Oral Answers to Questions
Jeremy Hunt Excerpts(6 years, 10 months ago)
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Bim Afolami (Hitchin and Harpenden) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
The NHS needs more nurses, which is why we are making big changes for new entries into the profession, including the new nurse associate role and new nurse degree apprenticeships.
Bim Afolami
I am glad to hear that the Secretary of State values the degree apprenticeship as a way to provide further routes into nursing, but will he consider working with the Treasury and across the Government to increase the funding that educational establishments receive from the Institute for Apprenticeships for nursing courses, to further incentivise universities and colleges to offer more places on those courses?
Mr Hunt
I thank my hon. Friend for his excellent question. It will strengthen my hand with the Department for Education, which decides what levels of funding are made available from the Institute for Apprenticeships. It has actually given us the highest level of funding, at £27,000, but we never say no to more.
Ms Angela Eagle (Wallasey) (Lab)
But will the Secretary of State admit that he made a basic error by scrapping nurse bursaries, which has led to a 23% fall in the number of people applying to nurse courses? Why does he not look at that if he wants to widen the entrance into nursing?
Mr Hunt
I am most grateful. That is a very rare compliment, so I shall savour it. I would gently say to her that the point about nurse degree apprenticeships is that it is possible to transition into nursing from being a healthcare assistant without any fees being paid at all. That is why it is a huge and highly significant change.
Mr Speaker
As the hon. Member for Wallasey (Ms Eagle) is sporting what appears to me to be a very fetching suffragette rosette, it is perhaps timely to record that in the great success our national health service has been under successive Governments, I think I am right in saying, as things stand, that well over 70% of the people who make it great are women.
Dr Sarah Wollaston (Totnes) (Con)
Following the recent inquiry by the Select Committee on Health into the nursing workforce, we absolutely welcome the new routes into nursing, including the new role of nursing associate. However, one of the issues highlighted strongly was the need to retain our existing nursing workforce as well as to recruit into it. Will the Secretary of State comment on that?
Mr Hunt
My hon. Friend speaks very wisely—we do need to be better at retaining our existing workforce. I think that is why the Treasury has given me extra latitude in negotiations on the pay rise—those discussions are currently happening—but we also need to be much better at flexible working and at recognising the challenges people have in their ordinary working lives.
Martyn Day (Linlithgow and East Falkirk) (SNP)
Unlike in Scotland, where student nurses receive free tuition and a nursing bursary of over £6,500 a year, nurses in England now face debts of £50,000 on graduation. Owing to that, training applications in England have dropped by a third since 2015, and the new nursing apprenticeship attracted only 30 trainees against a target of 1,000. Will the Secretary of State not accept that he got it wrong, and reinstate the nursing bursary?
Mr Hunt
I am interested to hear the hon. Gentleman say that, because we have published a draft of a workforce strategy in this country, but I notice that Audit Scotland says that in Scotland there is a lack of a long-term strategic plan for the workforce. I gently say to him that there are workforce pressures across the United Kingdom. We have a plan to dramatically increase the number of nurses that we employ in the NHS, and I am sure many people in Scotland would like to see the same there.
Martyn Day
The Secretary of State has claimed that the removal of the bursary would fund 10,000 extra training places, but the first 5,000 will start only this autumn and the nurses will qualify only in 2021. With more than 36,000 nursing vacancies in England, more nurses leaving than joining and a 90% drop in EU nurses coming to the UK because of Brexit, exactly who does he expect to care for patients in the meantime?
Mr Hunt
As we discussed earlier, we are broadening the routes into nursing from just traditional higher education courses, including nurse apprenticeships and people being able to train on the job over four years in a hospital. We hope that a whole group of healthcare assistants who currently find it difficult to get into nursing can become nurses. I think that would be very welcome in Scotland as well.
Chris Skidmore (Kingswood) (Con)
Will the Secretary of State update the House on progress made in reducing the cost of agency nurses so that the money can be reinvested in full-time nursing?
Mr Hunt
I am happy to do that. It is one of the great successes of NHS Improvement, which should be celebrated, that it has brought down the amount spent on agency nursing by £1 billion in the last couple of years. That is a huge achievement. Every penny of that goes back into frontline care.
Helen Jones (Warrington North) (Lab)
The Government cut the number of nurse training places in 2010, and when they scrapped bursaries applications from mature students suffered particularly. What is the point of blaming trusts for hiring agency staff when the Government simply do not train enough nurses to fill the vacancies?
Mr Hunt
Perhaps I should set the record straight for the hon. Lady. We have 52,000 nurses in training—more than was ever the case under the last Labour Government, who were planning to cut nurse training places by 6%. We are planning to increase them by 25%. That shows our commitment to nursing.
Justin Madders (Ellesmere Port and Neston) (Lab)
Yesterday, the Royal College of Nursing reported on the total failure of Government policies to increase the nursing workforce. As we have just heard, the Government hoped to recruit 1,000 trainees to the nursing apprenticeship, but ended up with just 30. This year, the number applying to university to study nursing has so far fallen by a staggering 33%. We have a workforce crisis exacerbated by badly thought out policies, so is it not time that the Secretary of State admitted that scrapping the bursary was a mistake?
Mr Hunt
I have a great deal of respect for the hon. Gentleman, but that is not the first time that he has presented a somewhat incomplete picture of what is actually happening. In the last five years, we have 15,700 more nurses, and the reason for those vacancies and for the pressure is that, as he knows very well, under the last Labour Government we had Mid Staffs, which was a crisis of short staffing that this Government are putting right. That is why we want to recruit those extra nurses.
Michelle Donelan (Chippenham) (Con)
Kirstene Hair (Angus) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
This week is Children’s Mental Health Week, and still too many children and young people wait too long for their mental health provision in the NHS. That is why, by the end of next year, we will have invested an extra £1.4 billion, meaning that 70,000 extra children and young people are seen every year.
Michelle Donelan
A constituent’s 14-year-old son suffers severe obsessive compulsive disorder, resulting in self-harm. Treatment options have failed and his doctor recommends an intensive residential programme, but as Ministers are aware, places are very limited. He has been waiting seven weeks and counting, with 24-hour parental support and supervision. What more can be done to ensure that that boy and other adolescents who are in desperate need of help get that help before it is too late?
Mr Hunt
I thank my hon. Friend for raising that issue, and I understand that in that particular case clinicians are meeting this week to resolve those issues. She is right: we need to expand the number of beds available for children and young people. They are at a record level—1,440, and that went up by another 81 last year—but more needs to be done, which is why we published our children and young people’s mental health Green Paper.
Edward Argar
I have been approached by a number of my constituents in Leicestershire who are concerned about the wait between a referral to child and adolescent mental health services and the allocation of a named caseworker and formal treatment. Will my right hon. Friend enlarge on how the steps that he is taking, which he has set out, will help to reduce such waits in Leicestershire and across the country?
Mr Hunt
I am happy to do that. The simple truth is that it is a tragedy for every child who has to wait too long to access mental health care, because half of all mental health conditions become established before the age of 14. If we do not nip them in the bud, they can get a lot worse. What are we doing? We are setting up a whole new service inside schools to spot such problems earlier and we are going to introduce a waiting time target for CAMHS appointments.
Kirstene Hair
In 2016-17, 65% of young people in England with eating disorders started urgent treatment within one week of referral. What has been done to ensure that the target of 95% by 2020 will be reached? Does the Secretary of State share my belief that waiting time targets are a vital tool for improving eating disorder treatment and should be in place in all parts of the United Kingdom?
Mr Hunt
I absolutely agree with that. I join my hon. Friend in supporting the introduction of waiting time targets in Scotland and other parts of the United Kingdom. How are we doing so far? In terms of the need for urgent treatment for eating disorders, we are hitting 79%, so we are on our way to the 95% target and we want to get there as soon as we can.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
I listened very carefully to what the Secretary of State said about the additional funding that is supposed to be reaching the frontline, but the Young Person’s Advisory Service, which is the main service for young people’s mental health in Liverpool, has seen a £757,000 cut—a cut of 43%—in this financial year. There are now 412 children in Liverpool waiting more than 28 weeks for an assessment—not even for treatment. It is absolutely shocking. How can he stand there in young people and children’s mental health week and say that everything is rosy?
Mr Hunt
I did not; I said the opposite. I said that we need to do a lot more and I told the House what we are doing. If the hon. Lady looks at what is happening in her own clinical commissioning group, she will see that the proportion that is spent on mental health has gone up from 12.3% to 13%. She will see that this Government have done a huge amount on mental health. In 13 years, Labour did not have any waiting time targets for mental health and did not introduce parity of esteem—a whole range of things that are now happening and that she should support.
Kelvin Hopkins (Luton North) (Ind)
Will the Government commission more extensive research into the causes of mental ill health among children and young people, both pre and post-natal, with a view to preventing as much ill health as possible?
Tim Farron (Westmorland and Lonsdale) (LD)
Specialist mental health crisis care for young people in south Cumbria is available only between the hours of 9 and 5 from Monday to Friday. Does the Secretary of State agree that in the light of the Care Quality Commission’s recent damning report of the partnership trust, that is not acceptable? Will he join me in asking the Morecambe Bay CCG to ensure that there is out-of-hours and weekend care for all people?
Mr Hunt
I am happy to look into that issue. The hon. Gentleman’s colleague, the right hon. Member for North Norfolk (Norman Lamb), did a huge amount to set up crisis care provision around the country. We need to build on that for the simple reason that, if we are to have parity of esteem, people need to be able to get help in a mental health crisis, just as they are if something goes wrong with their physical health.
Alex Chalk (Cheltenham) (Con)
Does my right hon. Friend agree that, as well as improving the treatment of adolescent ill health, everything possible needs to be done to prevent crisis from occurring in the first place? Does he agree that we need more research into why we are seeing a surge in Cheltenham and elsewhere in the world, so that clinicians can best tailor their response?
Mr Hunt
This is something that my hon. Friend has thought a lot about. A particular area of concern is the growth in mental health problems in young women between the ages of 18 and 24. We are looking carefully at whether that relates to social media use, which is an additional pressure that many of us did not face when we were that age. I thank him for his campaigning on this issue.
Ellie Reeves (Lewisham West and Penge) (Lab)
Mr Hunt
With respect, we are taking action. Last year, spending on mental health went up by £575 million and four out of five CCGs increased their mental health spend by more than their overall spend. This year, all CCGs will do that. That will apply in Lewisham, as it will everywhere else in the country.
Jack Brereton (Stoke-on-Trent South) (Con)
Under plans announced by NHS England, child victims of sexual assault in Stoke-on-Trent would have to travel as far as Birmingham to receive the vital support that they need. Will the Secretary of State agree to look urgently into the proposals to remove child sexual assault referral services from the city?
Paula Sherriff (Dewsbury) (Lab)
Research by the Children’s Commissioner revealed that the spend on children and young people’s mental health services varied by CCG from 0.2% to 9%, resulting in services in some areas being described as “shockingly poor”. Can the Secretary of State therefore explain the reason for the variation, and will he commit today to matching Labour’s pledge to increase the proportion of the mental health budget spend on CAMHS services?
Mr Hunt
The hon. Lady is right to shine a light on that variation, and that is why this Government have introduced Ofsted ratings for all CCGs—to make sure that we understand. It is not just in children and young people’s mental health, but in all mental health where we see that variation. Specifically when it comes to children and young people’s mental health, she will be pleased to know that last year overall spending went up by 20%, and the Green Paper that we published announced an additional £300 million in investment.
Gavin Newlands (Paisley and Renfrewshire North) (SNP)
Alison Thewliss (Glasgow Central) (SNP)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
Our ambition was to halve the number of maternal deaths, neonatal deaths, neonatal injuries and stillbirths by 2030, but because of the progress we have made with our maternity safety programme, we have brought that forward to 2025.
Alison Thewliss
I am glad to hear that progress is being made. The World Breastfeeding Trends Initiative’s 2016 report highlighted several gaps in access to breastfeeding support, including deficiencies in clinical training and a lack of integration between the NHS and voluntary sector services. What can be done through the maternity transformation programme to ensure that women can access, and health professionals can provide, the best-quality infant feeding advice right across the country?
Karin Smyth (Bristol South) (Lab)
Julian Sturdy (York Outer) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
It is five years today since the landmark publication of the Francis report on the Mid Staffordshire Foundation NHS Trust. Since then the NHS has made a huge number of changes, not the least being that 34 trusts have gone into special measures and 19 have come out. I particularly congratulate the West Hertfordshire Hospitals NHS Trust on coming out of special measures in January and securing a “good” score for its caring: that was a fantastic achievement by its staff.
Julian Sturdy
Given that York’s local health service is in special measures, the additional funds in the Budget to deal with winter health pressures were very welcome. I am pleased to say that York NHS has already received a tranche of those funds, but the remainder of its share has not been released, although discussions with NHS Improvement are ongoing. Will the Secretary of State undertake to look into the situation, as a matter of urgency?
Ms Harriet Harman (Camberwell and Peckham) (Lab)
The Secretary of State will be aware of the importance of King’s College Hospital to my constituents. In 2009, it was rated “excellent” and one of the top hospitals in the country; now it is missing its A&E waiting time targets and a key cancer treatment target, there has been a fourfold increase in the number of cancelled operations, and it is in special measures. The Government must take some responsibility for that. They must not wash their hands of it. Will they step up to the plate and help King’s by, for instance, giving it the resources that it needs?
Mr Hunt
Let me reassure the right hon. and learned Lady that we do not wash our hands of any trusts that go into special measures. The point of the special measures regime is to highlight where Government intervention is necessary. I know the right hon. and learned Lady will agree that a huge amount of very fine treatment happens at King’s every single day, but it is having profound issues in relation to the management of its finances and some of its waiting times, which is why we are doing everything we can to support it.
Mr Philip Hollobone (Kettering) (Con)
With a high delayed-discharge rate of 10%, Kettering General Hospital, which is in special measures, has 60 patients on any one day who have completed their treatment and await their transfer into the community. Northamptonshire County Council has been given millions of pounds, via the better care fund, but it is simply not up to the job. What can be done in those circumstances?
Mr Hunt
I am well aware of the pressures at Kettering. It is a very busy hospital, and it has undergone a number of changes of management. However, I can reassure my hon. Friend that a big improvement package is there to support it and that we want to take it out of special measures as soon as possible.
Helen Hayes (Dulwich and West Norwood) (Lab)
The previous chair of King's College Hospital NHS Foundation Trust resigned because he had concluded that the funding provided for King’s had placed the trust in an impossible position. The current interim chair has said that the proportion of GDP spent on health and social care needs to rise to match that in other European countries if our NHS is to be sustainable. When will the Secretary of State heed the warning cries and commit the funding that King’s and, more widely, our NHS need in order to deliver care to our constituents?
Mrs Pauline Latham (Mid Derbyshire) (Con)
Mr Speaker
I do not know whether the right hon. Lady is referring to my age, a proposition on which I think the House would have to divide, or the rosette. [Interruption.] Yes, I thought she meant the rosette.
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
On the day that we mark the 100th anniversary of giving a voice to women, I want to update the House on concerns in the medical profession that we may not be giving a voice to doctors and other clinicians who want the freedom to be able to learn from mistakes. The House will know that, as a Government Minister, I cannot comment on a court ruling, but it is fair to say that the recent Dr Bawa-Garba case has caused huge concern, so today I can announce that I have asked Professor Sir Norman Williams, former president of the Royal College of Surgeons and my senior clinical adviser, to conduct a rapid review into the application of gross negligence manslaughter in healthcare.
Working with senior lawyers, Sir Norman will review how we ensure the vital role of reflective learning, openness and transparency is protected so that mistakes are learned from and not covered up, how we ensure that there is clarity about where the line is drawn between gross negligence manslaughter and ordinary human error in medical practice so that doctors and other health professionals know where they stand in respect of criminal liability or professional misconduct, and any lessons that need to be learned by the General Medical Council and other professional regulators. I will engage the devolved Administrations, the Justice Secretary and the Professional Standards Authority for Health and Social Care in this vital review, which will report to me before the end of April 2018.
Anna Soubry
I thank the Secretary of State for that answer—or rather, for that statement—and also for the robust tweets that he makes on that and many other issues. Would he be amenable to the idea of following on Twitter the Oliver King Foundation? On the foundation’s advice, I have written to all the schools in Broxtowe urging them to install defibrillators. This is an important project. What assistance is the Department of Health giving to such an admirable charity and such an excellent project?
Barbara Keeley (Worsley and Eccles South) (Lab)
I welcome the review that the Health and Social Care Secretary has just announced. I also welcome the addition of social care to his role and the Government’s belated realisation that social care should be a Cabinet-level role, as Labour recognised with its shadow Cabinet in 2010. Yesterday, the Alzheimer’s Society reported that care homes were turning away people with advanced dementia—or even evicting them, sadly—because care providers do not get enough money from local authorities to cover the cost of their care. Will the Health and Social Care Secretary now be arguing with Treasury colleagues for the funding that is so badly needed to ensure that people with dementia are not evicted from care homes due to a lack of funding?
Mr Hunt
The hon. Lady always speaks powerfully about the social care system. One of the key parts of the social care Green Paper that we are currently working through is on market stabilisation. We have seen a number of care homes go under, although the number of beds overall has remained broadly stable, but our particular concern is, as she rightly points out, people in the advanced stages of dementia who might not be able to get the care that they want. This is a key focus of our work.
Craig Tracey (North Warwickshire) (Con)
Steve McCabe (Birmingham, Selly Oak) (Lab)
Will the Secretary of State give an assurance that any accountable care organisations that he establishes will not be able to use commercial confidentiality excuses to evade scrutiny under freedom of information legislation?
Mr Mark Harper (Forest of Dean) (Con)
As the Secretary of State carries out his social care funding review, I urge him to look carefully at whether we should look again at implementing the Dilnot commission’s proposals. Given that we legislated for them, they are the only way that we are going to tackle the issue with the sufficient urgency.
Mr Hunt
At the heart of the Dilnot proposals was the idea of risk pooling—that there is a randomness in the illnesses that affect us in the later years of our life that we would want, as a society, to do something about. I will confirm what the Prime Minister said in the election campaign: we will consult on a cap on social care costs.
Rosie Cooper (West Lancashire) (Lab)
Mr Gary Streeter (South West Devon) (Con)
For the first time ever in Devon and Plymouth, GP practices are struggling to recruit new doctors and new partners in particular and are spending a fortune on locums as a result. The Government have a plan to fix the situation by 2020, but what more can be done in the meantime to ensure that my constituents can access primary care services?
Mr Hunt
There are two things. First, we have succeeded in increasing the number of medical school graduates who go into general practice—a record 3,157 this year. Secondly—I know this from my conversations with GPs in my hon. Friend’s constituency—we are doing what we can to reinvigorate the partnership model. Since meeting those GPs, I have agreed with the Royal College of General Practitioners and the BMA that we will carry out a formal review of how the partnership model needs to evolve in the modern NHS.
Clive Efford (Eltham) (Lab)
Mr Hunt
I point the hon. Gentleman to what the King’s Fund says, which is that accountable care organisations and integrated care systems make a “massive difference” in care to patients. The King’s Fund is not a pro-Government organisation; it regularly holds the Government to account at election time and throughout the year. Not just the King’s Fund but Polly Toynbee and many other people are saying that.
Tom Pursglove (Corby) (Con)
It is very positive that Corby clinical commissioning group has announced that core urgent care services will be protected in Corby, along with the announced new GP access and new primary care facilities, but will the Minister join me in keeping a close eye on the CCG as it designs the new access arrangements? People need to be able to access those urgent care services at the right place, at the right time and without delay.
Stephen Morgan (Portsmouth South) (Lab)
Several hon. Members rose—
Stephen Timms (East Ham) (Lab)
At the weekend, NHS England, as my colleagues have pointed out, gave up on the key A&E waiting time target. Does the Minister agree that it is very important that when people go to A&E they do not have to wait longer than four hours, as more than 2.5 million did last year? Whose responsibility is this delivery failure?
Mr Hunt
I have great respect for the right hon. Gentleman, but he is saying something that is a big exaggeration. What the NHS has committed to is that by the end of the year coming up more than half of the trusts in the country will meet the A&E target and that we will go back to meeting it across the whole country in the following year. So we are absolutely committed to this target. We recognise there are real pressures, which is why it is going to take time to get back to it, but we will get there.
Mr Philip Dunne (Ludlow) (Con)
I congratulate the Secretary of State on securing the £10 billion capital commitment in the Budget at the end of the last year to spend on the NHS. May I take advantage of my position on these Benches to urge him for the next allocation of STP funding to adopt the advice of my hon. Friend the Member for Telford (Lucy Allan) and ensure that the Shrewsbury and Telford Hospital NHS Trust gets the Future Fit funding it needs?
Lucy Powell (Manchester Central) (Lab/Co-op)
The Secretary of State will be aware of the huge disruption at the Manchester hospitals this week because of problems with water supplies and a big water leak. He might also be aware that Emmeline Pankhurst’s home is on the site of the Manchester hospitals. What conversations has he had with United Utilities and other water companies to ensure that we have safe, constant supplies of water to our hospitals, so that these disruptions do not happen?
Jim Shannon (Strangford) (DUP)
Child suicide calls to Childline are at a record high among girls—it is at 68%. Despite that, the NHS spends only 11% of its budget on mental health issues. Will the Minister indicate what he is going to do to prevent child suicides?
Mr Hunt
We are very focused on reducing all suicides. As the hon. Gentleman will know, we have a plan to reduce suicide rates by 10%, and last week we announced a plan to reduce in-patient suicides to zero, which is a big aspiration to which the NHS in England is certainly committed. We are very committed to this agenda.
NHS Winter Crisis
Jeremy Hunt Excerpts(6 years, 11 months ago)
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The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I, too, start by offering, on behalf of the whole House, a massive “thank you” to all staff across the health and care system who went beyond the call of duty and gave up their Christmas and new year to keep patients safe. Their dedication makes the NHS the best healthcare system in the world. They visibly demonstrated their values, constantly putting the needs of patients before their own.
Attempts to politicise pressures on the NHS are a serious mistake. The last time the NHS had a difficult flu winter was 2009—the hon. Member for Leicester South (Jonathan Ashworth) might know that, because he was working in Downing Street at the time. In 2009, the shadow Health Secretary was Andrew Lansley. He refused to attack the Government, because it was an operational issue—in fact, the then Health Secretary, Andy Burnham, thanked him for his “measured tone”, which meant that
“together we can give a reassuring message to the public”.—[Official Report, 12 June 2009; Vol. 493, c. 1056.]
Sadly, I cannot say that to the shadow Health Secretary today.
The hon. Gentleman, who has used some extraordinary language today, says that the NHS is on its knees. Let us look at the facts: since 2010, we have 14,000 more doctors, 12,000 more nurses on our wards and 5,000 more operations every single day; and in A&Es, which he talked about a lot, 1,800 more people are seen and treated within four hours every single day.
Yasmin Qureshi (Bolton South East) (Lab)
In the spirit of sounding conciliatory, I thank the right hon. Gentleman for giving way. The Royal Bolton Hospital made provision for the Christmas period, but despite that it has had to cancel all routine operations, as well as elective operations in trauma and orthopaedics, until 1 February. What financial assistance will he give my local hospital, so that it does not suffer as a result?
Mr Hunt
We did provide an extra £1.4 million to the hon. Lady’s local hospital before Christmas, to help it to deal with the immediate pressures, but let me deal with this issue of cancelled elective care operations. I agree with the shadow Health Secretary that it is a big deal for patients who are told that their planned procedure is to be postponed. No one minimises the distress that that causes, but last year and in previous winters operations were cancelled at the last moment, which is much more distressing and challenging for hospitals to plan around. The decision was taken this year to take a much more planned approach. We hope that, overall, fewer operations will be cancelled at the last moment, but we need to do this in a planned way.
Rebecca Pow
I cannot help but intervene, because last year someone very close to me—a member of my family—was one of those people who was about to go into the operating theatre when the procedure was cancelled. I came to my right hon. Friend about the case. I can tell the House that that was not a good experience, so it is a much better approach to plan ahead and give people notice. Yes, emergencies will happen, but planning ahead makes for a better system. I think the Government have made a good move.
Mr Hunt
My hon. Friend is absolutely right. I hope she will not mind my saying that her case involved cancer, and one of the things that the planned approach allows us to do is make sure that we do not have to cancel cancer operations, which are the most important, at the last moment. That is essentially what we are trying to do: protect everyone who is in a life-critical situation.
Thangam Debbonaire (Bristol West) (Lab)
I have to intervene. I had treatment and an operation for cancer. If my operation had been cancelled, I would have been able to come to this House and ask the Secretary of State personally to intervene, but I am speaking today on behalf of Carly O’Neill, who went to the press to talk about her cancer operation. What explanation does the Health Secretary have to give Carly O’Neill and other cancer patients for their operations being cancelled?
Mr Hunt
I say, very directly, that the instructions from NHS England could not have been clearer that cancer operations should not be cancelled, because they are deemed to be urgent. From the perspective of the Government and NHS senior leadership, such cancellations are not acceptable. If the hon. Lady knows of individual cases, she should raise them with me and we will look into the matter. It is precisely because we want to preserve capacity for people who need it the most that we have taken these difficult decisions.
Norman Lamb (North Norfolk) (LD)
The Secretary of State complains about politicisation of the NHS, but 90 colleagues from all parts of the House, including many Conservatives, are offering a different approach—a cross-party mature conversation to find a solution. Lord Saatchi, Baroness Cavendish and Nick Timothy are now arguing for the same thing. Will he now embrace that approach—a civilised approach to come up with a consensus for this country on how we secure our health and care system?
Mr Hunt
I have said publicly that, as we come to the end of the five year forward view, we need to seek a consensus on the next stage for the NHS. We will need significantly more funding in the years ahead, and we need to build a national consensus on how to find that funding. My own view is that we should try to do that for a 10-year period, not a five-year period. I am open to all discussions with colleagues about the best ways to do that, but, as we heard earlier from the shadow Health Secretary, the Labour party is not interested in being part of those discussions, which illustrates how difficult it is to reach consensus.
Several hon. Members rose—
Mr Hunt
I will make some progress before giving way again.
Let us look closely at what the hon. Member for Leicester South has said. He used a lot of hyperbole today. He says the Government are sleepwalking into winter. This, of course, has been directly contradicted by Professor Sir Bruce Keogh, the medical director of NHS England, who has said:
“I think it’s the one”—
winter—
“that we’re best prepared for…This year we started preparing”
a year earlier. He continued:
“We have…a good plan.”
Chris Hopson of NHS Providers, who regularly criticises the Government when he disagrees with us, has said:
“This time preparations have never been more thorough.”
Several hon. Members rose—
Mr Hunt
I will make some progress and then give way further.
Let us look at those preparations. We have put £1 billion into the social care system. The biggest lesson from last year was that pressure in the social care system was making it difficult for hospitals to discharge. What has been the result of that investment? Combined with the extra £337 million in the Budget, it has freed up 1,100 hospital beds by reducing the number of delayed transfers of care. In total, 2,700 additional acute beds have been commissioned since November. The shadow Health Secretary told The Independent:
“It is completely unacceptable that the 85% bed occupancy target…has been missed”.
What was bed occupancy on Christmas eve? It was 84.2%, so this had a real impact.
Several hon. Members rose—
Mr Hunt
I have said I will give way in a moment, but I want to make some progress, too.
Secondly, because many patients can be better seen by GPs, last year’s spring Budget allocated £100 million of capital to help hospitals to set up GP streaming services. In the year the shadow Secretary of State says the Government were sleepwalking, the number of type 1 trusts with GP streaming tripled to 91% of all such trusts across the country. At the same time, we made it massively easier for people to access GPs and nurses over the Christmas period. For the first time, people could get urgent GP appointments at their own surgery, or one nearby, from 8 to 8, seven days a week, except on Christmas day. The number of 111 calls dealt with by a clinician increased to nearly 40%—nearly double the figure in the year before. That, too, has massively reduced pressure on A&Es.
Lady Hermon (North Down) (Ind)
I draw to the Secretary of State’s attention the fact that we continue to have no Northern Ireland Executive and therefore no local Health Minister, meaning that there is a specific problem in Northern Ireland. The NHS staff there are absolutely superb, but they have also been under enormous pressure in recent weeks, as have the ambulance crews. It is terribly demoralising and wearisome for them. The Government must take some responsibility, given the continued absence of a Northern Ireland Executive. What recent discussions—and with whom—has the Secretary of State had in Northern Ireland about dealing with the crisis in the NHS and among ambulance crews in Northern Ireland?
Mr Hunt
The hon. Lady will understand that because I am the Health Secretary for England, I have not been having an enormous number of discussions about the terribly challenging political situation in Northern Ireland, but I agree that it is incredibly unhelpful for the NHS in Northern Ireland if there is not an Executive. The former Northern Ireland Secretary—I know that the whole House wishes him well with his medical challenges—was very engaged in trying to address that issue, and I know that the new Northern Ireland Secretary will make it her top priority, too, precisely because it matters so much for public services.
Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)
The Secretary of State does not want to get drawn into Northern Ireland—I understand that—yet the Prime Minister seems willing at every opportunity to attempt to smear the Welsh NHS. Can we have some facts before us? Spending per head on the NHS and social care in Wales is 8% higher than in England, and it went up 4.5% last year. We are dealing with winter pressures and we are putting funding up, yet the Prime Minister seems to suggest otherwise.
Dame Caroline Spelman (Meriden) (Con)
May I bring the Secretary of State back to the benefit of having GP-led services in hospitals to take the pressure off A&Es? I commend Solihull Hospital for doing just that and reducing appreciably the number of examples of winter pressures being raised with us? Could that be replicated across the NHS?
Mr Hunt
This is what is so disappointing about some of the shrill tones we have heard this week in the media and today in the House. Reforms across the NHS are making a real difference. I totally commend what is happening at Solihull. The key to solving the long-term pressures on our emergency departments is to be better at treating people in the community. The growth in emergency admissions in the vanguard areas of the NHS is about half the national average. This is the five year forward view that we are rolling out across the country. We need to celebrate the successes.
Several hon. Members rose—
Mr Hunt
I want to make some progress before I give way again.
A very important point that we have not talked about much in this debate, although it is extremely relevant to people on the NHS frontline, is flu. This year, we have had a much bigger spike in the number of flu cases than at any time since the winter of 2009, but we also have in this country the most comprehensive flu vaccination programme in Europe. This year, for the first time, it was made available to those who are eight years and under and to care home staff. As a result, a million more people have been vaccinated for flu this year than in the year before. Uptake among NHS staff is at 59.3%, which is its highest ever level.
I say that because while the shadow Secretary of State tries to make the case that no preparations were made, the reality is that the NHS could not have been working harder to prepare for this winter. The result of those preparations is that A&E performance, having declined for six years in a row, last year stabilised for the first time, according to the latest verified data. In the week after Christmas, compared with the year before, we had fewer A&E diverts and more calls to NHS 111. Many Members have talked about trolley waits. It is totally unacceptable for people to be left on a trolley for a long time, but November’s figures, which are the latest verified figures, showed that the number of trolley waits had fallen by three quarters compared with the previous November, so a huge amount has been happening.
Paula Sherriff
Does the right hon. Gentleman think that patients being treated in cleaning cupboards and six patients in four-bed bays without lockers, curtains or call bells are signs of good preparation for the winter crisis?
Mr Hunt
That is completely unacceptable, but it is disappointing that the hon. Lady stands up and runs down the NHS when her own trust, which received £3.4 million before Christmas to help with winter, has managed to improve its performance: last November’s figure was 91.8% compared with 77.7% a year earlier. That is a huge achievement for Mid Yorkshire Hospitals NHS Trust. Why will she not praise what is happening, rather than running the NHS down?
John Redwood (Wokingham) (Con)
I support the leadership that the Secretary of State has offered during this winter crisis and the tone he has adopted in this debate. As a result, there is not the kind of crisis we have had in past years. Now that he has widened responsibilities for social care, will he help West Berkshire and Wokingham, which have had problems with past formulas and do not have enough money to take pressure off the hospital in the way he would like?
Mr Hunt
I will certainly revisit the issues in my right hon. Friend’s local authorities because I have looked at them before and know that there are particular pressures there. He alights on something else that the Opposition have not wanted to talk about, but which is very significant: the Prime Minister’s commitment to the integration of health and social care, which eluded the previous Labour Government over 13 years, despite their talking about it a lot. We are starting to see that happen in this country. Monday’s decision means that policy leadership will come back to the Department of Health, which will help us to make even faster progress.
Vicky Ford
I would like to take the Secretary of State back to his point about caring for people before they get to hospital and, in particular, issues to do with GPs. My local area has had difficulties recruiting GPs. It is vital that there is investment in increasing medical training for new doctors, so I plead with him to consider seriously the bid from Anglia Ruskin University to become the first medical school in Essex, where there is currently no pathway for our talented young people to train as doctors within the county.
Mr Hunt
I note my hon. Friend’s persuasive plea for her local university, Anglia Ruskin, but this is not a decision that I will be taking, because my own local university is also keen to offer more medical places. However, she is absolutely right to say that training the next generation of doctors and nurses is the long-term solution to these pressures.
Several hon. Members rose—
Mr Hunt
I will make progress and then take a final set of interventions.
The heart of the shadow Health Secretary’s case is that winter pressures are caused by political decisions, not operational issues. Let us put aside the difficult winters that Labour had in 1999, 2008 and 2009, but if he is to drag politics into this, he cannot first say that this is the fault of politicians in England and then totally gloss over the responsibility of politicians in Wales, which the Royal College of Emergency Medicine says is “a battlefield” where
“patient safety is being compromised daily”
and the situation
“is unsafe, undignified and distressing for patients and their family members.”
I simply ask the shadow Health Secretary this: if it is the Government’s fault that one in nine A&E patients waits too long here in England, whose fault is it that one in six does in Wales? Whose fault is it that people in Wales are nine times more likely to wait too long for test results?
Chris Davies (Brecon and Radnorshire) (Con)
I thank my right hon. Friend for giving way. On the Welsh NHS, he is absolutely right. Mr Speaker, I ask for your indulgence while I quote an A&E nurse in Wales, speaking last week: “On every shift, both corridors are full of patients on trolleys. We are housing ambulance crews for longer than ever, due to beds not being available in the hospital. Patients are being nursed in inappropriate areas due to no space. I have seen nurses in tears. I myself have been in tears. This is the first time that I have ever been demoralised and embarrassed to say that I am an A&E nurse in Wales.” That is in Wales, under Welsh Labour. Does my right hon. Friend agree that there is pure hypocrisy coming from Labour Members, who should take notice of the mistakes being made in Wales?
Mr Hunt
I totally agree. This is the central flaw in the Labour party’s case. We know that winter is the most difficult time, but Labour says that there is political responsibility in one part of the UK while saying absolutely nothing about Wales. I notice that the shadow Health Secretary is looking down at his notes as we talk about Wales, but the reality is that that completely blows apart his case. According to the British Medical Association, there is one area in Wales where not a single doctor was available overnight, and the performance of one A&E has fallen to 40%, which is unheard of in England—or, indeed, Scotland.
However, there is a political decision, which my hon. Friend the Member for Chelmsford (Vicky Ford) mentioned, that has a big impact on NHS winter performance: the number of doctors we train. Not once in my time as Health Secretary have I heard Labour call for an increase in training places. [Interruption.] No, I have not. The simple truth is that there is no point throwing money at a problem if there are not doctors and nurses available to spend the money on. While I have been Health Secretary, we have had 40,000 more doctors, nurses and other clinicians working in the NHS, but we need more. That is why, under this Prime Minister, we have announced the biggest increase in training places for doctors and nurses in the history of the NHS.
Several hon. Members rose—
Clive Efford (Eltham) (Lab)
I congratulate the Secretary of State on facing down the Prime Minister on Monday, when what emerged was one man, two jobs, no governor. He must accept that the £6 billion in cuts to social care since 2010 has had a major impact, particularly on winter crises. Does he regret the Government’s decision to take that money out of social care?
Mr Hunt
In 2010, we faced the worst financial crisis since the second world war. The hon. Gentleman will know which Government were in charge when that happened. People were talking about a run on the pound—I notice that the Labour party continues to talk about that—and the crisis had to be addressed. We, like other countries, had to make significant reductions in public funding, but when we got the economy back on its feet and started creating jobs—1,000 jobs a day since 2010—the first place into which we put extra money was the NHS and the social care system. There is £600 million more in the social care system than there was two years ago.
Several hon. Members rose—
Andrew Percy
I thank my right hon. Friend for giving way. He knows of my interest in ambulance services. I was on duty for Yorkshire Ambulance Service as a responder this Christmas and new year, and will be again tomorrow night. When he talks about workforce planning, he rightly talks a lot about doctors and nurses. Will he say something about how our incredibly well-trained paramedics can be used better to relieve pressure in A&E and reduce delays there?
Mr Hunt
I thank my hon. Friend for his work as a first responder; that is a fantastic example in his community. We have 1,700 more paramedics than we did seven years ago. My hon. Friend is absolutely right because the role of paramedics has changed dramatically over recent years. It used to be about scooping people up and taking them to hospitals; now, we are treating many more people on the spot. Paramedics have an extraordinarily important role, but it has changed. There is a changed emphasis, as in other parts of the NHS—a move towards doing as much as we can to treat people safely outside hospitals and to keep them at home, because we know that is the safest way.
Wes Streeting (Ilford North) (Lab)
I am grateful to the Health Secretary for giving way. The simple fact is that if we want more care in the community, the Government have to stop slashing social care budgets. If we want to stop people appearing at hospital with preventable conditions, we need to stop cutting public health funding. The Government do not have an economic record to be proud of, but even looking at the public spending that is being made, we see that the Government are penny wise and pound foolish.
Mr Hunt
I am sorry, but 3 million additional jobs have been created, so we do have a strong economic record, and that is why we have increased funding for social care recently. We have increased NHS funding significantly. As for slashing funding, the hon. Gentleman’s local trust received £9.7 million before Christmas.
Mr Dunne
Will my right hon. Friend reflect on the issue of beds? As a result of the measures that he has taken in recent weeks, Shrewsbury and Telford Hospital NHS Trust in my area managed to release an extra 120 beds to help it to cope with the significant winter pressures that it faced. Does he agree that community hospitals such as my area’s Bridgnorth Community Hospital and Ludlow Community Hospital, which have community beds, have a role to play in releasing pressure on acute hospitals from patients who no longer need acute care?
Mr Hunt
I agree. I want to take this chance to thank my hon. Friend for being an absolutely superb Minister of State at the Department of Health. The fact that the NHS is better prepared this year than it has been for very many years is partly because of his efforts, and I commend him for his fantastic contribution.
Several hon. Members rose—
Alex Chalk (Cheltenham) (Con)
Does my right hon. Friend agree that the calibre of local trust leadership can play a huge role? In Gloucestershire, new trust leadership has tackled serious internal financial failings head-on. As a result, A&E times have been slashed and turned around, which meant that A&E waiting targets were met in December. Does he agree that that shows what can be done with the right leadership?
Mr Hunt
It absolutely does, and no one campaigns more vigorously for his local trust than my hon. Friend. Just before Christmas, I visited his trust’s Gloucester site and met the management and staff. The situation there is extraordinarily impressive and a great inspiration to many parts of the NHS.
I finish on the issue of funding. The shadow Health Secretary has been using very strong language, but he has conveniently overlooked the fact that in the past four years, real-terms funding for the NHS has increased by £9.3 billion, which is £5.5 billion more than his party promised in 2015.
Mr Hunt
I will conclude, because a lot of hon. Members want to speak.
The shadow Health Secretary is right that there are real pressures, so what are the facts? We spend 9.9% of our GDP on health, which is 1% above the EU average, and about the same as the EU15—the western European countries—but we want to spend more, so in England, from 2011, funding went up by 15.6%. In Wales, Labour chose to increase funding by only 8%. This motion is about money. When it comes to NHS funding, Labour gives the speeches, but Conservatives give the cash.
Oral Answers to Questions
Jeremy Hunt Excerpts(7 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Sir Greg Knight (East Yorkshire) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
General practice remains under sustained pressure, which is why we remain committed to increasing the number of doctors working in general practice by 5,000, however challenging that might be.
Sir Greg Knight
Does my right hon. Friend not think it is unfortunate that, at a time when GP services are being sustained, local hospital services in some areas are being reduced? Does he share my concern that some NHS trust managers and clinical commissioning groups seem hellbent on removing valued local services from our smaller hospitals, such as at Driffield and at Bridlington in my constituency?
Mr Hunt
My right hon. Friend has talked to me extensively about this in private, and I fully understand his concerns. The Government are increasing funding to the NHS, which involves extra money going both to out-of-hospital services, such as general practice, and to hospital services. We expect all areas of the country to find sensible ways for those two sectors to work together.
Dr Paul Williams (Stockton South) (Lab)
I refer Members to my entry in the Register of Members’ Financial Interests.
Has the Secretary of State seen the recent report of the Royal College of General Practitioners, “Destination GP,” on how to inspire medical students to pursue a career in general practice? Will he consider the report’s recommendations to help to better support medical student placements in general practice?
Mr Hunt
I will absolutely consider the sensible recommendations of that report. People on both sides of the House, such as the hon. Gentleman, who were GPs before being elected do a fantastic job of flying the flag for general practice. We are making some progress. Some 3,157 medical school students have gone into general practice as a specialty—the most ever—but there is lots more work to do.
Mrs Maria Miller (Basingstoke) (Con)
I very much welcome the additional funding this Government have put into the NHS, but constituents tell me that they can better manage chronic conditions and illnesses if they have consistent care from general practitioners, which is something they find difficult to access in some surgeries in my constituency because of problems with recruitment and retention. What is the Secretary of State doing with his team to make sure we can lessen that problem in future?
Mr Hunt
I totally agree with my right hon. Friend. One of the best things about the NHS is that people have a GP who knows them and their family. There is a lot of evidence that that is the best way to manage people with long-term conditions, as she rightly says. The truth is that, for a very long time, successive Governments have not invested as much as they should in general practice. We are trying to put that right, and part of that is flying the flag for what an exciting career general practice is. It is the one part of medicine where doctors have an ongoing relationship with patients and their families over their whole lives, which is very motivating.
Thangam Debbonaire (Bristol West) (Lab)
The capacity and availability of at least one GP surgery in my constituency are both profoundly affected by the relationship with NHS Property Services—incomplete maintenance jobs and vastly increased rent are problems. Will the Secretary of State meet me and the practice manager of that GP surgery to discuss this?
Mr Hunt
I understand the concerns that the hon. Lady raises; they have been raised by a number of Members. There are historical issues on the levels of rent charged by NHS Property Services, which frankly are not fair given the variation in charges to different GP practices across the country. I will be happy to look carefully into the issues she raises.
Julie Cooper (Burnley) (Lab)
The NHS has lost 1,300 full-time GP equivalents in the past two years and 200 GP partners during the same period. Given that 20% of the GP workforce is aged over 60, there is clearly a retirement time-bomb looming. What steps does the Secretary of State intend to take to address the growing workforce crisis in general practice? His efforts so far have failed and patients are waiting longer than ever for a surgery appointment.
Mr Hunt
I would respectfully say that the figures the hon. Lady has pointed out do not take account of locum doctors. None the less, there is a big problem and she is right to draw it to the attention of the House. What are we doing? I think there are two things. First, we need to encourage more medical school graduates to go into general practice as a specialty, and our objective is that half of all medical school graduates should choose general practice as their specialty. We are making good progress on that. [Interruption.] As she is saying to me, rightly, retention is also extremely important. That is why we are putting in place a number of programmes that will make it easier for GPs who want to work for a limited period of time to work flexibly, and potentially for people who have family responsibilities to work from home. We hope that those programmes will also make a difference.
Peter Grant (Glenrothes) (SNP)
The Secretary of State for Health (Mr Jeremy Hunt)
We had productive discussions with the Chancellor of the Exchequer ahead of the Budget, which led to a £2.8 billion increase in NHS revenue funding and a £3.5 billion increase in NHS capital funding.
Peter Grant
Given that NHS trusts in England are facing a cumulative budget shortfall of more than £1 billion and yet one in six patients who attend accident and emergency in England will still wait for more than four hours to be treated, what will the Secretary of State be telling health service managers to prioritise this winter? Have they to concentrate on cutting the deficit or cutting the waiting times?
Mr Hunt
I am slightly bemused to hear that question from the hon. Gentleman, given that over the past four years NHS funding in England has increased by 10%, whereas in Scotland it has increased by only 5%. Indeed, Scotland now has the longest waiting times on record for elective surgery. What are we saying to NHS managers? We are saying, “We understand how tough it is. You and your teams are doing a brilliant job, and we want to do everything we can to support you through what will be a challenging winter.”
Sir Oliver Heald (North East Hertfordshire) (Con)
As it is Christmas time, may I congratulate my right hon. Friend on securing the extra funding and making sure that it is spent effectively in his Department? Does he agree that one important thing to think about at this time of year is winter pressures? In an area such as mine, it is important that there should be some extra funding at the hospital at this time of year. Is he able to say anything about that today in respect of the Lister Hospital in Hertfordshire?
Mr Ben Bradshaw (Exeter) (Lab)
With patients in Exeter now waiting more than a year, in pain, for vital surgery—well beyond the 18-week maximum guaranteed in the NHS constitution—can the Secretary of State explain the contradictory statements of the Chancellor, who said at the time of the Budget that he expected significant “inroads” to be made into growing waiting time lists, and the NHS England board, which met the following week and said that NHS waiting time standards
“will not be fully funded and met next year”?
Mr Hunt
I have been waiting for the right hon. Gentleman to issue the press release welcoming the £1.4 million of extra funding that the Royal Devon and Exeter got in the Chancellor’s Budget, but for some extraordinary reason it has not been forthcoming. Let me tell him that, as many people have commented, the NHS got a lot more money than it was expecting in the winter announcement—
John Stevenson (Carlisle) (Con)
I very much welcome the £2 million winter allocation for the hospitals in my area. Funding is clearly important, but given the improvements in the hospitals in my area that are down to the leadership of the chief executives, the leadership team and the staff, does the Secretary of State agree that leadership is as important as funding?
Mr Hunt
My hon. Friend is absolutely right. Of course, both things matter, and hospitals do need the right level of funding, but one of the highlights of the year for me was visiting my hon. Friend’s local trust in Carlisle and seeing the total transformation in leadership there. It was one of the most troubled trusts in the NHS but, thanks to the incredible dedication of the doctors, nurses and everyone working in the trust, it has really turned things around.
Martyn Day (Linlithgow and East Falkirk) (SNP)
The Scottish Government already pay nurses and care assistants the highest rate in the UK, have maintained the nursing bursary, and have now committed to a 3% pay rise for those earning £30,000 or less. Does the Secretary of State recognise that his failure similarly to value NHS staff in England is one reason why England’s nursing vacancy rate is more than double that of Scotland?
Mr Hunt
What I recognise is that life expectancy continues to rise in England but has ground to a halt in Scotland. One reason why is that the Scottish National party has consistently not taken the extra resources it could take and put them into the NHS, but has instead chosen other priorities.
Martyn Day
At the previous Health questions, the Secretary of State said that funding from the Chancellor to remove the pay cap would be based on productivity improvements. Will he elaborate on what productivity improvements are expected and when NHS England staff will get the pay rise that they deserve?
Mr Hunt
We are having fruitful and productive discussions about productivity with the “Agenda for Change” unions, including the Royal College of Nursing. We are looking at all sorts of things, including how the increments system works. I am hopeful that we will have a win-win: a modern contract that is fit for the future for “Agenda for Change” staff and that also allows us to go beyond the 1% cap, as the Chancellor has authorised me to do.
Huw Merriman (Bexhill and Battle) (Con)
Of course, this is not just about funding. The Secretary of State recently wrote to East Sussex Healthcare NHS Trust to recognise the fact that its A&E department was the most improved in the past six months. When I spoke to the chief executive, he said that the management focus on targets and delivery against them was the reason why that turnaround has occurred.
Mr Hunt
I met the chief executive in person last week and was able to congratulate him on several important changes that are happening. He will be pleased that we were able to find £1.9 million more for East Sussex in the Budget. My hon. Friend is absolutely right that it is not just about money. The difference between the Government and the Opposition is that they say it is all about money whereas we know that quality of leadership makes a critical difference in turning around our hospitals to make them the best in the world.
Justin Madders (Ellesmere Port and Neston) (Lab)
In the past few weeks, Simon Stevens, Sir Bob Kerslake, Sir Bruce Keogh, Jim Mackey, Chris Hopson and a number of other senior public servants have all told the Government that the NHS does not have the funding that it needs. It is patently obvious that, with most performance targets being missed, treatments being rationed and hard-working staff completely demoralised after seven years of pay restraint, funding levels are not sufficient. Arguing with celebrities on Twitter is not going to change that. Even though the Secretary of State has a new-found enthusiasm for 280-character statements, all I ask from him today is one word. Is the NHS getting the funding it says it needs—yes or no?
Mr Speaker
Order. We must observe the terms of debate. It is not for the Secretary of State to ask questions. He has been in the House long enough to know that. Please do not play games with the traditional and established procedures of the House, Secretary of State. You can do better than that.
Mr Hunt
Yes, I am delighted that the local hospital of the hon. Member for Ellesmere Port and Neston (Justin Madders) got £2.8 million in the Budget, but I am disappointed that he did not feel able to issue a press release to his local press. I have much enjoyed debating with the hon. Gentleman over the years, but the difference between me and him is that although we both want to find extra money for the NHS, he would do so by hiking corporation tax, which would destroy jobs, whereas Government Members want to get money into the NHS by creating jobs, which is what we are doing.
Dan Carden (Liverpool, Walton) (Lab)
Iain Stewart (Milton Keynes South) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
In order to increase the number of mental health patients we treat by 1 million every year by 2020-21, we are increasing the number of mental health posts in the NHS by 21,000.
Iain Stewart
I certainly welcome that increase, but does my right hon. Friend agree that there is a particular need to address mental health issues in schools? Could he set out what plans he has to give extra support there?
Mr Hunt
My hon. Friend is absolutely right, for the simple reason that prevention is better than cure, and about half of all mental health conditions become established before the age of 14. That is why it was so significant that, following the Budget, we announced the allocation of an extra £300 million through the mental health Green Paper, precisely to improve the service we offer students in schools.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
The Secretary of State has, on numerous occasions, to both the media and this House, referred to an increase of 4,300 staff working in mental health trusts since 2010. In response to my written parliamentary question, he was unable to clarify whether this 4,300 figure includes the 1,478 people who were rebadged as mental health trust staff following a trust merger in Manchester last year. Nor would he confirm whether this figure includes the 858 people NHS Digital says were already working in the sector, who transferred from primary care trusts to mental health trusts when primary care trusts closed back in 2013. Would the Secretary of State offer the House some festive cheer and take this opportunity to set the record straight?
Mr Hunt
I am very happy to offer the hon. Lady festive cheer and to explain to her that, even if her suspicion is right—and I do not believe it is—there has still been a significant increase in the number of staff employed in mental health trusts. The other suspicion she has constantly raised in the media and in this House is that mental health funding is being cut. She will know that the best news of this year is that, last year, funding actually went up by £575 million.
Mr Richard Bacon (South Norfolk) (Con)
Given that the NHS owns a great deal of land and buildings, and that mental health workers and other health workers face high accommodation costs, will the Secretary of State meet me so that I can explain how the benefits of the Self-build and Custom Housebuilding Act 2015 could be used as a powerful retention and recruitment tool for mental health workers?
Mr Hunt
I commend my hon. Friend for his work and thinking on this through the Public Accounts Committee, and he is absolutely right. I am more than happy to talk to him about this, but we actually have it as a priority to make sure that when NHS land is disposed of, NHS workers get the first opportunity to buy or rent the houses that are built.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
There are still not enough staff trained in autism diagnosis across the NHS. Would the Secretary of State consider training a specialist in each community child and adolescent mental health service right across the country to ensure that there is no longer a postcode lottery?
Ms Marie Rimmer (St Helens South and Whiston) (Lab)
Tom Pursglove (Corby) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
The Budget announced an extra £337 million to help NHS trusts to deal with the pressures of winter.
Tom Pursglove
I am grateful to the Secretary of State for that answer, and I welcome the additional £2.6 million for Kettering General Hospital. As he knows, the Corby urgent care centre is a vital service that helps to relieve pressure on Kettering General’s A&E all year round. What role does he see such facilities playing in relieving pressures, particularly during the winter period?
Mr Hunt
I thank my hon. Friend for his campaigning, and I am delighted that the Budget allocated an extra £2.4 million to help Kettering General Hospital. He is absolutely right that urgent care centres play a vital role in keeping people away from busy A&E departments. We need to be better at signposting the public so that they know when to go to a GP surgery, when to go to an urgent care centre and when to go to a hospital.
Mike Gapes (Ilford South) (Lab/Co-op)
One of the causes of pressure in my part of London is the continuing threat of impending closure to King George Hospital’s A&E. Will the Secretary of State today confirm that the consultation that is now being engaged in will result in the A&E at King George Hospital being saved?
Mr Hunt
I am afraid that the hon. Gentleman will have to wait until the result of that consultation is published. I visited the trust last week, although I went to the Romford end of it, and I think that it is making great strides in improving the quality of care. I congratulate all the staff at the trust on what they are achieving.
Maria Caulfield (Lewes) (Con)
Mr John Whittingdale (Maldon) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
Next week, many NHS and social care staff will give up their family Christmas to keep NHS patients safe. I know that the whole House would like to thank them for their dedication and commitment over the festive period.
Mr Whittingdale
Is my right hon. Friend aware that, due to the difficulties in recruiting general practitioners, neither of the two GP surgeries in Maldon are taking on any new patients, despite the significant development taking place in the town? May I therefore welcome the 1,500 extra medical training places that the Government have funded, and ask for his support for some of those to go to the excellent Anglia Ruskin medical school in Chelmsford?
Mr Hunt
I have a great deal of sympathy with what my right hon. Friend says, and he is right that the recruitment and retention of GPs is a big issue. I have a constituency interest, in that I have a university that is also very keen to host more medical school places, so I am recusing myself from the decision. However, I wish all universities good luck, because this is a historic expansion of medical school places for the NHS.
Jonathan Ashworth
May I join the Secretary of State in wishing all our NHS and social care staff a very merry Christmas, and in thanking them for their commitment this winter?
Virgin Care recently won a £100 million contract for children’s health services in Lancashire, but in the Secretary of State’s own backyard of Surrey, Virgin Care recently took legal action against the NHS, forcing it to settle out of court. This money should be going to patient care, not the coffers of Virgin Care, so why will he not step in and fix this scandal so that his Surrey constituents and the NHS do not lose out?
Mr Hunt
I, too, am very disappointed about the action taken by Virgin Care, but I gently point out to the hon. Gentleman that, contrary to the narrative that he and his colleagues put out, the reason why it took action was that the NHS stripped it of its contract and gave that back to the traditional NHS sector—hardly the mass privatisation that he is always talking about.
Jonathan Ashworth
The Secretary of State’s Surrey constituents will have heard that he will not be taking action against Virgin Care.
Our research has revealed that there are vacancies for 100,000 staff across the NHS, and there is a “national crisis in workforce”—not my words, but those of the Royal Surrey County Hospital NHS Foundation Trust in the Secretary of State’s constituency. With bed occupancy at the Royal Surrey hitting a peak of 98.7% this winter already, and 94.5% across the NHS on average, can he tell us how he expects the NHS to cope this winter when it is understaffed, overstretched and underfunded?
Mr Hunt
If we decide that we want more nurses following Mid Staffs, that creates vacancies. If we want to transform mental health provision, that creates vacancies. That is why we announced a workforce plan, which I notice the Welsh Government have not had time to do yet. But I will finish by wishing the hon. Gentleman a merry Christmas. If he wants to take a bit longer off and stay away for January, we are happy to hold the fort.
Craig Tracey (North Warwickshire) (Con)
Mr Jim Cunningham (Coventry South) (Lab)
Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
Neil Gray (Airdrie and Shotts) (SNP)
Mark Pawsey (Rugby) (Con)
Kate Green (Stretford and Urmston) (Lab)
Mary Robinson (Cheadle) (Con)
Mr Adrian Bailey (West Bromwich West) (Lab/Co-op)
Mr Hunt
We have not been very good at making it easy for people to work flexibility in the NHS. Contracts are too rigid and we are looking to change them. We recognise that for many nurses their commitment to the NHS runs very deep, but that they have to juggle that commitment with family responsibilities. We want to do better.
Mr Marcus Fysh (Yeovil) (Con)
There are many very committed individuals working in health and social care services in Somerset, but one challenge is getting enough registered nurses into the system to allow them to integrate. What can the Minister do to help to get more registered nurses?
Dr Matthew Offord (Hendon) (Con)
Given that my own brother’s funeral will be held later today, may I ask the Secretary of State what help and support he is giving to the families of drug and alcohol abusers?
Mr Hunt
The whole House will want to express its condolences to my hon. Friend on what is happening this afternoon. He, alongside many people on both sides of the House, including the shadow Health Secretary, has raised this issue, and we are looking closely at what more support we can give to children in one of the most vulnerable situations imaginable. I thank him for raising the issue.
Rachael Maskell (York Central) (Lab/Co-op)
The NHS patient declaration form for free dental care and prescriptions requires patients to determine the difference between contribution and income-related employment and support allowance. Getting it wrong attracts really hefty fines. Will the Minister ensure that patients first get the opportunity to make the right choice before fines are applied?
Steve McCabe (Birmingham, Selly Oak) (Lab)
There have been 15,000 violent assaults on mental health workers in the west midlands over the last five years. What is the Government’s response to the Care Quality Commission’s opposition to routine searches of all mental health service users for weapons on admission or return to acute in-patient units?
Mr Hunt
I have a great deal of sympathy with what the hon. Gentleman has said. We are putting a lot of effort into patient safety and staff safety in mental health trusts, and we are discovering that there is a wide variation between practices. The hon. Gentleman has made an important point, and, if I may, I will write to him to inform him of our progress.
Martin Vickers (Cleethorpes) (Con)
The patient transport service in northern Lincolnshire is contracted to Thames Ambulance Service Ltd, which is failing miserably to perform to an adequate standard. Will the Minister meet me, along with my hon. Friend the Member for Brigg and Goole (Andrew Percy) and other neighbouring Members, to discuss what influence the Department can bring to bear?
Mr Dennis Skinner (Bolsover) (Lab)
Is the Secretary of State aware that in the course of this hour there have been more questions about hospital closures than about almost anything else, covering East Yorkshire, Berwick on his own side, Warwickshire on our side, and High Peak in Derbyshire, including Bolsover and Bakewell Hospitals? There is a growing suspicion that what this Secretary of State is up to is leaving those hospitals and losing all the beds in them forever so that the private sector can move in and take the lot. That is what is going to happen.
Mr Hunt
I thank the hon. Gentleman for his Christmas cheer. Let me just say to him that if that were the Government’s intention, we would not have found an extra £2.8 billion for the NHS in the Budget, including £1.95 million for Chesterfield Hospital, which will benefit his own constituents.
Mims Davies (Eastleigh) (Con)
Some 50% of young people do not use a condom with a new partner and one in 10 young adults never uses one, which means the chance of an unwanted pregnancy or, indeed, a sexually transmitted disease. Please will the Department do something to ensure that people are aware of the benefits of condoms?
Liz McInnes (Heywood and Middleton) (Lab)
What funds are being made available to our mental health services to meet the additional demands placed on them by changes in the Mental Health Act 1983, which came into force on 11 December this year?
Karin Smyth (Bristol South) (Lab)
NHS Property Services exists on a merry-go-round of taxpayers’ money. Will the Secretary of State give us all a Christmas present by closing it down and returning the control of property to local health communities?
James Frith (Bury North) (Lab)
Will the Secretary of State consider the NHS as a funder of last resort for hospices such as Bury hospice, so that they can operate at full capacity and play their part in the delivery of social care?
NHS Pay: Resolution (13 September)
Jeremy Hunt Excerpts(7 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
We know pay restraint has been challenging for staff but it has helped the NHS to recruit an additional 32,300 professionally qualified clinical staff since 2010.
Increasing pressures on the NHS due to, among other things, an ageing population and changing public expectations continue to create increased demand and activity and this means that there have been shortages of some groups. We have been working hard to tackle this.
Since 2010 there are 10,100 more nurses on our wards. There are currently over 52,000 nurses in training. In addition, since September 2014 more than 2,400 nurses have completed the return to practice scheme.
This year there were nearly two applicants for every available nurse training place. On 4 December UCAS published their end-of-cycle data which shows 22,575 applicants with confirmed places to study pre-registration nursing and midwifery in England from August 2017. These figures show there still is strong demand for nursing and midwifery courses. There were more 18 to 20-year-olds from England accepted to nursing courses than ever before from August 2017.
We have already confirmed that the across-the-board 1% public sector pay policy will no longer apply to pay awards for 2018-19. This is due to a recognition that in some parts of the public sector flexibility to go above the 1% may be required to ensure continued delivery of world-class public services.
At the budget we announced that, in order to protect frontline services in the NHS, we are committing to fund pay awards as part of a pay deal for NHS staff on the agenda for change contract, including nurses, midwives and paramedics.
We will make final decisions on funding at the appropriate time after listening to the pay review bodies who will, as is usual practice, consider written and oral evidence from a range of stakeholders, not just from the Government. They will look at issues such as recruitment, retention and affordability, and will then come back with a recommendation. We expect their reports in May next year.
Public sector pay packages will continue to recognise workers’ vital contributions, while also being affordable and fair to taxpayers as a whole.
[HCWS319]
Children and Young People's Mental Health: Update
Jeremy Hunt Excerpts(7 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Together with my right hon Friend the Secretary of State for Education, I have today laid before Parliament “Transforming Children and Young People’s Mental Health Provision: a Green Paper” (CM 9523). The Green Paper forms part of the Government’s work to transform mental health support, ending what the Prime Minister has referred to as the “burning injustice” of inequality which those with mental health problems experience.
This Government have invested more than ever before in mental health services, and legislated for “parity of esteem”, to ensure that mental health is treated equally with physical health. Schools and colleges are already doing a great deal to support the mental health and wellbeing of children and young people. Most offer training to staff and many promote mental health and wellbeing through skills development sessions and taught sessions about particular mental health issues. Around half have a mental health lead.
However, there is more we need to do to create world-class support for children and young people’s mental health. Half of all mental health conditions begin before the age of 14. The Green Paper therefore focuses on earlier intervention and prevention before issues escalate, particularly in and around schools and colleges.
We are announcing plans to fund new collaboratively delivered mental health support teams. They will be made up of additional trained staff, supervised by NHS specialists, to provide support in or near schools and colleges for children and young people with emerging and more moderate needs, We will test how teams can work with other professionals and support vulnerable children and young people. We also want to continue to improve access to specialist services, and will pilot a four-week waiting time standard for accessing children’s mental health services.
We will also build on what schools already do—rolling out our “schools—children and young people’s mental health services link pilot” nationally. We will provide significant funding to incentivise schools and colleges to train designated senior leads for mental health to work with the new teams and implement whole-school approaches to mental health. The Green Paper also sets out how whole-school approaches will be supported by other developments that are underway, including our engagement process on relationships education, relationships and sex education and personal, social, health and economic education.
The Green Paper also contains a number of other proposals to improve support for young people’s mental health, including work to support the Department for Digital, Culture, Media and Sport’s work on keeping young people safe online, convening a new partnership to look at support for the mental health of 16 to 25-year-olds, and commissioning further research in a number of areas to build our understanding of the evidence.
The Green Paper has been developed with the input of a large range of individuals and organisations. We also commissioned an independent evidence review, conducted by University College London and the National Collaborating Centre for Mental Health, and have based our proposals on the evidence. We also benefited from the evidence submitted to the Health and Education Committees during their inquiry earlier this year into the role of education in children’s mental health. We are grateful to all who have helped shape our proposals.
The proposals as set out in the Green Paper would cost £215 million over the next three years towards the creation of mental health support teams, piloting a four-week waiting time standard and rolling out mental health first aid training to primary schools. Funding will be made available to take forward the final proposals following consultation. We will confirm the amounts to be provided to schools and colleges for training leads following consultation and development of training packages. However we will cover the costs of a significant training programme and provide up to £15 million to 20 million each year from 2019 to cover costs until all schools and colleges have had the chance to train a lead.
The Green Paper will be followed by a consultation and we welcome views on the proposals. Copies of the Green Paper will be available in the Vote Office and the Printed Paper Office. The consultation and Green Paper can be accessed at: www.gov.uk and https://engage.dh.gov. uk/youngmentalhealth.
[HCWS306]
Maternity Safety Strategy
Jeremy Hunt Excerpts(7 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
With permission, I will make a statement about the Government’s new strategy to improve safety in NHS maternity services.
Giving birth is the most common reason for admission to hospital in England. Thanks to the dedication and skill of NHS maternity teams, the vast majority of the roughly 700,000 babies born each year are delivered safely, with high levels of satisfaction from parents. However, there is still too much avoidable harm and death. Every child lost is a heart-rending tragedy for families that will stay with them for the rest of their lives. It is also deeply traumatic for the NHS staff involved. Stillbirth rates are falling but still lag behind those in many developed countries in Europe. When it comes to injury, brain damage sustained at birth can often last a lifetime, with about two multi-million pound claims settled against the NHS every single week. The Royal College of Obstetricians and Gynaecologists said this year that 76% of the 1,000 cases of birth-related deaths or serious brain injuries that occurred in 2015 might have had a different outcome with different care. So, in 2015, I announced a plan to halve the rate of maternal deaths, neonatal deaths, brain injuries and stillbirths, and last October I set out a detailed strategy to support that ambition.
Since then, local maternity systems have formed across England to work with the users of NHS maternity services to make them safer and more personal; more than 80% of trusts now have a named board-level maternity champion; 136 NHS trusts have received a share of an £8.1 million training fund; we are six months into a year-long training programme and, as of June, more than 12,000 additional staff have been trained; the maternal and neonatal health safety collaborative was launched on 28 February; 44 wave 1 trusts have attended intensive training on quality improvement science and are working on implementing local quality improvement projects with regular visits from a dedicated quality improvement manager; and 25 trusts were successful in their bids for a share of the £250,000 maternity safety innovation fund and have been progressing with their projects to drive improvements in safety.
However, the Government’s ambition is for the health service to give the safest, highest-quality care available anywhere in the world, so there is much more work that needs to be done. Today, I am therefore announcing a series of additional measures. First, we are still not good enough at sharing best practice. When someone flies to New York, their friends do not tell them to make sure that they get a good pilot. But if someone gets cancer, that is exactly what friends say about their doctor. We need to standardise best practice so that every NHS patient can be confident that they are getting the highest standards of care.
When it comes to maternity safety, we are going to try a completely different approach. From next year, every case of a stillbirth, neonatal death, suspected brain injury or maternal death that is notified to the Royal College of Obstetricians and Gynaecologists’ “Each Baby Counts” programme—that is about 1,000 incidents annually—will be investigated not by the trust at which the incident happened, but independently, with a thorough, learning-focused investigation conducted by the healthcare safety investigation branch. That new body started up this year, drawing on the approach taken to investigations in the airline industry, and it has successfully reduced fatalities with thorough, independent investigations, the lessons of which are rapidly disseminated around the whole system.
The new independent maternity safety investigations will involve families from the outset, and they will have an explicit remit not just to get to the bottom of what happened in an individual instance, but to spread knowledge around the system so that mistakes are not repeated. The first investigations will happen in April next year and they will be rolled out nationally throughout the year, meaning that we will have complied with recommendation 23 of the Kirkup report into Morecambe Bay.
Secondly, following concerns that some neonatal deaths are being wrongly classified as stillbirths, which means that a coroner’s inquest cannot take place, I will work with the Ministry of Justice to look closely into enabling, for the first time, full-term stillbirths to be covered by coronial law, giving due consideration to the impact on the devolved Administration in Wales. I would like to thank my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) for his campaigning on this issue.
Next, we will to do more to improve the training of maternity staff in best practice. Today, we are launching the Atain e-learning programme for healthcare professionals involved in the care of newborns to improve care for babies, mothers and families. The Atain programme works to reduce avoidable causes of harm that can lead to infants born at term being admitted to a neonatal unit. We will also increase training for consultants on the care of pregnant women with significant health conditions such as cardiovascular disease.
We know that smoking during pregnancy is closely correlated with neonatal harm. Our tobacco control plan commits the Government to reducing the prevalence of smoking in pregnancy from 10.7% to 6% or less by 2022. Today, we will provide new funding to train health practitioners, such as maternity support workers, to deliver evidence-based smoking cessation according to appropriate national standards.
The 1,000 new investigations into “Each Baby Counts” cases will help us to transform what can be a blame culture into the learning culture that is required, but one of the current barriers to learning is litigation. Earlier this year, I consulted on the rapid resolution and redress scheme, which offers families with brain-damaged children better access to support and compensation as an alternative to the court system. My intention is that in incidents of possibly avoidable serious brain injury at birth, successfully establishing the new independent HSIB investigations will be an important step on the road to introducing a full rapid resolution and redress scheme, to reduce delays in delivering support and compensation for families. Today, I am publishing a summary of responses to the consultation, which reflect strong support for the key aims of the scheme: to improve safety, to improve patients’ experience and to improve cost-effectiveness. I will look to launch the scheme, ideally, from 2019.
Finally, a word about the costs involved. NHS Resolution spent almost £500 million settling obstetric claims in 2016-17. For every £1 the NHS spends on delivering a baby, another 60p is spent by another part of the NHS on settling claims related to previous births. Trusts that improve their maternity safety are also saving the NHS money, allowing more funding to be made available for frontline care. To create a strong financial incentive to improve maternity safety, we will increase by 10% the maternity premium paid by every trust under the clinical negligence scheme for trusts, but we will refund the increase, possibly with an even greater discount, if a trust can demonstrate compliance with 10 criteria identified as best practice on maternity safety.
Taken together, these measures give me confidence that we can bring forward the date by which we achieve a halving of neonatal deaths, maternal deaths, injuries and stillbirths from 2030—the original planned date—to 2025. I am today setting that as the new target date for the “halve it” ambition. Our commitment to reduce the rate by 20% by 2020 remains and, following powerful representations made by voluntary sector organisations, I will also include in that ambition a reduction in the national rate of pre-term births from 8% to 6%. In particular, we need to build on the good evidence that women who have “continuity of carer” throughout their pregnancy are less likely to experience a pre-term delivery, with safer outcomes for themselves and their babies.
I would not be standing here today making this statement were it not for the campaigning of numerous parents who have been through the agony of losing a treasured child. Instead of moving on and trying to draw a line under their tragedy, they have chosen to relive it over and again. I have often mentioned members of the public such as James Titcombe and Carl Hendrickson, to whom I again pay tribute. But I also want to mention members of this House who have bravely spoken out about their own experiences, including my hon. Friends the Members for Colchester (Will Quince), for Eddisbury (Antoinette Sandbach) and for Banbury (Victoria Prentis), as well as the hon. Members for Lewisham, Deptford (Vicky Foxcroft), for Washington and Sunderland West (Mrs Hodgson) and for North Ayrshire and Arran (Patricia Gibson). Their passionate hope—and ours, as we stand shoulder to shoulder with them—is that drawing attention to what may have gone wrong in their own case will help to ensure that mistakes are not repeated and others are spared the terrible heartache that they and their families endured. We owe it to each and every one of them to make this new strategy work. I commend this statement to the House.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I am grateful to the Secretary of State for the advance copy of his statement. At the outset, may I pay tribute, as he has done, to the hon. Members who have spoken out so movingly in recent months about baby loss? They include, as he has said, the hon. Members for Colchester (Will Quince), for Eddisbury (Antoinette Sandbach), for Banbury (Victoria Prentis) and for North Ayrshire and Arran (Patricia Gibson), and my hon. Friends the Members for Lewisham, Deptford (Vicky Foxcroft) and for Washington and Sunderland West (Mrs Hodgson). They are all a credit to the House.
Our national health service offers some of the best neonatal care in the world, and the progress set out by the Secretary of State today is a tribute to the extraordinary work of midwives and maternity staff across the country. We welcome his announcement that all notifiable cases of stillbirth and neonatal death in England will now receive an independent investigation by the healthcare safety investigation branch. That is an important step, which will help to bring certainty and closure to hundreds of families every year.
We also welcome the move by the Secretary of State to allow coroners to investigate stillbirths. May I assure him that the Opposition stand ready to work constructively with him to ensure the smooth and timely passage of the relevant legislation, should he and the Government choose to bring any before the House? I also pay tribute to the work carried out by the team at the University of Leicester that leads on the perinatal aspects of the maternal, newborn and infant clinical outcome review programme, which provided the evidence for today’s announcement.
The number of deaths during childbirth has halved since 1993, saving about 220 lives a year, but we welcome the Secretary of State’s ambition to bring forward to 2025 the target date for halving the rate of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth. If that target is to be delivered, however, it is essential that NHS units providing these services are properly resourced and properly staffed. We welcome the launch of the Atain e-learning programme, as well as the increased training for consultants on the care of pregnant women with significant health conditions. We also welcome the emphasis on smoking cessation programmes, but we should remind the Secretary of State that public health budget cuts mean that many anti-smoking programmes have been cut back across the country.
The Secretary of State will know that the heavy workload in maternity units was among the main issues identified by today’s study, which found that “service capacity” issues in maternity units affected over a fifth of the deaths reviewed. Earlier this year, our research revealed that half of maternity units had closed their doors to mothers at some point in 2016, with staffing and capacity issues being the most common reasons for doing so. The Royal College of Midwives tells us that we are about 3,500 midwives short of the number needed. A survey published by the National Childbirth Trust this year showed that 50% of women having a baby experienced what the National Institute for Health and Care Excellence describes as a red flag event, which is an indicator of dangerously low staffing levels, such as a women not receiving one-to-one care during established labour.
We therefore believe that the NHS remains underfunded and understaffed. I would be grateful to the Secretary of State if he told us what further action he intends to take to ensure that maternity services are properly funded and to address the staffing shortages as part of a full strategy to improve safety across the board. The NHS has excellent psychological and bereavement support services for women affected by baby loss, but we all know that the quality of those services remains variable across the country. Indeed, we are still a long way from full parity of esteem for mental health in neonatal care. What action does the Secretary of State intend to take to plug these gaps?
Overall, this welcome set of announcements from the Secretary of State may help the NHS to provide the best quality of care for all mothers and their babies. The Opposition look forward to working constructively with the Secretary of State and the Government, but I hope he can reassure us that they will provide the resources that NHS midwives and their colleagues need to deliver on these ambitions.
Mr Hunt
I thank the shadow Health Secretary for the constructive tone of his response to the statement. I think he is right to point out both the achievements that have been made over many years, but also the challenges ahead. We have about 1,700 neonatal deaths every year—that has actually fallen by 10% since 2010—but behind that figure, there is variation across the country. For example, our best trust has about three deaths in 1,000, but in other trusts the figure can be 10 in 1,000, which is more than three times as many neonatal deaths. That shows we are not as good as we need to be at spreading best practice. Today’s announcement is really about ensuring that we can confidently look every expecting mum in the eye and say, “You are getting the very highest standards of care that we are able to deliver in the NHS.”
I thank the hon. Gentleman for his offer to co-operate on any legislation needed to expand the scope of inquests to full-term stillbirths, and we will get back to him on that. I also thank him for raising the issue of bereavement services. I spoke to a bereavement midwife this morning, and I think bereavement midwives are among the most extraordinary people working in the whole NHS. We do have a programme to improve the consistency of bereavement services and to roll out the use of bereavement suites across the NHS; our best trusts have such suites, but by no means all of them do.
The hon. Gentleman was absolutely correct to raise the issues of both funding and staffing. We have seen an increase of 1,600 in the number of midwives since 2010, which is a rise of 8%, and an increase of 600 in the number of obstetricians and doctors working in maternity departments, which is a rise of about 13%, but we need more. There are lots of pressures across the NHS, and we also have to fund the extra midwives and doctors that we need. There was a welcome boost for the NHS in the Budget, with an extra £1.6 billion available for the NHS next year. However, looking forward to the next 10 years and all the pressures coming down the track for the NHS—with a growing birth rate, but also with an ageing population—I do not pretend that we will not have to revisit the issue of NHS funding and find a long-term approach. Probably the most appropriate time to do that will be when we come to the end of the five year forward view and start to think about what happens following that. If we are to put more money into the NHS, we need to have the doctors, midwives and nurses to spend that money on, which is why, in the past year, the Government have committed to a 25% increase in the number of nurse training places and a 25% increase in the number of medical school training places.
My final point for the hon. Gentleman is that, although we have lots of debates in this House in which we take different positions in relation to the NHS, one thing we can be united on is our aspiration, which is shared across the House, that the NHS should be the safest healthcare system in the world, and I very much thank him for his support on that.
Several hon. Members rose—
Dr Sarah Wollaston (Totnes) (Con)
I warmly welcome the Secretary of State’s announcements today, including the move to allow coroners to investigate full-term stillbirths. Will he set out the current waiting time for post-mortems for infants because, as he will be aware, there is a shortage of the very highly specialised pathologists who carry out this vital work?
Dr Philippa Whitford (Central Ayrshire) (SNP)
Last month’s debate on baby loss has been mentioned, and I too took part in it, although I have thankfully been spared the pain suffered by some Members of the House. Such a debate really helps to bring out for everyone on both sides of the House how important this issue is, and I do not think there will be anyone who does not welcome this statement and the ambition it shows.
In Scotland, we had a higher stillbirth, neonatal and perinatal death rate in 2012, but our new chief medical officer was actually an obstetrician, and that may have led to the change of focus in 2013, when she established the maternity and children quality improvement collaborative and the national stillbirth group—all as part of the Scottish patient safety initiative—as well as the neonatal managed clinical networks across Scotland. That has enabled us to drop our stillbirth rate by more than a quarter, and to drop our neonatal death rate by 50%.
This has been achieved despite the challenges we face of really difficult geography, including getting people off islands. It is easy to spot the woman who has a history of difficult births or to spot a woman with comorbidities, such as obesity or diabetes, but anyone who has been involved in birth knows that even the healthiest pregnancy can go wrong at the last minute. For us, as in rural parts of the north and west of England, there are transport issues in relation to how women with problems during labour are identified and transported if a higher specialism is required, and those issues must be looked at.
This is very much about the provision of neonatal services, including the movement of patients, and the availability of expertise and of neonatal intensive care units. However, as came out several times during the debate on baby loss, another issue is that of pre-term birth and stillbirth, so this is also about trying to change some of those things. After Scotland’s recent review in February, the focus will be on the consistent monitoring of growth, as a failure to thrive can identify a third of impending stillbirths; the continuity of care, which the Secretary of State has referenced; and especially smoking. Although the Secretary of State mentioned getting smoking rates down—and in Scotland, sadly, they are higher—the rate in the most deprived communities is more than four times that in the least deprived communities. That has an impact on every level of child loss.
Finally, on research, it is important that we learn, for example from the new information about women sleeping on their side in the last trimester. We need to fund the research to learn those things and then share the information—
Mr Speaker
Order. I have the highest regard for the hon. Lady, who is a considerable medical authority. I gave her a little leeway, but I say very gently that not only did she exceed her time by a minute, but she pursued her usual, rather discursive approach. In these situations, what is required is a question or a series of questions with a question mark or a series of question marks, rather than general analysis. We will leave it there for now. I say that in the most good-natured spirit to the hon. Lady.
I call Antoinette Sandbach.
Mr Speaker
I forgot that we had heard from the hon. Member for Central Ayrshire (Dr Whitford), but we had not yet heard from the Secretary of State. Apologies.
Mr Speaker
Order. As I have just been advised by the distinguished Clerk at the Table, who swivelled round so to advise me, there is really no need for a response, because there was no question. However, I will indulge the right hon. Gentleman to the point of a paragraph.
Mr Hunt
Let me simply say that there is an excellent Scottish patient safety programme. Given that one of the main objectives behind the statement is to share best practice, I would be very happy to talk to the chief medical officer in Scotland and to Jason Leitch about how we can exchange information and learn from each other’s systems.
Antoinette Sandbach (Eddisbury) (Con)
As every parent who has lost a child knows, what they want most is answers. I therefore congratulate the Secretary of State on bringing forward the healthcare safety investigation branch, because such independence will be crucial in gaining the buy-in of parents and in their knowing what has happened in their particular case. How will the learning from those investigations be shared?
Mr Hunt
I thank my hon. Friend for her extraordinary campaigning on this issue. Yes, we want parents to get the answer more quickly, but we also want to be able to answer the question that every parent asks: “Can you guarantee that this won’t happen again?” The investigators will have an explicit dual remit: to get to the bottom of what happened, but also to spread that message around the system so that the same mistake is not repeated. That is the objective of setting up a new team of people to do this.
Lilian Greenwood (Nottingham South) (Lab)
My constituents Jack and Sarah Hawkins have spoken bravely about the tragic death of their daughter Harriet due to failures of care. Members may have heard them this morning. I spoke to Jack earlier and am pleased to tell the Secretary of State that they feel listened to and heard. They and I very much welcome his statement and his support for extending the power of coroners. However, Jack and Sarah need to be able to stop fighting and to begin healing, so I ask the Secretary of State to urge his colleagues at the Ministry of Justice to support the Bill introduced by the hon. Member for East Worthing and Shoreham (Tim Loughton) to bring about that change as soon as possible.
Mr Hunt
Through the hon. Lady, I express my thanks to Jack and Sarah for bravely telling their story this morning in the media, which was incredibly moving and touched a lot of hearts. With respect to allowing inquests into full-term stillbirths, our objective is to move as quickly as any legislative vehicle allows. If I am able to work closely with my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) to do that, that is exactly what I want to do.
Will Quince (Colchester) (Con)
I very much welcome the Secretary of State’s statement and congratulate him on it. Does he agree that the vast majority of grieving parents, if not all, not only want to know why, but want to know that their child’s life, however short, will have had meaning by ensuring that we learn lessons from them not as a statistic, but as a baby? That is why the independent investigation unit is so important. We must learn the lessons not just in one trust, but across the whole NHS and spread that learning to ensure that as few people as possible go through this emotional personal tragedy.
Mr Hunt
My hon. Friend is absolutely right. As he knows, because he has spoken so movingly on this subject many times, there is absolutely nothing we can do to make up for the searing loss of losing a loved one—a baby. It is the worst thing any parent can go through. We can at least give them the commitment that we will learn. If we are honest, we do not do so at the moment, because we sometimes wait 10 years for a court case to be settled, and even then it is not always clear to me that the lessons of what happened are properly learned around the system. This statement is an attempt to change that.
Diana Johnson (Kingston upon Hull North) (Lab)
I very much welcome the Secretary of State’s approach to more openness and transparency in the NHS around baby deaths. However, he will remember signing a letter in May 2016, along with the then Secretary of State for Communities and Local Government and the then Secretary of State for Justice, on an independent inquiry into the baby ashes scandal in Hull. That inquiry has never happened and parents still do not have the answers about what happened in the NHS and Hull City Council in respect of their babies’ ashes. Will the Secretary of State recommit to that independent inquiry going ahead with his permission?
Tim Loughton (East Worthing and Shoreham) (Con)
The hon. Member for Nottingham South (Lilian Greenwood) pre-empted my question about my Bill and coroners. I make the offer to sit down with the Secretary of State and his draftsman to decide on the wording of my private Member’s Bill, which will be debated on 2 February, as the fastest way to achieve his goals and get the solution that all Members of the House want.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
I am sure that the Secretary of State will realise that, even after all these years, when my wife and I hear news like what we heard this morning, it takes us back to our first baby daughter, who died at birth. After that, we had four healthy children and 10 grandchildren, but we still go back to that awful time. Our baby was sickly; it was not about poor care. We care very much about people who lose their children. As a constituency Member of Parliament, I am getting increasingly worried about rationalisations in which maternity units get further and further away from where the main population live. I also get very worried when we do not give our midwives and doctors our full support to give them the morale to do that difficult job.
Mr Hunt
We must give doctors, nurses and midwives our full support, because they do an extraordinary job. Sometimes there are difficult issues and the centralisation of certain maternity services can improve patient safety if it means that there is round-the-clock consultant cover and so on. In my experience, the most important thing is to spot the most risky births early in the process. I am not a doctor, but there is sometimes an assumption that it is all about what happens at the moment of labour when women go into hospital. Actually, a lot of this is about thinking earlier in the process about higher risk mums—mums who smoke and mums from lower socioeconomic backgrounds—and intervening earlier. That will be important for the hon. Gentleman’s constituents and for mine.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Pregnancy and childbirth are a time of joy for most families, but during my professional career, I sadly had to look after a number of babies who died. I therefore welcome the Secretary of State’s commitment to halving the number of neonatal deaths by 2025. In my professional experience, many babies who are stillborn were already dead or in serious trouble inside the mother before they arrived at hospital. Will the Secretary of State therefore confirm that the investigations will look at pre-hospital care, as well as hospital care, including things such as the measurement of babies’ growth? Will he also encourage expectant mothers to monitor foetal movements, as we know that a reduction in those can be a sign of distress?
Mr Hunt
I can absolutely confirm that. This follows a very interesting discussion on that topic we both had at lunch. My hon. Friend is right that the key is early intervention. Also, we know that continuity of carer makes a very big difference. If, well ahead of labour, people can meet the midwives who will be delivering their child, that can help reassure people and lead to safer births.
Graham Stringer (Blackley and Broughton) (Lab)
This is a very welcome statement. The Secretary of State will know of the very disturbing cases over the past few years in the Pennine health trust. Will he make space within the legislation for retrospective investigations where there have been a number of cases, as in the Pennine trust?
Mr Hunt
I will look into that very carefully. I am satisfied that there is strong new leadership at the Pennine trust and that it is being turned around, but it has told me about some of the cases to which the hon. Gentleman refers. They are of very great concern, and we absolutely must do everything we can to give answers to bereaved families.
Victoria Prentis (Banbury) (Con)
As a bereaved parent, but also as a lawyer who has conducted many inquests, I ask the Secretary of State to consider two points. The first is the fact that not many families will need an inquest to determine what went wrong during the birth of their child. Secondly, will he commit to the training of special coroners, just as we have in military inquests, to ensure that those who deal with these very sad cases are the best equipped people to do so? Finally, on behalf of the all-party group on baby loss, may I thank him for today’s announcement and encourage him in his work to make maternity care kinder, safer and closer to home—and may I encourage him to save Horton General Hospital?
Mr Hunt
First, may I apologise to my hon. Friend, because I should have mentioned her in my statement as someone who has spoken very passionately and movingly on this topic in the House? I will take away her point about specialist coroners, because we are now going to have specialist investigators, which we have never had before. I would make one other point. I hope she does not think I am doing down her former profession, but really when people go to the law, we have failed. If we get this right—if we can be more open, honest and transparent with families earlier on—it will, I hope, mean many fewer legal cases, although I am sure that the lawyers will always find work elsewhere.
Stephen Lloyd (Eastbourne) (LD)
I welcome the Secretary of State’s statement, like many others in the Chamber. He talked several times about learning lessons. As he knows, a recent report has highlighted that in my own trust, the East Sussex Healthcare NHS Trust, there were 19 stillbirths last year, which is a far higher percentage than in the rest of the UK. In the spirit of learning lessons, will he agree to someone in the Department of Health examining why that is the case?
Mr Hunt
I absolutely undertake to look into that case and ensure a proper investigation into what is happening. The hon. Gentleman is right; in the end, we need to be much more open about this data, so I commend the trust for sharing the data publicly. Until we access such data, we will not know where the issues are that we need to solve.
Mims Davies (Eastleigh) (Con)
With this vital new focus on safer births, will there be an opportunity to look at group B strep and other issues that if undetected in the later stages of pregnancy can result in baby loss?
Tony Lloyd (Rochdale) (Lab)
I welcome the Secretary of State’s announcement, but will he reconfirm the advice from NICE that midwife-led birthing centres are safe under the appropriate circumstances? In areas such as Rochdale, where the birth rate has shot up dramatically following the closure of its maternity unit, the provision of something like a midwife-led centre would be the right approach.
Andrew Selous (South West Bedfordshire) (Con)
Will the Secretary of State do everything possible to spread across the country the excellent “dads to be” courses that are part of the antenatal provision at Chelsea and Westminster and Kingston Hospitals? We know that they help solidify relationships between parents at a moment of strain and reduce family breakdown.
Dr David Drew (Stroud) (Lab/Co-op)
May I concur with my hon. Friend the Member for Rochdale (Tony Lloyd) and say that, although safety must be paramount, it would be wrong to see this as a reason to shut midwife-led units and, in particular, discourage home births for women likely to have a safe birth who chose to have the baby at home? Will the Secretary of State say something to make sure that those units are safe?
Mr Hunt
I am very happy to do that. Midwife-led units and home birthing are both part of the NHS maternity offer, but it is wrong to suggest that there is a conflict between patient safety and the choice made by mothers. No mother would ever actively make a choice to do something that was not the safest option for her and her child.
John Howell (Henley) (Con)
I welcome the statement, and I am glad that the Secretary of State mentioned the role of tobacco. Has he also considered the role of alcohol?
Mr Hunt
My hon. Friend is absolutely right to say that. The evidence is very clear about the damage done to foetuses and babies if there is too much—or, indeed, any—drinking by a mother. I did not mention it in the statement because we are focusing on smoking cessation training, but he is right to mention the issue.
John Woodcock (Barrow and Furness) (Lab/Co-op)
The brand new maternity unit at Furness General Hospital will open shortly, thanks to the campaigning of the whole community, but it will be safer thanks to the Secretary of State’s personal commitment, thanks to the staff and thanks to the parents of Elleanor Bennett, Alex Brady, Chester Hendrickson, Joshua Titcombe and others who have campaigned tirelessly for local and national change. Will he join my calls for their struggle to be permanently commemorated within the new unit?
Mr Hunt
I am happy to do that. I think I have met most of those parents. The hon. Gentleman has been incredibly supportive to them locally—they have told me that. When Carl Hendrickson came to see me, he brought his 11-year-old son, and I offered for the son to wait outside, but he said no—he wanted his son to be with him. I think it was because he wanted his son to know that he had been to the top to try to understand why his child and his wife died because of mistakes in that maternity unit. The hospital has done an incredible turnaround job—we are all really proud of what it has done—and we are confident that it would not happen again, but that is not to say that there is not a huge amount more we all need to do.
Kevin Foster (Torbay) (Con)
I welcome the Secretary of State’s remarks and the overall tenor of the comments made so far. Does he agree that the most important thing for families who experience tragedy in childbirth is to receive the straight answers they deserve and to know that lessons will be learned where necessary?
Mr Hunt
I do agree. I have visited my hon. Friend’s trust in Torbay and have been very impressed with the learning I saw from the Sam Morrish case, which was a very sad story of where that did not happen initially. However, as I say, I think the trust has learned all those lessons extremely impressively.
Jim Shannon (Strangford) (DUP)
I thank the Secretary of State for his statement and personal commitment. It is much appreciated. Will he confirm that part of the safety strategy includes ensuring that midwives on labour wards can take their breaks and rest periods and that midwife staffing levels on labour wards and post-section wards are checked, monitored and increased?
Mr Hunt
I agree that that is extremely important. I also extend through the hon. Gentleman a similar offer to the one I made to the hon. Member for Central Ayrshire (Dr Whitford), who speaks for the SNP: I am happy to pursue any collaboration possible between the Northern Irish and English healthcare systems to share best practice.
Rebecca Pow (Taunton Deane) (Con)
I welcome the measures that the Secretary of State has announced today and commend him and other colleagues for their sympathetic work. Without them, we would not be here today. I also want to mention Musgrove Park Hospital in my constituency, which is already demonstrating how much good work can be done. It has cut the number of stillbirths by a third in 18 months and has won awards for it. It has introduced a special app that people can use when they are on maternity leave, and it has introduced much-improved special sepsis management. It also has a ground-breaking maternity apprenticeship scheme.
Does the Secretary of State agree that sharing such best practice is the best way to ensure that everyone else can do some great work and that we do not have to hear about these terrible examples again?
Oral Answers to Questions
Jeremy Hunt Excerpts(7 years, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
David Warburton (Somerton and Frome) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
The NHS needs more doctors, which is why last year we announced one of the biggest-ever increases—a 25% increase—in the number of medical school places. Some 500 additional students will start next year and a further 1,000 the year after.
David Warburton
I am pleased to hear that the Department is working on addressing these issues, but can we also look closely at other difficulties specifically facing rural areas? Local patient transport is certainly one of these. With rural bus links thin on the ground and struggling, will the Secretary of State assure us that adequate provision will be made to ensure that patients can always access the services they need?
Mr Hunt
My hon. Friend is right to raise the question. I visited a GP surgery in Thornbury, in his neighbouring county, on Friday and discussed some of these issues. The NHS has an obligation to make sure that people can access its services, and in certain circumstances people are entitled to funding to help them do that. I thank him for raising the issue, however, and know that he will continue to fight hard on it.
Mr Ben Bradshaw (Exeter) (Lab)
All four witnesses who gave evidence to the Health Committee inquiry into the current workforce crisis last week described the current situation as “unprecedented”. Janet Davies, the head of the Royal College of Nursing, said that if Brexit happened, it would be devastating. Does the Secretary of State accept that if there is no deal next month on the rights of EU nationals, the current stream of EU workers leaving our NHS and social care system will become a flood?
Mr Hunt
With respect, I do not think it helps to reassure the brilliant NHS professionals from the EU who are working in the system when the right hon. Gentleman asks questions like that. The reality is that those people are staying in the NHS, and I take every opportunity to ensure that they feel welcome. I try to stress how important they are, and how the NHS would fall over without them. The Government continue to make every possible effort to secure a deal for their future, which we are very confident that we will achieve.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Grantham accident and emergency department is very important to my constituents and those of my neighbour, my hon. Friend the Member for Grantham and Stamford (Nick Boles). It is also very important to me, as it saved my husband’s life on two occasions. Last August it was closed overnight because there were not enough doctors to staff it safely. There are enough doctors now, but unfortunately NHS Improvement has interfered to stop its reopening, postponing it by at least a month. Does the Secretary of State agree that it should be reopened in December?
Mr Hunt
I think I have said to my hon. Friend in the House, and I have certainly said to my hon. Friend the Member for Grantham and Stamford (Nick Boles)—who I am delighted to see back in the Chamber after an incredibly brave battle against cancer—that this was a temporary closure based on difficulties in recruiting doctors, so I will certainly look into the issue very carefully.
Dr Rosena Allin-Khan (Tooting) (Lab)
Last winter, patients were languishing on trolleys in A&E for up to 12 hours. The Red Cross was called in, and people were leaving A&E before their treatment. Does the Secretary of State recognise that it would be absolutely unacceptable for that to happen again this winter? What steps is he taking to ensure that it will not?
Mr Hunt
With respect, the Red Cross was not called in. As the hon. Lady well knows—as a doctor working at Tooting hospital—NHS trusts contract with the Red Cross throughout the year. However, she is right to say that what happened last year was not acceptable. We have done a huge amount: perhaps most important is our provision of an extra £1 billion for this year’s social care budget and a further £1 billion for next year’s budget, because that is where particular pressures were, but we have also allocated £100 million to a capital fund to help A&E departments to improve their facilities.
James Heappey (Wells) (Con)
A shortage of nurses has led to the closure of the in-patient ward at Shepton Mallet Community Hospital this winter. What have the Government done to increase the number of nurses available in rural areas such as Somerset, and to encourage the Somerset clinical commissioning group to recommit itself to the hospital’s future as a matter of urgency?
Mr Hunt
I congratulate my hon. Friend on the close interest that he takes in his local community hospital, which matters so much not just to his constituents but to the NHS, because many people are discharged to it from busy district general hospitals. As he says, there has been a shortage of nurses. That is why we have decided to increase the number of training places by 25%, which is the biggest increase in the history of the NHS.
Jim Shannon (Strangford) (DUP)
Would the Secretary of State consider introducing a bursary-type scheme whereby young doctors’ student debt would be wiped out after they had spent five years in general practice in areas with a shortage of doctors?
Mr Hunt
We have introduced something similar. In areas where it has been difficult to recruit GP trainees for three years or more, we have provided a £20,000 salary supplement to attract people to those areas. It has been very successful, and we have extended it to 200 places this year.
Ms Nusrat Ghani (Wealden) (Con)
High Weald Lewes Havens clinical commissioning group has undertaken a consultation on closing Rotherfield surgery, which is in my constituency, against the wishes of the community and local councillors. Does my right hon. Friend agree that CCGs have responsibilities and liabilities when it comes to supporting rural practices, and that they should do all that they can to recruit GPs in rural areas?
Mr Hunt
I do agree. I also know that, although areas such as Wealden are beautiful places in which to live, it is sometimes very difficult to recruit people to become, in particular, new partners in general practices in such areas. We are concerned about that. Nationally, we have a plan to recruit 5,000 more GPs by 2020-21, but we need to ensure that they go to rural areas such as that represented by my hon. Friend.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
The Secretary of State will know that there are huge numbers of vacancies across the NHS, particularly in nursing, partly driven by pay restraint. He has said that the pay cap will be scrapped, so does he agree with Simon Stevens, who said that it would be an “own goal” not to fully fund the scrapping of that pay cap in the Budget next week and to expect it to be paid for by productivity gains?
Mr Hunt
I have been clear about this: the Government are willing to be flexible in terms of funding additional pay beyond the 1% for nurses, but we want some important reforms to the contracts that they operate under. If those negotiations go well—at the moment we have been having very constructive discussions with the Royal College of Nursing—I am hopeful that we can get a deal that everyone will be happy with.
Jonathan Ashworth
So the Secretary of State does not agree with Simon Stevens. May I ask him about Simon Stevens’s comments last week? He warned that if the underfunding continues, waiting lists will rise from 4 million to 5 million, cancer care will deteriorate, the mental health pledges the Secretary of State has committed to will not be met, and the 18-week target will be permanently abandoned. And is it not the case that if in next week’s Budget the Chancellor does not allocate at least an extra £6 billion a year for the NHS, the right hon. Gentleman will have failed in his responsibility as Secretary of State?
Mr Hunt
What Simon Stevens noticed, and we all noticed, was that when he came with this plan in 2014 Labour refused to back it, and in the 2015 election they refused to fund it—to the tune of the £5.5 billion more that the Conservatives were prepared to put in, but the hon. Gentleman’s party refused to put in. He is quoting Simon Stevens, who also said that when the British economy sneezes, the NHS catches a cold—it will be far worse than a cold for the NHS if we have Labour’s run on the pound.
Suella Fernandes (Fareham) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
This Government have changed policy so that all NHS patients will be able to book routine GP appointments in the evening and at weekends. That is very important both for NHS patients and to relieve pressure on A&E departments.
Suella Fernandes
In September, Jubilee surgery, Whiteley surgery, Stubbington medical practice and Highlands practice launched a same-day access scheme in Fareham, based at Fareham Community Hospital, which had the honour of welcoming the Secretary of State on a visit last year. It is commission-led and supported by Fareham Community Hospital taskforce. Will my right hon. Friend join me in congratulating the GPs—including Dr Tom Bertram, who has taken the lead on this scheme—and Fareham and Gosport clinical commissioning group, and explain how patients will be able to access a GP in Fareham?
Mr Hunt
I was honoured to meet them, and Richard Samuel and his team have done a fantastic job in transforming services in a way that reduces pressure on local hospitals, but also improves services for local people. There was a real buzz there. I also note that neighbouring Gosport has made changes that have improved patient satisfaction to 90%, with 60% of issues being dealt with on the same day. So some really exciting things are happening.
Helen Jones (Warrington North) (Lab)
Warrington has fewer full time-equivalent GPs than in 2010, despite the growth in its population, and many GPs are now quitting the service because of the pressures. What is the Secretary of State going to do not only to attract more people into the GP service, but to keep those who are already there?
Mr Hunt
Those are important questions. I had an excellent visit to Warrington hospital towards the end of the summer, and saw some fantastic work there, particularly on sepsis prevention. The hon. Lady is right: the issues are, first, about getting more medical school graduates to go into general practice—this year we think we will get 3,019 medical school graduates to go into general practice, which is a record as the number has never been that high; and this is also about retention and looking at some of the things that frustrate GPs. One of them is the costs of indemnity, their insurance policy, so we have announced that we will move to a national scheme to help control those costs.
Mr Nigel Evans (Ribble Valley) (Con)
One village medical practice in my constituency, in Slaidburn, was under threat a few years ago, but fortunately it was saved. It does tremendous service to the local community. If it was not there, the elderly patients would have to travel over 40 minutes to Clitheroe, and there is no capacity to take any extra people there. Will the Secretary of State ensure that practices like Slaidburn have a future?
Mr Hunt
It is essential in very rural constituencies such as my hon. Friend’s that we continue to have active GP surgeries; I notice that they sometimes give the best care in the whole NHS, because they know patients and their families and there is continuity of care. They are incredibly important for the local community, so I congratulate my hon. Friend on what he did to save that practice.
Dr David Drew (Stroud) (Lab/Co-op)
Is it right that constituents in Stroud now have to wait weeks to get an ordinary appointment with their GP? The sustainability and transformation partnerships are now saying that there is going to be an acute shortage of GPs. What is the Secretary of State going to do about it?
Mr Hunt
No one should have to wait weeks for a GP appointment in Stroud or anywhere else. We have a lack of capacity in general practice, which is why we decided to embark on a plan to get 5,000 more doctors working in general practice. That is one of the biggest ever increases in the capacity of general practice. I am afraid that it will take time to feed its way through the system, but we are confident that we will deliver it.
Antoinette Sandbach (Eddisbury) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
It is me again, Mr Speaker. Every week, we have four claims against the NHS relating to brain-injured babies, and there is still far too much avoidable harm and avoidable death when it comes to our maternity services. That is why I launched an ambition in 2014 to halve the amount of neonatal death, neonatal injury, maternal death and stillbirths.
Antoinette Sandbach
The Secretary of State has rightly focused on the importance of reducing infant mortality. The police are investigating the unusually high number of baby deaths at the Countess of Chester Hospital. Will he update my constituents on the progress of that investigation and on the measures being taken to ensure safety at the Countess of Chester, which serves the northern part of my constituency?
Mr Hunt
First, I should like to thank my hon. Friend for her campaigning on maternity safety, which has engendered huge respect on both sides of the House. She will obviously understand that I cannot comment on that particular police investigation. None the less, immediately after the issues surfaced, safety measures were taken so that the hospital does not now provide care for babies born before 32 weeks, and it is implementing 24 recommendations from the Royal College of Paediatrics and Child Health.
John Cryer (Leyton and Wanstead) (Lab)
The shortfall in midwives and the financial crisis in the NHS are threatening the “safety, quality and sustainability” of midwifery services. Those are the words of the Royal College of Midwives. How will the Secretary of State restore the confidence of the RCM and the other professional bodies?
Mr Hunt
The hon. Gentleman is right to say that we need more midwives. We have 6,000 midwives in training, and we have 2,000 more midwives than we had in 2010. It is also important to recognise the progress that is being made. Stillbirth rates were down 14% between 2010 and 2015, and neonatal death rates are down 10%, so there is some really important progress happening.
Sir Nicholas Soames (Mid Sussex) (Con)
Will my right hon. Friend join me in congratulating my constituents in Group B Strep Support, and the Royal College of Obstetricians and Gynaecologists, on the September update to the green-top clinical guidelines on group B strep infection, which I am sure he will agree are a significant step forward in preventing that wicked and wholly unnecessary neonatal infection?
Mr Hunt
I am happy to offer my congratulations, because that is an incredibly important area. We have done really well on clostridium difficile and MRSA infections, but the rates of other infections such as group B strep and E. coli are higher than they need to be. In fact, I am speaking at a conference on infection prevention and control this afternoon.
Alison Thewliss (Glasgow Central) (SNP)
Only 57% of maternity units in England have UNICEF baby-friendly accreditation, compared with 100% in Scotland and Northern Ireland and 79% in Wales. What plans does the Secretary of State have to increase UNICEF baby-friendly accreditation to all maternity units?
Mr Hunt
Despite the rivalry that sometimes happens between our nations, I actually have a lot of respect for some of the patient safety initiatives in Scotland, and we will certainly look at this. However, we have what we think is the most ambitious plan to improve maternity safety not just in the UK but in Europe. This is one of those areas that the two countries should work together on.
Chris Philp (Croydon South) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
This is the very last one from me, Mr Speaker. We have one of the most ambitious plans in Europe to expand mental health provision. That means that we need to recruit an extra 21,000 posts over the next three years, and plans are in place to do that.
Chris Philp
I thank the Secretary of State for his encouraging answer, but what does that mean specifically for mental health provision and funding in the London Borough of Croydon?
Mr Hunt
My hon. Friend is right to challenge me on that, because we are asking all clinical commissioning groups to increase their funding for mental health in real terms year in, year out. Some 85% of CCGs are doing that, and an extra half a billion pounds reached the frontline of mental health last year. Regrettably, Croydon is not part of that 85%, so I will take his question away and find out exactly what is happening.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
How does the Secretary of State expect to achieve the plans to increase the mental health workforce when only last week the head of NHS England, Simon Stevens, said:
“On the current funding outlook, it is going to be increasingly hard to expand mental health services”?
Mr Hunt
It has been challenging to expand mental health services over the past seven years due to the financial pressure on the NHS, but we have succeeded. We have 4,300 more people working in mental health trusts and £1.4 billion more is being spent on mental health than three years ago. We have a plan—it is a good one—and we are going to ensure that it happens.
Bim Afolami (Hitchin and Harpenden) (Con)
I am sure that the Secretary of State will welcome the fact that cancer survival rates are at a record high, but will he explain how the Government are going to fund the latest technology, so that we can continue to stay ahead of this terrible disease?
Mr Hunt
I am grateful for my hon. Friend’s question. As he knows, 150 more people are starting cancer treatment every single day compared with 2010, which is why there are 7,000 people alive today who would not have been if we had the cancer survival rates of five years ago. However, we are still behind western European averages, and we want to do something about that. A big investment in capital equipment for cancer is therefore something that we are prioritising.
Rachael Maskell (York Central) (Lab/Co-op)
Constituents in York who have experienced sexual trauma have no clinical pathway to address their psychological support. Will the Secretary of State therefore take action to ensure that we have a national framework to support women in particular, but also the staff who provide that service?
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
Further to the Secretary of State’s response to the question of my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), I feel that the Secretary of State is not being clear with the House. Will the extra money that Simon Stevens asked for be in the Budget or not?
Mr Hunt
I am afraid that the hon. Lady will have to wait until the Chancellor delivers his Budget. There are huge financial pressures on the NHS. We inherited a financial recession but, if she looks at this Government’s record she will see that, unlike her party, we refused to cut spending on the NHS; we are now increasing it.
Maggie Throup (Erewash) (Con)
Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)
The Secretary of State for Health (Mr Jeremy Hunt)
As well as congratulating the Minister for Public Health on being an excellent ambassador for the United Kingdom at the G7 health summit in Milan, I congratulate Colchester Hospital University NHS Foundation Trust on exiting special measures. It is the 21st trust to do so and was in special measures for longer than any other trust. The fact that it got a good rating for compassion, for the effectiveness of its care and for its leadership is a huge tribute to the hard work of staff.
Stuart C. McDonald
Back in July, Ministers said that the goal was to ensure that patient access to innovative medicine is well protected
“through the strongest regulatory framework and sharing of data.”
Therefore, will the Secretary of State confirm that the UK will definitely be signing up to the new clinical trials regulation system, so that pharmaceutical companies do not have to move trials overseas?
Tim Loughton (East Worthing and Shoreham) (Con)
Kelly Tolhurst (Rochester and Strood) (Con)
Mr Hunt
I am happy to do that. I had a very good visit to Medway recently, and Lesley Dwyer and her team are doing a fantastic job there. They had real challenges to turn the trust around, but they succeeded, and the staff did amazingly well. However, the truth is that we still have far too high levels of avoidable harm across the NHS. I want us to be the safest in the world. That is why, in the next few months, we will see campaigns to improve maternity safety, to deal with medication error and to improve transparency when there are avoidable deaths.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
Mr Hunt
My hon. Friend makes an important point. We have no plans for legislative changes, but we do want to see closer working between NHS Improvement and NHS England on the ground, so that people working in constituencies and areas such as his get only one set of instructions. We are making good progress.
Paula Sherriff (Dewsbury) (Lab)
Mr Hunt
I am very happy to accept the hon. Lady’s invitation to visit her area, which I will do, but what I know I will see when I go there is that 8,300 more people are being treated within four hours at her local hospital, where there are 42 more doctors and 56 more nurses than in 2010.
Mr Ian Liddell-Grainger (Bridgwater and West Somerset) (Con)
Mr Hunt
I am very happy to do that, and it is very straightforward. We listened hard when local authorities said they needed more support for the social care budget. We put an extra £2 billion into it in this year’s Budget. Spending is going up this year by 8.6%, so all local authorities are expected to play their part in reducing pressure on hospitals.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Robert Jenrick (Newark) (Con)
Liz McInnes (Heywood and Middleton) (Lab)
What safeguards will the Secretary of State put in place to ensure that NHS trusts do not finance the lifting of the pay cap by making staff cuts, downgrading roles or reducing terms and conditions under the guise of reforms?
Jenny Chapman (Darlington) (Lab)
Will the Department urgently review waiting times targets for children to access mental health services? Even if CAMHS—child and adolescent mental health services—in my constituency achieves its targets, on current referral rates more than 100 children will need to wait more than nine weeks for their first appointment.
Dr Sarah Wollaston (Totnes) (Con)
In its annual “State of Care” report, the Care Quality Commission has highlighted that there are 4,000 fewer nursing home beds in England than there were in April 2015. What plans does the Secretary of State have to address the workforce and funding issues that lie behind this? Will he meet me to discuss the situation in my constituency and nationally?
Mr Hunt
I congratulate my hon. Friend on becoming Chair of the Liaison Committee. Of course, I am always happy to meet her, and the issue that she has raised is very important. Our figures show that the number of nursing home beds, as distinct from the number of nursing homes, is broadly stable. There is real pressure in the market, however, and there are real issues about market failure in some parts of the country, so I am more than happy to talk to her about that.
Tim Farron (Westmorland and Lonsdale) (LD)
The south Cumbria area is one of the few places in England where patients who need even the least complex radiotherapy treatment must travel for longer than the maximum 45 minutes recommended by the National Radiotherapy Advisory Group. In NHS England’s consultation, which will close on 18 December, will the Secretary of State make sure that access to radiotherapy within 45 minutes is a key criterion in allocating resources so that Westmorland general can be given its much-needed satellite radiotherapy unit?
Helen Whately (Faversham and Mid Kent) (Con)
Local A&Es serving my constituents in Kent now have 24/7 mental health services, thanks to this Government’s determination to improve mental healthcare. Can my right hon. Friend assure me that the Government will fulfil their commitment to increase mental health spending by at least £1 billion by 2020?
Mr Hunt
We are absolutely committed to that. We are spending around £1.4 billion more than we were three years ago, and there is more that we need to invest. I am pleased that my hon. Friend mentioned crisis care, because for people who believe in parity of esteem, ensuring that people can get help in a mental health crisis as quickly as they could go to A&E for a physical health crisis is one of the big gaps that we have to fill.
Ms Marie Rimmer (St Helens South and Whiston) (Lab)
I know that the Secretary of State will have been impressed by and enjoyed his visit to Whiston and St Helens hospitals. I am very proud of the collaboration between St Helens Council, the CCG and the hospitals, but additional resources are needed. The Secretary of State will see the good use that is made of those resources, but we cannot deliver everything that is required without that additional push of resources. Will he help us, please?
Mr Hunt
I recognise the picture that the hon. Lady paints. I did have an excellent visit to the hospitals, and they are doing some fantastic work on patient safety. Collaboration between the partners in the local health economy is much better than it has been, but there are financial pressures. We are going to have a million more over-75s in this country in 10 years’ time, and that is why we have committed to increasing the resources going into both the NHS and the social care system.
Peter Heaton-Jones (North Devon) (Con)
The NHS sustainability and transformation plan review in my region recently recommended that all acute services be maintained at North Devon District Hospital. That was a very welcome decision and a victory for the community. Will the Minister work with me and local NHS managers to ensure that the clinical need that has been identified can be fully met?
Matt Warman (Boston and Skegness) (Con)
Recruitment and retention is just one reason why United Lincolnshire Hospitals Trust is currently going through the special measures process. Will the Secretary of State join me in paying tribute to the staff in Lincolnshire, and does he agree that part of the challenge that the trust faces on recruitment and retention will be solved by the establishment of a medical school in Lincolnshire?
Mr Hunt
If I may say so, that question was absolutely beautifully put. I do congratulate the staff. I have met the staff of Lincoln hospital, although I have not been to all the hospitals in the trust, and it is very nice to see the hon. Member for Lincoln (Ms Lee) in her place. Wherever the new medical schools eventually end up, one of the key priorities will be their ability to get more doctors from areas where we are struggling to recruit.
Several hon. Members rose—
Health
Jeremy Hunt Excerpts(7 years, 2 months ago)
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Mr Hunt
What I accept is that we have 30,000 more professionals working in mental health than when my Government came into office. There has been a decline in the number of mental health nurses, but we have in place plans to train 8,000 more mental health nurses, and that will make a big difference.
[Official Report, 10 October 2017, Vol. 629, c. 163.]
Letter of correction from Mr Hunt:
An error has been identified in the response I gave to a topical question.
The correct response should have been:
Mr Hunt
What I accept is that we have 30,000 more professionals working in the NHS than when my Government came into office. There has been a decline in the number of mental health nurses, but we have in place plans to train 8,000 more mental health nurses, and that will make a big difference.
Health
Jeremy Hunt Excerpts(7 years, 2 months ago)
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Stephen McPartland (Stevenage) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
Today is World Mental Health Day and the whole House will want to congratulate Time2Change on its 10th anniversary and the remarkable change in attitudes towards mental illness that it has helped to bring about. Our mental health workforce has increased by 30,000 since 2010 and another 21,000 posts are planned.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Secretary of State’s claim that thousands of extra mental health staff will be appointed by 2021 is fanciful unless he tells us how they will be funded. Today, the Care Quality Commission reports that mental health services are struggling to staff wards safely. We have also learned recently that two out of five mental health staff have been abused or attacked by patients in the past year. Most blame staff shortages for that violence. Rather than telling us about recruiting for 2021, what is the Secretary of State going to do today to protect staff from violence?
Mr Hunt
Let me tell the hon. Lady what has happened in mental health. Some 30,000 more people are working in mental health today than when her Government left office—a 5.8% increase in clinical staff.
[Official Report, 10 October 2017, Vol. 629, c. 143-45.]
Letter of correction from Mr Hunt:
Errors have been identified in the responses I gave to Questions to the Secretary of State for Health.
The correct responses should have been:
The Secretary of State for Health (Mr Jeremy Hunt)
Today is World Mental Health Day and the whole House will want to congratulate Time2Change on its 10th anniversary and the remarkable change in attitudes towards mental illness that it has helped to bring about. Our workforce has increased by 30,000 since 2010 and another 21,000 mental health posts are planned.
General Practice Indemnity
Jeremy Hunt Excerpts(7 years, 2 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I am today updating the House on recent developments regarding indemnity arrangements for NHS general practice in England.
The Government are committed to ensuring that general practice is an attractive long-term career option that gives stimulus and stability to our brightest medical graduates. Therefore, today I have announced that the Department of Health is planning, subject to examination of relevant issues, the development of a state-backed indemnity scheme for general practice in England.
Rising cost of indemnity is a great source of concern for general practitioners (GPs). Our ambition is to deliver a more stable and more affordable system for GPs and their patients. The scheme could provide financially sustainable cover for future, and potentially historic, claims arising from the delivery of NHS services.
The Department has benefited from the engagement with the four Medical Defence Organisations (MDOs) and GP representatives over recent months. Any new scheme should meet the needs of current and future GPs, be in the interest of patients and represent value for money for taxpayers. Transfer of historic liabilities from MDOs to a new scheme would be dependent on satisfactory negotiation with the MDOs.
We will explore with GP representatives how to embed new indemnity arrangements, including the future costs, into GP contract negotiations. The Department will set up a stakeholder group and arrange a first roundtable next month with the Royal College of General Practitioners, the British Medical Association and other GP representatives to gather views from general practice and agree how best to engage with the sector going forward.
Any scheme would take at least 12 to 18 months to establish and require careful negotiation. GPs should continue to ensure they have appropriate indemnity cover in line with General Medical Council requirements to enable them to practise. NHS England has already committed to provide additional funding to GP practices to cover the estimated annual indemnity inflation for 2016-17 and 2017-18. NHS England has also announced additional money for indemnity cover over the coming winter.
Indemnity arrangements are a devolved matter and the Department will continue to liaise with the devolved Administrations, who will make their own decisions about indemnity provision in their territories.
[HCWS159]