Oral Answers to Questions
Jeremy Hunt Excerpts(7 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Stephen McPartland (Stevenage) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
Today is World Mental Health Day and the whole House will want to congratulate Time2Change on its 10th anniversary and the remarkable change in attitudes towards mental illness that it has helped to bring about. Our mental health workforce has increased by 30,000 since 2010 and another 21,000 posts are planned. [Official Report, 16 October 2017, Vol. 629, c. 4MC.]
Stephen McPartland
On World Mental Health Day, I congratulate the Secretary of State on the work he has done, especially for children. We have had 42% more children receiving care for eating disorders and over 21,000 more children have received access to mental health provision. What targets does the Secretary of State have to help to improve such provision?
Mr Kevan Jones (North Durham) (Lab)
One of the staffing shortages is actually in children and young people’s services. In County Durham in my constituency, the waiting time for autism diagnosis is two years. I have raised this with the mental health trust and NHS England, but the problem seems to be with the clinical commissioning group. What can the Secretary of State do to ensure that the extra money that he has pledged to put into the service actually gets to the service?
Mr Hunt
I would like to thank the hon. Gentleman for speaking out about mental health, like so many colleagues in this House, which makes a massive difference to the Time2Change campaign. It is unacceptable for someone to be waiting that long, and I do not want to stand here and defend it. I will certainly look into the individual case that the hon. Gentleman raises, but the fact is that many Members will know of similar cases. The money is starting to get through to the frontline. It is not just money, though; it is also capacity, and having trained mental health therapists—nurses; psychiatrists—and that is why we are boosting their training, too.
Dr Sarah Wollaston (Totnes) (Con)
As someone who is married to an NHS psychiatrist, may I start by paying tribute to all those volunteers, carers and professionals working in mental health on World Mental Health Day? Has the Secretary of State seen today’s briefing by the Children’s Commissioner, highlighting the vital importance of prevention and early intervention? Will he set out what steps he is taking to support a growing workforce—volunteers and professionals—working in prevention and early intervention?
Mr Hunt
My hon. Friend is absolutely right. I am aware of the report that she talks about. We know that half of mental health conditions become established before the age of 14, which is why early intervention is so important. In July, I announced an expansion in the mental health workforce—another 21,000 posts. A number of those will be in children’s mental health, to address the issues she raises.
Tim Farron (Westmorland and Lonsdale) (LD)
The Secretary of State may know that because of a reduction in the number of mental health clinicians in Cumbria, the Cumbria Partnership NHS Foundation Trust has now chosen to end consultant psychiatric call-out care from 8 pm to 9 am. It would have started last week, but it is going to start in the next two or three weeks. That means, as I am sure he is aware, that it will not be possible to section people under the Mental Health Acts between those hours unless they are within an NHS facility. People in police stations, people in care homes and people at A&E departments will not be—
Tim Farron
The question is: does the Secretary of State agree that that is not an appropriate use of resources, and will he provide the resources that are needed?
Mims Davies (Eastleigh) (Con)
Mr Hunt
My hon. Friend is right to draw attention to the issues around Southern Health, which will have directly affected a number of her constituents. That organisation is being turned around. However, she is also right to say that too many people are travelling out of area for their treatment. We have record numbers of children’s beds commissioned, but in the end this is about the capacity of the system of trained psychiatrists, psychologists and therapists, which was why we announced the extra 21,000 posts.
Barbara Keeley (Worsley and Eccles South) (Lab)
On World Mental Health Day, may I thank my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) for wearing yellow for #HelloYellow on behalf of our team?
The Secretary of State’s claim that thousands of extra mental health staff will be appointed by 2021 is fanciful unless he tells us how they will be funded. Today, the Care Quality Commission reports that mental health services are struggling to staff wards safely. We have also learned recently that two out of five mental health staff have been abused or attacked by patients in the past year. Most blame staff shortages for that violence. Rather than telling us about recruiting for 2021, what is the Secretary of State going to do today to protect staff from violence? [Official Report, 16 October 2017, Vol. 629, c. 4MC.]
Mr Hunt
Let me tell the hon. Lady what has happened in mental health. Some 30,000 more people are working in mental health today than when her Government left office—a 5.8% increase in clinical staff. On top of that —she asked about money—we have committed an extra £1 billion a year by 2021 so that we can employ even more people. We are the first Government to admit that where we are now is not good enough. We want to be the best in the world; that is why we are investing to deliver that.
Fiona Bruce (Congleton) (Con)
Rachel Maclean (Redditch) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
Developing new routes into nursing is a priority for my Department, which was why last week I announced plans to train 12,500 new nursing associates through the apprentice route in the next two years and to increase the number of nurses we train by 25%—the biggest increase in the history of the NHS.
Rachel Maclean
I welcome the fact that there are currently record numbers of nurses working in the NHS, but what is the Secretary of State doing to provide assurances to hospitals, such as the Alex in my constituency, that have faced issues with recruitment and retention? I very much welcome the new routes into nursing, including degree apprenticeships. What further actions does he propose to take?
Mr Hunt
My hon. Friend is absolutely right to raise this issue. The Alex is going through a difficult period and I know that as the local MP she is giving it a lot of support. The fact is that in 2014 we turned down 37,000 applicants to nurse degree courses. That is why we think that we need to do much, much better in training a number of people who would make brilliant nurses. That was why we announced the big increase last week, which will help the Alex and many other hospitals.
Mr Ben Bradshaw (Exeter) (Lab)
University admissions departments have reported an 8% fall in the number of people accepted on to nursing courses this autumn, so the situation is getting worse, not better as the Secretary of State claims. What contingency does he have in place, in the event that we crash out of the European Union, to address a further haemorrhaging of European Union staff from the NHS, and when will he review his disastrous decision to abolish nurse bursaries, which has had such a negative impact?
Mr Hunt
Let us be clear: we took the difficult decision on nurse bursaries precisely so that we could have the biggest expansion in nurse training places we have ever had. When we had the higher education reforms in 2011, which the right hon. Gentleman’s party opposed, we also saw a drop in initial applications, but then we saw them soaring to record levels. That is what we want to happen with nurses, because we need more nurses for the Royal Devon and Exeter, and all the hospitals that serve our constituents.
Maria Caulfield (Lewes) (Con)
I welcome the apprenticeship route and the associate nurse route into nursing because living on a bursary of £400 a month is no fun, believe me. However, will the Secretary of State look at nurse training so that when nurses qualify they are able to take on courses such as venepuncture and cannulation as soon as possible? Many student nurses and newly qualified nurses are frustrated that they cannot be used in those roles.
Mr Hunt
I will certainly look into that. Of course, my hon. Friend understands this issue better than many in this House. The really exciting change is that it will now be possible for healthcare assistants who could make fantastic nurses to progress to being nurses without needing to take out student loans because they will be able to carry on earning while they learn. That will open up big opportunities for many people.
Justin Madders (Ellesmere Port and Neston) (Lab)
Although we support moves to broaden access to nursing, these measures are effectively an admission that the scrapping of bursaries has been a disaster, but whatever recruitment strategies there are, the Government need to improve retention. The Royal College of Nursing recently reported that half of nurses surveyed said that
“staff shortages are compromising…care”.
What steps are the Government taking to ensure that nurses can do their jobs properly right now?
Mr Hunt
The hon. Gentleman is right to bring that up. One thing we can do a lot better is to improve the opportunities for flexible working. We have announced that we will be making new flexible working arrangements available to all NHS staff during this Parliament. We are also expanding programmes to encourage people who may have left the profession to come back into nursing.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I think everyone would welcome an expansion of nurse training places, but the Council of Deans of Health stated in June that no new extra places had been funded either in universities or, crucially, in hospitals, where 50% of the course is carried out. Will the Secretary of State clarify when that funding will be made available?
Dr Whitford
Obviously we know that it takes quite some time to train a nurse, and one in 10 posts in England is vacant—that is twice the rate we face in Scotland. We also know that there is a 51% increase in nurses leaving the profession, a 96% drop in those coming from the European Union, and a limit on the use of agency staff, so where does the Secretary of State expect NHS England to find the 40,000 nurses it needs right now?
Mr Hunt
Let me just remind the hon. Lady that there are 11,300 more nurses on our wards than there were just four years ago, so we are increasing the number of nurses in the NHS. She mentions what is happening in Scotland. I gently remind her that nearly double the proportion of patients are waiting too long for their operations in Scotland as in England.
Richard Graham (Gloucester) (Con)
Mr Hunt
I support all universities that are trying to move into offering more courses that can help me to ensure that we have enough staff for the NHS. I am sure that the University of Gloucestershire’s bid will be powerful, but I am aware that other hon. Members are supporting bids from their own constituency—including, I have to say, that of the University of Surrey, which puts me in a somewhat difficult position.
Marsha De Cordova (Battersea) (Lab)
The Secretary of State for Health (Mr Jeremy Hunt)
NHS staff do a fantastic job in tough circumstances, and pay restraint has been challenging for many of them. However, given the financial pressures, it is also true that the NHS would not have been able to recruit an additional 30,000 staff since May 2010 without the cap.
Christian Matheson
The NHS is short of 3,500 midwives and 40,000 nurses. What proportion of those numbers does the Secretary of State put down to the public sector pay cap?
Mr Hunt
As I said in my previous answer, without pay restraint we would not have 11,300 more doctors in the NHS and 11,300 more nurses on our wards. The hon. Gentleman will know that we recognise that it was not sustainable to carry on with the 1% rise going forward, which is why we have been given the leeway to have more flexible negotiations next year.
Marsha De Cordova
Hospital wards and GP surgeries are chronically understaffed, and the knock-on effect is that waiting lists are spiralling out of control. Is it not in the best interests of patients to scrap the pay cap so that the NHS can be run with the relevant number of staff in place?
Helen Whately (Faversham and Mid Kent) (Con)
In the work that I have done in hospitals, staff have told me that they are most unhappy about too much reliance on temporary staff, rota gaps and not feeling valued, as opposed to issues around pay. The latter—not feeling valued—often goes hand in hand with poor management practices. What is my right hon. Friend doing about those causes of staff unhappiness?
Mr Hunt
My hon. Friend, who has a lot of experience of working in the NHS, is absolutely right. The new Care Quality Commission inspection regime is designed precisely to identify good, strong leadership, because that has the best impact on staff and, through that, the best impact on patients.
Jeff Smith (Manchester, Withington) (Lab)
Mary Glindon (North Tyneside) (Lab)
The Secretary of State for Health (Mr Jeremy Hunt)
Ahead of our autumn Green Paper on children and young people’s mental health, we are having productive discussions with the Department for Education on the vital role that schools can play in tackling both mental health problems and the stigma surrounding them.
Mary Glindon
The YMCA and NHS’s #IAMWHOLE campaign, which was launched this morning, shows that young people seeking help are often dismissed by those around them, largely due to a lack of understanding of mental health difficulties. Will the Secretary of State meet the YMCA to discuss what can be done to combat the stigma?
Mr Hunt
I am more than happy to meet the YMCA. I also want to point out the amazing work done by the “Time2Change” campaign. I was at an event to mark its 10th anniversary, and I heard from young people who have spoken up about their mental health conditions, which takes a lot of courage. Things are changing, and we can draw a lot of hope from what is happening on the ground.
Sir Desmond Swayne (New Forest West) (Con)
Family doctors undertake such work, but why have only a quarter of them had any formal training in mental health?
Mr Hunt
My right hon. Friend is absolutely right to point out that a GP is often the first point of contact for many people. What are we doing? Three thousand mental health professionals will be seconded to GP surgeries over the next few years to give GPs the back-up they need in that area.
Mr Speaker
Not for the first time, I implore the right hon. Member for New Forest West (Sir Desmond Swayne) to issue to colleagues his textbook on succinct questions.
Sir Vince Cable (Twickenham) (LD)
Since the demand for children and youth mental health services far outstrips supply, will the Secretary of State consider diverting resources to voluntary bodies, such as the admirable Off The Record in my constituency, which have a much lower threshold for referral?
Mr Hunt
We will look at the role of voluntary organisations, and I totally agree with the right hon. Gentleman that they have an incredibly important role to play. We must also consider the role of schools, because teachers are extremely enthusiastic to do more around mental health. I think that if we give them more support there is a lot more they could do.
Jim Shannon (Strangford) (DUP)
The Secretary of State will know that when it comes to physical health and stigma, the Department will react right away. Do the Government now recognise the importance of treating mental health with equal status to physical health?
Richard Burden (Birmingham, Northfield) (Lab)
Mr Jim Cunningham (Coventry South) (Lab)
The Secretary of State for Health (Mr Jeremy Hunt)
This week is Baby Loss Awareness Week, and the whole House will want to mark the tragedy faced by too many parents every year by redoubling our efforts to reduce avoidable baby death and harm. I am pleased to tell the House that to mark World Mental Health Day today the entire Cabinet was this morning briefed by two of the country’s leading mental health experts, Poppy Jaman and Professor Sir Simon Wessely, on our plans announced today to roll out mental health first aid to 1 million people in England.
Mr Cunningham
Can the Secretary of State tell us what progress has been made regarding an inquiry into the contaminated blood scandal?
Mr Hunt
I can absolutely tell the hon. Gentleman the answer to that: we have been making very important progress with families over the summer; and we have decided the shape of the inquiry and the leadership of the inquiry and all the factors around the terms of reference need to be decided in close consultation with the affected families. So we are keen to get on as quickly as possible, but we have made some progress in understanding their wishes.
Royston Smith (Southampton, Itchen) (Con)
Jonathan Ashworth (Leicester South) (Lab/Co-op)
Can the Secretary of State tell us how many elective operations he expects to be cancelled by 31 December?
Jonathan Ashworth
I am grateful to the Secretary of State for his answer, but already more than 80,000 elective operations have been cancelled. That is an increase on the past year. A&E attendance is up on the past year, bed occupancy is higher than last year and the Care Quality Commission has today warned that the NHS is straining at the seams. Winter is coming. Last week, the Tory party made spending commitments worth £15 billion, but not 1p extra for the NHS, so will the NHS fare worse or better than last year this winter, or are we set for another winter crisis made in Downing Street?
Mr Hunt
What the CQC actually said this morning is that the majority of health and care systems across the NHS are providing good or outstanding quality; that the safety of care is going up; and that performance is improving. None the less, the hon. Gentleman is right that we are always concerned about winter. Let me tell him the new things that are happening this year to help prepare the NHS: £1 billion more going into the social care system in the most recent Budget; a £100 million capital programme for A&E departments; 2,400 beds being freed up; and an increasing number of clinicians at 111 call centres. A lot is happening, but, overall, let me remind him that our NHS is seeing 1,800 more people every single day within four hours—that is something to celebrate.
Robert Neill (Bromley and Chislehurst) (Con)
John Mann (Bassetlaw) (Lab)
Mr Hunt
That is a very attractive offer, and I am always happy to have a chinwag with the hon. Gentleman. Last week, we announced something that I hope will resolve that, which is that we are looking at holding nurse training courses on-site in hospital and community sites so that experienced healthcare assistants do not have to go to a higher education institution to do their training.
Clive Lewis (Norwich South) (Lab)
Mr Hunt
Accountable care systems are supported by such rabid right wingers as Polly Toynbee, writing in The Guardian, because they are about health systems coming together to co-operate to give the best care for patients. That is what is happening across the NHS, and it is already delivering great results.
Craig Tracey (North Warwickshire) (Con)
This Friday marks Secondary Breast Cancer Awareness Day. In 2015, the Government recognised that data collection for this type of cancer was not good enough. However, research by Breast Cancer Care shows that less than a third of trusts collect the number of people diagnosed with secondary breast cancer. Will the Minister confirm what actions the Government are taking to ensure that all trusts are collecting this information, given its importance to improving outcomes?
Grahame Morris (Easington) (Lab)
Will the Minister abolish the patient penalty and scrap hospital car parking charges, which punish both the sick and hard-working NHS staff, as well as causing problems for residents living adjacent to NHS hospitals, such as Peterlee Community Hospital in my constituency?
Kevin Hollinrake (Thirsk and Malton) (Con)
Antibiotic resistance is a major threat to humanity. Will the Minister outline the progress we have made in opening up the £50 million global antimicrobial resistance innovation fund to applications?
Dr Rosena Allin-Khan (Tooting) (Lab)
There is a crisis in mental health staffing levels. Does the Secretary of State accept that today, throughout the country, there are 2,000 fewer mental health nurses than there were when he took charge five years ago?
Mr Hunt
What I accept is that we have 30,000 more professionals working in mental health than when my Government came into office. There has been a decline in the number of mental health nurses, but we have in place plans to train 8,000 more mental health nurses, and that will make a big difference.[Official Report, 17 October 2017, Vol. 629, c. 6MC.]
Richard Graham (Gloucester) (Con)
The Gloucestershire Hospitals NHS Foundation Trust capital expenditure bid would fund a 24-hour urgent care service, and it would also increase bed capacity and improve hospital performance in Gloucester and Cheltenham, to the benefit of patients throughout the county. When do Ministers expect to announce the results of the bid? Will they take this particular bid into careful consideration?
Kate Green (Stretford and Urmston) (Lab)
GPs in my constituency tell me that because of changes to personal data rules they will no longer be able to charge for providing reports for private insurance and legal claims. Will Ministers update the House on the situation? What assessment has been made of how GPs will cope with the additional costs they will face?
Helen Jones (Warrington North) (Lab)
If nurses or other NHS staff are awarded a pay rise above the current pay cap, will the Government fund that pay rise fully, or will they require it to be met by cuts in patient services?
Mr Hunt
That is something I cannot answer right now, because the latitude that the Chancellor has given me with respect to the negotiation of future pay rises is partly linked to productivity improvements that we will negotiate at the same time. The fact is, though, that we do have that flexibility, and I hope we can get a win-win as a result.
Heidi Alexander (Lewisham East) (Lab)
May I take the Secretary of State back to the issue of nursing associates? Given that evidence shows that for every 25 patients for whom a professionally qualified nurse is replaced by a non-nurse, mortality on an average ward rises by 21%, how comfortable is he with reports that hospitals in Lincolnshire and Leicester are using nursing associates to plug gaps in the nursing workforce?
Bill Esterson (Sefton Central) (Lab)
Under this Government, there has been an unprecedented fall in the number of nurses: the NHS is short of 40,000 nurses and more than 6,000 have gone since 2010, under this Conservative Government. When will the Secretary of State acknowledge that he is failing the NHS and failing patients, and when will he do something about it?
Mr Hunt
With respect, I really think the hon. Gentleman needs to get his facts right. The number of nurses has gone up, not down, since this Government have been in office. The number of nurses in our hospitals has gone up by more than 11,000, because this Government are supporting safer care in all our hospitals.
John Cryer (Leyton and Wanstead) (Lab)
The number of unfilled nursing posts in London is now more than 10,000—whatever the Secretary of State’s figures say, it is more than 10,000. When will they be filled?
Jo Swinson (East Dunbartonshire) (LD)
Suicide is the most common cause of death for men under the age of 45, and men are significantly less likely than women to seek support from loved ones or medical professionals when they have mental health problems. How can services be better targeted at men to encourage them to seek help more quickly and thereby reduce misery?
Mr Hunt
This is a very important issue and the hon. Lady is right to raise it. The Time to Change campaign has said that this year it will focus on men, specifically to try to address the issues she mentioned. We are rolling out crisis plans throughout the country to make sure we are better able to reach people who reach out to us.
Mike Amesbury (Weaver Vale) (Lab)
What reassurance can the Secretary of State give to the Amplify youth project in Northwich in my constituency that timely and improved access to mental health services will be provided?
Mr Hunt
We have said that by 2020-21 we want to be treating an extra 70,000 young people every year, but the truth is that that is still not enough. We need to bring down waiting times much more dramatically, which is why we are doing a lot of work across Government and we have a Green Paper coming out shortly.
James Frith (Bury North) (Lab)
Newly released NHS guidance makes it clear that walk-in services can have a future as part of urgent treatment centres. Does the Secretary of State agree with me and thousands of patients in Bury North that Bury walk-in centre can, should and must stay open and that Bury CCG should ensure this when it concludes its review?
Mr Geoffrey Robinson (Coventry North West) (Lab)
Is the Secretary of State aware that there is widespread support in the House for his Government’s commitment to enact the principle of deemed consent for organ donation? He knows from a previous meeting that my private Member’s Bill is due for its Second Reading early in the new year. Will he therefore agree to an early meeting now, so that we can co-ordinate the two and see how to advance his intentions? I know that my hon. Friend the Member for Barnsley Central (Dan Jarvis) will be with me again and, with the Secretary of State’s commitment to this, we look forward to an early meeting.
Mr Hunt
I very much enjoyed our previous meeting, which was not so very long ago. I hope the hon. Gentleman is happy that we have made good progress since that meeting, with the Prime Minister announcing that we will start a consultation, but I am always happy to see him and his colleague the hon. Member for Barnsley Central (Dan Jarvis).
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
The Secretary of State will be aware that he and he alone has responsibilities under the Health and Social Care Act 2012 to deal with referrals from local authorities of clinical commissioning group decisions. Almost a year ago, Stoke-on-Trent City Council and Staffordshire County Council referred a matter to the Minister regarding the closure of community care beds. To date we have had no response. Letters from me and my hon. Friend the Member for Stoke-on-Trent North (Ruth Smeeth) have gone unanswered. When will we get a response? Is this a case of wilful indifference towards his responsibilities or just ignorance of the Act?
Mohammad Yasin (Bedford) (Lab)
Yesterday the private ambulance service that provided non-urgent patient transport at Bedford hospital ceased trading, leaving the East of England Ambulance Service NHS Trust to pick up the pieces. Will the Minister order an inquiry to establish what went wrong, and does he agree that using private companies to run key services for our NHS is simply not working?
Mental Health Act Review
Jeremy Hunt Excerpts(7 years, 2 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
The Government have commissioned an independent review of mental health legislation and practice to tackle the issue of mental health detention.
There have been concerns that detention rates under the Mental Health Act are too high. The number of detentions has been rising year on year, and last year on average there were 180 cases a day where people were sectioned under the terms of the act. People from black and minority ethnic populations are disproportionately affected, with black people in particular being almost four times more likely than white people to be detained.
The Government are committed to improving mental health services and ensuring that people with mental health problems receive the treatment and support they need, when they need it. This can mean that people need to be made subject to the Mental Health Act—that is, be detained or ‘sectioned’. In these cases, our dedicated professional staff—including psychiatrists, nurses, social workers, and the police—work tirelessly to ensure that people are treated with dignity under the Act, and that their liberty and autonomy are respected as far as possible.
Professor Sir Simon Wessely, former president of the Royal College of Psychiatrists, will lead the review which will deliver recommendations for change to the Government. Sir Simon will look at the evidence, review practice, and above all consider the needs of service users and their families, and how best the system can help and support them. He will identify improvements in how the Act is used in practice, as well as how we might need to change the Act itself. Vice chairs will be appointed to work with Sir Simon and ensure the leadership of the review has comprehensive professional expertise whilst also being representative of service users and others affected by the Mental Health Act.
Following consultation with stakeholders, Sir Simon will produce an interim report identifying priorities for the review’s work in early 2018, and develop a final report containing detailed recommendations on its priorities, by autumn 2018.
Further detail on the independent review, including its terms of reference, can be found at:
https://www.gov.uk/government/news/prime-minister-announces-review-to-tackle-detention-of-those-with-mental-ill-health.
[HCWS143]
NHS Pay
Jeremy Hunt Excerpts(7 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I thank the shadow Health Secretary for introducing this debate. NHS staff are doing a superb job in tough circumstances, and it is right for this House to debate whether we are giving them an appropriate level of support.
I start by addressing the areas on which we agree with the Opposition. First, it is incredibly important to have motivated staff, simply because motivated staff give better care to patients. It is critical for patient safety that we have enough staff in our NHS and social care system, so recruitment and retention matter. It is also true that, right now, it is very tough on the frontline for NHS staff as they cope with the pressures of an ageing population, of financial constraints that have not been as tough in many years, and of changing consumer expectations of what the NHS should deliver. We agree on all that, but there are some fundamental disagreements that I also need to surface.
The shadow Health Secretary talks about the former 1% cap and the pay restraint that we have indeed had for the last seven years, which his party frequently characterises as austerity—some ideological mission by the Conservatives to reduce the size of the state. [Interruption.] I can see some nods, but it is absolute nonsense.
I remind Labour Members that in 2010 we inherited the worst financial crisis in our history and the worst recession since the great depression. The shadow Health Secretary was an adviser to Gordon Brown in 2010—he does not talk about that very much—and he knows just how serious the crisis was. He uses the phrase “Tory economics,” but the 2010 Labour manifesto, which he may well have had a hand in drafting, wanted to cut the NHS budget. The Health Secretary at the time, Andy Burnham, said that it would be “irresponsible” not to cut the NHS budget.
In 2015, five years on from that terrible crisis, the Labour party wanted to put £5.5 billion less into the NHS than the Conservative party did. In short, the austerity that the shadow Health Secretary criticises today is austerity that Labour wanted to go much further with when it comes to the NHS. Labour needs to recognise that if we had followed its advice we would not even have been able to honour a 1% pay rise, we would not have been able to recruit 12,000 more nurses for our wards, we would not have record numbers of doctors and we would not have record funding for the NHS.
Catherine West
Will the Health Secretary apologise for the current dreadful state? We have thousands and thousands of nurse places, and hospital trusts are having to go as far as the Philippines to recruit student nurses. Student nurses are coming out of university with £56,000 fees. NHS recruitment and retention is in a deep crisis. Will he apologise?
Mr Hunt
What I will not apologise for is the dreadful short staffing on NHS hospital wards that we inherited in 2010, which led directly to the problems of Mid Staffs. Nor will I apologise for sorting that out and making sure that we have 12,000 more nurses on our hospital wards today than we had in 2010.
Alison McGovern
The Secretary of State is repeating words that the Tories have used to excuse their cuts for years but that have not dealt with the deficit, which is still with us. My constituents do not care about that; they care about Eastham walk-in centre, which is closed because of staff shortages. Will he answer this simple question? When will Eastham walk-in centre reopen?
Mr Hunt
What the hon. Lady’s constituents care about is that today we announced the lowest unemployment level since 1975, which is a massive benefit to her constituents. She says that we have been repeating our reasons for this terrible financial discipline, which has been so difficult. I am not someone who says that the entire responsibility for the recession in 2010 is the Labour party’s. I recognise that it was a global crash, but what Labour cannot deny is that the recession we faced here was far, far worse than in other countries. Why is that? What did the Governor of the Bank of England say at the time?
Several hon. Members rose—
Mr Hunt
Hang on. I think it is important to listen to what the Governor of the Bank of England said. Sir Mervyn King said:
“we came into this crisis with fiscal policy along a path that was not…sustainable and a correction was needed.”
What was he talking about in 2010? The Government borrowed £1 in every £4 that they spent. The deficit was 10.2%, the highest since records began. The reason that, say, Germany did not have to go through austerity is not because a German equivalent of the Leader of the Opposition was throwing prudence to the wind but because Germany did not allow its public finances to get recklessly out of control, which is what happened under the Labour Government.
Ms Karen Lee
This is a genuine question. I am a nurse, and I see the situation at first hand. I go to work once a month—I still do bank shifts—and the situation is truly awful. We are so understaffed that it is unbelievable. I looked after 10 patients on my last shift. That is not for the audience; it is the truth. The NHS is in that sort of state. Lincoln’s walk-in centre is threatened with closure. All that is going on. I take the Secretary of State’s point about paying for it, but the Conservative party talks about cutting corporation tax and it is paying the Democratic Unionist party more than £1 billion. While that is happening, he cannot talk to us about austerity and say that we cannot have decent NHS services. I am sorry, but he should listen to what I am saying. The NHS really is in crisis.
Mr Hunt
I thank the hon. Lady for her work in the NHS. I am honoured that we have nurses on both sides of the House who do a fantastic job. I agree that we need more nurses. We needed more nurses when I became Health Secretary—the NHS was planning to lose nurses, and I stopped that—and we still need more nurses. I will explain exactly how we will get those nurses.
Several hon. Members rose—
Helen Whately
Opposition Members are raising concerns about staff shortages and about recruiting staff from overseas. I am sure we all have hospitals serving our constituents that have had to go overseas to recruit. We do not want to see that; we want to see nurses trained in the UK and British nurses. I welcome the fact that the Secretary of State has taken action to remove the cap on nurses in training so that we can train more home-grown nurses.
Robert Halfon (Harlow) (Con)
I thank my right hon. Friend for the huge and strong support he has given to Princess Alexandra hospital in Harlow and to our campaign for a new hospital. I welcome the moves the Government are making on the pay cap and I look forward to announcements in the coming weeks. May I urge him to do even more than the Government are doing on nursing apprenticeships, because they are one key way forward? These apprentices do not have any loans and they can do nursing. Finally, let me make the wider point that one of the best ways of helping lower-paid nurses, and everyone in the public and private sectors, is by continuing to do what the Government are doing by cutting taxes for lower earners and acting through the national living wage.
Several hon. Members rose—
Mr Hunt
I am going to make some progress and then I will give way further. I want to talk about the recruitment issues raised by the hon. Member for Hornsey and Wood Green (Catherine West) and others, but I wish to conclude on the point about financial discipline, of which Opposition Members are so critical. The consequences for a Government of losing financial discipline are not just pay freezes and 1% caps, but 1 million people unemployed—as a result of that recession post-2008. Every Labour Government in modern times has left office with unemployment higher than when they arrived. That is why this afternoon’s motion is so bogus, because the difference between the Government and the Opposition is not about a desire to invest in public services; it is about the ability to deliver a strong economy so that we can make that investment.
Mr Hunt
I want to make some progress on the recruitment issues, which a number of hon. Members have raised. The argument we seem to be hearing from the shadow Health Secretary is that Labour’s policies would mean more nurses for the NHS and better care for patients, but nothing is further from the truth. Let us look at Labour’s policies at the last election. What did the independent Institute for Fiscal Studies say then about Labour’s spending plans? It said there was a black hole of up to £29 billion, which made even Gordon Brown look like the paragon of prudence that he never was. How can a black hole like that be filled? There are only two ways of doing it. The first is by raising taxes on ordinary people—this is what the IFS said would be one of the biggest tax increases in the past 30 years, equivalent to a 7% increase in income tax. For a nurse on average earnings, this would be a £1,400 tax hike every year. Alternatively, the hole could be filled by increasing borrowing, but that simply passes on debts to future generations in a con as explicit as the con of telling students before an election that their debt will be waived only to cancel the promise after the election.
Julian Knight (Solihull) (Con)
My right hon. Friend does not even need to cite the IFS to see what things would be like with Labour in charge of the UK NHS—he just needs to look to Wales, where the NHS has been cut by 10% and one in seven people are on the NHS waiting list. That is Labour in action.
Mr Hunt
My hon. Friend is absolutely right about that. The whole problem with the tone of the argument made by the shadow Health Secretary is that he is saying that the difference between the Government and Labour is about our support for public sector workers, but we all agree, in all parts of the House, that they do a fantastic job. I see that in the NHS every week. The difference between us and Labour is about knowing what harms public sector workers the most; it is between ignoring and repeating the mistakes of the 2008 crash, as Labour Members are, and what we think, which is that we need to learn from those mistakes and not repeat them.
James Heappey
Does my right hon. Friend agree that Labour was not the only party with an irresponsible policy at the general election on funding health and social care, and that although the Liberal Democrats can muster only one MP to debate this important subject today, their 1p on income tax gimmick would have gone nowhere far enough to funding the properly increased services they promised?
Lady Hermon
Will the Health Secretary take a few moments to address the serious issue of staff morale in the NHS? In Northern Ireland, we have no Assembly and, thus, no Health Minister, so there is no mechanism by which to give our nurses any pay increase. He needs to speak to the Secretary of State for Northern Ireland, as a start, and to address the crucial and concerning issue of staff morale, which is affected by low pay and the pay cap.
Several hon. Members rose—
Mr Hunt
I will make some progress now, because I know that lots of people want to speak in this debate.
The other completely bogus claim we have heard this afternoon is that somehow the financial discipline of pay restraint that we have had to have has been deliberately targeted at ordinary people. Again, that is absolute nonsense, as we see when we look at what has happened. Despite the recession and the pressures on public finance, this Government have taken 4 million of the lowest-paid people out of income tax altogether. At the same time, the top 1% are paying more and the top 20% are paying more, and we have gone further, introducing the national living wage, which since its introduction in April has increased the pay of people at that level of pay by £1,400 per annum. The record overall—this is where we see the most obnoxious untruth spread by the story on austerity—shows that over the past seven years we have seen 600,000 fewer people in absolute poverty and 200,000 fewer children in absolute poverty. Income inequality has reduced to its lowest level for 30 years. Why is it that this apparently evil Tory Government have reduced inequality? It is because we have done what Labour never does, which is grow the economy, with 1 million new businesses, 3 million new jobs and unemployment at its lowest since 1975. Today, youth unemployment is below 5% for the first time and there has been a 40% drop since 2010.
Several hon. Members rose—
Mr Hunt
I am going to make some progress, because I want to deal with the issue of morale, and then I will give way for a final round of interventions.
A lot of comments have been made about the NHS being at breaking point, at a tipping point and so on. There is huge pressure on the NHS, but, as has been said by my right hon. Friend the Member for Broxtowe (Anna Soubry), who is no longer present, that is not the whole picture. What the shadow Health Secretary did not say is that 7,000 people are alive today who would not have been had we stayed at the cancer survival rates of just four years ago. We are having probably the biggest expansion of mental health treatment in Europe, and an independent NHS England report says that for most major conditions outcomes have dramatically improved over the past three, five or 10 years.
Norman Lamb (North Norfolk) (LD)
I feel that as the sole Liberal Democrat present it is my duty to intervene. Does the Secretary of State accept, as a principle, that ultimately we cannot sustain the NHS on the back of real-terms cuts to people’s pay within the NHS and that that would be unconscionable year after year? Does he also accept that as the difference between public and private sector pay narrows so much, people will just vote with their feet and leave? Therefore, not only is this morally wrong, but it will not work ultimately.
Mr Hunt
I agree with the right hon. Gentleman that when deciding policy on pay we absolutely have to look at the impact on recruitment and retention, and that if we are going to deal with the pressures of an ageing population in the way that he and I would both want, we are going to need to recruit many more doctors and nurses for the NHS over the years ahead.
The progress that we have made in the NHS in improving outcomes for patients, despite the huge pressure on the frontline, is possible because of the brilliant staff we have in the NHS. I want to recognise that pay restraint has been extremely challenging, which is why yesterday my right hon. Friend the Chief Secretary to the Treasury announced a new policy, allowing Departments flexibility where there are recruitment and retention issues, and where productivity savings can be found. We will also honour the commitment we made prior to yesterday’s announcement, which was that before we take any decisions we will listen to the independent advice of the pay-review bodies.
To value staff also means to look at non-pay issues as well. It means we should look at making sure that we are training enough staff, so that when hospitals have the budgets to employ staff, they are there for them to employ; it means we should look at flexible working—on which, frankly, the NHS can do a lot better—if we are to tackle the agency bill that the shadow Health Secretary spoke about; it means we should put in place measures to encourage nurses to return to practice, which is why Health Education England is increasing the number of return-to-practice training places to 1,250 from 2019-20; it means we should look at new support roles for nurses, such as the 2,000 nurse associates who are starting training this year; and it means we should look at new routes into nursing, such as the nurse apprentice route that we are opening this year.
Mr Hunt
I am going to wind up my comments now, because lots of people wish to speak. [Hon. Members: “Oh!”] Okay, the House has persuaded me. I shall give way first to the hon. Member for Hornsey and Wood Green (Catherine West) and then to my hon. Friend the Member for Redditch (Rachel Maclean).
Catherine West
I thank the Secretary of State for his generosity in giving way to me twice. Will he look again at the issue of student bursaries? It is such mistake.
Mr Hunt
I assure the hon. Lady that we are making reforms because we want to train more nurses and to fund more nurse training places. There has been a dip in the number of people taking up nurse training places this year, as there was when the higher education reforms were introduced in 2012, but it recovered soon after that and we now see in other parts of higher education record numbers of students from poorer backgrounds going to university.
Rachel Maclean
On my right hon. Friend’s earlier point about the recruitment and retention of staff, one problem, which I know from having spoken to the Worcestershire Acute Hospitals NHS Trust and the Alex Hospital in my constituency, is the constant negative messaging the public receive. Members from all parties deeply back NHS workers, appreciate and respect how hard they work, and recognise the challenges. If Opposition Members really care about easing the recruitment and retention crisis, I call on them to join us in talking about some of the good news and the good messages that are coming out of the NHS. Those are the things that get through to the public’s mind and that encourage nurses to join the profession, and that is why we have twice the number of applicants for nursing places this year.
Mr Hunt
My hon. Friend is absolutely right. From some of the debates we have in this House, a person would never know that in July, for the second time running, an independent American think-tank looked at health systems in all the world’s major countries, compared us with the United States, Germany, France, Australia and others, and said that the NHS was top—the best healthcare system of any major country. We have a huge amount to be proud of.
Several hon. Members rose—
Mr Hunt
I am going to conclude my comments by asking three questions. First, who is the real friend of public sector workers—the party that wrecked the economy, leading to massive cuts, or the party that turned the economy around with 3 million new jobs? Who is the real champion of public services—the party that did not only wreck the public finances but wants to do so all over again, or the party that is restoring discipline to the public finances so that we can start to invest more in our public services? Who is the real friend of the NHS—the party that has delivered more doctors, nurses and funding than ever before in its history, or the party that plays politics with the NHS in election after election, despite doing it so much harm?
NHS Transformation: Investment
Jeremy Hunt Excerpts(7 years, 5 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
This Government are backing the NHS’s own plan for the future, the Five Year Forward View, and funding it with an additional £8 billion a year in real terms by the end of the Parliament. Delivering that vision relies on health and care organisations working together at a local level, which the NHS is taking forward through sustainability and transformation partnerships. These are clinically led, locally driven—and can deliver real improvements for patients. The independent King’s Fund has called STPs “the right approach for improving care and meeting the needs of an ageing population”.
In the spring Budget the Chancellor of the Exchequer announced an additional £325 million of capital funding to invest in local areas who have come together and developed robust plans.
Today, I announce the provisional allocation of this first tranche of capital funding. From a large number of proposals, 25 schemes have been selected in total from across the 15 STP areas as follows:
Greater Manchester
Lancashire and South Cumbria
Dorset
Leicester, Leicestershire and Rutland
Milton Keynes, Bedfordshire and Luton
Derbyshire
West, North and East Cumbria
Nottinghamshire
Suffolk and North East Essex
Herefordshire and Worcestershire
South Yorkshire and Bassetlaw
Mid and South Essex
Norfolk and Waveney
Buckinghamshire, Oxfordshire and Berkshire West
North East London
Further detail on the schemes that will receive funding is available as an online attachment.
In order to qualify for this first tranche of funding, these areas were all judged to be sufficiently advanced on the basis of the STP assessment data (that NHS England will publish on Friday). This data allows patients, managers and the public to see how their STP area is performing across three themes: hospital performance, patient-focused change, and transformation. Each theme is underpinned by key metrics, such as performance in emergency and elective care, safety and leadership. It is a mechanism by which organisations, patients and the public can hold their STP to account.
The quality and diversity of proposals put forward show that the NHS is working innovatively to identify opportunities for transformation in the delivery of health services across their local footprint. The Government are fully committed to supporting this process and the schemes selected for funding will make a substantial difference to the performance of local health systems.
Final confirmation of this funding will be subject to the successful approval of business cases. Organisations receiving funding will also be required to demonstrate that their proposals form part of a robust capital and estates strategy which maximises all opportunities for generating receipts from surplus land disposals within their STP area. We will also expect them to agree a clear delivery plan for generating these receipts. This process will be supported by a central team of strategic estates advisers
The Government remain committed to considering a further round of local proposals for funding in the autumn Budget, subject to the same rigorous value for money tests. In considering these bids we will look to STPs to demonstrate further progress on generating funding from disposals receipts and other sources of finance.
Attachments can be viewed at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statements/Commons/2017-07-19/HCWS71/.
[HCWS71]
Medicines and Healthcare Products Regulatory Agency
Jeremy Hunt Excerpts(7 years, 5 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
On Wednesday 12 July, Ministers at the Department of Health were informed by the Medicines and Healthcare products Regulatory Agency (MHRA) about an issue identified during a routine inspection of Bio Products Laboratory (BPL). The MHRA provided confirmation on Monday of this week that, in light of all of the information currently available, their assessment is that no patients have been harmed and none put at additional risk of harm due to the issue.
BPL is responsible for the supply of a range of plasma products to the NHS and a range of other major health systems around the world. The company, in line with best practice, operates a three stage process to ensure the safety of its products:
1. Selection of healthy donors, with all donations tested and traceable to the donor.
2. Further safety tests of plasma in advance of the manufacturing process.
3. During the manufacturing process, all products are specially treated to inactivate viruses.
The MHRA informed Ministers that their inspection identified a problem with the computer software, which controls the stage one process set out above. Following the identification of the issue by the MHRA, a manual review was undertaken by the company to ensure that no inappropriate donations made it through this stage of the process due to the problems with the computer system. This manual review confirmed that no inappropriate samples had made it through to the next stage of the process, and a range of other risk mitigation steps were also implemented.
The MHRA have continued to provide progress updates to Ministers regularly since notification on 12 July.
On Monday of this week the MHRA confirmed to Ministers their assessment that the problem had been addressed through interim measures to provide the necessary assurance while long-term solutions are being implemented. In the opinion of the MHRA, due to the three stage process outlined above, and in light of all of the information currently available, no patients have been harmed and none put at additional risk of harm due to the issue.
The MHRA is continuing to undertake all necessary regulatory activities in order to ensure patient safety, and will continue to keep Ministers informed of this work.
Although there is no evidence of risk to patients in this case, in the interest of transparency, I wanted to update the House to this situation as quickly as possible with the relevant information. In the unlikely event of any changes, I will update the House accordingly.
[HCWS70]
Annual Assessment of NHS England
Jeremy Hunt Excerpts(7 years, 5 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
Today, I am laying before Parliament my annual assessment of the NHS Commissioning Board (known as NHS England) for 2016-17. A copy is available as an online attachment. This draws on and responds to NHS England’s annual report and accounts 2016-17, which were laid earlier today (HC101).
The Government’s mandate to NHS England sets out the steps that we expect it to take to help deliver our shared vision for the safest, most compassionate, highest quality health system in the world. We recognise that this can only be achieved through the outstanding contribution that the 1.3 million NHS staff across the country make each and every day in delivering care and support for patients, and I would like to pay tribute to their diligence, professionalism and expertise.
NHS England’s annual report sets out the progress made in delivering the mandate. It describes an organisation that continues to ensure that high-quality care is delivered in the face of rising public demand and cost pressures across the system, and emphasises the need to deliver the next steps on the five year forward view to address these challenges. The Government support the NHS’s plan, including the development of clinically led and locally supported sustainability and transformation partnerships.
My annual assessment welcomes the good progress that has been made in challenging circumstances, while recognising that there remains a great deal more to do, particularly to improve quality, access and safety while maintaining financial sustainability for the future.
NHS England’s core aim is to deliver excellence in access and outcomes for patients and, this year, substantial advances have been made across a number of areas, including mental health, maternity care and diabetes prevention. NHS England has also made a significant contribution to overall financial balance in the NHS.
However, continued growth in demand has put pressure on services and the NHS is not meeting core patient access standards. This remains a key priority and, to help address this, in 2017-18 NHS England will need to better manage demand, including by working with local government to ensure patients are transferred to more appropriate care when they are fit to leave hospital. To support this, the Government have provided an extra £2 billion for local authority-funded adult social care over the next three years, with £1 billion available in 2017-18.
My assessment sets out the Government’s expectation that the NHS will make further progress in the year ahead on achieving parity of esteem for mental health. Continuing the constructive joint working with NHS Improvement and Health Education England to better manage the challenges the NHS experiences over winter, as well as continuing progress to retain and increase the workforce, will be key. We will also look to NHS England, working with NHS Improvement, to deliver a balanced NHS budget.
We will continue to work closely with NHS England to address the significant challenges ahead and provide a sustainable and efficient health service with quality, transparency and safety at its heart.
Copies of my annual assessment and NHS England’s annual report will be available from the Vote Office and Printed Paper Office.
Attachments can be viewed online at: http://www.parliament. uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-07-18/HCWS64/
[HCWS64]
Ambulance Response Programme
Jeremy Hunt Excerpts(7 years, 5 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I am today announcing the publication of the University of Sheffield report on the ambulance response programme and subsequent recommendations by Sir Bruce Keogh, NHS England’s national medical director. The report evaluates a series of pilots that I announced to the House in my written statement of 6 January 2015, intended to support ambulance services in England to maintain and improve clinical outcomes for patients in the face of unprecedented increases in demand. Copies of the report and Sir Bruce’s recommendations are attached.
Based on the extensive evidence base detailed in the report, NHS England is proposing a new framework of ambulance performance standards and related operational changes that are focused on patients’ clinical needs and will help the service to operate more efficiently. In particular:
enabling ambulances to dispatch resources much more clearly based on the clinical needs of patients ensuring the consistent delivery of very rapid responses to those who genuinely need them, through putting in place a four tier response time based on the clinical needs of patients;
introducing specific standards for stroke and heart attack, aimed at ensuring patients start the right treatment in hospital as quickly as possible;
improving performance management of “tail” waits by introducing mean and 90th centile measures; and,
achieving greater consistency and transparency for less urgent calls by bringing all response standards into a consistent national framework.
These ambulance response times are more stringent than anywhere else in the UK. Moreover, evidence from the pilots suggest that these changes will be beneficial for rural populations, narrowing the gap which currently exists in the time it takes for an ambulance resource to transport patients to hospital.
In my statement in January 2015 I said I would apply the following three tests before extending the ambulance response programme:
there is clear clinical consensus that the proposed change will be beneficial to patient outcomes as a whole, and will act to reduce overall clinical risk in the system;
there is evidence from the analysis of existing data and piloting that the proposed change will have the intended benefits, and is safe for patients; and,
there is an associated increase in operational efficiency. The aim is to reduce the average number of vehicles allocated to each 999 call and the ambulance utilisation rate.
I have accepted Sir Bruce’s advice that these tests have been met. I am authorising NHS England to implement the ambulance response programme recommendations in all ambulance services in England so that patients across the country will benefit from the improvements seen in the pilot ambulance services.
1. Report on Ambulance Response Programme (ARPReport_Final.pdf)
2. Letter with Sir Bruce Keogh's recommendations (13.7.17 Jeremy Hunt - Ambulance Response Programme letter.pdf)
The above documents can be viewed online at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-07-13/HCWS45/ .
[HCWS45]
Oral Answers to Questions
Jeremy Hunt Excerpts(7 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Alistair Carmichael (Orkney and Shetland) (LD)
1. What recent discussions he has had with the Home Secretary on ensuring that the NHS has the workforce it needs after the UK leaves the EU.
The Secretary of State for Health (Mr Jeremy Hunt)
The 150,000 EU nationals working in our health and care services do a brilliant job and we want them to continue doing it. I am in regular talks with Cabinet colleagues to inform both domestic workforce plans and the Government’s negotiations with the EU.
Mr Carmichael
The Secretary of State will be aware that that figure represents in excess of 5% of the total workforce in the NHS. This matter will have to be addressed, engaging with the recruitment sector, the employment sector and, indeed, the devolved Administrations. Is that how he will handle it?
Mr Hunt
We absolutely will be taking a UK-wide approach. The numbers for England are actually slightly higher than those the right hon. Gentleman talks about—about 9% of doctors and about 19% of nurses are EU nationals. However, we are still seeing doctors and nurses coming to the UK, and we need to do everything in all parts of this House to reassure them that we see them as having a bright and vital future in the NHS.
Sir Desmond Swayne (New Forest West) (Con)
If students with four As at A-level continue to find it very difficult to get into a medical degree in this country, is it any wonder that we have to import them from Europe?
Mr Hunt
My right hon. Friend makes a very important point. That is precisely why last year we increased the number of medical school places with, I think, the second biggest hike in the history of the NHS—a 25% increase. We absolutely do believe that this country should be training all the doctors and nurses that we need.
Heidi Alexander (Lewisham East) (Lab)
The truth is that EU staff no longer want to come here. Doctors and nurses are leaving in their droves, and thanks to the abolition of the NHS bursary, our nurses of tomorrow are going to have to pay to train. When will the Secretary of State understand that this staffing crisis has not materialised out of thin air but is directly attributable to his actions and the actions of his Government over the past seven years?
Mr Hunt
The hon. Lady may have noticed a little thing called Brexit that happened last year, which is the cause of understandable concern. If she looks at the facts about how many doctors came from the EU to the NHS in the year ending this March, in other words, post-Brexit, she will see that 2,200—[Interruption.] Someone asked about nurses. I happen to have that information here: 4,000 nurses joined the NHS from the EU in the year ending in March.
Dr Andrew Murrison (South West Wiltshire) (Con)
One of the consequences of free movement in the European Union is that proportionately we take in rather fewer doctors, in particular, and fewer nurses from the Indian subcontinent and other places. What assessment has the Secretary of State made of the capacity to revisit the strong relationship we had with those workforces in the immediate post-war years?
Mr Hunt
My hon. Friend makes an important point. We want to attract the brightest and best into the NHS from all over the world, wherever they come from, if there is a need. The only caveat I would make is that we have imported a number of doctors from very, very poor countries that actually need those skills back home. We have to recognise that we have international responsibilities to make sure that we train the number of doctors and nurses we need ourselves.
Mr Chris Leslie (Nottingham East) (Lab/Co-op)
The Secretary of State should know that staff shortages are not just bad for patients—they are also costing a lot more, in Nottingham and elsewhere, because of locum and agency costs. Is it not clear that if we start restricting access from the EU for staffing purposes, it will cost the NHS an absolute fortune more?
Mr Hunt
Let me reassure the hon. Gentleman that there is no intention to restrict access to vital professions such as the clinical professions in the NHS post-Brexit. We have said many times that we will have a pragmatic immigration policy. The long-term solution is not to depend on being able to import doctors and nurses from anywhere, because the World Health Organisation says that there is a worldwide shortage of about 2 million clinical professionals; we are not the only people facing the challenge of an ageing population.
Mrs Maria Miller (Basingstoke) (Con)
I welcome the Secretary of State’s words and his deeds in terms of recruiting more doctors and nurses domestically, but as he said, hospitals such as mine in Basingstoke rely on the best and the brightest from around the world. What can he do to make sure that when we need to recruit nurses, in particular, we have the travel permits and work permits available to enable them to move in swiftly rather than having to wait for long periods of time?
Mr Hunt
My right hon. Friend is absolutely right to make that point. Nurses are, in fact, on the Home Office’s tier 2 shortage occupation list, and they will remain so for as long as we need them to do so. The bigger issue is that for a long time we have relied on being able to import as many doctors and nurses from the EU as we need to, and that has meant that we have not trained enough people ourselves. That is bad for EU countries and for our own young people.
Justin Tomlinson (North Swindon) (Con)
2. What steps are being taken to increase the supply of doctors and nurses in the NHS.
Mr William Wragg (Hazel Grove) (Con)
12. What steps his Department is taking to increase the number of doctors and nurses working in the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
Last year this Government announced one of the biggest expansions of medical training places in the history of the NHS, involving funding 1,500 additional medical school places every year—of which 500 start this September—and reforms that will enable universities to offer up to 10,000 additional nurse training places every year.
Justin Tomlinson
Swindon clinical commissioning group secured pilot funding for its successful video campaign to recruit additional GPs to fill vacancies in our local community. Will the Secretary of State commit to exploring further innovative ways to match newly qualified staff to vacancies that they might not have considered?
Mr Hunt
My hon. Friend makes a really important point. In parts of the country, GP shortages have been successfully addressed as the CCG has done in Swindon. An important part of this is persuading people who go into medicine that general practice is one of the most exciting and rapidly changing parts of medicine today. We have seen a 9% increase in the number of medical students choosing to go into general practice since 2015.
Mr Hunt
I heard a lot about Stepping Hill when I went to visit my hon. Friend; I think it was last year. I had the privilege of visiting the hospital more recently after the horrific terrorist attacks, and I commend the hospital for the brilliant work that it did in the wake of the bomb. The hospital has done a good job of recruiting; I think it has recruited 93 more doctors and nearly 300 more nurses since 2010. A national programme to help all trusts to retain their nursing staff has been launched by NHS Improvement in the last week.
Dr Rosena Allin-Khan (Tooting) (Lab)
In this country, we are short of approximately 40,000 nurses, and applications for nursing places have gone down by 23%. Can the Secretary of State tell us why he and his Government think that that is the case?
Mr Hunt
The hon. Lady happens to work in an NHS hospital in which there has been a big increase in the number of nurses. Across the country, there are actually 13,000 more nurses working on our wards than there were in 2010, but she is right: we need more nurses and nursing staff, and that is why we are expanding the number of nurse associates. This year we are, for the first time, opening up an apprenticeship route into nursing, which means that people from non-traditional backgrounds—particularly band 3 healthcare assistants—will find it much easier to get into nursing. That is how we will expand the workforce.
Derek Twigg (Halton) (Lab)
According to the latest NHS indicators published by the House of Commons Library last week, the number of GPs is estimated to have fallen over the past 12 months, and the figures for March 2017 are expected to show a further fall. Why is that?
David Tredinnick (Bosworth) (Con)
May I congratulate my right hon. Friend on serving as Health Secretary for three Parliaments, and say to him that besides doctors and nurses, he should look to increase the use of properly regulated acupuncturists, herbalists, homeopaths, chiropractors and osteopaths, who would reduce the burden on doctors and nurses in the health service.
Dr Philippa Whitford (Central Ayrshire) (SNP)
When the Government removed the nursing bursary and introduced tuition fees, the Secretary of State said that it was being done, as he has repeated this morning, to fund 10,000 extra student nurse places. The universities are saying that no extra places have been commissioned, however, so when will we see an expansion of student nurse training?
Mr Hunt
I always welcome the hon. Lady’s forensic interest in matters south of the border, but given that Scotland has just seen its first fall in life expectancy for over 100 years, she might want to think about her own constituents. With respect to the number of nurses, we now have more than 50,000 nurses in training, and we are confident that we will deliver a big increase in the supply of nurses to the NHS.
Dr Whitford
We still have a nursing bursary and we have no tuition charges, so the Secretary of State may want to explain why universities claim there are no additional places. In addition, we are losing almost half of junior doctors at the end of their foundation years. What action is the Secretary of State taking to find out why?
Mr Hunt
At the heart of this is the need to open up avenues for more flexible working for both doctors and nurses. If the hon. Lady followed what we have done in England—by successfully pioneering such working, we have reduced agency spend by 19% in a year, whereas it is still going up in Scotland—she might find the NHS in Scotland has more money to spend on her own constituents.
Rachel Maclean (Redditch) (Con)
Will the Secretary of State confirm what specific actions he is taking to help trusts, such as the Worcestershire Acute Hospitals NHS Trust that runs the Alex hospital in my constituency of Redditch, which are in special measures? Such trusts face special pressures in recruiting and retaining staff.
Mr Hunt
I welcome my hon. Friend’s first question to me. I am very aware of the issues faced by the Worcestershire Acute Hospitals NHS Trust, which I visited during the difficult winter period that it has just come through. It now has a new chief executive and leadership team, who have made a very promising start. From the experience of many other hospitals that have been through difficult patches, we have found that it is usually never about the commitment of staff, but about getting the right leadership in place. I can assure her that I saw outstanding commitment from the staff of the trust.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
The number of nurses has fallen for the first time in a decade, which is why we need fair pay now. I read in the newspapers that the Health Secretary now supports the Labour party policy of scrapping the cap, although he did not vote with us last week. Given that he supports our policy, when he soon sets the remit for the NHS Pay Review Body, will he tell it to scrap the cap, and will he publish his instructions before the summer recess?
Mr Hunt
I did not vote for the hon. Gentleman’s amendment, because—as usual—Labour Members have told us a lot about how they want to spend the money, without having the faintest idea of where it will come from. He is ignoring an elephant in the room: if we had followed the spending plans he campaigned for in 2015, the NHS would have £2.6 billion less this year, which is the equivalent of 85,000 fewer nurses.
Jonathan Ashworth
I want to talk about the spending plans for 2017, in which the Secretary of State can find £1 billion for Northern Ireland, but nothing for nurses in England. Would it not be fairer not to go ahead with further cuts to corporation tax, and to put that money towards giving our doctors and nurses a fair pay rise?
Mr Hunt
Let me tell the hon. Gentleman what extra money is going into the NHS: three years ago, £1.8 billion, which was not asked for by Labour; two years ago, £3.8 billion, which is nearly £1 billion more than Labour was promising; and this year, £1.3 billion. That is a lot of extra money. Why is it going in? Because, under this Government, we have created nearly 3 million jobs, and that strong economy is funding an improving NHS.
Rebecca Pow (Taunton Deane) (Con)
3. What steps he is taking to increase the number of dermatologists in the NHS.
Jeremy Lefroy (Stafford) (Con)
7. What steps he has to secure the future of accident and emergency departments.
The Secretary of State for Health (Mr Jeremy Hunt)
Last year our A&Es saw 1,800 more people every day within the four-hour target than they did in 2010. We also have nearly 1,500 more emergency care doctors and over 600 more emergency care consultants.
Jeremy Lefroy
A&E departments and associated acute care services at district hospitals such as Stafford and Burton are a critical part of the regional emergency infrastructure, enabling the large city-based departments to deal with major trauma specialist cases as well as day-to-day emergencies. Will my right hon. Friend ensure that that vital emergency infrastructure is protected, enhanced and funded?
Mr Hunt
I absolutely agree with my hon. Friend that an emergency care network that works well for his constituents is essential. As he fully understands, that will mean relying on a network of hospitals. I recognise the concern at his own local hospital, for which he campaigns extremely vigorously, and I assure him that I shall be watching very carefully what happens there.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Will the Secretary of State now confirm what the Prime Minister said when she visited west Yorkshire, namely that it was scaremongering to talk of the closure of Huddersfield A&E? Will he also confirm that we should have a real plan with a gold-standard university for a new medical school in Huddersfield, so that we can really attract talent? That would do a great deal for morale, which would lead to the recruitment of good doctors and nurses everywhere.
Mr Hunt
The hon. Gentleman is right to say that it is time we had more medical schools, given that health and social care will be one of the fastest-expanding areas of the economy in the coming years. I think the Prime Minister was absolutely right to say that there should be no scaremongering about important local plans that will improve services for patients.
Victoria Prentis (Banbury) (Con)
Will the Secretary of State reassure my constituents that the component parts of the NHS can communicate with each other sufficiently to ensure that decisions such as the one by a medical dean to remove accreditation for anaesthetic training will not lead to the closure of A&E departments in hospitals such as Houghton general, where my father was treated so well last Friday?
Mr Speaker
The hon. Lady’s father is a splendid fellow, and he is now in another place. [Laughter.] I was referring to another House of Parliament.
Mr Hunt
I was concerned about the general laughter following that comment, Mr Speaker.
I am delighted that my hon. Friend’s father was treated so well, and I very much enjoyed my visit to the hospital recently. She is right: where there are changes in the patterns of training, we need to be very careful to ensure that they do not interrupt the delivery of local services in a disadvantageous way.
Tim Farron (Westmorland and Lonsdale) (LD)
The boundaries of the sustainability and transformation partnerships are bound to cause concern about the future of A&E and other acute departments given the nature of them. My area, south Cumbria—relatively sparsely populated and rural—is lumped in with Lancashire, which is largely urban. Will the Secretary of State confirm that the voices of rural communities will not be dwarfed by those of the larger urban ones, and in this week, as we celebrate the 25th anniversary of Westmorland general hospital, will he give guarantees that it will not be closed and will indeed not receive any downgrading as a result of the STP process?
Mr Hunt
Westmorland general hospital has a very important future in the NHS and I am happy to give the hon. Gentleman that assurance. I do not think he should be concerned about STP footprints covering both rural and urban areas. However, where there is an issue in his constituency, and many others, it is the response times for ambulances in the most remote areas, and we are looking at that.
Justin Madders (Ellesmere Port and Neston) (Lab)
Another threat to A&E units is the capped expenditure process, which will mean hundreds of millions of pounds cut from NHS budgets. That was sneaked out during the election, but so far we have had nothing but silence from this Government. It is time that we had the truth: when did the Secretary of State sign off these plans and when is he going to publish them?
Mr Hunt
The capped expenditure process is an NHS England initiative to meet its statutory duty to live within its budget, and I support the principle that in a period where real expenditure on the NHS is going up by £5 billion, those benefits should be spread fairly among patients in all parts of the country.
Maria Caulfield (Lewes) (Con)
8. What progress is being made on improving end-of-life care.
Bridget Phillipson (Houghton and Sunderland South) (Lab)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
Yesterday I updated the House on the action that we are taking to address delayed discharges from hospitals in advance of the winter. Since February, there has been a record decrease in delayed discharges, but faster progress is still needed to free up beds for the sickest patients and to reduce pressure on A&Es. Yesterday we therefore set out further measures to support the NHS and local government to reduce delays, including specific reductions required in all local areas, a prospective review of next year’s social care funding for poorly performing local authorities, and immediate CQC reviews in the worst-performing areas.
Bridget Phillipson
The latest figures from the British Medical Association show a huge rise in the number of patients with mental health conditions who are being sent hundreds of miles away from home for treatment. Is not any talk of parity of esteem meaningless unless and until patients can access the support they need close to home?
Mr Hunt
I completely agree with the hon. Lady that that is a very important issue. It is particularly important because people with mental health conditions need regular visits from their friends and family to help them to get over a crisis. Indeed, their chances of getting discharged and being able to go home are much higher when they are nearer home. She will be aware that we have a commitment to eliminate all out-of-area placements for children by 2020, and we are making big efforts with adults as well.
Edward Argar (Charnwood) (Con)
T4. Leicester and Leicestershire MPs, irrespective of party and led by the hon. Member for Leicester West (Liz Kendall), are united with local people, patients and medical professionals in opposition to NHS England’s badly thought out and, frankly, wrong proposals to close Glenfield hospital’s children’s heart unit. Can my right hon. Friend reassure me that he continues to appreciate the strength of feeling on this issue and that he will ensure that the eventual decision reflects the responses received to the consultation?
Barbara Keeley (Worsley and Eccles South) (Lab)
Today is the sixth anniversary of the publication of the Dilnot commission’s report on the funding of social care. In those six years, Ministers have legislated for a cap and a floor on care costs, and then abandoned those measures. They brought forward disastrous proposals in their manifesto for what became known as the “dementia tax”, and they appear to have abandoned those measures, too. Will the Secretary of State confirm that those policies have indeed been abandoned? Will he tell me, and more than 1 million people with unmet care needs, when he expects to have some new proposals for reform?
Mr Hunt
I have great respect for the hon. Lady, because she campaigns consistently on this issue, but I do not think that what she says is a fair reflection of what has happened. In the last year of the previous Labour Government, 45,000 people had to sell their home to pay for their care costs, whereas this Government have made it the law that no one has to sell their home. There is more work to do, but we have made important progress and will continue to do so.
Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)
T5. Nothing is more important than that people can access a GP when they need one. With that in mind, will the Minister join me in welcoming the move made by South Tees clinical commissioning group to enable 90,000 more appointments a year to be generated for people in Middlesbrough, Redcar and Cleveland by ensuring that appointments are available on evenings, weekends and bank holidays?
Ronnie Cowan (Inverclyde) (SNP)
T2. With the Scottish Government now committed to a soft opt-out system for organ donation similar to that implemented in Wales in 2015, is it not time that the UK Government followed the lead of the Welsh and Scottish Governments by introducing a similar system south of the border?
Mr Hunt
There is a lot of merit in the opt-out system that has been developed in Wales for some time and is now happening in Scotland. We are looking closely at the evidence, but we have a lot of sympathy with this. If the system does lead to an increase in organ donations, it is certainly something we would want to pursue here.
Matt Warman (Boston and Skegness) (Con)
T6. One-year cancer survival rates are now at a record high of 70%, but does the Minister agree that we should and can go further by improving early diagnosis and screening?
Matthew Pennycook (Greenwich and Woolwich) (Lab)
T7. At the height of the recent election campaign, NHS England took forward plans to merge, in effect, six south London CCGs, including Greenwich CCG, under one single chief officer. Does the Minister agree that that would be a retrograde step, not only in terms of local accountability, but at a time when primary care has been devolved downwards and all the emphasis is on collaboration and integration at a local borough level?
Mr Hunt
I think the answer is that this varies from area to area. The CCGs grew up organically following the Health and Social Care Act 2012. Some parts of the country are discovering that the groups can be more effective if they combine forces, but these things have to be decided locally.
Andrew Selous (South West Bedfordshire) (Con)
In addition to the Government’s welcome focus on mental health first aid, may we have equal focus on mental health keep fit, looking particularly at the Mental Health Foundation’s 10 pointers, so that we can all keep our mental health in good condition?
Mr Jim Cunningham (Coventry South) (Lab)
T9. What recent assessment has the Secretary of State made of the financial sustainability of Coventry and Rugby clinical commissioning group?
Martin Vickers (Cleethorpes) (Con)
May I return the Minister’s attention to the issues facing Northern Lincolnshire and Goole NHS Foundation Trust? My constituents are worried that both Grimsby and Scunthorpe hospitals are in special measures for the second time in as many years. Will he meet me and neighbouring MPs to discuss the situation?
Liz Twist (Blaydon) (Lab)
T10. What action does the Secretary of State intend to take to address the link between suicide and socioeconomic deprivation highlighted in the Samaritans’ “Dying from inequality” report as he seeks to reduce the suicide rate by 10% by 2020?
Andrew Bridgen (North West Leicestershire) (Con)
Funding our national health service to meet the needs of UK residents is one proposition; funding an international health service open to the world is another proposition entirely. Are there any indications that advance charging for non-emergency treatment for overseas patients is putting more money into our NHS?
Karin Smyth (Bristol South) (Lab)
NHS Property Services has just signed a £1 million lease on a central London location. May I suggest that other properties were available? Would the Secretary of State like me to inquire in my constituency, where NHS Property Services increased Knowle West Health Park’s rent threefold? Better value for the taxpayer is available.
Will Quince (Colchester) (Con)
I know that Ministers share my passion for ensuring that a bereavement suite is attached to every maternity unit in the country. What steps can the Government take to make that a reality?
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
During the election campaign, a lady in my constituency told me that she had had to wait nearly four hours for an ambulance to arrive at her home to help her off the floor. Does the Secretary of State have confidence in the ambulance service in London and other regions where targets have been consistently missed? Will he now look at extra resources for the ambulance service across the country, which is so urgently needed by all of our constituents?
Mr Hunt
If I may say so, that was a brilliant recovery. The hon. Lady is absolutely right to focus her attention on the performance of ambulance services. They are under pressure. They are hitting around 71% for their category A calls, and the target is to hit 75%. However, there are some bigger issues with the way those targets work, which we are looking at. Her ambulance service has just had a Care Quality Commission inspection.
Dr Sarah Wollaston (Totnes) (Con)
As a result of the capped expenditure process, the wider Devon sustainability and transformation plan is being asked to make £78 million of savings at short notice—within the next nine months. Does the Secretary of State share my concern about the impact on patients, the short timeframe and the undermining of savings already agreed by the STP? Will he meet me to discuss this matter and the wider CEP?
Mr Hunt
I am more than happy to meet my hon. Friend. The principle behind the capped expenditure process is that we should have fairness between patients in different parts of the country. We should not see patients in one part of the country disadvantaged because the NHS has overspent in their neighbouring area, but the way in which we implement the process must be sensitive and fair. We must ensure that we get it right.
Rosie Cooper (West Lancashire) (Lab)
What advice would the Secretary of State give to my constituents who receive their urgent care from Virgin Care, and are told that wounds should be dressed only once and that, in the event that they need to re-attend, they should purchase further dressings from the local chemist? Free at the point of delivery?
Maggie Throup (Erewash) (Con)
I was delighted to hear that, in answer to my hon. Friend the Member for Boston and Skegness (Matt Warman), the Minister was positive about the progress of genome screening. On a recent visit to Nottingham University, I saw similar techniques applied to Alzheimer’s research. Will he back using the process for that, as well as for cancer diagnosis and treatment?
Delayed Transfers of Care
Jeremy Hunt Excerpts(7 years, 5 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I would like to update the House about action we are taking to address delayed discharges from hospital in advance of this winter. Last year there were 2.25 million delayed discharges, up 24.5% from 1.81 million in the previous year. The Government are clear that no-one should stay in a hospital bed longer than necessary: it removes people’s dignity, reduces their quality of life; leads to poorer health and care outcomes for people; and is more expensive for the taxpayer.
In this year’s mandate to NHS England I set a clear expectation that delayed transfers of care (DToCs) should equate to no more than 3.5% of all hospital beds by September. Alongside this, the spring 2017 Budget announced an additional £2 billion to councils in England over the next three years to spend on adult social care services.
The system has worked extremely hard to agree spending plans and put in place actions to make use of the £1 billion provided in 2017-18 to meet the three purposes of the funding:
meeting adult social care needs;
reducing pressures on the NHS, including getting supporting more people to be discharged from hospital when they are ready; and,
ensuring that the local social care provider market is supported.
Since February, there have been significant improvements within the health and care system, with a record decrease in month-on month delayed discharges in April 2017. We are supportive of the best performing systems where local government and the NHS are working together to tackle the challenge of delayed transfers of care. However, we are clear that we must make much faster and more significant progress well in advance of next winter to help free up hospital beds for the sickest patients and reduce pressures on overcrowded A&E departments.
This is why today we are setting out a further package of measures to support both the NHS and local government to reduce delays. This package supports all organisations to make improvements, and includes:
The integration and better care fund planning requirements 2017-19, clarifying how this, and other aspects of the better care fund planning process, will operate.
Joint NHS England, NHS Improvement, Local Government Association and Association of Directors of Adult Social Services guidance on implementing trusted assessors.
A performance dashboard showing how local areas in England are performing against metrics across the NHS-social care interface including delayed discharges.
Plans for local government to deliver an equal share to the NHS of the expectation to free up 2,500 hospital beds, including a breakdown of delayed days per 100,000 of the population and the indicative reduction levels required by each local authority and local NHS, which can be shared out differently at local level if agreed by both organisations.
Considering a review, in November, of 2018-19 allocations of the social care funding provided at spring Budget 2017 for areas that are poorly performing. This funding will all remain with local government, to be used for adult social care.
In addition, I have asked the chief executive of the Care Quality Commission to commission 12 reviews of local areas to consider how well they are working at the health and social care boundary. A further 8 reviews will be commissioned based on the performance dashboard and informed by local authority returns due in July. These reviews will commence immediately with the majority complete by the end of November, with a view to identifying issues and driving rapid improvement.
We are also putting in place a comprehensive sector-led support offer and in early July NHS England, NHS improvement, Local Government Association, Association of Directors of Adult Social Services and the better care support team are publishing the definitive national offer to support reductions in delayed transfers of care to all areas.
The health and care system has committed health and social care staff and managers up and down the country working every single day to deliver the best outcomes for people. Today’s announcement will give our workforce and their leaders clarity on how the Government expect the NHS and local government to work together to achieve this joint ambition.
[HCWS24]
NHS Shared Business Services
Jeremy Hunt Excerpts(7 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
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 Statement to make a statement on NHS Shared Business Services.
The Secretary of State for Health (Mr Jeremy Hunt)
As the House knows, on 24 March 2016 I was informed of a serious incident involving a large backlog of unprocessed NHS patient correspondence by the company contracted to deliver it to GP surgeries—NHS Shared Business Services. The backlog arose from the primary care services’ GP mail redirection service that SBS was contracted to run. No documents were lost, and all were kept in secure storage, but my immediate concern was that patient safety had been compromised by the delay in forwarding correspondence. A rapid process was started to identify whether anyone had been put at risk.
The Department of Health and NHS England immediately established an incident team. All the documentation has now been sent on to the relevant GP surgery where it was possible to do so, following an initial clinical assessment of where any patient risk may lie. Some 200,000 pieces were temporary residence forms and a further 535,000 pieces were assessed as low risk. A first triage identified 2,508 items with a higher risk of harm, of which the vast majority have now been assessed by a GP. Of those 84% were confirmed to be of no harm to patients and 9% as needing a further clinical review. To date, no harm has been confirmed to any patients as a result of this incident.
Today’s National Audit Office report confirms that patient safety was the Department and NHS England’s primary concern, but as well as patient safety, transparency with both the public and the House has been my priority. I was advised by my officials not to make the issue public last March until an assessment of the risks to patient safety had been completed and all relevant GP surgeries informed. I accepted that advice for the very simple reason that publicising the issue would have meant GP surgeries being inundated with inquiries from worried patients, which would have prevented them from doing the most important work, namely investigating the named patients who were potentially at risk.
A proactive statement about what had happened was again not recommended by my Department in July for the same reasons and because the process was not complete. However, as I explained to the House in February, on balance I decided that it was important for the House to know what had happened before we broke for recess, so I overruled that advice and placed a written statement on 21 July. Since then, the Public Accounts Committee has been kept regularly informed, most recently being updated by my permanent secretary in February. The Information Commissioner was updated in August.
In July 2016, I committed to keeping the House updated once the investigations were complete and more was known, and I will continue to do so.
Jonathan Ashworth
I welcome the Secretary of State to his place, but is it not an absolute scandal that 709,000 letters, including blood test results, cancer screening appointments and child protection notes, failed to be delivered, were left in an unknown warehouse and, in many cases, were destroyed? Does not the National Audit Office reveal today a shambolic catalogue of failure that took place on the Secretary of State’s watch?
As of four weeks ago, 1,700 cases of potential harm to patients had been identified, with this number set to rise, and a third of GPs have yet to respond on whether unprocessed items sent to them indicate potential harm for patients. Does the Health Secretary agree that this delay is unacceptable? When will all outstanding items be reviewed and processed?
The Secretary of State talks about transparency, but he came to this House in February because we summoned him here. In February, he told us that he first knew of the situation on 24 March 2016, yet the NAO report makes it clear that the Department of Health was informed of the issues on 17 March and that NHS England set up the incident team on 23 March, before he was informed, despite his implying that he set up the incident team. Will he clear up the discrepancies in the timelines between what he told the House and what the NAO reported?
The Secretary of State is a board member of Shared Business Services, and many hon. Members, not least my right hon. Friend the Member for Exeter (Mr Bradshaw), have warned him of the problems and delays with the transfer of records from SBS. Given that those warnings were on the record, why did he not insist on stronger oversight of the contract?
The cost of this debacle could be at least £6.6 million in administration fees alone, equivalent to the average annual salary of 230 nurses. Can the Health Secretary say how those costs will be met and whether he expects them to escalate?
Finally, does the right hon. Gentleman agree with the NAO that there is a conflict of interest between his role as Secretary of State and his role as a board member? Further to that, can he explain why his predecessor as Secretary of State sold one share on 1 January from the Department to Steria, leaving the Secretary of State as a minority stake owner in the company, and never informed Parliament or reported that share in the Department’s annual report—
Mr Speaker
Order. We are immensely grateful to the hon. Gentleman, but sooner or later the discipline of sticking to the two minutes has to take root. I am afraid that it is as simple as that and I am sorry, but he has had two and a half minutes.
Mr Hunt
Let me respond to those points. First, what happened at SBS was totally unacceptable. It was incompetent and it should never have allowed that backlog to develop, but before the hon. Gentleman gets on his high horse, may I remind him that SBS and the governance arrangements surrounding it were set up in 2008, at a time when a Labour Government were rather keen on contracting with the private sector? I know that things have changed, but the fact of the matter is that throughout this process our priority has been to keep patients safe. Transparency is nearly always the right thing; I am the Secretary of State who introduced transparency over standards of care in hospitals—[Laughter.] It is interesting that Opposition Members are laughing, as Labour was the party responsible for sitting on what happened at Mid Staffs for more than four years, when nothing was done.
Transparency is incredibly important but it is not an absolute virtue, and in this case there was a specific reason for that. If we had informed the public and the House immediately, GP surgeries would have been overwhelmed—we are talking about 709,000 pieces of patient data—and they would not have been able to get on as quickly as we needed them to with identifying risk. That was the priority and that is what today’s report confirms: patient safety was the priority of the Department and NHS England. I put it to the hon. Member for Leicester South (Jonathan Ashworth) that if he were in my shoes, and faced with advice that said that it was wrong to go public straight away as that would compromise the very important work GPs had to do to keep patients safe, he would have followed exactly the same advice. That is why, while I completely recognise that there is a potential conflict of interest with the Government arrangements, I do not accept that there was an actual conflict of interest, because patient safety concerns always overrode any interests we had as a shareholder in SBS.
The NHS is a large organisation. It has a huge number of contracts with both the public and private sectors, and no Government of any party can ever guarantee that there will be absolutely no breach of contract. However, what we can do is ensure that we react quickly when there is such a breach, which happened on this occasion, and that we have better assurance than we had on this occasion. I assure the House that the appropriate lessons will be learned.
Dr Sarah Wollaston (Totnes) (Con)
While Members from across the House will be relieved that so far no patients are identified as having been harmed by this appalling incident, will the Secretary of State set out what steps he is taking to ensure that this can never happen again?
Mr Hunt
Absolutely. There is a short-term and long-term lesson. The short-term point is that it is unlikely this would happen again because it was paper correspondence, and we are increasingly moving all the transfer of correspondence to electronic systems. The longer-term point is exactly that—[Interruption.] An Opposition Member mentions cyber-attacks; they are absolutely right to do so, because of course we have different risks. This clearly indicates that we need better checks in place, so that when we trust an independent contractor with very important work, we know that the job is actually being done, and that did not happen in this case.
Martyn Day (Linlithgow and East Falkirk) (SNP)
The NAO’s findings are deeply concerning for the families of patients caught up in this chaotic shambles. For those involved and the wider public, this will only deepen their mistrust and misgivings in how the Tories are running the NHS; we can be grateful that they are not in charge in Scotland. Surely it is simply astonishing that a company partly owned by the Department of Health failed to deliver 500,000 NHS letters, many of which contained information critical to patient care. Not only were 1,700 people potentially at risk of harm, but thousands of others were put at risk. Was this SBS contract properly scrutinised by the Secretary of State? Was patient care or cost-cutting at the forefront of that decision? Why did he publish a vague written statement in July 2016 when he actually knew what was going on four months earlier?
Mr Speaker
Splendid—the hon. Gentleman was within his time. He gets an additional brownie point.
Mr Hunt
I gently say to the hon. Gentleman that it is totally inappropriate to try to make political capital from this incident. The facts of the case are that the NAO today published a report saying that patient safety was the primary concern of both the Department of Health and NHS England throughout. There were some problems with the assurance of that contract, but the contract and the relationship with SBS in particular dates back to 2008. Both sides of the House need to learn the lessons of properly assuring NHS contracts, and I dare say the same is true in Scotland.
John Redwood (Wokingham) (Con)
I fully support the Secretary of State’s actions, which were quite right in the difficult circumstances in which he found himself, but what action will be taken against the executives who presided over this shambles? Is there any enforcement mechanism under the contract against the other owner of the company?
Mr Hunt
The company has been stripped of that contract; it was relieved of the contract back in 2015. We are very clear that it will have to fulfil all its contractual requirements, including paying its fair share of the costs that have been incurred as a result of this wholly regrettable incident.
Dr Rosena Allin-Khan (Tooting) (Lab)
Patient confidentiality and safety must be treated with the utmost seriousness at all times, and the NHS fails if it loses the trust of its patients, so how did the Secretary of State for Health come to the conclusion that risk to more than 1,700 patients was merely due to an issue of mail redistribution?
Mr Hunt
I did not come to that conclusion. The hon. Lady is right, as a doctor, to say that patients’ trust in the way we hold their records is very important. In this case, the correspondence concerning patients was not forwarded, but it was not lost either. It was held securely, so no patient data were put at risk, but it should have been forwarded to another part of the NHS, and it was not; it was effectively stockpiled. That is what caused the concerns. We have been going through the high-priority cases. So far, the vast majority of cases have had two clinical reviews, and the ones we are still concerned about are having a third clinical review. We are taking this extremely seriously.
Jeremy Lefroy (Stafford) (Con)
The Secretary of State mentioned Mid Staffordshire and patient safety, which is absolutely critical, but may I point out that the County hospital in Stafford now has an excellent record? It is currently seeing 27 patients in A&E with a waiting time of not much more than one hour, according to the app that I have on my phone. Will he confirm that the situation has been transformed because of the fantastic work of the staff in that hospital?
Mr Hunt
I am happy to confirm that. I am also happy to say that the problems in the old Mid Staffs, which I am afraid we had in many parts of the NHS, are being addressed much more quickly because of an independent oversight regime—the new Care Quality Commission inspection regime—and the appointment of a chief inspector of hospitals, who is independent in law and gives his judgment independently in law. That is something the Labour party regrettably tried to vote down.
Mr Ben Bradshaw (Exeter) (Lab)
May I commend to the House the record of the debate I secured in November 2011, in which I warned the Government in terms about the very poor record of SBS and urged them not to part-privatise what had been an excellent NHS service? Ministers said at the time that the new contract would save £250 million. Will the Secretary of State now tell the House how much this scandal has cost, rather than saved, the taxpayer? Will he apologise both to the staff and the patients affected?
Mr Hunt
The costs are in excess of £6 million, and we are seeking to recover as much of that as we can from the company involved. I know that the regime in the Labour party has changed, but to try to turn this into an issue of privatisation when under the right hon. Gentleman’s own party’s Government—and indeed, during his own time as Health Secretary—we had problems at Mid Staffs that were squarely in the public sector is wholly inappropriate. This is about proper assurance of what is going on in the NHS, and both sides of the House need to learn the lessons.
Victoria Atkins (Louth and Horncastle) (Con)
In order to reassure my constituents, will my right hon. Friend confirm that NHS SBS no longer provides this mail redirection service, that all backlogged correspondence has now been delivered to the relevant GP surgeries for filing and that no patient harm has been found in this case?
Mr Hunt
My hon. Friend is exactly right. Of course we welcome the fact that no patient harm has been identified to date. We have to wait until the process of the third clinical review is completed on at-risk patients’ records, which will happen by the end of December. She is absolutely right to say that SBS is no longer performing this contract; it has been taken in-house. Other parts of the SBS contract not related to what we are discussing today were given to another supplier.
Stephen Lloyd (Eastbourne) (LD)
Does the Secretary of State agree that this is a very straightforward case? It shows a woeful lack of transparency, is a good example of why so many of us have concerns about too much private sector involvement in the NHS and, bluntly, there is a conflict of interest for the Secretary of State.
Mr Hunt
I acknowledged in my statement that there is, or was, a potential conflict of interest when the contract with SBS was in operation, and the National Audit Office talks about that today. In reality, as the National Audit Office confirms, patient safety was always our overriding priority in all the decisions we took. I suggest to the hon. Gentleman, as I do to the shadow Health Secretary, that he would have taken exactly the same decisions had he been in my shoes.
Bob Blackman (Harrow East) (Con)
My right hon. Friend has confirmed that the contract has now been taken in-house. Can he also confirm that it is a totally different operation and that none of the people who were involved in making the decisions is now involved in making the decisions on the current service?
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
I am pleased that the Secretary of State at least acknowledges that this was incompetent but, crucially, does this not run deeper? Problems were first raised in January 2014, and then again internally by an administrator in June 2015. He found out, as Secretary of State for Health, only in March last year, and the Public Accounts Committee found out and was able to look at this only in September, because information was released on the final day that Parliament sat last summer. He talks about transparency, but does he not think there are deeper lessons to be learned here not only about transparency but about how the NHS supports whistleblowers?
Mr Hunt
There are two big lessons that we need to learn. First, why did the company have no internal systems in place to deal with the fact that from 2011 the mail was building up into a backlog? According to the NAO report, the situation was not escalated to the chief executive’s level until the end of 2015. That is wholly unacceptable. Secondly, it is also unacceptable that we did not have the assurance systems in place that would have allowed us to know that a backlog was building up. That is why it is so important that lessons are learned.
Sir Desmond Swayne (New Forest West) (Con)
Who drew up the contract for the redirection service that omitted any key performance indicators?
Jim Shannon (Strangford) (DUP)
Over 700,000 pieces of sensitive medical information went missing, and the situation was allowed to escalate over a five-year period without being discovered, which I think shows gross incompetence. What has been done to set right this wrong, especially for the families left behind who have been affected by this worrying incident?
Mr Hunt
There has been a huge operation to deal with this. As the hon. Gentleman will know, there were 709,000 pieces of correspondence. We did an initial clinical triage to identify which ones were low risk, such as notifications of change of address, and which ones were higher risk, such as test results. We identified 2,500 that had a high priority, and 84% of those have so far been identified as being of no clinical risk, but we are continuing to do more thorough clinical risk assessment.
Kevin Foster (Torbay) (Con)
As I am sure the Secretary of State is aware, for many patients the image created by the media is one of documents being lost. Can he confirm that at all times the correspondence was kept either in secure conditions on NHS premises or in secure archive facilities?
Steve McCabe (Birmingham, Selly Oak) (Lab)
The Secretary of State says that no patients were harmed and that the documents were securely stored, but 35 sacks of mail were destroyed. How does he know that he made the right call in every situation?
Mr Hunt
Just to be clear, what I said was that to date there is no evidence of any patients being harmed, but the process of proper clinical review, with multidisciplinary teams, will take until the end of the year. We have to do this properly to get to the answer. We hope that it remains the case that no patients were harmed, but we will not know that until the end of the year. However, throughout this whole process we have prioritised the highest risk cases and made sure that they get the most urgent attention.
Justin Tomlinson (North Swindon) (Con)
Following this failure, I welcome the Secretary of State’s decisive action in bringing in the national incident team. How will we learn the lessons and share the best practice, as discovered by that team?
Mr Hunt
The NHS is extremely good at responding to crises and emergencies, as tragically we have found out in recent months. This is an example of the NHS doing a very good job when it realises the scale of the problem. For me, the lessons that really need to be learned are about not the response to the issue but the assurance processes that allowed the problem to happen in the first place.
Margaret Greenwood (Wirral West) (Lab)
The National Audit Office says that the review of the backlog of correspondence has found 1,788 cases of potential patient harm, so what action is the Secretary of State taking to support those patients?
Mr Hunt
All those cases have already been looked at by two sets of clinicians, and so far, on the basis of those two reviews, no patient harm has been identified. However, because we want to be absolutely sure, we are having a third clinical review that will be even more thorough, potentially with more than one set of clinicians, so that we can get to the bottom of this and find out.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
I understand that the inquiry has focused on patient risk, but has there been any analysis of the impact on patient waiting times, which are also extremely important for patient care? Exactly how many patients have waited longer than they should have for treatment?
Mr Hunt
The hon. Lady is right. That is one of the most critical questions when it comes to trying to understand whether there was any actual patient harm. Ordinarily, if a patient was waiting for a test result that did not arrive at their GP’s surgery, the GP would chase it up and get a copy, so there would be no delay in treatment. However, only by looking at the patient’s notes can we understand whether any harm is likely to have happened. So far we have not identified any patient harm, but we will continue to look.
Helen Jones (Warrington North) (Lab)
The Secretary of State told the House in February that all correspondence was kept safe and secure, and he has repeated that claim today, so when did he know that 35 sacks of mail had been destroyed by staff, and why has he not mentioned it since?
Mr Hunt
As the hon. Lady knows, I was informed at the end of March 2016. The issue with the correspondence that was destroyed relates to procedures around what it is legitimate to do when patients have been dead for 10 years. At the moment we are not aware of any specific risk to patients as a result of those sacks of mail being destroyed, but we will continue to look at the issue very closely.
Clive Efford (Eltham) (Lab)
The Secretary of State was made aware of the failings of the contract and warned about the dangers in the House in 2011, yet he did not take up two places on the company’s board. Would that not have added to the overall scrutiny of the contract? Is he not guilty of being asleep at the wheel?
Mr Hunt
I have been Health Secretary for a long time, but not since as far back as 2011. However, the hon. Gentleman asks an important question. It is true that the Department was entitled to three seats on the SBS board but took up only one, but I do not believe that would have made a difference in this case, because the board directors were intended to represent the Department as SBS shareholders. What we needed was better assurance of the implementation of the contract. That needed to happen with the NHS as a contractor. That is the lesson that needs to be learned.
Kerry McCarthy (Bristol East) (Lab)
The Secretary of State talks about the need to learn lessons, but we have seen a pattern across Government—not just in the Department of Health, but in the Department for Work and Pensions and the Home Office, for example—of companies being awarded contracts and then failing miserably. Those companies have the contract taken away but are then awarded another one. Clearly the lesson to be learned across Government is that some companies are simply not fit for purpose when it comes to delivering public services.
Mr Hunt
We do need to be robust when companies fail in their contracts with the public sector. I do not think that this affects only private sector companies, because we contract with people in the public sector and are let down. Equally, we need to be robust when the right things do not happen. Most importantly, the lesson from what happened with SBS is that we need to understand much more quickly when things are going wrong, so that we can nip problems in the bud. That did not happen in this case.
Mr Dennis Skinner (Bolsover) (Lab)
How many more times is the Secretary of State going to come to this House, as he has done on countless occasions, when he personally is at the centre of a controversy? Even a cat has only nine lives.
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
My hon. Friend the Member for Tooting (Dr Allin-Khan) was absolutely right when she suggested that the Secretary of State is trying to downgrade 1,788 cases of potential harm and a potential conflict of interest to no more than an administrative error by a contracted-out service. In my constituency, a tender for cancer care was ended prematurely, costing the taxpayer millions of pounds. Are these not examples of where the Conservative party’s ideological agenda to contract out our NHS services is failing and patients are suffering as a result?
Paul Flynn (Newport West) (Lab)
Shared services in my constituency saved £120 million in four years. When the system was privatised under Steria, it lost £4 million and goes on being inefficient. Can the Government escape from this paralysis of thought that is costing the country so much—that everything private is good and everything public is bad? Will they look to not outsourcing but insourcing services from the inefficient private sector back to our wonderful, efficient civil service?
Mr Hunt
I gently remind the hon. Gentleman that the last Government who had an active policy of increasing private sector market share in the NHS were the last Labour Government. This Government legislated to stop the Government nationally prioritising the private sector and made that a decision for individual doctors at a local level.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
As a doctor, I understand the importance of ensuring that results and letters are reviewed in a timely manner. There will always be opportunity for error in any system relying on bits of paper being sent around. Hospitals such as Peterborough City hospital, where I have worked, provide results electronically, which is quicker, as well as having a back-up paper form, which provides for patient safety. Will the Secretary of State reassure us that good practice such as this is being rolled out elsewhere?
Mr Hunt
Absolutely. My hon. Friend is right to point out that we are in a different world from the world of 2011. The future is to transport patient records securely over electronic systems. It is much quicker and there is much less room for error, but we do need the back-up systems that she mentioned.
Stephen Twigg (Liverpool, West Derby) (Lab/Co-op)
I wrote to the Secretary of State in January on behalf of a GP practice in my constituency that is concerned about the potential impact on staff working at the practice. I raised the matter again four months ago during the previous urgent question, and the Secretary of State promised to look into the impact on staff. Can he report back to the House today?
Mr Hunt
I will relook at the situation in that surgery to ensure that we are learning any lessons that need to be learned. However, this is a complex process. There have already been two clinical reviews in the vast majority of the high risk cases, and we want to have a third review to really establish whether there was any actual patient harm. That takes clinician time, which is one of the reasons why we have not been able to complete the process by today. It will take until Christmas to do that because we have to balance the other responsibilities that clinicians have in their daily work.
Peter Grant (Glenrothes) (SNP)
Earlier, the Secretary of State assured the House that the individual directors who are responsible for this catastrophe are no longer in a position to cause similar damage. Is he aware that the briefest of searches through Companies House records shows that the same three or four names associated with Shared Business Services come up time and again?
There are about a dozen companies, many of which come under the Sopra Steria Ltd group of companies, and most of which advertise the fact that they do a lot of work for the NHS right now. One is titled NHS Shared Employee Services Ltd, which suggests that, far from having been removed from any influence, the individual directors who were legally responsible for this disaster are still very much in a position to make money for themselves while presiding over similar disasters in the future.
Mr Hunt
I note the hon. Gentleman’s comments, but he will understand that I am not in a position to pass judgment at the Dispatch Box on the behaviour of individuals. The Department for Business, Energy and Industrial Strategy has respected and well-established systems in place to ensure that people who are not fit and proper to be company directors are not able to continue with their duties.
Kate Green (Stretford and Urmston) (Lab)
My constituents are served not by the SBS contract, but by the Capita contract. I have raised problems with that contract to the Secretary of State on many occasions. There are still problems with the helpline, which appears incapable of logging and following through with complaints. Why is this contract, which is clearly failing, not taken back in-house by the Government?
Mr Hunt
Just to be clear, this is a different contract, as I know the hon. Lady understands. We have been working hard, and I know that the hon. Lady worked hard with my Department in the previous Parliament to try to get to the bottom of the problems with the Capita contract. My understanding is that the situation is improving, but I will happily look into the individual situation she mentioned.
Tracy Brabin (Batley and Spen) (Lab/Co-op)
The Secretary of State said that this takes time and, if I heard correctly, that a third of GPs have failed to respond. What steps is he taking to ensure that patient care is not being compromised by the extra admin burden on already overworked GPs?
Mr Hunt
We are paying GP surgeries for the extra admin time that this is taking. That is designed to ensure that, where necessary, they can buy in extra resources to deal with the extra admin. The hon. Lady is absolutely right that we have to ensure that GPs’ core work is not compromised by the issue.
Liz McInnes (Heywood and Middleton) (Lab)
I used to work as a clinical scientist in the NHS, so I know only too well the harm that can be caused by the non-arrival of a test result. If a diagnostic test is performed and the result goes nowhere and is not seen by a clinician, as in this case, it is the same health outcome as if the test was not done at all. Will the Secretary of State stop trying to downplay the situation and own up to the seriousness of this scandal?
Mr Hunt
No one listening objectively could possibly say that I am, or that anyone on this side of the House is, downplaying this very serious situation. Since the issue came to light, we have instituted a review of 709,000 pieces of patient correspondence. We have identified the high-priority ones, of which there are 2,508. Two, and sometimes three, clinical tests have been done on all of them. No patient harm has been identified to date, but we are not complacent. We will continue the process until we have been through every single patient record with that thoroughness.
Rachael Maskell (York Central) (Lab/Co-op)
I too will mention the Capita contract. This is not an isolated case. A pattern is occurring. The Government are failing in their governance over patient records. Will the Secretary of State now review that governance and bring it back in-house? It is so urgent that we oversee the safety of patients first.
Mr Hunt
As I confirmed to the hon. Member for Stretford and Urmston (Kate Green), I will look into the outstanding issues with the Capita contract for GPs that are not related to the delivery of patient records. My understanding is that things have got better, but we were very unhappy with the initial performance from Capita.