NHS Long-Term Plan
Jeremy Hunt Excerpts(8 years, 1 month ago)
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The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
With permission Mr Speaker, I will make a statement about the Prime Minister’s announcement yesterday of a new long-term funding plan for the NHS. The NHS was built on the principle that good healthcare should be available for everyone, whatever their background and whatever their needs. Seventy years on, it remains this country’s most valued public service: an institution that is there for every family, everywhere, at the best of times and at the worst, so no one in this House underestimates the importance of putting the NHS on a steady financial footing, not just for the sake of their constituents but also for their own families and loved ones. That is why I am proud today that this Government have announced their commitment to a long-term funding settlement for the NHS.
From vaccinations to IVF, to radiotherapy and to next-generation immunotherapies, the NHS has always been at the forefront of excellence in medicine, but as only the sixth universal healthcare system in the world, it has also come to symbolise equity both at home and abroad. Despite pressures in recent years, the Commonwealth Fund rates the NHS as the best healthcare system in the world, cancer survival rates are at a record high, stroke mortality is improving faster than almost anywhere else in the OECD and heart disease mortality rates continue to fall. All this is thanks to NHS staff who continue to work tirelessly, day in, day out to make it the world-class service it truly is.
But alongside advances in medicine, demographic pressures pose a potentially existential threat to the NHS as we know it. With the number of over-75s expected to increase by 1.5 million in the next 10 years, these pressures, far from reducing, will intensify. So in March the Prime Minister made the bold decision to commit to a 10-year plan for the NHS backed up by a multi-year funding settlement. Since then I have been working closely with the Prime Minister and the Chancellor, and I can today announce that the NHS will receive an increase of £20.5 billion a year in real terms by 2023-24—an average of 3.4% per year growth over the next five years. The funding will be front-loaded with increases of 3.6% in the first two years, which means £4 billion extra next year in real terms, with an additional £1.25 billion cash to cope with specific pension pressures. Others talk about their commitment to the NHS, but this settlement makes it clear that it is this Government that delivers, and the details will shortly be placed in the Library of the House.
This intervention is only possible due to difficult decisions taken by the Government—opposed by many—to get our nation’s finances back in order and our national debt falling. Some of the new investment in the NHS will be paid for by our no longer having to send annual membership subscriptions to the EU after we have left, but the commitment that the Government are making goes further, and we will all need to make a greater contribution through the tax system in a way that is fair and balanced. My right hon. Friend the Prime Minister said that we will listen to views about how we do that and, my right hon. Friend the Chancellor will set out the detail in due course. I want to pay particular tribute to the Chancellor, whose careful stewardship of the economy—alongside that of George Osborne before him—is what makes today’s announcement possible.
The British public also, rightly, want to know that every pound in the NHS budget is spent wisely. It is therefore critical to the success of the plan that the whole NHS improves productivity and efficiency, eliminates provider deficits, reduces unwarranted variation in the system so that people get the consistently high standards of care wherever they live, gets better at managing demand effectively, and makes more effective use of capital investment. We have set the NHS five key financial tests to show how it will play its part in putting the service onto a more sustainable footing, and I will expect the NHS to give this work the utmost priority. The tests will be a key part of the long-term plan.
However, this is more than just a plan to get finances back on track. In its 70th year, we also want our NHS to make strides towards being the safest, highest-quality healthcare system in the world. That means making a number of improvements to the treatment and care currently offered, including getting back on track to delivering agreed performance standards, locking in and further building on the recent progress made in the safety and quality of care, and transforming the care offered to our most frail and vulnerable patients, so that we prioritise prevention as much as cure. It also means transforming our cancer care, where we still lag behind France and Germany despite record survival rates. There is no family in this country that has not been touched by cancer, so the whole House will want to know how the NHS intends to make our cancer treatment and care among the best in Europe.
Many of our constituents worry about the mental health of their loved ones, families and friends. Again, I am proud of this Government’s record here: investing more in mental health than ever before and legislating for true parity as part of one of the biggest expansions in mental health provision in Europe. A critical part of the plan will be to decide what next steps will enable us to claim not just that we aspire to parity of provision with mental health, but that we are actually delivering it.
For our most vulnerable citizens with both health and care needs, we also recognise that NHS and social care provision are two sides of the same coin. It is not possible to have a plan for one sector without having a plan for the other. Indeed, we have been clear with the NHS that a key plank of its plan must be the full integration of the two services. As part of the NHS plan, we will review the current functioning and structure of the Better Care Fund to make sure that it supports that. While the long-term funding profile of the social care system will not be settled until the spending review, we will publish the social care Green Paper ahead of that. However, because we want to integrate plans for social care with the new NHS plan, it does not make sense to publish it before the NHS plan has even been drafted, so we now intend to publish the social care Green Paper in the autumn around the same time as the NHS plan.
Finally, there are two further elements crucial to putting the NHS on a sustainable footing. Alongside the 10-year plan, we will also publish a long-term workforce plan recognising that there can be no transformation without the right number of staff, in the right settings and with the right skills. This applies to both new and existing staff. As part of this, we will consider a multi-year funding plan for clinical training to support this aim. Similarly, we know that capital funding is critical for building the NHS services of the future and, again, we will consider proposals from the NHS for a multi-year capital plan to support the transformation plans outlined in the long-term plan.
Given the national economic situation, yesterday’s announcement is bold and ambitious. For the first time, national leaders of the NHS will develop a plan for the next decade that is clinically led, that listens to the views of patients and the public and that is backed by five years of core funding. We want to give the NHS the space, the certainty and the funds to deliver a comprehensive long-term plan to transform health and care and to ensure that our children and grandchildren benefit from the same groundbreaking health service in the next 70 years as we all have done in the first 70.
That is the Government’s commitment to our NHS, and I commend this statement to the House.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for an advance copy of his statement.
Today’s announcement is the clearest admission that eight years of cuts, of the tightest financial squeeze in its history and of privatisation have pushed the NHS to the brink. Is not the announcement of new potential legislation the clearest admission that the Health and Social Care Act 2012 has been a wasteful mess and should never have been introduced in the first place?
With waiting lists at 4 million, with winters in our NHS so severe that they were branded a “humanitarian crisis” and with 26,000 cancer patients waiting more than 60 days for treatment, Tory MPs should not be boasting today but should be apologising for what they have done to the NHS.
We have long called for a sustainable funding plan for the NHS, and I note that the Secretary of State did not use the words “Brexit dividend.” Is that because he knows—I say this for the benefit of his own Back Benchers—there is no such thing as a Brexit dividend? That is why the Institute for Fiscal Studies said with respect to the Brexit dividend that
“over the period, there is literally zero available”.
If the Secretary of State disagrees with the IFS, will he confirm the Government’s own Office for Budget Responsibility forecasts that there is no Brexit dividend initially for the public finances? Is it not the truth that this package will be paid for by extra borrowing and higher taxation? The Prime Minister should level with the British public and not take them for fools.
The Secretary of State is graceful enough to concede that higher taxation is on the way, but do the British public not deserve to know how much extra tax they will be paying? Will VAT go up under the Tories? Will the basic rate of income tax go up under the Tories? It is not good enough for him to say that these are matters for the Chancellor, because they are matters for the Cabinet of which he is a member.
Given that the Secretary of State is putting up tax and borrowing, and of course every £1 should be spent wisely, can he guarantee that not a further penny piece will be siphoned off into poor-quality, poor-value privatisation? Three years ago, he told us that the NHS would find £22 billion-worth of efficiency savings. How much of those efficiency savings came to fruition?
How much will the NHS be spending on agency workers and locums in the coming years? The NHS already spends £3 billion a year. Staffing gaps have led to clinical negligence claims of £1.7 billion a year, twice the rate of 2010. How much of this new money will go to further claims? The NHS spends £389 million a year on consultancy costs. Will consultancy costs increase, or will the Secretary of State cap them? With hospital trusts in deficit by £1 billion, can he guarantee that trusts will break even next year?
Is it not the truth, as expert after expert has said, that this settlement is not good enough to deliver the needed improvements in care? Indeed that is why the Prime Minister could not even confirm, when asked a basic question today, whether this funding will deliver the NHS’s constitutional standards on treatment waits, A&E waits and cancer waits.
Can the Secretary of State tell us whether, this time next year, the waiting list for NHS treatment will be higher or lower than the 4 million it is today? This time next year, will there be more or fewer patients waiting more than 60 days for cancer treatment? This time next year, will there be more than 2.5 million people waiting beyond four hours in accident and emergency or fewer? If he cannot give us basic answers to these fundamental performance target questions, that exposes the inadequacy of this settlement.
Why does the Secretary of State not tell us what was left out of this settlement? We have a childhood obesity crisis; we have seen cuts to sexual health services and to addiction services; and health visitor numbers are falling. Yet there is no new money for public health in this announcement—instead we are told to wait until next year. We have a £5 billion repair bill facing the NHS and outdated equipment, yet there is no new money for capital in this settlement—instead we are told to wait until next year.
On social care, we have had £7 billion in cuts and we have had 400,000 people losing care support. The social care Green Paper is delayed again. Is it not a total abdication of responsibility to have left social care out of this settlement? This is not a credible long-term funding plan for our NHS; it is a standstill settlement for the NHS. The reality is that under this plan the NHS will remain understaffed, under-equipped and underfunded—it needs to be under new management.
Mr Hunt
It was a valiant effort, but the hon. Gentleman could not get away from the truth in British politics: when it comes to the NHS, Labour writes the speeches, Conservatives write the cheques. He gamely managed to avoid smiling when he said that this settlement was not enough. He said the same thing on “Sunday Politics” yesterday. Let me remind him that at the last election his party was promising not the 3.4% annual increases that we are offering today, but 2.2%. What today he says was not enough he said in the election was enough to
“'restore the NHS to be the envy of the world”.
His leader said that it would
“give our NHS the resources it needs”.
What we are offering today is not 10% or 20% more than that, but 50% more. In five years’ time this Conservative Government will be giving the NHS £7 billion more every year than Labour was prepared to give. [Interruption.] It is funny, isn’t it, that Labour Members talk about funding the NHS but when we talk about it they try to talk it down? They do not want to hear the fact that under a Conservative Government there will be £7 billion more funding every year—that is 225,000 more nurses’ salaries under a Conservative Government. [Interruption.]
Mr Speaker
Order. There is far too much noise in this Chamber. As is my usual practice, I was addressing Education Centre students via Skype this morning. They were from a primary school from Wythenshawe and Sale East. One of the youngsters said to me, “Is it not the case, Mr Speaker, that often Members speak very rudely to and at each other?” I could not dissent from that proposition. I think it would be helpful if Members calmed themselves. The Secretary of State is accustomed to delivering statements and responding to urgent questions in this place, and he knows, and will expect, that there will be plenty of opportunity for people to question him. As he gives his answers, it is only right that he be heard, as I want then to hear every Member.
Mr Hunt
Thank you, Mr Speaker. The hon. Gentleman said just now that there is
“no such thing as a Brexit dividend”.
I have heard lots of other people say that from a sedentary position. But what did their leader say on 26 February? These were his exact words:
“and we will use the funds returned from Brussels after Brexit to invest in our public services and the jobs of the future”.
So who is right: is it the hon. Gentleman or his leader?
After paying the Brexit divorce bill this Conservative Government will use the contributions that would have gone to Brussels to fund our NHS—that is what the British people voted for. But the main reason we are able to announce today’s rise, one of the biggest ever single rises in the history of the NHS, is not the Brexit dividend but the deficit reduction dividend, the jobs dividend, the “putting the economy back on its feet” dividend, after the wreck left behind by the Labour party. Every measure we have taken to put the economy back on its feet has been opposed by the Labour party, but without those measures there would be no NHS dividend today; with the Conservatives you don’t just get a strong NHS, you get the strong economy to pay for it.
In the next few weeks, as Labour scrabbles around to raise its offer on the NHS, we will no doubt hear that it is offering more for the NHS, but when the Labour party comes forward with that offer, the British people will know that the only reason it has done so is that a Conservative Government shamed it into doing so with an offer far more generous than anything Labour was prepared to contemplate.
Another thing I have heard said about NHS funding is, “Whatever the Conservatives offer, we’ll match and do more,” but the trouble is that the opposite is true, because under this Government NHS spending in England is up 20% in the past five-year period, but in Wales it is up just 14%. That is to say that for every extra pound per head invested in England, in Wales it is just 84p, which is why people are 70% more likely to wait too long in A&Es in Wales. The right response to this statement would be for Labour to say that every additional penny though the Barnett formula will go into the NHS in Wales, but we did not hear that pledge.
The hon. Gentleman also talked about social care, and this matters. I fully agree with him that we need to have a strong plan for social care and that it needs to go side by side with the NHS plan, and we have made some important commitments to the social care sector today. But if he is going to criticise social care cuts, he might at least ask why austerity happened. It was not, as he continually suggests, because of an ideological mission to shrink the state, but to save our economy and create jobs so that we could reinvest in public services. The evidence for that is shown today, with the first ever five-year NHS funding plan, to go alongside a 10-year plan. This is a Conservative Government putting the NHS first and shooting to pieces his phoney arguments about Conservative values.
Dr Sarah Wollaston (Totnes) (Con)
I recognise and thank the Secretary of State for his tireless efforts in making the case for this funding uplift and for a long-term plan. Will he now go further and set out whether, as a result of the extra funding, we will see an end to capital-to-revenue transfers? Will he also set out the role of transformation funding, because we all know that that is essential to get the best from the resources that we are going to add?
Mr Hunt
My hon. Friend asks two important questions. As she knows, we have committed to phase out capital-to-revenue funding, because if we are to make the NHS sustainable in the long run, we urgently need to make capital investment in estates, technology and a whole range of new machinery, including cancer-diagnostic machinery and so on, and we will not be able to do that if we continually have to raid capital funds for day-to-day running costs. That was one of the main reasons why we decided that we had to put revenue funding on a more sustainable footing. My hon. Friend is absolutely right about that.
Transformation funding is also important, because when the five year forward view was published, pressures in secondary care and the acute sector meant that a lot of transformation funding was sucked into the hospital sector and we were not able to focus on the really important prevention work that can transform services in the long run. I am very sympathetic to the idea that we need, if not a formal ring fence, a pretty strong ring fence for transformation funding, so that the really exciting progress that we see in some parts of the country can start to spread everywhere.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I echo the comments made about the approach of the NHS’s 70-year anniversary across the four countries of the UK, having myself spent a fair chunk of those 70 years—perhaps slightly longer than I care to admit—working in the NHS.
Like most people present, I imagine, I absolutely welcome the additional funding, which has been described as bringing the UK to the same level of spending as France by 2023. In that description is, though, the admission that we do not spend the equivalent of what France spends right now. Indeed, we saw a deficit of almost £1 billion in 2017-18, despite transformation funding being sucked in to try to clear that deficit.
I echo what the hon. Member for Totnes (Dr Wollaston) said: is transformation funding on top of this funding? If it is just revenue funding, will there be a separate announcement about transformation funding? The Secretary of State also mentioned the need for prevention, yet we do not see any mention of money for public health. That is where we need to be doing prevention.
It is said that we need a 3.9% increase in social care spending, but that is not identified in the statement. If the Green Paper is to come only in the autumn, social care may not get real funding until next year. With the demographic challenge that the Secretary of State mentioned, that is just too far away. The NHS has faced, on average, an uplift of 1.2% over the past eight years, according to the King’s Fund. Taking it up to 3.4% brings it more in line with the traditional uplifts that we have seen, and yet, in actual fact, with an ageing population, the pressure is even higher. Hopefully, this will stop the slide of the NHS, but the NHS Confederation says that it is not possible to transform on this kind of money. It is, therefore, important that these other projects are looked at separately and are funded separately.
As for where that money is to come from, I do not know how the Prime Minister kept a straight face when she talked about the Brexit dividend. The Institute for Fiscal Studies says that there will not be a dividend. The Office for Budget Responsibility talks about a £15 billion drop in public service and finances. I want to know how the rise will be funded. Will it all be just borrowing and tax rises? The Government should be honest about how they will fund this rise.
Mr Hunt
First, may I thank the hon. Lady for doing something that the shadow Health Secretary did not do, which is to welcome this £20 billion annual rise in the NHS budget? I completely agree with her about the importance of prevention, the importance of social care and the importance of making sure that we sustainably invest in transformation funding. The think tanks do disagree on what level of rise is necessary. Lord Darzi and the Institute for Public Policy Research said 3.5%; we are on 3.4%, which is not far off that. The IPPR went a little higher, but, like the hon. Lady, Paul Johnson said that this will stop the NHS going backwards.
With respect to overall funding levels for the NHS, the United Kingdom currently funds the NHS at the western European average as a percentage of GDP. That is not as high as France or Germany and it is true that, by the end of this five-year period, our funding will end up at broadly similar levels to those of France today, although of course it may change them over the five-year period.
I gently say to the hon. Lady that if that is a worry for her, she needs to explain to NHS users in Scotland why, when NHS spending has increased by 20% in England over the past five years, it has increased by only 14% in Scotland because of choices made by the Scottish National party. For every additional pound per head invested in the NHS in England only 85p has been invested in the NHS in Scotland. I hope that she makes a pledge, as I hope Labour does with its responsibility for Wales, that every extra penny that she gets through the Barnett formula will go to the NHS, because that is what the voters in Scotland want.
John Redwood (Wokingham) (Con)
As soon as we are fully out of the EU, there will indeed be a very big Brexit dividend, which a lot of us want to get on and enjoy here at home. Will the Secretary of State confirm that some of that money will be spent on training and educating and recruiting people already settled here into full-time NHS jobs to cut down on very expensive agency staff and to stop denuding the health services often of poorer countries around the world?
Mr Hunt
My right hon. Friend is absolutely right. One thing that we have historically got wrong in the NHS is not having a long-term workforce plan. Whatever Members’ views on the Brexit debate, it was always a false economy to say that we could get away with not training enough people because we could import them from other EU countries. The truth is that we are not the only country with an ageing population: France, Spain and Portugal need their doctors and nurses as well, as indeed, as he rightly says, do poorer countries.
Mr Dennis Skinner (Bolsover) (Lab)
For the sake of the record, is the Minister aware that, when John Major’s Government fell and Labour came into office, £33 billion was being spent on the national health service? By the time the Labour Government left office, they had trebled the amount of money in real terms to an average of 5.9%. People like me are proud of that achievement. The reason why the people will not listen to him and his 10-year plan is that he is the same man who, only two years ago, was calling on the junior hospital doctors to work seven days a week. He caused chaos in the national health service and he is not fit to run it.
Mr Hunt
Okay, may I decisively say to the hon. Gentleman, if he was so proud of what the last Labour Government did, why did he say nothing when, at the last election, his party was only offering a 2.2% increase? If he thinks it is important to be generous, he should be welcoming what we are saying today.
Theresa Villiers (Chipping Barnet) (Con)
I warmly welcome this new money for the NHS in its 70th anniversary year. Does the Secretary of State agree that it should devote some of these new resources to more staff dealing with early diagnosis of cancer, to help more people beat this condition in accordance with the “Shoulder to Shoulder” campaign being run by Cancer Research UK?
Mr Hunt
I absolutely agree. In fact, the critical thing that we need to improve in our cancer care is diagnosing more people at stages 1 and 2, rather than at stages 3 and 4. That means more staff and more diagnostic machinery. One of the most encouraging points about Simon Stevens’s response to the new settlement was that he said that it will allow us to accelerate the improvements that we are making in cancer care.
Norman Lamb (North Norfolk) (LD)
I welcome this as a step in the right direction, but there is a complete absence of any clarity about how this will be funded. Given that, given—as he knows—the lack of any Brexit dividend and given that there has been nothing of detail at all on social care despite the Secretary of State recognising the need to bring health and social care together, can I tempt him again to engage in genuine cross-party discussions to reach a proper, long-term settlement, including consideration of a dedicated NHS and care tax?
Mr Hunt
With respect, this is a huge increase in NHS funding, the like of which I am not aware that the Liberal Democrats were proposing at the last election. Although I am grateful to the right hon. Gentleman for welcoming the settlement, for him to stand up and say that it is not enough is not a satisfactory response. As he knows, we have actually put our money where our mouth is and demonstrated that we are committed to the NHS, with one of the biggest single injections of cash in the history of the NHS.
Sir Peter Bottomley (Worthing West) (Con)
I am glad that both my right hon. Friend and the Prime Minister have welcomed the fact that all parties have supported the health service: the Liberals first with Christopher Addison, for whom my father once worked, in 1919; Henry Willink, a Conservative member of the coalition Government, in 1944; and Aneurin Bevan, who made some changes and nationalised the hospitals, rather than the family doctors. Both the resources and the reform are needed, and future generations will be grateful to this Government—hopefully with the support of other parties—for taking this forward.
Mr Hunt
I thank my hon. Friend for that comment. If there is ever a memorial built to Sir Henry Willink for his role in the White Paper that critically announced to this House that we were going to have a national health service, my hon. Friend should certainly be the person to unveil it because he has done a huge amount to make the point that, although Nye Bevan’s role was absolutely critical, other people in other parties also played a vital role.
Frank Field (Birkenhead) (Lab)
Well done. But is it well done enough? For 20 years some of us have been calling for a reform of NHS and social care financing by showing that the public’s wish is for a reform of the national insurance base. When is the Secretary of State going to win that battle for us, please?
Mr Hunt
Given that I thought the response from the right hon. Gentleman’s Front Bench was a bit churlish, I am going to be very grateful for the fact that he said well done. I think that “well done enough” is what we say when we deliver the plan that is now being developed because, as he knows incredibly well, having a plan is not the same as delivering it. With respect to imaginative proposals as to how we fund the NHS, the right hon. Gentleman always speaks incredibly interestingly and powerfully on the subject. The Prime Minister has said that she will listen to all views on that ahead of the Budget.
Sir Oliver Heald (North East Hertfordshire) (Con)
I congratulate my right hon. Friend not only on being the longest-serving Health Secretary, but on the tenacious way in which he has campaigned for the money that we are hearing about today. In talking about improving cancer outcomes, does he agree that the patient experience is very important, and that the campaign of Hertfordshire MPs for a radiotherapy centre in our county is something that may possibly benefit from this new largesse?
Mr Hunt
I have listened carefully to what my right hon. and learned Friend says. With regard to cancer care for people who have had a cancer diagnosis, I commend the work of Dimbleby Cancer Care—a really fantastic charity. The shadow Health Secretary, the Lib Dem health spokesman—the right hon. Member for North Norfolk (Norman Lamb)—and I attended the start of its annual 50 km walk on Friday night.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
The Secretary of State closed by saying that he wants to transform health and social care, but every economic expert, from the Institute for Fiscal Studies to the Health Foundation, tells us that with a growing ageing population increasingly living with long-term conditions, this announcement will do nothing more than see the NHS stand still. Will he now admit that it is not enough to repair the damage of the past eight years of cuts to public health, GPs, and social care? How will he ensure that we have a service with new models of care fit for the 21st century?
Mr Hunt
It is funny, isn’t it: the hon. Lady says that this is not enough, but she did not say that when her own party was offering almost half the amount at the last election. She also says that every economic expert says that it is not enough. Let me tell her about one economic expert that does not say that—the Institute for Public Policy Research, left-leaning, in a piece of work done by Lord Ara Darzi, a former Labour Health Minister, who says that 3.5% is enough.
Mr Philip Dunne (Ludlow) (Con)
May I wholeheartedly congratulate my right hon. Friend on this historic achievement in securing a long-term funding increase for the NHS? I suspect that it is because he is now the longest-serving Health Secretary that he has the credibility within Cabinet to secure this achievement. I also congratulate him on proposing to get the NHS to develop a 10-year plan alongside a long-term workforce plan—which is such a critical element of this—and a long-term capital funding plan, because this needs to be seen coherently alongside the social care Green Paper. Bringing them all together at the right time must be the right thing to do. Will he, as part of the deployment of this new-found funding, look to use the data revolution to innovate to ensure that we have world-class data driving better patient outcomes?
Mr Hunt
As usual, my hon. Friend speaks very perceptively. When he was a Minister in my Department, he did a fantastic job in getting our capital funding and our workforce planning into a much, much better place. He is right. Although this is a big opportunity for the NHS, we must not make the mistake of solving yesterday’s problems tomorrow. A huge data and tech revolution is about to happen in healthcare all over the world, and we must make sure that we are at the forefront of it.
Dr Paul Williams (Stockton South) (Lab)
How does the Secretary of State plan to lead the transformation from reactive hospital care to preventive community care? He has presided over a fall in community nurses, a fall in GP numbers, cuts to public health and social care, and widening health inequalities. How are the next five years going to be any different from the past five years?
Mr Hunt
Let me tell the hon. Gentleman what I presided over: 10,100 more doctors; 14,300 more nurses; the Commonwealth Fund saying that our healthcare system is the best in the world; the biggest expansion in mental health provision; and improved outcomes for cancer, heart attacks, strokes and nearly every other disease category. I can do that because this Conservative Government have put the economy back on its feet. Everyone in the NHS knows that, in the end, that is how we get more resources into it.
Sir Desmond Swayne (New Forest West) (Con)
Clinicians tell me that half of interventions have no value to the patient whatsoever, and yet the Medicines and Healthcare Products Regulatory Agency wages war on new entrants with inexpensive and effective remedies. There is plenty of scope for reform, isn’t there?
Mr Hunt
There certainly is. The pattern to date had been very different in tone between the two sides. My right hon. Friend is right to challenge the NHS on this, because the truth is that we do not adopt new treatments and new medicines nearly quickly enough. I hope that this new settlement will mean that we can change that.
Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)
The Government have promised parity of esteem for mental health. Can the Secretary of State clarify whether there is a ring-fenced element of this funding for mental health?
Mr Hunt
I can clarify that NHS England has a mandatory—[Interruption.] I can confirm, if the Opposition would be kind enough to listen to what I am about to say, that NHS England has a mandatory mental health standard, which means that every CCG is required to increase its mental health funding by more than its total funding. That is an effective ring fence.
David Tredinnick (Bosworth) (Con)
To follow on from the question asked by my right hon. Friend the Member for New Forest West (Sir Desmond Swayne), will the Secretary of State look at making greater use of the Professional Standards Authority’s accredited register of 85,000 practitioners? If he made it possible for them to refer to doctors, he would reduce the burden on doctors. That is a recommendation of that statutory body.
Mr Kevan Jones (North Durham) (Lab)
I welcome any new money for the NHS, but does the Secretary of State agree that prevention is better than cure? Durham County Council has had its public health budget cut every single year for the last eight years. Can he tell me how much of this new money will be going to public health, or is he now going to have another fight with the Treasury to get it to release more money for public health?
Mr Hunt
Today’s announcement is for NHS England’s core frontline services, but the right hon. Gentleman is right about the critical role of public health. Many of those services are delivered by the NHS, and we are very clear in what we are saying today and in a further announcement we will make in due course that there cannot be a transformation of the NHS without a proper emphasis on public health.
Neil O'Brien (Harborough) (Con)
The Secretary of State recently visited my constituency, so he will be aware of the important capital investments in my area, such as the new St Luke’s Hospital in Market Harborough, the decision to keep Glenfield Hospital’s children’s heart unit and the brand new state-of-the-art A&E at Leicester Royal Infirmary. Does the Minister agree that capital investments that improve productivity have an important part to play in the long-term plan for the NHS? Does he also agree that Leicestershire would be a very good place to make those investments?
Mr Hunt
Leicestershire would, I am sure, be a very good place to make them. Indeed, my hon. Friend will know that there has been considerable capital investment in Leicestershire. He makes an important point: one of the real benefits of a long-term plan is that we can create a stable environment for capital investment. One of the problems we have had is that when the budget is set hand to mouth, year in, year out, people do not make long-term investments in things such as IT systems. We have to put that right.
Mr Pat McFadden (Wolverhampton South East) (Lab)
It is important to be honest about where public spending is coming from. Can the Secretary of State confirm that the Government’s own estimates, released in part by the Brexit Select Committee, show that far from there being a Brexit dividend, the plan that they are set to follow is scheduled to increase public borrowing by £55 billion a year by the end of the forecast period, meaning that this spending will have to be funded in spite of Brexit, not because of it?
Mr Hunt
It is a matter of fact that when we leave the EU we will not have to pay membership subscriptions. There will be a divorce bill, and when that is settled, those subscriptions will be available for the NHS, which was exactly what the British people voted for. The right hon. Gentleman is talking about the projections for the economy in the meantime. All I will say is that there is a lot of debate about those projections. They have not always been right in the past, and the British economy has been much more resilient than many people predicted.
Richard Graham (Gloucester) (Con)
An announcement of the largest ever new injection of funds into the NHS is a triumph for our longest ever serving Health Secretary and the Prime Minister, because it shows the outstanding priority of this Government. Every Member of the House should welcome that. When my right hon. Friend looks at productivity gains in the NHS, will he focus on the implementation of IT projects? Although Gloucestershire Hospitals NHS Foundation Trust does a remarkable job in many ways and its staff work unbelievably hard, the expensive and underperforming Smartcare project could have been better done.
Mr Hunt
I thank my hon. Friend for hosting me at his local hospital, which was very informative. He is absolutely right: it is an enormous cause of frustration to staff throughout the NHS that so many of our hospital systems are, frankly, antediluvian. We must put that right, because so many nurses could spend so much more time with patients if they were not having to fill out forms, and the same is true for doctors.
Liz Kendall (Leicester West) (Lab)
We cannot put the NHS on a steady financial footing without a proper funding settlement for social care, yet the Secretary of State now says that that will not happen until the spending review, which in reality means no substantial extra money for social care until 2020 at the earliest. We cannot transform care for older people or reduce pressure on the NHS until we look at the two together. Why are the Government still ducking this vital issue?
Mr Hunt
I always listen to the hon. Lady very carefully when she talks about the social care sector. I would say to her that while we are not announcing a new long-term plan for social care today, we are making some very important commitments to the NHS and the social care system, including the commitment that we will not allow the pressure from the social care system on the NHS to increase further. That means that, even before the date she mentioned, we are going to have to look very carefully at the settlement for social care.
Dr Andrew Murrison (South West Wiltshire) (Con)
I congratulate my right hon. Friend, whose commitment to our NHS is very clear. Does he agree with me, however, that the Commonwealth Fund indicator that really matters concerns clinical outcomes, some of which he referred to in his statement, and on that the news is not good? Will he do everything he can to make sure that the increased funding he has announced today is absolutely dedicated to improving outcomes for stroke, cancer and heart attack, on all of which we still lag well behind countries with which we can reasonably be compared?
Mr Hunt
I absolutely agree 100% with my hon. Friend, and we really must look at outcomes. The Commonwealth Fund was kind enough to say that that was actually one of the areas in which we are one of the fastest improving Commonwealth Fund countries. However, it has to be said that that was from a very low base, and we need to sort that out.
Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)
Can we get the facts straight? The Welsh NHS is spending 8% more per head on NHS and social care combined than in England—per head—so let us not have any more stories about the Welsh NHS.
It is absolutely clear that there is no Brexit dividend. The Institute for Fiscal Studies says it, the Financial Times says it and the Government’s own analysis from the Treasury shows it. What is more, Brexit is already having a cost. The Home Office has had to have an extra almost £500 million in the past two years to pay for Brexit preparations, such as registering EU nationals, which would pay the salaries of 20,000 nurses. Will the Secretary of State admit that that is what is really going on—a Brexit deficit, not a dividend?
Mr Hunt
We do need to get the facts straight about what is happening in Wales. A&E performance is over 8% lower in Wales, according to the latest figures, which means that Welsh NHS patients are 70% more likely to wait too long in their A&Es than patients in England. The Welsh Government have taken a series of decisions not to invest every penny available in the Welsh NHS, which is why spending has risen at a slower rate. Had they not done so, hundreds of millions more could have gone into the Welsh NHS.
Victoria Prentis (Banbury) (Con)
On Friday, I was lucky enough to visit the award-winning neck of femur service at the great Horton General Hospital. The length of time that patients stay is very dependent on great links between the hospital and social care. Does my right hon. Friend agree that spending to save is possible, so that even more of this great funding can be spent on patient returns?
Mr Hunt
Absolutely. The most important way of spending to save is to invest in prevention, and a lot of that work comes from strong local hospitals. Before my hon. Friend finally leaves this place, I have no doubt at all that her local hospital will be called not the Horton General Hospital, but the Great Horton General Hospital.
Karen Lee (Lincoln) (Lab)
Does the Secretary of State agree with me that without the reinstatement of the nursing bursary, we cannot even hope to train enough nurses. The figures show that the numbers training have fallen—this is a serious inquiry—and until we can train enough nurses, we can talk about extra nurses, but we will always need agency nurses. Does he agree that we need to reinstate the nursing bursary so that people can afford to train?
Mr Hunt
The reason why we took what I fully accept was a very difficult decision was that we wanted to fund the training of an additional 5,000 nurses every year. When there is a reform of higher education funding, there is always an initial dip in applications. In this case, record numbers of 18 to 19-year-olds applied, but there was a dip among mature students. That is why we have introduced the apprenticeship route. We need to make sure that that works if that dip is to be reversed.
Richard Drax (South Dorset) (Con)
I welcome my right hon. Friend’s statement. Like all colleagues in the House, I am a great supporter of community hospitals. Under the latest Dorset clinical commissioning group review, Portland Community Hospital is to be replaced with a medical hub on the island. Will the extra money allow the CCG to review the review, and perhaps save hospitals such as Portland Community Hospital?
Mr Hunt
Obviously, that would be for the CCG to look at; it will focus on anything that allows it to focus on prevention and not cure. I do not know the specifics of that case, but in general there is a strong and important role for community hospitals, although not always doing exactly the same things they have done in the past. Often, they can become local NHS hubs, offering a wide range of services. That tends to be the best way to preserve their future.
Wes Streeting (Ilford North) (Lab)
Standing at that Dispatch Box, the Secretary of State made the astonishing claim that when it comes to NHS funding, the Conservatives write the cheques and Labour writes the speeches. Let me tell him about increases in health spending under every Government in my lifetime: a measly 1.4% increase under David Cameron; 2.7% under Mrs Thatcher; even John Major managed a better 4.7%. It was only under the Labour Governments of Gordon Brown and Tony Blair that we saw increases in NHS spending of 5.4%, under Gordon Brown, and 6.1%, under Tony Blair. Does that not demonstrate that we cannot trust the Conservatives on the Brexit dividend and we cannot trust their claims on NHS spending? Until the Conservatives sort out social care and public health spending, the Labour Governments will have a record that this Government cannot even begin to touch.
Mr Hunt
The hon. Gentleman has just proved my point about Labour making speeches about the NHS. He talked about a “measly” increase under David Cameron; what he forgot to tell the House was that his own party’s plans that year were to cut the NHS budget because of the train crash of an economy that they left the country with.
Mr Marcus Jones (Nuneaton) (Con)
This is a massive and welcome boost for our NHS, and I very much welcome it. Will my right hon. Friend say more about the importance of public health and social care in the context of his announcement today and what his plans are? The issue is not just about getting people to live longer, but getting them to live well for longer.
Mr Hunt
My hon. Friend asks a very smart question. The truth is that no healthcare system anywhere in the world, faced with our demographic challenge, would ever feel it had enough money unless it transformed its model of care to one based on prevention rather than cure. That is why public health and the social care system are absolutely critical. One of the big lessons that we need to learn with this new funding is to spend it in a way that brings down the long-term rate of growth in demand for hospital services. That is the only way in which we can make it work.
Catherine McKinnell (Newcastle upon Tyne North) (Lab)
World-leading childhood cancer research and treatment take place in Newcastle, but those leading that research are clear that there is no sight of a Brexit dividend, given the loss of EU staff and the uncertainty hanging over intra-EU collaboration and EU funding. Rather than peddling Brexit mythology, will the Secretary of State take on board those very genuine and very serious concerns?
Mr Hunt
We have taken on the concerns of everyone in the NHS. Whether someone agrees with Brexit or the Brexit dividend, the Government are making a commitment for a £20 billion annual increase in the NHS budget in five years’ time. I hope that will help people in Newcastle and everywhere else in the country.
Chris Davies (Brecon and Radnorshire) (Con)
As the Labour Welsh Government are the only Government in recent times to reduce funding for the NHS, will my right hon. Friend do all he can to ensure that the very welcome £1.2 billion that will come to Wales under the Barnett formula will not be spent on another Welsh Labour Government pet project, but will be spent on the health of the people of Wales?
Mr Hunt
My hon. Friend speaks on behalf of not just his constituents but all NHS users in the whole of Wales who are asking themselves why it is that their Government have chosen not to invest in the NHS in the way that has happened in England, as a result of which they have much longer waits in their A&Es.
Jim Shannon (Strangford) (DUP)
I very much welcome the Secretary of State’s statement. I congratulate him on staying the course, and on his perseverance and dedication. I say very well done. It has been indicated that the Northern Ireland Department of Health will also benefit over the next few years. What discussions have taken place with the Northern Ireland Department of Health to ascertain the monies to be allocated, and the focus and priorities?
Mr Hunt
This is, as the hon. Gentleman knows, a devolved matter, but I would say that England, Scotland, Wales and Northern Ireland are all on the same journey when it comes to the NHS. We are all moving to integrated out-of-hospital care built around the person and focused on prevention. In one respect, Northern Ireland has gone further faster than anywhere in the UK: I refer to the integration of the health and social care systems. There is plenty we can learn from them and they from us.
Jeremy Lefroy (Stafford) (Con)
I congratulate the Secretary of State on this very welcome announcement and reiterate what others have said about the importance of prevention and public health. Since this is a long-term settlement, may I ask him to ensure that the disparities between various parts of England are narrowed over the coming years? They are too great, with some getting £300 or £400 a year per person less than other areas. That is just too much of a difference.
Mr Hunt
I totally take on board what my hon. Friend says. I am happy to engage with him and with NHS England. As he knows, we have taken the politics out of that particular process by giving it to NHS England, which I think is the right thing to do. I know NHS England would be happy to engage with him on that.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
I welcome long-term planning in funding for the NHS, which is needed. However, as chair of the all-party group for disability, I know there are concerns that the learning disability workforce has fallen by a third, learning disability training is not yet compulsory and there are 1,200 avoidable deaths in the learning disability population annually. In Learning Disability Week, people are asking to be treated well. Will the Secretary of State prioritise this area and make sure our most vulnerable people with learning disabilities are no longer left behind?
Mr Hunt
I thank the hon. Lady for asking that important question. We have introduced a £10,000 golden hello for postgraduates who go into the learning disability field. She is right that we have had particular pressure on the learning disability workforce. In the aftermath of Mid Staffs, there has been a whole range of measures to improve hospital ward staffing ratios for nurses and that has had an impact on learning disability nurses. That is absolutely something we hope to address with this new funding.
Simon Hoare (North Dorset) (Con)
I echo the thoughts of my hon. Friend the Member for South Dorset (Richard Drax) on the role of community hospitals as the segue between the acute sector and patients going home. Will my right hon. Friend confirm that, with this very welcome new money coming into the health service, the drive for efficiencies and increases in productivity will continue and indeed be increased to ensure that the biggest bung—the biggest bang is felt for those bucks?
Mr Hunt
My hon. Friend is absolutely right not to use the word “bung” in his question and to correct that very quickly indeed. He is also right to talk about productivity. The last Labour Government made important progress in bringing down waiting times. That required significant extra resources. When Alan Milburn had a 10-year plan, there was not a big productivity element to it. This time, when resources are much tighter, we have to make sure that productivity and efficiency gains are at the heart of the progress we make.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
The Secretary of State is right that more funding is urgently needed, because he knows better than anyone that the percentage of NHS trusts in deficit rose from 5% in 2010 to 44% last year. Today, he has talked repeatedly about prevention, but he has failed to say directly what will happen to public health. Will he therefore clarify whether any of the settlement he has announced today will go towards public health services, vital for prevention and tackling health inequalities, which are being cut by £800 million over five years?
Mr Hunt
Today’s settlement covers NHS frontline services. As I explained in the statement, it does not cover public health, but we fully recognise its importance. The hon. Lady talks about the increase in trust deficits. It is true that the number of hospitals in deficit has gone up, but that is because we deliberately decided to be very careful in the way that we performance-managed trusts with deficits. In Mid Staffs, getting rid of the deficit was one of the reasons why the number of nurses in wards was stripped down to totally inappropriate levels. We have to make sure that we handle this in an appropriate way.
Rebecca Pow (Taunton Deane) (Con)
This announcement is really welcome and the Secretary of State’s commitment shines forth. The financial commitment is much needed, but, as two GPs said to me on the platform as I left Taunton this morning, waste in the NHS must be tackled, as well as funding. On top of that, best practice systems must be introduced, particularly in the cancer pathway.
Mr Hunt
My hon. Friend knows about that from her own family experience and I thank her for telling me about some of the challenges she has had in the interests of improving them for all NHS patients. She is right that one of the biggest opportunities the NHS has is to standardise best practice across the whole health economy. We collect, share and publish more data than any other healthcare system anywhere in the world, so we have the chance to get this right in a way that is not possible in other countries. I know we are absolutely determined to do so.
Judith Cummins (Bradford South) (Lab)
Given the crisis in access to NHS dentistry, in particular for our children, will the Secretary of State confirm that dentistry will get its fair share of this funding in line with demand?
Alex Chalk (Cheltenham) (Con)
I warmly welcome this enormous funding boost, which is far in excess of that proposed by any Opposition party. Does my right hon. Friend agree that local trusts should consider using these further resources to help to attract and retain additional doctors in tough-to-recruit fields such as emergency medicine, to support and extend A&E in hospitals such as Cheltenham General Hospital?
Mr Hunt
Of course I agree with that. My hon. Friend campaigns extremely vigorously on behalf of his own hospital in Cheltenham. Recruitment will be one of our top priorities. One way we want to tackle that is very simply by giving hope to people in the NHS and to people thinking of going into medicine that there is a long-term plan that has the support of the NHS, and which is at one remove from the party politics that we always get around the NHS. I think that is something doctors and nurses overwhelmingly want.
Mike Gapes (Ilford South) (Lab/Co-op)
How much of this welcome additional money will be used simply to pay off accumulated debt and current deficits, and how much will be a real increase?
Mr Hunt
The think-tanks who pore over the numbers disagree on that. Some say that it is about enough to stabilise the current situation—that is what Paul Johnson of the IFS says—and others say there is enough room to transform. Who is proved right will depend on how much we do on productivity and efficiency to create the headroom for the real changes we all want to see. That is why we have to get that bit of the equation right.
Mr Philip Hollobone (Kettering) (Con)
An extra £20 billion a year in real terms in five years’ time is a massive financial boost for the NHS. The Secretary of State knows Kettering General Hospital well because he has been there twice. Would he ensure that just £20 million to £30 million of that goes on funding the new urgent care hub at Kettering General Hospital, which everyone says is what the hospital desperately needs?
Ben Lake (Ceredigion) (PC)
Given that the Secretary of State has confirmed this afternoon that increased NHS funding will not be wholly accounted for by any fantastical Brexit dividend, could he clarify whether the Welsh Government will be expected to increase the Welsh rates of income tax if the UK Government’s promise of an additional £1.2 billion for Wales is to be realised?
Mr Hunt
Any funding commitment made by the UK Government will be appropriated to Wales in accordance with the Barnett formula. That is the procedure that we have followed. The choice for the Welsh Government is whether they put all that money into the NHS or, as they have done in the past, choose to prioritise it elsewhere.
Henry Smith (Crawley) (Con)
I very much welcome my right hon. Friend’s announcement that some of the subscriptions that we will no longer be paying to the European Union will be redeployed for the national health service. Under the last Labour Government, Crawley Hospital lost its A&E department and its maternity department. Over the last eight years, services have been returning. Can I have an assurance that this additional spending on the NHS will follow through with the return of further local services?
Mr Hunt
It absolutely needs to boost local services. If there is one lesson that we have learnt from the last few years, it is that we will not, in the long run, crack the funding pressures in our health system unless we find a way of properly investing in local services, which I know my hon. Friend has campaigned for so hard.
Mr Adrian Bailey (West Bromwich West) (Lab/Co-op)
An omission from this otherwise welcome statement was any mention of capital spending. It is vital for future health outcomes in the Black country and west Birmingham that the midland metro hospital, currently half built and suspended following Carillion’s collapse, is completed. Will the Secretary of State tell me where in this package the funding will be found for that, and when?
Mr Hunt
The hon. Gentleman is right to raise that issue, which is of great concern to us, as I know it is to him. The Minister of State responsible for hospitals, my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay), visited the trust last Thursday and I know is working incredibly hard to try to resolve that situation as soon as possible.
Alberto Costa (South Leicestershire) (Con)
I congratulate the Secretary of State on his very welcome intervention in ensuring the longevity of our NHS with these wonderful proposals. Will he give some consideration to the way in which doctors are trained? At present, it is a costly and time-consuming affair. Only around 10 UK medical schools have a graduate entry system. In his long-term plan, looking at recruitment, will he consider how the skillset that we see among our population—for example, medical scientists and other related professionals—can best be harvested in training future medics?
Mr Hunt
My hon. Friend asks a profoundly important question. The medical school students who are going to medical school this year will become consultants in 2031 at the earliest, so we have to make sure that we update the way people are trained for the totally different world that they will be facing in terms of technology, medical innovation and the demarcations and roles inside hospitals and community care. This is very much part of the long-term workforce plan that will be announced alongside the NHS long-term plan later this year—it is what that will be about.
Stella Creasy (Walthamstow) (Lab/Co-op)
I can understand why some in Government think that there is a Brexit dividend. After all, we know that the Health Secretary’s colleagues in the Home Office have been given enough money from Brexit to cover the cost of 20,000 nurses. His colleagues in the Department for Environment, Food and Rural Affairs have been given 14,000 nurses’ worth of money and even his colleagues in the taxman’s office have been given 11,000 nurses’ worth of money. I am sure that the Secretary of State would not want to betray the good will of a single doctor, nurse, cancer patient or future patient by making promises that he cannot keep, so can he tell us, once and for all, whether he personally believes that there is a Brexit dividend—yes or no?
Nigel Huddleston (Mid Worcestershire) (Con)
I and my constituents warmly welcome this extra money for the NHS. Does the Secretary of State agree that the British public are not stupid? They, unlike some of the Opposition, are well aware that any and all Government expenditure always comes from taxation, either now or in future. We have listened. We have had a conversation. They have told us that they want more spending on the NHS. We have said, “But that may mean you paying more taxes,” and they have said, “Fine, it’s that important.” Is that not a good and honest agreement between the public and the Government?
Mr Hunt
My hon. Friend could not have put it better. The only surprise here is that having spent years and years saying that we should invest more in the NHS through the tax system, when the Government actually stand here and say that is what they are doing, the Opposition tell us that they are against it.
Peter Kyle (Hove) (Lab)
Whether it is mentioned by the Prime Minister, the Leader of the Opposition or anyone else, there is only one fact about the Brexit dividend, and that is that it does not exist. Will the Secretary of State tell all the staff in the NHS how much of the money announced today is contingent on the Brexit dividend, so that they can bank for the future based on how much will actually materialise come autumn?
Mr Hunt
I am very happy to tell the hon. Gentleman that all this money will materialise, because this is a Government that keep their promises. If he is so worried about the Brexit dividend, he should be speaking not to me but to his own leader, who said that he wants to
“use funds returned from Brussels after Brexit to invest in our public services”.
Have a word with him!
Stephen Kerr (Stirling) (Con)
I also welcome the statement from the Secretary of State, but I note that it relates to health spending in England only. Will my right hon. Friend spell out what this means for Scotland in particular, thanks to the Barnett consequentials, and how can we ensure that the additional funds provided to the Scottish Government are spent on the NHS in Scotland, which has not always happened in the past?
Mr Hunt
My hon. Friend is right to raise that question, because under the Barnett consequentials, for every £1 per head additional for the NHS in England, there will be £1 per head available for the NHS in Scotland. The Scottish National party has chosen to invest only 84p of every £1, which is why people in Scotland are 30% more likely to wait too long for their elective care in Scotland. That is a choice made by the SNP in Scotland and I hope that it will do it differently this time.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
I welcome any additional funding because, let us face it, it is not just the NHS that is in deep crisis, but social care, too. However, as others have said, it is still not enough—3.5% was the minimum that was needed to see actual improvements. What assessment has the Secretary of State done to gauge what the improvements will be in the next 12 months? What financial scenarios is the Chancellor considering, and will the Secretary of State commit to stop tendering health services to the private sector, which is a waste of money for the public?
Mr Hunt
It is really extraordinary that on a day that we have announced a £20 billion annual rise in the NHS budget—you could not get a bigger commitment from a Government to state-funded healthcare—Labour is still running off down the rabbit hole of privatisation. If it is any reassurance to the hon. Lady, last year the proportion of NHS services contracted to the private sector went up by the enormous amount of zero.
Derek Thomas (St Ives) (Con)
This statement is very welcome, but I have raised in this place before how the money is distributed around the UK; it is well known that the south-west gets about 2% less a year of increased NHS funding. When the Secretary of State has a moment, will he look again at how funding is distributed, and ensure that as it increases, it is increased fairly?
Mr Hunt
I am happy to do that. My hon. Friend asks the same question as my hon. Friend the Member for Stafford (Jeremy Lefroy). These matters are now decided at arm’s length by NHS England because we think that the fairest way is to take the politics out of it, but I am happy to work with him to engage with NHS England on the Cornish questions.
Diana Johnson (Kingston upon Hull North) (Lab)
I listened to what the Secretary of State said earlier about how there can be no transformation of the NHS without a proper emphasis on public health. How will the planned £800 million of cuts to public health help with that transformation, particularly when it comes to tackling the child obesity crisis, the growing sexual health services crisis and the cuts to addiction services, which are causing enormous problems for individuals and the communities now having to deal with them?
Mr Hunt
I fully recognise the pressures the hon. Lady is talking about. I said what I said about public health because I do not believe there is a sustainable long-term solution to NHS funding pressures unless we have an equally sustainable solution for public health, and indeed for social care, which she also talks about. She will have to wait for us to negotiate our next spending review settlement to understand how we intend to address those.
Martin Vickers (Cleethorpes) (Con)
I welcome the Secretary of State’s statement and congratulate him on securing cross-Government support for his proposals. He rightly said that every pound must be spent wisely, and he will know that there is great variation in procurement across the NHS. What will he do to ensure better procurement?
Marsha De Cordova (Battersea) (Lab)
The Government’s new NHS funding includes no additional funding for social care. The Secretary of State has said that the Government will publish a social care Green Paper in the autumn. Will he confirm—yes or no—whether the Green Paper will include social care funding for working-age disabled adults?
Afzal Khan
Will the Secretary of State clarify how this money will be divided between the regions? Children growing up in the north, in constituencies such as mine, have vastly different life chances from their counterparts in the south. We do not want this funding to reinforce the north-south divide.
Mr Hunt
As the hon. Gentleman knows, we take deprivation into account very seriously when we allocate NHS funding, because it has a direct impact on people’s demand for NHS services, but other things also have an impact on people’s health, such as housing and employment prospects. The bigger lesson is that we need to integrate all our services for our most disadvantaged citizens.
Mr Hunt
My hon. Friend is absolutely right, and that is a big priority for us, which is why this year we will publish a final 10-year NHS workforce plan, at the same time as the NHS plan that Simon Stevens is putting together. Together they are designed precisely to avoid shortages in particular and very important specialties.
Nic Dakin (Scunthorpe) (Lab)
Community pharmacies feel stretched at the moment, yet they are well placed, at the heart of the community, to have a real impact by taking pressure off GPs. Will the Secretary of State give a commitment that some of this money will go to reinforce the strength of community pharmacies so that they can play their part in prevention as well as cure?
Mr Hunt
The hon. Gentleman is right that community pharmacies have a vital role to play. I do not think we use them enough. We need to find better ways for them to help us in the prevention agenda, and one way we are doing that is by integrating medical records so that they can be accessed by pharmacies, which will help them to give good advice to patients.
Karin Smyth (Bristol South) (Lab)
May I press the Secretary of State on the issue of transformation and his hint—I think—at ring-fencing? If the people of Bristol South are to be asked to spend more money on the NHS, how will they know that it is being used to improve health outcomes and not simply to bail out local hospital deficits?
Mr Hunt
The hon. Lady is right to ask that question, and I encourage her to hold her local NHS to account on that. There are some simple metrics, which we can share with her, that can tell us whether the NHS is using the money wisely, and one of them is whether her local hospitals are managing to reduce their emergency admissions by providing better care in the community. She is right that it is the litmus test of whether the money is being spent wisely.
Kate Green (Stretford and Urmston) (Lab)
May I press the Secretary of State on his answer to my hon. Friend the Member for Battersea (Marsha De Cordova), particularly in relation to profoundly disabled adults, who need not just excellent healthcare, not even just excellent physical and social care, but access to services that maximise their social participation? Will he say a little more about the work being done in parallel with the social care Green Paper?
Mr Hunt
I want to reassure the hon. Lady that, in all our discussions about core social care funding and the funding accessed by local councils, we discuss working-age disabled adults every bit as much as the frail elderly. They are central. Many councils actually spend more on that group than on older people. We will not crack the social care problem unless we take that group of people extremely seriously.
Paul Blomfield (Sheffield Central) (Lab)
The Secretary of State talked about mental health funding without mentioning the crisis facing our young people. He knows that across the country there are appalling waiting times to access child and adolescent mental health services. How significant is today’s announcement to tackling that issue?
Mr Hunt
It is very significant, first, because we have been clear that a transformation in mental health is central to our ambition for the new 10-year plan, and secondly, because, as the hon. Gentleman knows, the Green Paper will over that period see the number of people employed in looking after young people with mental health problems increase from 9,000 by an additional 8,000—a near doubling in the size of the workforce. This financial plan gives us the confidence to say we can deliver that.
Gross Negligence Manslaughter in Healthcare: Review
Jeremy Hunt Excerpts(8 years, 1 month ago)
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The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
On 6 February 2018 I informed the House that I had asked Professor Sir Norman Williams to carry out a rapid policy review of gross negligence manslaughter in healthcare settings. This review was prompted by concerns among healthcare professionals that errors could result in prosecution for gross negligence manslaughter, even in the face of broader organisation and system failings. In particular, there was concern that this fear had had a negative impact on reflection and learning by healthcare professionals, which is vital to improving patient care.
My Department is today publishing the report of Sir Norman’s rapid policy review.
Any investigation of a healthcare professional for suspected gross negligence manslaughter begins with the death of a patient a—life needlessly cut short and a family grieving. Sir Norman and his Panel have heard from such families. Their experiences were vital in informing this review and I would particularly like to thank them for their courage in providing evidence to the review.
The report finds that prosecutions and convictions of healthcare professionals for gross negligence manslaughter are rare. It also finds that the legal test for the offence is set at an appropriately high level. This should reassure healthcare professionals that only where conduct is “truly, exceptionally bad” and in consideration of “all the circumstances” will the bar for gross negligence manslaughter be met.
However in order to provide greater consistency the report makes recommendations to improve the investigation of allegations of gross negligence manslaughter involving healthcare professionals. These include:
developing an agreed understanding of gross negligence manslaughter that reflects the most recent case law;
improvements to the way that healthcare professionals provide expert advice and evidence; and
improvements to local investigations into unexpected deaths in healthcare to provide a full understanding of the cause of death, ensuring improvements are made to reduce the likelihood of similar incidents.
The report also considers the impact of criminal and regulatory investigations on the willingness of healthcare professionals to reflect on their practice. It finds that reflective material is rarely sought in such investigations. Nonetheless, in order to provide clear assurance to professionals, the report recommends that those regulators that have a power to require information from registrants when investigating their fitness to practise should have this power removed in respect of reflective material.
Finally the report looks at the regulation of healthcare professionals. It makes a number of recommendations for further work to understand inconsistencies in the way that different regulators carry out their fitness to practise functions. It also finds that the General Medical Council’s right to appeal decisions of the Medical Practitioners Tribunal Service has resulted in a lack of confidence in their regulator as well as having an unanticipated impact on the willingness of doctors, especially trainees, to reflect fully on their practice. Since the PSA has a near identical right of appeal to Medical Practitioners Tribunal Service decisions, it is clear that there would be no gap in the law where regulatory action is being taken as a result of a serious criminal conviction, and the report recommends that the GMC’s right of appeal should be removed.
These recommendations aim to support a just and learning culture in healthcare, where professionals are able to raise concerns and reflect openly on their mistakes but where those who are responsible for providing unacceptable standards of care are held to account. This will support improvements in patient safety.
I thank Sir Norman and his panel for their work in delivering this important report. I accept the recommendations in full.
Attachments can be viewed online at: http://www. parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2018-06-11/HCWS751.
[HCWS751]
Breast Cancer Screening
Jeremy Hunt Excerpts(8 years, 1 month ago)
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The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
On 2 May 2018 I informed the House of a serious failing in the national breast screening programme in England, which resulted in thousands of women aged between 68 and 71 not being invited to their final breast screening between 2009 and May 2018. This statement provides an update on the specific commitments I made in my oral statement and the actions we are now taking to support those affected and prevent similar incidents from happening in the future.
First, in my original statement, I committed that the NHS would offer an appointment for screening to all women who missed their scheduled appointment as a result of this error, and that we would provide clear information and advice for anyone with concerns. I asked Public Health England to work with the NHS to contact women who missed their screening by the end of May. I can now confirm that Public Health England met this deadline by 18 May, contacting 195,565 women registered with a GP in England. In addition, all the affected women known to have moved to Scotland, Wales or Northern Ireland were also written to by 1 June 2018.
The result of this is that as of 1 June 2018, 26,774 women have now received an appointment for screening, with hundreds already screened. I am providing detailed information on how many women have been contacted in each English constituency, alongside the confirmation that we have written to all those women now registered with a GP in one of the devolved administrations— 503 women in Scotland, 94 women in Wales and 72 women in Northern Ireland. In addition, a dedicated helpline was established on 2 May 2018 to support women who may have concerns. This helpline operates from 8am to 8pm, 7 days a week, and has received over 46,000 calls.
Secondly, I made clear that no one would face delays to their routine screening as a result of the NHS catching up on these additional appointments. I can confirm that, over the last four weeks, the NHS has put in place an additional 68,000 screening appointments nationally and is on track to ensure that all women affected who want a screen will be seen by the end of October, without impacting on other patients. I want to put on record my enormous gratitude to clinical staff who have worked tirelessly to offer additional appointments and to management teams who have co-ordinated and pooled their resources across different centres, or looked to other private providers, to expand capacity to manage the extra demand.
Thirdly, I explained to the House that we were still attempting to understand how many women had been affected and how many had experienced harm as a result. I made it clear that some of the figures I provided were provisional estimates and undertook to provide a further update. I can now confirm, based on analysis by Public Health England, using data provided by NHS Digital that up to 174,000 women were affected by this issue, of which we know that up to 130,000 are still alive. As a result, the numbers who may have had their lives shortened as a result of missing their screening is now estimated to be fewer than 75. While this figure is lower than the original estimates given in my statement, this does not lessen the devastating impact that this has had on some people’s lives.
Finally, the most important thing we can do in cases of serious error is to ensure there is a robust and thorough process to investigate, understand and learn from what went wrong. In my original statement, I also announced an independent review, chaired by Lynda Thomas, chief executive of Macmillan Cancer Support, and Professor Martin Gore, consultant medical oncologist and professor of cancer medicine at the Royal Marsden with Peter Wyman from the CQC as the Vice Chair. I can now confirm that we have agreed the terms of reference for this review, details of which are attached to this statement. The Chairs are considering how best to involve affected women, their families and wider stakeholders and will release information on this when it is available.
Our cancer screening programme is widely recognised as world-leading, but on this occasion a number of women have been let down. It is now clear that this may have resulted in significant harm for a small number of women, while thousands more have faced unnecessary distress and anxiety as they waited to hear if they have been affected. I would like to repeat my wholehearted and unreserved apology to the women affected and their families—and above all reassure them that we are working hard to understand what went wrong and what we need to do to stop similar incidents from happening in the future.
[HCWS731]
NHS Outsourcing and Privatisation
Jeremy Hunt Excerpts(8 years, 2 months ago)
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The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I welcome the opportunity of this debate to dispel some particularly pernicious myths.
May I say how much I enjoyed the shadow Health Secretary’s speech? If they had listened to his denunciation of privatisation and outsourcing, I think my children would have said that Alice in Wonderland has nothing on the Labour party when it comes to taking totally contradictory positions on an identical issue. My favourite thing was the stirring way in which he said, “What concerns me most is contracts handed out that are poor value for taxpayers,” after his Government left £80 billion-worth of PFI contracts for the NHS to pick up the pieces. That costs the NHS £2 billion every year—money that cannot be used for good patient care. He had lots of other gems and we will return to them during the course of this speech.
I want to start with the motion. I am afraid that it is a transparent attempt to set hares running about NHS privatisation that is not happening. He used the phrase “creeping toxic privatisation”, but the truth is that we know it is not happening and the Opposition know it is not happening. With all the pressures facing the NHS today, to scare staff and the public with fake news is breathtakingly irresponsible.
In the motion, the Opposition use the Humble Address mechanism to ask for the release of documents, knowing full well that it will fuel wild conspiracy theories if we refuse to release those documents, as we must for reasons that are nothing to do with the NHS, but to do with good governance. However, there is a flaw in their Machiavellian logic. When I asked officials for advice on what submissions we as Ministers hold on privatisation—this great swathe of secret plans that the Opposition constantly allege—this is the written advice that I got back: “Officials have, since the Humble Address was received, sought to find submissions about the privatisation of clinical or patient services within the period specified, but to this point none have been identified. Her Majesty’s Government has no plans to privatise the NHS.” That was the official advice, but don’t take it from me. The respected King’s Fund said in 2015 that
“claims of widespread privatisation are exaggerated.”
Another way in which the Labour party loves to try to scare the public is to deliberately muddle up privatisation and outsourcing, which of course are quite separate. I think the shadow Health Secretary knows that, going by some of his comments. What are the facts on outsourcing? The Prime Minister did indeed wax lyrical about the possibility of 40% of acute operations in the private sector being done under the NHS banner—not this Prime Minister, but Tony Blair in 2006. Had we followed Tony Blair’s advice, we would be spending nearly £2 billion more on outsourcing than we currently spend. The Secretary of State from that period also said quite openly, “We intend to use the private sector when it can bring expertise or resources to help improve services.” That is not me, but Alan Milburn in 2002.
And boy, did team Labour set about that outsourcing with enthusiasm: not just increasing the PFIs we have talked about and not just giving the first contract for an NHS acute hospital to the private sector in 2009—that was Andy Burnham—but increasing the amount spent on outsourcing by 50% in the last four years of that Government. [Interruption.] Fifty per cent. These are the facts. I know the hon. Member for Dewsbury (Paula Sherriff) wants to do the fake news and the scare stories, but let us just listen to the facts. Let us talk about what has been happening under this Government. In my first year as Health Secretary, the proportion going to the independent sector went up by 0.6%. In the second year it was 1.2%, in the third year it was 0.4% and last year it was 0%.
I need to correct the record. During Prime Minister’s questions, I hurriedly passed the Prime Minister a note about the increase in Wales in the use of the independent sector. She said at the Dispatch Box that in Wales it had gone up last year by 0.8%. I need to correct that, because in fact it went up by 1.2%—50% more than I thought. Wales, where Labour is in government, is racing ahead. In fact, in pounds spent, the use of the independent sector last year in Wales went up by a third. What that shows is not just that these allegations are nonsense, but that Labour knows they are nonsense. If there was any truth to them they would not be increasing outsourcing in Wales by one third at the same time as branding it as verging on the criminal in England. With the huge pressures facing the NHS and immense efforts by frontline staff to cope with flu, winter and an ageing population, can the Labour party really be trusted with the NHS when it spends its time putting out fake news?
Unlike Labour, we do not believe that the NHS should close its ears to innovation in other sectors or other countries. We want the NHS to be the best in the world and there are things to learn from others that will help patients and help the NHS. Sometimes those innovations will even come—dare I say it?—from America. But to copy global best practice from one small part of what is happening in America does not mean that we want to copy its system itself, which I think, and I think most people in this House think, is an affront to that great country, with poor outcomes, lack of coverage and high cost.
To stop ideology trumping the needs of patients, the Conservative-led Government in 2012 legislated to stop politicians choosing whether to boost the private or the public sector, formally and legally giving that decision to clinicians who run clinical commissioning groups. I will tell the House why we did that. What would happen if we followed what the shadow Chancellor advocated last year, when he said
“we will reverse Tory privatisation by renationalising the NHS”
is that 120,000 people would have to wait longer for operations on their hips, knees and for other elective surgery. The price of Labour ideology, putting ideology before patients, would be nearly 200 people waiting longer in every constituency in this House.
Julian Knight (Solihull) (Con)
The Secretary of State touches on a point that is very pertinent in my constituency. I met a former police officer who had an NHS operation on his hip. The operation went wrong, so the local NHS trust paid privately for the officer to have the operation done correctly. Does that not show that at times it can be a very good thing to involve the private sector? The key is that the NHS is free at the point of need.
Karin Smyth (Bristol South) (Lab)
I am listening carefully to the Secretary of State’s comments on ideology and the Health and Social Care Act 2012. He will remember that I, in a CCG, was implementing the 2012 Act. Is he saying that he is proud of the Act and that it has worked out as intended?
Mr Hunt
As Chinese Premier Zhou Enlai said about the French revolution, it is too early to tell.
As my hon. Friend the Member for Solihull (Julian Knight) alluded to, there is one ideology that we will not compromise on: our belief that the NHS should be free at the point of use and available to all. And why will we not compromise on this? It is because, contrary to Labour’s creation myth about the NHS, it was a Conservative Health Minister, Sir Henry Willink, who first proposed it in 1944. Here are his words from 1944 announcing the setting up of the NHS:
“Whatever your income, if you want to use the service…there’ll be no charge for treatment. The National Health Service will include”—
[Interruption.] I know this is difficult for Labour Members, but let me tell them what the Conservatives said when we were setting up the NHS:
“The National Health Service will include family doctors”
and will
“cover any medicines you may need, specialist advice, and of course hospital treatment whatever the illness”.
Nye Bevan deserves great credit for delivering that Conservative dream, but let us be clear today that no party has a monopoly on compassion, and no party has a monopoly on our NHS. There are some other myths—
Jonathan Ashworth
I really do think the Secretary of State has some brass neck. The Tory party voted against the creation of the NHS 20-odd times. That is the reality of what happened in 1948, including on Third Reading in this House. It is a Labour creation.
Mr Hunt
As the shadow Health Secretary knows perfectly well, the way that this House works is that Oppositions often vote against the Government when they disagree with elements of a Bill, but that does not mean that they disagree with the principles of the Bill. I remember the hon. Gentleman’s party voting against the Care Act 2014. That does not mean that they disagreed with the principles behind it.
Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)
The circumstances around the recent collapse of Carillion have left Liverpool with an unfinished hospital. Negotiations with a potential new contractor are under way but may require ministerial involvement because of the involvement of other Departments. Will the Secretary of State give me an absolute assurance that he will do whatever he can within his power to ensure that that new hospital is completed as soon as possible?
Mr Hunt
I can give the hon. Lady that assurance. I am most grateful to her for raising that issue and reassure her that my hon. Friend the Minister of State responsible for hospitals was at the hospital on Friday, going into detail about how we make sure that there are no delays on that issue.
Jamie Stone
I thank the Secretary of State for giving way. On the issue of freedom of access and equality of access, would he at least concede that where there are issues of distance, rurality and remoteness of location, that is a challenge—although health is devolved to the Scottish Parliament—which means that it is not quite as free for some of my constituents as it is for people who live in Glasgow, Edinburgh or London?
Mr Hunt
The hon. Gentleman makes a fair point, which would be echoed by many Government Members who represent rural constituencies. There is a balance to be struck between the benefits of specialist surgery, where greater volumes of a particular procedure are done, leading to better outcomes for patients, and the trade-off that we make with travel times. I know that that is something that the local NHS, in all parts of the UK, thinks through very carefully.
There is another myth we always get from the Labour party that I think it is very important to dispel: the narrative about the NHS being in total decline. Let us be clear about the pressures facing the NHS. We had to deal with the financial crisis of 2008, which left this country’s coffers empty. We have had to deal with the fact that over the last seven years, we have had half a million more over-75s. We had to deal with a crisis of care at Mid Staffs, which turned out to be a problem affecting many other parts of the NHS.
Yes, it is true that we are missing some important targets at the moment, but let us not forget the extraordinary things that have been achieved despite that pressure, such as for cancer. We inherited some of the lowest cancer survival rates in western Europe. In 2010, only 10% of patients got intensity-modulated radiotherapy; that figure is now 44%. We have two new proton beam therapy machines—at the Christie and University College London Hospitals—and there are 7,000 people alive today who would not be had we stayed with the cancer survival rates of 2010. Every day, 168 more people start cancer treatment than did in 2010. This is a huge step forward.
On mental health, previously we had no national talking therapy service for people with anxiety and depression; today, 1,500 more people are starting or benefiting from talking therapy services every single day, and we have huge plans to extend mental health provision to 1 million more people.
Mr Hunt
No, I do not think it acceptable at all, but I would ask the hon. Lady to bear it in mind that we have 2,000 more paramedics than we did in 2010 and that we have invested in a huge amount of capital equipment for the ambulance services. Of course we need to do more, but, when she talks about A&E, she should recognise the achievements of many hospitals, including her own. Every day across the NHS—even over this difficult winter—2,500 more people are seen within four hours than were in 2010.
Labour seems to think that quality problems in the NHS started in 2010. I should point out that because of what we have done to deal with the problems of Mid Staffs, which happened on Labour’s watch, including through the new Care Quality Commission regime, 2.1 million more patients every year benefit from good or outstanding hospitals than did five years ago. A couple of weeks ago for the first time the majority of hospitals in the NHS were good or outstanding, which is a huge step forward and a huge tribute to NHS staff. That might be just one reason the Commonwealth Fund last year said that the NHS was the best healthcare system in the world. When Labour was in office, it was not even the best in Europe.
There is another reason to oppose the motion. It has nothing to do with health policy, but is a much bigger point of principle. After more than five years in this role, the one thing I have learned is that good policy can be made only through frank and open discussion between Ministers and officials. It will not surprise the House to know that Ministers are human, we make multiple mistakes—not me of course—and it is critical that the Secretary of State in charge of the largest health system in the world can get honest, high-quality advice, but the motion would fundamentally undermine that.
This is not a party political point. Many Labour Members have benefitted from such advice, and all of us would want Ministers of any party in power to benefit from such advice, regardless of whether we support the Government, yet the motion asks us to release not just that written advice from officials, which would have an enormous chilling effect, but notes of confidential discussions between Ministers and officials. In short, as my right hon. Friend the Member for Aylesbury (Mr Lidington) said only last week, it would undermine the safe space within which Ministers and civil servants consider all the options and weigh up the best approach. Officials must be able to give advice to Ministers in confidence. The candour of all involved would be seriously affected if there were any fear of those discussions being disclosed.
No Government of any party have ever operated in an environment where advice is sought one week and made public the next. Let us look back to what Andy Burnham said in 2007 when he as a Minister was asked to release information. His words were:
“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1191.]
Far from increasing the accountability of the Executive to the legislature, releasing such information would risk weakening it, as more and more discussions would end up taking place informally with no minutes taken at all.
Alex Chalk (Cheltenham) (Con)
Does my right hon. Friend agree that it would be completely inconsistent with the Freedom of Information Act—passed, by the way, by a Labour Government—which deliberately carved out an exemption for precisely these sorts of communications? It would be very odd—in fact, completely counterproductive—to turn that on its head.
Mr Hunt
My hon. Friend speaks extremely wisely. He is right: it would fundamentally weaken the ability of the Executive—which the Freedom of Information Act tried to protect—to make considered, thoughtful and wise decisions. Ultimately, that would put at risk the credibility of our democracy itself.
I think it fair to say that, despite my many faults as Health Secretary, I have pursued transparency in the NHS with greater vigour than has been the case previously. I passionately believe that in this House we must be accountable for the outcomes of all the decisions that we make, but all of us are mortal—all of us make mistakes—so if accountability is the watchword after a decision is made, thoughtfulness must be the watchword before it is made. Any measures that affect the honesty and frankness of the advice that Ministers receive would fundamentally reduce that thoughtfulness and reduce the effectiveness of our Government for the people whom they serve.
For those reasons—as well as because of all the ridiculous myths about the millions and privatisation—I have absolutely no hesitation in asking my right hon. and hon. Friends to vigorously and thoroughly oppose the motion.
Several hon. Members rose—
Oral Answers to Questions
Jeremy Hunt Excerpts(8 years, 2 months ago)
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Mike Gapes (Ilford South) (Lab/Co-op)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
The health and social care systems are inextricably linked, which is why we need to improve access to the social care system, and we will be setting out plans to do so in a Green Paper.
Mike Gapes
Age UK says that 1.2 million older people have unmet social care needs. Is it not time that we thought about integration in a practical way, and where we have acute hospitals with land next to them, such as King George Hospital in my constituency, we start to build sheltered accommodation or intermediate care on those sites so that people can easily be transferred into and out of the beds, freeing them up for other people who need them?
Mr Hunt
That is a wise suggestion, and it is exactly the direction of our thinking in the social care Green Paper, which will have a significant chapter on housing. Integration is not just about integrating health and social care; it is also about other services offered by local authorities. I commend, too, the hon. Gentleman’s local authority of Redbridge: it is No. 1 in the country for user satisfaction with the social care system and No. 4 for carer satisfaction.
Dr Sarah Wollaston (Totnes) (Con)
One of the most pressing issues for those who depend on social care is resolution of the back-pay issue for sleep-in shifts. Will the Secretary of State update the House with his own estimate of the liability? The independent sector puts this liability collectively at around £400 million. Will he also update us on the progress being made, because he will know that many sectors are handing back their contracts and withdrawing?
Mr Hunt
I thank my hon. Friend for raising this serious issue, and I can reassure her that a lot of work has been going on inside the Government to work out how to resolve the issue. A court case is due that may have a material impact on those numbers, but we are continuing to work very hard and fully understand the fragility of the current market situation.
Laura Smith (Crewe and Nantwich) (Lab)
In December, the health survey for England revealed that older people in more deprived areas are twice as likely as average to have unmet social care needs. Is this not yet another example of Tory cuts reducing councils’ abilities to meet the requirements of people with care needs?
Mr Hunt
I welcome the question, but let me also gently tell the hon. Lady what the actual story is with respect to cuts. Yes, the social care budget was cut after the 2008 financial recession, but she may remember that a different party was in power when that happened. Under this Prime Minister, those cuts have been reversed and the social care budget is going up by £9.4 billion in this spending review period.
Julia Lopez (Hornchurch and Upminster) (Con)
Inadequate social and primary care provision lies at the root of a great deal of pressure on hospital A&Es, so we need to plan much better for the demand for services at that level. Will the Secretary of State press the Treasury to ensure that receipts from NHS property transactions are retained by local healthcare trusts, so that they can build much larger primary care facilities than those currently planned?
Mr Hunt
My hon. Friend makes an important point: unless we make it easier for trusts to retain the receipts of property transactions, they will be likely to sit on these properties and we will not get the positive ideas such as that suggested earlier by the hon. Member for Ilford South (Mike Gapes), so we do need to find a way to make sure that local areas benefit when they do these deals.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Alzheimer’s Society estimates that at least 10,000 people with dementia have been stuck in hospital in the last year despite being ready to leave, and many of the delays were caused by a lack of care in the community for them. There can be no more disorientating thing for a person with dementia than being stuck in hospital when they do not need to be there. So with dementia awareness week approaching, is it not time for the Secretary of State to meet the social care needs of people with dementia fully by meeting the funding gap for social care in this Parliament?
Mr Hunt
Let me explain what is happening on that front. In the first five years after 2010, social care funding went down by 1.3% a year—we had a terrible financial crisis that we were trying to deal with—but since then, in the current spending review period, it is going up by 2.2% a year, which is an 8% real-terms increase over this spending review period. I completely agree with the hon. Lady that we need to do a much better job. [Interruption.] Opposition Members talk from a sedentary position about priorities; our priority has been to get this economy on its feet so that we can put more money into the NHS and social care system, and that is what will continue to happen under a Conservative Government.
Tom Tugendhat (Tonbridge and Malling) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
We want all NHS patients to be able to access appointments in the evenings and at weekends. Thanks to our programme, 40% of the population currently do so, and that will rise to 100% next October.
Tom Tugendhat
Forgive me for rushing in; I was tied up with Committee matters.
My right hon. Friend has set out a great vision for the national health service over recent years, and I very much welcome it, but does he agree that, in local areas, some of the GP provision could do with a little more work? I am particularly thinking of West Malling in my own constituency where a large element of the community is finding it harder to get access, and there is a danger that the GP surgery may leave the high street.
Mr Hunt
My hon. Friend is right to draw attention to that issue. He does have, I think, 28 more GPs in the west Kent clinical commissioning group area than in 2010, but there is a particular issue over premises. The need to invest in premises is deterring younger GPs from becoming partners, and sometimes making GP surgeries unviable. We are looking at that problem now.
Mrs Madeleine Moon (Bridgend) (Lab)
So many GP practices—no matter what salaries or what terms and conditions they offer—are reporting a reluctance by newly qualified GPs to go into GP practice. What will the Minister do about the hours of work—the time given to consult with constituents—to make it easier for people to see GP practice as a viable opportunity to serve their community?
Mr Hunt
I do very much agree with the hon. Lady, which is why we are working hard to recruit 5,000 extra GPs into general practice in England. I gently point out to her that the Royal College of General Practitioners says that, while we spend 9.2% of the NHS budget in England on general practice, it is only 7.3% in Wales.
David Tredinnick (Bosworth) (Con)
Has my right hon. Friend had time to consider the recent Professional Standards Authority report, “Untapped Resources”, of which the principal recommendation is that practitioners on PSA-accredited registers should have powers to make direct NHS referrals, which would reduce the burden on GP surgeries?
Helen Jones (Warrington North) (Lab)
The Secretary of State knows—because I keep telling him—that Warrington has fewer GPs than its population warrants. What concrete steps will he take to attract GPs to areas that are under-doctored?
Mr Hunt
Most parts of the country would say that they need more GPs, which is why we are trying to improve the capacity across the country. So, what have we done? Well, very recently we announced six new medical schools, which will have a specific focus on attracting new students into general practice. That is one of a number of measures.
Neil Gray (Airdrie and Shotts) (SNP)
Victoria Prentis (Banbury) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
Childhood obesity is one of the biggest public health challenges we face, which is why we are committed to reducing the sugar in products consumed by children by 20% over four years.
Victoria Prentis
I recently met my constituent, Professor John Wass, at an Obesity Health Alliance tea, where—the Secretary of State will be pleased to know—no cake was served. Professor Wass shares my concerns about the availability of hospital services for those with established obesity. Will my right hon. Friend set out what plans his Department has to treat those who are already obese?
Mr Hunt
We recognise the value of bariatric surgery, which is of course subject to the normal waiting time standards for those for whom it is appropriate. However, prevention is better than cure. That is why we are hoping to bring forward shortly further measures to tackle childhood obesity, which is one of our biggest concerns.
Rachael Maskell (York Central) (Lab/Co-op)
Obesity- related hospital admissions in York have more than doubled in the last three years. As part of NHS70, we in York are launching a city-wide public health initiative to ensure that we address issues around obesity, diet and exercise. Will the Secretary of State support such work and ensure that we get the funding that we need to run this initiative for the whole constituency and the city?
Mr Hunt
I am happy to give the project my wholehearted support. If we are going to tackle obesity, we need an approach that goes across all Departments of Government, including local government, and this initiative sounds excellent. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), will be looking into the funding.
Kevin Hollinrake (Thirsk and Malton) (Con)
Lambert Hospital in Thirsk was bequeathed to the town by Sara Lambert in 1890, and was closed via the back door by South Tees Hospitals NHS Foundation Trust last year. NHS Property Services is planning a sell-off to the highest bidder, despite the fair offer that is on the table from the local authority which could include provision for community use such as public health advice. Does my right hon. Friend agree that there are times when value to the public might outweigh the requirement to maximise a price?
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
This August marks two years since the world’s first childhood obesity plan was published, but the Government’s plan, at just 13 pages, left a lot to be desired. More than 5.5 million children in this country are now officially classed as overweight or obese, with 140,000 classed as morbidly obese, as the hon. Member for South West Bedfordshire (Andrew Selous) mentioned. This is now an epidemic. Will the Secretary of State confirm whether the Government’s second childhood obesity plan—due this summer, we have heard—will include meaningful policies such as restricting junk food advertising and the sale of energy drinks to children?
Mr Hunt
I agree with the hon. Lady that we need to do more, because this is a very serious issue. I think that she is being slightly unfair on our first initiative. The sugary drinks tax has been responsible for 45 million kg of sugar being removed from the market, which is enormously important for children. There is more to be done and I hope that we will be able to announce plans soon.
Tom Pursglove (Corby) (Con)
The Daily Mile initiative in schools has huge potential in reducing childhood obesity, improving academic attainment, and improving the mental wellbeing of our young people. Will my right hon. Friend look closely at that and have conversations across Government about the benefits it could bring?
Liz McInnes (Heywood and Middleton) (Lab)
In tackling childhood obesity, will the Health Secretary declare his support for Jamie Oliver’s AdEnough campaign and get rid of pre-watershed television advertising of junk food to our children?
Kate Green (Stretford and Urmston) (Lab)
James Morris (Halesowen and Rowley Regis) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
We are worried about the effects of social media on children and young people, which is why we have asked the chief medical officer to undertake a systematic review of all the international literature, to help us understand what further steps to take.
James Morris
I recently met a group of headteachers in Halesowen, who expressed real concern about the effects of social media on the health of their pupils. Does the Secretary of State agree that peer-to-peer support among young people in the classroom and in our communities is a vital way of benefiting young people through the positive aspects of social media and combating the negative effects on their mental health?
Helen Goodman (Bishop Auckland) (Lab)
Durham police tell me that when there is a problem on social media, particularly Facebook, it can take six months between their asking for action and the social media company tackling it. Will the Secretary of State speak to the Home Office to get the system changed and speed it up?
Kevin Foster (Torbay) (Con)
Does the Secretary of State agree that some of this is about ensuring that parents use appropriate techniques—for example, having specific screen times and engaging with their children about what they see on social media—and giving them the tools to do so?
Lucy Powell (Manchester Central) (Lab/Co-op)
Speak to any young person about what is causing child mental health issues, and the No. 1 issue is not social media, but exam and test pressure in schools, as we have found in the joint inquiry by the Health and Education Committees. Will the Secretary of State be as harsh on his colleagues in the Department for Education as he is on the social media companies when it comes to child mental health?
Mr Hunt
What we actually now have is a record number of children in good or outstanding schools—nearly 2 million more children. That is something we all want for our children, but when it comes to mental health, the NHS has very specific responsibilities, and we of course look into every possible cause.
Anna Turley (Redcar) (Lab/Co-op)
Ian Murray (Edinburgh South) (Lab)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I would like to give an update on the breast cancer screening failure. I met the Public Health England chief executive this afternoon, and I am informed that 65,000 letters were sent out last week, and the helpline has taken nearly 14,000 calls to date. Further letters are going out this week, and the first invitations to catch-up screenings will go out next week. Due to the lack of clinical consensus about the effectiveness of screening for older women, we will provide advice and support for all who missed scans and support them in making their own decision as to whether to proceed. We will also publish the terms of reference for the independent inquiry shortly, and I can assure the House that no stone will be left unturned in uncovering the truth.
Ian Murray
I am grateful to the Secretary of State for that update, but I would like to ask him about the Brexit transition agreement, which cuts the UK out of the European Medicines Agency. Can he give this House a cast-iron guarantee that that will not stop the regulation of new drugs in the UK to help patients, and will not prevent our world-class pharmaceutical companies from basing themselves here to do world-class research and development?
Robert Halfon (Harlow) (Con)
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for his update on breast cancer screening. I welcome his letter this morning with respect to patient safety in the private sector, but is not the truth that the best quality of care is provided by a public national health service? Is it not time to legislate to ensure that private hospitals improve their patient safety standards, and if he accepts that levels of safety are not acceptable in the private sector, why is the NHS still referring patients to the unsafe private sector? Should there not be a moratorium on those referrals until these issues are sorted out?
Mr Hunt
The hon. Gentleman should be very careful in making generalisations about the independent sector, just as he is about the NHS sector, because the truth is that there is too much poor care in both sectors, but both sectors also have outstanding care. I have always said that there will be no special favours for the independent sector, which we will hold to the same high standard of care, through the Care Quality Commission regime, as we do with NHS hospitals. Let me just say to him that if we stopped referring people to the independent sector, 140,000 people would wait longer for their operations, and that is not good care.
Jonathan Ashworth
We have seen the private sector fail—the NHS is sued by Virgin Care, patient transport contracts have to come back in-house, and Carillion collapses and cleaning contracts have to come back in-house—and now we learn that the hotline for women affected by the breast cancer screening failures is provided by Serco and staffed by call handlers who, far from having medical or counselling training, have had one hour’s training. Do not the women affected deserve better than that? Will the Secretary of State provide the resources for that phone line to be brought back in-house and staffed by medical professionals?
Mr Hunt
I normally have so much respect for the hon. Gentleman, but I think those women deserve a lot better than that posturing. The helpline was set up at very short notice because, obviously, the call handlers could not do all their training until I had made a statement to Parliament, which I judged was the most important thing to do first. It is not the only help that the women affected will be getting—on the basis of the advice received, they will be referred back for help at their local hospital, with Macmillan Cancer Support or through specialist clinicians at Public Health England—but we thought it was right that that number was made available as quickly as possible.
Several hon. Members rose—
Stella Creasy (Walthamstow) (Lab/Co-op)
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Dispensing practices are a lifeline in rural constituencies such as Sleaford and North Hykeham. Does my right hon. Friend agree that patients who live far from a pharmacy and attend their local dispensing practice should all have access to that dispensing service?
Alan Mak (Havant) (Con)
Healthcare delivered by app and other new technologies is increasingly popular with patients. Will my right hon. Friend undertake to ensure that the NHS fully explores the possibilities of new technologies when delivering front-line services?
John Grogan (Keighley) (Lab)
Paul Masterton (East Renfrewshire) (Con)
My constituent Susan is desperately waiting for the Government to bring forward the remedial order for single parent surrogates. The Joint Committee on Human Rights published its response to the original draft in March. Is there any update on when we will get the next version?
Jeremy Lefroy (Stafford) (Con)
Five years on from the Francis report, how does my right hon. Friend assess patient safety in the NHS?
Mr Hunt
There are still many things to tackle when it comes to patient safety, but I think the NHS has risen magnificently to the challenges in the report. There are nearly 45,000 more doctors and nurses across the system. Although there is more to be done, much credit should go to the NHS.
Lisa Nandy (Wigan) (Lab)
This week marks two and a half months since the independent inquiry into child sexual abuse recommended that compensation be paid urgently to children sent abroad by their Government and subjected to the most appalling child abuse. In that time, the Secretary of State’s Department, despite repeated requests for action, has made not a single statement. Many former child migrants have died and others are dying. How many more will have to wait, and die waiting, for justice before this Government get their act together and pay them the compensation that is owed?
Hilary Benn (Leeds Central) (Lab)
The European health insurance card enables British citizens to get medical treatment in the EU, including kidney patients who need dialysis. Without it, many of them simply could not go on holiday at all. Will the Secretary of State tell the House whether it remains the Government’s objective to keep the EHIC in place after we have left the EU, and, if so, what progress is being made to ensure that that happens?
Mr Hunt
It is absolutely our intention. We think it is beneficial for Brits and beneficial for Europeans. We are very confident that we will be able to negotiate reciprocal healthcare arrangements to protect those benefits, but our first preference would be a continuation of the current scheme.
Bim Afolami (Hitchin and Harpenden) (Con)
Will the Minister explain how and when the community pharmacy sector will gain access to the pharmacy integration fund? Millions have been promised. When will it be delivered?
Dr Sarah Wollaston (Totnes) (Con)
Thank you, Mr Speaker. Will the Secretary of State commit to publishing the progress report on sugar reduction and the next steps strategy on the reformulation programme, so that the Health Committee can examine that when Public Health England appears before us on 22 May?
Breast Cancer Screening
Jeremy Hunt Excerpts(8 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I wish to inform the House of a serious failure that has come to light in the national breast screening programme in England.
The NHS breast screening programme is overseen by Public Health England and is one of the most comprehensive in the world. It screens 2 million people every year, with women between the ages of 50 and 70 receiving a screen every three years up to their 71st birthday. However, earlier this year PHE analysis of trial data from the service found that there was a computer algorithm failure dating back to 2009. The latest estimates I have received from PHE is that, as a result, between 2009 and the start of 2018, an estimated 450,000 women aged between 68 and 71 were not invited to their final breast screening.
At this stage, it is unclear whether any delay in diagnosis will have resulted in any avoidable harm or death, and that is one of the reasons I am ordering an independent review to establish the clinical impact. Our current best estimate—which comes with caveats, as it is based on statistical modelling rather than on patient reviews, and because there is currently no clinical consensus about the benefits of screening for this age group—is that there may be between 135 and 270 women who have had their lives shortened as a result. I am advised that it is unlikely to be more than this range and may be considerably less. However, tragically, there are likely to be some people in this group who would have been alive today if the failure had not happened.
The issue came to light because an upgrade to the breast screening invitation IT system provided improved data to local services on the actual ages of the women receiving screening invitations. This highlighted that some women on the AgeX trial, set up to examine whether women up to the age of 73 could benefit from screening, were not receiving an invitation to their final screen as a 70-year-old. Further analysis of the data quantified the problem and has found a number of linked causes, including issues with the system’s IT and how age parameters are programmed into it. The investigation also found variations in how local services send out invitations to women in different parts of the country.
The existence of a potential issue was brought to the attention of the Department of Health and Social Care by Public Health England in January, although at that stage, its advice was that the risk to patients was limited. Following that, an urgent clinical evaluation took place to determine the extent of harm and the remedial measures necessary. Public Health England escalated the matter to Ministers in March, with clear clinical advice that the matter should not be made public. This was to ensure that a plan could be put in place that ensured any remedies did not overwhelm the existing screening programme and was able to offer proper support for affected patients.
I am now taking the earliest opportunity to update the House on all the remedial measures that have been put in place, which are as follows. First, urgent remedial work to stop the failure continuing has now been completed according to the chief executive of Public Health England. This was finished by 1 April and PHE is clear that the issue is not now affecting any women going forward.
Of the estimated 450,000 women who missed invitations to a scan, 309,000 are estimated to still be alive. Our intention is to contact all those living within the United Kingdom who are registered with a GP before the end of May, with the first 65,000 letters going out this week. Following independent expert clinical advice, the letters will inform all those under 72 that they will automatically be sent an invitation to a catch-up screening. Those aged 72 and over will be given access to a helpline through which they can get clinical advice to help them decide whether a screening is appropriate for their particular situation. This is because for older women, there is a significant risk that screening will pick up non-threatening cancers that may lead to unnecessary and harmful tests and treatment. However, this is an individual choice and in all cases, the wishes of the patients affected will be followed. By sending all the letters to UK residents registered with a GP by the end of May, we hope to reassure anyone who does not receive a letter this month that they are not likely to have been affected.
It is a major priority to do our very best to make sure that the additional scans do not cause any delays in the regular breast screening programme for those under 71, so NHS England has taken major steps to expand the capacity of screening services, and has today confirmed that all women affected who wish to be screened will receive an appointment within the next six months. Of course, we intend the vast majority to be much sooner than that.
We have held helpful discussions with the devolved Administrations to alert them to the issue. Scotland uses a different IT system, and while the systems in Wales and Northern Ireland are similar, neither believe they are affected. However, we are discussing with each of them the best way to reach women who have moved to another part of the UK during this period. This is obviously more complicated, but we are confident that those affected will still be contacted by the end of May.
In addition, and as soon as possible, we will make our best endeavours to contact the appropriate next of kin of those we believe missed a scan and have subsequently died of breast cancer. As well as apologising to the families affected, we would wish to offer any further advice they might find helpful, including the process by which we can establish whether the missed scan is a likely cause of death and compensation is therefore payable. We recognise that this will be incredibly distressing for some families, and we will approach the issue as sensitively as possible.
Irrespective of when the incident started, the fact is that for many years, oversight of our screening programme has not been good enough. Many families will be deeply disturbed by these revelations, not least because there will be some people who receive a letter having had a recent diagnosis of breast cancer. We must also recognise that there may be some who receive a letter having had a recent terminal diagnosis. For them and others, it is incredibly upsetting to know that you did not receive an invitation for screening at the correct time, and totally devastating to hear you may have lost or be about to lose a loved one because of administrative incompetence. So on behalf of the Government, Public Health England and the NHS, I apologise wholeheartedly and unreservedly for the suffering caused. But words alone are not enough. We also need to get to the bottom of precisely how many people were affected, why it actually happened and most importantly, how we can prevent it ever happening again.
Many in this House will also have legitimate questions that need answering: why did the algorithm failure occur in the first place, and how can we guarantee it does not happen again? Why did quality assurance processes not pick up the problem over a decade or more? Were there any warnings, written or otherwise, which should have been heeded earlier? Was the issue escalated to Ministers at the appropriate time? What are the broader patient safety lessons for screening IT systems?
I am therefore commissioning an independent review of the NHS breast screening programme to look at these and other issues, including its processes, IT systems and further changes and improvements that can be made to the system to minimise the risk of any repetition. The review will be chaired by Lynda Thomas, chief executive of Macmillan Cancer Support, and Professor Martin Gore, consultant medical oncologist and professor of cancer medicine at the Royal Mardsen, and is expected to report in six months.
The NHS has made huge progress under Governments of both sides of this House on improving cancer survival rates, which are now at their highest ever. Seven thousand people are alive today who would not have been if mortality rates had remained unchanged from 2010, but this progress makes system failures even more heartbreaking when they happen. Today, everyone in this House will be thinking of families up and down the country who are worried that they may have been affected by this failure. We cannot give all the answers today, but we can commit to take all the necessary steps to give people the information that they need as quickly as possible. Most of all, we want to be able to promise that this will not happen again, so today, the whole House will be united in our resolve to be transparent about what went wrong and to take the necessary actions to learn from the mistakes made. I commend this statement to the House.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for advance sight of his statement and for his personal courtesy in directly briefing me as well. The thoughts of the whole House are with those whose screening was missed and who sadly lost their lives from breast cancer, or who have subsequently developed cancer. Anyone who has had a loved one taken by breast cancer, or indeed any cancer, will know of the great pain and anguish of that loss. I understand that the Secretary of State has referred to estimates, but when the facts are established, will he assure us that each and every case will be looked into sensitively and in a timely manner? Our thoughts also turn to the 450,000 women who were not offered the screening that they should have had, so I welcome the Secretary of State’s commitment to contact the 309,000 women who are estimated to be still alive.
Early detection and treatment are vital to reducing breast cancer mortality rates, which was why the AgeX pilots were established in 2009 and rolled out nationally from late 2010, when the Government expanded the screening programme. Given the problems that Public Health England has identified with its randomisation algorithm for those trials, will the Secretary of State tell us whether any evaluations and assessments of those pilots had been done by the Department before the national roll-out of the programme?
I welcome the Secretary of State’s candour in questioning why this problem was not picked up—eight years is a long time for an error of this magnitude to go undetected. Did the Department receive any warnings in that time? Is there any record of how many women raised concerns that they had not received the appropriate screening? Were there any missed opportunities to correct this mistake? He said graciously that oversight of the screening programme was not good enough. How does he intend to improve that oversight? What other trials are in place across the NHS and is he satisfied with their oversight?
We welcome the establishment of the national inquiry. Will it be hosted and staffed by the Department of Health or another Department? In the interests of transparency, will the Secretary of State place in the Library the Public Health England analysis from this year that identified the problem with the algorithm? Although the parallels are not exact, where the NHS offers bowel cancer screenings for women between the ages of 60 and 74 and cervical cancer screenings for women up to 64, what assurances can he give that the systems supporting those services are running properly, and what checks are being carried out to make sure that nobody misses out on screenings for other cancers?
The Secretary of State says that NHS England will take steps to expand the capacity of screening services. Will he say a little more about that? What extra resources will be made available to help the NHS provide the extra screening now needed? He will know that the NHS faces huge workforce pressures—according to Macmillan, there are more than 400 vacancies in cancer nursing, the Royal College of Radiologists has found that 25% of NHS breast screening programme units are understaffed, and there are vacancies for radiographers too. Will he assure us that the NHS will have the staff to carry out this extra work, and may I gently suggest that, if it needs extra international cancer staff, he ensures that the Home Office does not block their visas?
More broadly, does the Secretary of State share my concerns that screening rates are falling generally? The proportion of women aged 50 to 70 taking up routine breast screening invitations fell to 71.1% last year—the lowest rate in the last decade. There is also a wide regional variation in screening rates. The number of women attending breast screening in England is as low as 55.4% in some areas, and, as the all-party group on breast cancer found, there are stark inequalities in NHS services in England, with women in the worst-affected areas more than twice as likely to die from breast cancer under the age of 75. Beyond the problems identified today, what more are the Government doing to make sure that screening rates rise again so that cancer care for patients is the best it can be?
Finally, many of our constituents over whom breast cancer has cast a shadow will feel anxious and worried tonight. Members on both sides of the House want to see cancer prevented and those who have it fully supported. Transparency and clarity are vital. Will the Secretary of State undertake to keep the House fully informed of developments to offer our constituents the peace of mind they deserve?
Mr Hunt
I thank the hon. Gentleman for his constructive tone, and I want to reassure him that each and every case will be looked at in detail. The sad truth is that we cannot establish whether not being invited to a screen might have been critical for someone without looking at their individual case notes, and in some cases, sadly, establishing a link will mean looking at the medical case notes of someone who has died.
It is important to explain that the reason for these estimates, which are much broader than we would like, is that there is no clinical consensus about the efficacy of breast screening for older women. As I understand it, that is because the incidences of cancers among older women are higher, but a higher proportion of them are not malignant or life-threatening, which makes it particularly difficult. It is also the case that breast cancer treatment has improved dramatically in recent years and so it is less important than it was to pick up breast cancer early. None the less, we believe it will have made a difference to some women, which is why it is such a serious issue.
The evaluations of the AgeX trial, which brought this to light at the start of the year, have been continued by Oxford University throughout the trial period. I am not aware of any evaluations shared with the Department that could have brought this problem to light, but obviously the inquiry will look into that. We need to find ways to improve oversight, and modern IT systems can greatly improve safety and reliability—in fact it was during the upgrading of the IT system that this problem was brought to light.
I will share with the hon. Gentleman the advice the Department received from Public Health England in January, which was the first time we were alerted to the issue, and we will certainly provide any extra resources the NHS needs to undertake additional cancer screening. One of our biggest priorities is that women between the ages of 50 and 70, when the screens are of their highest clinical value, do not find their regular screens delayed by the extra screening we do to put this problem right. He is right that one thing that has come to light is the regional variation in how the programme is operated. It was previously operated by the old primary care trusts, under the supervision of strategic health authorities, and then brought under the remit of Public Health England, but the regional variations have continued for a long time, so this problem will be worse in some parts of the country than in others. I undertake to keep the House fully informed.
Dr Sarah Wollaston (Totnes) (Con)
I thank the Secretary of State for the commitments and actions he has set out. Colleagues across the House will be thinking of the hundreds of thousands of women not called for their final screening test. They now need consistent, high-quality, evidence-based guidance so that they can make an informed choice about whether to take up the offer of screening. There is much material available setting out pictorially and clearly how they can weigh up the risks and benefits. Will he assure the House not only that a helpline will be in place but that it will be backed up with high-quality material available directly to patients and their GPs, many of whom will be directly counselling women following this news?
Mr Hunt
Yes, and I can reassure my hon. Friend that GPs will be briefed and that people will be referred for additional support to clinically trained staff at Macmillan Cancer Support and Breast Cancer Care. We have to be transparent with patients, however, about the absence of a clear clinical consensus on the efficacy of scanning for women in their 70s. The fairest thing is to explain that different people have different views and allow them to come to an individual choice, and that is what we are doing. It will of course cause considerable distress to those given that dilemma, but if anyone wants a scan, we will do that scan.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I thank the Secretary of State for my advance briefing, but, as a breast surgeon and co-chair of the all-party group on breast cancer, I gently take issue with his comment that we do not need to diagnose breast cancer early because of the changes in treatment. I would not like that message to stand: diagnosing early is still crucial.
Obviously this is horrendous for the women involved, but it will also create anxiety for women who are not aware whether they are involved and who might not have been part of the trial. Reassuring them will be a challenge. I welcome the independent review into how it happened and how it went so long without being picked up, and I am interested to know what will happen with the trial now—the loss of almost 500,000 women from it might have a major impact.
Given the normal pick-up rate of breast screening, approximately 2,500 cancers would have been picked up across England in the last round. As the Secretary of State says, this issue did not apply in Scotland, but some of the women affected might have moved and settled in Scotland, so when did he inform the Scottish Government?
The Secretary of State said that the Department knew in January. As far as I can establish, officers in Scotland were informed of a minor issue in March, were told only last week that it was actually more major, and were not told that it might affect women who now live in Scotland. There has clearly been preparation and talk about funding in England, but how many women who live in Scotland have been identified, and what efforts have been made to track them down? What preparations for funding or the expansion of services have been made for Scotland and, indeed, for the other devolved nations?
As was mentioned by the hon. Member for Leicester South (Jonathan Ashworth), radiology, and particularly breast radiology, is a huge shortage specialty. What funds will be provided to ensure that it can be delivered without messing up the normal system?
Will women who do not receive a letter in the next few weeks be able to telephone, or can the Secretary of State really guarantee that if they have not heard by the end of the month, they are clear? As a doctor, I find that a bit scary.
Mr Hunt
The hon. Lady has asked some important questions. I am sorry if what I said was not clear, but I do not think I said that there was no need to diagnose early. It is obviously incredibly important for cancer to be diagnosed as early as possible. What I said was that I had been advised that in many cases, because of advances in breast cancer treatment, it would not make a difference to the particular women affected in this case. I fully accept that in some cases it will, and of course it is very important to diagnose all cancers as early as possible.
I will find out from Oxford University the dates on which it expects to report the full outcome of the AgeX trial. Obviously we all want to hear the results as soon as possible. I will also inform the hon. Lady of the exact date on which Scottish Government officials were informed. Let me reassure her that if there are any additional costs to the Scottish health system, it will of course be recompensed.
We do not think that major pressures will be created in the Scottish screening programme, and we are confident that we will be able to contact everyone in the UK who is registered with a GP—whether in Scotland, Wales, Northern Ireland or England—by the end of May. We have had very productive discussions with Scottish officials about the IT exchange that will be necessary to ensure that women living in Scotland also receive their letters by the end of May. We cannot guarantee that every single one of them will have been contacted by then—some will have moved abroad, and some will not be registered with a GP for whatever reason—but we think that we can contact the vast majority, and the helpline will be open for anyone to call if they think they may have been affected.
Mr Philip Dunne (Ludlow) (Con)
I think that Members on both sides of the House have appreciated the measured way in which my right hon. Friend has come to the House and revealed detailed commitments to helping the women who have suffered as a result of this terrible, unfortunate IT event. I also think that the measured response from the hon. Member for Leicester South (Jonathan Ashworth) properly reflected the concern that everyone shares.
My right hon. Friend referred to additional screening capacity to ensure that there is no impact on other, younger women. What undertakings can he give to any women who have been affected, and who find that they are suffering from a malignant growth in their breast, that they will be able to receive the appropriate treatment as rapidly as possible?
Mr Hunt
I thank my hon. Friend for the work that he did on cancer when he was working at the Department of Health, and for his broader work in supporting the hospital sector. He is absolutely right: additional people will come forward for treatment, so one of the other matters that we have been looking into is our treatment capacity. We certainly intend to ensure that people are treated within the normal short period if a cancer is detected, and the first step in that process is to ensure that everyone has a scan in the next six months. During that period, we will make certain that they are able to look forward to the same rapid treatment that all other people whose cancers are detected can be confident of receiving.
Dr Paul Williams (Stockton South) (Lab)
We have an ethical duty to get screening right, because we are inviting well people into our health service and offering them an intervention. May I ask the Secretary of State whether the uptake of screening by 68 to 71-year-olds during the period concerned was any lower than expected? If it was less than expected, why was that not properly analysed?
Mr Hunt
I do not know the answer to that question, but I will look into it. If we find that the uptake was lower than expected in that age group, it will be a very important clue about something that may have gone wrong, and I am sure that the review panel will want to examine it. The overall uptake rate is about 80%, but I agree with the hon. Gentleman that we should look into what the rates were in specific age cohorts.
Mrs Maria Miller (Basingstoke) (Con)
I thank the Secretary of State for his measured statement, and for all he is doing to ensure that the women affected are given the treatment and support that they need. I particularly welcome his independent review of the NHS screening programme. Will he also be looking at quality assurance programmes more widely within the NHS in relation to screening programmes? It is deeply worrying that the NHS did not identify this error for more than a decade, and there may be a need to review those programmes.
Mr Hunt
I am afraid that my right hon. Friend is absolutely right. The truth is that we do have a quality assurance programme, and it failed to pick up this problem for far too long. We need to understand why that happened. We think that a single IT mistake was made at the very start of the programme, and we understand that sometimes such mistakes are devilishly difficult to identify. None the less, as was suggested by the hon. Member for Stockton South (Dr Williams), there must have been clues that could have been picked up—or so one would think—and we need to get to the bottom of that.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
I think that anyone who listened to the statement will be devastated and appalled to learn about this fatal failure, especially given that the UK’s breast cancer survival rate is below the EU average. The Secretary of State talked about the advice line that might be available to people who had been affected, but has he given any consideration to any emotional or mental health support that should be extended to those people and their families?
Mr Hunt
We are indeed talking to the charities operating in this sector about how we can best provide all kinds of support, including mental health support, as well as clinical guidance. We often talk in the House about the challenges facing the NHS, but it is important to note that breast cancer is an area in which survival rates have been improving, and have actually been catching up with those in other European countries. The NHS deserves great credit for that, despite today’s very serious failing.
Dr Andrew Murrison (South West Wiltshire) (Con)
I commend my right hon. Friend for the way in which he brought this very bad news to the House, and the hon. Member for Leicester South (Jonathan Ashworth) for the way in which he responded to it.
As my right hon. Friend will know, breast cancer is not just about survival nowadays; it is also about quality of life after treatment. Will his contact with those who have been affected extend to those who have been treated, but who may have had to be treated in a more radical way than might have been the case had their cancers been picked up earlier?
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I thank my right hon. Friend for his statement and for the work he is doing to ensure that women who are affected are supported and treated promptly, but what is he doing to ensure that people who are due for cervical and other NHS screening programmes are being properly called, and can he tell women who are affected—and, no doubt, very worried today—what they should do now? Whom should they call, should they be waiting for a letter, and how soon can they expect a scan if they wish to have one?
Mr Hunt
According to the advice that I have received so far, there is no read-across to other screening programmes, but obviously the independent review panel will look into that as it seeks to examine all aspects of the issue. We have made the commitment today that we will invite for scans all those who either should be scanned or should consider whether they wish to have a scan, and will offer them a date before the end of October, although we hope that in the vast majority of cases it will be much sooner than that.
Ann Clwyd (Cynon Valley) (Lab)
What conversations has the Secretary of State had with the Welsh Secretary? Having long since passed the ages he mentioned, I certainly was never invited for a screening; I had to ask for one, and I eventually got the screening in England.
Mr Hunt
We have not had conversations at ministerial level, but we have had conversations at official level. The Welsh Administration do not believe this problem has affected them, even though Wales was using the same IT system we were using in England. Our concern is about people living in England who are registered with a Welsh GP or people living in Wales registered with an English GP. That is why we are having constructive discussions to share IT information and make sure everyone in England or Wales registered with a GP will get that letter.
To respond to the earlier question about what people should do now, anyone is free to call the helpline number, which will be made public today, but we are hoping to get the letters out as quickly as possible over the next four weeks, during the month of May, so that everyone can be pretty confident that they are okay if they have not received one of those letters.
Maria Caulfield (Lewes) (Con)
I welcome the Secretary of State’s announcement today that there will be an independent review; it is important that women have confidence in the screening programme. As someone who worked in breast cancer for over 10 years before being elected, I gently say to women that the screening mammogram is just one tool in the early detection of breast cancer and that if they notice a change in the interval of three years between mammograms they must seek medical advice. Also, not all mammograms pick up breast cancers, so they must not just rely on screening mammograms.
Mr Hunt
I thank my hon. Friend for her excellent advice, which gives me the opportunity to repeat that the advice for women about looking after their breasts and making sure they are alert to potential breast cancer remains unchanged. All women should take great care over this and should always come forward to see their GP or local cancer service if they have any concerns or doubts.
Lisa Nandy (Wigan) (Lab)
I thank the Secretary of State for his statement. There is no other way to describe what has happened than utterly, utterly heart-breaking, and it is hard to imagine what some of the worst affected families will be going through over the next few weeks.
I am grateful to the Secretary of State for his assurance that capacity will be expanded to ensure that women can now access screening, but unless he puts further resources into the system, other people will go to the back of the queue as a consequence. In my region of the north-west, one in five posts are currently vacant, and for far too many women in this country where they live currently determines whether they live or die. So will the Secretary of State put in the additional resources needed to make sure all women can get the screening they need when they need it?
Mr Hunt
I thank the hon. Lady for her comments. We have many other occasions to have a broader discussion about resourcing of the NHS, but I recognise what she says: in the specific situation we are in now, with the people who will need additional scans and additional treatments over and above what the NHS would have otherwise done, we will need to find additional resources to make sure others are not disadvantaged.
Mr Mark Harper (Forest of Dean) (Con)
May I add my words of support to the Secretary of State for the way he has approached this issue, and to Opposition Members for their approach too?
On the scope of the independent review, will it look at other screening programmes? It might be the case that this particular issue is not replicated, but I think people will want assurances about other screening programmes. Also, as the NHS looks to use IT as a powerful way to combat illness and disease, will the Secretary of State make sure that appropriate checks are in place so that there are proper assurances in the system and these kinds of problems do not arise in the future?
Mr Hunt
My right hon. Friend is absolutely right, and I assure him that the review being done by Lynda Thomas, one of the most senior cancer campaigners in the country, and Professor Gore, one of the most senior oncologists in the country, will look at what lessons can be learned for the entire cancer programme, and not just at the specific issue of why this particular IT problem occurred.
Diana Johnson (Kingston upon Hull North) (Lab)
The statement the Secretary of State has made today is truly shocking, and many women and their families will be very worried this afternoon. The Secretary of State said that it is estimated that 309,000 women in this group are still alive and that the first 65,000 letters are going out this week. Why are the letters not going out this afternoon to all 309,000 women? Why are we having to wait until the end of May to put at rest the minds of these women and their families?
Mr Hunt
That is a reasonable question, and I assure the hon. Lady that we are sending these letters out as quickly as we possibly can, but we felt that, even though we are not able to send them all out this afternoon—for example, because we have to reconcile with the clinical databases in Scotland, Wales and Northern Ireland for women who have moved to those areas and that is going to take place later this month—it was important to come to the House as soon as possible, without delay, to inform Members that this was happening. There will be a period of a few weeks during which people will have to wait to see if they get one of the letters, and we fully appreciate that that will cause a lot of worry to the women involved.
Sir Hugo Swire (East Devon) (Con)
This is a good time to pay tribute to all the excellent cancer support charities, counselling services, Maggie’s centres and so forth up and down the country. I am reassured that the Secretary of State has said he will be working with them, but will he commit this afternoon to contacting all these charities proactively and providing them with the resources they need to meet what will obviously be an increased demand over the coming weeks and months?
Derek Twigg (Halton) (Lab)
When did the Secretary of State or the Minister with direct responsibility for screening last ask their officials about the accuracy of the screening programme and the robustness of the checks and assurances in place to ensure it was working properly and efficiently? When, before January this year, did he last ask his officials that?
Mr Hunt
I will have to get back to the hon. Gentleman with a detailed answer to that question. Ministers were informed of this issue in March, and we are responsible, as Ministers, for the effective functioning of that system—in the way all Ministers have responsibility for their various areas—so one of the questions we need to ask is whether the right escalation procedures and checks and balances were in place so that Ministers could be informed if there was likely to be a problem.
Dame Caroline Spelman (Meriden) (Con)
My constituency has many breast cancer sufferers who were victims of the rogue surgeon Mr Paterson, so I thank my right hon. Friend for setting up an inquiry chaired by the Bishop of Norwich, in which victims feel properly listened to, and, most importantly, are being compensated. Will any of the women caught up in this current situation who might have been harmed be eligible for compensation?
Mr Hunt
I thank my right hon. Friend for suggesting the Bishop of Norwich as a good person to help in the Paterson review, and the answer to her question is yes: if, because of a failing by the NHS, harm has happened, people will be eligible for compensation, and we will do all the necessary work to establish whether that is the case.
Nic Dakin (Scunthorpe) (Lab)
Breast cancer screening makes a real difference to outcomes for breast cancer patients by diagnosing early, so I applaud the Secretary of State for saying he will look at ways of improving performance in this area across the country, but what is he going to do to try to make women who have moved out of the UK who might be affected aware of what has happened?
Mr Hunt
We will look at whether we are able to get in contact with people and will get in contact whenever we can, but there is of course a helpline through which anyone can contact us. It is also important to say that, according to the advice I have received, missing the final screening will in many cases not make a difference to a patient’s cancer or the treatment they receive, but we will do everything we can to support everyone who thinks they might have been affected.
Dr Julian Lewis (New Forest East) (Con)
While it will be for the review to investigate and report on why the fault with the algorithm was not discovered earlier, can the Secretary of State throw any more light on the circumstances in which it eventually came to be discovered? He said, for example, that it was in the course of a computer upgrade. Obviously, the circumstances that led to its discovery could be a pointer towards greater safeguards for the future.
Mr Hunt
That is a very good point. The original issue—or the original potential issue—was identified by people working on the AgeX trial for Oxford University, who then brought it to the attention of Public Health England in early January. One of the issues seems to have been the confusion about whether the scans stopped when someone turned 70 or whether they should carry on until their 71st birthday. That is why we think the original coding error happened, but obviously this is a matter for the review, and we need to learn everything from it.
Lady Hermon (North Down) (Ind)
This is a hugely upsetting and serious issue, and I commend the Secretary of State for the great compassion and sensitivity with which he has delivered this very bad news for women throughout the United Kingdom. He mentioned the fact that the Northern Ireland breast screening scheme was slightly different, but he will appreciate that he absolutely must say more to reassure women in Northern Ireland at this time because we have no Health Minister. May we please have more reassurance for women in Northern Ireland?
Alberto Costa (South Leicestershire) (Con)
I also thank the Secretary of State for his measured and sensitive tone in delivering this afternoon’s statement. He mentioned that the figures of 450,000 and 309,000 were estimates. What is not an estimate, however, is that 65,000 letters will be going out at the end of this month. Will he assure us that his team in the Department will write to Members of Parliament to indicate the number of women affected in each constituency, so that we can prepare for the inevitable contacts that constituents will make with us?
Liz McInnes (Heywood and Middleton) (Lab)
I hope that the independent review will investigate this, but is the Secretary of State aware of any instances of GPs inquiring why patients who should have had a final breast screen were not invited to have one?
Mr Hunt
That is a very good question. I am not aware of any such instances, but that is exactly what we want to look at in the review. It does seem strange that people who were expecting to be invited did not come forward, and that their not receiving an invitation did not set any hares running. That is one of the things that we need to look at.
Sir Desmond Swayne (New Forest West) (Con)
How many cancers are detected for every 10,000 screenings, and what is the clinical consensus on the effectiveness of that?
Mr Hunt
My right hon. Friend is testing my clinical knowledge here; there will be other people in the Chamber who are better able to answer that question. I am ready to be corrected by eminent experts on this, but my understanding is that, in relation to women in their 70s, for every 1,000 women there are around 12 cancers, and of those 12 cancers, around three are potentially life-threatening.
Stephen Lloyd (Eastbourne) (LD)
Let us be clear that this is an utterly desperate situation. We know that some women may well have died who might not have done had they been identified. However, I would like to pay tribute to the Secretary of State’s statement. It was transparent, it ’fessed up and it made clear what the Department of Health and Social Care will be doing to remedy the situation. I appreciate that. What will the Department do to raise awareness of breast cancer screening among women who are not currently registered with a GP?
Mr Hunt
That is an important question. We have the Be Clear on Cancer campaign, which is a national advertising campaign but, as my hon. Friend the Member for Lewes (Maria Caulfield) said, it is important for people to recognise that, if we are going to protect them from cancer, they will have to take an active and proactive role in detecting any cancers they might have. Important though the screening service might be, they cannot rely on the screening service, because their own experience of how their own body is functioning is the most important detection method of all.
Andrew Jones (Harrogate and Knaresborough) (Con)
I thank my right hon. Friend for his statement, and for the urgency and sensitivity with which he is treating this issue. Women all over the country will be very anxious at hearing this news. Will he guarantee that all women who did not get invited for their scan will now be guaranteed their screening?
Mr Hunt
We are absolutely guaranteeing that all women affected who are still alive will be invited to have a screening if they want it. Only those under 72 will automatically be sent a date and time for their screening. Those over 72 will be invited to talk to the helpline so that they can form a judgment as to whether a screening is appropriate, but anyone who wants one will get one.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
I should like to thank the Secretary of State for his comprehensive response. Can he advise me how many women who have moved to Scotland might be affected? If not, will he work double time to ensure that those who have been affected and who have moved to Scotland will get their letters timeously within the correct period?
Mr Hunt
I believe that the IT work, which is a collaboration between the Scottish NHS and the English NHS, will be completed in the week of 15 May. That is why we are confident that we will be able to get the letters out to people registered with Scottish GPs who have moved from England by the end of May, which is the same timescale as for getting the letters out to people living in England. We will then know that number, and I will of course let the hon. Lady know.
Michelle Donelan (Chippenham) (Con)
My grandmother died of breast cancer a few years ago, and my heart goes out to all women affected by this fatal IT malfunction. I welcome my right hon. Friend’s assurance that he is going to do everything he possibly can to ensure that this does not happen again. Has any consideration been given to the impact of this on GP surgeries? I expect that, during the next few days while women wait for their letters, they might make appointments with their GPs in anticipation, and in fear.
Mr Hunt
Yes, we are briefing all GP surgeries and all GPs about what the appropriate response is, because we recognise that that might happen. Of course, GPs are there for people to talk to at any time if they have concerns, and some people may choose to do that. We have also set up a specialist helpline that will be open seven days a week from 8 am to 8 pm, where people will be able to get advice straightaway by picking up the phone. We think that that will be the most practical option for most people.
Several hon. Members rose—
Jim Shannon (Strangford) (DUP)
I thank the Secretary of State for his statement and for his compassion and care. Is he aware of any discussions on the continued alignment with the European Medicines Agency’s drug licensing process to ensure that our breast cancer patients, and indeed all cancer patients, have access to the benefits of the European trials and UK citizens are able to participate in clinical trials? This is very important.
Several hon. Members rose—
Huw Merriman (Bexhill and Battle) (Con)
And I am very proud to have been.
The Secretary of State knows well and cares deeply about safety matters. As he also knows, I have spent too much of my time with the clinicians in the cancer centres of Maidstone and Tunbridge Wells. Will the review perhaps look at administrative and back-office resources and at whether they play any part in improving survival rates?
Mr Hunt
The whole House is thinking of my hon. Friend who, like many people in this country, is going through a huge amount of personal pressure as cancer strikes close to home. He is right that back-office systems are often poor when it comes to contacting patients, which is in contrast to the superb clinical care that we are usually able to offer, so we will absolutely consider that as part of the review.
Mr Speaker
I wish the hon. Gentleman well in the period ahead. I was not aware of those personal circumstances, but the whole House will wish his nearest and dearest all the best.
Simon Hoare (North Dorset) (Con)
As I understand it, Public Health England, which is of course operationally independent of Ministers, runs the screening programme, so what assurances have the chair and chief executive of that important organisation given my right hon. Friend that the actions that he has usefully set out today will be completed within the required deadlines to meet the obvious and legitimate demands of patients?
Craig Tracey (North Warwickshire) (Con)
I thank the Secretary of State for his statement. As co-chair of the all-party parliamentary group on breast cancer, I know that his Department takes breast cancer seriously, so the Secretary of State and the ministerial team will no doubt be as disappointed as I am that the statement was necessary today. However, will he set out what the women affected need to do and, importantly, what additional steps can be taken to reassure and support those women?
Mr Hunt
Anyone who has concerns as of today is welcome to call the helpline, but the women whom we know have been affected will be contacted by the end of the month. The first thing that many people will do is take action on receipt of a letter. If they are under 72, the letter will tell them that they will shortly be sent a date for a catch-up scan. If they are over 72, it will tell them how they can get advice as to whether that is appropriate for them.
Kevin Foster (Torbay) (Con)
I welcome the tone of the Secretary of State’s statement, even though its contents will be devastating for many people and families across my constituency. Will he confirm what engagement there will be with groups such as local health watches and support networks to ensure that the information that he has given is relayed to them and their users?
Henry Smith (Crawley) (Con)
As chair of the all-party parliamentary group on blood cancer, I am pleased that the Secretary of State talked about the lessons that will be learned from this breast screening error. Will he assure me that what is picked up will inform future diagnostic programmes?
Jeremy Quin (Horsham) (Con)
Tragically, it seems that the flaws were of long standing—I think the Secretary of State referred to a decade or more. Notwithstanding the length of time that has passed, will he assure the House that lessons will be learned that relate back to the procurement and design decisions that were made at the outset?
Matt Warman (Boston and Skegness) (Con)
I welcome the compassionate tone of the Opposition spokesman and the Secretary of State, and I particularly welcome the fact that he personally said sorry. Will he do all that he can to ensure that faith is restored in such technologies, because they do an awful lot of good when they work?
Mr Hunt
My hon. Friend is absolutely right. One of the most important ways of getting that change in mindset is by giving patients more control. Later this year, we will be offering all NHS patients an app through which they can access their medical record, and that should start to become a way in which people take control of their healthcare destiny, including such things as invitations to screenings for all cancers and many other public health measures.
Mary Robinson (Cheadle) (Con)
While Stockport is one of the best areas for cancer identification, there will be concern that some people may have missed a routine call for screening. Last year, my constituents in Heald Green were particularly affected when their local breast cancer screening provision was relocated to Macclesfield District Hospital, which is over an hour away. As we address the screening issue, does my right hon. Friend agree that we must ensure that breast cancer screening is local and accessible?
Anna Soubry (Broxtowe) (Con)
My friend Emma Agnew, a woman in her own right but also known as “Mrs Aggers” because she is married to the cricket commentator Jonathan Agnew, is one of a remarkable group of women who have faced breast cancer and beaten it, but it must be said that she had huge support from her husband, and our thoughts are also with my hon. Friend the Member for Bexhill and Battle (Huw Merriman). Emma had mammography last February and thought all was good, but she kept on checking her breasts. Screening is wonderful, but she checked her breasts, which was why she knew something was wrong in July. She was immediately diagnosed, she received fantastic treatment on the NHS and she is a survivor. Will the Secretary of State reiterate that we must all keep an eye out for cancer, whatever age we are?
Kevin Hollinrake (Thirsk and Malton) (Con)
I thank my right hon. Friend for his statement and for his tone. This was clearly a failure not only of IT, but of quality assurance, so will he commission a review of quality assurance right across the health service to ensure that it is as effective as it should be?
Mr Hunt
My hon. Friend may well be right that we need to do that, but what I would like to do first is to see the outcome of this review, what the lessons are and what precisely it says about the quality assurance that applied in this case, and then make a judgment about the implications for the rest of the NHS.
Fiona Bruce (Congleton) (Con)
I thank the Secretary of State for the genuine personal concern that he has shown today and for his determination to get to the bottom of the matter. Will he continue to keep the House and, more importantly, the public and any women affected informed as further information comes to light?
Chris Skidmore (Kingswood) (Con)
An additional 200,000 to 300,000 women could be seeking breast cancer screening within the next six months, which works out roughly at an additional 2,000 women a day. What reassurances can the Secretary of State give to the women who were due a screening anyway that their treatment will not be delayed as a result of the additional need?
Mr Hunt
That is an important question. One of our top priorities has been to construct a resolution to the problem that will not have an impact on the regular screening programme for women between the ages of 50 and 70, which is so important. All I can say is that a huge amount of trouble has been taken to try to ensure that we are putting additional capacity into the system to deal with the extra work.
Robert Courts (Witney) (Con)
I also welcome the compassionate tone used by hon. Members on both sides of the House today, and my thoughts are with all those affected. Will the Secretary of State reassure those in west Oxfordshire and beyond who will be concerned that this IT failure may be present in other critical systems that he will do everything possible to ensure that that is not the case?
Cancer Treatment
Jeremy Hunt Excerpts(8 years, 3 months ago)
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James Brokenshire (Old Bexley and Sidcup) (Con)
I am very grateful to the Backbench Business Committee for enabling the House to debate these important issues this afternoon. It is a pleasure to follow the hon. Member for Croydon Central (Sarah Jones), who introduced the debate in such a powerful and effective way.
I do not think that anyone who watched Baroness Tessa Jowell’s speech could have been anything but moved by her powerful and poignant words. I know it moved me, having got to know, like and respect Tessa over many years for her work in Government and in the House, and for the way she is able to bring people together from across politics with a very constructive, focused and tenacious approach just to get things done.
The timing of Tessa’s speech also touched a particular chord with me, coming as it did just a week or so after my own surgery to remove a tumour from my lung. It was a brave, humbling and inspiring speech in equal measure, with her very personal description of her brain tumour and the impact it has had on her, her call to action to secure more funding for brain tumour research, and her stressing the need for more effective clinical trials and the joining up of analysis and data.
But fundamentally, what shone through in Tessa’s words was a profound message of hope—hope for the future; hope in the face of her own physical adversity—and her unstinting passion to secure positive change for the benefit of others. So many debates in this House or in the Lords, while passionate and important, can sometimes appear sterile, perhaps a little arcane, with discussions of statistics, policy or implementation of points of law. Tessa’s speech cut through all that to focus on the human condition: the life well led, what gives it meaning and purpose, and the overriding power of human kindness, compassion and love.
Tessa’s campaign has already made a difference. I warmly welcome the positive response from the Government by the Prime Minister, the Health Secretary and Members across Government to make change happen.
James Brokenshire
Perhaps I can give way to the Health Secretary on that point.
Mr Hunt
I am most grateful to my right hon. Friend. I wonder whether, on behalf of the Prime Minister and the Cabinet, I could follow the shadow Health Secretary in commending Tessa’s campaigning. Most people come to this place hoping to leave a legacy, but she has left not just one legacy, but two—her amazing achievements with London 2012 and her amazing campaigning on cancer. It is our privilege to take part in this debate and our duty to act on what she says.
James Brokenshire
I am extremely grateful to my right hon. Friend for underlining what can and will come out of this debate, which is continued momentum and a sense of purpose to bring about real change. Like the debate in the House of Lords, today’s debate should be a day not for political difference, but for how, together, we can all play our part in securing positive change to ensure that we use the best science to help beat cancer, and to offer the best support to those living with or beyond the disease.
After nearly eight years as the Member of Parliament for Old Bexley and Sidcup, this is my first opportunity to address the House from the Back Benches. While this is most certainly not a maiden speech, I hope colleagues will understand if I place some of my comments in a very local context. A few weeks ago, I was contacted by Lisa and Matt Taylor, the parents of young Olivia Taylor. In January, when Olivia was 17 months old, she was diagnosed with a large slow-growing glioma tumour, which is located at the centre of her brain. By February, Olivia had lost her sight and many other cognitive functions.
Olivia is no longer able to know whether it is night or day, impacting on sleeping patterns not just for her, but for the rest of the family. Because of its location, sadly the tumour is inoperable, and Olivia is receiving chemotherapy to keep the tumour stable and to help retain as much of her quality of life as possible. She is a very brave little girl and clearly surrounded by so much love.
As a parent, I find that a heart-breaking story, and the family face an incredible strain in meeting Olivia’s immediate needs and those that lie ahead. Despite all this, I have been struck by their hugely positive outlook in ensuring that Olivia has happy memories and that she has access to all the right support. They have launched a campaign with the hashtag #KeepOliviaSmiling to help to raise awareness of the signs and symptoms of brain tumours in children and the need for early diagnosis.
Brain tumours are the biggest cause of preventable or treatable blindness in children and the family believe that if the signs of Olivia’s tumour had been spotted sooner, her sight might have been saved. The campaign is also intended to help raise funds to support future treatment for Olivia, which might not be available in the UK. The family have highlighted to me the need for better join-up between hospitals on available treatments, accessibility to international trials and the need for greater research in childhood brain tumours, which can develop in different ways from adult tumours.
I warmly welcome the additional £45 million investment in brain tumour research, which has been committed by the Government in conjunction with Cancer Research UK. I hope that in winding up the debate the Minister will be able to commit to ensuring that part of that funding is used to advance our understanding of, and deliver new treatments specifically for, brain tumours in children. Making a difference in individual cases such as Olivia’s is precisely what today’s debate is all about. I hope that, in some way, today we too can help to keep Olivia smiling.
There is no doubt that the science and analysis of cancer are advancing rapidly. Increasing amounts of patient data are being generated, as well as much greater recognition of the ways cancer develops and the individual mutations that can cause one tumour to behave in a completely different way from another. The challenge, as we heard from the hon. Member for Croydon Central, is co-ordinating the data in a consistent way that leads to more effective treatments and therapies.
One example of that is genetic analysis to help predict a cancer’s evolutionary path. I commend Cancer Research UK for its support of the innovative and significant work to examine the genetic make-up of individual tumours. I recently gave permission for a sample of my own tumour to form part of this molecular research. I hope that in some small way that might add to our understanding of the disease.
Such work is clearly leading to much clearer analysis not just of the nature of individual cancers, but of treatments and immunotherapies that are more likely to be effective for the patient. Rather than talking generally about cancer in a particular organ, we are increasingly able to talk about the nature of a specific tumour for that individual. That is a potential game changer, but it also raises new challenges and potential restrictions that must be overcome if we are to make the necessary progress.
I believe that the UK can be a world leader in this new era of precision medicine, driving forward innovative research to deliver new treatment options, but that will take time, when time for many is a precious commodity. That is why the use of adaptive clinical trials remains important. Yes, there are existing routes for new drug treatments to be made available, such as the early access to medicines scheme, and the cancer drugs fund, but we should be prepared to be more radical.
I pay tribute to the work of the incredible people in our NHS who deliver the care and compassion that Tessa Jowell rightly highlighted. They are amazing, and having received significant NHS treatment and support over recent months, I know just how special they are. I also want to recognise the huge impact that charities such as Cancer Research UK, Macmillan Cancer Support, the Brain Tumour Charity, and the Roy Castle Lung Cancer Foundation have on the lives of thousands of people.
We need to do more as part of the broader cancer strategy, and I will return to a number of topics on another occasion, but we should be positive about what we can achieve, the difference that can be made and the outcomes that can be secured if we work together. In connection with that, some of Tessa Jowell’s own words from her speech in the House of Lords bear repeating:
“I hope that this debate will give hope to other cancer patients like me, so that we can live well together with cancer—not just dying of it—all of us, for longer.”—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]
That inspiring message is one that we should all take to heart.
NHS Winter Performance
Jeremy Hunt Excerpts(8 years, 3 months ago)
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The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I would like to update the House on the winter pressures on the NHS following the opposition day debate held in January.
This winter we have seen worse weather than in many recent years, with sustained drops in temperature known to increase heart attacks, stroke and respiratory conditions. This has been coupled with prolonged pressure on hospitals from beds occupied by patients with norovirus and also flu, having experienced the worst flu season since 2010.
However, despite these extra pressures, thanks to the hard work of NHS staff:
over 55,000 people were seen within four hours per day in February. This is 1,000 more people per day than in the same month last year.
NHS 111 offered 150,000 extra calls each month over winter with the amount of callers receiving clinical advice increased to nearly half; and
over one and a half million more people have been vaccinated against flu compared to the same period last year, with the highest ever uptake among healthcare workers at 68.7%.
Last year’s spring Budget allocated £100 million of capital to help hospitals set up GP streaming services with 99% of NHS trusts now having this in place. In addition, at the autumn Budget, the Government provided £337 million for NHS winter funding; this funding has helped the NHS to open over 2,600 acute beds over the winter period.
In order to support emergency care across the NHS, national clinical leaders advised that non-urgent operations should be postponed in January. NHS England has published the information showing that this freed up around 1,400 beds across hospitals in England. This represents around 3% fewer planned admissions this January compared to last year.
The Government remain firmly committed to ensuring that patients are seen promptly when they need urgent and emergency care. The NHS will receive an additional £2.8 billion between 2017-18 and 2019-20. The NHS England Mandate for 2018-19 sets out the milestones for improved A&E performance during 2018-19.
[HCWS603]
Maternity Safety
Jeremy Hunt Excerpts(8 years, 4 months ago)
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The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I am today announcing steps towards ensuring that the majority of women will receive care from the same small team of midwives throughout their pregnancy, labour and birth by 2021, starting with 20% of women benefiting from a ‘continuity of carer’ model by March 2019.
Women who have continuity of carer are 19% less likely to miscarry, 16% less likely to lose their baby and 24% less likely to have a premature baby.
To support this, the Department of Health and Social Care is planning the largest ever increase in NHS midwives and maternity support staff, 650 new training places for midwives in 2019—a 25% increase. We will continue to work with universities and the NHS to create even more training places in subsequent years to fill the gap of 3,000 midwives.
Other key parts of the announcement include:
Professionalising the maternity support worker role by developing a nationally defined role and national competency frameworks for maternity support workers together with a voluntary accreditation register.
Working with our key partners including the Royal College of Midwives, to identify better and clearer pathways for staff to progress and to develop new training routes to become a registered midwife.
[HCWS588]
NHS Staff Pay
Jeremy Hunt Excerpts(8 years, 4 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Jonathan Ashworth (Leicester South) (Lab/Co-op)
(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on NHS pay.
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
The whole House will want to pay tribute to the hard work of NHS staff up and down the country during one of the most difficult winters in living memory. Today’s agreement on a new pay deal reflects public appreciation for just how much they have done and continue to do, but it is much more than that. The agreement that NHS trade unions have recommended to their members today is a something for something deal that brings in profound changes in productivity in exchange for significant rises in pay.
The deal will ensure better value for money from the £36 billion NHS pay bill, with some of the most important changes to working practices in a decade, including a commitment to work together to improve the health and wellbeing of NHS staff to bring sickness absence in line with the best in the public sector. We know that NHS sickness rates are around a third higher than the public sector average, and reducing sickness absence by just 1% in the NHS will save around £280 million. The deal will put appraisal and personal development at the heart of pay progression, with often automatic incremental pay replaced by larger, less frequent pay increases based on the achievement of agreed professional milestones. It includes a significantly higher boost to lower-paid staff, to boost recruitment in a period when we know the NHS needs a significant increase in staffing to deal with the pressures of an ageing population. Pay rises range from 6.5% to 29% over three years, with much higher rises targeted on those on the lowest and starting rates of pay.
As part of the deal, the lowest starting salary in the NHS will increase by more than £2,500, from £15,404 this year to £18,040 in 2020-21, and a newly qualified nurse will receive starting pay 12.6%—nearly £3,000—higher in 2020-21 than this year. But this deal is about retention as well as recruitment. It makes many other changes that NHS staff have been asking for—such as shared parental leave and the ability to buy extra or sell back annual leave—so they can better manage their work and family lives, work flexibly and balance caring commitments.
The additional funding that Chancellor announced in the Budget to cover this deal—an estimated £4.2 billion over three years—cements the Government’s commitment to protecting services for NHS patients, while recognising the work of NHS staff up and down the country. This is only possible because of the balanced approach we are taking—investing in our public services and helping families with the cost of living, while getting our debt falling. Rarely has a pay rise been so well deserved for NHS staff, who have never worked harder.
Jonathan Ashworth
The Secretary of State has finally given the lowest-paid NHS staff a pay rise. Staff, royal colleges, trade unions and the Labour party have today been vindicated in saying that a pay rise is long overdue. But when we have seen nurses, paramedics and midwives losing thousands of pounds from the value of their pay, heard stories of NHS staff turning to food banks, have 100,000 vacancies across the service, seen more nurses leaving the profession than entering and seen trusts spending billions of pounds on agency staff, this pay cap should have been scrapped years ago.
In the general election, Ministers said that scrapping the pay cap was nonsensical. When a nurse pleaded with the Prime Minister for a pay rise on national television, she was told that there was no magic money tree. Can the Secretary of State tell us how this pay rise will be paid for? Have the Prime Minister’s horticultural skills grown said magic money tree? We have heard that there will be additional money. When will trusts get the allocations, and if the money is additional, will it be paid for by extra borrowing or extra taxation? Public servants deserve reassurances that the Government will not give with one hand and take with the other.
Given the projections for inflation, can the Secretary of State guarantee that staff will not face a real-terms pay cut in any single year of the deal? We note that he has backed down on docking a day’s holiday. Will he commit to not tabling that proposal again? We also note that he will not block the transfer of hospital staff to wholly owned subsidiary companies. Will he at least guarantee that all staff employed by such companies will be covered by “Agenda for Change” terms? Can he tell us when the rest of the public sector will get a pay deal?
NHS pay has been held back for the best part of a decade. Today is a first step, but the NHS remains underfunded and understaffed. We urgently need a plan to give the NHS the funding it needs for the future.
Mr Hunt
If the hon. Gentleman wants a plan to give the NHS the funding it needs, can he explain why Labour in Wales has deprived the NHS of £1 billion of funding that it would have had if funding had increased at the same rate as in England? Far from Labour being vindicated, the House will remember that the pay restraint in the NHS for the past eight years was caused by the worst financial recession since the second world war, caused by a catastrophic loss of control of public finances.
The hon. Gentleman asks for some details. Today’s pay deal means that someone starting work in the NHS as a healthcare assistant will see their rate of pay over the next three years go up by 26%, nearly £4,000. A nurse with three years’ experience will see a 25% increase, which is more than £6,000 over three years. A band 6 paramedic with four years’ experience will see a £4,000 rise. On top of that, we are putting in a huge number of things that NHS staff will welcome, including, for example, statutory child bereavement leave and shared parental leave. Yes, we are asking for important productivity changes in return, but this is about the modernisation of NHS staff terms and conditions, which is good for them and good for taxpayers.
The hon. Gentleman asks where the money is coming from: it is additional funding from the Treasury for the NHS. It is not coming from extra borrowing. If he had been listening to the autumn statement, he would have heard that debt as a proportion of GDP is starting to fall this year for the first time. That is possible because we have taken very difficult decisions over the past eight years—they were opposed by the Labour party—that have meant 3 million more jobs and have transformed our economy out of recession into growth. None of that would have been possible if we did what his party is now advocating, which is to lose control of public finances by increasing borrowing by £350 billion. Let us just remind ourselves that countries that lose control of their finances do not put more money into their health services—they put less. In Portugal, the amount is down 17%, and in Greece, it is down 39%. The reason that we can announce today’s deal is very simple: this country is led by a Government who know that only a strong economy gives us a strong NHS.
Dr Sarah Wollaston (Totnes) (Con)
I warmly welcome today’s announcement of a well-deserved pay rise for NHS staff and, in particular, that this will be additional funding of £4.2 billion over three years, rather than it coming out of existing resources. I particularly welcome the focus on staff health and wellbeing, which was raised by the recent Health Committee inquiry into the nursing workforce. In particular, I ask the Secretary of State to go further and talk about what will be done on continuing professional development for NHS staff, because this was identified as a key factor in retention. He referred to it partially in his comments, but I wonder whether he could go further.
Mr Hunt
I thank my hon. Friend for her comments. Underneath this agreement, there is a very important new partnership between NHS employers and the unions to improve the health and wellbeing of staff through mental health provision and the implementation of the Stevenson-Farmer review, taking on board a number of points raised by the Health Committee, and through improved support for people with musculoskeletal conditions, because a lot of NHS work is very physical. However, she is absolutely right: professional development is also very important. By reforming the increments system that we have been using for many years, we will give staff the chance to see their pay go up in a way that is linked to their skills going up as well. That is something that many staff will welcome.
David Linden (Glasgow East) (SNP)
May I associate myself with the comments made by the Secretary of State in paying tribute to our NHS staff? It is good to have not just warm words today, but substantive action. He has referred to devolved nations elsewhere in the UK, and I hope that he will acknowledge that the Scottish Government were the first Government in the UK to lift the public sector pay cap.
Although this announcement is welcome, we have committed to using any additional funds that come to Scotland through consequentials to go into the Scottish pay agreement. However, the Office for Budget Responsibility has projected that average earnings will go up by 7.7% in the next three years, while the retail prices index goes up by over 9%. Has the Secretary of State taken that into account, or are the Government ignoring the OBR on average earnings? Committing to a three-year deal could stagnate wages and lower the standard of living, and none of us in this House wants that to happen.
Mr Hunt
The majority of NHS staff will see that their pay is protected against the cost of living, but many NHS staff, including the lowest-paid, will see increases that are substantially higher than inflation rates, because, first, that is the kind of society that we believe in. Conservative Members want everyone to be given decent rates of pay, and there are many parts of the country where the cost of living is very high and this will make a very big difference. We also recognise that there will be 1 million more over-75s in 10 years’ time, so we need to expand the number of staff in the NHS and its capacity to deal with those pressures. We therefore need to attract more people into working for the NHS and social care systems.
Mr Iain Duncan Smith (Chingford and Woodford Green) (Con)
I congratulate my right hon. Friend; I know of his huge personal commitment to the NHS and how he has battled for it over the years—I have seen that personally. I unashamedly, absolutely agree that this is a very good deal, and I congratulate nurses and others on this pay rise, which they deserve and for which they have worked very hard. Is it not also right to recognise and remember that back in 2008-09, Labour’s great depression plunged the economy into the biggest and most difficult economic trench that it has faced? As a result of our stewardship and our support of the NHS through that period, unlike many other countries that cut their health spending, we secured 200,000 jobs in the NHS, and now we can start rewarding staff for their hard work.
Mr Hunt
I thank my right hon. Friend and commend him on his courage in putting through some incredibly challenging and important reforms to our welfare state, when many people said that it was nigh on impossible. He is right: the biggest and most misleading thing that we hear is the charge that in austerity Britain, the NHS budget has been cut. In fact, the countries that cut their health budgets were Portugal and Greece—countries that are following precisely the policies that are advocated by the Opposition. In this country—so-called austerity Britain—NHS spending has gone up by 9%.
Sir Vince Cable (Twickenham) (LD)
On the vexed question of how to pay for the NHS, has the Secretary of State been in any way influenced by the testimony of the recently retired permanent secretary to the Treasury, who at last acknowledged that the only way to do it was to have some form of earmarked taxation?
Rebecca Pow (Taunton Deane) (Con)
I have met many nurses from Taunton Deane to press their case for a rise in salary, and I have passed that on not just to the Department of Health and Social Care, but to the Chancellor. I welcome today’s pay rise; I think these hard-working nurses all deserve it, and we congratulate them. Does my right hon. Friend agree that today’s £4 billion commitment demonstrates that this is a listening Government who are taking investment in the health service extremely seriously?
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
We have lost over 5,000 nurses working in mental health since 2010. As a result of this announcement on pay, when does the Secretary of State expect the number of mental health nurses to return to 2010 levels?
Mr Hunt
We would have more nurses in mental health if we had not had to deal with the crisis at Mid Staffs and pronounced short staffing in our acute hospitals. Since I have been Health Secretary, we have 15,000 more nurses in the NHS and we are also finding more money to go into mental health. It is time that the hon. Lady recognised that, rather than trying to paint the opposite picture.
Mr Philip Dunne (Ludlow) (Con)
I add my voice to those congratulating the Secretary of State and his ministerial team on a tremendous achievement in discussions with the Treasury to secure this additional funding. I invite him to comment on the work that has been done by the health unions and the Royal College of Nursing, in particular, in helping to deliver this agreement and particularly to give many of the people on starting salaries a significant uplift, which he referred to earlier. This will make it easier to attract people to the vital starting roles for future generations.
Mr Hunt
I would like to pay tribute to my hon. Friend because, when he was working in my Department, he laid a lot of foundations for this deal. He chaired some very important meetings. In particular, one of the most important areas of consensus that has emerged, which he should take enormous credit for, is that we are saying today that the minimum salary for anyone working in the NHS will go up by £2,000. That is going to make a huge difference—100,000 people will benefit from that important change—and he should be very proud of that.
Bambos Charalambous (Enfield, Southgate) (Lab)
NHS trusts are spending £3 billion a year on agency staff to plug gaps in the workforce. Has the pay cap not been totally self-defeating and led to huge amounts of public money going to private staffing agencies?
Mr Hunt
What led to the mushrooming agency fee was the realisation, post Mid Staffs, that we needed a lot more nurses. Nursing staff numbers were going down until the Francis report was published, but the report created huge demand among hospitals, which realised they needed to improve patient safety by recruiting more staff. The hon. Gentleman will be pleased to know, however, that we are bringing down the agency bill, and I expect it to be significantly lower this year.
Maria Caulfield (Lewes) (Con)
It is disappointing to see the lack of welcome from Labour Members for this pay rise for NHS staff in England—one day after the announcement of five new medical schools across the country. Has the Secretary of State had discussions with the Labour Government in Wales to see if they will be replicating this pay rise for NHS staff in Wales?
Mr Hunt
First, I want to pay tribute to my hon. Friend as one of the practising nurses in the House and someone who always makes sure that the voice of nursing is heard loud and proud in this place. I very much hope that the devolved Governments will follow suit with this deal, although for every additional pound per head we have put into the NHS in England, Labour in Wales has put in only 57p.
Stella Creasy (Walthamstow) (Lab/Co-op)
Further to the question from my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous), we all know how much agency nurses cost the NHS, and the same goes for private finance initiatives. These companies are making £1 billion in profits, which is money that will not touch any of our hospital budgets, including that of my own, Whipps Cross Hospital, which has a 17% agency rate and tried to deal with its PFI debt by downgrading the pay of nurses to save money. What is the Secretary of State doing to cut the PFI bill for our hospitals and prevent them from balancing their books off the backs of hard-working staff?
Mr Hunt
The hon. Lady is right to draw attention to that problem. We have certainly stopped doing any new PFI deals of the disastrous kind that lead to the consequences she talks about. We have given some relief to a number of hospitals in that area, but I will look again at her local hospital, because it is clearly totally unacceptable if that is happening.
Will Quince (Colchester) (Con)
Colchester General Hospital has recently come out of special measures, and the staff there have worked so hard to turn our hospital around, so I welcome wholeheartedly this announcement of extra money, which means that our staff will get a well-deserved pay rise. I will always champion our hospital, however, so will my right hon. Friend commit to continuing to invest in our hospital and its people? In particular, will he look at the accident and emergency department?
Mr Hunt
I will happily do that. The hon. Gentleman has championed his hospital, which has been on a rollercoaster journey during his time in this House but which has now turned a corner. The staff have worked incredibly hard to improve safety standards for patients, but I know that, like many places, they would like more investment in their A&E, and I will certainly look at it.
Ben Lake (Ceredigion) (PC)
I, like many others, welcome the fact that NHS workers in England will finally receive a pay rise they deserve. Of course, health is devolved to the Welsh Government, so could the Secretary of State clarify how much of this additional funding is new funding and what the Barnett consequential will be for the Welsh Government?
Mr Hunt
This constitutes an investment by the Treasury of £4.2 billion, and the normal Barnett consequentials will apply, so it is perfectly possible for the Labour Government in Wales to replicate this deal if they choose to, but we know, of course, that had they replicated the increases in funding to the NHS in England, the NHS in Wales would have had an additional £1 billion spent on it over the past five years.
Dr Murrison
I warmly welcome this announcement and congratulate my right hon. Friend, the trade unions and NHS Employers on reaching this deal. One problem facing our NHS is that of people not returning to work after they have had caring responsibilities. What elements of the deal will encourage more people to consider coming back into the workforce? I am thinking, in particular, of the non-pay elements and the reform of pay structures that he has mentioned.
Mr Hunt
The most important thing about the deal is that it will discourage people who might be reaching breaking point, because of personal circumstances, from packing it all in and leaving the NHS family. There is a particular proposal to allow much greater flexibility in the buying and selling of annual leave, so that people who need to work less because of things that happen at home, and perhaps people who want to work more, find it much easier to do so. This is therefore part of a much bigger shift towards the flexible working that we know everyone wants these days.
Eleanor Smith (Wolverhampton South West) (Lab)
I absolutely appreciate the Secretary of State’s announcement on pay. As a nurse who has worked for more than 40 years, I know that it is greatly welcomed by everybody across the patch, including porters. I want to ask, however, about wholly owned subsidiary staff. I believe that some of them are not under “Agenda for Change” terms. Will they get the pay rise as well?
Mr Hunt
First, I thank the hon. Lady for welcoming the deal. I think she is the first Labour Member who has done so, and it is not insignificant that she is a nurse. A wholly owned subsidiary is a legal structure that was made possible by a change in the law introduced in 2006, under her party’s Government, and is actually an alternative to outsourcing. Employees would be far more likely to benefit from “Agenda for Change” pay rates within such a structure than if they were outsourced, which the last Labour Government tried so hard to encourage.
Mr Gary Streeter (South West Devon) (Con)
When I met Devon’s secretary of the Royal College of Nursing recently to discuss nurses’ pay, she made the obvious point that she was getting a bit fed up with politicians saying that they valued nurses while not actually adding to their pay packets. Does my right hon. Friend agree that from today not only will we be saying that we value nurses, but that that will be reflected in their pay packets? I congratulate him and the RCN on achieving such a good deal.
Ruth Smeeth (Stoke-on-Trent North) (Lab)
My healthcare economy was held together over the winter solely by the good will of NHS workers, yet they have had a 14% pay cut in real terms since 2010. This announcement is a drop in the ocean. How does the Secretary of State think that it will help retention rates?
Mr Hunt
I cannot agree that this is a drop in the ocean. If the hon. Lady does not want to hear it from me, let me point out what was said by the Unison head of health, Sara Gorton, who is also the head negotiator for the NHS unions. She said that the deal
“would go a long way towards making dedicated health staff feel more valued, lift flagging morale, and help turn the tide on employers’ staffing problems.”
That is not a drop in the ocean.
Robert Halfon (Harlow) (Con)
I strongly welcome the measures that my right hon. Friend has announced. He will have heard my question to the Prime Minister earlier, and he will acknowledge that Harlow Hospital is out of special measures and that this pay award is much deserved by staff. In the future, will he look at the particular problem we face—we are just outside London, and a lot of staff work in London, which makes it harder for Harlow Hospital to recruit—and perhaps think again about the pay scales?
Mr Hunt
I am happy to do that and to congratulate the staff at my right hon. Friend’s hospital, which he has long championed and whose pressures and needs he has highlighted assiduously. To come out of special measures is a huge achievement. I have recorded a video message, but I am happy to say in the House how proud we all are of what the staff have achieved. I also recognise the capital issues at the hospital and the fact that the building is not fit for purpose.
Tim Farron (Westmorland and Lonsdale) (LD)
The minimum amount that nurses in south Cumbria will have lost since the pay freeze is £4,306. Given that the average house price in my constituency is 10 times the value of the average nurse’s salary, Members will understand the huge impact that there has been on retention and recruitment. The rise is therefore deserved, welcome and overdue, but without a long-term plan for funding health and social care, this announcement will not be trusted, so does the Secretary of State not agree that we need a new deal to refresh Beveridge’s vision for the 21st century, and should we not be prepared to be honest with the British people and say that this will involve a modest but clear increase in taxation?
Mr Hunt
I disagree that the deal will not be believed—it is a concrete deal. NHS staff still have to vote for it, but the Government have committed to significant rises in pay. I agree, however, that we will need to find the best way of getting more money into the NHS and social care system as we face the pressures of an ageing population.
Dr Julian Lewis
Will the Secretary of State expand a little on what he briefly said about flexibility of working hours and family bereavement among NHS staff? After this urgent question, will he kindly give a short tutorial to those of us with an interest in defence on his successful techniques for extracting £5 billion from the Treasury for a Department that urgently needs it?
Mr Hunt
I would not dare to talk about an area outside my own Department’s responsibilities, even to such an eminent person as my right hon. Friend.
Flexible pay is at the heart of what we need to do differently in the NHS. This is really about two types of NHS worker. First, many people find that the shift patterns in the NHS are very unpredictable. Every six weeks their lives are turned upside down as they are given a new set of times when they have to work. People want regularity and predictability, and we do not offer that at the moment, which makes life much tougher for those who are trying to achieve a work-life balance. Secondly, we make life hard for people who want to do extra shifts at the last minute. Both those factors are important, and they will be helped by this new pay deal.
Mr Paul Sweeney (Glasgow North East) (Lab/Co-op)
We have already heard about the 14% real-terms fall in NHS staff pay since 2010. There have been eight long years of pay restraint, and this deal does not go far enough to offset that historic deficit.
The Secretary of State is having to deal with the massive problem of an ageing population and the need to increase the capacity of the NHS to deal with it. Does he agree that alienating an entire generation of junior doctors was not a productive way of achieving that?
Mr Hunt
We do not recognise the figures that the hon. Gentleman has given but, in any event, he cannot say that the deal does not go far enough without asking why that has happened. It happened because in 2008 we had the worst financial recession since the second world war, which was made an awful lot worse by the Labour Government’s loss of financial discipline. What I think is most disturbing for people in the NHS is that the hon. Gentleman’s party seems set on repeating the same mistake.
Rachel Maclean (Redditch) (Con)
I join colleagues in welcoming my right hon. Friend’s announcement. Will he join me in congratulating the nurses and doctors at the Alexandra Hospital in Redditch on their incredibly hard work in keeping people safe and well cared for throughout the winter? Following yesterday’s announcement about new medical schools and nursing apprenticeships, his announcement today represents a real, solid investment in our NHS workforce that will enable us to open the urgent care centre at the Alex for which I have been campaigning.
Mr Hunt
I certainly recognise my hon. Friend’s strong argument for an urgent care centre, and I commend the very hard work of the staff at the Alex. I know that the new leadership at the trust is making progress and turning things around, and I hope that what has happened at Harlow today will be an inspiration.
What we are doing today is significant. The extra doctors and nurses whom we are training, and a pay deal that is intended to boost recruitment in the NHS, demonstrate our recognition that we need a significant increase in capacity in the NHS and the social care system if we are to ensure that every older person gets the care that they really need, which is what the Government want.
Chris Elmore (Ogmore) (Lab)
May I press the Secretary of State a little further on Barnett consequentials? Will he confirm that there will be consequentials for each of the three years of the pay rise? Will he also welcome the Welsh Government’s introduction of a living wage in the NHS in 2014, and does he recognise that NHS and social care spending is higher in Wales than it is in England? That is a matter of fact.
Julian Knight (Solihull) (Con)
I have the great good fortune to be married to a former renal nurse, and she tells me regularly that much of retention is about work-life balance, training and interactions with management. Will the Secretary of State tell us what progress he is making in those areas?
Mr Hunt
I am happy to do so. Work-life balance is something that we need to handle a lot better. I think we have been slow to recognise that today’s NHS staff are likely to live in households in which both partners are working and that juggling life and work has therefore become much more complex than it was 30 or 40 years ago. The reform of the increments system means that there will be more focus on training and skills, which will be much more motivating for NHS staff, so I hope that my hon. Friend’s wife is pleased.
Diana Johnson (Kingston upon Hull North) (Lab)
I welcome the Government’s change of heart in awarding a pay rise to our hard-working NHS staff. May I pursue the point made by the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston)? Our Committee’s report emphasised that continuing professional development was key to the retention of nurses. It was not clear to me from what the Secretary of State said whether money would be ring-fenced—sadly, the amount has been cut—to ensure that nurses can access CPD not only in the NHS, but in social care settings.
Mr Hunt
I recognise that there have been pressures on the CPD budget, and that is because we have made increasing the number of nurse training places our main priority. We have increased that by 25%, which has meant that difficult decisions have had to be made about other parts of the budget. I can reassure the hon. Lady, however, that I think that CPD will continue to have a vital role, and we will need to return to the issue.
Huw Merriman (Bexhill and Battle) (Con)
Efficiency and productivity deserve to be rewarded, and, given the 16% increase in emergency admissions, NHS professionals have certainly earned that. In the light of this new working relationship, does the Secretary of State envisage staff and the Government working in partnership to challenge patients to be more respectful to those who work in the health service?
Mr Hunt
I thank my hon. Friend for making that point. He often raises difficult issues that need to be talked about in this place. We all know that the vast majority of patients are incredibly grateful for the care that they receive from NHS professionals, but occasionally that does not happen. Occasionally, people use services that they do not need to use, which creates pressures and denies other patients what they do need. My hon. Friend is absolutely right that as we start to expand NHS capacity, we need the public to understand their responsibilities as well.
Lady Hermon (North Down) (Ind)
I am happy to welcome the statement, but let me take a moment to remind the Secretary of State that we in Northern Ireland have not had a functioning Assembly for 14 months, and we have had no Health Minister for 14 months. How can the hard-working staff members of the NHS in Northern Ireland benefit from the new pay deal? Will the Secretary of State commit himself to speaking to the Secretary of State for Northern Ireland, whom I am delighted to see sitting on the Front Bench, to ensure that NHS staff in Northern Ireland see the benefits of the deal?
Mr Hunt
The hon. Lady speaks eloquently and my right hon. Friend the Secretary of State for Northern Ireland was listening to her comments. It is a matter of great sadness that nurses’ pay has fallen behind in Northern Ireland, not because the money was not available, but simply because the Administration were not in place to implement changes. I know that my right hon. Friend will do everything she can.
Helen Whately (Faversham and Mid Kent) (Con)
I welcome the proposed pay rise, especially the increase for the lowest paid in the NHS. Nurses at my local hospitals tell me that as well as a pay rise, what they really want is flexibility in relation to things that happen in their lives, so I particularly welcome that aspect of the proposal. Does my right hon. Friend agree that flexibility and investment in training will enable NHS employers to show their appreciation for the valuable contribution that each individual member of staff makes to the care of patients?
Mr Hunt
My hon. Friend is absolutely right and speaks with a great deal of knowledge. Let me give an example of something we are doing that is not part of this deal, but that backs up what she says. We are prioritising the use in every hospital of an effective e-rostering system that enables people to book the shifts that they want on their phones and to change them very easily through a modern IT system. That makes an enormous difference to the control that they have over the hours they work, and I think that, in combination with the new deal, that will make a big difference.
Ellie Reeves (Lewisham West and Penge) (Lab)
The NHS is now short of 100,000 staff because of the Government’s neglect of the NHS workforce. When the Government scrapped the nursing bursary, they said that that would lead to the training of more nurses, but UCAS data shows that since then the number of applications has fallen by 15,000. Will the Government now commit themselves to reintroducing the bursary?
Mr Hunt
What the hon. Lady chose not to tell the House was that since the time of the last Labour Government, we now have 5,500 more nurses and 15,000 more doctors in the NHS, and there has been a 9% rise in NHS funding. [Interruption.] I hear the shadow Secretary of State talking about vacancies from a sedentary position. I hope that he will also welcome the 25% increase in the number of doctors and nurses whom we are training precisely so that we can fill those vacancies.
Craig Tracey (North Warwickshire) (Con)
I welcome the announcement, and it was great to see the Secretary of State meeting staff at my excellent local hospital, the George Eliot, recently. What will be particularly welcomed is the hugely progressive nature of this deal, with its focus on the lowest paid. What exactly does it mean for those at the very bottom of the pay scale?
Mr Hunt
For people starting off in nursing, there will be a rise of about £2,000, which will make a very big difference, and we are increasing the minimum starting salary for anyone working in the NHS by about £2,500. This is completely in line with the Government’s policies over a whole range of areas. We have prioritised increasing the amount people can earn tax-free before paying any income tax at all. We have taken millions of people out of income tax. That is because this Government are committed to helping the lowest paid.
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
It has taken six years, but finally the Health Secretary has come to the conclusion that Labour Members reached many years ago: the pay cap is a folly. I thank Sara Gorton and the team at Unison and the GMB for campaigning on this matter for years, standing up not just for clinical staff, but for the support staff without whom our NHS simply would not function. Given that the offer in the second and third years of the pay deal is below inflation, what guarantees can the Secretary of State give that this is not a one-off deal to hide the fact that he is failing in his job, and is instead a long-term engagement to achieve proper pay in our NHS?
Nigel Huddleston (Mid Worcestershire) (Con)
I welcome the announcement and believe that it is a further obvious commitment by the Government to the NHS and NHS staff. I will continue to have a debate on whether the record spending is enough, as, personally, I would support more spending, but does the Secretary of State share my disappointment and anger that there continue to be campaigners and campaigning organisations that, for whatever reasons and motivations, spread the untruth that there have been cuts in spending in the NHS?
Mr Hunt
My hon. Friend is right. Just to reassure him, I do not think that any Health Secretary would ever say the NHS does not need additional funding. He makes an important point, and the truth is that at the 2010 election there was one party that wanted to cut funding for the NHS. It was the Labour party, and we stopped it.
Vicky Foxcroft (Lewisham, Deptford) (Lab)
When my sister broke her neck only weeks ago, I saw at first hand the pressures that NHS staff are under. They start shifts early and finish shifts late, and there are not the right staffing levels on wards. Those staff were amazing, however. The NHS is now short of 100,000 staff because of this Government’s neglect of the NHS workforce. Will the Government apologise to all NHS workers for undervaluing them for so long?
Mr Hunt
The hon. Lady needs to look at the facts before making those kinds of claims. Let us look at what has happened in the last five years—the period during which I have been Health Secretary. The numbers of qualified clinical staff have not gone down, but have gone up by 43,000. We are doing everything we can to increase the capacity of the NHS, and the hon. Lady should be welcoming that.
Michael Tomlinson (Mid Dorset and North Poole) (Con)
I warmly welcome the Secretary of State’s statement. I met representatives from the Royal College of Nursing in my constituency recently, and I am sure that they, too, will welcome this statement. Does this not show that, contrary to the assertion so often made by Labour, it is this Government and Secretary of State who are committed to long-term investment in our NHS?
Mr Hunt
I am grateful to my hon. Friend for saying that. The truth is that there is probably one thing that those on both sides of the House agree on: the long-term future of the NHS depends on long-term funding for the NHS. Sadly, there is one thing that only Conservative Members understand: to do that, we need a strong economy.
Tom Brake (Carshalton and Wallington) (LD)
I welcome the statement. Has the Secretary of State had time to assess the impact on retention and recruitment of EU citizens who work in the NHS? If he is feeling generous, may I remind him that St Helier Hospital is in need of £400 million?
Mr Hunt
I am aware of the estate issues at St Helier Hospital. I have seen them myself and know that that building is, in many areas, not fit for purpose. On EU citizens, the picture is mixed. We have seen a small decline in the number of EU nurses, but overall the number of EU citizens working in the NHS has gone up by 3,200 since the referendum. That has happened because the Government and NHS staff have made a huge effort to reassure them of just how valued they are and that we want them to stay.