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.

Ockenden Review of Maternity Care: Shrewsbury and Telford

Jeremy Hunt Excerpts

Wednesday 15th January 2020 Commons Chamber

[Lucy Allan (Telford) (Con)]

I am delighted to have been granted this Adjournment debate on this very important issue. I want to raise it because the issue deserves the platform that Parliament affords. It concerns the safety of women and babies receiving maternity care at hospitals in Shropshire. I raise that in the context of the Morecambe Bay trust inquiry into maternity deaths in 2015, which at the time was considered to be a one-off. What has come to light at Shrewsbury and Telford Hospital NHS Trust suggests that there may be systemic problems within the NHS and maternity care, and there are without doubt significant concerns about the lack of transparency and openness around what went wrong.

The Ockenden review was set up two and half years ago to look at 23 possible cases of maternity malpractice at the Shrewsbury and Telford Hospital Trust. So far there have been no formal published findings. However, in November 2019 interim findings were leaked to the media. Those findings show not only that had some very serious failings indeed been uncovered by the review, but that the scale of the malpractice, and the number of women and babies affected by it, exceeded anything that had been expected when the review was initiated.

The interim findings stated that there had been in excess of 40 avoidable maternity deaths and 50 brain-injured babies. NHS Improvement was given that information almost a year ago and appears to have kept quiet about the findings. The findings also make reference to “widespread failings, a toxic culture and a failure to learn lessons.” Since those findings were made public, many, many more women have come forward—women who knew nothing about a review being held. The review is now looking at over 600 cases of possible maternity care malpractice.

Those interim findings directly contradict what senior management were saying publicly at the time when the review was commissioned. Senior management claimed that this was all overblown by the media, that it was all historical, and that good practice was in place now. The chief executive claimed that concerns raised about the possible scale of malpractice were “scaremongering”—his word. Senior hospital management adopted the stance that “it simply couldn’t happen here.” The CEO said that the media, particularly the BBC, had it in for them; that is what they actually said to me, the MP. How, in that kind of environment, can lessons be learned if there is no acceptance that anything has gone wrong?

We had the same response from the authorities in Telford when the scale of child sexual exploitation in the town was revealed. That denial, or perhaps being in denial, seems to be the standard response from those in positions of authority—minimising the problem, blaming the media and depicting those affected as being in some way troublesome.

Let us compare the review from Shrewsbury and Telford Hospital NHS Trust with that from Morecambe Bay, where there were 11 avoidable baby deaths and one maternal death. The Morecambe Bay inquiry reported promptly, and the then Secretary of State, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), came immediately to the House, made a statement, and apologised to the families. He pledged that lessons would be learned, and that the legacy of those tragic deaths would mean that such things could not happen again. My right hon. Friend is in the Chamber today, and I am grateful that he did not just accept the position taken by senior management, NHS bureaucrats, and officials from Shrewsbury and Telford NHS Hospital Trust at face value. I commend him for initiating the Ockenden review, and for his commitment to encouraging a culture of transparency and openness across the NHS. We must continue with that approach.

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

I wish to repay the compliment and thank my hon. Friend for her tireless campaigning on this issue. It is not easy publicly to criticise a local hospital trust, and for an hon. Member to do that, as in this case, shows enormous courage. Does she agree that the biggest mistake the Government could make when they publish and respond to the Ockenden review would be to say that this is a one-off incident? The most important thing is to consider what went wrong at Shrewsbury and Telford, and to learn those lessons for the whole NHS. The big thing that we learned from Morecambe Bay and Mid Staffs was that such lessons apply across the system.

[Lucy Allan]

My right hon. Friend makes an important point—I was going to come to it in my speech, so I will bring it in now. The Morecambe Bay inquiry was led by Dr Bill Kirkup, who said of the recent findings at Shrewsbury and Telford Hospital NHS Trust that

“two clinical organisational failures are not two one offs”,

and that that points to an “underlying systemic problem” that may exist in other hospitals. My right hon. Friend is right to make that point, and I thank him for his kind comments.

The interim findings in the Ockenden review were not published, and I understand that the hospital trust has not been told about them. The families were certainly not told about them, and neither were MPs. There has been no statement to the House, and we do not know what action is being taken to ensure the safety of women and babies at Shrewsbury and Telford Hospital NHS Trust.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

It is an absolute honour and a delight to be responding to this debate with you in the Chair, Mr Speaker—it is the first time I have done so—and congratulations.

I congratulate my hon. Friend the Member for Telford (Lucy Allan) on securing the debate. Before I respond to her specific comments, I turn to the wider points that she raised that addressed the UK as a whole.

To reassure people—mothers, particularly—I would like to make one or two points about the wider context of the debate: the safety of giving birth in the UK. The NHS in this country remains one of the safest places in the world to have a baby. The Government’s maternity ambition is to halve the 2010 rates of stillbirths, neonatal and maternal deaths, and brain injuries in babies occurring during or soon after birth, by 2025. That ambition also includes reducing the rates of pre-term births from 8% to 6%. I reassure her that we have already achieved our ambition for a 20% decrease in stillbirths by 2020, so we are very much on track with those ambitions.

First and foremost, I express my heartfelt sympathies to every family who has been affected by previous failings in the trust’s maternity services. There can be no greater pain for a parent than to lose a child.

I pay tribute to my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the former Secretary of State, who asked NHS Improvement to commission the independent review of maternity services at Shrewsbury and Telford in 2017, which is two years ago now—my hon. Friend was quite right about that. I take mild issue with one of her points, however, which was that NHS Improvement kept quiet about the failings. I find that slightly disappointing, because the raison d’être of NHS Improvement, which was also established by my right hon. Friend, is to investigate, expose and learn from failings, so I think she would agree it is not something that NHS Improvement would do. It is not in the culture of the organisation; the exact opposite is true.

The review being chaired by Donna Ockenden, a clinical expert in maternity and a registered midwife, was tasked with assessing the quality of previous investigations and the implementation of recommendations at the trust relating to new-born, infant and maternal harm. The original terms of reference covered the handling of 23 cases. The terms of reference have since been updated and were published in November to reflect the expanded scope of the review, and the review team will be in touch in the following weeks with the affected families to ensure that they are appropriately supported throughout the process. I am afraid I have to inform my hon. Friend and the House that the additional cases have now been identified and the total number relevant to the review now stands at 900, a small number of which go back 40 years.

The extra cases have been found by a number of means—from looking at previous incidents reported at the hospital to parents brave enough to come forward and talk about their own experiences. I am sure my hon. Friend will understand that, unlike with Morecambe Bay, which involved a small number of cases, it will take the review considerably longer to investigate 900 cases[Official Report, 20 January 2020, Vol. 670, c. 1MC.]. That is why there has been no report so far. The interim finding was not 600; the number is greater. It is appropriate that, while this important work is being done, we do not influence or comment on it and that we let Donna Ockenden get on with her vital work. It is our responsibility to let her do that and to provide the additional support needed given the additional cases identified. It is a huge increase on the original number of cases.

[Jeremy Hunt]

I thank the Minister for her personal commitment to patient safety, which I have seen on many occasions, but she will be aware that what she has just told the House is deeply shocking. She is saying that the scale of potential avoidable death at Shrewsbury and Telford may be no different from that at Mid Staffs. Could she reassure the House, given the huge resources devoted to the public inquiry into what happened at Mid Staffs, that the Department will make sure that Donna Ockenden has all the resources and support she needs, because getting to the bottom of this will be a huge job? Does the Minister also recognise that, while it will take more time, the families would also like it resolved as quickly as possible?

[Ms Dorries]

Absolutely, and I thank my right hon. Friend for his comments. Yes, the Department is liaising closely with Donna Ockenden about what support she needs to conclude her work as soon as possible, for the sake of the families. As he will understand, the review cannot be rushed; it has to be done properly and thoroughly. We have to get to the bottom of this matter, which is why Donna Ockenden is being supported in the way she is. Anything she needs in order to conclude this review successfully she will have. I thank my right hon. Friend for his personal comments. As he will know, and as he has said, I am utterly committed to patient safety, to eradicating avoidable harms and to making the NHS the safest place—not one of the safest—in the world to give birth. The review is important in the light of that.

As well as the families who came forward when the review was launched, media coverage has raised awareness of it, prompting further contacts with the trust and the review team. More recently, Donna Ockenden herself made a final appeal for any more families who believe that they have been affected to come forward. I am grateful to all the families who have voluntarily agreed to assist the review, although that may mean their having to revisit painful and distressing experiences. We expect it to conclude by the end of the year, at which point the Government will work closely with NHS England and NHS Improvement to consider the next steps.

As I have said, it is important for the review to be allowed to proceed unhindered, and without speculation about its conclusions or findings. However, I am very aware that current maternity patients at the trust may want reassurance that they will be safe and looked after. My hon. Friend the Member for Telford referred to “red lights”. I can reassure her that steps are being taken at the trust. It is completely understandable that people are asking questions, but I have asked for a meeting with the interim chief executive, because I want to see for myself that those steps are working. She has already made a public statement to reassure all families using the trust’s maternity services that much work has already been done to address issues raised by previous cases and to improve services, while acknowledging that the trust—obviously—had further to go.

During the November inspection of the trust’s maternity services, the Care Quality Commission found that the trust had taken action following the last inspection in April, so it was clearly listening and implementing the recommendations. As a result, there had been a number of improvements. Although more work was still needed, staffing had increased, and morale and governance had improved. However, I expect the CQC to keep a close eye on what is going on.

Let me end by restating the strength of our commitment to improving the quality and safety of maternity care. As I have said, the Government’s maternity ambition is to halve the 2010 rates of stillbirth, and we are on track to do that, which is incredibly important. Let me also say to my hon. Friend that, although I cannot reveal to her what is happening in the review—I cannot find out what is happening myself, because Donna Ockenden needs that autonomy—my door is always open. If my hon. Friend wants to discuss with me at any time what I have said tonight about the improvements that are being made at the trust, she need only pick up the phone. I am there to answer any questions that she may have on behalf of her constituents, and I ask her please not to hesitate to contact me if she needs further reassurances.

As I have said, the NHS remains one of the safest places, although we want to make it the safest place. What is most important is to ensure that the tragic cases that the Ockenden review is examining are not repeated anywhere else. That must be the objective. Women deserve a better maternity experience, and that is what we are determined to achieve.

Question put and agreed to.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 29th October 2019 Commons Chamber

[Ms Dorries]

That is a big question because it covers two areas. This Government have invested £2.3 billion in mental health services, a huge amount of which is to go into salaries, to deliver community health services where they are needed: close to patients and to their relatives and families. It is also to provide community health teams and support teams in schools for young people. Clinical commissioning groups are under an obligation to provide those mental health services with the set funding. If the hon. Lady would like to meet to hear more about that, I will be happy to discuss it with her.

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

As this is your last Health questions, Mr Speaker, may I thank you for your many years of campaigning for speech and language therapy for children? It has given great hope to many families in a situation similar to your own.

On the issue of early intervention, given that half of all mental health conditions are established before the age of 14, does the Minister, who is passionate about this, agree that mental health provision in schools is essential? Will she update the House on progress towards the 2023 objective of a quarter of schools having a mental health lead?

[Ms Dorries]

I thank my right hon. Friend for his question and for his work as Secretary of State. He was the longest-serving Secretary of State for Health ever, and he is passionately interested in this subject, too. Yes, we are on track—in fact, we are more than on track—to meet our objective of 25% of schools being covered by a school mental health support team by 2023-24.

The school mental health support teams have been launched in trailblazer areas, and I visited one a few weeks ago at Springwest Academy in Hounslow to see the amazing work the teams are doing with young children. The teams are teaching coping strategies and identifying mental health problems as they arise very early in life, which helps children to deal with those mental health problems now and into adulthood. We are on track and we hope to meet that objective.

--- Later in debate ---

[Matt Hancock]

I want to pay tribute to the hon. Lady for the work that she, her Health Committee and all its members have done on this legislation. I think that the legislation proposed by the NHS—with the support of the Select Committee, which will of course scrutinise it further—is an important step forward. I am delighted that Her Majesty committed in the Queen’s Speech to legislation on the NHS, of which these proposals will be the basis.

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

Haslemere in my constituency has a busy minor injuries unit, used by 8,000 people a year, which is currently threatened with closure. Given that that would be catastrophic for the town of Haslemere and for the Royal Surrey A&E in Guildford, will the Secretary of State listen to the residents of Haslemere and agree not to close this vital facility?

[Matt Hancock]

My predecessor, my right hon. Friend, is an assiduous campaigner for South West Surrey. There is no better spokesman for South West Surrey than my right hon. Friend. He has raised this issue with me in private over recent weeks since these concerns were raised. I have in turn raised it with the chief executive of the NHS, and I can confirm that the walk-in centre will stay open.

Baby Loss Awareness Week

Jeremy Hunt Excerpts

Tuesday 8th October 2019 Commons Chamber

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

It is a great privilege to speak from the Back Benches for the first time in over a decade following two extremely powerful speeches from both Front Benches. I thank the Minister of State and the shadow Minister for two extremely compassionate and understanding speeches in which they spoke about the sheer pain felt by so many families up and down the country.

I also thank the many hon. Members on all sides—my hon. Friends the Members for Eddisbury (Antoinette Sandbach), for Colchester (Will Quince) and for Banbury (Victoria Prentis), the hon. Member for Washington and Sunderland West (Mrs Hodgson) and many others—who have spoken so powerfully on this matter. I cannot possibly compete with the power of their words because there is nothing that anyone can suffer more than the loss of a child. I just want to make one observation from my many years—some would say too many—as Health Secretary with respect to this issue, and that observation is about the impact on professionals.

When you go around hospitals up and down the country, and ask the doctors, nurses and midwives, “What is the most traumatic thing that has ever happened to you in your professional career?”, almost invariably they will say that it is when they lose a baby. We often talk about the trauma for the families, who of course are the primary victims in this situation, but we must never forget the people who are sometimes called the second victims: the doctors, nurses, midwives and other professionals who have to go home, worrying that if they had done something differently that baby might still be alive, and who have to come back to work the next day and struggle on, dealing with that incredible trauma.

In that situation, those professionals want nothing more than to be completely open, transparent and honest with the families and with their colleagues about what happened to ensure that lessons are learned and that that tragedy is never repeated again. But in the NHS today, we make that practically impossible. People are terrified of the Nursing and Midwifery Council, the General Medical Council, the Care Quality Commission and their trust. They are worried about being fired and they are worried about all sorts of consequences, so the one thing that should happen—the one thing that everyone in that situation wants to happen more than anything else, which is that lessons are learned from that tragedy—is often the one thing that never happens at all.

Let us remember that there are 1,400 neonatal deaths every year, as the shadow Minister said. That is about four every single day across the NHS. The great tragedy—not just in the NHS but in hospitals all over the world—is the fact that a tragedy can happen in Blackpool one day, and a month later exactly the same tragedy can happen in Cornwall. There has not been enough effort to try to share the learnings from such tragedies. I commend the efforts of the Government and my successor Ministers for doing everything they possibly can to put this right and to ensure that we really do become a learning organisation. In truth, though, this is a big job that will take a long time, because it is about changing culture.

The NHS needs to look at other industries that have successfully changed from having a blame culture to having a learning culture. The airline industry is the most famous example, but there are also the nuclear and oil industries. That job of changing culture will be our central responsibility if we are to reduce the agony for parents and the professionals involved in the care of babies. The most powerful way to change culture is to shout out loud and clear those human stories of the terrible loss involved, because that is what promotes change.

I finish by commending everyone involved in Baby Loss Awareness Week—the brave Members of this House who have spoken out, and given many others hope that they are not alone; the many brave members of the public who have relived their own tragedies over and over again to try to promote change in this area; and the Ministers concerned, who have a heavy responsibility when it comes to this agenda, and who I know take that responsibility with the utmost seriousness.

--- Later in debate ---

[Victoria Prentis (Banbury) (Con)]

As ever, I am grateful to be called to speak, Madam Deputy Speaker, although I was not anticipating it because I was not here at the beginning of the debate. I can only apologise for that, but I was elsewhere on unavoidable duties.

This is a debate in which we love to hate participating. It is not a pleasurable experience for anyone who has lost a child, and I know that some Members across the House feel exactly as I do when speaking in this debate. Nevertheless, I am grateful for the opportunity to lay my annual asks on the table.

First, I must give an enormous amount of thanks to the previous Secretary of State for Health and Social Care, my right hon. Friend the Member for South West Surrey (Mr Hunt), whose speech I am really looking forward to watching on catch-up tonight. I am immensely grateful, as are all of us who have been involved in this area for many years, for all that he did. It must be counted as one of his major achievements as Secretary of State that there has been a 19% reduction in stillbirths and an 8% reduction in maternal mortality since 2010. Those are really good figures, and I hope that he will look back on his career in many years when he retires—

[Mr Hunt]

I can retire now. [Laughter.]

[Victoria Prentis]

I hope that my right hon. Friend will count that among his most important achievements. I expect that he said, as did the hon. Member for Ellesmere Port and Neston (Justin Madders), that blame is probably not the way to go, and that we need a cultural shift in the NHS, so my ask this year is that we should make maternal death a never event. Luckily, maternal deaths are rare—I was almost one of them myself—but making them a never event, with the definition and the muscle that that provides, would be very helpful.

With my prison service background, I should add that a child or, indeed, a mother dying in custody should also probably be a never event, with all the chain of investigations that should flow from that. I know that the recent death in custody is being very well investigated, and there is no need to comment further on that case now. The never event definition is helpful, because it sets in train a course of investigations that need not be blamed-filled but which are helpful for learning.

Sadly, the situation elsewhere is not as helpful as in this country. A baby dies every 11 seconds worldwide, and many maternal deaths are completely preventable. I am pleased that the Secretary of State for International Development has chosen to make maternity a priority for the Department for International Trade. He wrote an excellent article about it in The Times last week, and I encourage hon. Members to read that article.

The Secretary of State for International Development is helping members of the Royal College of Midwives to provide training in rural Bangladesh, and he is resourcing organisations that work with women who have had female genital mutilation performed on them and who have dreadful maternal complications as a result. He is working to provide vaccinations, which are so helpful in preventing the death of newborn babies. Across the board, the fact that maternity is now a priority for DFID is really helpful.

I close by thanking you, Madam Deputy Speaker, for your support in this area and for allowing me to say a few brief words this afternoon, and by advertising the baby loss service at St Mary’s, Banbury at 6 o’clock this Sunday. It is an extraordinary event, and we have been doing it for only a few years. People came to that church in the first year who had never talked about their loss, and it is overwhelming.

Such services are taking place all over the country, as the hon. Member for Ellesmere Port and Neston said. Unfortunately we have not organised one in Parliament this year, as we normally do, because we are not sitting, but I am sure we will organise one in future years. I thank everybody who has taken part in this debate, which I think is now annual. I am thrilled that we have Government time, and I hope we have it again in future.

NHS Pay Review Body and Agenda for Change Pay Deal

Jeremy Hunt Excerpts

Wednesday 27th June 2018 Written Statements

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

I am responding on behalf of my right hon. Friend the Prime Minister to the 31st report of the NHS Pay Review Body (NHSPRB). The report has been laid before Parliament today (Cm 9641). I am grateful to the chair and members of the NHSPRB for their report.

The Government welcome the 31st report of the NHS Pay Review Body, which endorses the “Agenda For Change” multi-year pay and contract reform deal (2018-19 to 2020-21).

NHS staff do a fantastic job in delivering world-class care. Even with increasing pressures on the NHS due to, among other things, an ageing population and changing public expectations, they work incredibly hard, always putting patients first and keeping them safe while providing the high-quality care we all expect.

We have already announced that, to secure the future of the health service as it approaches its 70th birthday, we have increased NHS funding by an average 3.4% per year, which will see the NHS receive £20.5 billion a year in real terms by 2023.

The Government accept the NHSRPB’s observations and are very pleased to confirm their acceptance of the “Agenda For Change” multi-year pay and contract reform deal.

The new deal will see nearly 1 million NHS workers benefit over three years and help deliver better value for money from the £36 billion “Agenda For Change” pay bill, with some of the most important changes to working practices in a decade.

The deal includes a range of pay and non-pay proposals that will benefit staff and patients. Most NHS staff below the top of their pay band will benefit from pay increases through the restructuring of the pay bands—higher starting pay, removal of overlapping pay points and shorter pay scales.

From this year the lowest NHS starting salary will increase year on year from £15,404 to £18,005 in 2020-21.

The starting salary of a nurse will rise to £24,907 in 2020-21 which will have a significant impact on retention and recruitment issues.

The deal also guarantees fair basic pay awards for the next three years to staff who are at the top of pay bands—a cumulative 6.5% over three years.

The agreement will put learning and development right at the heart of local annual appraisals, helping to improve the experience for staff, ensuring they demonstrate the required standards for their role before moving to the next pay point. We know that getting appraisals right helps improve staff engagement and through that better outcomes for patients. The deal also commits NHS employers to support staff to improve their physical and mental health, helping to reduce sickness absence, increasing capacity for patient care.

This is a major step forward. The agreement reflects the Government’s public sector pay policy that pay flexibility should be in return for reforms that improve recruitment and retention and boost productivity.

During the NHS trades unions consultation on the AfC framework agreement, the Department of Health and Social Care received a number of representations from non-statutory non-NHS organisations that provide NHS services seeking additional funding on the same basis as NHS bodies.

It is important to stress that the AfC reforms were those, based on the AfC employment contract (and all the terms and conditions) the NHS Staff Council agreed could help the NHS recruit, retain, motivate and boost the productivity/capacity of its workforce.

We know that there a small number of non-statutory non-NHS organisations that provide NHS services, employ existing and new staff on the AfC contract and will be required to implement the reforms.

I believe it is right that these organisations should receive a share of the additional funding made available for AfC staff employed by NHS bodies listed at annex 1 of the NHS terms and conditions of service handbook; each employ existing and new staff on the AfC contract, are required to implement the deal and will need to meet the costs of doing so.

From 2018-19, the AfC pay deal will apply to existing and new staff on the AfC employment contract employed in both NHS bodies and non-statutory non-NHS organisations that provide NHS services, the terms and conditions of which are set out in the NHS terms and conditions of service handbook.

I have asked my officials to write directly to all NHS commissioners and provide them with further detail of the eligibility criteria for additional funding during the three years of the pay deal, that will apply to those non-statutory non-NHS providers of NHS services.

In line with the Chancellor’s commitment at Budget 2017, the Government will release the £800 million already set aside to support the pay deal for 2018-19 in England. Barnett consequential will flow to the devolved Administrations in the usual way. Following the recent announcement on the NHS long-term funding settlement, for the remaining two years of the deal (2019-20 to 2020-21) funding will be met from the settlement. The long-term settlement will provide the NHS with increased funding of £20.5 billion per year in real terms by the end of five years.

[HCWS803]

Gosport Independent Panel: Publication of Report

Jeremy Hunt Excerpts

Wednesday 20th June 2018 Commons Chamber

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

This morning, the Gosport Independent Panel published its report on what happened at Gosport Memorial Hospital between 1987 and 2001. Its findings can only be described as truly shocking. The panel found that, over the period, the lives of more than 450 patients were shortened by clinically inappropriate use of opioid analgesics, with an additional 200 lives also likely to have been shortened if missing medical records are taken into account.

The first concerns were raised by brave nurse whistleblowers in 1991, but then systematically ignored. Families first raised concerns in 1998 and they, too, were ignored. In short, there was a catalogue of failings by the local NHS, Hampshire constabulary, the General Medical Council, the Nursing and Midwifery Council, the coroners and, as steward of the system, the Department of Health.

Nothing I say today will lessen the anguish and pain of families who have campaigned for 20 years for justice after the loss of a loved one. But I can at least, on behalf of the Government and the NHS, apologise for what happened and what they have been through. Had the establishment listened when junior NHS staff spoke out, and had the establishment listened when ordinary families raised concerns instead of treating them as “troublemakers”, many of those deaths would not have happened.

I pay tribute to those families for their courage and determination to find the truth. As Bishop James Jones, who led the panel, says in his introduction:

“what has to be recognised by those who head up our public institutions is how difficult it is for ordinary people to challenge the closing of ranks of those who hold power...it is a lonely place seeking answers that others wish you were not asking.”

I also thank Bishop Jones and his panel for their extremely thorough and often harrowing work. I particularly want to thank the right hon. Member for North Norfolk (Norman Lamb), who, as my Minister of State in 2013, came to me and asked me to overturn the official advice he had received that there should not be an independent panel. I accepted his advice and can say today that, without his campaigning in and out of office, justice would have been denied to hundreds of families.

In order to maintain trust with the families, the panel followed a “families first” approach in its work, which meant that the families were shown the report before it was presented to Parliament. I, too, saw it for the first time only this morning, so today is an initial response and the Government will bring forward a more considered response in the autumn.

That response will need to consider the answers to some very important questions. Why was the Baker report, completed in 2003, only able to be published 10 years later? The clear advice was given that it could not be published during police investigations and while inquests were being concluded, but can it be right for our system to have to wait 10 years before learning critically important lessons that could save the lives of other patients? Likewise, why did the GMC and NMC, the regulators with responsibility for keeping the public safe from rogue practice, take so long? The doctor principally involved was found guilty of serious professional misconduct in 2010, but why was there a 10-year delay before her actions were considered by a fitness to practise panel? While the incidents seemed to involve one doctor in particular, why was the practice not stopped by supervising consultants or nurses who would have known from their professional training that these doses were wrong?

Why did Hampshire constabulary conduct investigations that the report says were

“limited in their depth and range of offences pursued”,

and why did the Crown Prosecution Service not consider corporate liability and health and safety offences? Why did the coroner and assistant deputy coroner take nearly two years to proceed with inquests after the CPS had decided not to prosecute? Finally and more broadly, was there an institutional desire to blame the issues on one rogue doctor rather than to examine systemic failings that prevented issues from being picked up and dealt with quickly, driven, as the report suggests it may have been, by a desire to protect organisational reputations?

I want to reassure the public that important changes have taken place since these events that would make the catalogue of failures listed in the report less likely. These include the work of the Care Quality Commission as an independent inspectorate with a strong focus on patient safety, the introduction of the duty of candour and the learning from deaths programme, and the establishment of medical examiners across NHS hospitals from next April. But today’s report shows that we still need to ask ourselves searching questions as to whether we have got everything right. We will do that as thoroughly and quickly as possible when we come back to the House with our full response.

Families will want to know what happens next. I hope that they and hon. Members will understand the need to avoid making any statement that could prejudice the pursuit of justice. The police, working with the Crown Prosecution Service and clinicians as necessary, will now carefully examine the new material in the report before determining their next steps, in particular whether criminal charges should now be brought. In my own mind, I am clear that any further action by the relevant criminal justice and health authorities must be thorough, transparent and independent of any organisation that may have an institutional vested interest in the outcome. For that reason, Hampshire constabulary will want to consider carefully whether further police investigations should be undertaken by another police force.

My Department will provide support for families from today, as the panel’s work has now concluded, and I intend to meet as many of the families as I can before we give our detailed response in the autumn. I am also delighted that Bishop James Jones has agreed to continue to provide a link to the families, and to lead a meeting with them in October to allow them to understand progress on the agenda and any further processes that follow the report. I commend the role played by the current MP for the area, my hon. Friend the Member for Gosport (Caroline Dinenage), who campaigned tirelessly for an independent inquiry and is unable to be here today because she is with the affected families in Portsmouth.

For others who are reading about what happened and have concerns that it may also have affected their loved ones, we have put in place a helpline. The number is available on the Gosport Independent Panel website and the Department of Health and Social Care website. We are putting in place counselling provision for those affected by the tragic events and who would find it helpful.

Let me finish by quoting again from Bishop Jones’s foreword to the report. He talks powerfully about the sense of betrayal felt by families:

“Handing over a loved one to a hospital, to doctors and nurses, is an act of trust and you take for granted that they will always do that which is best for the one you love.”

Today’s report will shake that trust, but we should not allow it to cast a shadow over the remarkable dedication of the vast majority of people working incredibly hard on the NHS frontline. Working with those professionals, the Government will leave no stone unturned to restore that trust. I commend this statement to the House.

[Mr Speaker]

Just before I call the shadow Secretary of State—the Secretary of State made reference to this point in passing—I think that it is only fair to mention to the House that a number of colleagues whose constituencies have been affected by the events at Gosport Hospital are unable to speak in these exchanges because they serve either as Ministers or, in one case, as Parliamentary Private Secretary to the Prime Minister. It should be acknowledged and respected that a number of those affected individuals are present on the Front Bench. I am of course referring to the Minister for Care, the hon. Member for Gosport (Caroline Dinenage); the Secretary of State for International Development, the right hon. Member for Portsmouth North (Penny Mordaunt); the Under-Secretary of State for Exiting the European Union, the hon. Member for Fareham (Suella Braverman); and the hon. Member for Meon Valley (George Hollingbery).

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

I thank the Secretary of State for the advance copy of his statement. I welcome the tone of his remarks and the apology that he has offered on behalf of the Government and the national health service.

This is a devastating, shocking and heartbreaking report. Our thoughts must be with the families of the 456 patients whose lives were shortened. I, like the Secretary of State, pay tribute to the right hon. Member for North Norfolk (Norman Lamb), whose persistence in establishing this inquiry in the face of a bureaucracy that, in his own words, attempted to close ranks, must be applauded. I know that other Members have also played an important part, including the hon. Member for Eastbourne (Stephen Lloyd), who is in his place, and the Minister for Care, who is understandably and properly in her Gosport constituency this afternoon. I also thank all those who served on the inquiry panel, and offer particular thanks for the extraordinary dedication, calm, compassionate, relentless and determined leadership—yet again—of the former Bishop of Liverpool, James Jones, in uncovering an injustice and revealing a truth about a shameful episode in our nation’s recent history.

As the Secretary of State quoted, the Right Rev. James Jones said:

“Handing over a loved one to a hospital, to doctors and nurses, is an act of trust and you take for granted that they will always do that which is best for the one you love.”

That trust was betrayed. He continued:

“whereas a large number of patients and their relatives understood that their admission to the hospital was for either rehabilitation or respite care, they were, in effect, put on a terminal care pathway.”

Others will come to their own judgment, but for me that is unforgivable.

This is a substantial, 400-page report that was only published in the last hour or so, and it will take some time for the House to fully absorb each and every detail, but let me offer a few reflections and ask a few questions of the Secretary of State. Like the Secretary of State, the question that lingers in my mind is, how could this have been allowed to go on for so long? How could so many warnings go unheeded?

The report is clear that concerns were first raised by a nurse in 1991. The hospital chose not to rectify the practice of prescribing the drugs involved. Concerns were raised at a national level, and the report runs through a complicated set of back and forths between different versions of health trusts and successor health trusts, management bodies and national bodies about what to do and what sort of inquiry would be appropriate. An inquiry was eventually conducted and it found an

“almost routine use of opiates”

that

“almost certainly shortened the lives of some patients”.

It seems that that report was left on a shelf, gathering dust.

I am sure that many of the officials and players acted in good faith but, taken as a whole, there was a systemic failure properly to investigate what went wrong and to rectify the situation. In the words of the report, serious allegations were handled

“in a way that limits the impact on the organisation and its perceived reputation.”

The consequence of that failure was devastating.

To this day, the NHS landscape understandably remains complex and is often fragmented. How confident is the Secretary of State that similar failures—if, God forbid, they were to happen again somewhere—would be more easily rectified in the future? Equally, as the Secretary of State recognises, there are questions about Hampshire constabulary. As the report says,

“the quality of the police investigations was consistently poor.”

Why is it that the police investigated the deaths of 92 patients, yet no prosecutions were brought? The report has only just been published, but what early discussions will the Secretary of State be having with the Home Secretary to ensure that police constabularies are equipped to carry out investigations of this nature, if anything so devastating were to happen anywhere else?

What about the voice of the families? Why did families who had lost loved ones have to take on such a burden and a toll to demand answers? It is clear that the concerns of families were often too readily dismissed and treated as irritants. It is shameful. No family should be put through that. I recognise that the Secretary of State has done work on this in the past and I genuinely pay tribute to him, but how can he ensure that the family voice is heard fully in future? He is right that we must be cautious in our remarks today, but can he give me the reassurance that all the relevant authorities will properly investigate and take this further? If there is a police investigation, can he guarantee that a different force will carry it out?

I also want the Secretary of State to give us some more general reassurances. Is he satisfied that the oversight of medicines in the NHS is now tight enough that incidents such as this could never be allowed to happen again? What wider lessons are there for patient safety in the NHS? Is additional legislation now required? Does he see a need for any tightening of the draft Health Service Safety Investigations Bill to reflect the learnings from this case?

The Right Rev. James Jones has provided a serious, devastating, far-reaching service in a far-reaching report. Aggrieved families have had to suffer the most terrible injustice. In the next few weeks, we will rightly acknowledge 70 years of our national health service. The Secretary of State is right to say that this must not cast a shadow over the extraordinary work done every day by health professionals in our NHS. But on this occasion, the system has let so many down. We must ask ourselves why that was allowed to happen and dedicate ourselves to ensuring that it never happens again.

[Mr Hunt]

I thank the shadow Health Secretary for the considered tone of his comments. I agree with everything he says. Members across the House will understand that we are all constrained in what we can say about the individual doctor concerned—because that is now a matter for the police and the CPS to take forward—but we are not constrained in debating what system lessons can be learned, and we should debate them fully, not just today but in the future. The big question for us is not so much, “How could this have happened once?”—because in a huge healthcare system we are, unfortunately, always occasionally going to get things that go wrong, however horrific that sometimes is—but, “How could it have been allowed to go on for so long without being stopped?”

Reflecting the hon. Gentleman’s comments, the poor treatment of whistleblowers, the ignoring of families and the closing of ranks is wrong, and we must stop it. We must go further than we have gone to date. In a way, though, it is straightforward, because we know exactly what the problem is and we just have to make sure that the culture changes. The more difficult bit is where there were process issues that happened in good faith but had a terrible outcome.

In particular, this report is a salutary lesson about the importance of transparency. Obviously I had only a couple of hours to read it—so not very long—but it looks as though the Baker report was left to gather dust for 10 years, for the perfectly straightforward and understandable reason that people said that it could not be published in the course of a police investigation or while an inquest was going on. I am speculating here, but I am pretty certain that had it been published, transparency would have prompted much more rapid action, and some of the things that we may now decide to do we would have done much, much earlier. That is an incredibly powerful argument for the transparency that has sadly been lacking.

How confident can I be that this would not happen again? I do think that the culture is changing in the NHS, that the NHS is more transparent and more open, and that interactions with families are much better than they were. However, I do not, by any means, think that we are there yet. I think that we will uncover from this a number of things that we are still not getting right.

As the hon. Gentleman will understand, it is not a decision for the Government as to which police force conducts these investigations. We have separation of powers and that has to be a matter for the police. One of the things that we have to ask about police investigations is whether forces have access to the expertise they need to decide whether they should prioritise an investigation. When the medical establishment closes ranks, it can be difficult for the police to know whether they should challenge that, and it does appear that that happened in this case.

In terms of wider lessons on the oversight of medicines and the Health Service Safety Investigations Bill, we will certainly take on board whether any changes need to be made there.

[Gillian Keegan (Chichester) (Con)]

The culture of closing ranks and ignoring whistleblowers in the NHS is gravely worrying. Even as a new MP, I have had constituency cases where people have alerted me to this, and I feel that it could still happen today. What implications will the report have for the wider health service, particularly for elderly care and people who have family members in these situations?

[Mr Hunt]

There is one very important point that the shadow Health Secretary mentioned that it is important to understand from this report. We very often have a problem where people in an end of life situation are not treated in the way that we would want for our own relatives or parents. To put it very bluntly, the worry is that someone’s end may be hastened more quickly than it should be. We have made a number of changes, including scrapping the Liverpool care pathway, which happened under the coalition Government. But in this case, these patients were not in an end of life situation. They were actually going to the hospital for rehabilitation and expecting to recover—but they were old. One of the things that we will have to try to understand—all of us—is how this could have been allowed to happen and how this culture developed. I am afraid that the report is very clear that, inasmuch as the doctor was responsible—I have to be careful with my words here—lots of other people knew what was going on.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am very grateful to the Secretary of State for an advance copy of his statement. There is much in it that I agree with, both in tone and content.

These are truly horrific events, and our first thoughts must always be with the families of those who have been affected by this scandal. It is deeply distressing to lose a loved one in any circumstances, and the circumstances in this case, with all the press coverage, will only have amplified that distress for everyone concerned.

When the inquiry was originally announced, it was expected to take two years, and it is extremely disappointing that it has stretched out until now. There has no doubt been a catastrophic failure of monitoring and accountability, not only with regard to the doctor concerned but those who failed to investigate these actions. The Government are also included in this failure. However, I am grateful to the Secretary of State for issuing the apology that he has today, and welcome the fact that the Government will bring forward more considered responses in the autumn.

I sincerely hope that this will be the beginning of justice, and ultimately closure, for the families affected. I hope that the Secretary of State will support the opening of criminal investigations into the events following the report’s findings. The public find it very difficult to have faith in health regulators who act both as investigators and prosecutors—and even the judge—in complaints. I hope that he will look at this aspect to ensure public confidence and faith in the healthcare regulation system in the future.

[Mr Hunt]

I thank the hon. Gentleman for his comments and agree with what he says. Of course, if the police decide to bring forward criminal prosecutions, that would have the support of the Government, but the police must make that decision independently. If a family feel that an injustice has been done, who can they go to if they feel that ranks are being closed? I think we have made progress on that question, but we need to reflect very carefully on whether it is enough progress.

[Alan Mak (Havant) (Con)]

The events at the hospital and the panel’s report are of significant interest to me and my constituents, and those of my hon. Friend the Member for Meon Valley (George Hollingbery), on whose behalf I am also speaking. His constituents and mine have asked whether the families can be confident that the report’s findings will be acted on and that people will be held accountable for what happened.

[Mr Hunt]

My hon. Friend is right to ask that question. The best parallel is the Hillsborough process, which was also led by Bishop Jones. A similar report was published that put documents into the public arena, essentially enabling people to understand truthfully what happened. On the basis of that, inquests were reopened, criminal prosecutions happened and so on. We are at that stage of the process. I hope that the transparency and thoroughness of the report will give families hope that they are at last being listened to.

[Norman Lamb (North Norfolk) (LD)]

May I first thank the Secretary of State for backing and trusting my judgment in 2013, without hesitation, and proceeding with this panel inquiry? I join him in paying tribute to the work of Bishop James Jones and the whole panel. Bishop James Jones is a remarkable man who has shown extraordinary clarity of thought that has, in a very impressive way, built the trust of families who have been involved in this process.

I am not sure that I share the Secretary of State’s confidence that an earlier publication of the Baker report would have resulted in the transparency he called for, bearing in mind that I had to intervene in 2013 to stop a statement being made that there would be no public inquiry even after the publication of that report. Does he agree that we have to find a way of overcoming the problem of having different inquiries through inquests, through the police and through regulators, because, together, those stopped the vital information getting out into the public domain and stopped proper investigation into these issues? Does he also agree that we need a mechanism to ensure that in future families are never ignored again, and that when legitimate allegations of wrongdoing are made, they are investigated properly and families are involved in that process?

[Mr Hunt]

First, I again pay tribute to the role that the right hon. Gentleman played. One of the most difficult things for any Minister is knowing when to accept advice, which is what we do most of the time, and when to overrule it. His instincts have been proved absolutely right. It is not an easy thing to do, and it causes all sorts of feathers to be ruffled, but he stuck to his guns, and rightly so. Bishop James Jones, who is a truly remarkable public servant, talked in the Hillsborough panel report about the

“patronising disposition of unaccountable power”.

That is what we have to be incredibly on guard against.

The right hon. Gentleman is right: at the heart is the problem that we did not listen to families early enough and we did not listen to whistleblowers inside the NHS early enough. My reason for saying that all these things need to see the sunlight of transparency much sooner is frankly that if they had come to light sooner and if proper attention had been given to this in 2001—we all know that Mid Staffs started in 2005—how many other lessons and tragedies throughout the health service could have been avoided? That is why I think it would be the wrong reaction today to say that we are getting there on patient safety and that transparency problems are solved: there is a lot further to go.

[Dr Julian Lewis (New Forest East) (Con)]

Within the last few hours, I have learned that I have a constituent whose grandmother had recovered from successful hip surgery without the need for any drug interventions and was sent to Gosport War Memorial Hospital for rehabilitation, only to be given a lethal cocktail of drugs that killed her. The matter was reported to Gosport police when it happened in 1998. Does the Secretary of State agree that if people are found wilfully to have administered lethal drug doses unnecessarily, they deserve to lose their liberty, and that if people are found wilfully to have covered up such crimes—for that is what they are—they deserve to lose their jobs?

[Mr Hunt]

I think everyone in the House would share my right hon. Friend’s sentiments, but we have to let the law take its course, and we have to make sure that justice is done, because it has been denied for too long.

[Stephen Morgan (Portsmouth South) (Lab)]

On behalf of my constituents, I thank the Secretary of State for the apology and the statement today. Can he confirm that all families affected have been contacted and say a bit more about the support that will be available to those who have lost loved ones?

[Mr Hunt]

I am happy to do that. All the families who think they had a relative affected have been part of the panel process, and they were all invited for a briefing by Bishop Jones this morning in Portsmouth. We will provide ongoing support and counselling if necessary through the Department of Health and Social Care, which was a specific request of Bishop Jones. We are also conscious that when people read the news, they may suddenly decide that they or a loved one were affected by this. We have set up a helpline so that people can contact us and we can help them to trace whether they too have been affected.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

Does not every instance of people being scared to speak out and relatives finding it too difficult to complain underline the importance of the Healthcare Safety Investigation Branch, which the Secretary of State has established? I remind him that I am chairing the Joint Committee of both Houses that is carrying out prelegislative scrutiny of the draft Health Service Safety Investigations Bill. When we report on 24 July, will my right hon. Friend undertake to bring that into law as quickly as possible? That will afford the safe space that people need to report such matters without fear or favour.

[Mr Hunt]

Absolutely. I commend my hon. Friend for his work and for being one of the colleagues in this place who have thought and talked about the importance of getting the right safety culture in the NHS. The Healthcare Safety Investigation Branch matters because in situations such as this, it could have been called in, done a totally independent investigation, got to the truth of what was happening quickly and prevented a recurrence of the problem. That is one of a number of things that we need to think about.

[Stephen Lloyd (Eastbourne) (LD)]

Ten years ago, a constituent came to see me called Mrs Gillian McKenzie. She told me a story that sounded so far-fetched that I struggled to believe it. In her opinion, her mother and many other elderly people had effectively been killed before their time at a hospital in Gosport. I found it staggering. I then read the hundreds of pages of documents that this amazing woman, Mrs McKenzie, had put together over the weekend, and I came to the harrowing conclusion that there could be a chance of a significant number of early deaths at the Gosport War Memorial Hospital.

I was a candidate then, not the MP. I contacted my good friend, my right hon. Friend the Member for North Norfolk (Norman Lamb), and I took Mrs McKenzie and relatives up to London to meet him. He agreed that this could be something wicked beyond compare. Over the next few years, there was continual campaigning and lobbying, and continual pushback. Finally—I pay tribute to my right hon. Friend—we got this commission off the ground. By the way, Mr Speaker, Mrs McKenzie is now 84. I saw her on Saturday evening, wished her luck and gave her a hug. Twenty years later, we are talking about the deaths of more than 450 and possibly 600 elderly people. The relatives today got the truth.

[Stephen Lloyd]

I am, Mr Speaker. I appreciate the latitude.

This has been a 10-year battle. Today, the relatives got the truth. The relatives and I demand justice. I urge the House, the Government and the police to do everything necessary to ensure that the individuals named in the report are brought to justice.

[Mr Hunt]

There can be no justice unless the truth is put on the table. That is the crucial first step, and now justice must proceed. I thank the hon. Gentleman for his campaign for Mrs McKenzie. Perhaps the best words I can use are these of the panel in the report:

“Yes, we have listened and yes, you, the families, were right. Your concerns are shown to be valid.”

[Mr Philip Dunne (Ludlow) (Con)]

I echo the tributes to the work of Bishop James Jones and the integrity and diligence that he and the panel have shown in conducting this inquiry. The Secretary of State has rightly focused on the impact on families, and I was pleased to hear in his statement that there will be a helpline for families who suspect that they have been affected—not least because the immediate catchment area around Gosport includes a lot of retirement homes, and many families whose elderly relatives went to the area to retire may live some distance away. Given the publicity that the report has given rise to, a considerable number of people may need to get in touch. Will he ensure that the helpline is adequately resourced?

[Mr Hunt]

Yes, I will absolutely do that. I ought to say that I know my hon. Friend met many families and relatives during his time as a Minister in my Department, and he always dealt with those cases with a huge amount of compassion. The facts of the matter are, according to the report, that 650-plus people had their lives shortened, but we are in touch with only about 100 families, so we are expecting more people to come forward.

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

I, too, join in the comments that have made about the remarkable work of Bishop James Jones—not only in this important report, but on Hillsborough and on mediating with the Government last summer about moving the contaminated blood inquiry away from the Department of Health. I seek an assurance from the Secretary of State about the approach that Bishop Jones has put forward, which is the “families first” approach. Is there now a commitment from the Government to making that approach—families first—the hallmark of any inquiry that is ever held in the future?

[Mr Hunt]

I think actions speak louder than words. Such an approach is what Bishop Jones requested on this occasion, and we have done that. We obviously need to think through some process issues, because when a Minister wants to report to the House, they need to be a little bit informed as to what they are talking about. However, I think we have found a way to do that with this report and with the Francis report, so I think it is a good template.

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

May I commend the diligence and determination of the right hon. Member for North Norfolk (Norman Lamb), without whose efforts we would not be hearing the truth today, as grim and disturbing as that truth might be? Does my right hon. Friend agree that this raises further questions about the way in which doctors’ performance and patient safety are monitored? With the GMC, doctors are in effect policing themselves. Is it not time to say that this system has to change?

[Mr Hunt]

We do have to ask those questions, and we have to be able to respond to the concerns of my hon. Friend and his constituents about how we can be absolutely certain there will not be a closing of ranks. My experience, however, is that doctors are very quick to want to remove those of their number who are letting the profession down because this damages everyone’s reputation. There are some very difficult questions for the GMC and for the NMC. Because their processes took so long, I do not think they can put their hand on their heart and say that they have kept patients safe during that period.

[Mr Kevan Jones (North Durham) (Lab)]

The legislation regulating both doctors and healthcare professionals is now 35 years old. It is inefficient, outdated and—as I know from a constituency case in which the individual concerned is into the fifth year of her complaint to the GMC—not user-friendly for the complainant. The GMC and other healthcare professionals want change and the Secretary of State’s Department has already consulted on change, so will he give a guarantee that he will bring forward legislation to ensure that the system is not only effective, but effective for patients who make complaints?

[Mr Hunt]

The right hon. Gentleman is absolutely right: we have a regulatory landscape that is very complex, does not achieve the results we want, and forces regulators to spend time doing things they do not want to do and does not give them enough time for things they do want to do. Obviously, because of the parliamentary arithmetic, if we are able to get parliamentary consensus on such a change, that would speed forward the legislation.

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

There are many “if onlys”, but one of them is: if only the junior doctors and others who spoke up had been listened to. I know my right hon. Friend is committed to making sure that people and whistleblowers are listened to and that he is committed to transparency. Will he say a bit more about what he is doing to make sure that everyone involved in patient care—from consultants to healthcare assistants, porters, patients and families—are listened to and that their concerns are acted on?

[Mr Hunt]

I think we have made progress when it comes to whistleblowing because every trust now has a “freedom to speak up” guardian—an independent person inside the trust whom clinicians can contact if they have patient safety concerns. That is a big step forward, which was recommended by Robert Francis. Where I am less clear that we have solved the problem is in relation to having someone for families to go to if they think that everyone is closing ranks, and we now need to reflect on that.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I refer the House to my entry in the Register of Members’ Financial Interests and my history of working in the NHS.

A brave nurse came forward all those many years ago to highlight a concern, but the concern was not taken forward adequately at that time. Often in these circumstances, the NHS closes ranks, management remove the individual who raises the concern—the clinician in this instance—and allows the system to continue. Is there some way of monitoring the types of concerns raised by clinicians, ensuring that the staff who raise these concerns are not themselves penalised and that the system then takes accountability forward?

[Mr Hunt]

The hon. Lady is absolutely right to raise that matter. The nurse concerned, Anita Tubbritt, talks in the report about her concerns and the pressure that she was put under, and it was a brave thing to do. When the hon. Lady reads the report, she will see that nurse auxiliaries and others who were not professionally trained clinicians also came forward with concerns and were also worried about the impact that doing so would have on their own career. That is what we have got to stop because, in whatever part of the UK, getting a culture in which people can speak openly about patient safety issues is absolutely essential.

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

I was a junior doctor at the Royal Hospital Haslar in Gosport, which is just around the corner from the Gosport War Memorial Hospital, so I know that hospital fairly well, and I also know that the people of Gosport will be disappointed and distressed by this, since they very much value their community hospital.

Does the Secretary of State agree with me that there is an issue about the governance of smaller institutions, as we have seen in the past? I in no way wish to disparage the excellent work done by community hospitals, of which I have been a champion for many years, but will he look specifically at the pages in the report that touch on this? There is an issue about governing and ensuring safety in small institutions—whether in general practice or in hospitals?

[Mr Hunt]

I think that that is actually an excellent point, and we should definitely look at it. Big hospitals have clear lines of accountability—boards, chief executives—but those often do not exist in community hospitals and there is no one who can say they are the boss of that trust, so we should look at that.

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

The grandmother of one of my constituents died in Gosport War Memorial Hospital in January 1999—in other words, after concerns were being raised by families and by staff at the hospital. The family believe that her morphine dose was well above that needed for her reported pain. I thank the Health Secretary for the tone of his statement, and I also thank Bishop Jones for the work he did on this inquiry. Does the Secretary of State believe that this report shows a need for tightening the draft Health Service Safety Investigations Bill?

[Mr Hunt]

I thank the hon. Lady for her comments. I do not want to jump to a conclusion about any changes to the draft Bill. However, we should definitely reflect on any legislative changes that might be needed as a result of this report, and that Bill could be a very powerful vehicle for doing so.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

My right hon. Friend has mentioned trust, and as a doctor myself, I am very aware of and humbled by the fact that people come to me with their children and put their trust in me to look after them. When events such as this occur, trusts can be shaken, and it is therefore important that these things are dealt with quickly. In this case, the investigation, since complaints were first received, has been going on for far too long. What will my right hon. Friend do to reassure people that any such complaints will be dealt with much more quickly in future, and that opportunities to save lives will not be lost in the meantime?

[Mr Hunt]

That is the big question we have to answer for both the House and the British people. However, I would say to the hon. Lady that I am confident that, where there is unsafe practice, it is surfaced much more quickly now in the NHS than it has been in the past. I am less confident about whether we have removed the bureaucratic obstacles that mean the processes of doing such investigations are not delayed inordinately so that the broader lessons that need to be learned can be learned.

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

One of the reasons for the growing success of the “Getting it right first time” programme is the creation of clinician-agreed datasets. Will the Secretary of State give the House an assurance that there will in future be proper analysis of the data on the excess number of deaths and the use of this particular type of drug in excessive amounts? Such analysis would have shown this hospital as an outlier, so questions could have been asked, as is now happening successfully with the GIRFT programme.

[Mr Hunt]

I thank my hon. Friend for his championing of the GIRFT programme, which is incredibly powerful and successful. He will have noticed that we announced last week that we are expanding it into a national clinical information programme, which will cover more than 70% of consultants. What is disturbing in this case, though, if I may say so, is that the data was really around mortality, and we have actually had that data for this whole period. There is really nothing to stop anyone looking at data, and we can see a spike in the mortality rates in this hospital between 1997 and 2001. They go down dramatically in 2001, when the practices around opiates were changed. That is why we have to ask ourselves the very difficult question about why no one looked at that data or, if they did, why no one did anything about it.

[Robert Courts (Witney) (Con)]

Will the Secretary of State commit to look at the wider structural issues that affect patient safety, and particularly at things such as staffing levels and pressures on doctors and nurses?

[Mr Hunt]

Absolutely. One of the big lessons from this report is that we have to look at systemic issues as much as at the practice of an individual doctor or nurse.

[Alex Burghart (Brentwood and Ongar) (Con)]

I congratulate the Secretary of State and the right hon. Member for North Norfolk (Norman Lamb) for getting us to this point. I was deeply concerned to hear in the Secretary of State’s statement that Ministers had been given advice not to proceed with this independent panel. Is the Secretary of State convinced that Ministers are now receiving better advice?

--- Later in debate ---

[Mr Hunt]

Of course that is an issue that we will look into. I would just say, in the interests of transparency, that the Department of Health has been on the same journey as the whole of the rest of the NHS with respect to patient safety issues.

[Eddie Hughes (Walsall North) (Con)]

Does the Secretary of State agree that this report highlights the importance of the CQC to the NHS and patient safety? Will he consider giving that body greater regulatory powers?

[Mr Hunt]

The legal independence of the CQC, and its ability to act as the nation’s whistleblower-in-chief, is one of the big, important reforms of recent years, and I think that will give the public confidence. However, I do not think that that is the entire answer, and I still think there is an issue about who families go to when they think they are being ignored by the establishment.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

We have had Mid Staffs, Morecambe Bay and now the Gosport War Memorial Hospital. That tells us that significant patient failures are not one-offs; indeed, the Francis report of 2013 was one of the most challenging public documents I have ever read. My right hon. Friend has made patient safety a personal priority, with his customary judgment and compassion. Can he confirm that this developing culture within the NHS remains a priority for him and that the NHS will do all that it can to protect the most frail and vulnerable that it looks after?

[Mr Hunt]

That is absolutely my priority, and my hon. Friend worked very closely with me on that when he was my Parliamentary Private Secretary. Changing culture is a long, long process, but I think we can start through some of the things we do in this House. Reacting afresh to this report, and not just saying, “We’ve done what we need to do, because we had Mid Staffs and Morecambe Bay,” is a very important next step.

[Mr Philip Hollobone (Kettering) (Con)]

For me, the two most shocking things are the number of deaths and the length of time it has taken for this scandal to be exposed. Further to the earlier question, until the Secretary of State overruled it, the official advice from the Department of Health was that this public inquiry should not take place. Is there going to be an official investigation into why that official advice was given and which civil servant should be held accountable for it?

[Mr Hunt]

We will, of course, look at that. That was why I said in my statement that there were failures by the Department of Health—the specific incident needs to be looked at—and also as the steward of the system in which so many other things went wrong.

[Nigel Huddleston (Mid Worcestershire) (Con)]

Can the Secretary of State confirm that all deaths in the NHS will be properly assessed by a coroner or a medical examiner so that lessons can be learned and avoidable deaths minimised?

[Mr Hunt]

I can confirm that, from next April, all hospital deaths will be examined by an independent doctor—this is the medical examiner process. We are expanding the learning from deaths programme to primary care. That is exactly where we want to go.