will engage with the Opposition on the potential measures as and when that is necessary.

On public health allocations, we have already been clear that the public health grant is going up in aggregate. As my right hon. Friend the Communities Secretary set out last week, we have seen a 4.4% real-terms increase in local authority budgets this year, and the social care budget is going up by £1 billion. I think that that takes into account the issues that the hon. Gentleman raised.

The hon. Gentleman also raised engagement with the World Health Organisation We have supported the WHO with extra funding. On engaging with the EU, I have regular engagement with colleagues from across Europe, and some of the reports I have seen in the newspapers are not accurate, because the questions of engagement with the EU on matters of health security are a matter for the negotiations, as set out on Thursday in the negotiations document.

[Jeremy Hunt (South West Surrey) (Con)]

I would like to commend the Health Secretary for the calm way in which he has been dealing with this crisis and for his very clear public messaging. He called me last Friday to tell me that there had been a coronavirus outbreak in my constituency. I would like to thank the staff at the Haslemere health centre for their extraordinary commitment in working over the weekend so that the health centre could be open again on Monday morning. This shows, however, that some of the people at greatest risk are our frontline health workers. One study in China showed that 7% of the people who got the virus in Wuhan were health workers. Will the Health Secretary confirm whether hospitals, GP surgeries, care homes and nursing homes have enough face masks, gloves and hand gel, and will he outline any other measures he is taking to ensure that NHS staff are kept safe?

Maternity Services: East Kent

Jeremy Hunt Excerpts

Thursday 13th February 2020 Commons Chamber

[Ms Dorries]

I thank the hon. Gentleman for his collaborative tone on this issue. I think he may have missed my last comment, which was that NHS England and NHS Improvement will be commissioning an independent inquiry. That has been decided this morning, so that will happen.

On the hon. Gentleman’s first question about what is happening to support the trust now, NHS Improvement is in there. As I said, the chief midwife, Jacqueline Dunkley-Bent, has sent in some of the best midwives, obstetricians and neonatologists in the country from outstanding trusts to support the trust. They are having twice-daily huddles on the wards, which is where multi- disciplinary teams get together and discuss on an ongoing and regular basis what is happening on the wards, what disciplines are involved and what measures are being taken. We have fresh eyes looking at the cartography that measures foetal heart rates and contractions. We have a second pair of eyes reading those cartography read-outs, so it is not just down to one midwife.

A huge amount of support has gone into the trust. As I said, it is today a safe place for anyone to give birth. We are also asking HSIB to go in to do that deep dive to look at historical issues. Whether that will continue in light of the fact that NHS England is commissioning an independent inquiry is something I need to find out when I leave the Chamber. However, I want to reassure the hon. Gentleman and everybody that this is an issue that I take very, very seriously.

Babies bring joy and happiness when they arrive, and every family—every mother, every father and, indeed, every grandparent—is entitled to know that when they or their relative is in hospital, the delivery will happen in a safe environment, with the very best care. I can say that that is the case at East Kent now, and I—we all—will strive to make sure that it is the case at every hospital.

[Jeremy Hunt (South West Surrey) (Con)]

I thank my right hon. Friend the Member for North Thanet (Sir Roger Gale) for tabling this urgent question and for speaking so powerfully. I also thank the Minister for her work to respond to this. I, for one, hope that she continues in her role after the reshuffle because of her incredible commitment to patient safety.

What worries members of the public is that the NHS appears to be much better at transparency about care failures, but not always much better at learning from those failures. Does the Minister agree that that underlines the vital importance of the independent investigations that HSIB does into every Each Baby Counts incident, and the need for safe spaces so that doctors, nurses and midwives can talk openly and freely about what they think went wrong? Will she also consider publishing the report that CQC has already done into what is happening to reassure families that we are indeed confronting all these difficult issues?

[Ms Dorries]

My right hon. Friend is absolutely right. One of the issues in dealing with the ongoing problem—this is a bit like the airline industry—is that we need to generate a culture in which NHS staff feel able to speak up without fear of blame or litigation and we can take learning forward. Another issue is that when we have inquiries, we should take the recommendations and ensure that they are implemented. That piece of work is also going forward, along with HSIB and inquiries. We should look at implementing absolutely everything that we can to make sure that the safest possible environment exists.

Wuhan Coronavirus

Jeremy Hunt Excerpts

Tuesday 11th February 2020 Commons Chamber

[Matt Hancock]

I am grateful for the support of the Opposition for the measures we have taken. The best way to deal with an outbreak like this is on a bipartisan basis. The approach the House has taken has thus far helped to enable as efficient and capable a response as possible to what is obviously a very difficult situation. I entirely agree with the hon. Gentleman that the use of the powers we brought into force yesterday must be proportionate. Enforcement, too, needs to be reasonable. That is a very important consideration.

The hon. Gentleman is right to ask about NHS 111. We will ensure that NHS 111 services have support available. We have plans in place to expand support for those taking the calls on 111 if necessary. Thus far, we have not had to do that. Compared with the huge scale of the millions of calls to NHS 111 that are made, the number concerning those who think they may have coronavirus is still relatively small, but of course we stand ready to do that if necessary.

On timing, as far as I understand it business managers have not yet scheduled the debate on the affirmative procedure for the statutory instruments I presented yesterday. They are made affirmative—as in, they become law—the moment they are signed and thus are law now. They remain in force, with the requirement for Parliament to debate and pass them within 28 days. We will ensure that that happens. They then stay in force for two years, or until the end of the public health emergency is declared.

The hon. Gentleman asked about links with the local authority in Brighton. That is an incredibly important question. I understand that the links have been very close and that the public health officers in Brighton have been working very closely with Public Health England. I thank them, as well.

The hon. Gentleman asked about access to capital for GPs. If GP facilities or other parts of the NHS need capital upgrades, we will of course look at that. In the first instance, though, it is very important that people do not go immediately to their GP, but rather call NHS 111. If they do go to A&E, we will ensure that pods are available so that people are separated from the vast majority of those going to A&E, as we do not want them to be contaminated.

The advice remains absolutely clear: if you suspect that you may have coronavirus, call 111 and do not leave home until you have spoken to a clinician.

[Jeremy Hunt (South West Surrey) (Con)]

I thank the Health Secretary for the way he has handled this crisis. We are all very aware that appearances before this House are only a tiny fraction of the huge amount of work going on behind the scenes. I also thank the shadow Health Secretary for the non-partisan way his party is approaching this public health crisis.

One of the most distressing things we see on TV in relation to what is happening in China in the affected province is people being denied basic hospital treatment because the hospitals are full, whether because of coronavirus or another illness they happen to have. Will the Health Secretary give some idea of the preparations that are being made to protect people who will continue to have urgent illnesses, such as cancer, which will continue to need to be dealt with very promptly, even in such a situation as the virus exploding in the UK?

[Matt Hancock]

This is a very important strand of our prepare and mitigate policy to ensure that should things get worse here the NHS is fully prepared. The NHS has the capability now to cope with the very highest level of intensity and isolation with 50 cases, and the capability to expand that to 500 cases without an impact on the wider work of the NHS. If the number of cases gets bigger, we will of course need to take further steps. As my right hon. Friend knows from his time in my shoes, extensive plans are already in place for how they should happen if we reach that eventuality.

NHS Funding Bill

Jeremy Hunt Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[Jeremy Hunt (South West Surrey) (Con)]

It is a great pleasure to follow the hon. Member for Ellesmere Port and Neston (Justin Madders). We were on opposite Front Benches for many years, but I always had great respect for his detailed understanding of healthcare issues and the integrity of his approach. He once wrote me a private letter. I will not divulge its contents; suffice it to say that it demonstrated his recognition that we are human beings on this side of the House. That was a rare admission from a member of the Labour party, and I am very grateful to him for it.

I will not be supporting the hon. Gentleman’s amendments and new clauses, but I think he is right to raise the issues that he has raised, and I want to propose some different ways of achieving his objectives. I am very pleased that he has raised the issue of mental health and mental health funding, and I therefore wish to speak to amendments 1 and 2 and new clauses 1, 2 and 3.

I think that all hon Members have knocked on the doors of constituents—I did as Health Secretary—and been confronted by people who have been given a totally inadequate service in relation to their mental health or that of their children. One person I met, who was not a constituent, was a very remarkable gentleman called Steve Mallen. He had a son, Edward, who had an extraordinarily promising life in front of him. Edward had secured a place at Cambridge, he was very musical, he had friends; and then, in the year before he was due to go up to Cambridge, he had a six-month period of severe mental illness and ended up killing himself, five years ago this Sunday. I think that all of us have to have people like Edward Mallen at the back of our minds, and to remember, as we enjoy a normal weekend, that for Edward’s family Sunday will be a very, very challenging day.

I believe we could all come up with stories like that. I mentioned Steve Mallen because he has chosen to relive the grief that he feels for his son Edward. He made a promise at Edward’s funeral that he would campaign to ensure that other people received the mental health provision that Edward did not receive. He subsequently set up the Zero Suicide Alliance with an inspirational NHS chief executive called Jo Rafferty, who runs Mersey Care. It is a fantastic project, and I am pleased to say that the Health Secretary has agreed to a meeting to discuss continued funds for the alliance. As we think about people like Edward, it is important to understand just why funding for mental health has not increased at the rate at which it should have, and why we do not have the service provision that we should have.

[Stephanie Peacock (Barnsley East) (Lab)]

Does the right hon. Gentleman share my concern about the fact that the mental health charity Combat Stress has said it is unable to accept any more new cases? Support for the charity, which helps military veterans, has fallen in the last few years, and 90% of its income consists of public donations.

[Jeremy Hunt]

I am well aware of the fantastic work done by Combat Stress, and I think it is important for it to receive the funds that it needs. However, when we look at the root cause of the problems in mental health funding, we see that on both sides of the Committee there is some culpability, and that on both sides it was completely unintentional. I hope that the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), will forgive me if I start with the other side.

The truth is that when targets were introduced in the 2000s for A&E and elective care waiting times they were hugely effective, but they were introduced only for physical healthcare. As a result, during the austerity period when the budgets of clinical commissioning groups or primary care trusts were under pressure, money was sucked out of community and mental health services. That is at the heart of the problem that has bedevilled mental health care. The position changed in 2012, because a Labour amendment to the Bill that became the Health and Social Care Act 2012 instituted parity of esteem between mental and physical health. We were the first country in the world to do that.

As a Conservative, I am always deeply sceptical about legislating for principles, because I am not totally convinced that it ever changes anything, but that amendment did bring about a significant and very practical change, which I discovered myself as Health Secretary. No Health Secretary and no NHS chief executive ever wants to have to say publicly that the proportion of funding going to mental health has fallen on his or her watch, because that would be a direct contradiction of the principle of parity of esteem. That is why, since this became law, we have seen the proportion of funding of the entire NHS budget going into mental health either stabilised or starting to go up. That should put to rest some of the Opposition’s concerns about the risk of a decreasing proportion of NHS funding going into mental health, but it does not solve the problem.

The issue when it comes to mental health services for our constituencies is not about political will or funding; it is about capacity. We have an enormous number of ambitious plans on mental health. I unveiled one—in 2016, from memory—that said we would treat 1 million more people by 2020 and increase spending by several billion pounds. The mental health “Forward View” had some very ambitious plans, and we had the children and young people’s Green Paper. There are also targets to increase access to talking therapies, which are essential for people with anxiety and depression. But if we do not increase the capacity of the system to deliver these services, in the end we will miss the targets. For example, the children and young people’s Green Paper is an incredibly important programme, with a plan for every secondary school in the country to have a mental health lead among the teaching staff who would have some of the basic training that a GP would have to spot a mild mental health illness, anxiety or depression, or a severe one such as OCD or bipolar, and therefore know to refer it—[Interruption.] I am getting a look. I understand, and I will draw my comments to a close—

[Steve Double (St Austell and Newquay) (Con)]

No, you are meant to face the Chair.

[Jeremy Hunt]

Thank you. I am sorry—I am new to this Back-Bench stuff. Apologies for not facing the Chair. I will now do so more diligently.

The point I wanted to make, Dame Rosie, is simply that the children and young people’s Green Paper requires an increase in the children and young people’s work- force of—from my memory as Health Secretary—9,000 additional people. The CAMHS workforce is actually only 10,000, so the Green Paper alone requires a near doubling of the mental health workforce. Far be it from me to teach experienced Opposition Members how to scrutinise the Government or hold them to account, but if they really want to know whether we are going to deliver on those promises, looking at the workforce numbers in children and young people’s mental health in the CAMHS workforce is the way to understand whether we are going to be able to deliver those extra commitments.

[Mark Tami]

Is not that the key point? Young people’s experience of CAMHS on the ground is that they just cannot get an appointment. Rather than being seen in the early stages, as they should be, they often get seen only when they have become suicidal or have tried to commit suicide. That is the wrong way round.

[Jeremy Hunt]

The hon Gentleman is absolutely right. On both sides of the Chamber, we are totally committed to the NHS and totally committed to transforming mental health services, but I am afraid that young people are regularly turned away from CAMHS and told, “You are not ill enough yet. Come back when things get worse.” Why is that such a tragedy? Because half of all mental health conditions become established before the age of 14, and the way to reduce the pressure on the NHS is to intervene early. That is what does not happen.

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

In support of what my right hon. Friend has said, I think that one of this Government’s great initiatives in respect of children’s mental health in the past decade has been the work done through the health and wellbeing boards. I know that this was strongly supported by him when he was Secretary of State and by other Ministers since. Every local authority, using its connections with the schools and general practitioners in its local area, has a plan that reflects local need. This has evolved over the years to change the commissioning priorities at local level, which is reflected in what is purchased from NHS providers to address local need. I offer as an example an online counselling service that has been introduced to serve my constituents. The feedback from young people is that it is tremendously more accessible than what was there previously, and it is a lot less expensive than the type of services previously being commissioned. That demonstrates the commitment we have on the Government Benches to addressing children’s mental health.

[Jeremy Hunt]

My hon. Friend has huge experience of this in local government, and he is absolutely right. The big surprise for me when we were conceiving of the children and young people’s Green Paper was the willingness of NHS professionals to accept that the people who know the kids best are their teachers, rather than GPs, because the teachers see them every day and are probably going to be better at spotting a mental illness and being able to do something about it.

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

I would like the right hon. Gentleman to consider whether he supports an important proposal that we put forward at the general election. It was that there should be a trained counsellor in every school to spot mental health problems. Putting that burden on to teachers and others in the teaching profession is the wrong way forward. In Wales, we have the experience that having trained counsellors in schools relieves the pressure on CAMHS. If we want to take children’s mental health seriously and relieve the pressure on CAMHS, we should do this. I have a couple of schools in my constituency that have trained counsellors, and it really helps. The other thing that we proposed was to have a mental health hub in every local authority area, so that children and their families in crisis would have somewhere to go where there would be professionals and charities that work in mental health. Those ideas that we put forward really should be considered, and I wonder whether the right hon. Gentleman supports them.

[Jeremy Hunt]

They are both interesting ideas. The plan at the moment is that resource will be given to schools for a teacher to volunteer to devote a proportion of their time to this, and that there will be funding for them to do so, similar to the way in which schools have a special educational needs co-ordinator who is a teacher devoted to the special needs of the pupils in that school. I personally would have no objection if that were a separate counsellor, but this needs to be a resource inside the school—someone who is regularly at the school and who knows the children there. That is the important thing.

With permission, Dame Rosie, I would like to comment on some of the other amendments and on some of the comments made by the hon. Member for Ellesmere Port and Neston. He rightly talked about the issues around maternity safety, and I agree that it is vital that we continue the maternity safety training fund. That is not directly the subject of one of his amendments, but it is indirectly connected to it. Twice a week in the NHS, the Health Secretary has to sign off a multi-million pound settlement to a family whose child has been disabled for life as a result of medical negligence. What is even more depressing is that there is no discernible evidence that that number is going down. The reason for that is that when such tragedies happen, instead of doing the most important thing, which is learning the lesson of what went wrong and ensuring that it is spread throughout the whole country, we end up with a six-year legal case. It is impossible for a family with a child disabled at birth to get compensation from the NHS unless they prove in court that the doctor was negligent. Obviously, the doctor will fight that. That is why we still have too much of a cover-up culture, despite the best intentions of doctors and nurses. This is the last thing they want to do, but the system ends up putting them under pressure to do it. That is why we are not learning from mistakes. I am afraid that that is the same thing that was referred to in the Paterson inquiry report that was published today: the systemic covering up of problems that allowed Mr Paterson’s work to carry on undetected for so long. The hon. Member for Ellesmere Port and Neston is absolutely right on that.

I think it is a fair assessment of safety in the NHS to say that huge strides have been made in the past five or six years on transparency. It is much more open about things that go wrong than it used to be, and that is a very positive development. But transparency alone is not enough. We have to change the practice of doctors and nurses on the ground, and that means spreading best practice. Unfortunately, that is not happening, which is why, even after the tragedies of Mid Staffs, Morecambe Bay and Southern Health, we are facing yet another tragedy at Shrewsbury and Telford—I see my hon. Friend the Member for Telford (Lucy Allan) in her place, and she has campaigned actively on that issue. The big challenge now is to think about ways to change our blame culture into a learning culture.

[Jerome Mayhew (Broadland) (Con)]

I declare an interest in that, a long time ago, I was a personal injury barrister, including in cases of medical negligence. Does my right hon. Friend think a possible solution to the resistance to blame in the national health service might be the adoption of a no-fault compensation scheme much like that in the personal injury sphere in New Zealand, for example?

[Jeremy Hunt]

My hon. Friend makes an important suggestion. We considered such a thing when I was at the Department of Health and Social Care, but we decided that it would be very expensive. One of the tragedies is that many people who suffer actually make no legal claim because they are so committed to the NHS, so we have a system that gives huge amounts of money to one group of people and nothing at all to those who decide that they do not want to sue the NHS.

We need to look at tort reform, because most barristers and lawyers working in this field want the outcome of their cases to be that the NHS learns from what went wrong and does not repeat it. Unfortunately, that is not what happens with the current system. The involvement of lawyers and litigation causes a defensive culture to emerge, and we actually do the opposite. We do not learn from mistakes, and that is what we now have to grip and change.

I want to say something positive, because if we do change that we will be the first healthcare system in the world to do it properly. We are already by far the most transparent system in the world, mainly because people in this place are always asking questions about the NHS—and rightly so. Healthcare systems all over the world experience the same problem. It is difficult to talk openly about mistakes because one can make a mistake in any other walk of life and get on with one’s life, but if someone dies because of the mistake, that is an incredibly difficult thing for the individuals concerned to come to terms with. That is why we end up on this in this vicious legal circle.

On capital to revenue transfers, I was a guilty party during my time as Health Secretary. There were many capital to revenue transfers because we were running out of money, so capital budgets were raided. I fully understand why the Opposition wanted to table amendment 3, but I respectfully suggest that the trouble is that it would result not in more money going into the NHS but in more money going back to the Treasury from unspent capital amounts. The real issue of capital projects is getting through the bureaucratic processes that mean that capital budgets are actually spent.

[Pete Wishart]

I congratulate the right hon. Gentleman on securing the chairmanship of the Health and Social Care Committee, and I look forward to joining him on the Liaison Committee. He is a former Secretary of State, so he surely understands and appreciates that this Bill has a significant impact on Scotland, because it will affect our budgets through the Barnett consequentials. Does he think it is right that we are excluded from tabling or even voting on any amendments?

--- Later in debate ---

[Jeremy Hunt]

I do, because this Bill about the NHS in England. It would be nice if we occasionally had a word of thanks, because the Bill will result in a lot more money being made available for the NHS in Scotland. The hon. Gentleman should, if I may say so, welcome that, because I think that will be as welcomed among the Scots as it will be welcomed by the English.

My point about capital to revenue transfers is that it is a big deal to get a hospital building project off the ground. So many get delayed because hospital management teams are very busy. They may have struggling A&E departments and are trying to meet other targets and to deal with safety issues—whatever it is—and they do not have the management resource to invest in putting together the case that, quite rightly, the Treasury and the Department of Health and Social Care demand is extremely rigorous and thorough. That is why things get delayed. If we want to ensure that these 40 hospitals get built, the Government should consider a central team at the Department of Health and Social Care to put at the disposal of hospitals that we want to build extensions or new buildings, so that they can actually navigate those hurdles—[Interruption.] I am getting nods from the very capable Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), so that might be under consideration.

[Alex Cunningham]

I am grateful to the former Secretary of State for giving way. I admire his admitting his role in converting capital to revenue, and I am sure he regrets that he was unable to build the hospital we need in Stockton to close the health inequality gaps in our society. If he has any influence left in Government, perhaps he will have a word in some ears and say, “They really do need a new hospital in Stockton-on-Tees.”

[Jeremy Hunt]

I can be honest with the hon. Gentleman and say that I regret not being able to build lots of hospitals around the country in that period, because funding was short. Now, however, we are in a different situation. It is important that we build these extra hospitals, but there will be some big challenges in ensuring that we do so.

[Dr Whitford]

I thank the right hon. Gentleman for giving way. I welcome his suggestion of a central design team, because the NHS is over 70 years old and we seem repeatedly to reinvent the wheel. Does he recognise that it is not just about building new hospitals, because maintenance has also been allowed to slide? There are leaking roofs and leaking sewers, and patients are still in hospitals that are basically not fit for use. Maintenance is most urgent.

[Jeremy Hunt]

I agree with the hon. Lady. Maintenance is a big issue in many hospitals. A number of hospitals are still essentially prefab buildings that should have been torn down a long time ago, and there are others where maintenance can solve the problem. I think we have to attack all of that, and I welcome the fact that there is a real commitment from the Government to do so.

Finally, I want to talk about new clause 4, which relates to whether the Government are giving enough to the NHS to meet the current waiting time targets for elective care, A&E, cancer and so on. I welcome the Opposition’s focus on this matter, because the public absolutely expect us to get back to meeting those targets. It was an important step forward for the NHS that we did bring down waiting times, and I have often credited the previous Labour Government for that happening, as I hope the Labour party will credit this Government for the focus on safety and quality in the wake of Mid Staffs. However, as we focus on safety and quality, I would not want to lose the achievements that were made on waiting times, because it is fundamental to all patients that they do not have to wait too long for care. Indeed, waiting times themselves can be a matter of patient safety.

[David Simmonds]

My right hon. Friend mentioned targets and people getting access to care. The hon. Member for Harrow West (Gareth Thomas) referenced Pinn Medical Centre, which is in my constituency, and the impact on Northwick Park Hospital in his constituency. This is a really good example of when the issue is not with the total sum of funding but with how the NHS is spending it. If the system can afford £300 to pay for each A&E attendance, I am sure it can afford £70 for those patients to attend a walk-in centre instead. This is not about an arms race and who can spend the most, but about who can bring the most focus to spending the money in the way that benefits patients and our constituents the greatest.

[Jeremy Hunt]

My hon. Friend neatly makes the point that I was hoping to make next. I will elaborate on the brilliance of his insight and simply say that when we think about waiting times it is very important that it is not just a debate about money. I appreciate that the Bill is about money, and that is why amendments have been tabled about money, but I want to give the example of the annual cycle of winter crises that we seem to have in the NHS now. I looked up the figures and, over the past five years that I was doing the job, in the first year I gave the NHS £300 million to avoid a winter crisis; in the second year, £400 million; in the third year, £700 million; in the fourth year, £400 million; and in the fifth year, £400 million. In four of those five years, we still had a winter crisis. That is because in the end it is not about money as much as it is about capacity.

--- Later in debate ---

[Patrick Grady (Glasgow North) (SNP)]

The third final point.

[Jeremy Hunt]

It was always the final point, and it is very much the final point.

The other area that is essential for capacity is the social care system. My hon. Friend the Member for Ruislip, Northwood and Pinner (David Simmonds) talked about how money can be wasted. One of the biggest wastes of money is that we pay for people to be in hospital beds, which cost three times as much as care home beds, because we do not have the capacity in the social care system. It is very important that we encourage people to save for the future and protect people against losing their homes, but if we want to see a change in the NHS in the next five years it is fundamental that we increase the ability of local authorities to deliver adult social care to people who cannot afford it. At the moment, they do not have enough to do that, and we must put that right.

[Patrick Grady]

Finally, here we are, in the English Parliament after all these years. Isn’t it great? The Mace is down, the signs are up, and the dream of David Cameron has finally been realised. For the first time since 1707, English Members of Parliament will get to vote on English legislation to the active exclusion of the rest of us. I wonder if the Minister could have even dreamed, when he and I were but lowly Back-Bench members of the Procedure Committee back in 2015 and scrutinising the EVEL processes, that this is where we would end up today.

On 19 September 2014 David Cameron promised, in response to the independence referendum in Scotland, that we would have English votes for English laws. Three general elections, two Prime Ministers and countless Leaders of the House later, here it is in all its glory. I wonder, given the responses and speeches that we have heard today, whether anyone on the Government Benches really understands what is going on. We are debating clauses and amendments to a Bill that has been certified as being only relevant to England, but as the amendment themselves demonstrate, and as we have heard in speeches, it will have implications for health spending policy across the whole of the United Kingdom—and very serious issues, too—for mental health, for the construction of hospitals, and for the difference between capital and revenue spending on the NHS.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 28th January 2020 Commons Chamber

[Caroline Dinenage]

This year. However, there are complex questions to address. A Joint Committee of the Housing, Communities and Local Government Committee and the Health and Social Care Committee came up with an entirely different solution—a social insurance model—which shows why we want to build a consensus. Even the Liberal Democrats have said that they want to build cross-party consensus, but we know the hon. Lady’s view on cross-party consensus: her way or the high way.

[Jeremy Hunt (South West Surrey) (Con)]

Given that we will not end the annual cycle of winter crises until we fix the problems in adult social care, does the Minister agree that, however important the commitment that people will not have to sell their home, the absolute priority in any discussions with the Treasury must be to get more money to local authorities so that they can discharge their responsibilities to older and more vulnerable people?

[Caroline Dinenage]

My right hon. Friend did some incredible work in this area when he was Secretary of State for Health and Social Care. In fact, he presided over the Department being renamed to draw reference to the importance of social care. He is absolutely right that we must ensure that councils have the money they need for the short term, but we must also work towards a consensus so that everybody will have safety and security and that nobody will be forced to sell their home to pay for their care.

NHS Funding Bill

Jeremy Hunt Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Jeremy Hunt (South West Surrey) (Con)]

It is a pleasure to see you in your place, Madam Deputy Speaker. I refer hon. Members to my entry in the Register of Members’ Financial Interests as a trustee of the charity Patient Safety Watch. I also wish to correct a detail in the last speech I gave in the House in which I said there were four instances of wrong site surgery every day; I should have said every week. It is still an enormous number, but it is important to get the record absolutely right.

I congratulate the Health Secretary on putting the NHS front and centre of the Government’s agenda. When I was in his job, I fought two general elections with Prime Ministers who were rather keen not to talk about the NHS. The second of the two did want to talk about the social care system, and I think both of us, with the benefit of hindsight, rather regret that. But if the Conservatives want to be the party of NHS, we have to talk about it, and my right hon. Friend is doing precisely that.

I thank my right hon. Friend for putting into law the deal for the future of the NHS that I negotiated in May 2018. It is the challenge of the holder of his job—formerly mine—to stand at the Dispatch Box and constantly say that the NHS has enough money, when in reality it very rarely does. One of the most difficult challenges for Health Secretaries of all parties is meeting people who are denied access to a medicine that is not available on the NHS. He did that with the Orkambi families just before the election, and he did a brilliant job in securing access to that medicine, which will transform the lives of many families. I hope that he will now use the same magic to get access to Kuvan for sufferers of phenylketonuria, including Holly and Callum, the children of my constituent Caroline Graham, who kindly agreed to a meeting.

On funding, the central issue of this debate has been whether the amount the Government propose is enough. The facts are relatively straightforward: we spend 9.7% of our GDP on healthcare, and the EU average is 9.9%—almost the same. Our spending is almost identical to the OECD average and slightly less than that of the majority of G7 countries. Those numbers only reflect the situation today, though. We are in the first year of a five-year programme whereby spending on the NHS will rise by about double the growth in GDP, so we are heading toward being in the top quartile of spenders on health as a proportion of GDP among developed countries. That is a significant increase.

[Dr Whitford]

The right hon. Gentleman’s overall figure for health spend is correct, but the public health spend—as opposed to private patients—is only 7.5% of GDP, and that is the figure the public are interested in, not the figure including people who can afford to go private.

[Jeremy Hunt]

I suggest to the hon. Lady, whom I greatly respect, that the overall figure is actually what counts. I agree that public health spending matters, but it is absolutely the case that we are heading to being one of the higher spenders in our commitment to health. That is very significant and should not be dismissed.

Often, the debate about funding can distort some of the real debates that we need to have about the NHS. One of those is the debate on social care. If we do not have an equivalent five-year funding plan for social care, there will not be enough money for the NHS. That is because of the total interdependence of the health and social care systems. It is not about finding money to stop people having to sell their homes if they get dementia, important though that is; it is about the core money available to local authorities to spend on their responsibilities in adult social care. I tried to negotiate a five-year deal for social care at the same time as the NHS funding deal we are debating today. I failed, but I am delighted to have a successor who has enormously strong skills of persuasion and great contacts in the Treasury. I have no doubt that he will secure a fantastic deal for adult social care to sit alongside the deal on funding, and I wish him every success in that vital area.

The second distortion that often happens in a debate about funding is that while everyone on the NHS front line welcomes additional funding, their real concern is about capacity. The capacity of staff to deliver really matters. I remember year after year trying to avert a winter crisis by giving the NHS extra money, and most of the time I gave the money and we still had a winter crisis, because ultimately we can give the NHS £2 billion or £3 billion more, but if there are not doctors and nurses available to hire for that £2 billion or £3 billion, the result is simply to inflate the salaries of locum doctors and agency nurses and the money is wasted. Central to understanding capacity is the recognition that it takes three years to train a nurse, seven years to train a doctor and 13 years to train a consultant, so a long-term plan is needed. It is essential that alongside the funding plan, we have in the people plan that I know the NHS is to publish soon an independently verified 10-year workforce plan that specifies how many doctors, nurses, midwives, allied healthcare professionals and so on we will need.

[Victoria Prentis (Banbury) (Con)]

Will my right hon. Friend give us his views on the maternity safety training fund, which I understand is up for renewal soon, and its importance to the midwives of the future?

[Jeremy Hunt]

When we talk about the workforce, training is vital. We know from the 2018 “Mind the Gap” report on the issues at the Shrewsbury and Telford and the East Kent trusts, among others, that only 8% of trusts supply all the care needs in the saving babies’ lives bundle, so the maternity safety training fund is essential. I hope the Health Secretary will renew it, because it makes a big difference.

It is vital that we have an independent figure for the number of doctors and nurses the NHS needs, not a figure negotiated between the Department of Health and Social Care and the Treasury because the Treasury will always try to negotiate the number down and we will end up not training enough people. I know the Health Secretary is on the case.

The final distortion when we talk about funding for the NHS is the link between funding and the quality of care. It is totally understandable that many people think that the way to improve the quality of care is to increase funding, but in reality the relationship is much more complex. As the Health Secretary knows well, we pay the same tariff to all hospitals in the NHS, and with the same amount of money some of them deliver absolutely outstanding, world-class care and others do not. Almost without exception, hospitals rated good or outstanding by the Care Quality Commission have better finances than those rated as requiring improvement or inadequate, which are often losing huge sums. The reason for that, as every doctor or nurse in the NHS knows, is that poor care is usually the most expensive type of care to deliver. A patient who acquires a bedsore or an MRSA or C. diff infection, or has a fall that could have been avoided, will stay in hospital longer, which will cost more. It will cost the hospital more, it will cost the NHS more, and finances will deteriorate. Invariably, the path the safer care is the same as the path to lower cost. That is why it is so important that we recognise that the safety and quality agenda is consistent with the plan to get NHS finances under control.

It is also why it is important to remember that the Mid Staffs scandal happened in a period of record funding increases for the NHS. So when it comes to NHS funding, transparency, openness, a culture that learns from mistakes, innovation and prevention are every bit as important as pounds and pence.

Health and Social Care

Jeremy Hunt Excerpts

Thursday 16th January 2020 Commons Chamber

[Jeremy Hunt (South West Surrey) (Con)]

Let me start by saying that it is wonderful to see you in the Chair, Mr Deputy Speaker, and that your presence there is a signal to every new Member that it is possible to undergo the ups and downs of politics and come through on the other side.

I thank the Health Secretary for his personal commitment to patient safety in including the Health Service Safety Investigations Bill in the Queen’s Speech, and I thank the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), for her personal commitment in ensuring that it featured in both last year’s Queen’s Speech and the current one, despite many competing pressures. It is about patient safety that I wish to talk in my brief six minutes. When I became Health Secretary in 2012, I had not heard the phrase.

The first crisis with which I had to deal was the one at Mid Staffs. I remember the then chief executive of the NHS, Sir David Nicholson, taking me aside and saying, “You just need to understand, Jeremy, that in healthcare we harm 10% of patients. That is what happens all over the world.” I then asked the awkward question about how many people actually died because of mistakes in healthcare.

It is important to point out that this is not about the NHS; it is about how healthcare is practised everywhere. However, being the good old NHS, we have carried out endless academic studies on this. The Hogan and Black analysis shows that, at that time, 4% of hospital deaths had had a 50% or more chance of being preventable. If we do the maths, that works out at about 150 preventable deaths every single week—the equivalent of an aircraft falling out of the sky every single week.

Then I met a group of people who persuaded me that this issue should be my main focus as Health Secretary. I met Scott and Sue Morrish, a young couple from Devon who lost their son Sam to sepsis when he was three because it was not picked up early enough; James Titcombe, who lost his son Joshua at Morecambe Bay when he was nine days old; Deb Hazeldine, who lost her mother in a horrible death at Mid Staffs; Martin Bromiley, who lost his wife Elaine because of a surgery error at a hospital in Milton Keynes; and Melissa Mead, who lost her son William when he was just 12 months old—in December 2014, when I was Health Secretary—again because sepsis was not picked up.

Those people all did something that most of us would never do. Most of us, when we have a tragedy in our lives, want to close the chapter and move on, but they chose to relive their tragedy every single day because they wanted to tell their story and make the NHS change so that other families did not go through what they had been through. They paid a terrible price for doing that. James Titcombe had to write more than 400 emails over several years before we were prepared to admit why Joshua died. Martin Bromiley sacrifices 40% of his salary as an airline pilot so that he can go round the NHS talking in hospitals free of charge about what happened to Elaine. Melissa Mead carries William’s teddy everywhere. She goes into TV studios to try to alert people to the dangers of sepsis, and she brought it to her first meeting with me. Inside that teddy were William’s ashes. That is a meeting I will never forget as a Minister.

We must not let this blind us to the fact that the vast majority of NHS care is absolutely brilliant. I have three beautiful healthy children, thanks to the NHS. About a year before I was Health Secretary, I was in the Cabinet and I had a basal cell carcinoma removed from my head. A local anaesthetic was administered, and the surgeon had his scalpel out. The head nurse looked at me and said, “By the way, Mr Hunt, what is it you do for a living?” This was a time of austerity and cuts, and I froze before giving the answer to that question. But thanks to substantial additional funding by the last Labour Government and by this Government, the NHS has improved dramatically, and we now have record survival rates for every major disease category.

[Yasmin Qureshi (Bolton South East) (Lab)]

I thank the right hon. Gentleman for giving way. Three years ago my mother died of sepsis, and sepsis is still a big problem that needs to be addressed in hospitals.

[Jeremy Hunt]

I thank the hon. Lady for raising that. We have made huge progress in sepsis care, and the vast majority of people who go to A&E now are checked for sepsis, but mistakes still happen, and I am sure that it affected her as it affected the families of the people I have talked about.

We must not be complacent about the things that go wrong. In the NHS, we talk about “never events”—the things that should never happen. Even now, after all the progress on patient safety, we operate on the wrong part of someone’s body four times a day. It is called wrong site surgery. When I was Health Secretary, we amputated someone’s wrong toe, and a lady had her ovary removed instead of her appendix.

[Dr Whitford]

I know that the right hon. Gentleman visited the Scottish patient safety programme to see in action the WHO checklist, which is designed precisely to prevent such events, so can he explain why the checklist was never introduced during his time as Secretary of State?

[Jeremy Hunt]

Actually, we do have WHO checklists throughout the NHS in England—I think they were introduced under Lord Darzi in the last Labour Government—but the truth is that even with those checklists, which are an important innovation, mistakes are still made because sometimes people read through lists and automatically give the answer they think people want to hear. This is why we have to be continually vigilant.

What is the solution? It is to ask ourselves honestly, when a mistake happens and when there is a tragedy, whether we really learn from that mistake or whether we brush it under the carpet. To understand how difficult an issue that is, we have to put ourselves in the shoes of the doctor or nurse when something terrible happens, such as a baby dying. It is incredibly traumatic for them, just as it is for the family. They want to do nothing more than to be completely open and transparent about what happened and to learn the lessons, but we make that practically impossible. People are terrified about being struck off by the Nursing and Midwifery Council or the General Medical Council. They are worried about the Care Quality Commission and about their professional reputation. They are worried about being fired. In order for a family whose child is disabled at birth to get compensation, they have to prove that the doctor was negligent, but any doctor is going to fight that.

The truth is that many of the mistakes that are made are not negligence, but we make it so difficult to be open about the ordinary human errors that any of us make in all our jobs. As we are not doctors and nurses, people do not generally die when we make mistakes. That shows the courage of entering that profession, and if we make it difficult for people to be open, we will not learn from those mistakes. That is why we need to change from a blame culture to a learning culture. That is also why, as we reflect on the devastating news that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), gave the House last night that the Shrewsbury and Telford Hospital NHS Trust is now examining 900 cases dating back 40 years, we realise that the journey that the NHS has started on patient safety must continue. We should take pride in the fact that we are the only healthcare system in the world that is talking about this issue as much as we are, and if we get this right, we can be a beacon for safe healthcare across the world and really turn the NHS into the safest and highest-quality healthcare system anywhere.