NHS Pay Review Body
Jeremy Hunt Excerpts(7 years, 8 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I am responding on behalf of my right hon. Friend the Prime Minister to the 30th Report of the NHS Pay Review Body (NHSPRB). The report has been laid before Parliament today (Cm 9440) and is attached.
We welcome the 30th report of the NHS Pay Review Body.
The Government are pleased to accept its recommendations for a 1% increase to all “Agenda for Change” pay points from 1 April 2017 and the high cost area supplement minimum and maximum payments. This will be in addition to incremental pay for those that are eligible.
The recommendation that Health Departments should ensure that annual pay awards do not have unintended consequences in reducing the take-home pay of staff whose pay award causes them to cross pension contribution thresholds, will be considered as part of the four-yearly valuation of the NHS pension scheme, a process which will determine the appropriate level of employer and employee pension contributions from April 2019.
The Government will consider all the observations and report progress to the NHS Pay Review Body in due course.
Attachments can be viewed online at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-03-28/HCWS565/
[HCWS565]
Doctors’ and Dentists’ Remuneration (Review Body)
Jeremy Hunt Excerpts(7 years, 8 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I am responding on behalf of my right hon. Friend the Prime Minister to the 45th report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The report has been laid before Parliament today (Cm 9441) and is available as an attachment online. I am grateful to the chair and members of the DDRB for their report.
We welcome the 45th report of the DDRB.
The Government are pleased to accept its recommendations for a 1% increase for 2017-18 to:
the national salary scales for salaried doctors and dentists. This will be in addition to incremental pay for those that are eligible;
the maximum and minimum of the salary range for salaried general medical practitioners;
pay, net of expenses, for independent contractor general medical and dental practitioners;
the general medical practitioners trainers’ grant;
the flexible pay premia included in the new junior doctors’ contract; and
the value of the awards for consultants—clinical excellence awards, discretionary points and commitment awards.
The Government also accept the DDRB’s recommendations that the supplement payable to general practice specialty registrars should remain at 45% of basic salary for those on the existing UK-wide contract and that the rate for general medical practitioner appraisers should remain at £500.
he Government accept the recommendations to report to the DDRB on doctors and dentists taking early retirement and reasons for this.
The Government note the recommendation for giving further consideration to pay targeting by specialty and geography.
The Government also note the DDRB’s observation that there is at present insufficient evidence about aspects of our workforce of salaried general medical practitioners.
Attachments can be viewed online at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-03-28/HCWS568/
[HCWS568]
Oral Answers to Questions
Jeremy Hunt Excerpts(7 years, 9 months ago)
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Rebecca Pow (Taunton Deane) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
We are funding 1,500 additional medical school places each year to ensure that the NHS can continue to deliver safe, compassionate and effective care well into the future. Around 500 places will be made available in September 2018, and the remaining 1,000 places by September 2019.
Rebecca Pow
In Taunton Deane, we are desperately short of trained health professionals, from dermatologists to nurses, but one of the worst shortages is of GPs, with some practices not even able to get locums. I know Ministers are working on this, but could my right hon. Friend update me on what the Department is doing to encourage more medical students to become GPs? It is hard to believe they do not want to come to Somerset, but what are we doing to encourage them?
Mr Hunt
There is no greater champion for Somerset than my hon. Friend. What I would say to her is what I would say to all medical students, which is that general practice is going to be the biggest area of expansion in the NHS over the coming years; in fact, we are planning to have the biggest increase in GPs in the history of the NHS.
Mr Ben Bradshaw (Exeter) (Lab)
It will take many years for the doctors the Secretary of State has just talked about to come on stream, and we have a workforce crisis in the NHS now, partly because of the cuts the Government made in the last Parliament, but also because of their irrational pursuit of the hardest of Brexits. He could do something very simple today to address this crisis in the short term, and that is to announce that all EU nationals who do vital work in our NHS will be able to stay when we leave the European Union.
Mr Hunt
The one simple thing the Government are not going to do is refuse to listen to what the British people said when they voted on 23 June. We will do what they said—it is the right thing to do. However, the right hon. Gentleman is absolutely right to highlight the vital role that the around 10,000 EU doctors in the NHS play in this country. I can reassure him that the number of doctors joining the NHS from the EU was higher in the four months following the referendum result than in the same four months the previous year.
Helen Whately (Faversham and Mid Kent) (Con)
Mr Hunt
I can absolutely confirm that the garden of England would be an ideal place for a new medical school—alongside many other parts of the country that are actively competing to start medical schools as a result of the expansion in doctor numbers. It is an independent process run by the General Medical Council, and we will await what it says with great interest.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
On this wonderful first day of spring, will the Secretary of State think anew about the training of GPs? We want more GPs, we want them highly trained and we want them to know that someone who suffers from atrial fibrillation should not be neglected and should not be put on aspirin or warfarin, but should be given the new anti-coagulants.
Mr Hunt
The hon. Gentleman speaks very wisely about this, and he is one of a number of people who say we need to look at the training we give GPs on patient safety, on growing, new areas like mental health, and on things like the identification of cancers. This is something we are having an ongoing discussion with the Royal College of General Practitioners about.
Sir Simon Burns (Chelmsford) (Con)
Given the importance of training new doctors and nurses to the future of the health service, will my right hon. Friend welcome the building, which will commence later this summer at the Anglia Ruskin University in Chelmsford, of a new medical school that is solely there to train doctors to meet the needs of people in Essex and beyond its borders?
Dr Philippa Whitford (Central Ayrshire) (SNP)
Plans to train more UK doctors are absolutely welcome, but the Secretary of State knows that it takes at least 10 years to train a doctor, so what is his response to the surveys by the British Medical Association and the GMC showing that, having been left hanging for nine months, 40% to 60% of EU doctors are thinking of leaving?
Mr Hunt
My response is the one I give many times in this House, which is to stress to all those doctors how valued they are as critical parts of the NHS. We do not see any evidence of the number of doctors joining from the EU going down. The NHS is one of the best health services in the world, and it is a great place for people from other countries to work and train.
Dr Whitford
The workforce is one of the biggest challenges right across the nations of the UK, and particularly in rural areas, as we heard earlier. With a 92% drop in the number of EU nurses coming to the UK and a 60% increase in the number who left last year, how does the Secretary of State plan to avoid an NHS staffing crisis immediately post-Brexit, before there is time to train anybody extra?
Mr Hunt
The hon. Lady needs to be very careful in her use of statistics, because she will know that one reason for the drop in the number of nurses coming from the EU is that prior to the Brexit vote we introduced much stricter language tests, as that is better for the safety of patients and a very important thing that we need to get right. We are very confident that nurses will continue to want to work in the NHS, because it is a great place to work.
Dr Rosena Allin-Khan (Tooting) (Lab)
Christian Matheson (City of Chester) (Lab)
The Secretary of State for Health (Mr Jeremy Hunt)
Between February 2016 and January 2017, there were just under 3,500 waits of longer than 12 hours from decision to admit to admission. That is completely unacceptable, which is why the Government took urgent steps to free up NHS bed capacity in this month’s Budget.
Dr Allin-Khan
Earlier this month, the chair of the Royal College of General Practitioners said that the “best place for GPs” is working within their communities to provide the highest possible general practice quality. What forecast has the Secretary of State made of the reduction in A&E waiting times next winter as a result of the new GP triage units in A&E departments? Does he agree that this is simply a small sticking plaster on the gaping wound that is our drastically underfunded NHS?
Mr Speaker
Order. The hon. Lady had a question, it was rather overlong and the least courtesy she can do the House is to listen quietly and with good manners to the reply.
Mr Hunt
Thank you, Mr Speaker. To continue, let me say that in this so-called “drastically underfunded NHS”, the hon. Lady’s local hospital—St George’s in Tooting—now has 36 more doctors working in A&E than there were in 2010. However, we also think that as a lot of people go to A&E departments with minor injuries and things that can be dealt with by GPs, we need to have GPs on site, and this Parliament we are planning to have 5,000 more doctors working in general practice.
Christian Matheson
In January, more than 1,000 patients at the Countess of Chester’s A&E unit had to wait more than four hours and only 81% of patients had to wait less than four hours. Now that the 95% target has been abandoned, until at least midway through next year, what guarantee can the Secretary of State give my constituents that we will not get a repeat of this next winter?
Mr Hunt
On the contrary, we have not abandoned the 95% target—we have reiterated its importance. There is, however, one part of the United Kingdom that has said it wants to move away from the 95% target—Wales. The Welsh Health Minister said last week:
“You can go to A&E and be there five hours but have…a good experience.”
That is not looking after patients; it is giving up on them.
Jason McCartney (Colne Valley) (Con)
On this important issue of A&Es, does the Secretary of State agree that it makes no sense at all for my local clinical commissioning group to be bringing forward a business case to spend an extra £300 million on bulldozing Huddersfield royal infirmary and downgrading our A&E?
Mr Hunt
I recognise the very strong arguments my hon. Friend makes and the strong campaigning he does on behalf of his constituents. We are waiting for the final recommendations to come from his local CCG, but I agree that too often we have closed beds in the NHS when we do not have alternative capacity in the community, and we need to be very careful not to repeat that mistake.
Huw Merriman (Bexhill and Battle) (Con)
The cost of presenting with a minor ailment at a pharmacy is only 10% of the cost of presenting at A&E. What more can be done to help persuade those who present themselves to A&E that the pharmacy sector could be a better use of their time?
Mr Hunt
I entirely agree with my hon. Friend on that. Despite the current debates, the pharmacy sector has a very bright future, and we have set up a £40 million integration fund precisely to help pharmacists to play more of a role in the NHS and, in particular, to reduce pressure on A&Es.
Justin Madders (Ellesmere Port and Neston) (Lab)
This year, the winter crisis in A&E has been the worst ever. Things have got so bad that, rather than waiting in A&E, record numbers of people are just giving up—I am sure there are many who wish the Secretary of State would do likewise. In January, nearly 1,000 people were stuck on trolleys waiting more than 12 hours to be admitted to A&E. Will the Secretary of State accept that that is far more than just a small number of isolated incidents? After five years in the job, he has to accept responsibility for the crisis he has created.
Mr Hunt
I accept responsibility for everything that happens in the NHS, including the fact that, compared with 2010, we are seeing 2,500 more patients within four hours every single day. We are also seeing a big increase in demand, which is why there were particular measures in the Budget to make sure that we return to the 95% target, including £2 billion for social care, which is £2 billion more than the Labour party promised for social care at the election.
Tom Pursglove (Corby) (Con)
The urgent care centre at Corby has done much to relieve the pressures on Kettering A&E, and it is a class leader. Given the announcement of £100 million for new triaging projects, would the Secretary of State like to visit the Corby urgent care centre to see this beacon of best practice at first hand?
John Mc Nally (Falkirk) (SNP)
Paula Sherriff (Dewsbury) (Lab)
The Secretary of State for Health (Mr Jeremy Hunt)
This Government were the first to set a national ambition to eliminate inappropriate out-of-area placements by 2020-21. By then, no adult, child or young person will be sent away from their local area to be treated for a general mental health condition.
Paula Sherriff
I thank the Secretary of State for his response. My 17-year-old constituent Jess needed an acute mental health bed. The nearest available was in Colchester. She was allowed to go home some weekends, but it meant an 800-mile trip for her mum. We can only imagine the emotional and financial hardship that that caused. The Secretary of State tells us that he is working on this matter, and I believe that he does want to improve things, but what progress has actually been made, as this is really, really not good enough for Jess and others?
Mr Hunt
I agree with the hon. Lady and she makes her case very powerfully. We need to make progress and we need to make it fast, particularly for young people, as their recovery can be very closely linked with the potential of their parents to come to visit them. Nearby places such as the Sheffield Health and Social Care Foundation Trust, which do not serve her constituents, have eliminated out-of-area placements and saved £2 million in the process. It is about spreading that best practice.
John Howell (Henley) (Con)
Mr Hunt
My hon. Friend speaks very wisely on this matter. In the end, schools are a vital place in which to spot mental health conditions early. We know that around half of mental health conditions become established before the age of 14, and this will be a big part of the Green Paper that we publish later this year.
Ms Margaret Ritchie (South Down) (SDLP)
Does the Secretary of State recognise the ways in which poverty, the associated financial strain and deprivation intersect with mental health; understand the need for him to work with the Secretary of State for Work and Pensions to ensure that mental health is properly recognised in personal independence payment assessments; and recognise that the problem is more acutely affected if people have to travel out of their area of residence?
Philip Davies (Shipley) (Con)
Some innovative and award-winning work is being done by Bradford District NHS Care Trust. It is working alongside excellent voluntary organisations and charitable organisations such as the Cellar Trust in Shipley, which is delivering much improved support for mental health patients. Will the Secretary of State congratulate the work that is being done in Bradford, and would he like to pay a visit so that he can share this best practice with other parts of the UK?
Mr Hunt
I am happy to congratulate the Cellar Trust, and to pay a visit if I can find the time to do so. My hon. Friend is right to say that voluntary organisations play a vital role. Very often, they can see the whole picture and they treat the whole person, not just the specific NHS or specific housing issue, so he is right to commend its work.
Barbara Keeley (Worsley and Eccles South) (Lab)
Recent figures show that 18 mental health patients were placed more than 185 miles away from their home for treatment, including five from the northern region—Jess is one such example. Their families will have to travel the equivalent of Manchester to London, or further, to visit them. We have also learned that £800 million was taken out of CCG budgets, which could be funding services such as mental health in-patient beds, just to help NHS England balance the books. Will the Secretary of State tell those patients and families why they should be treated so far from home when their local CCG should be able to fund the in-patient beds they need?
Mr Hunt
With great respect to the hon. Lady, we are the first Government to count out-of-area placements, and to commit to eradicating them. What she does not tell the House is the context, which is the biggest expansion in mental health provision anywhere in Europe, with 1,400 more people being treated every single day, and an extra £342 million being spent this year on mental health compared with last year.
David Mackintosh (Northampton South) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
As part of our plan to improve access to general practice, we are taking steps to ensure that there will be an extra 5,000 doctors by 2020. We are increasing the number of GP training places, recruiting up to 500 doctors from overseas and encouraging doctors who have retired to return to general practice.
David Mackintosh
I am aware of a number of issues with the recruitment of GPs in my constituency, such as at St Luke’s surgery in Duston. Will my right hon. Friend meet me to discuss the issues with that surgery in particular?
Mr Hunt
I am very happy to meet my hon. Friend. He will know that the surgery got an £80,000 grant this year through NHS England’s general practice resilience scheme, but I am aware that there are lots of pressures on surgeries such as St Luke’s and I am happy to talk about it further.
Melanie Onn (Great Grimsby) (Lab)
I am delighted to hear the Secretary of State issue some information about the additional GPs who will be coming on stream in the coming years. How many will be coming to north-east Lincolnshire and when will they be there? We have a critical shortage of GPs and people are struggling to get appointments.
Mr Hunt
The hon. Lady is absolutely right that areas such as Lincolnshire find it particularly difficult to attract GP recruits, which is why we have set up a fund that gives new GP trainees a financial incentive to move to some of the more remote parts of the country. This is beginning to have some effect, and I am happy to write to her with more details.
Andrew Selous (South West Bedfordshire) (Con)
I warmly welcome the Secretary of State’s efforts to recruit more GPs, and I know that he wants all GPs and, indeed, doctors to have high levels of job satisfaction. Is he aware of the fact that reasonable numbers of doctors are leaving the UK to work overseas? Given the cost of medical training and the money that taxpayers put into that education, will he look at that issue, perhaps by requiring a certain commitment to the NHS?
Mr Hunt
My hon. Friend raises an important point. There is currently no evidence of an increase in the number of doctors going to work abroad, but there is an issue of fairness because it costs around £230,000 to train a doctor over five years. In return for that, there should be some commitment to spend some time working in the NHS, and we are consulting on that at the moment.
Julie Cooper (Burnley) (Lab)
GPs around the country are facing unprecedented pressures as they work to deliver the highest possible standards of care, despite underinvestment and increasing patient demand. A record number of GP practices closed in 2016. Are the Government really serious about addressing the problem for the sake of GPs and their patients? If so, why has the promised £16 million resilience fund not been delivered in full, when it was promised by October 2016? There is very little evidence to date of the Government delivering on any of their promises in “General Practice Forward View”, no sign of the extra £2.4 billion, no sign of—
Mr Speaker
Order. We have got the general drift. May I gently say to the hon. Lady that the longer the Opposition Front Benchers take, the less time there is for Back Benchers on both sides? This is becoming a worsening phenomenon. It is not only the fault of the hon. Lady, but it really must stop. It is not fair to Back-Bench Members.
Mr Hunt
During my time as Health Secretary, the real-terms investment in general practice has gone up by £700 million or 8%, and we are planning to increase it by 14%—£2.4 billion—over this Parliament. A lot of extra money is going in, but I recognise that there are still a lot of pressures.
David Tredinnick (Bosworth) (Con)
The Secretary of State’s plans to recruit doctors will be widely welcomed in Leicestershire, but should he not be making greater use of already properly regulated practitioners—those who are regulated by the Professional Standards Authority—of whom there are 20,000, including hypnotherapists?
Mr Hunt
My hon. Friend’s ingenuity in bringing these issues up in question after question never ceases to amaze me. As he knows, we recognise that the pressure in primary care cannot just be borne by general practice, but we must always follow the science as to where we get our help from.
Derek Twigg (Halton) (Lab)
Only recently, a surgery has been closed down in the borough of Halton. There is a clear shortage of GPs. Despite the efforts of the clinical commissioning group to try to find replacements, that has not happened. How will merging CCGs help, and can the Secretary of State rule out any merger between Warrington and Halton?
Mary Robinson (Cheadle) (Con)
Margaret Ferrier (Rutherglen and Hamilton West) (SNP)
The Secretary of State for Health (Mr Jeremy Hunt)
As part of our ambition to make the NHS the safest healthcare system in the world, I will today be speaking at the largest ever conference on learning from avoidable deaths and what we can do to improve care in the future. As part of that, I can inform the House that the NHS Litigation Authority will radically change its focus from simply defending NHS litigation claims to the early settlement of cases, learning from what goes wrong and the prevention of errors. As part of those changes, it will change its name to NHS Resolution.
Margaret Ferrier
My constituent Pauline Cafferkey was cleared of misconduct last September, following a very public case surrounding her return from Sierra Leone and her contraction of Ebola. Will she receive an apology from Public Health England and will it reimburse her legal costs?
Mr Hunt
With respect to Pauline Cafferkey, who is a very brave lady and who gave very good service to this country and the people of Sierra Leone with her work during the Ebola crisis, the hon. Lady will understand that disciplinary procedures are an independent matter. They are not dealt with by the Government. They have to be done at arm’s length and we have to respect whatever is said or done.
Amanda Solloway (Derby North) (Con)
Jonathan Ashworth (Leicester South) (Lab)
The Government have not met the four-hour target for A&E since July 2015. In the NHS mandate, finally published yesterday, the Secretary of State is effectively telling hospitals that they do not need to meet it in 2017 and that it only needs to be met in aggregate across hospitals
“within the course of 2018”.
Is that not the clearest admission that the targets will not be met next year, because in the next 12 months the NHS will be denied the funding it needs and, as a consequence, patients will suffer?
Mr Hunt
Apart from observing that if the hon. Gentleman cares so much about the 95% target he might want to ask his colleagues in Wales why they are looking at scrapping it, on the money let me be very clear: in the next year, the NHS will be getting about £1.5 billion more than his party were promising at the last election and the social care system will be getting £1.5 billion more than his party were promising at the last election. We are doing our job.
Jonathan Ashworth
The Secretary of State says he is doing his job, so why does he not take that up with NHS Providers, which is warning that because of the underfunding, it will be “mission impossible” in the next 12 months to deliver standards of care. Returning to the NHS mandate, did you notice, Mr Speaker, that in that mandate there is no mention whatsoever of Brexit, even though the NHS relies on 140,000 NHS and care workers? I know that the Secretary of State is not a member of the Cabinet Brexit committee, but will he use his considerable influence with the Prime Minister to ensure that when she triggers article 50 next week, she will finally give an absolute guarantee of the rights of all those EU workers in our NHS?
Mr Hunt
First, let me first reassure you, Mr Speaker, that I will be attending the Brexit committee when it is relevant to the NHS; in fact, I shall attend it this week, because issues relating to the NHS are coming up in it. What we are not going to do in that committee, however, is to take steps that would risk the welfare of British citizens living in countries such as Spain, Ireland and France. That is why, although it is a top priority for us to negotiate the rights of EU citizens living in Britain, including those working in the NHS, it has to be part of an agreement that protects the rights of British citizens abroad.
Antoinette Sandbach (Eddisbury) (Con)
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Ben Howlett (Bath) (Con)
Diana Johnson (Kingston upon Hull North) (Lab)
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
Vicky Foxcroft (Lewisham, Deptford) (Lab)
Mr Hunt
The hon. Lady is absolutely right to say that this is a serious issue. I commend the brilliant work done by NHS trauma centres throughout the country, which are world-beating, but, as well as setting up those centres, we have established much closer co-operation with local police forces so that we can work out where the crime hotspots are and help the police to prevent such things from happening.
Sir Edward Leigh (Gainsborough) (Con)
Michael Dugher (Barnsley East) (Lab)
The British Medical Association said recently that the funds for sustainability and transformation plans that were announced in the Budget would be completely inadequate for the task. Health trusts throughout the country are being forced to consider rationing treatment and ending or downgrading local services such as A&E, which will result in even longer waits and journey times to access care. Why do the Government not call STPs what they really are—secret Tory plans to decimate the national health service further?
Mr Hunt
This is a year in which funding for the NHS has risen by £3.8 billion in real terms. I do not know how the hon. Gentleman can say what he has said, given that in 2015 he stood on a platform to give the NHS £1.3 billion less this year than it is receiving under the Conservatives.
Mr Peter Bone (Wellingborough) (Con)
Dr Sarah Wollaston (Totnes) (Con)
The NHS mandate was published yesterday, just days before coming into force. Can the Secretary of State set out the reason for the delay, because it allows very little time for scrutiny of this important document by this House? Will he also set out how he is going to prevent money being leached from mental health services and primary care to prop up provider deficits, so that we can meet objective 6 on improving community services?
Mr Hunt
My hon. Friend makes very important points. The reason for the delay was because about a month ago we had wind that we might be successful in securing extra money for social care in the Budget, and we needed to wait until the Budget was completed before we concluded discussions on the mandate. Our confidence as a result of what is in the Budget has enabled us to make the commitments we have made in the mandate, including making sure that we continue to invest in the transformation of out-of-hospital care.
Several hon. Members rose—
Fiona Mactaggart (Slough) (Lab)
The Secretary of State will be aware that many migrants in the UK are not registered with GPs, yet now when they come to Britain they have to pay an NHS fine. What is he doing, with the Home Office, to ensure that migrants are registered with a GP and are aware of community health facilities?
Mr Hunt
I am not quite sure whether I understand the right hon. Lady’s question, but there is not a fining system for migrants; what we say is that people who come to the UK as visitors should pay for their healthcare, or pay the visa surcharge if they are coming for a longer period. There is an exemption for public health, because it is important for everyone that we make sure that we treat people for things like tuberculosis.
Robert Courts (Witney) (Con)
The Secretary of State is aware of the concern that I and the people of Witney have about the future of Deer Park medical centre, which is a vital local resource. I am grateful to him for meeting me and for our correspondence. Please will he confirm that he will press the Independent Review Panel for a response at the earliest opportunity, given that the clinical commissioning group is determined to close this vital practice in three days’ time, and that he will consider the views of the patients of Witney very carefully indeed?
Several hon. Members rose—
NHS Shared Business Services
Jeremy Hunt Excerpts(7 years, 9 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)
(Urgent Question): To ask the Secretary of State for Health to make a statement on the loss of confidential NHS correspondence by NHS Shared Business Services.
The Secretary of State for Health (Mr Jeremy Hunt)
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 general practitioners’ surgeries, NHS Shared Business Services—SBS. The backlog arose from the primary care services GP mail redirection service that SBS was contracted to run between 2011 and 2016. However, in three areas of England—the east midlands, north-east London and the south-west of England—this did not happen, affecting 708,000 items of correspondence. None of the documents was lost and all were kept in secure storage, but my immediate concern was that patient safety might have been compromised by the delay in forwarding correspondence, so 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 led by Jill Matthews, who heads the NHS England primary care support services team.
All the documentation has now been sent on to the relevant GP surgery, where it is possible to do so, following an initial clinical assessment of where any patient risk might lie. Some 200,000 pieces were temporary residence forms, and a further 500,000 pieces were assessed as low risk. A first triage identified a further 2,500 items that had potential risk of harm and needed further investigation, but follow-up by local GPs has already identified nearly 2,000 of those as having “no patient harm”. The remainder are still being assessed, but so far no patient harm has been identified.
As well as patient safety, transparency for both the public and this House has been my priority. I was advised by 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 could 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.
For the same reasons, and in good faith, a proactive statement about what had happened was again not recommended by my Department in July. However, on balance I decided it was important for the House to know what had happened before we broke for recess, so I did not follow that advice and placed a written statement before the House on 21 July. Since then, the Public Accounts Committee has been kept regularly informed, most recently being updated by my permanent secretary only last Friday. The Information Commissioner was updated in August, and the National Audit Office is currently reviewing the response. I committed in July 2016 to keeping the House updated once the investigations were complete and more was known, and will continue to do so.
Jonathan Ashworth
Let us be under no illusions: this is a catastrophic breach of data protection. More than half a million pieces of patient data—including blood test results, cancer screening results, biopsy results, and even correspondence relating to cases of child protection—were all undelivered, languishing in a warehouse, on the Secretary of State’s watch. It is an absolute scandal.
Time and again this Health Secretary promises us transparency; today, he stands accused of a cover-up. The Department of Health knew about this in March 2016, so why did it take this self-proclaimed champion of transparency until the last day before the House rose last summer to issue a 138-word statement to Parliament? That statement said that just “some correspondence” had not reached the intended recipients. When the Secretary of State made that statement, was he aware that it amounted to more than 700,000 letters? If so, why did he not inform Parliament? If he did not know, does that not call into question his competence?
What guarantees can the Secretary of State give us that no more warehouses of letters are yet to be discovered? Was the private contractor involved paid for the delivery of the letters? If so, what steps are being taken to recover the money? How many patients were harmed because their GP did not receive information about their ongoing treatment? Do patients remain at risk? The Secretary of State talks about NHS England’s ongoing investigation into 2,500 items; when are we likely to know the outcome?
We understand that Capita now has the contract to deliver these services. What scrutiny is the Secretary of State putting Capita under so that it does not happen again? Is it not better that, rather than this relentless pursuit of privatisation, we bring services back in-house?
Two months into 2017 and the Health Secretary lurches from one crisis to another: hospitals overcrowded and waiting lists out of control. He cannot deliver the investment that our NHS needs; he cannot deliver a social care solution; he cannot deliver patient safety; and now he cannot even deliver the post. He has overseen a shambles that puts patient safety at risk. Patients deserve answers and they deserve an apology.
Mr Hunt
The hon. Gentleman is reasonable and sensible, but sadly those commendable sides to his character have not been on display this afternoon, not least because I answered a number of his questions before he read out his pre-prepared script. He said that there had been a catastrophic breach of data protection. Let me remind him that no patient data were lost and all patient data were kept in secure settings. I know that it is a great temptation to go on about the privatisation agenda, but may I gently tell him that, since SBS lost this account, this particular work has been taken in-house? It is being done not by Capita, but by the NHS—so much for the Government’s “relentless pursuit” of the private sector.
More seriously, the hon. Gentleman is quoted in this morning’s edition of The Guardian as saying:
“Patient safety will have been put seriously at risk.”
As he knows, patient safety is always our primary concern, but if he had listened to my response he would have heard that, as things stand, there is no evidence so far that patients’ safety has been put at risk. [Interruption.] Well, we have been through more than 700,000 documents, and so far, we can find no such evidence. We are now doing a second check, with GPs, on 2,500 documents—so a second clinical opinion is being sought—nearly 2,000 of which we believe will not show any evidence, and we are now going through the remaining ones.
Let me say that it was indeed totally incompetent of SBS to allow this incident to happen, and we take full responsibility as a Government, because we were responsible at the time. None the less, the measure of the competence of a Government is not when suppliers make mistakes—I gently remind the hon. Gentleman that that did happen a few times when Labour was running the NHS—but what we do to sort out the problem. We immediately set up a national incident team. Every single piece of correspondence has been assessed, and around 80% of the higher risk cases have been assessed by a second clinician.
The hon. Gentleman then went on to suggest that the Government have been trying to hide the matter. If he had listened to what I said, he would have heard that I did not follow the advice that I got from my officials, which was not to publicise the matter. I actually decided that the House needed to know about it. It was only a week after I was reappointed to this job last summer that I not only laid a written ministerial statement, but referred to the matter in my Department’s annual report and accounts. He said this morning that I played down the severity of what happened, but what did that annual report say? It said that a “serious incident was identified”, and it talked about
“a large backlog of unprocessed correspondence relating to patients.”
It could not have been clearer.
This Government have always cared about patient safety. We have listened to the advice of people—as the hon. Gentleman would have done had he been in office—who said that if we had gone public right away, GP surgeries could have been prevented from doing what we needed them to do, which is making detailed assessments of a small number of at-risk cases. That was why we paused, but as soon as we judged that it was possible to do so, we informed this House and the public and we stayed absolutely true to our commitment both to patient safety and to transparency.
Dr Sarah Wollaston (Totnes) (Con)
This is undoubtedly a very serious incident, but I welcome the detailed and thorough steps that the Secretary of State has taken to protect patient safety. However, he will know that there are ongoing problems with the transfer of patient records. GPs and hospitals spend endless hours chasing up results, investigations and letters on a daily basis. Is it not time that patients were given direct control of their own records, and will the Secretary of State provide an update on that to the House?
Mr Hunt
I thank my hon. Friend for her sensible contribution. She is right that, although the process of sending on these particular documents has been taken in-house, other parts of the contract were taken on by a company called Capita—[Interruption.] The hon. Member for Leicester South (Jonathan Ashworth) cannot stop, can he? Let me repeat that the work in question has been taken in-house. The other work, which is being done by Capita, has had some teething problems, of which we are very aware. We know it has been causing problems for GPs. The Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood) has been meeting Capita and people relating to that contract on a fortnightly basis to try to identify the problems.
My hon. Friend the Member for Totnes (Dr Wollaston) is right that the aim in the long run is to give people control of their records. I am proud that, under this Government, we have become the first country in the world to give every patient access to their own records online. From September, people will be able to do that without having to go to their GP’s surgery.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I am sure that everyone across the House is glad that these 750,000 incidents have not, so far, resulted in patients suffering. Frankly, that is luck, rather than plan, for which we should all be grateful. This is yet another situation similar to that of Concentrix and others we have seen. When we are outsourcing and taking on these companies, what is the basis of the contract and what is the governance? The Secretary of State mentioned the other incidents of transferring data when a patient moves to another GP’s surgery, and that has also been an issue. When will data in England become more digital so that things are not sent by post? We have not used that method for several years in Scotland, and it is holding back the entire primary care and hospital system here. When will the Secretary of State’s vision for that come about?
Mr Hunt
The hon. Lady is always very good at telling the House things that Scotland does better than the NHS in England; there are, indeed, some. She is a little bit coyer about things that Scotland does less well than the NHS in England. If we put aside those issues, I think we can both agree that the sooner the NHS across the whole UK goes electronic, the better. That has been a big priority for this Government, and we have made big progress. More than two thirds of hospital A&E departments can now access a summary of people’s GP records, and we are going further every month.
Mr David Nuttall (Bury North) (Con)
As the affected patients could have moved anywhere in the country, will my right hon. Friend assure me or let me know, either today or by writing to me, whether any of my constituents in Bury North have been affected?
Mr Ben Bradshaw (Exeter) (Lab)
I raised my concerns about the contracting out of the patient record service to SBS back in 2011, and I was told by the Secretary of State’s predecessor that this was about saving money. Will he tell us how much money has been saved, given all the problems, and how many of the 708,000 patients affected are in the south-west?
Mr Hunt
The south-west was one of the regions affected, as I mentioned in my statement. I am happy to write to the right hon. Gentleman to tell him exactly how many patients I think were affected in the south-west. I gently say to him that the use of the private sector was championed when his Government were in office and when he was a Health Minister. I know that this is not very fashionable in his party at the moment, but on this side of the House, we think that if we want the NHS to be the safest and best in the world, we should be open—
Victoria Atkins (Louth and Horncastle) (Con)
There have been cries of privatisation from the Opposition. Is not the truth that in 2007, Her Majesty’s Revenue and Customs lost the entire collection of child benefit records, affecting 25 million people? Is not the point that all data holders, whether in the private or public sector, must hold our private information securely?
Mr Hunt
That is absolutely the point. What people will be wondering is, when we were faced with this issue, which was indeed serious, did we react as quickly as we could to keep patients safe? I believe the answer is yes. Did that happen under the last Labour Government? I will leave the House to draw its own conclusions.
Sarah Olney (Richmond Park) (LD)
The Secretary of State just stated with great authority that no patient data were lost. I would be interested to know how he can be so certain, given that all these data were missing for a long time without anybody noticing. What controls are in place now that were not in place then that mean he can make that statement with such confidence?
Mr Hunt
I welcome the hon. Lady to the House. I do not know whether she has done a Health question with me before, but let me say to her that we are assured that the data were not lost: they were kept in a secure setting, which means they were safe, they were not breached and they were not accessed by anyone else. What should have happened, but did not, was passing on the data to the right GP surgery, and that is why we have taken all the steps we have to try to make sure patients are kept safe.
Sir Oliver Letwin (West Dorset) (Con)
My right hon. Friend may recall times when we found ourselves in opposition and hoped we had a huge success on our hands, and the image that springs to mind at present is of foxes and shooting them. Does he agree that the Department he so expertly guides now needs to focus its attention on using electronic data for all our citizens and patients, rather than dealing with spurious Opposition problems?
Mr Hunt
As ever, my right hon. Friend is thinking extremely intelligently about the problems we really face. The hon. Member for Richmond Park (Sarah Olney) asked about the security of the data files, but the security of electronic files is the issue we are going to have to think about much more seriously as we give everyone access to their electronic records, and because of the known issues around hacking. This is an issue we are taking very seriously and doing more work on.
Stephen Twigg (Liverpool, West Derby) (Lab/Co-op)
I wrote to the Secretary of State on this subject on behalf of the Jubilee medical centre in Croxteth, in my constituency, on 13 January. I have not yet had a reply from him, but perhaps he could respond today to the point I raised about staff safety. We have had the issue of patient safety, but what about the potential danger to staff from these records not being available about patients?
Mr Hunt
I would like to reflect on the hon. Gentleman’s question in a bit more detail rather than giving an instant answer, because, to date, no one has brought to my notice particular issues about staff safety, but that is always something we take extremely seriously. We are aware of the extra administrative pressure on staff caused by needing to go through records where there is a higher risk of harm to patients—indeed, we have given GP surgeries extra resources to cover that additional time—but I will look into the issue the hon. Gentleman raises.
Jeremy Lefroy (Stafford) (Con)
Since at least 2015, it has been a statutory requirement to use a unique and consistent identifier on health and social care records. Given that that would, as the hon. Member for Central Ayrshire (Dr Whitford) said, help with putting data electronically on health and social care systems, will the Secretary of State update the House on the issue?
Mr Hunt
I am very happy to do so. Clearly, when we are all able to access our health records electronically, there are potentially huge benefits for patients. In particular, people with long-term conditions who use the NHS a lot would be able to take more control of what happens and also to spot mistakes, which sometimes happen in medical records—that is one of the big findings from the US, where people have had more widespread access to electronic records for longer. The issue is the security with which people access those records online, and we are looking very closely at the systems used by banks, for example. Those are pretty robust, but we are looking at whether we can have systems that are even more robust, because it is very important that patients have confidence that only they and those they give permission to can access those records.
Chris Leslie (Nottingham East) (Lab/Co-op)
Can the Secretary of State tell us a little more about which areas in the east midlands have been particularly affected? Given the opaque and byzantine structures of the NHS, can he specifically tell the House which member of his ministerial team had the job of keeping watch on NHS Shared Business Services?
Mr Hunt
The Minister responsible is the Under-Secretary, my hon. Friend the Member for Oxford West and Abingdon. This case happened before she was in post, so I took personal responsibility given it was such an important issue. I will write to the hon. Gentleman with more details about how the east midlands has been affected.
Dr Andrew Murrison (South West Wiltshire) (Con)
Does the Secretary of State agree that it is vital that we move towards a fully paperless national health service, but that it will be very difficult to do so as long as national health service trusts cannot talk to each other electronically? Radiological images, for example, are often not available when consultants see patients, who therefore have to have the test again, which is contrary to all the precepts of good practice in the Ionising Radiations Regulations 1999.
Mr Hunt
My hon. Friend is absolutely right. This is a very big part of our transformation plans for the NHS. Where the NHS does well internationally is in out-of-hospital records; our GP records are among the best of any country’s. GPs have done a fantastic job over the past 15 years in keeping all their records electronically, and they provide a lifetime snapshot of a patient’s history. Where we are less good is in our hospital records, where one can still find paper records in widespread use. That is not just very, very expensive but—he is quite right—unsafe at times.
Liz McInnes (Heywood and Middleton) (Lab)
I used to work in a pathology lab, and it absolutely pains me to think of those results generated by the hard work of pathology staff languishing in a warehouse somewhere, unseen by anybody. If GPs do not get lab results, they will ring the laboratory and ask for them, so has the Secretary of State made any estimate of the time wasted in phone calls from GP surgeries to pathology labs?
Mr Hunt
I am sure that, regrettably, because of what happened extra work was created for GPs. However, because of GPs’ commitment to their patients, it appears that in the vast majority of cases patient harm was avoided. When results do not come through that a GP is expecting, the GP chases them to make sure that the right thing is done for patients—but of course, as the hon. Lady rightly says, at the cost of extra work.
James Cleverly (Braintree) (Con)
Does my right hon. Friend agree that had the then Labour Government not made such a catastrophe of implementing the NHS computer system, such records would have been digitised many years ago and problems with storage of paper records would not have impacted on the patients who are currently suffering?
Mr Hunt
My hon. Friend speaks wisely. Many members of the public will be faintly amused to hear Labour Members say how important it is that we move to electronic health records. The NHS IT project was an absolute catastrophe, costing billions of pounds. The intention was right but the delivery was wrong, and that is what we are trying to sort out.
Mike Gapes (Ilford South) (Lab/Co-op)
I understand that large numbers of patients in north-east London were affected by this failure of the service. How many of my constituents were affected, how many of them were cancer patients, and how many would have been subjected therefore to an inordinate delay in receiving referrals for treatment? Can the Secretary of State give that itemised breakdown to all Members of Parliament who will have constituents affected by this?
Mr Hunt
I am very happy to write to hon. Members in the areas affected with any extra information that we are able to provide. However, I reassure the hon. Gentleman that to date we have not been able to identify any patient in any part of the country who has come to harm as a result of what happened.
Mr Stewart Jackson (Peterborough) (Con)
It is a shame that the synthetic outrage from Labour Members was not apparent when they were calling for a public inquiry into deaths in Mid Staffordshire, or, officially, the worst ever IT white elephant disaster, with £12 billion of costs uncovered by the Public Accounts Committee in 2013. Has not my right hon. Friend observed the appropriate parliamentary accountability protocols? He not only employed clinical expertise but came to the House in July, his officials updated the PAC in September, and he came here again today? There is no cover-up.
Mr Hunt
I am grateful to my hon. Friend. As he rightly points out, this was a judgment call, because going public at a very early stage about what happened risked overwhelming GP surgeries, with GPs being unable to investigate the most serious cases as quickly as possible. That is why I received very sensible advice to hold back, but I did decide that the House needed to know before the summer break, which is why I made the effort.
Margaret Greenwood (Wirral West) (Lab)
A number of GP practices in Wirral West have made clear to me their concerns about Capita’s handling of confidential patient records. There have been cases of patient records being delayed when they move to another practice, and in some instances confidential records have not arrived at all. As my hon. Friend the Member for Liverpool, West Derby (Stephen Twigg) has said, there is also concern that, if a patient is a risk to a doctor because of a mental health issue, that has not been flagged up to medical staff. That is a very serious risk to put staff under. Does the Secretary of State share the view of the chair of the British Medical Association’s GP committee, who said that this is
“an example of what happens when the NHS tries to cut costs by inviting private companies to do work which they don’t do properly”?
Mr Hunt
The hon. Lady makes very important points about the need for the rapid transfer of records when people move GP surgeries. I gently point out to her—I am sure she was asked to ask her question—that the reality is that, because of the failures of this contract, we have taken this work in-house. It is not about the Government pressing on with privatisation irresponsibly, or whatever it is that she is trying to say. This work is now being done in-house.
Mr Peter Bone (Wellingborough) (Con)
We have an excellent Secretary of State and the Government seem to have taken the appropriate action. My only concern is what he said about his Department’s officials recommending that this House not be informed. Under Gordon Brown and Tony Blair, I remember that we would get 80-odd written statements on the last day of term. May I gently suggest to the Secretary of State that it would have been better if the written statement had been made earlier in the week so that Members could have considered whether an urgent question was appropriate?
Mr Hunt
In ordinary circumstances, my hon. Friend’s point would be completely fair and reasonable. He may remember that certain other things were happening at that time last year and, as I have said, it had been only a week since I had been reappointed to my post, so there were a number of other issues. However, my priority was to make sure that we did not go away for the summer without the House being informed of the situation.
Tracy Brabin (Batley and Spen) (Lab)
The Secretary of State says that he has paid people—I assume that they are GPs—to clear the backlog. How much have you paid the GPs, and do you intend to recoup that money to the NHS?
Mr Speaker
I have made no such payment and I have no plans to recoup anything, but the Secretary of State might have.
Mr Hunt
I regret to say that the £2.2 million has not gone to you, Mr Speaker, but it has been paid to GPs for the extra administrative work that needs to be done. That is fair payment for the extra time that they are taking. It is, indeed, a cost to the taxpayer, but it was the right thing to do.
Tom Pursglove (Corby) (Con)
Will the Secretary of State reassure the House that appropriate staffing resources have been made available throughout to deal with the backlogs, not just nationally but in the east midlands?
Mr Hunt
We have always been concerned to make sure that, because of the extra administrative work involved in going through more than 700,000 records, other patients using the NHS do not find that their care is delayed. We made extra resources available for GP practices so that they could do that without interrupting the ordinary work that they have to do for their patients.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Surely the Secretary of State agrees that if everything were going swimmingly in the NHS, if we were investing in it like our European neighbours and if people were confident that their A&E departments and trusts were safe and that the whole health service was not in trouble, with privatisation biting into it, this issue could be put in perspective. But the NHS, under his watch, is in chaos. That is why we are so worried about this issue.
Mr Hunt
Let me gently remind the hon. Gentleman that, because of the decisions this Government have taken, we are actually now investing more than the European average in the NHS, which would have been much more difficult to do if we had followed his party’s spending plans. He tries to characterise our approach as one of suggesting that the NHS does not have problems. We think the NHS has some very big problems—it is working very hard to tackle them—but we are providing more doctors, more nurses, more funding and more operations than ever before in its history.
Mr Philip Hollobone (Kettering) (Con)
May I commend the Secretary of State for his response to the situation once he was told about it and welcome his pledge to provide constituency-wide data to the House? However, my constituents in Kettering will be amazed that, for five years, no one spotted that 700,000 records had gone missing. How was that discovered, and why in the three areas did such a large amount of data in effect disappear from public view?
Mr Hunt
I wish I could give my hon. Friend the answer to that question. I think it is completely extraordinary that for such a long period it was not noticed that the data had gone missing. It was discovered towards the end of the SPS contract. There are lessons for the NHS—this relates very closely to what other hon. Members have said—about the dangers of over-reliance on paper rather than electronic systems, with which it is much easier to keep track of what is happening. [Interruption.] Let me say to the hon. Member for Leicester South (Jonathan Ashworth), who continues to make comments from a sedentary position, that when it comes to making the NHS electronic, people will compare his Government’s records and ours and will say which is better.
Paula Sherriff (Dewsbury) (Lab)
I am sure all Members will be able to identify with people with anxiety caused by waiting for test results or diagnoses—I certainly can—so does the Secretary of State concur that it is scant consolation to those 700,000-odd people to be told that their letters were not lost, but are residing in a warehouse somewhere?
Mr Hunt
It is a completely unacceptable lapse of efficiency, and this supplier is no longer performing that job for the NHS. Of course it causes many people frustration when the information they are waiting for does not reach their GP’s surgery. However, the most important thing, as the hon. Lady and I would agree, is the safety of patients. That is why our biggest priority has been not the administrative inconvenience, frustrating though it is, but making sure we understand whether any patients have actually been put at risk.
Henry Smith (Crawley) (Con)
This morning, I was very pleased to tour the new clinical assessment unit that was opened last month at Crawley hospital. That was made possible partly because the hospital used to store paper records in that space, but has now moved to electronic records. May I commend the Secretary of State for increasing the drive to using electronic rather than paper records, and urge him to redouble his efforts?
Mr Hunt
I am very happy to follow my hon. Friend’s advice in that respect. I think we all know that although the proper use of electronic records creates huge opportunities, we have to carry the public with us and make sure they are confident that the data will be held securely. That is why we have introduced the new post of a National Data Guardian, Dame Fiona Caldicott, who is the patients’ watchdog in this area.
Margaret Ferrier (Rutherglen and Hamilton West) (SNP)
NHS Shared Business Services Ltd exists for one reason only, which is to deliver £1 billion in savings by 2020. The results of this Government’s ideological obsession with savings and austerity have surely now been laid bare for all to see, and we are quite lucky that this did not, quite literally, kill anyone. Will the Secretary of State agree to meet the Chancellor urgently to discuss increased funding for a health service that is being starved of the resources it needs to run effectively?
Wendy Morton (Aldridge-Brownhills) (Con)
As the Secretary of State is aware, patient safety is paramount. For the benefit of my constituents, will he confirm that patient safety was throughout the process and remains his primary concern?
Louise Haigh (Sheffield, Heeley) (Lab)
The Secretary of State was responsible for the entirety of the contract, yet has come to the House to respond to the urgent question and told us that he does not know how the situation came to light to NHS England, and that he has no answers. Mr Speaker, do you think he should have been better prepared today? What assurances can he give us that he now has controls in place to monitor any future contracts?
Mr Hunt
The hon. Lady should have listened to the facts when I told her. When this came to light, more than 700,000 records were checked: 2,500 of the higher-risk ones are being checked by two clinicians—80% of them have already been checked. A huge amount of work has been done to clear up the situation. I completely agree with her that it was unacceptable that it happened in the first place, but I gently say to her that we are not the first Government to be let down by suppliers.
Kate Green (Stretford and Urmston) (Lab)
A few moments ago, the Secretary of State alluded to teething problems with the Capita contract. I must tell him that GP practices in my constituency told me only a couple of weeks ago that those problems not only continue but are worsening. How much longer will the Secretary of State give Capita to perform under the contract it has with the Department of Health? If it cannot perform, how quickly can we expect the Secretary of State to decide to take that work back in-house?
Mr Hunt
If Capita does not perform what it is contracted to do, we will take all necessary measures, including ending the contract. The hon. Lady is right that there have been a number of problems with that contract in its early days. We believe that the situation on the ground is beginning to improve, but a lot of progress still needs to be made.
Oral Answers to Questions
Jeremy Hunt Excerpts(7 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Philip Hollobone (Kettering) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
Under this Government, the amount recovered from international visitors has trebled from £81 million to £289 million. Yesterday, I announced that we were going further by introducing upfront ID checks and payment for elective care, stopping IVF being available for those who pay the health visa surcharge and asking GPs to help to identify European citizens at the point of registration so that we can recharge their costs to their home country.
Mr Hollobone
My constituents in Kettering welcome the Government’s latest crackdown on this abuse of our national health service at a time when we are struggling to find enough money to pay for the care of elderly people who have paid into the NHS all their lives. We simply cannot afford to provide a free international health service.
Mr Hunt
My hon. Friend is absolutely right. It is a national health service, not an international health service. I was disappointed to see comments from the Opposition yesterday that the money this would raise would be a drop in the ocean—[Hon. Members: “It is.”] We are seeking to raise £500 million. That is enough to finance 5,000 GPs, who could help the constituents of everyone in this House.
Mr Ben Bradshaw (Exeter) (Lab)
Is it not a coincidence that, whenever we hear about disastrous figures for NHS performance and a huge deterioration in waiting times, as we did at the weekend, the Government re-announce yet another measure to crack down on health tourism? Is not the main problem with our health and social care system the fact that it is chronically underfunded, and that this Government are doing nothing about it?
Mr Hunt
I will tell the right hon. Gentleman what we are doing about the underfunding. We are raising three times more from international visitors than when he was a Health Minister, and that is paying for doctors, nurses and better care for older people in his constituency and in all our constituencies.
Dr Sarah Wollaston (Totnes) (Con)
Given the Government’s stated objective of reducing health inequalities, will the Secretary of State set out how he will guarantee that those who are, for example, homeless or who have severe enduring mental illness—the most disadvantaged in our society, who are unlikely to have the required documentation—will receive the treatment they need?
Mr Hunt
I can absolutely reassure my hon. Friend. What we are doing is based on good evidence from hospitals such as Peterborough hospital, which has introduced ID checks for elective care and has seen absolutely no evidence that anyone who needs care has been denied it. This is not about denying anyone the care they need in urgent or emergency situations; it is about ensuring that we abide by the fundamental principle of fairness so that people who do not pay for the NHS through their taxes should pay for the care we provide.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Has the Secretary of State actually been recently to a clinical commissioning group like ours in Huddersfield, where one more duty would really break the camel’s back? We have just heard that the CCG is changing its constitution, excluding GPs and totally changing the nature of the CCG. Like most of them, our CCG is under-resourced and under stress, and asking it to do something else like this, which will be complex, difficult and perhaps impossible, will kill the poor bloody animal.
Mr Speaker
With reference to foreign nationals, and including a question mark at the end of the hon. Gentleman’s observations.
Mr Peter Bone (Wellingborough) (Con)
When I was in the travel industry, I learned that anyone wanting to travel to, say, America had to have medical insurance. Could it not be a requirement for people coming into this country to ensure that they had such insurance?
Mr Hunt
We looked at this extremely carefully, and I have a lot of sympathy with what my hon. Friend is saying. People do not have to have medical insurance if they visit countries such as America as a tourist, and we do not want to insist on that for visitors to this country because of our tourism industry here. We concluded that it was better to have a system in which people who get a visa to come and live here have to pay a surcharge. That is why we have introduced the visa health surcharge, which raises several hundred million pounds for our NHS.
Helen Jones (Warrington North) (Lab)
I have always supported the view that we are not running an international health service, but as well as directing his energies towards that question will the Secretary of State direct them towards stopping the waste of money that occurs elsewhere in the NHS when highly trained surgeons and theatre teams are forced to wait to operate because beds are not available for their patients and have to spend their time doing nothing? How much is wasted in that way because of the chronic underfunding that this Government have introduced?
Rehman Chishti (Gillingham and Rainham) (Con)
Lucy Frazer (South East Cambridgeshire) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
In the last four years, 31 trusts have been put into special measures—more than one in 10 of all NHS trusts. Of those, 16 have now come out, and I congratulate the staff of Addenbrooke’s and all at Cambridge University Hospitals NHS Foundation Trust, which came out of special measures last month.
Let me also take this opportunity to thank Professor Sir Mike Richards, who has announced his retirement as chief inspector of hospitals. His legacy will be a safer, more caring NHS for the 3 million patients who use it every week. He can feel extremely proud of what he has achieved.
Chris Green
Royal Bolton hospital was in special measures four years ago, but it has since come out following a huge amount of hard work. The trust is now running a surplus, which is being reinvested into patient care. Will my right hon. Friend join me in congratulating all the staff on their excellent hard work?
Mr Hunt
I am happy to do so. It is a fantastic example of what is possible in challenging circumstances with a lot of pressure on the frontline, so the staff should feel proud. Trusts put into special measures go on to recruit, on average, 63 more doctors and 189 more nurses and see visible improvements in the quality of patient care.
Lucy Frazer
The Secretary of State is right to congratulate Addenbrooke’s, which came out of special measures in the last month due to the dedication of its staff, but we still need to reduce pressure on the A&E. One way of doing that is to increase care locally in rural hubs. Does the Secretary of State agree that money spent on the minor injuries unit at Ely’s Princess of Wales hospital would be money extremely well spent?
Mr Hunt
I remember visiting my hon. Friend in Ely last autumn, and I know how much she campaigns and cares for her local health services. The Cambridgeshire and Peterborough CCG knows the importance of Ely’s minor injuries unit. It is setting up some public engagement meetings, but if any changes are deemed necessary, I reassure her that there will be a formal consultation before anything happens.
Heidi Alexander (Lewisham East) (Lab)
The Heath Secretary’s self-congratulatory tone is astonishing. In the last year, the number of people waiting longer than four hours in A&E has increased by 63%, the number of people waiting on trolleys has gone up by 55%, and the number of delayed discharges is up by 22%. While all of us want hospitals in special measures to improve, what is the Health Secretary’s answer to those urgent problems that affect the NHS across the board?
Mr Hunt
I will tell the hon. Lady what is happening in the NHS compared with when her party was in power: 130 more people are starting cancer treatment every single day; 2,500 more people are being seen in A&Es within four hours every single day; and there are 5,000 more operations every single day. None of that would be possible if we cut the NHS budget, which is what her party wanted to do.
Neil Coyle (Bermondsey and Old Southwark) (Lab)
Norfolk and Suffolk NHS Foundation Trust has been taken out of special measures, despite continued growth in the number of people with mental health problems dying in unexpected or avoidable circumstances from things such as suicide. “Panorama” and the Health Foundation have shown that in 33 trusts the number of avoidable deaths has doubled in the last three years as those trusts have collectively experienced a real-terms cut of £150 million. What specific measures is the Secretary of State taking to tackle the problem of avoidable deaths of people with mental health problems?
Mr Hunt
We have committed, and the Prime Minister affirmed the commitment only last month, to spend £1 billion more every year on mental health services, but we recognise that it is not just about money. It is also about having a proper suicide prevention plan—we have updated the plan—and making sure that, across the NHS, we properly investigate and learn from avoidable deaths. That is why, following the tragedy of what happened at Southern Health, we have now started a big new programme—the first of its kind in the world—whereby every trust will publish its number of avoidable deaths quarterly.
Huw Merriman (Bexhill and Battle) (Con)
Mr Hunt
I join my hon. Friend in doing that. It is really important, contrary to what the former shadow Health Secretary, the hon. Member for Lewisham East (Heidi Alexander), says, that we praise NHS staff when they do remarkable things. There is a lot of pressure everywhere in the NHS, and praising NHS staff is not being self-congratulatory; it is recognising when a good job is being done.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Further to the very important question of my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle), Members on both sides of the House may have seen “Panorama” last night. Frankly, it was shocking and disgusting. I am ashamed to live in a country where in the past year there have been over 1,000 more unexpected deaths under the care of our mental health trusts. That is not a reflection of a country that cares equally about mental health and physical health. In spite of what the Secretary of State just told us, the money is not getting to where it is intended. What is he actually going to do to ensure that no person in our country—not a single person—loses their life because they have a mental health condition for which they are not being treated properly?
Mr Hunt
I agree with the hon. Lady that there is a huge amount that we need to do to improve mental health provision in this country, but a huge amount has been done and is being done. As she knows, we are now seeing 1,400 more people every day with mental health conditions. We are committing huge amounts of extra money to mental health provision, and we are becoming a global leader in mental health provision, certainly according to the person in charge of the Royal College of Psychiatrists. We have to support the efforts happening in the NHS, because we are one of the best in the world.
Simon Hoare (North Dorset) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
Last month the Prime Minister made a major speech in which she made it clear that improving the mental health of children and young people is a major priority for this Government. My Department will work with the Department for Education to publish an ambitious Green Paper outlining our plans before the end of the year.
Simon Hoare
I am grateful to my right hon. Friend and the Prime Minister for their commitment to this important area of health and the parity that the Government are giving it. Does the Secretary of State agree that, as well as providing mental health support in both schools and colleges, community hospitals, due to their locality, status and scale, can often provide a useful forum for providing these vital services?
Mr Hunt
I am pleased that my hon. Friend raises that point, because when we discuss mental health we often talk about services provided by mental health trusts but do not give enough credit to the work done in primary care, both in community hospitals and by general practitioners, who have a very important role as a first point of contact. He is absolutely right to make that point.
Dame Rosie Winterton (Doncaster Central) (Lab)
Will the Green Paper look at the role that educational psychologists could play not only in providing support and assistance to young people with mental health problems but in preventive work? Cuts in local authority budgets have meant that the service has become quite fragmented, but there are practical ways in which it could be improved to help young people with mental health problems.
Mr Hunt
The right hon. Lady is absolutely right. We have looked into this and realised that there are two issues when it comes to improving children’s and young people’s mental health. The first is improving access to specialist care for those who need it. The other is prevention: the work that can be done by teachers within schools and in training people in mental health first aid. Those kinds of things can make a huge difference and we want to make sure we do them both.
Mr Charles Walker (Broxbourne) (Con)
I welcome the Secretary of State’s focus on child and adolescent mental healthcare, but what is he going to do about out-of-area transfers, which too often mean that children are found beds 200 or 300 miles away from their home? That is not in anyone’s interest, and it certainly is not in a child’s interest to be that far away from their support network.
Mr Hunt
I thank my hon. Friend for his continuing campaign on mental health issues. He is right to say that this situation is completely unacceptable, not least because if we want a child to get better quickly, the more visits from friends and family they can have, the better it is and the faster their recuperation is likely to be. We have commissioned 56 more beds, so the total number of beds commissioned for children is at a record 1,442, but we are determined to end out-of-area treatments by the end of this Parliament.
Ian Austin (Dudley North) (Lab)
No one is going to disagree with what the Secretary of State has said, but it is not going to help people at Dove house in Dudley, which has been helping people with mental health problems since the 1970s but faces closure this year, for the want of quite a small amount of money. Will he look at this personally and do everything he can to keep this valuable facility open? It is closing because Dudley is losing 20% of its funding, which compares with the figure of just 1% in Surrey, which he represents.
Mr Hunt
Dudley CCG has seen its funding go up, and we are asking all CCGs to increase the proportion of their spend on mental health. I am happy to look into the situation the hon. Gentleman talks about, but I will be very disappointed if increasing resources are not going into mental health provision in Dudley.
Mark Pawsey (Rugby) (Con)
Will the Secretary of State say a little more about how children’s mental health services can work more closely with schools and the education system more broadly?
Mr Hunt
I am happy to do that. Some interesting innovation is going on in many parts of the country. In Hove, a school I visited has a CAMHS––child and adolescent mental health services—worker based full-time in the school. That had a transformational effect, as it meant teachers always had someone they knew they could talk to and their understanding of mental health improved. That is the kind of innovation we want to encourage.
Mr Gregory Campbell (East Londonderry) (DUP)
Further to that, what pressure and persuasiveness is the Minister bringing to bear in the education system, particularly in primary schools, where young people have, on occasion, had this kind of a diagnosis and problems have been created within the school environment?
Mr Hunt
This is a very important issue because, as the hon. Gentleman knows, half of all mental health conditions are diagnosed before or become established before people are 14, and the sooner we catch them, the better the chance of giving someone a full cure. We therefore need to find a way whereby there is some mental health expertise in every primary school, so we can head off some of these terrible problems.
Barbara Keeley (Worsley and Eccles South) (Lab)
As my hon. Friends the Members for Bermondsey and Old Southwark (Neil Coyle) and for Liverpool, Wavertree (Luciana Berger) have already said, last night’s “Panorama” showed that mental health services are not funded properly. At the Norfolk and Suffolk mental health trust funding cuts led to community teams being disbanded, a loss of staff and the loss of in-patient psychiatry beds. Most disturbing of all is to hear parents talk of what happens to their children when they are denied support in a crisis—when they are self-harming or suicidal but there are no in-patient beds. One parent called it a “living nightmare”. We do not need any more warm words from this Secretary of State—we need action to make sure that mental health services are properly funded and properly staffed.
Craig Williams (Cardiff North) (Con)
Pauline Latham (Mid Derbyshire) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
We know that a strong primary care system is the bedrock of the NHS, which is why I am pleased to announce today that NHS England will publish the new GP contract, agreed by the Government, NHS England and the British Medical Association. It will see almost £240 million extra invested in GP services; require GPs to establish whether overseas visitors are eligible for free care, allowing the NHS to better recoup the costs of that care; and improve access for patients by removing extra funding if GPs regularly close for afternoons during the working week.
Pauline Latham
Will the Secretary of State consider putting a GP in every A&E department so that they can additionally triage patients who are not so ill and advise them to go home and see their own GP on another occasion?
Jonathan Ashworth (Leicester South) (Lab)
With respect to A&Es, diverts have been at twice the level of last year, 4,000 people have had urgent operations cancelled, 18,000 people a week in January were waiting on trolleys in corridors, and nine out of 10 hospitals have been overcrowded and are at unsafe levels. I have even read in the Secretary of State’s local paper that his local hospital had to put patients in the gym overnight. Does the Secretary of State agree with the Prime Minister that the crisis facing our NHS amounts to a “small number of incidents”?
Mr Hunt
The NHS is under a lot of pressure, but what we never get from the hon. Gentleman is any solutions. Our solution is 600 more A&E consultants since 2010, 1,500 more A&E doctors, 2,000 more paramedics, and 2,500 more people being seen within four hours every day. His solution at the last election was to cut the NHS budget by £1.3 billion.
Jonathan Ashworth
The Secretary of State’s solution has been to blame everybody else but never take responsibility himself.
What is the Secretary of State going to do about the crisis that we are now facing in staffing? Last week, we learned that half of junior doctors are abandoning specialist training. We have already heard that applications for nursing degrees are down by a quarter following the axing of the student bursary and we heard today that there is a shortage of midwives. I know that the right hon. Gentleman has been in the US and that he will try to give us his alternative facts, but when will he give us an alternative plan and deal with the staffing crisis—an issue that the Minister of State, the hon. Member for Ludlow (Mr Dunne), could not respond to a few moments ago?
Mr Hunt
Let us look at the reality, instead of the hon. Gentleman’s rhetoric. In his own local trust in Leicester, there are 246 more nurses than in 2010 and 313 more doctors. Some 185 more patients are being seen in A&E every day and next year a new £43 million emergency floor will open at the Leicester Royal Infirmary. That is because we are backing the NHS instead of wanting to cut its budget.
Mr John Baron (Basildon and Billericay) (Con)
John Pugh (Southport) (LD)
Derek Thomas (St Ives) (Con)
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
Andrew Selous (South West Bedfordshire) (Con)
Young people with severe anxiety can spend years out of school and become very isolated. Does the Secretary of State agree that we need to think more imaginatively about community and voluntary solutions to reach out to those young people, whose futures we must not give up on?
Norman Lamb (North Norfolk) (LD)
Mr Hunt
I am always somewhat disappointed by the right hon. Gentleman’s rhetoric, given that we are spending about £1 billion more every year than when he was mental health Minister. This April, we will reintroduce maximum waiting times for eating disorders. As he knows, we have committed to publish pathways for all conditions during this Parliament. That will include his constituent who, I agree, is waiting much too long at the moment.
Jake Berry (Rossendale and Darwen) (Con)
Some GP practices in east Lancashire have, through sheer frustration, started publishing the number of missed appointments. When will the Secretary of State consider giving GPs the power that they want, and that the public want them to have, to charge those who miss repeated GP appointments, including in east Lancashire?
Paula Sherriff (Dewsbury) (Lab)
Mr Hunt
May I gently tell the hon. Lady that I do not think our debates on the NHS are helped by her taking my comments out of context? I was quoting Chris Hopson, from NHS Providers, talking about a specific week when he said there were, in that week, a small number of incidents. We recognise the pressures across the NHS, which is why this Government are backing the NHS with record funding.
Mr Steve Baker (Wycombe) (Con)
A small business in my constituency was driven out of business by slow payments for relatively small sums by NHS providers. Will he ensure strict compliance with the guidelines for timely payments?
Steven Paterson (Stirling) (SNP)
The Royal College of Psychiatrists warns that half of all child and adolescent mental health training posts are unfilled. With 11% of trainees being EU nationals, how do the Government plan to avoid a Brexit-inspired staffing crisis?
Dr Tania Mathias (Twickenham) (Con)
My constituent, Nicola Johnson, has had primary breast cancer. The secondary was discovered at 10 months. Will the Minister meet me and Nicola, because she falls within the six-month to 12-month period? She is eligible for neither pertuzumab nor trastuzumab emtansine.
Tom Pursglove (Corby) (Con)
Thank you, Mr Speaker. Corby and east Northamptonshire is taking thousands and thousands of new homes. What reassurance can Ministers give to my constituents that GP services will keep up with housing growth?
NHS and Social Care Funding
Jeremy Hunt Excerpts(7 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Jonathan Ashworth
I will give way in a moment. As the King’s Fund said, the reason there is a problem is quite simply because there is a
“mismatch between funding and activity”
affecting our hospitals. The response of Ministers, from the Prime Minister downwards, has been one of utter complacency. The Secretary of State told “Sky News” on Monday that things had only been
“falling over in a couple of places”.
When he came to the House on Monday to make his statement, he did not commit to extra emergency funding for social care and he did not promise that the financial settlements would be reassessed in the March Budget. It is worse than that, because while he was making his statement, his spin doctors were telling the Health Service Journal—this on the day when the winter crisis is leading the news and he is making a statement in the House—and letting it be known that there is “no prospect” of
“additional funding to support emergency care any time before the next election.”
So there is nothing for social care, nothing for emergency care, nothing to tackle understaffing and nothing to tackle underfunding—well thank you very much. What did we get as a response? We got a downgrade of the four-hour A&E target.
Jonathan Ashworth
The Secretary of State shakes his head and says, “Nonsense”, but let me remind him of what he said in the House on Monday:
“we need to have an honest discussion with the public about the purpose of A&E departments.”
He began by saying he wanted to provoke a discussion. He has certainly provoked a backlash, not least by blaming the public, it seems, for turning up at A&E departments. He went on to say that the four-hour target
“is a promise to sort out all urgent health problems within four hours”,
but he added a little clarification, continuing:
“but not all health problems, however minor.”—[Official Report, 9 January 2017; Vol. 619, c. 38.]
That is what he said in the House, and now we have seen the letter from NHS Improvement to trusts a few weeks ago, which talks of
“broadening our oversight of A&E”.
On the four-hour standard, it said that it believed
“there is merit in broadening our oversight approach, beyond a single metric”.
So in the interests of that discussion the Secretary of State wants to engage in, perhaps he can answer our questions, although I know he avoided the questions on Sky yesterday. Does he recall that in 2015, when he asked Sir Bruce Keogh to review these matters on waiting times, Sir Bruce said:
“The A&E standard has been an important means of ensuring people who need it get rapid access to urgent and emergency care and we must not lose this focus”?
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move an amendment, to leave out from “House” in line 1 to the end and add:
“commends NHS staff for their hard work in ensuring record numbers of patients are being seen in A&E; supports and endorses the target for 95 per cent of patients using A&E to be seen and discharged or admitted within four hours; welcomes the Government's support for the Five Year Forward View, the NHS's own plan to reduce pressure on hospitals by expanding community provision; notes that improvements to 111 and ensuring evening and weekend access to GPs, already covering 17 million people, will further help to relieve that pressure; and believes that funding for the NHS and social care is underpinned by the maintenance of a strong economy, which under this administration is now the fastest growing in the G7.”
I thank the shadow Health Secretary for bringing this afternoon’s debate to the House. He is right to draw attention to the pressures in the NHS, but, regrettably, I will have to spend much of my time correcting some totally inaccurate assertions that he has made, and that is a shame. This is an important debate for our constituents—for his and for mine—and for the NHS. The country deserves a proper debate, but that is difficult when we are given misinformation at a time when the NHS is under sustained pressure.
I am also very pleased to see the Leader of the Opposition in his place. I think that he has become rather a fan of my parliamentary appearances—[Interruption.] It is a Jeremy thing, he says—if only. I wish to address one part of my speech to him, because it is an area of policy for which he is perhaps more personally responsible.
Winter is always challenging period, and I want to repeat the thanks of the shadow Health Secretary and the thanks that I gave on Monday to NHS staff. According to NHS Improvement, on the Tuesday after Christmas the NHS had its busiest day ever. Earlier in December, it treated a record number of patients within four hours. Overall, as the Prime Minister said this morning, we are seeing 2,500 more patients within the four-hour standard every single day compared with what happened in 2010. As we discussed on Monday, the NHS made record numbers of preparations for this winter, because it is always a difficult time, including having 3,000 more nurses and 1,600 more doctors in full-time employment.
Let me address what the shadow Health Secretary said with regard to Worcestershire. I met colleagues from Worcestershire on Monday. A huge number of actions are now being taken, but we must say right up front that it is totally unacceptable for anyone to wait 35 hours on a trolley and that we expect the hospital to ensure that that does not happen again. There are plans in place to open additional bed capacity this week. We have already had capacity made available by Worcester Community Trust to support the flow. The trust has deployed its chief operating officer on the task of facilitating discharges. The trust is in special measures, so we have a big management change, and a new chief executive will be starting later on in the spring.
What is wrong with what the shadow Health Secretary has just said is the suggestion that winter problems are entirely unusual. As my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) said, the NHS had difficult winters in 1999, 2008, and 2009. He remembers difficult winters from his time as Health Secretary, but there are things that are different today. One of them is that, compared with six years ago, we have 340,000 more over-80s, many of whom are highly vulnerable or have dementia. We know that when people of that age go to an A&E at this time of year, there is an 80% chance that they will be admitted to hospital.
Derek Twigg
The Secretary of State talks about correcting the points that have been made so that the House has the right information. May I repeat the question that I asked him on Monday? What are the latest figures—he should have them up to this week—for the number of people who could be discharged but have to remain in hospital because there is no community support available for them? Can he give us that figure now? He said that he would write to me, but he must know that figure now.
Mr Hunt
Let me answer the hon. Gentleman’s question. I said that I would write to him, and I will do so. He may have noticed that there are other issues that we are dealing with, which is why I may not have had time to sign the letter. The £400 million extra for local authorities over the next two years will make a significant difference and he should recognise that.
Richard Fuller (Bedford) (Con)
I am attending this debate because there will be constituents in Bedford and Kent who are concerned about the headlines that they have read. I am pleased that the Secretary of State will correct some of the points that have been made. What our constituents want to know is what is being done, or what should be done. I listened for 33 minutes to the shadow Secretary of State—the Labour spokesman on the NHS—on this issue, and there was not a single new idea other than spending money. Will my right hon. Friend please provide some practical answers to the problems that are being raised in the papers?
Several hon. Members rose—
Mr Hunt
I will give way, but first I want to make some progress.
I want to talk about something else that is different in our A&E departments today compared with six years ago. Although we are sticking to the four-hour target, we also insist on much higher standards of safety and quality.
On Monday, I congratulated Labour on the introduction of the four-hour target—I support it—but we should also remember that four years after that standard was introduced, we started to see some horrific problems at Mid Staffs, many of which were in the A&E department. Some were caused because people thought they would be fired if they missed the target. Robert Francis said that the failures at Mid Staffs were
“in part the consequence of allowing a focus on reaching national access targets.”
Therefore, although we retain targets, we will not allow them to be followed slavishly in a way that damages patient care.
Mr Hunt
I have already given way to the hon. Gentleman. There are many other Members who want to intervene.
That is why we have a new inspection regime that makes it harder to cut corners in the way that used to happen when beds were not being washed, there was poor infection control and ambulances were being used as waiting rooms.
Toby Perkins
I am grateful to the Health Secretary for outlining some of the steps that he is taking in the face of this immediate emergency. Does he also recognise that the major cause of the problems in A&E is simply a lack of staff? Consequently, does he regret the huge cuts to training budgets in 2010, 2011 and 2012, which are having a real impact now on the number of nurses and doctors in our NHS?
Mr Hunt
I agree that staff numbers are critical, but we have, since 2010, 1,500 more doctors in our A&E departments and 600 more consultants. Across the NHS, we have more than 11,000 additional doctors, so we do recognise the pressures that the NHS faces. Indeed, we have 1,600 more doctors than this time last year, so we are doing a great deal to solve the problem.
Graham Evans (Weaver Vale) (Con)
Does my right hon. Friend agree that we need to learn best practice in the NHS? The hospitals that manage to integrate health and social care, such as those in Wigan and Salford which have managed to create those beds, are providing examples of best practice from which the whole NHS can learn.
Mr Hunt
My hon. Friend is absolutely right. It is a mistake in this debate to try—as I understand Opposition parties want to do—to boil this all down to the issue of Government funding when there is actually a lot of variability in the country. At this time of year, which is always difficult, some hospitals are doing superbly well in extremely challenging circumstances. We have just heard about some of the hospitals that are doing well, and there are a number of them.
Several hon. Members rose—
Mr Hunt
I will give way to as many people as I can, but I also want to address the substantive points made by the shadow Health Secretary. He talked about the four-hour target. In his motion and his speech, he made the totally spurious suggestion that we are not committed to that target. I remind him what my right hon. Friend the former Chief Whip quoted me as saying on Monday. I did not just commit the Government to the target; I said that it was one of the best things that the NHS does. However, I also said that we need to find different ways to offer treatment to people who do not need to be in A&E. It is hardly rocket science. When there is pressure in A&E, it is sensible—indeed, I would argue that it is the duty of the Health Secretary—to suggest that people who can relieve pressure on A&E by using other facilities do so.
Henry Smith
Just yesterday at Crawley hospital, an acute care unit was opened, which is designed precisely to ensure that people who do not need to attend A&E are properly directed to the most appropriate care, which is good for them as individual patients and good for the whole system.
Mr Hunt
That is absolutely right. To back up my hon. Friend’s point, yesterday’s OECD report said that in Australia, Belgium, Canada, France, Italy and Portugal, at least 20% of A&E visits are inappropriate. NHS England’s figure is up to 30%, which is why we need the public’s help to relieve pressure and that is what I meant when I talked about an honest discussion.
Luciana Berger
The Secretary of State told us just a moment ago that there are now over 300,000 more people over the age of 80. Surely he would have known that information from census and Office for National Statistics data when his Government took over seven years ago, so why is it that we are now seeing on the front pages of our newspapers that one in four of our A&E wards is unsafe and that we have so many challenges across the country, including in my constituency?
Mr Hunt
We did know that information and that is why we thought it was totally irresponsible to want to cut the NHS budget in 2010, and not to back the NHS’s own plan in 2015. As a result, we have 11,000 more doctors. In the hon. Lady’s local hospital, 243 more people are being treated within four hours every single day.
Mr Hunt
I will make some progress and then give way. I could have put what I said on Monday another way. I could have said:
“We have to persuade those people not in medical emergencies to use other parts of the system to get the help they need”.
I did not actually say that, but I will tell the House who did. It was the then Labour Health Minister in Wales, Mark Drakeford, in January 2015. Frankly, when the NHS is under such pressure, it is totally irresponsible for the Labour party to criticise the Health Secretary in England for saying exactly the same thing that a Labour Health Minister in Wales also says.
Owen Smith
The Secretary of State has sowed confusion in the House and in the country on this question this week, and he is doing so again today. If he is saying the same as my friend the former Health Minister in Wales—that we want to divert people who do not need to go to A&E from doing so—I am sure that everybody in this House would support him. But we suspect that he is saying that the four-hour wait target will be disapplied to some people turning up to A&E, and that that is the downgrading he is talking about. If that is the case, the Secretary of State should come clean, and he should be clear about whose job it will be to disapply the target to some people with minor ailments.
Mr Hunt
I did not say that because we are not going to do it. As we have had an intervention from a Welshman, let me tell the hon. Gentleman a rather inconvenient truth about what is happening in Wales. Last year, A&E performance in Wales was 10% lower than in England, and Wales has not hit the A&E target for eight years. We will not let that happen in England.
I noticed that the shadow Health Secretary quoted a number of people, but one that he did not quote was the Royal College of Emergency Medicine. I wonder whether that was because of what it said about Wales this week. It said:
“Emergency care in Wales is in a state of crisis…Performance is as bad, if not worse, as England, in some areas.”
There we have it: in the areas in which Labour is in control, these problems are worse.
Several hon. Members rose—
Several hon. Members rose—
Maria Caulfield
May I reiterate the Secretary of State’s point about the four-hour target? During the Labour Government, I was working in the NHS. Significant pressure was put on us by managers to meet the four-hour target, negating clinical need. Patients were often prioritised according to meeting the target, rather than by clinical need. That was a disgrace.
Mr Hunt
That is exactly the problem we had with Mid Staffs. We had a culture in the NHS where people were hitting the target and missing the point. Although targets are important management tools in all organisations, it is important that they are followed in a sensible way that puts the interests of patients first.
Several hon. Members rose—
Mr Hunt
I would just like to make another point about Wales while we have the privilege of having someone here who aspired to lead the Labour party, as the current leader of the Labour party is no longer in his place.
Something that Wales and England have in common is the need to ensure that, if we want alternatives to A&E, people are able to see their GPs. I have said many times that people wait too long to see their GPs. In all honesty, I think that the GP contract changes in 2004 were a disaster. The result was that 90% of GPs opted out of out-of-hours care. But we have been putting that right. Now 17 million people in England—about 30% of the population—have access to weekend and evening GP appointments. More than that, we have committed to a 14% real-terms increase in the GP budget by the end of this Parliament. That is an extra £2.4 billion and we expect that to mean an extra 5,000 doctors working in general practice.
Margaret Greenwood (Wirral West) (Lab)
I can see Wales from my constituency, to continue the theme. I received an email this morning from a very distressed senior NHS manager, who says:
“I truly despair that there will not be an NHS this time next year”—[Interruption.]
You need to listen on the Government Benches, and understand what your Secretary of State is doing to the health service. I will give a precis of what my constituent is talking about.
Margaret Greenwood
Apologies, Madam Deputy Speaker. I should not have used the word “you.”
My constituent has written to me saying:
“The NHS is in crisis, the government knows this, CCGs have failed, foundation trusts are failing. GPs are on their knees. So they’re”—
the Government—
“handing it back to local areas and saying, ‘you fix it, and by the way there’s no money.’ It’s a whole system reorganisation”,
and there is no money.
Mr Hunt
I will make some progress before giving way again.
The second part of the motion talks about funding. There is no doubt at all that we will need to look after 1 million more over-65s in five years’ time and we will need to continue to increase investment in the NHS and social care system. That is happening with an extra £3.8 billion going into the NHS this year. Can I just remind Labour Members that that is £1.3 billion more than they promised when they stood for election last year? I just say this: it is not enough to talk about extra funding—you have to actually deliver it. Labour Members have to answer to their constituents as to why, for two elections in a row, they have promised less money for the NHS than the Conservatives, and why, in the one area where they are responsible for the NHS, they have cut funding.
Julian Knight (Solihull) (Con)
The Secretary of State is taking exactly the right, measured tone, which was absent earlier in the debate. We recognise that many trusts are under financial pressures, but some of these situations are historic, and in my area they reflect very poor private finance initiative contracts, which were thrust on them in a Gordon Brown sleight of hand.
Victoria Atkins (Louth and Horncastle) (Con)
An example of how we are spending money practically on the ground to make sure patients get a better deal is in Lincolnshire, where, because there is a shortage of GPs, the local health authority is offering £20,000 as a golden hello to new GPs. Is that not the way to manage resources, to attract the best medical talent into our areas and to help ensure that patients get the best care?
Mr Hunt
My hon. Friend is absolutely right, and I talked about these issues when I visited her in her constituency. The truth is that, to solve this problem, we are going to have to have a dramatic increase in the number of people working in general practice, which is why we are funding the second biggest increase in the number of GPs in the NHS’s history.
It is a great shame that the Leader of the Opposition is not here, because this is the bit that I wanted to address to him—his proposal to put extra funding into the NHS by scrapping the corporation tax cuts. That reveals, I am afraid, a fundamental misunderstanding of how we fund the NHS. Corporation taxes are being cut so that we can boost jobs, strengthen the economy and fund the NHS. The reason we have been able to protect and increase funding in the NHS in the last six years, when the Labour party was not willing to do so, is precisely that we have created 2 million jobs and given this country the fastest growing economy in the G7, and that is even more important post-Brexit. To risk that growth, which is what the Labour party’s proposal would do, would not just risk funding for the NHS, but be dangerous for the economy and mortally dangerous for the NHS.
Norman Lamb (North Norfolk) (LD)
I just want to understand exactly what the Secretary of State was saying on Monday about the four-hour A&E target. Is it conceivable that some of the people who are currently within the A&E target will, at some stage, fall outside the A&E target?
Mr Hunt
I am committed to people using A&Es falling within the four-hour target, but I also think that we need to be much more effective at diverting people who do not need to go to A&E to other places, as is happening in Wales, as is happening in Scotland and which, frankly, is the only sensible thing to do.
However, going back to the funding issue, I just want to make this point: for all the heat in this Chamber in debates on the NHS, probably the biggest difference between the two sides of the House is not on NHS policy but on the ability to deliver the strong economy that the NHS needs to give it the funding that it requires. I am afraid that the proposals in the motion today reveal that divide even more starkly.
Several hon. Members rose—
Mr Harper
We had the debate at the election about the need for a strong economy to pay for the NHS, and the public decided that the Conservative party won that argument. May I give my right hon. Friend another example, from yesterday, from his friend Jeremy—the Leader of the Opposition? He proposed to cap high pay, but the top 1% of taxpayers pay 27% of income tax revenues. That proposal would cut the funding available to the NHS and damage the services that hard-working members of staff produce.
Helen Whately
Does my right hon. Friend agree that Opposition Members, rather than making meaningless and totally unfunded promises of more money for the NHS, contrary to their manifesto back in 2015, would do better to recognise demographic changes, such as the ageing population, and the need for the NHS to change, and support the locally developed plans for change in the national health service—the sustainability and transformation plans?
Several hon. Members rose—
John Woodcock (Barrow and Furness) (Lab/Co-op)
As the Government often point out, they want to hand decisions to local groups, but could the Secretary of State explain to worried patients in the south and west of Cumbria why local health services are suggesting the changes to A&E in the west and potentially the south? I know he has spent a lot of time looking at this area.
Mr Hunt
First, I would like to use this moment to congratulate the hon. Gentleman’s local trust on coming out of special measures last year and on the progress it is making. In a way, that is the answer to his point. His local trust was in special measures, and North Cumbria is still in special measures. We had some profound worries about patient care in both trusts, and we still do in the North Cumbria trust. That is why the status quo is not an option, but we understand the concerns of his constituents and many others about some of the proposals being made.
Catherine West (Hornsey and Wood Green) (Lab)
What does the Secretary of State make of the talk among professionals at the moment about the potential for a flu epidemic? What does he make of the comments by the doctor who wrote to me on Sunday saying that she is extremely concerned that staff are too busy to isolate patients who are coming in—who need oxygen—so that others do not potentially catch flu?
Mr Hunt
There is a concern at the moment about a growth in respiratory infections, and that is causing capacity constraints. We are watching what is happening on flu very carefully, but we have a record 13 million people vaccinated against flu, and I hope that that will put the NHS in a good position.
Robert Jenrick (Newark) (Con)
Money is of course important, but may I support the Health Secretary in not viewing these issues solely through that lens? My local trust, Sherwood Forest, which has some of the worst finances of any trust in the country—almost all due to a PFI deal signed by Gordon Brown—is actually improving. It is under pressure this winter, but the management have said it is definitely not in crisis. That is an example of a trust improving due to quality management, reform and good-quality processes.
Mr Hunt
That is absolutely the point, and the last point I want to make before concluding on funding is that we miss a trick—I think the shadow Health Secretary is in some ways more reasonable than his leader on these issues, which is probably terminal for his career—if we say that this is just about money. We forget the debate we went through on schools in this country 20 years ago, when there was, again, a debate about money, but we realised that the issue is actually also about standards and quality. That is what has happened in Sherwood Forest, and I congratulate the trust. It is important that we do not let debates about funding eclipse that very important progress that we need to make on standards.
Mr Hunt
I am going to conclude now because lots of people want to come in, I am afraid.
The shadow Health Secretary’s central claim—these are his words—was that the culpability for what is happening in the NHS “lies at the door of Downing Street”. I owe it to the country and this House to set the record straight on this Government’s record on the NHS. It is not just the fact that there are 11,000 more nurses and 11,000 more doctors; not just the fact that, on cancer, we are starting treatment for 130 more people every single day, and have record cancer survival rates; not just the fact that we have 1,400 more people getting mental health treatment every day and some of the highest dementia diagnosis rates in the world; and not just the fact that we are doing 5,000 more operations every day and that, despite those 5,000 more operations every day, MRSA rates have halved. We have an NHS with more doctors and more nurses, and despite difficult winters, with patients saying they have never been treated more safely and with more dignity and more respect.
Next year the NHS will be 70 years old. This Government’s vision is simple: we want it to offer the safest, highest quality care anywhere in the world. When we have difficult winters and an ageing population, of course that makes things more challenging, but it also makes us more determined. It means that we are backing the NHS’s plan; it means more GPs and better mental health provision; and it means an NHS turning heads in the 21st century just as it did when it was founded in the 20th century.
Mental Health and NHS Performance
Jeremy Hunt Excerpts(7 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I would like to make a statement on mental health and NHS performance. This Government are committed to a shared society in which public services work to the highest standards for everyone. This includes plans announced by the Prime Minister this morning on mental health. I am proud that, under this Government, 1,400 more people are accessing mental health services every day compared with in 2010 and that we are investing more in mental health than ever before, with plans for 1 million more people with mental health conditions to access services by 2020.
But we recognise that there is more to do, so we will proceed with plans to further improve mental health provision, including: formally accepting the recommendations of the independent taskforce on mental health, which will see mental health spend increase by £1 billion a year by the end of the Parliament; a Green Paper on children and young people’s mental health to be published before the end of the year; enabling every secondary school to train someone in mental health first aid; a new partnership with employers to support mental health in the workplace; up to £15 million extra invested in places of safety for those in crisis, following the highly successful start to the programme in the last Parliament; an ambitious expansion of digital mental health provision; and an updated and more comprehensive suicide prevention strategy. Further details of these plans are contained in the written ministerial statement laid before the House this morning.
I turn now to the winter. As our most precious public service, the NHS has been under sustained pressure for a number of years. In just six years the number of people aged over 80 has risen by 340,000, and life expectancy has risen by 12 months. As a result, demand is unprecedented. The Tuesday after Christmas was the busiest day in the history of the NHS, and some hospitals are reporting that A&E attendances are up to 30% higher than last year. I therefore want to set out how we intend to protect the service through an extremely challenging period and sustain it for the future.
First, I pay tribute to staff on the frontline. The 1.3 million NHS staff, alongside another 1.4 million in the social care system, do an incredible job, which is frankly humbling for all of us in this House. An estimated 150,000 medical staff, and many more non-medical staff, worked on Christmas day and new year’s day. They have never worked harder to keep patients safe, and the whole country is in their debt.
This winter, the NHS has made more extensive preparations than ever before. We started the run-up to the winter period with over 1,600 more doctors and 3,000 more nurses than just a year ago, bringing the total increase since 2010 to 11,400 more doctors and 11,200 more hospital nurses. The NHS allocated £400 million to local health systems for winter preparedness; it nationally assured the winter plans of every trust; it launched the largest ever flu vaccination programme, with more than 13 million people already vaccinated; and it bolstered support outside A&Es, with 12,000 additional GP sessions offered over the festive period.
The result has been that this winter has already seen days when A&Es have treated a record number of people within four hours, and there have been fewer serious incidents declared than many expected. As Chris Hopson, head of NHS Providers, said, although there have been serious problems at some trusts, the system as a whole is doing slightly better than last year.
However, there are indeed a number of trusts where the situation has been extremely fragile. All of last week’s A&E diverts happened in 19 trusts, of which four are in special measures. The most recent statistics show that nearly three quarters of trolley waits occurred in just two trusts. In Worcestershire, in particular, there have been a number of unacceptably long trolley waits, and the media have reported two deaths of patients in A&E. We are also aware of ongoing problems in North Midlands, with extremely high numbers of 12-hour trolley waits. Nationally, the NHS has taken urgent action to support those trusts, including working intensively with leadership and brokering conversations with social care partners to generate a joined-up approach across systems of concern.
As of this weekend, there are some signs that pressure is easing both in the most distressed trusts and across the system. However, with further cold weather on the way this weekend, a spike in respiratory infections and a rise in flu, there will be further challenges ahead. NHS England and NHS Improvement will also consider a series of further measures that may be taken in particularly distressed systems on a temporary basis at the discretion of local clinical leaders. These may include: temporarily releasing time for GPs to support urgent care work; clinically triaging non-urgent calls to the ambulance service for residents of nursing and residential homes before they are taken to hospital; continuing to suspend elective care, including, where appropriate, suspension of non-urgent outpatient appointments; working with the Care Quality Commission on rapid re-inspection where this has the potential to re-open community health and social care bed capacity; and working with community trusts and community nursing teams to speed up discharge. Taken together, these actions will give the NHS the flexibility to take further measures as and when appropriate at a local level.
However, looking to the future, it is clear we need to have an honest discussion with the public about the purpose of A&E departments. Nowhere outside the UK commits to all patients to sort out any urgent health need within four hours. Only four other countries—New Zealand, Sweden, Australia and Canada—have similar national standards, which are generally less stringent than ours. This Government are committed to maintaining and delivering that vital four-hour commitment to patients, but since it was announced in 2000, there are nearly 9 million more visits to our A&Es, up to 30% of which NHS England estimates do not need to be made, and the tide is continuing to rise. If we are going to protect our four-hour standard, we need to be clear that it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor. As Professor Keith Willett, NHS England’s medical director for acute care, has said, no country in the world has a standard for all health problems, however small, and if we are to protect services for the most vulnerable, nor can we.
NHS England and NHS Improvement will continue to explore ways to ensure that at least some of the patients who do not need to be in our A&Es can be given good, alternative options, building on progress under way with a streaming policy in the NHS England A&E plan. In this way, we will be able to improve the patient experience for those with more minor conditions who are currently not seen within four hours, as well as protect the four-hour promise for those who actually need it.
Taken together, what I have announced today are plans to support the NHS in a difficult period; and plans for a Government who are ambitious for our NHS, quite simply, to offer the safest, highest-quality care available anywhere, for both mental and physical health. But they will take time to come to fruition, and in the meantime all our thoughts are with NHS and social care staff who are working extremely hard over the winter, and throughout the year, both inside and outside our hospitals. I commend this statement to the House.
Jonathan Ashworth (Leicester South) (Lab)
I am grateful to the Secretary of State for an advance copy of his statement. I, too, begin by paying tribute to all the NHS staff who are working day in, day out to provide the best possible care to patients during this busy period. Of course we welcome measures to improve mental health services in this country, as indeed we welcomed such announcements exactly 12 months ago, when the then Prime Minister made similar promises. But does the Secretary of State not agree that if this Prime Minister wants to shine a light on mental health provision, she should aim her torch at the Government’s record: 6,600 fewer nurses working in mental health; a reduction in mental health beds; 400 fewer doctors working in mental health; and, perhaps most disgracefully of all, the raiding of children’s local mental health budgets in order to plug funding gaps in the wider NHS? Could he therefore tell us why the Prime Minister was unable to confirm this morning that money for mental health would be ring-fenced to prevent this raiding of budgets from happening in the future? We welcome measures to improve mental health support in schools. Will the Government offer more resources to local authority education psychologists? What provision will be in place to give teachers suitable training for doing this work?
On the winter crisis, this morning the Secretary of State said that things have only been “falling over in a couple of places”. Let us look at the facts: a third of hospitals declared last month that they needed urgent help to deal with the number of patients coming through the doors; A&E departments have turned patients away more than 140 times; 15 hospitals ran out of beds in one day in December; several hospitals have warned that they cannot offer comprehensive care; and elderly patients have been left languishing on hospital trolleys in corridors, sometimes for more than 24 hours. And he says that care is only falling over in a couple of places! I know that “La La Land” did well at the Golden Globes last night, but I did not realise the Secretary of State was living there—perhaps that is where he has been all weekend. Will he confirm that the NHS is facing a winter crisis, and that the blame lies at the doors of No. 10 Downing Street?
Does the Secretary of State agree that it was a monumental error to ignore the pleas for extra support for social care to be included in the autumn statement only weeks ago? Will he support calls to bring forward now the extra £700 million that is allocated for 2019, to help social care? Will he urge the Chancellor and the Prime Minister to announce a new funding settlement for the NHS and social care in the March Budget so that a crisis like this year’s never happens again?
I press the Secretary of State further on the announcement he has just made on the four-hour A&E target. Is he really telling patients that rather than trying to hit that four-hour target, the Government are now in fact rewriting and downgrading it? If so, does NHS England support that move? What guidance has he had from the Royal College of Emergency Medicine to say that that is an appropriate change to the waiting-time standard?
The Secretary of State has made patient safety an absolute priority; in that, he has our unswerving support. I am sure he will agree that one of the most upsetting reports to come out of hospitals last week was that on the death of two patients at Worcestershire Royal hospital who had been waiting on trolleys. Will he commit to personally lead an inquiry into those deaths? Does he know whether they were isolated incidents? When does the trust intend to report back on its investigation? Will he undertake to keep the House updated on those matters?
There is no doubt that the current crisis could have been averted. Hospital bosses, council leaders, patients groups and MPs from both sides of the House urged the Chancellor to give the NHS and social care extra money in the autumn statement. Those requests fell on deaf ears and we are now seeing the dismal consequences. NHS staff deserve better. Patients deserve better. The Government need to do better. I urge the Health Secretary to get a grip.
Mr Hunt
I am happy to respond to the hon. Gentleman’s comments and, indeed, to the comments of all Members, but I shall first say this about the tone of what he said. He speaks as if the NHS never had any problems over winters when Labour was in power. The one thing NHS staff do not want right now is for any party to start weaponising the NHS for party political purposes. I remind him that when his party runs the NHS, the number of people on waiting lists for treatments doubles, A&E performance is 10% lower and people wait twice as long to have their hips replaced. Whatever the problems are in the NHS, Labour is not the solution.
The hon. Gentleman talked about mental health, so let me tell him what is happening on that. Thanks to the efforts of this Government and the Conservative-led coalition, we now have some of the highest dementia diagnosis rates in the world. Our talking therapies programme—one of the most popular programmes for the treatment of depression and anxiety—is treating 750,000 more people every year and is being copied in Sweden. Every day, we are treating 1,400 more people with mental health conditions and we have record numbers of psychiatrists. The hon. Gentleman mentioned mental health nurses: in this Parliament we are training 8,000 more, which is a 22% increase.
All that is backed up by what we are confirming today, which has not been done before: the Government are accepting the report of the independent taskforce review—led by Paul Farmer, the chief executive of Mind—which commits us to spending £1 billion more a year on mental health by the end of the Parliament. That would not be possible with the spending commitments that Labour was prepared to make for the NHS in the previous Parliament. It is because of this Government’s funding that we are able to make such commitments on mental health.
The hon. Gentleman talked about the NHS and gave completely the wrong impression of what I said this morning. I was completely clear that all NHS hospitals are operating under greater pressure than they ever have. He should listen to independent voices, such as that of Chris Hopson—no friend of the Government when it comes to NHS policy—who is clear that in the vast majority of trusts people are actually coping slightly better than last year. However, we have some very serious problems in a few trusts, including in Worcestershire and a number of others. I can commit to him that we will follow closely the investigations into the two reported deaths at Worcestershire and keep the House updated.
The hon. Gentleman talked about social care, which is where, I think, his politicising goes wrong. Last year, spending on social care went up by around £600 million. At the last election, he stood on a platform of not a penny more to local authorities for social care, so to stand here as a defender of social care is, frankly, an insult to vulnerable people up and down the country, particularly to those living under Labour councils such as Hounslow, Merton and Ealing, which are refusing to raise the social care precept, but complaining about social care funding.
The hon. Gentleman talked more generally about NHS funding, but in the last Parliament it was not the Conservatives who wanted to cut funding for the NHS—it was his party. It was not the Conservatives who said that funding the five-year forward view was impossible—it was his party. Labour said that the cheque would bounce. Well, it has not bounced, and we are putting in that money.
In conclusion, it is tough on the NHS frontline. The hon. Gentleman was right to raise this issue in this House, but wrong to raise it in the way that he did. Under this Government, the NHS has record numbers of doctors and nurses and record funding. Despite the pressures of winter, care is safer, of higher quality and reaching more people than ever before. It is time to support those on the frontline, and not try to use them for party political points.
Dr Sarah Wollaston (Totnes) (Con)
I welcome the Secretary of State’s statement and the Prime Minister’s focus on mental health in her speech today. She spoke of holding the NHS leadership to account for the extra £1 billion that we will be investing in mental health. Will the Secretary of State set out in further detail how clinical commissioning groups will be held to account for ensuring that that money gets to the frontline so that we can deliver progress on parity of esteem?
Mr Hunt
Yes, I can do that. It is a very important point. We have had a patchy record in the NHS of ensuring that money promised for mental health actually reaches the frontline. The way that we intend to address this is by creating independently compiled Ofsted-style ratings for every CCG in the country that highlight where mental health provision is inadequate. Those ratings are decided by an independent committee chaired by Paul Farmer, who is responsible for the independent taskforce report, so he is able to check up on progress towards his recommendations. I am confident that, by doing that, we will be able to shine a light on those areas that are not delivering on the promises that this Government have made to the country.
Dr Philippa Whitford (Central Ayrshire) (SNP)
After the Health Committee’s recent inquiry into suicide, I absolutely welcome the extra funding for mental health. I am sure that the Secretary of State remembers some of the discussions that we had in that room.
I also pay tribute to the staff. Obviously, with my background, I know exactly what it is like when A&E is swamped and there is nowhere to put people. The staff across NHS England are not afraid of us discussing this topic and weaponising it. They are in tears; they are exhausted; and they are demoralised. They have never experienced a winter like this. Perhaps the Secretary of State will explain why his figures suggest 19 diverts and only two trusts in serious problems, whereas we are hearing from the Nuffield Trust that that 42 or 50 trusts are diverting, which is a third. That means that the problem is widespread.
I totally agree with the point about people going to A&E when they do not need to be there, but they are not the people who are three-deep on trolleys waiting for a bed for 36 hours—those are people who need a bed and who are there because they are ill. We have discussed sustainability and transformation plans and NHS sustainability on several occasions. The concern that people have is that, because there is not the money for a redesign, there will be A&E closures and bed cuts. I hope that this incident will show that that is simply not possible. It is not possible for the UK, particularly NHS England, to lose any more beds. In Scotland, we face the same problem of increased demand and shortage of doctors, yet 93.5% of our patients were seen within four hours in Christmas week. The president of the Royal College of Emergency Medicine estimates that in areas of England the figure is between 50% and 60%. That difference is down to how it is organised. It is the fragmentation and the lack of integration. There are things that can be done. We can use community pharmacies and GPs, and try to bring the NHS back together.
Mr Speaker
Yes, but that was then, and this is now. That was when I was a badly behaved Back Bencher like the hon. Gentleman.
Mr Hunt
I will try to interpret the questions in what the hon. Lady said. If she was asking whether the problems in England are similar to those in Scotland, I think that we share problems, particularly across the busy winter period. She has observed that Scotland is also failing to meet the target. She is right to say that bed capacity is absolutely critical, and that is something we have not always got right in England. There have been times when beds have been decommissioned and the alternative provision that was promised has not been made, which has big knock-on effects. When it comes to what happens in Scotland and England, I think that Scotland has gone further than England in the use of community pharmacy, which is to be commended, but England has gone further in our plans to reform and increase investment into general practice. That was what the president of the Royal College of General Practitioners was talking about over Christmas when she said that she was keen for Scotland to match the package that we have in England.
Alistair Burt (North East Bedfordshire) (Con)
I commend my right hon. Friend’s statement. Of course, we all know the work that is done in our local areas by all those working in the NHS at such a difficult time. In relation to mental health, will he confirm that the Prime Minister’s very welcome speech this morning also emphasised the importance of perinatal mental health, and that some of the extra resource will continue the great work on that? Will he also emphasise the point about transparency, because knowing what CCGs are doing assists Members of Parliament not only in calling for extra resource, but in ensuring that our areas do the best they can compared with others, rather than simply making a general point about resources, which is always the easiest point to make?
Mr Hunt
My right hon. Friend did a huge amount of good work on mental health when he was a colleague in the Department of Health. On perinatal mental health, we know that 20% of mothers suffer some form of pre or post-natal depression, which has a huge impact on the child, with lifetime costs of around £10,000 for every birth in this country, caused by lack of proper mental health provision. The plan announced today means that we will be able to treat an extra 30,000 women better—we think that is the number who need to be treated. He makes an important point about transparency. I would put it like this: funding matters, and we have some of the best mental health provision in the world, but it is not consistent. The only way that we can make it consistent is by shining a light on the relative performance of different parts of the country, so that we can bring all areas up to the standard of the best.
Mr Skinner
The Minister says that there are 9 million more patient visits now than there were in 2000. Is he aware that in that climate, shutting hospitals such as the Bolsover community hospital, led by the Hardwick clinical commissioning group, makes no sense at all? He turns a blind eye to it. Will he look at this question, because when those hospitals are shut, the beds are gone forever? Get stuck in.
Mr Hunt
I actually think that broadly the hon. Gentleman makes an important point. It is not just about decisions to downgrade or close A&E departments when there is no alternative provision; it is also about community hospitals, which are very important places for A&E departments and hospitals to step people down to. He is right to say that the NHS—[Interruption.] I am getting comments from a sedentary position. With the greatest respect, this process has been going on in the NHS for decades, and I do not think that we always got it right under both parties, but I think that he is right to say that when there are changes in provision in community hospitals, we need to ensure that we have good alternative plans.
Mr Speaker
In wishing the hon. Members for Morley and Outwood and for Filton and Bradley Stoke all the best in the weeks and months ahead, I call Andrea Jenkyns.
Andrea Jenkyns (Morley and Outwood) (Con)
Thank you, Mr Speaker. First, I echo some of the points made by the Secretary of State regarding mental health support for expectant mothers. As one myself, I have to say that the midwives have been fantastic. Right from the very first appointments at grassroots level, they mention mental health, so we are feeling the support on the ground.
I welcome today’s statement, which shows the Government’s commitment to mental health by making it a centrepiece of the agenda. One in 50 young people in Yorkshire receive care for mental health. How will the new approach address the concerns of the young people and their parents, and what measures are in place to reduce the waiting list for child and adolescent mental health services?
Mr Hunt
I add to Mr Speaker’s comments my very good wishes and confidence that my hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) will get superb care from the NHS. I thank her for campaigning on patient safety. I am sure she will be pleased to hear that our principal safety campaign this year is on maternity safety.
In bald numbers, the plan will mean that we will treat 1 million more people with mental health conditions a year by the end of this Parliament. Of course, many of those will be in Yorkshire. An additional 70,000 young people will get treatment every single year and I hope that will bring down the CAMHS waiting times. We also want to do work in schools to prevent people from getting on the CAMHS waiting list in the first place.
Norman Lamb (North Norfolk) (LD)
The YoungMinds survey published before Christmas showed a failure in 50% of clinical commissioning group areas to spend the full amount of extra investment allocated to children and young people’s mental health. That is scandalous. I note the Secretary of State’s point about Ofsted-style ratings, but does he not need to introduce a system that guarantees that the money the Government promised for children’s mental health is actually spent as intended?
Mr Hunt
The right hon. Gentleman is right to want to ensure that we live up to those promises. He was a Minister when some of those promises were made and they are very important. I would say that we are delivering what he wants. We are on track this year to spend around £1 billion more, compared with two years ago when he was Minister for mental health. It has taken time for the NHS to get the message on mental health, but it is getting through loud and clear.
Sir Nicholas Soames (Mid Sussex) (Con)
As a frequent user and admirer of the Red Cross, I regard its claims as being grossly over the top. I join the Secretary of State in his tribute to the wonderful work of the frontline staff of the NHS at a very difficult time. Does he agree that the pressures are not going to go away, and that there must be a continuing drive for reform and to do these things better? What exactly are the impediments in the NHS to the sharing of best practice, and what steps is he taking to create a more experienced and better trained leadership who are more prepared for the exceptional medical and management challenges that the NHS now faces?
Mr Hunt
My right hon. Friend speaks extremely wisely. I, too, think that we have to be very careful about the language we use in these situations because many vulnerable people can be frightened if we get the tone wrong. The vast majority of NHS services are performing extremely well under a great deal of pressure. His point about leadership is extremely important and one to which I have given a lot of thought. At the heart of the problem is that we do not have enough hospitals being run by doctors and nurses. Around 56% of our managers have a clinical background, compared with 76% in Canada and 96% in Sweden. To put it bluntly, doctors like to be given instructions by other doctors. Exceptional people from a non-clinical background can do it, but it is hard because doctors have many years of training and are highly experienced people. I have put in place measures to try to make it easier for more clinicians to become our managers of the future.
Mr Speaker
In wishing the hon. Member for Liverpool, Wavertree all the best in the period ahead, I call Luciana Berger.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
In her speech today, the Prime Minister made a number of hard-hitting observations. She said:
“there is no escaping the fact that people with mental health problems are still not treated the same as if they have a physical ailment”.
She reported on the increase in self-harm among young people, and she told us about the shocking reality that, on average, 13 people take their life every single day in England. Given that the Conservative party has been in government for almost seven years, and that the Secretary of State has been Health Secretary for almost four of those years, who does he think is responsible for the terrible failures highlighted by the Prime Minister today?
Mr Hunt
With great respect to the hon. Lady—she campaigns tirelessly on mental health, and she deserves great credit for that—that is the same as saying that the last Labour Government should have sorted out every single problem in mental health by 2010, and I am not standing here saying that. The truth is that we have made good progress; if she thinks that it is trivial that we are treating 1,400 more people every day for mental health conditions, she should go and talk to some of her own constituents who are getting access to mental health provision, who would not have been getting that access under the policies of the last Labour Government. We have made big strides in our mental health provision, but there is much more to do, and we are determined to do what it takes.
Sir Alan Haselhurst (Saffron Walden) (Con)
Recognising that the supply of extra resources for the NHS will be a vital and continuing issue, is my right hon. Friend not exactly right when he says that equal attention has to be given to controlling demand so that people do not simply instinctively make calls on GPs’ surgeries and A&E departments, which doctors themselves believe are avoidable and which could be dealt with in other ways?
Mr Hunt
My right hon. Friend speaks extremely wisely. At the heart of it, we have a good commitment—the four-hour commitment, which was introduced by a Labour Government. I think it is one of the best things the NHS does: the promise that if someone is ill and needs urgent help, we will do something about it and get them under proper medical care within four hours. However, if we have the situation that NHS England now describes, where up to 30% of the people in A&E departments do not actually need to be there, we risk not being able to deliver that promise for the people who really do need it. That is why looking at how we can control demand from the people who do not need to be in A&Es, such as through the significant increase in investment in general practice and other measures, is going to be vital if we are going to crack this.
Mr Ben Bradshaw (Exeter) (Lab)
The Secretary of State seems to be blaming the public for overwhelming A&E departments, when he well knows that the reason they go to A&E is that they cannot get to see their GP and social care is in crisis. Will he confirm that he has just announced another significant watering-down of the four-hour A&E target, following the watering-down by the coalition in their first year in office back in 2010? What is he personally doing to address the chronic long-term underperformance of hospitals, such as that at Worcester, where two people died on trolleys, and Plymouth, which is one of the hospitals that had to call in the Red Cross over the Christmas period?
Mr Hunt
I think—probably because of the forum we are in now—the right hon. Gentleman is misinterpreting what I have said, and it needs to be put right. Far from watering down the four-hour target, I have today recommitted the Government to that four-hour target. In just the answer before he spoke—maybe he was not listening—I actually said I thought it was one of the best things about the NHS that we have this four-hour promise. But the public will go to the place where it is easiest to get in front of a doctor quickly, and if we do not recognise that there is an issue with the fact that a number of people who do not need to go to A&Es are using them, and we do not try to address that problem, we will not make A&Es better for his constituents and mine. If he asks what we are doing to turn around hospitals in difficulty, we have introduced the new Care Quality Commission inspection regime and a chief inspector of hospitals—the most rigorous inspection regime in the world, which the Labour party tried to vote down.
Mr Mark Harper (Forest of Dean) (Con)
I welcome the Prime Minister’s announcement and the Secretary of State’s confirmation of extra support for mental health. I particularly welcome the review to be led by Lord Stevenson and Paul Farmer. As they carry out that review on improving businesses’ ability to support people with mental health problems, will they particularly look at how we can help smaller businesses—those that perhaps do not have the human resource expertise that larger businesses may have—to make sure that people with mental health problems stay in work and are able to get back into work when they fall out of it? They are the biggest single category of disabled people not currently working, and we could make a huge difference.
Mr Hunt
My right hon. Friend will of course know that from his distinguished time as a Minister in the Department for Work and Pensions. He is right. The central problem we are trying to address is that if someone, for example, stops going to work and is signed off work because of severe depression, that is bad for the individual and also bad for the business. Too often, what happens at the moment is that it then becomes entirely the NHS’s responsibility to get that person back to work; the business says, “Well, it’s not our responsibility anymore because they’re not turning up.” With a little bit of help from the business, we could get the person back to work much more quickly, meaning that they recovered more quickly and the business would not lose someone important. That is what Dennis Stevenson and Paul Farmer will be looking into.
Liz Kendall (Leicester West) (Lab)
We will never solve the challenges facing the NHS and social care until there is a long-term settlement for funding both. Does the Secretary of State understand that the social care precept is completely inadequate to fill the gap and will increase inequality, because the areas that most need publicly funded care will be least able to raise that money? Will he speak to the Chancellor and the Communities and Local Government Secretary to look again at this issue and get the funding that social care desperately needs?
Mr Hunt
I agree with the hon. Lady that there are serious funding pressures in social care. We need a long-term solution to this, and we are doing important work on that. The precept is part of the solution. The local government settlement has been adjusted to take account of the different spending powers, or revenue-raising powers, of wealthier counties and wealthier local authority areas compared with other areas. We have to take into account the equality issue, and she is absolutely right to do that. However, if she is saying, “Have we solved the whole problem?”, the answer is no—there is more work to do.
Anna Soubry (Broxtowe) (Con)
I welcome the statement by my right hon. Friend. May I pay huge tribute to everybody working at Nottingham University Hospitals NHS Trust, especially in A&E, and especially over the nine days between Christmas and 2 January? Admissions almost doubled. At one point in the Queen’s medical centre A&E department there were 180 people seeking treatment—that is a record. There were 395 more admissions than discharges in that nine-day period. I pay huge tribute to everybody who is working in our NHS. Can my right hon. Friend give me an assurance that he will continue to work with our hospital trusts, like NUHT, as they bring forward plans to change schemes —it is not just simply about money—and do everything that he can to support them in these unprecedented times?
Mr Hunt
I am happy to do that. I echo my right hon. Friend’s praise for the staff at NUHT, which was particularly pressured over Christmas. They have made particular efforts to improve patient safety and quality of care over recent years. She is absolutely right, and of course I will continue to work closely with her trust and others.
Mr Geoffrey Robinson (Coventry North West) (Lab)
At 9.30 am today I received an email from a constituent in Coventry who asked me to bring it to the Secretary of State’s attention; I am delighted to do so. She writes as follows:
“I am a nurse with 26 years’ experience who has always worked full time and has paid my tax and national insurance without ever having to burden the government, social services or the NHS in my lifetime but have gladly served and given 100%”
to it. She continues:
“Unfortunately, my 18 year old daughter has recently become unwell mentally and attempted suicide twice in a 3 week period…I am really sad to say—
this comes from a nurse of 23 years’ experience—
“that the care she has been given has been dreadful. I am somebody who works in the NHS so I understand the strains the service is under but I also expect that as a family who give so much to society that when it is our time of need that we can expect a service that meets our needs.”
I ask the Secretary of State whether he will kindly agree to meet Mrs Hardy and me—Sarah Hardy is the lady’s name—or arrange for her to meet somebody who can give her some sort of reassurance. She continues that she has been waiting six months without any mental health assessment or support from the NHS—six months for a daughter of 18 years of age. Will he agree to do that so that it is not just a case of more hollow words?
Mr Hunt
I am more than happy to meet Mrs Hardy, but ahead of that I would like to look at the particular issue of why she has had to wait for so long. The hon. Gentleman put it very eloquently, and she put it very eloquently, and we owe a huge debt to such people. What she has described with her 19-year-old daughter’s treatment is just not satisfactory: it is not good enough. That is why the Prime Minister talked this morning about the injustice of having to wait so long for treatment, and that is exactly what we are trying to put right.
Dr James Davies (Vale of Clwyd) (Con)
The House of Commons Library has calculated that the real-terms increase in health-related spending between 2010 and 2016 was 9.4% in England, yet it was zero in Wales. Not only are A&E waiting times consistently longer in Wales than in England, but waiting times for routine procedures can be as much as two and a half times longer in Wales. I regularly see constituents in tears who are waiting well in excess of a year for hip operations. Does the Secretary of State agree that the Labour party must start to acknowledge the challenges facing the NHS in Wales and accept responsibility for them? [Interruption.]
Mr Hunt
I think my hon. Friend’s constituents in Wales would be appalled by the reaction we have just had. Labour Members stand on their high horse in complaining about NHS care in England, but when he brings up poor NHS care in Wales, they tut and make noises as though they do not want to hear about it. If they care about NHS patients, they should care about them throughout the whole of the United Kingdom. I am afraid that that just shows the party political agenda. Yes, my hon. Friend is right: NHS care in Wales is worse, and Labour needs to do something about it.
Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)
I have been contacted by several constituents who have spent 14 hours in A&E waiting for a bed. As well as by social care cuts, we have been hampered by a shortage of A&E doctors. The Department of Health was warned that that would become a growing problem over five years ago, and the Health Committee warned about it again last year. When will this shortage of A&E doctors be ended by the Government—by the summer, by next year, by the following year? The Secretary of State has had seven years. When will he deal with the shortage of A&E doctors?
Mr Hunt
Let me tell the right hon. Lady what we have done about A&E doctors. Their number has gone up by 1,200 since 2010, which is an increase of over 50%. The number of A&E consultants has gone up by 500, which is an increase of over 20%. At the same time, we have recruited 2,000 more paramedics. As a result of those changes, our emergency departments are seeing—within the four-hour target—2,500 more people every single day compared with 2010. That is not to minimise the pressures in the NHS we have had over the winter or to say that there is not more that needs to be done, which is why I outlined a number of things in my statement.
Sir Peter Bottomley (Worthing West) (Con)
The Secretary of State kindly came to see the plans for the emergency room at Worthing hospital and came back six years later to see how it is working and to admire it in operation. I hope that the next time he comes he can look at the Zachary Merton community hospital and the Swandean mental health services as well.
On child mental health care, may I put it to him that a quarter of the 700,000 teenagers going through each stage each year will have bumps and need resilience, and that their parents and teachers need help? Will he make sure that the Green Paper covers advice to parents and teachers so that they know what is in the normal range of behaviours and what is outside that range?
Mr Hunt
I commend my hon. Friend for his one-man campaign, which I continue to admire on many occasions, against the misinformation put out by 38 Degrees. I thank the staff at Worthing hospital for their fantastic work over the busy Christmas period. As usual, he puts his finger on a very important issue, which is that as we seek to raise the profile of mental health treatment for children and young people, we must not medicalise every single moment of stress. For example, worries before exams are not cause to talk to an NHS psychiatrist. A lot of work on the Green Paper will be looking at how we can promote self-help and at how we can help schools to support people through difficult patches, but we will also look at how we can make sure people get NHS care quickly when it is needed.
Dr Rosena Allin-Khan (Tooting) (Lab)
It is great to see the Secretary of State here today in the Chamber after enjoying his Christmas recess. While he was away staff on the NHS frontline had to work double shifts, the London ambulance service computer system crashed and we found out that the Red Cross needed to be drafted into our hospitals. Will the Secretary of State tell us which hospitals he visited during the Christmas recess?
Mr Hunt
I was in touch with what was happening in the NHS every single day throughout the Christmas recess. As someone who has worked in a hospital, the hon. Lady might question whether it is particularly helpful for NHS hospitals to have visits by high-profile politicians right at their busiest periods. I have been very closely in touch. She talks about the problem at London ambulance service. That was a problem staff have been trained to deal with. The staff of her own hospital worked extremely well, but they do not welcome attempts—she is making one this afternoon—to politicise the problems the NHS faces.
Dr Andrew Murrison (South West Wiltshire) (Con)
On the changes to the four-hour standard that the Secretary of State heralded, what can be done to incentivise and upskill GPs who may wish to take a closer interest in minor and moderate illnesses, including the use of nurse-led minor injury units?
Mr Hunt
They have a very important role. Some of the most successful and best-performing trusts, such as Luton and Dunstable, have a very good streaming process at the A&E front door, with good alternatives when it is not appropriate for people to go to an A&E department. We need to learn from that. Nurse-led units can be very important. GP-led units can make a big difference, too. It will not be the same everywhere, for reasons of space if nothing else, but there is a solution that everywhere can adopt.
Caroline Flint (Don Valley) (Lab)
In the past few weeks, we have seen pressures in the NHS that, to a certain extent, the Secretary of State has acknowledged. Given that we are not yet in the midst of a very desperate cold spell, and given that we are not in the throes of a flu epidemic, how can he come here today and complacently suggest he has a grip on our NHS services? Why was he not on top of those trusts he knew were weak? He knew they would be under threat if there was any pressure. What is he going to do when we hit a cold snap and people are suffering from flu in large numbers?
Mr Hunt
I am afraid that I reject that suggestion. The right hon. Lady wants to know what we have been doing over the course of the year. As I said in the statement, we have 1,600 more doctors than we had just a year ago, over 3,000 more nurses, the biggest flu vaccination programme in our history and 12,000 additional GP sessions booked over the festive period. A huge amount of work has been done, with a particular focus on distressed areas. Many of those distressed areas coped extremely well—not all of them, which is why there is more work to do.
David Tredinnick (Bosworth) (Con)
When the Health Committee in the previous Parliament looked at children and adolescent mental health services, one of the main concerns was the distance travelled by patients—sometimes halfway across the country—to get treatment. Will the Secretary of State expand on his plans to reduce attendance at A&E? Does he envisage a new form of gatekeeper and does he intend to try to keep drunks out of A&E?
Mr Hunt
I would probably use the word “streaming”, rather than gatekeeper, to ensure that we have good, alternative offers for people who do not need to be in A&E. Frankly, it is not safe for an A&E department to have people there for six, seven or eight hours with a minor injury and no urgent health need. It is distracting for staff and can make it more difficult for them to deal with people who have more immediate needs.
On distances travelled, as the Prime Minister said this morning it is completely unacceptable for people to have to go 400 miles for a mental health bed. What is the solution? We are commissioning more beds, but the actual solution is to intervene earlier so that people do not get to that stage in treatment where they need in-patient care. We know that if we intervene earlier we can in many cases head off that need and help people to get better more quickly.
Chris Leslie (Nottingham East) (Lab/Co-op)
This afternoon, patients at Nottingham’s Queen’s Medical Centre emergency department are waiting on average for more than four hours. In the last month for which figures are available, 3,500 people had to wait for more than four hours in the emergency department. We cannot go on like this, so will the Secretary of State agree to fast-track the capital we need to increase capacity at Nottingham’s emergency department?
Dr Julian Lewis (New Forest East) (Con)
The Secretary of State has acknowledged that there is a shortage of acute mental health beds. That arises from the decision by many health trusts to close beds in favour of putting resources into services in the community. One effect is that people approaching a mental health crisis find it harder to know where to turn for help. Will he explain more about the crisis provision in which we are investing the extra £15 million? Is there a common way of knowing how one can easily access those vital services?
Mr Hunt
I am happy to supply more details. The £15 million is for places of safety—it is very specifically focused on support for the police service so that we can ensure that we live up to our legal commitment from this year not to send young people into police cells when they actually need mental health support.
More broadly, my right hon. Friend is right that there is a policy change—most people think it is the right thing—to treat more people in the community where we can. What is not working is the system that divides people up into four tiers, which means that we sometimes say to people, “We can’t treat you because you are tier 3.” People get sent away, which is not acceptable. That is why we are producing a Green Paper. We want to look at a better way forward.
Ms Margaret Ritchie (South Down) (SDLP)
Does the Secretary of State accept that the deepening crisis in the NHS is not solely down to an ageing society, and that failure to provide sufficient funding is the key to the crisis, and therefore that it is possible to address it? What will he do about it?
Mr Hunt
If the hon. Lady is worried about funding, she might explain why funding for the NHS in England went up by double the rate of funding for the NHS in Scotland over the last Parliament—[Interruption.] I will get her the figures on Northern Ireland, but I say that by way of reference. I apologise for my error.
I agree with the hon. Lady that it is not just about the ageing society; it is about changing consumer expectations and the fact that people want access to healthcare 24/7 today in a way that was not the case 10 or 20 years ago. That in itself is the cause of a lot of the additional pressure.
Helen Whately (Faversham and Mid Kent) (Con)
I welcome today’s announcement on mental health. It is absolutely clear that the Government are serious about improving mental health treatment and prevention. The challenge is to translate ambitions into action. Will my right hon. Friend assure me that he will put in place mechanisms to ensure that the proposals and those in the five-year forward view for mental health become reality? Specifically, will he look at ensuring that no sustainability and transformation plan is signed off without clear plans and funding for improving mental healthcare?
Mr Hunt
I can assure my hon. Friend that that is happening. Indeed, one of the key metrics by which we will judge STPs is their progress on delivering our mental health targets. She is absolutely right to say that ambitions need to turn into action, but she will find that, because of the comments that she and many other hon. Members have made over the past few years, there is much more understanding in the NHS that mental healthcare is a big priority, and more understanding that we need to stop resources constantly being sucked into the acute sector, as has happened over many years.
Michael Dugher (Barnsley East) (Lab)
The Secretary of State recently announced that the Government were pressing ahead with significant cuts to the community pharmacy budget in the Department of Health in the face of huge opposition from Members on both sides of the House, members of the public and healthcare professionals. Given the evidence that one in five people who would usually see a pharmacist for medical advice say that they will make a GP appointment if their local pharmacist is closed—in areas of higher deprivation such as mine, it is four in five—and with the risk that many of those people in desperation will turn up at the local hospital, are the Government in danger of making an appalling crisis in the NHS even worse?
Mr Hunt
As with all parts of the NHS, we have to ask the pharmacy sector to make efficiency savings. Some 40% of pharmacies are clustered in groups of three or more, and it does not make sense for the NHS to continue to subsidise pharmacies that are very close to other pharmacies. Our reforms are designed to ensure, however, that where there is only one local pharmacy that people can access, that pharmacy is protected.
Seema Kennedy (South Ribble) (Con)
Does my right hon. Friend acknowledge the damaging effect that loneliness can have on mental health, and will he join me in welcoming the launch of the Jo Cox loneliness commission at the end of this month?
Mr Hunt
I am happy to do that and to acknowledge the importance of this issue. The latest figures I have seen are that 5 million older people say that their main form of company is the television, which is not acceptable, and we all have a responsibility to do better. It is not just a moral but a practical issue, as loneliness makes people more likely to need hospital treatment, which is of course expensive and challenging for the NHS.
Ms Angela Eagle (Wallasey) (Lab)
The Secretary of State has talked a great deal about preventing people from needing to go to A&E by intervening much earlier, yet surely he must recognise that the cuts to local authorities and social care make it much more likely that people will not be picked up earlier in the progress of an illness but will have to resort to the health service in a much more difficult situation. Can he not now have a discussion with his ministerial colleagues, particularly the Chancellor, and tell them that they have got this wrong and that we have to invest in preventive services? That means more funding for local authorities, rather than the 57% cut my authority has had, and investing now in proper social care, not the £5 billion of cuts in social care since 2010, otherwise the pressure on our NHS will just continue.
Mr Hunt
I actually agree with the hon. Lady’s broad point about the importance of the social care system and its interconnectedness with the NHS. As she well knows—her party’s manifesto reflected this as well—in 2010 we faced a very challenging economic situation, and both parties recognised the need for cuts in public spending. What changed in 2015, however, at least in the Conservative party’s manifesto, was the recognition that we needed to increase funding for the social care system, and with the changes announced by the Secretary of State for Communities and Local Government in December, all local authorities can now increase funding for social care in real terms. I hope that we can start to turn things around.
Neil Carmichael (Stroud) (Con)
With the recent Education Committee report on children in care in mind, I welcome the Prime Minister’s refocus on mental health and the Secretary of State’s continued support for action. What practical steps does he have in mind, given our finding that local integration, effective relationships and the teaching of personal, social and health and economic education all help to produce good outcomes?
Mr Hunt
My hon. Friend is absolutely right—obviously his role on the Select Committee gives him a particular insight—but we do not want to rush to a solution, which is why we have said that we will produce a Green Paper before the end of the year. It is a complex area. Other hon. Members have alluded to the risk of medicalising problems, given that, as we know, all young people at school experience periods of stress, anxiety and worry that are not necessarily diagnosable mental health conditions and which we would not want to make out to be such. This is about thinking through a smart way to improve resilience training and self-help and to educate schools so that they can spot when something is just a temporary thing in the run-up to exams, or whatever, and when it could be something a lot more serious, such as obsessive compulsive disorder, an eating disorder or something else that needs more immediate help. We have today started a big education programme with schools, but we want to go further.
Jess Phillips (Birmingham, Yardley) (Lab)
I welcome the extra investment, if that is what it turns out to be, in mental health, but I want to press the Secretary of State on the question asked from the Dispatch Box by my hon. Friend the Member for Leicester South (Jonathan Ashworth) about educational psychology and how it will work. I speak as a mother of a child with SEN issues who has relied on clinical and educational psychology in schools. The school that my children currently attend is increasing class sizes from 30 to 33 and reducing the teaching staff—specifically those who engage with SEN children—because of changes to education funding. How does the Secretary of State think that will affect the mental health of pupils in my children’s school?
Mr Hunt
The hon. Lady raises a very important issue. Like her, I have had constituents who found it difficult to access educational psychologists and they have not been able to get approval for the plan that they need. We will consider these issues in the build-up to the Green Paper, and I encourage the hon. Lady to participate in that process.
Jason McCartney (Colne Valley) (Con)
Will the Health Secretary please get the message out there loud and clear to health bosses up and down the country that we need more capacity in our A&Es, so that when my CCG goes to NHS England with a request for £285 million for its appalling plan to downgrade my local A&E, bulldoze Huddersfield royal infirmary and replace it with a small planned care unit with fewer beds, it will realise that that money would be better spent on frontline A&E care in one of the country’s biggest towns.
Mr Hunt
I take seriously, of course, everything my hon. Friend says. I will say that the NHS does not always get these things right. I led a campaign against an A&E closure in my constituency when I was a Back Bencher—[Interruption]—and the Labour party was in power and about to take a wholly mistaken decision, which I was luckily able to persuade the Government not to take in the interests of my constituents. We will look carefully into these issues. On the broader point that my hon. Friend makes, we have to understand across the NHS that capacity matters, but in the long run, we will not solve the problem solely by increasing capacity in A&Es for ever. We need alternative forms of provision. Demand is growing, so we need to find different ways to offer treatment to people who do not need to be in an A&E. That is what we are exploring.
Lucy Powell (Manchester Central) (Lab/Co-op)
I declare an interest in that my husband is an A&E consultant. If the Secretary of State were to speak to him, he would be told that, as we have already heard, the extra pressures on A&E are the result of the almost disappearance of preventive care, social care and other services. The problem is not individuals arriving in A&E who should not be there; it is other services that are referring people to A&E when they should not. Will the Secretary of State take responsibility for his Government’s decisions over the past six years that have now turned out to have been a false economy, because cutting all these vital services back to the bone is what is putting A&E on the brink of breakdown?
Mr Hunt
I agree with the broader principle that preventive care is vital, but with respect, I disagree with the suggestion that services have been cut to the bone. We have 1,600 more GPs—an increase of 5%—and the NHS was protected in the last Parliament. We recognise that there are problems in the social care system, which we are now in the process of putting right. Both at the last election, when the hon. Lady put a lot of input into Labour’s policies, and the one before it, the party promising the most resources for the NHS was the Conservative party, not the Labour party.
Sir Edward Leigh (Gainsborough) (Con)
Everyone knows that the Secretary of State has an impossible job, which he does with humanity and energy. One part of his impossible job relates to the two-tier system, whereby much depends on where people live. In rural north Lincolnshire, people can wait more than three weeks to see a doctor and can wait two hours for an ambulance to come—[Interruption.] Yes, people have waited two hours, lying in the street, in places such as Market Rasen, while they wait for an ambulance. That is not acceptable, and it can be even worse on occasions. This comes on top of long-term lack of investment, which means we lack a psychiatric unit at the Peter Hodgkinson centre in Lincoln. I wonder whether we now need to start an honest discussion with the people about how we are going to devote more resources to health in this country. It could be through social insurance models or even—God forbid, and I know people will not agree with this—charging people who do not turn up for appointments.
Mr Hunt
While I do not agree with moving to a social insurance model, I have some sympathy with what my hon. Friend has said about the broader issue of resourcing healthcare. If there are to be a million more over-65s in the next five years, we shall have to find a way to continue to invest more in our health and social care systems over the decades ahead. We are doing that this year in providing an extra £3.8 billion, and Governments will need to continue to do it in the coming decades.
My hon. Friend has rightly highlighted a specific problem. I do not have a solution to it now, but I want him to know that I understand that, in rural areas, people can wait too long for ambulances. Our system of targets gives ambulance services an incentive to prioritise the calls to which they can respond quickly in nearby towns, but I shall look into the issue.
Derek Twigg (Halton) (Lab)
The Secretary of State tells us that he has a plan and a strategy, so I assume that he is on top of all the facts, but will he assure us that he understands the scale of the problem by answering this question? As of the latest count this week, how many hospital beds were being blocked by people who could not be discharged because no facilities for their care were available in the community?
Andrew Selous (South West Bedfordshire) (Con)
More than a third of A&E attendances at peak times are caused by drunkenness. Behaviour on such a scale is as unacceptable as it is irresponsible. What more can be done to reduce that proportion hugely by this time next year?
Mr Hunt
My hon. Friend has raised an issue of public accountability. These are our national health services, and we need to treat them in a responsible way. It is selfish to behave irresponsibly and impose pressure on an A&E department, because someone else who needs help may not be able to get it.
Mr Ivan Lewis (Bury South) (Lab)
First, may I ask whether the Secretary of State is accusing the Red Cross of weaponising the national health service? Secondly, let me point out that when the NHS makes cuts, the services that suffer time and again are the so-called Cinderella services: mental health services. The only way to prevent that is to ring-fence the funds and force local commissioners to demonstrate to local populations that the extra money is genuinely being spent on improving mental health services. Finally, as we heard from my hon. Friend the Member for Manchester Central (Lucy Powell), when local authority services are cut to the bone, they can only provide statutory services and all the preventive services go—never mind the cuts in social care. What is preventing the Secretary of State from commissioning an all-party group to seek a sustainable, long-term funding model for social care?
Mr Hunt
The Prime Minister has said that we need to find a long-term solution to the problem of funding social care, and that work is ongoing. We recognise the urgency of the situation.
As for the evidence of whether mental health services are reaching the frontline, we need to establish whether more money is being spent on mental health provision than in previous years, and, as I said earlier, about £1 billion more is being spent than two years ago.
Karen Lumley (Redditch) (Con)
As my right hon. Friend has mentioned, the A&E departments at the Worcestershire royal hospital and the Alexandra hospital in Redditch have been under huge pressure over the past few weeks. Can he reassure patients at both our hospitals that everything possible is being done to alleviate the problem? While I am grateful for the measures that have been introduced, what our trust really needs is agreement on a £29 million bid to increase capacity, and I urge my right hon. Friend to consider that as a matter of urgency.
Mr Hunt
I thank my hon. Friend for her interest—on behalf of her constituents—in what has been happening. Subject to staffing, a new ward will be opened at the trust next week, and a new chief executive will arrive in the spring. We recognise the need for capital spending to increase capacity at both the Alex and the royal, and we will consider that bid sympathetically.
Owen Smith (Pontypridd) (Lab)
The Secretary of State could not resist making his customary political attack on the Welsh NHS. This weekend, I had cause to visit my local hospital A&E department with a family member, and we received a brilliant, speedy and expert service. Will the Secretary of State join me in congratulating the staff at the Royal Glamorgan hospital? Will he also congratulate the Welsh Labour Government on not having to call the Red Cross to any hospital in Wales, and will he further congratulate them on their long-standing emphasis on mental health? Wales spends more on mental health provision per capita than England or, indeed, any part of the United Kingdom, notwithstanding the £2 billion that he has cut from the Welsh budget in the past six years.
Mr Hunt
In the hon. Gentleman’s long list of statistics, what he was not prepared to say is that people wait twice as long for a hip replacement in Wales, more than double the proportion of the population is on a waiting list for NHS care—that is one in seven people in Wales, compared with one in 15 in England—and those in Wales are 40 times more likely than those in England to be waiting too long for a diagnostic test result.
Kevin Foster (Torbay) (Con)
Torbay, like many other places, has been under pressure owing to the demographics of an ageing population in the bay area, but does the Secretary of State agree that it is encouraging to hear of work being done in places such as the Chelston Hall practice, which I visited on Friday, to make sure doctors can be available on the day for those who need them and people are sent on to specialists who can help them better, such as a physiotherapist, rather than just taking up vital GP appointments?
Lilian Greenwood (Nottingham South) (Lab)
Over the new year, East Midlands Ambulance Service NHS Trust saw life-threatening calls up 42% on last year, and the chair of Nottingham University Hospitals NHS Trust described its emergency department as pushed to the limit, with, as the right hon. Member for Broxtowe (Anna Soubry) said, almost double the normal number of hospital admissions, so clearly these were necessary attendances, but surely many of them could have been prevented. The Secretary of State has already acknowledged the connection between inadequate social care and this entirely foreseeable crisis, so I ask again: will he commit his Government to fund this properly?
Mr Hunt
I find these questions about funding curious coming from members of the Labour party, as, had we followed its plans, we would be spending £1.3 billion less on the NHS this year than what the NHS is actually getting, and I just say to them that the reason why we are able to spend that extra money on the NHS is that we know how to run the economy.
Ben Howlett (Bath) (Con)
All too often, mental health patients have wondered whether this issue has enough leadership, and I am incredibly pleased that the Prime Minister made one of her earlier speeches on this issue, but while no one in this House would oppose an extra £1.4 billion being invested over the course of this Parliament, may I echo the words of the chief executive of Mind that the proof will be in the impact this investment has on patients’ day-to-day experiences? So will the Secretary of State ask the relevant Minister to meet me to discuss plans to build a new psychiatric and dementia care unit at Bath, to service the whole of the south-west?
Mr Hunt
I am happy, on my hon. Friend’s behalf, to ask the Minister responsible to meet him to discuss that psychiatric unit. Of course the proof of the pudding is in the eating, but this is the first time that I can remember that a Prime Minister has made her first major speech on the NHS about mental health and indeed talked, on the steps of Downing Street as she arrived, about the importance of sorting out mental health. That is a sign of the commitment coming right from the top.
Ms Karen Buck (Westminster North) (Lab)
The fabulous team at Imperial, St Mary’s in west London are featuring in a television programme this week, and the chief of service for emergency care is reported as saying:
“We’ve just had our worst 10 days on record. There’s nowhere in the hospital to move anybody. What’s happened in the last two years is the whole system, countrywide, has ground to a halt.”
That is partly because there is more than the equivalent of a ward of patients at any time who cannot move out of the hospital because there is nowhere for them to go. Does the Secretary of State accept that his Government have gone too far in the destruction of local government finance, including for social care, and does he accept that next year, despite all the rhetoric, local government finance will go down, not up?
Mr Hunt
First, I would like to thank the staff at Imperial, who, alongside other NHS staff, have done a fantastic job over a very difficult period. I would say to the hon. Lady that 50% of councils have no delayed discharges of care. It is a problem in many hospitals, but there are many areas that are managing to deal with it. I suggest that the local authorities that serve her constituency should look at the other parts of the country that are dealing with this problem.
John Howell (Henley) (Con)
I welcome the provision of mental health facilities and services for schools, but will my right hon. Friend ensure that the type of first aid that he is proposing will also be made available to MPs and their staff, given the number of people with mental health problems that we deal with during our surgeries?
Bill Esterson (Sefton Central) (Lab)
The problems in A&E that we have been hearing about this afternoon are symptomatic of problems elsewhere in the system. At Aintree hospital, whose staff are doing a fantastic job in very difficult circumstances, there are 130 patients who are medically fit for discharge today but social services are unable to support them to go home or to go into care elsewhere. The Secretary of State needs to accept that the cut of £4.6 billion to social services was a mistake. He also needs to accept that the better care fund is simply not delivering. It involves money being recycled from elsewhere in the system. Let us look at the figures for Sefton, which was promised £9 million but has received less than £1 million. If he is serious about sorting out the problems in social care in the long term, he needs to get the funding right. He needs to reinstate all the cuts that have been made.
Mr Hunt
I accept that more funding needs to go into social care, and that is why we are putting an extra £3.5 billion per annum into social care by the end of the Parliament. Despite the very real pressures in social care, however, there are many local authority areas and hospitals that have no delayed discharges at all. Half of all delayed discharges are in just 20 local authorities. As we wait for that funding to come on stream—it is not all coming on stream at the start of the Parliament—there is lots that can be done.
Maria Caulfield (Lewes) (Con)
I thank the Secretary of State for paying tribute to frontline staff. I declare an interest as someone who worked in the NHS over the Christmas period and who saw at first hand some of the pressures that staff are facing, but I know from my 20 years’ experience working as a nurse that these are winter pressures that are faced every year. On mental health, will my right hon. Friend pay tribute to the mental health care nurses in Sussex and to Sussex police? Through their joint working, they have reduced the number of patients being placed in prison cells as a place of safety by 50%. That is a huge achievement in the county that contains Birling Gap and Beachy Head.
Mr Hunt
I welcome my hon. Friend’s contribution as a practising nurse; it adds greatly to the House. I am more than happy to pay tribute to our brilliant mental health nurses. They have one of the most stressful jobs anyone can have, and I pay particular tribute to the ones in Sussex, which has those tragic suicide hotspots.
Catherine West (Hornsey and Wood Green) (Lab)
Given that the cold weather is coming, I want to return to the risk of a flu epidemic. A desperate doctor wrote to me last night to say:
“Sooner or later, there will be an epidemic and let me tell you: we cannot cope. Another shift, another full hospital. Another gridlocked A&E, more desperate but often implausibly understanding patients. Another 13 or 14 hour shift with one 10 or 15 minute break. Some patients and relatives get angry, some despair, most watch us and realise we can’t physically do anything more.”
Please help me, as her MP, to represent her, and please help us to have more staff.
Mr Hunt
That doctor speaks for many doctors who are working incredibly hard, particularly in our emergency departments. I would say to that doctor that we recognise the need for more doctors and we are recruiting more doctors, not just across the NHS but in emergency departments in particular. We also recognise that we need to find a different way to deal with some of the patients who come to the hospital front door, so that we can alleviate the pressure. That is what we are looking at.
Robert Courts (Witney) (Con)
I recently visited Bridewell organic gardens, an award-winning charity in my constituency that improves the mental wellbeing of those suffering from a range of mental health conditions. I welcome the Prime Minister’s announcement this morning raising awareness of the ongoing stigma regarding mental health, as well as the £1 billion investment and the commitment to improving services, but is the Secretary of State prepared to investigate schemes such as the one I mentioned to ensure that treatment of those suffering from mental health conditions is not simply limited to the provision of medication?
Mr Hunt
I am absolutely prepared to do that. We need to be open-minded about the fact that mental health, in some ways, is a relatively new field, and research on what works best is continuing to uncover many new things—much of that research is happening in this country. There has been a big move away from thinking that medication is always the best way forward. We have seen a huge expansion in talking therapies in the past few years in this country, and I am sure that trend will continue.
Paula Sherriff (Dewsbury) (Lab)
Despite the best efforts of dedicated NHS staff, patients attending one of my local A&Es were told that they would routinely have to wait 11 hours just to be seen. People were routinely on hospital trolleys for up to 20 hours. Mental health patients were sent to Colchester because it had the nearest available in-patient beds for 17-year-olds. Somebody I know waited six hours for a 999 ambulance, despite calling 999 three times. We can do better than that. To that end, I implore the Secretary of State—in fact, I plead with him—to intervene and suspend the needless downgrades of Dewsbury and Huddersfield hospitals, which will cost lives.
Mr Hunt
None of those examples of poor care is remotely acceptable. On my watch and under this Government we will see no return to the bad old days when people were routinely waiting far too long. [Interruption.] We recognise the problems that we have just had, and we are absolutely determined to make sure that we sort them out. If the hon. Lady’s local hospital reconfiguration ends up on my desk because it is referred by the local health scrutiny committee, I will look at the matter carefully and consider whether to refer it to the independent reconfiguration panel.
Wendy Morton (Aldridge-Brownhills) (Con)
I welcome the Secretary of State’s statement and the Prime Minister’s focus on mental health, particularly the suicide prevention strategy and the £1 billion funding commitment to improving services. Mental health often not only affects the patient but affects their family and those closest and dearest to them—those who care for the patient. Does he agree that raising awareness and addressing the ongoing stigma of mental health is a vital part of our work on mental health?
Mr Hunt
My hon. Friend is absolutely right to mention that. We can approach this area with some optimism about the potential for change. If she looks at our progress on dementia over the past four years, she will see that not a day goes past without something in the newspapers about dementia. The understanding of dementia has changed dramatically. We can change attitudes, and we absolutely need to do so because the only way to get help to people in mental health crisis is if they talk about it openly. That is a vital thing to change.
Kerry McCarthy (Bristol East) (Lab)
I entirely agree with the comments about the pressures on GP services, preventive health and social care, but I particularly want to ask about mental health services for students. There were three suspected suicides in the first few weeks of term this year at Bristol University, and I know from speaking to Dr Dominique Thompson, who runs the student health services there, that the number of students presenting with mental health issues has grown exponentially over recent years. What can the Secretary of State say to reassure us that students leaving home for the first time to go to university will be in safe hands?
Mr Hunt
I had an interesting afternoon visiting the suicide prevention unit at Bristol Royal infirmary, where I had a good discussion about its pioneering work. I learned a great deal from that visit. We have a particular concern about the very significant growth in mental ill health among women aged 18 to 24. Today, the Prime Minister announced that we have updated the suicide prevention strategy to make sure that all parts of the country can learn from best practice, including places like Bristol.
Justin Tomlinson (North Swindon) (Con)
I welcome today’s announcement on mental health, where excellent work is being done, led by Paul Farmer of Mind. Often, the key challenge is to identify those who need help and support, so will the Secretary of State agree to meet the Department for Work and Pensions to look at ways in which we can help to signpost those identified through the personal independence payments process to the additional support and help available?
Mr Hunt
Let me reassure my hon. Friend that those meetings are already happening; we have a health and work Green Paper, and we are particularly trying to speed up access to mental health services for people on benefits whom we can help to be more independent if we address their mental health problem more quickly.
Tracy Brabin (Batley and Spen) (Lab)
I wish to pick up on a point the Secretary of State made about the right sort of patient arriving at A&E. Pat, a frail, elderly constituent of mine who had pneumonia-like symptoms, did not want to go to A&E and put pressure on hard-working staff, so she rang NHS Direct, only to be told there were 100 people in front of her for a doctor’s visit. Of course she thought she was going to die if she was left in her house, so she went to A&E, where she waited 20 hours for a bed. As the Secretary of State knows, that is unacceptable, so does he agree that there is urgent and immediate demand for out-of-hours doctors? If so, what is he going to do about it?
Mr Hunt
The hon. Lady is right to say that we need better alternatives to A&E for people such as her constituent. Sometimes those do not exist, but one thing we need to do is make sure that people who call 111 and need to speak to a clinician can do so quickly. One thing we have piloted successfully in other parts of the country is better GP supervision of people in care homes, who are sometimes the most vulnerable patients. We are looking at all these things, but on the broad direction of travel she is right to say that we need to find a better way forward for people such as her constituent.
Matt Warman (Boston and Skegness) (Con)
In sparsely populated rural Lincolnshire, vital reforms of health and social care risk being undermined by the performance of East Midlands ambulance service. Our police and crime commissioner says that his officers are routinely acting, in effect, as ambulance drivers. I know the Secretary of State understands the problems we face in rural Lincolnshire, but does he agree that, as currently constituted, East Midlands ambulance service is not serving the rural parts of its area as well as its staff want to and as well as my constituents need it to?
Mr Hunt
As we discussed earlier when my hon. Friend the Member for Gainsborough (Sir Edward Leigh) spoke, there are places where the service that the ambulance service provides to rural areas is not as good as it should be, sometimes because of the perverse incentives relating to how the targets work. I have been nervous about changing the targets, because that can sometimes be taken as a signal to relax and I am absolutely determined that we should meet the current targets, but I did make a commitment to him that I would look into this issue and I will do so.
Louise Haigh (Sheffield, Heeley) (Lab)
Last year, just 67% of category red 1 ambulance calls in Sheffield were answered within eight minutes. Last week, I met a constituent whose husband died while he waited for an ambulance for two hours and 40 minutes. Can the Secretary of State continue to stand at that Dispatch Box and say that there is no link between the underfunding of our NHS and these irresponsible and completely unacceptable response times?
Mr Hunt
First, of course what happened in that situation is totally unacceptable, but the hon. Lady makes a mistake to continually bring this back to funding, as it is also about demand pressures and models of care. Let me reassure her about the extra funding that has gone into ambulance services. We have about 200 more ambulances and about 2,000 more paramedics, and every day the ambulance service is doing about 3,400 more blue-light calls than it was six years ago. Significant investment has been made, but clearly more needs to happen.
Mims Davies (Eastleigh) (Con)
The number of mental health patients in police cells is, rightly, down by 80%. People have bravely come to my surgery to talk about when they and their families have been struggling with mental health provision for those between the ages of 18 and 24. I pay tribute to Solent Mind and Southern Health, which are doing their level best to deal with this issue. One issue directly affecting that age group is the tier system, and people not being “sick enough” and not being sure where they should be going. Will the Secretary of State please confirm that he will focus on recruiting specialists in this area, because it is not about funding in my local clinical commissioning group—it is about finding the people to help those in need?
Mr Hunt
My hon. Friend is right on both counts. We need to look carefully at where the tier system is not working, and that should be part of our work on the Green Paper that the Prime Minister announced this morning. It is unacceptable for people to be told that they are not sick enough to get the care they urgently need. All the things we have announced and intend to announce to improve mental health will fail if we do not get the recruitment and training of new staff right. Along with the commitment we are making today to invest more in mental health must come some important strategic workforce planning, which I hope will benefit my hon. Friend’s constituents.
Mike Gapes (Ilford South) (Lab/Co-op)
The Secretary of State referred to temporary assistance being given to distressed trusts, but is there not a more fundamental ticking time bomb in the form of the sustainability and transformation plans? I draw his attention to the debate I led on 16 December on the north-east London plan, which envisages a deficit of £578 million by 2021 and says that on a “business as usual” case model, with normal-type reductions and savings, there will still be a £240 million gap. That will mean poorer services. There is no capital provision for the closure of the King George hospital A&E and its re-provisioning at Queen’s hospital. Will he look into this matter urgently? There is going to be a massive crisis in my area unless urgent steps are taken to provide more resources.
Mr Hunt
I am happy to look into that issue. I take this opportunity to pay tribute to the staff of both Queen’s and King George hospital, who have not only done very well over the winter but have made great progress in turning around the trust, which, as the hon. Gentleman knows, is in special measures. We are hopeful that it might be able to come out of special measures at some stage this year under its new leadership, but that is obviously a decision for the CQC.
Mr Peter Bone (Wellingborough) (Con)
Kettering general hospital, which serves my constituency, has a significant problem with delayed discharges. Whatever the issues relating to money, perhaps the problem with social care is the model. Would it not be a good idea if the Opposition were to give a genuine commitment to try to work together to find a social care system for the future?
Mr Hunt
My hon. Friend is right to say that we need to have these discussions in a less politically charged way, because we need to find a solution that will survive changes of Government and be fit for the long term. We miss a trick when we say that the problem is primarily about funding. We have a huge variation in provision, and there are many local authorities where there are no delayed discharges of care, as we discussed earlier. What does not happen enough in the NHS and the social care system is people learning from best practice in other parts of the country. That is what we to change.
Anna Turley (Redcar) (Lab/Co-op)
The Secretary of State has spoken a lot today about trying to avoid unnecessary admissions to A&E. Will he tell me why admissions to A&E on Teesside as a result of chronic malnutrition have trebled under the Conservative Government? Does he think that is any reflection on their broader approach to public policy and tackling poverty in this country?
Mr Hunt
The way to deal with those kinds of terrible problems is to have a strong economy that allows us to support people through difficult periods in their life. We have one of the strongest economies—in fact, I think we will be the strongest economy in the G7 this year. That allows us to do things such as invest in our health and social care system. It is the Conservative party that can deliver that.
Daniel Zeichner (Cambridge) (Lab)
I have spoken before about the staggering rise in the number of patients presenting at A&E at Addenbrooke’s in Cambridge, and the hospital confirmed to me this morning that it continues to see more than 300 people each day, with high levels of delayed transfers of care. The impact was brought home to me by a constituent, Ann, who told me that on Thursday last week the facilities were so overcrowded that an adjacent seminar room was pressed into use. Bloods were being taken in the room, and she was treated there behind a makeshift curtain, reclining on a standard chair. Those are awful conditions in which to be treated, and in which to have to work. The Secretary of State says that it is not about funding; if it is not, will he come to Cambridgeshire and sit down with his Conservative colleagues on the county council and tell them where they are going wrong?
Mr Hunt
I went to Addenbrooke’s in the autumn and saw at first hand how hard the staff there are working. That is another trust that is in special measures, but it has made huge progress in trying to turn things around. I met several staff in the emergency department as well, and I pay tribute to them for their very hard work. I have never said that it is not about funding; what I say is that it is not just about funding. There is huge variation. In parts of the country, emergency departments avoid precisely the kind of overcrowding that the hon. Gentleman described at Addenbrooke’s. Hospitals that do that very successfully include Luton and Dunstable. We need all hospitals to adopt what the best hospitals do.
Mrs Madeleine Moon (Bridgend) (Lab)
I welcome the publication of the new suicide prevention strategy, and I welcome the fact that it includes self-harm. I am also grateful for the mention of the work of the all-party group on suicide and self-harm prevention, which I chair. Will the Secretary of State meet Dr Robert Colgate? He has set out a triaging system for mental health, which means that people do not have to wait six to nine months to see a consultant. With the support of frontline staff, they can get an immediate triage assessment and assistance for their condition. Will the Secretary of State meet urgently Dr Colgate, whose work is being peer reviewed by the University of Manchester, to look at how his system, which is being rolled out throughout England, can help us to tackle the problems we have?
Mr Hunt
I thank the hon. Lady for her work on the all-party group. I am more than happy to meet Dr Colgate. The purpose of the refreshed suicide prevention strategy is to try to ensure that we adopt best practice throughout the country. Some areas of the country are doing a very good job in suicide prevention, particularly in co-opting the public so that they understand that they can make a difference, too, but I am happy to explore with the hon. Lady what more can be done.
Liz McInnes (Heywood and Middleton) (Lab)
The Secretary of State rightly pays tribute to NHS staff, but the reality is that many of our NHS workers are now at breaking point. They continue to perform their work with care and compassion in spite of, rather than because of, any action taken by the Health Secretary. It is now time for him to act. What commitment will he give to investing properly in NHS staff, and to reversing the process of the deskilling, demoralisation and downgrading of NHS staff that he and his Government have presided over since 2010?
Mr Hunt
With respect to the hon. Lady, who I know cares passionately about the NHS and often asks me questions about it, we now have 11,400 more doctors and 11,200 more nurses in the NHS than in 2010. We protected the NHS budget in 2010, when her party wanted to cut it, and we promised £5.5 billion more for the NHS than her party was prepared to promise at the most recent election. Her characterisation of this Government as not being prepared to back NHS staff is utterly absurd.
John Woodcock (Barrow and Furness) (Lab/Co-op)
The Prime Minister’s focus on mental health today is welcome, but does the Secretary of State accept that we will achieve parity of esteem only if we are prepared to accept how far we currently are from it? It is not a recent problem: the lack of recognition for mental health dates back to the inception of the national health service and is driven by our culture and choices as a country, rather than by any particular Government. Nevertheless, does the Minister accept that even the measures set out today, each of which is welcome in and of itself, will only really provide a sticking plaster for the problem? As it stands, on current progress, we are looking at having to wait decades before we achieve parity of esteem for mental health conditions.
Mr Hunt
I thank the hon. Gentleman for his interest in that issue. Sometimes, this is a challenging area. We legislated for parity of esteem, with cross-party support, in 2012. The danger is that such a concept can be nebulous, which is why we asked Paul Farmer, the chief executive of Mind, to look independently at what would be reasonable, fair and sensible progress towards parity of esteem by 2020. He said that he thought it would be a 10-year process, but that this was the right ambition for 2020. It was his report that the Prime Minister accepted this morning. We are making progress against benchmarks that independent people have looked at. The hon. Gentleman is right to say that we will not get there by 2020, but we must make sure that we deliver on that commitment while he and I are both MPs.
Kate Green (Stretford and Urmston) (Lab)
Very seriously mentally ill people rely on support from a whole range of services, including—obviously—mental health services, but also housing, social services, sometimes the criminal justice system and, crucially, family support services. What is being done to ensure a whole-Government strategy to raise the standard of care, particularly for very severely ill people who need protection from harm both to themselves and, sadly, sometimes to others in society?
Mr Hunt
The hon. Lady is absolutely right. One example where that is particularly true is in addiction services. Highly vulnerable people whom we are trying to help kick a drugs habit may also have a housing problem, a debt problem or a work problem. Unless we solve those problems holistically, we are unlikely to be able to address the health problem that sits at the heart of those challenges. In essence, that is what the STP process is trying to address—I am talking about providing more joined-up integrated services. I am happy to have further discussions with her as to how we can make more progress in that area.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
In his statement, the Secretary of State promised a Green Paper on children and young people’s mental health before the end of the year. That could be 11 and a half months away. One in four people have a mental health disorder, and the Government’s own research says that young people are disproportionately affected. We have all heard stories—I certainly have in my constituency—of young people waiting more than a year for support, including those who have been victims of domestic violence. Schools and parents are picking up the pieces. Young people deserve better. Will he clarify the reasons for what appears to be quite a long delay and commit to bringing forward the Green Paper so that action can be taken more quickly and that this pressing issue is not kicked into the long grass?
Mr Hunt
May I reassure the hon. Lady that we will not be kicking the issue into the long grass? The Prime Minister has made a statement that we will have a Green Paper. There is a very specific reason why we need a bit of time: we want to ensure that the changes that we make—[Interruption.] We are getting a bit of chuntering from the Labour Front-Bench team. They might want to listen to the answer. The reason why we need to take some time is that a number of pilots concerning the improvement of mental health provision are taking place in schools at the moment, and we want to see them go through and evaluate them to inform what we do in the Green Paper. That will take a bit of time, but, at the end of it, we will get a better evidence base for the right way forward.
Paul Blomfield (Sheffield Central) (Lab)
Young people in Sheffield have for some time now been telling me that they are waiting 25 weeks for an appointment with CAMHS after referral. Headteachers are telling me that they are digging into their budgets to buy in support for pupils in crisis, because they cannot access NHS services. Is it not deeply cynical for the Prime Minister to be raising hopes that we will be tackling the mental health crisis of our young people when the measures and the money that have been announced fall so desperately short of what we need?
Mr Hunt
It would be cynical if we raised hopes and had no intention of doing anything about the matter. What the Prime Minister said this morning in her speech was that this was the start of a process. She pointed to those problems and said that we will have a Green Paper to look at how we deal with them in detail, which does take some time. I hope that we will get to a position when we can deal with those problems. The hon. Gentleman is lucky to have Professor Tim Kendall working in Sheffield, as he is the NHS lead mental health psychiatrist and a specialist in homelessness, and he is helping us to shape the strategy.
Mr Speaker
I am grateful to the Secretary of State and to colleagues across the House.
Mental Health
Jeremy Hunt Excerpts(7 years, 11 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I would like to update the House following today’s announcement made by the Prime Minister about this Government’s plans to reform mental health services in this country.
For too long those suffering mental illness in England have experienced a hidden injustice. Mental illness has been shrouded in stigma and the needs of those with mental health problems have been neglected compared to those with physical illness. An estimated one in four people in the UK will experience a mental health problem at any one time and the economic and social cost of mental illness is estimated to be £105 billion a year. Left unaddressed, mental illness can destroy lives, cause untold pain to families and prevent people from fulfilling their potential at work, school or in society.
This Government are determined to address the historic failure—over successive generations and Governments—to tackle mental illness. We are grateful to the Independent Mental Health Taskforce for publishing the Five Year Forward View for Mental Health last year, which set out a clear roadmap for the NHS, our arm’s length bodies and Government. In February, the Department for Health supported their recommendations with an additional investment of £1 billion per year by 2020. NHS England accepted the recommendations for the National Health Service in full and have published an implementation plan. Today the Prime Minister announced that the Government accept all the recommendations made to it by the Independent Taskforce on Mental Health and are publishing an update on our progress against these recommendations. The Government’s response to the Mental Health Taskforce can be viewed online at: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-01-09/HCWS397.
But we must go further still. The challenge of mental illness is growing and we must all—at every stage of life and every level in society—take steps to tackle it.
First, because we know that children and young people are most susceptible to mental illness and most disorders originate in childhood, we must make mental health a priority in our classrooms and in our families. The Government have therefore announced a series of steps to ensure children and young people get the support they need. We will:
Commission a major thematic review of children and adolescent mental health services across the country, led by the Care Quality Commission with assistance from Ofsted—the first of its kind.
Bring forward a new Green Paper on children and young people’s mental health later this year, to set out plans to transform services in schools, universities and for families.
Introduce new support for schools with every secondary school in the country to be offered mental health first aid training and new trials to look at how to strengthen the links between schools and local NHS mental health staff.
Develop peer support for children and young people’s mental health and emotional wellbeing—confirming a programme of pilot activity on peer support, as outlined earlier in the year, along with £1.5 million in funding.
Launch a programme of randomised control trials of promising preventative programmes, across three different approaches to mental health promotion and prevention.
Second, we must work with employers to ensure better mental wellbeing in the workplace. Because we know that there are important steps businesses can take to support their workforce, and those that do see benefits in higher productivity and lower absence. The Prime Minister has therefore appointed Lord Dennis Stevenson, the long-time campaigner for greater understanding and treatment of mental illness, and Paul Farmer CBE, CEO of Mind and Chair of the NHS Mental Health Taskforce, to drive work with business and the public sector to support mental health in the workplace. These experts will lead a review on how best to ensure employees with mental health problems are enabled to thrive in the workplace and perform at their best. This will involve practical help including promoting best practice and learning from trailblazer employers, as well as offering tools to organisations, whatever size they are, to assist with employee wellbeing and mental health. We will also review recommendations around discrimination in the workplace on the grounds of mental health.
Third, we need to offer alternatives to hospital to support people in the community. We recognise that seeing a GP or going to A&E is not or does not feel like the right intervention for many people with mental ill-health, the Government will build on their initial £15 million investment to provide and promote new models of community-based care such as crisis cafes and community clinics. The initial £15 million investment led to 88 new places of safety being created. Since 2011-12, there has been an almost 80% reduction in England of people experiencing a mental health crisis being taken to police cells, utilising health-based place of safety, rather than being held in a cell, ensuring people get the best support—in the right place, at the right time, in the right way. The Government now plan to spend up to a further £15 million to build on this success.
Fourth, we will expand treatment by investing in and expanding digital mental health services. Digitally assisted therapy has already proved successful in other countries and the Government will speed up the delivery of a £67.7 million digital mental health package so that those worried about stress, anxiety or more serious issues can go online, check their symptoms and if needed, receive clinically-assisted therapy over the internet, when this is clinically appropriate for the person rather than waiting weeks for a face-to-face appointment—with face-to-face sessions offered as necessary. We will:
Introduce a major £60 million investment, £30 million from Government and £30 million from trusts, of digitally assisted mental health services in six mental health trusts, badged Global Digital Exemplars for mental health. Global Digital Exemplars will be expected to make a step change in their use of digital technology, informatics and data to improve value overall by improving the processes of care, using information to better inform decision making about care, improving the levels of safety and effectiveness of care, improving the ability to sustain continuous quality improvement and improving patient access to appropriate evidence based care.
Pilot digitally-assisted therapy for the NHS’s talking therapies programme. This £3 million pilot will trial existing treatments and offer patients faster effective therapy for illnesses such as anxiety and depression and involve working with NICE to establish a new accelerated accreditation process, to ensure mental health patients can access treatments that take full advantage of changing technology which have been properly tested and accredited, with products becoming part of the mainstream offer to people if meeting NICE standards.
Strengthen the mental health content of the clinical triage platform for NHS 111 with a £3.3 million investment, ensuring improved waging of those experiencing mental ill-health using the NHS’ online platforms, as well as allow self-referrals online.
Pilot and further roll out the health based place of safety capacity management app at a cost of £900,000 to help police and health services manage places of safety spaces in real time.
Develop a set of apps and resources for £500,000, which will be included on an online digital health tools library, and rolled out on commercial platforms like the Apple App store.
Fifth, we must right the everyday injustices that those with mental health problems face. We will:
Work with money and mental health policy institute to undertake a review of the mental health and debt form and agree an approach that will end this unfair practice.
Support NHS England’s commitment, made this year, to eliminate inappropriate placements to inpatient beds for children and young people by 2020-21.
Publish the refreshed Government Suicide Prevention strategy a copy of which can be viewed at: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-01-09/HCWS397.
Suicide Prevention
The latest figures from the Office for National Statistics show that 4,820 suicides were registered in England during 2015—equivalent to 13 people per day. Self-harm is also on the rise, with up to 300,000 hospital attendances per year in England categorised as resulting from self-inflicted injury.
We are already taking steps to help reduce suicide. The £247 million investment in mental health liaison services will see trained psychiatrists and counsellors made available in emergency departments to assess, counsel and refer patients on to other mental health services if they present with signs of self-harm or other psychological distress.
Local authorities will also be expected to strengthen local suicide prevention plans, and there is an explicit focus on improving how services respond to cases of self-harm, which is the biggest single indicator that a person may be at increased risk of suicide.
It is hoped that the new strategy, which sets out how local areas should do more to support those at high risk of suicide, will also encourage local authorities strengthen efforts to reach other groups known to be at increased risk.
These include young men—who are three times more likely to die by suicide than women—those in contact with the criminal justice system and certain occupational groups.
Many parts of the country already have established preventative plans. These vary by area, but have included: stronger outreach and liaison services, dedicated services for young people who self-harm and training programmes to help health professionals, police and other community services to understand how to identify and respond to people in acute distress.
All local authorities will now be expected to develop strong, multi-agency suicide prevention plans by the end of 2017, ahead of these being checked and approved by the Department of Health.
In addition, NHS England will develop a new care pathway for self-harm, which will provide greater consistency in how those groups are cared for across the NHS, with consistent treatment guidelines for the recognition, treatment and management of self-harm.
There will also be an increased focus on ensuring those who have been recently bereaved—which are another group at increased risk of suicide—receive information and follow-up support to help them cope with their loss.
[HCWS397]
Oral Answers to Questions
Jeremy Hunt Excerpts(8 years ago)
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Lucy Allan (Telford) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
As we wish each other a merry Christmas, the whole House will also this morning remember the people of Berlin as they face up to yesterday’s horrific suspected terrorist attack. Germany and its capital Berlin have been beacons of freedom and tolerance in modern times, and all our thoughts and prayers are with them today.
Evidence from all over the world suggests that higher standards of care for patients relate directly to the quality of clinical leadership, which was why last month I announced a number of measures to increase the number of doctors and nurses in leadership roles in the NHS.
Lucy Allan
I thank my right hon. Friend for his response. Clinicians in Telford have been showing real leadership by rejecting a proposal to close a brand new women and children’s unit, and elements of our emergency services. The quango responsible for this idea has spent £3 million and taken three years to come up with the proposal, which has been rejected by local people and clinicians. Will my right hon. Friend meet me and my local colleagues to bring an end to this farce, and to ensure that we do not continue in limbo any longer?
Mr Hunt
I recognise the extent of my hon. Friend’s campaigning on this issue in Telford, and that she expresses the concerns of many of her constituents. As she knows, service changes must be driven locally and must have the support of local GP commissioners. She will also know that the actual situation, very frustratingly, has not led to consensus between clinicians in different parts of Telford and Shropshire. I agree that the process has taken much too long, and I am more than happy to meet her and to try to bring this situation to a close as quickly as possible.
Heidi Alexander (Lewisham East) (Lab)
In a year when the Health Secretary has spent quite a lot of time knocking clinicians, it is good to hear him speak so positively about them. After four years in the job, what responsibility does he accept for the lack of suitably qualified individuals—not just clinicians—who are prepared to take on the top jobs in the NHS on a permanent basis?
Mr Hunt
I will tell the hon. Lady what I take responsibility for: more doctors, more nurses and more funding than ever before in the history of the NHS. We know that the highest standards are often achieved when there is strong clinical leadership. Only 54% of managers in this country are clinicians, compared with 74% in Canada and 94% in Sweden. That is why it is right that we do everything we can to encourage more clinicians into leadership roles.
Andrew Selous (South West Bedfordshire) (Con)
Does the Secretary of State agree that the clinical leadership involved in the Getting It Right First Time initiative is important, not only because it will save £1.5 billion, which could be put back into patient care, but because patients will be in less pain and will end up having fewer revision operations, and some will even survive treatment that they would not otherwise have survived?
Mr Hunt
My hon. Friend is absolutely right. I thank him for bringing Professor Tim Briggs to see me to explain just how superb this programme is. Infection rates for orthopaedic surgery vary between one in 20 patients in some trusts to one in 500 in others. Getting this right can transform care for patients and save money at the same time.
Mr Ben Bradshaw (Exeter) (Lab)
I associate myself with the Secretary of State’s comments about Berlin, my one-time home.
Does the Secretary of State accept that we have the best clinical leaders anywhere in the world? The challenge facing the NHS is not one of clinical leadership, or the dedication or skill of staff, but one of chronic underfunding by this Conservative Government.
Mr Hunt
We do indeed have superb clinical leaders, such as Marianne Griffiths at Worthing, which was recently given an outstanding rating. We also have superb non-clinical leaders, such as David Dalton at Salford Royal. I would gently say to the right hon. Gentleman that if he is worried about funding, why did he stand in the election on a platform that would have seen the NHS have £1.3 billion less this year?
Mr Steve Baker (Wycombe) (Con)
Will the Secretary of State ensure that clinical leaders are able to apply important techniques from other disciplines, such as lean production, which can drive up productivity?
Dame Rosie Winterton (Doncaster Central) (Lab)
Does the Secretary of State agree that if the board of Doncaster and Bassetlaw Hospitals NHS Foundation Trust agrees to establish a teaching hospital today, that will enable the trust to train its doctors of tomorrow so that they are more able to move into clinical leadership roles as quickly as possible?
Mr Hunt
I thank the right hon. Lady for her question and welcome Doncaster hospital’s aspirations and ambitions. Any final decision will obviously be a matter for the NHS and Health Education England, but it is very encouraging that it is reaching for the stars in this way. Yes, we do need to train more doctors, and I hope that the hospital can make a good contribution.
Mr Speaker
The constituency of the hon. Member for Bassetlaw (John Mann) was just mentioned and he came in on cue. Unfortunately, he was not within the curtilage of the Chamber at the material time. No doubt we will hear from him at a later date, to which we look forward with eager anticipation.
Gavin Newlands (Paisley and Renfrewshire North) (SNP)
The Secretary of State for Health (Mr Jeremy Hunt)
There are currently 127,000 staff from the EU doing a vital job for patients in the NHS and social care system. In this year of Brexit, we salute their excellent work and remain confident that we will be able to negotiate for them to continue it in the future.
Gavin Newlands
There are more than 50,000 EU nationals working as nurses and doctors throughout the United Kingdom, along with 80,000 in the social care sector. The NHS already faces extensive rota gaps owing to a shortage of senior and junior doctors. Will the Secretary of State join our First Minister in demanding an unequivocal guarantee that EU nationals who are already living here will have the right to remain?
Mr Hunt
That is exactly what we intend to achieve through negotiations, but we must remember the British citizens, including people from Scotland, who are living in the EU and whose rights we also wish to protect. That is why the Prime Minister has made a big point of saying that she wishes to negotiate the issue at an early stage in order to give certainty to those people.
Sir Edward Leigh (Gainsborough) (Con)
We are not going to leave the EU for two and a half years, but I want the Secretary of State to grip GP services in Lincolnshire now and to start training more doctors. The Pottergate surgery in Gainsborough is closing, potentially throwing hundreds of people out without a GP, and there is a shortage of 80 GPs against a target of 915 in Lincolnshire, and only six out of 30 training places were taken up recently. Will the Secretary of State now grip the GP services in Lincolnshire for the sake of our people?
Mr Speaker
Order. The hon. Gentleman has rather cheekily brushed aside the part of the question that does not suit his purposes. Only to focus on half a question is very cheeky; we will allow him to get away with it on this one occasion only.
Mr Hunt
I hope that I can reassure my hon. Friend about this because the reality is that we increased the number of GPs by 5% in the previous Parliament, and in this Parliament we are planning an increase of another 5,000, which will be the biggest increase in GPs in the history of the NHS, and will go along with considerable extra resources.
Helen Goodman (Bishop Auckland) (Lab)
I will focus on the half of the question that the hon. Member for Gainsborough (Sir Edward Leigh) missed out. The other day I had a meeting with some constituents who told me that they were so pleased that we were leaving the European Union because it meant that the extra £350 million could be used to reopen the A&E department at Bishop Auckland. Has the Secretary of State found that £350 million yet?
Mr Hunt
The hon. Lady might have noticed that I personally did not talk very much about that £350 million. Whatever resources we have post-Brexit will have to be set in the overall economic context, but of course the great thing is that, post-Brexit, that will be a decision for this Parliament.
Richard Fuller (Bedford) (Con)
Many members of the NHS workforce across Bedford and Kempston come from the EU, but many others come from Caribbean countries, the Philippines, India and many countries in Africa. Will my right hon. Friend make sure that, in the future, people from those countries are given equal access to work in our NHS as that for EU nationals?
Mr Hunt
The benefit of Brexit will be that we can take precisely such decisions in this Parliament, because we will get back control of our borders. I am grateful to my hon. Friend for mentioning the very important work done by people from outside the EU in the NHS. Because I happened to meet the Philippines ambassador last week, I want to pay credit particularly to the Filipino workers in the NHS and the social care system, who do a fantastic job.
Martyn Day (Linlithgow and East Falkirk) (SNP)
May I start by extending my party’s sympathies to the victims of the Berlin attack?
Much of what we have heard today is about keeping those who are already here, but BMA Scotland has said that insecurity is stopping EU nationals from taking up posts that really need to be filled. This is an urgent problem, so does the Secretary of State agree that it is time to create some certainty for EU nationals and to avoid a self-made workforce crisis?
Mr Hunt
I absolutely agree with the hon. Gentleman, which is why it is extremely frustrating that the current signals from the EU are that it is unwilling to bring forward negotiations about the status of EU nationals here, and indeed that of British nationals in the EU. No one from either side of the Brexit debate has ever said that there will be no immigration post-Brexit; they have simply said that we will control that immigration ourselves through this House and through decisions made by the British people at general elections.
Justin Madders (Ellesmere Port and Neston) (Lab)
On behalf of the official Opposition, may I echo the words of the Secretary of State in relation to the tragic events in Berlin and send our condolences to the people there?
The Institute for Employment Studies has today warned that Brexit could make nursing shortages even worse. That follows The Times reporting that
“applications for nursing, midwifery and allied health courses were down by about 20%”
and that in some institutions applications had halved. The decision to scrap nurse bursaries is having the consequences that every expert predicted it would. With the uncertainty of Brexit looming over our workforce, now is not the time to be taking a massive gamble with our nurses so, in the light of the evidence, will the Secretary of State now agree to scrap that disastrous policy?
Mr Hunt
I simply say to the hon. Gentleman that the purpose of that policy was to allow us to train more nurses; in fact, we will be training 40,000 more nurses during this Parliament. We have more than 11,000 more nurses in our NHS wards, and at Countess of Chester hospital—the hon. Gentleman’s own hospital—there are 172 more nurses than in 2010.
Rehman Chishti (Gillingham and Rainham) (Con)
Conor McGinn (St Helens North) (Lab)
The Secretary of State for Health (Mr Jeremy Hunt)
Last year, the number of excess winter deaths was 45% lower than in the previous year, and contingency planning for this winter is well under way, with £400 million allocated to local health systems for winter preparedness.
Conor McGinn
This time last year, St Helens CCG told me it needed to postpone elective operations and referrals in order to get through winter. Six months later, it was £12.5 million in deficit and proposing to cancel all non-urgent surgery indefinitely. What the Health Secretary is proposing does not make the problems go away—it stores them up. When will the Government give local trusts and clinicians the funding they require? Stop passing the buck and start passing the bucks!
Mr Hunt
With the greatest respect, I do not think it is passing the buck to put £1.3 billion more into the NHS this year than the hon. Gentleman was proposing at the last election. A lot of actions are being taken in Cheshire and Merseyside; a local accident and emergency delivery board was set up, which is doing very important work, and the emergency care improvement programme is working very well at his local trust.
Jeremy Lefroy (Stafford) (Con)
There is great pressure on emergency services throughout Staffordshire at the moment. There would be even more without the accident and emergency centres in Stafford and Burton, yet the sustainability and transformation plan proposes to reduce one of them, so there will only be two left in the county. Will the Secretary of State speak to the authors of the STP to make it clear that this is totally unacceptable given the current situation?
Derek Twigg (Halton) (Lab)
Mr Hunt
All I would do is urge the hon. Gentleman to listen to what the Prime Minister said at this Dispatch Box last week. She said that we recognise the short-term pressures—indeed, the Communities Secretary came up with a package of £900 million extra over the next couple of years—but that we also need a long-term sustainable solution, on which the Government are working hard.
Sir Simon Burns (Chelmsford) (Con)
Does my right hon. Friend agree that one of the pressures of winter that needs improving is inappropriate admissions to A&E? Does he accept that the proposals by the Essex success regime to ensure that the three hospitals concerned will retain their A&E departments but that there will be a specialist centre for cardiothoracic care and for burns and plastic surgery care are the right way forward to improve and enhance the care for those suffering from accidents and emergencies?
Mr Hunt
My right hon. Friend understands these matters extremely well from his time as a very distinguished Health Minister. He is absolutely right; the truth is that we want widespread availability of A&Es but we do not serve patients best by offering identical services everywhere. That is why in the past three or four years one of the things we are most proud of is the setting up of a national network of 26 trauma centres, which has had a dramatic impact on mortality rates for the most serious cases.
Mr Speaker
I have just been advised by a very sagacious source that in supplementary questions and answers to this question some reference to winter is desirable.
Jonathan Ashworth (Leicester South) (Lab)
I associate myself with the Secretary of State’s remarks about Berlin. I wish everyone in the House a merry Christmas and I extend my best wishes for a very peaceful and joyful Christmas and new year to all NHS staff, especially those working over Christmas.
Pressures on the NHS this winter are such and the underfunding is so severe that hospitals have been ordered to close operating theatres for elective surgery over Christmas. Is this what the Secretary of State means by a seven-day NHS?
Mr Hunt
Let me wish the shadow Health Secretary a merry Christmas and say that despite his rhetoric I see that Santa has been quite generous to him. His local trust in Leicester has 254 more nurses and 306 more doctors than in 2010. Next year, we will have a new £43 million emergency floor at the Leicester royal infirmary. We need to ensure that there is sufficient bed capacity in our hospitals over winter—that is a very important part of winter planning—but we are also doing 5,000 more elective operations every day than when Labour was in office.
Jonathan Ashworth
I am delighted that the Secretary of State has done his research on Leicester, but is closing operating theatres for a month this Christmas not, in reality, a short-term fix? The truth is that when the pause ends and hospitals fill up again above the 85% occupancy recommendations, patients will be left with a simple choice: get stuck on a waiting list while hospitals try to reduce occupancy rates to safe levels, or risk going into a hospital when it is at full capacity and potentially unsafe and be exposed to higher infection risks. Which option would the Secretary of State choose?
Mr Hunt
May I gently urge the hon. Gentleman to be careful with his rhetoric? We are not closing operating theatres for a month over Christmas. We need to be very careful what we say in this place, because people outside are listening. The answer is to ensure that we increase capacity in the NHS, and that is why we have 11,000 more doctors and 11,000 more hospital nurses than we had six years ago. We are training 15,000 more doctors every year from 2018-19 to ensure that we can avoid these problems in the future.
Andrew Bridgen (North West Leicestershire) (Con)
Chris Green (Bolton West) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
As we enter the challenging winter period, I want, on behalf of the whole country, to thank the 2.7 million people working in the health and care system—particularly those giving up all or part of their own Christmas day to look after patients. We are in their debt, and we wish them a merry Christmas, whenever they get the chance to celebrate it with their families.
Chris Green
Bolton A&E is employing new measures to cope with the staggering demand on its service. What are the Government doing to educate people that A&E is for serious and life-threatening conditions only, so that staff and resources can go where they are needed most?
Mr Hunt
That is an excellent question. We are doing a number of things. First, we have the Stay Well this Winter campaign, which has a lot of advice to go out to his constituents and all our constituents about how to avoid things that can lead to their having to go to A&E. However, we also urge the public to remember that accident and emergency departments are for precisely that.
Barbara Keeley (Worsley and Eccles South) (Lab)
There was no new money from the Government for social care in the local government settlement—just a recycling of money from the new homes bonus to social care, and that is for 2017-18 only. Fifty-seven councils will actually lose funding owing to this recycling. Salford, which was recently praised by the Prime Minister for its integration of social care, will lose £2.3 million due to this inept settlement. Is it not time for the Secretary of State to accept that social care is in crisis and that his Government cannot just dump the issue of funding it on councils and council tax payers?
Mr Hunt
I do listen carefully to what the hon. Lady says, because she has campaigned long and hard for social care. However, with respect, I would say to her that she is ignoring one simple fact: there is more money going into social care now than would have been the case if we had followed her advice at the last election. What the Communities Secretary announced was £900 million of additional help over the next two years.
Barbara Keeley
The Government’s plans for funding social care look inept because they have tied care funding, which is related to need, to council tax and to deductions from the new homes bonus. Last week’s settlement was a pathetic attempt to deal with a funding gap of £2 billion for social care by recycling £240 million within budgets. The chief executive of the British Red Cross has described the social care crisis as
“a humanitarian crisis that needs urgent action.”
When is the Secretary of State going to take that crisis seriously?
Mr Hunt
The hon. Lady talks about council tax, but she does not call out Labour councils like Hillingdon, Hounslow, Merton and Stoke which complain about pressures in the social care system and then refuse to introduce the social care precept that could make a difference to their residents. We are taking the situation seriously. More was done this week and more will be done in future.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
John Mann (Bassetlaw) (Lab)
Mr Jeremy Hunt
First, I absolutely commend the hon. Gentleman for standing with his constituents and championing individual cases. I will happily look into the proposed changes and how they will affect people like Zac. I assure the hon. Gentleman that when we make these changes it is to improve the services of people and his constituents; that is why we are making them.
Dr Sarah Wollaston (Totnes) (Con)
The Health Committee has just published its interim report on preventing suicide. I thank all those who gave evidence to our inquiry and all members of the Department of Health advisory group. We support the strategy, but the clear message that we heard was that implementation needs to be strengthened. Will the Secretary of State meet me to discuss our report’s recommendations, and will he join me in thanking members of the Samaritans and other voluntary groups around the country who will be working tirelessly over Christmas, as they do every day, to support those in crisis?
Mr Jeremy Hunt
My hon. Friend speaks wisely. Christmas can be a very lonely time for a number of people, so we all commend the work of voluntary organisations that do so well. I would be delighted to meet her.
Fiona Mactaggart (Slough) (Lab)
More than a third of my male constituents live until they are over 80, and yet next door in Windsor and Maidenhead the same is true of well over half of the residents. In the 10 years before 2010, that gap narrowed. What is the Secretary of State doing to narrow the gap in future?
Mr Hunt
The best thing we can do to narrow the gap is make sure that we continue to invest properly in the NHS and social care system, and make good progress on public health, which often has the biggest effect on health inequalities. That is why it is good news that we have record low smoking rates.
Dr Andrew Murrison (South West Wiltshire) (Con)
With acute hospital bed blocking at a record high, do Ministers agree that it is a great pity that so very few of the 40 sustainability and transformation plans now in the public domain deal directly with step-down care and, in particular, with community hospitals?
Kerry McCarthy (Bristol East) (Lab)
Recent figures from the Royal College of Psychiatrists show that children and adolescent mental health services are still underfunded in many parts of the country—particularly worrying for me is the fact that Bristol seems to be the 13th lowest in the country. What are Ministers doing to ensure that children across England and the rest of the UK get the health services that they need?
Mr Jeremy Hunt
The hon. Lady is right to highlight this issue and I agree with her. I am not happy with the service that we provide through CAMHS at the moment. It is a big area of focus for the Government. We are putting a lot of investment in, but there is lots more to be done.
Mrs Maria Miller (Basingstoke) (Con)
My constituency has been waiting some time for the go-ahead for a new critical treatment hospital providing 24/7 care for the sickest patients, which is very much in line with Government policy. The hospital’s chief executive, Mary Edwards, retires this month after 21 years of exceptional service. Will the Secretary of State give her a retirement present and help me to secure a decision from NHS England?
Norman Lamb (North Norfolk) (LD)
The Secretary of State will be aware of the horrifying case of Fiona Hollings, a 19-year-old with anorexia who for the past four months has been nearly 400 miles away from home, in a bed in Glasgow. Her family have travelled 8,000 miles in that time to see her. The Government commit to ending this horrific practice by 2020, but do families really have to put up with it until then? How would he feel if it was his child?
Mr Jeremy Hunt
We are taking action and I agree with the right hon. Gentleman that what has happened in that case is completely unacceptable. We are currently commissioning a record number of in-patient mental health beds, and it is a very big priority for us to eliminate the problem entirely by the end of the Parliament.
Mark Pawsey (Rugby) (Con)
My constituent Marie Bingham administers a drug at home using pre-filled syringes, but she is unable to dispose of the used needles, partly because they are in 2.5 litre sharps tubs rather than 1 litre sharps tubs. It is a ludicrous situation. Is the Minister aware of the problem, and are there any steps he can take to deal with it?
Mr Dennis Skinner (Bolsover) (Lab)
He is a mine of information, isn’t he? He would like to contribute, really.
Does the Secretary of State not think that it is a scandal to be shutting Bolsover hospital, with 16 valuable beds that will go for ever, at a time when people are lined up on trolleys in nearly every hospital in Britain? Why does the Secretary of State not give Bolsover a Christmas present and announce that Bolsover hospital will be saved? Come on!
Mr Jeremy Hunt
I add my congratulations to those of the Speaker on the hon. Gentleman’s long service, which has included campaigning for Bolsover hospital. I simply say to him that we will look very carefully at all proposals to change the services offered. I think community hospitals have an important role in the future of the NHS, but the services they provide will change as more people want to be treated at home.
CQC: NHS Deaths Review
Jeremy Hunt Excerpts(8 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I will make a statement. On 12 April, I asked the Care Quality Commission to conduct an investigation into lessons that needed to be learned following the tragic death of Connor Sparrowhawk in 2013 at Southern Health NHS Foundation Trust. I pay tribute to his family, and particularly to his mother, Sara Ryan, for persistently and determinedly campaigning for a proper investigation into what happened. The lesson of Mid Staffs, Morecambe Bay and indeed other injustices such as Hillsborough is that when families speak out, we must listen. In this case, thanks to Dr Ryan’s efforts, many improvements will be made to the care of people with learning disabilities and many lives will be saved.
I asked the CQC to look at what happened at Southern Health NHS Foundation Trust and to assess more broadly what lessons there are for the NHS as a whole. Its findings make sobering reading. Among other findings, the report says that families and carers often have a poor experience of mortality investigations; that they are sometimes not treated with kindness, respect and sensitivity; that they can feel that their involvement is tokenistic; and that they often question the independence of the reports.
The report also says that the NHS does not prioritise learning from deaths and misses countless opportunities to learn and improve as a result, and that there is no single framework that sets out how local NHS organisations should identify, analyse and learn from deaths of patients in their care or those who have recently been in their care. As a result, there is inconsistency. Some NHS trusts get elements of mortality reporting right, but not one gets all the elements right. In particular, the leaders of NHS organisations and their doctors, nurses and other staff simply do not have access to the full picture of how many patients die in their care, which deaths were preventable, and what needs to be learned.
I thank Professor Sir Mike Richards and his CQC colleagues for an extremely thoughtful and thorough report. I am accepting all their recommendations. From 31 March next year, the boards of all NHS trusts and foundation trusts will be required to collect a range of specified information on potentially avoidable deaths and serious incidents, and to consider what lessons need to be learned, on a regular basis. This will include estimates of how many deaths could have been prevented in their own organisation and an assessment of why this might vary positively or negatively from the national average, based on methodology adapted by the Royal College of Physicians from work done by Professor Nick Black and Dr Helen Hogan.
We will require trusts to publish that information quarterly, in accordance with regulations that I will lay before the House, so that patients and the public can see whether and where progress is being made. Alongside those data, trusts will publish evidence of learning and action that is happening as a consequence of that information. They will feed the information back to NHS Improvement at a national level so that the whole NHS can learn more rapidly from individual incidents.
All trusts will be asked to identify a board-level leader as patient safety director to take responsibility for this agenda and ensure that it is prioritised and resourced within their organisation. This person is likely to be the medical director. They will be asked to appoint a non-executive director to take oversight of progress.
We will ensure that investigations of any deaths that may be the result of problems in care are more thorough and that they genuinely involve families and carers. More broadly, instead of the patchwork approach that we currently have, all trusts will be asked to follow a standardised national framework for identifying potentially avoidable deaths, reviewing the care provided and learning from mistakes.
I have asked the NHS National Quality Board, which includes senior clinicians from all national NHS organisations, to draw up guidance on reviewing and learning from the care provided to people who die, in consultation with Keith Conradi, the new chief investigator of healthcare safety. These guidelines will be published before the end of March next year, for implementation by all trusts in the year starting next April. We will also be working with the National Quality Board to ensure that much more support is offered to bereaved families. As the report highlights issues around support to families, Health Education England will be asked to review the training for all doctors and nurses with respect to engaging with patients and families after a tragedy and, equally importantly, maintaining their own mental health and resilience in extremely challenging situations.
As the report identified particular concerns about the treatment of people with learning disabilities, we will take two further actions. In acute trusts we will ask for particular priority to be given to identifying patients with a mental health problem or a learning disability to make sure that their care responds to their particular needs, and that particular trouble is taken over any mortality investigations to ensure that wrong assumptions are not made about the inevitability of death. We will also ensure that the NHS reviews and learns from all deaths of people with learning disabilities, in all settings. The learning disabilities mortality review—LeDeR—programme will provide support to families and local NHS areas to enable reporting and an independent, standardised review of all learning disability deaths of people between the ages of four and 74.
We will ensure that there is coverage in all regions by the end of next year and full national roll-out by 2019. As the programme develops, all learnings will be transferred to the national avoidable mortality programme. I have today asked the LeDeR programme to provide annual reports to the Department of Health on its findings and how best to take forward the learnings across the NHS. From next year we will become the first country in the world to publish data on avoidable deaths at a hospital-by-hospital level.
I want to address the issue of how we ensure that data published about avoidable deaths are accurate, fair and meaningful, and that the process of publication rewards openness and honesty. Of course we will be working closely with the CQC, NHS Improvement and senior NHS doctors and nurses to get this right, but I want to make it clear to the House that I will not be setting any target for reducing reported avoidable deaths, and nor do I believe it will be valid to compare numbers between hospitals because the data depend on clinical views that may change or vary. I expect—this might surprise some in the House—to see an increase in the number of reported avoidable deaths. This is more likely to be because hospitals get better at spotting and reporting them than because care is deteriorating.
We should also remember that when there is a tragedy in the NHS, there is always a second victim—namely, the doctor or nurse involved, who invariably suffers huge anguish. So let us today also give credit to all NHS front-line staff for the changes that are already taking place to improve patient safety. For example, the number of people experiencing the four main hospital harms is down by a third since November 2012; MRSA and clostridium difficile rates have halved since 2010; and we have 10,000 more hospital nurses in our wards since the Francis report, and they are now at record numbers.
There is a new healthcare safety investigations branch to perform speedy, no-blame inquiries into avoidable harm and death, modelled on the successful system that has operated in the airline industry for many years. There is also a consultation concluding this week on legislation to create a safe space for NHS staff to talk openly about how to improve the safety of care for patients, without having to worry about litigation or professional consequences.
The culture of the NHS is changing following a number of tragedies, but this report shows that there is much progress to be made in the collection of information about unexpected deaths, analysis of what was preventable and learning from the results. Only by implementing the report’s recommendations in full will we honour the memory of Connor Sparrowhawk, and I commend the statement to the House.
Jonathan Ashworth (Leicester South) (Lab)
I thank the Secretary of State for advance sight of his statement, and I thank the CQC for its report.
Any death is a tragedy for families, but when that death could have been prevented, or was the fault of a system that is meant to care for our loved ones, the trauma is all the more difficult to cope with. The circumstances of Connor Sparrowhawk’s death were shocking, and I, like the Secretary of State, pay tribute to his family, who have fought so hard for justice and to ensure other families do not have to go through what they went through. Connor Sparrowhawk’s step-father, Richard, told Radio 5 live:
“When a loved one dies in care, knowing how and why they died is the very least a family should be able to expect”.
We agree.
The findings of the CQC are a wake-up call: relatives shut out of investigations; reasonable questions going unanswered; and grieving families made to feel like a “pain in the neck” or feeling they would be better dealt with at a “supermarket checkout”. This is totally unacceptable—it is shameful and it has to change. We therefore strongly welcome the recommendation of a national framework and the specific measures the Secretary of State has outlined today. I assure him we will work with him and the Care Quality Commission to support the establishment of such a framework in a timely fashion.
Families and patients should not be forgotten in this process. Will the Secretary of State pledge that families and carers will be equal partners in developing the Government’s plans for implementing the CQC’s recommendations? Does he agree that those who work in the NHS show extraordinary compassion, good will and professionalism? Does he accept that when something, sadly and tragically, goes wrong, it can often be the result of a number of interplaying systemic failures and that therefore a national framework will provide welcome standards and guidance across the service?
Does the Secretary of State recall that the National Patient Safety Agency was responsible for monitoring patient safety incidents in the NHS, including medication and prescribing errors, before it was scrapped under the Health and Social Care Act 2012? Will he perhaps acknowledge in retrospect that scrapping that agency was a mistake?
For such a national framework and the Secretary of State’s proposed measures to succeed, investment will be necessary. Will hospitals and trusts receive extra funding to carry out the additional requirements that the CQC has recommended? More generally, hospitals across England are suffering chronic staff shortages, which is leaving doctors and nurses overstretched and struggling to do basic tasks. We all recall that Sir Robert Francis called for safe nurse staffing levels to be published by the National Institute for Health and Care Excellence, but this guidance has been blocked. Will the Secretary of State now consider committing to NICE publishing safe nurse staffing levels, as recommended by the Francis report?
The Secretary of State is aware of the wider pressures on the service. Will he acknowledge that cuts to social care and the failure to provide it with extra investment in the autumn statement two weeks ago are leaving hospitals dangerously overstretched, with patients at risk of harm?
The Secretary of State will also be aware of the pressures on mental health provision. Over the weekend, we saw reports that bed shortages in England are now such that seriously ill patients with eating disorders are having to travel hundreds of miles for treatment. What does he make of this practice, and does he consider it safe and sustainable?
May I ask the Secretary of State about the heart-breaking case of the death of baby Elizabeth Dixon? I know that he has spoken of this in the past. He rightly ordered an investigation, but I understand from the family that 16 months down the line the investigation has not started. Will he provide the House with an update?
The CQC has called for the issues addressed in its report to be a national priority, and for all those involved in delivering safe care to review the findings and publish a full report. We absolutely agree. Action is needed. We welcome the recommendations and stand ready to work with the Government to ensure that these issues are no longer ignored.
Mr Hunt
I thank the shadow Health Secretary for the constructive nature of his comments. He is absolutely right in that, because this issue can unite people in all parts of the House. In fairness, these tragedies happen when those on either side of the House are responsible for the NHS, and we all have a responsibility to work to do better than we are doing at the moment.
I particularly agree with the hon. Gentleman that front-line doctors and nurses work incredibly hard, and we need to get away from a blame culture when these tragedies happen. That blame culture is the root cause of why we are not learning as we should from the problems that arise, because people are worried about what will happen to them personally if they speak out. We have seen this with a number of tragedies. Through the national framework, we are trying to move away from a blame culture. Of course people have to be held accountable. If there is gross negligence and people do totally irresponsible things, then there must be no hiding place and proper accountability: that is what families rightly insist on. For the vast majority of the time, however, people are just trying to do their jobs as best they can. As he rightly says, it is often a systemic problem that can be solved with systemic changes. We are now trying to implement the culture of investigation that has worked so successfully in the airline industry and other industries.
I absolutely assure the hon. Gentleman that families and carers will be equal partners as we develop the new national guidance. This area was one of the most shocking things about the CQC report. I am sure that it was a great surprise to many people in the NHS how excluded many families felt. We clearly have to do better in that respect.
The hon. Gentleman talked about the National Patient Safety Agency, and I pay credit to Sir Liam Donaldson, who was chief medical officer under the previous Labour Government and a great champion of patient safety, but we now have different structures in place. The new CQC inspection regime and the healthcare safety investigation branch are giving equal, if not greater, priority to patient safety.
We discuss on many occasions the funding issues that the hon. Gentleman raised, as I think he is acknowledging with his facial expressions. The point I would make, because we have had a good exchange and I do not want to get into the specific politics of NHS funding, is that this is a win-win, because avoidable harm and death is incredibly expensive for the NHS. The time it takes to carry out investigations when things go wrong is utterly exhausting for the doctors, nurses and managers involved, who would much rather be doing front-line care. Preventing these things from happening in future is the best possible way of freeing up time for people on the frontline.
I will take away what the hon. Gentleman said about the Elizabeth Dixon case and find out what is happening with that review.
The real lesson of today is that every family, every doctor and every nurse has a simple aim when a tragedy happens. It is not about money; it is about making sure that lessons are learned openly and transparently so that history does not repeat itself. That is really what this is about, and that is why we will continue our mission to make NHS care the safest and highest quality in the world.
Andrea Jenkyns (Morley and Outwood) (Con)
The Secretary of State has answered my point, but I would like to say, as chair of the all-party parliamentary group on patient safety, that the publication of avoidable death figures is really welcome news. I support what he said about creating a just culture where clinicians and other staff feel safe. That is important so that they can speak up about failure, and vital in delivering the high-quality but, most importantly, safer and better-value services the NHS aspires to.
Mr Hunt
I thank my hon. Friend, who does a huge amount of work on patient safety, not least because of sadness in her own family’s experiences that gives her particular passion in this respect. This is absolutely about creating a just culture. Inspiring people like James Titcombe, who lost his own son at Morecambe Bay, talk far more eloquently than I can about the need to get this right. Part of that just culture is about justice for people who use the NHS in future, to whom we have a responsibility to learn the lessons and make sure that mistakes are not repeated. One of the really important things we need to get right is to make sure that when something goes wrong in one place, there is a national way in which the lessons can be conveyed right across the NHS as quickly as possible.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I welcome this statement and remember the discussion of this tragic case. Obviously the majority of people who go into hospital and die in hospital will be people who are simply too ill for us to save, but we must not be nihilistic in imagining that that applies to everybody. The particular failure here was that people with learning difficulties or mental health needs were somehow just set aside and not looked at.
I welcome the idea of a safety board; there will be lots of things that can be learned and shared in that. I slightly pick up the Secretary of State on what he said about the Scottish patient safety programme, which is a national programme that has been running since the beginning of 2008. Part of that was about breaking down all the barriers, very much like in the airline business—being on first-name terms and making it everybody’s business so that even the cleaner in the theatre feels they can point out that they think a mistake is going to be made, but then when something happens having these adverse case reviews. In my hospital, we also reviewed near misses, and I commend that. It means that there is a review when what might have happened would have been serious. Certainly in the cases that I have been involved in, the family have been involved repeatedly. That is really important.
I also welcome the idea of a safe place for whistleblowers. People who have raised issues in the past and have been appallingly treated by the NHS still stand there as a terrible example to those who currently work in the NHS, so there needs to be some ability to go back to these old cases and provide justice for people who have ended up losing their careers by trying to raise patient safety issues.
Mr Hunt
I thank the hon. Lady for her contribution. I recognise the progress made in the Scottish patient programme, and particularly the inspirational leadership of Jason Leitch, who has done a fantastic job in Scotland and some very pioneering work.
The hon. Lady made some good points that I will take in reverse order. On whistleblowers, I asked Sir Robert Francis to look at this in his second report. He concluded that it would be very difficult, if not impossible, to go back over historical cases, because the courts have pronounced and it is very difficult to create a fair process where legal judgments have already been made. However, I take on board what she says, and I do not think that that means that we cannot learn from what has happened in previous cases; they are very powerful voices.
The hon. Lady is absolutely right about near misses, and we will include that issue in the “learning from mistakes” ambition.
The hon. Lady is most right of all about people with learning disabilities. The heart of the problem is deciding when a death was expected and when it was unexpected. About half of us die in hospitals. As she rightly says, the vast majority of those deaths are expected, but when a person has a learning difficulty it is very easy for a wrong assumption to be made that they would have died anyway. That is a prejudice that we have to tackle, and one that Connor Sparrowhawk’s mother talks about extremely powerfully. We have to make sure that this is not just about lessons for the whole NHS, but particularly about ensuring that we do better for people who have learning disabilities.
Mr Mark Harper (Forest of Dean) (Con)
As chair of the all-party parliamentary group on learning disability, for me the most chilling phrase in the foreword of the report was when Mike Richards and his team said:
“We found that the level of acceptance and sense of inevitability when people with a learning disability or mental illness die early is too common.”
Will the Secretary of State put on the record what Mike Richards says in the report, namely that there can be no tolerance of treating the deaths of people with learning disabilities with any less importance than the deaths of any other patient in the national health service?
Mr Hunt
I am happy to put on the record the fact that those words have the Government’s wholehearted support. I credit my right hon. Friend for his work leading the APPG. I commissioned the CQC report because a year ago we had a report by Mazars on what happened at Southern Health, which said that only 19% of unexpected deaths were investigated and that that fell to 1% for people with learning disabilities. That cannot be acceptable, and it is why it is so important that we act on today’s report.
Toby Perkins (Chesterfield) (Lab)
I seek the indulgence of the House while I raise a personal issue. This Thursday I should have been attending the inquest into my father’s death, which I anticipate will conclude that his death was avoidable. An hour ago I was notified that one of the key witnesses will not be attending because the hospital had incorrect contact details for him—he was a locum, and was unaware that the inquest was taking place. For the second time, therefore, it is being cancelled. Will the Secretary of State tell us whether the report looked into the issue of locum doctors—the pressure, and the failure to learn lessons because so many people in the health service, and in A&E in particular, come to the specific hospital on a one-off occasion, which is partly the cause of the defensiveness in the system?
Mr Hunt
First, I am sure the whole House will join me in offering my condolences to the hon. Gentleman for what happened to his father. The incredible grief that he and others feel when they lose a family member is compounded if it is subsequently discovered that the death was avoidable.
The hon. Gentleman raises a very important point. The CQC was not specifically looking at the issue of locums in this report, but in many other reports, on many occasions, it has talked about the dangers of locum and agency staff for precisely the reason he mentions. It is partly because people are not necessarily around at the time of an investigation, as they have moved on and work somewhere else, but it is also partly because, as I am sure we all believe, staff can give better care if they are in a team of people who know and trust each other. That is not possible if the majority of staff are employed on a temporary basis. He makes a very important point.
Antoinette Sandbach (Eddisbury) (Con)
It is clear that half of medical negligence claims are in the field of maternity. Does the Secretary of State agree that the fear of legal action often prevents people from speaking out? How will the safe space be created that does not allow lawyers to intervene—very often lawyers slow up the process? An early admission of fault and a willingness to express the fact that lessons have been learned would provide so much comfort for families.
Mr Hunt
My hon. Friend has spoken very eloquently about that issue many times in this House. If a baby is born with a serious brain injury there will typically be a court case that lasts 11 years, and a settlement of around £6 million. That family are having to cope with the shock of having a disabled child—some families say that that is a kind of mourning process because the baby is not the one they were expecting, although they then go on to give the most extraordinary love to that child—and we compound it by making them go through a legal process that lasts more than a decade. It is absolutely shocking and despicable if that happens. We need to find a way to get those families the financial support that they need earlier, and make sure that we learn the lessons more quickly. That is absolutely what this agenda is all about.
Norman Lamb (North Norfolk) (LD)
I also pay tribute to Sara Ryan, the mother of Connor Sparrowhawk, who has fought tirelessly for justice for those with learning disabilities. I warn the Secretary of State that I think she will take some convincing that things really will change, given all the resistance she has come up against. I hope he has managed to meet her; if not, would he be willing to meet her, with me, to discuss the plans going forward?
One key issue not covered in the report or statement is the timeliness of investigations. A report nine months or a year after the incident is often no good at all: the organisation has moved on, and people have forgotten what has happened. I commend Mersey Care, which does a very quick, thorough investigation within 48 hours, when the information is really current and people are still shocked by what has happened. That is how Mersey Care seeks to implement the lessons from every tragedy.
Mr Hunt
I want to put on the record that the right hon. Gentleman was a big champion for people with learning disabilities when he was in my ministerial team, in particular over issues such as Winterbourne View, which he brought to my attention and did a huge amount of positive work on.
I have met Sara Ryan. I spoke to her again yesterday. I repeat what I said in my statement: that without her campaigning we would not now be making the huge changes on a national level that we are. I wholeheartedly agree with the right hon. Gentleman’s other comments.
Andrew Selous (South West Bedfordshire) (Con)
The review found that acute and community trusts do not always record whether a patient has a mental health illness or learning disability. What steps will we take—such as, for example, the expansion of liaison psychiatry services—to make sure there is proper join-up and real parity of esteem?
Mr Hunt
My hon. Friend makes a very good point. We are making sure that all A&Es have liaison psychiatry services by the end of this Parliament. The critical issue is that someone with a severe mental health problem or learning disability who turns up in an A&E has special needs, and has bigger needs than the other patients there, but unless that is recognised early in the process, they are unlikely to get the care they need. If a tragedy then happens and they go on to die—as sadly happens sometimes—but the illness or disability is not known about, people do not realise that there are other potential issues. That is why the report is very clear that all acute trusts are required to know when patients have learning disabilities or mental health problems and to pay particular attention in any mortality investigations that happen regarding those patients.
Graham Stringer (Blackley and Broughton) (Lab)
The CQC has produced a grim report, and there was an even grimmer internal report on maternity services operated by Pennine Acute NHS Trust. Mothers and babies have died. I have put in parliamentary questions to the right hon. Gentleman and talked to the chief executive to try to find out which of those deaths were avoidable. I welcome today’s statement, but is it possible to be retrospective, so that the families of those people who have died in the Pennine maternity service can find out whether those deaths were preventable?
Mr Hunt
When the new guidelines are published, we need to investigate, as far as we possibly can, deaths that have already happened. I totally recognise the hon. Gentleman’s picture of Pennine and share his real worry about the standard of care in that trust. The positive thing is that under the leadership of Sir David Dalton—the chief executive of Salford Royal, which is one of the safest trusts in the NHS and a CQC outstanding trust—things are beginning to turn around. I have spoken to him about the situation at Pennine on many occasions. The hon. Gentleman is right to say that there is a lot of work to do there.
Craig Whittaker (Calder Valley) (Con)
Many people will be shocked to hear that some trusts do not even know how many in-patients have died in their care. Will my right hon. Friend say more about what action should be taken against boards and leaders who are negligent in that way?
Mr Hunt
My hon. Friend is absolutely right. Boards now have a legal duty of candour, and are obliged to tell patients the truth about what has happened when something goes wrong, but how can they possibly do so if they do not properly record deaths or avoidable deaths? That is why this is a very significant moment. From next year, on a quarterly basis, all trusts will be publishing how many avoidable deaths there are in the trust. Those figures will be compared with national benchmarks. That is how we will start to make boards feel that they have a critical responsibility on this.
Fiona Mactaggart (Slough) (Lab)
I welcome the learning disability mortality review that the Secretary of State has announced, but I am keen to ensure that it includes unexpected deaths in care settings other than the NHS. When I was first elected, Longcroft, which purported to be a care home for people with learning disabilities, was actually a torture chamber for people with learning disabilities. We have ended that kind of thing, but we need to ensure that unexplained deaths of people with learning disabilities in other care settings are fully investigated, and that those investigations feed into this review.
Mr Hunt
The right hon. Lady is absolutely right. I will take away with me the question of what the legal responsibilities will be for people in adult social care settings. One thing the report highlights, which I had not particularly anticipated, was the problem that a number of people with learning disabilities are cared for in multiple settings, so if there is a tragedy, the place where the tragedy happens may not be the place responsible for what went wrong. Often, the person’s previous care provider never even finds out that that person has died. One thing that Sir Mike Richards talks about is making sure that all care providers are informed promptly when something happens, so that there can be a multi-institution examination of what went wrong.
Bob Blackman (Harrow East) (Con)
I welcome my right hon. Friend’s statement and the measures that he has announced. I have been supporting the family of a constituent who died unexpectedly in hospital, and they have suffered at every step along the way. There has been a wall of silence, the trust has refused to co-operate and the CQC has refused to investigate. Every step along the way, the family have been frustrated. That has been made even more important by the fact that the son of the deceased is a doctor in the NHS, and he knows that processes have been badly handled. All he wants is for the NHS to learn from its mistakes. Will my right hon. Friend undertake to say what he will do about the number of unexplained deaths that have occurred in the NHS over the past few years, and whether any of those cases can be examined by an appropriate authority?
Mr Hunt
I am happy to look personally at the case that my hon. Friend talks about. I think he speaks for all patients and families who have suffered tragedies when he says that the only thing people want is for lessons to be learned. A more challenging issue is that staff sometimes do not feel empowered to speak out in such situations, and they worry about the consequences. A number of trusts have an outstanding learning culture that is really supportive of staff, but that is not the case everywhere. One of the big lessons from today is that we must work out how to spread that positive culture across the NHS.
Diana Johnson (Kingston upon Hull North) (Lab)
On 10 December last year, I asked:
“Is the Secretary of State satisfied that families seeking truth and justice for their loved ones are having to rely on pro bono lawyers for advice and representation, and on crowdsourcing to get legal advice?”
He said:
“It should never come down to lawyers.”—[Official Report, 10 December 2015; Vol. 603, c. 1147.]
Sadly, we all know that, on occasion, it will come down to lawyers getting involved. Will any of the recommendations from the CQC cover such eventualities?
Mr Hunt
It is a difficult one, because access to lawyers is a matter for the Ministry of Justice. I am not trying to duck the issue, but my responsibility, in what we are trying to do today, is to try to make sure that families do not feel as though they need to go to lawyers, because the NHS is open and transparent enough. With the values of people in the NHS, I think that ought to be achievable. I am happy to look at the case that she raises, and to bring it up with my colleague the Lord Chancellor.
Mr Philip Hollobone (Kettering) (Con)
Will the Secretary of State tell the House more about the healthcare safety investigation branch? How big will it be, who will head it up, where will it be based and how will it use its forensic detective work locally to get to the nitty gritty of the things that cause problems for hospitals?
Mr Hunt
I am happy to do that. The best way to understand what we are trying to achieve—this relates to what the right hon. Member for North Norfolk (Norman Lamb) said earlier about the speed of investigation—is to think about the tragedy of the recent Croydon tram crash. Within one week of the accident, the rail accident investigation branch produced and published a full investigation into exactly what happened, which made it possible to transmit that learning around the whole tram industry. That is what we are looking for. We have modelled the healthcare safety investigation branch on what happens in the transport industry. It has already been set up, and we are lucky that the person heading it up is Keith Conradi, who headed up the air accident investigation branch and knows exactly how these things should happen.
Lilian Greenwood (Nottingham South) (Lab)
The CQC clearly identifies the need for a change in culture, and the Secretary of State acknowledged that a number of times in his remarks today. The NHS has to be less defensive, and it needs to be more honest and open with families if there is to be a genuine commitment to reflect, learn and make sure that things are different in future. What does he think are the barriers to ensuring that that culture change takes place, and what steps does he intend to take to overcome those barriers?
Mr Hunt
There are a number of barriers, one of which is time. Staff feel very pressured for time. I strongly argue that it is a false economy not to allow time for lessons to be learned, because tragedies, when they happen, take up a huge amount of time. From a management and leadership point of view, we have to make sure that doctors and nurses are given the time for reflective learning as part of what they do.
Another thing is the management culture. If people feel that the management of their trust are open and listening, they are more likely to be open and listening themselves. If they feel that there is a hire-and-fire culture, they are less likely to take that approach. There are a number of lessons.
Kevin Foster (Torbay) (Con)
Given the case of three-year-old Sam Morrish, who died at Torbay hospital in 2010, and the conclusions of the Parliamentary and Health Service Ombudsman that many investigations into avoidable deaths were not fit for purpose, I welcome the statement. I also welcome the spirit of openness that will follow in relation to these extremely difficult issues. We are, ultimately, all mortal. Although I think it is absolutely right that we will not be setting targets, will the Secretary of State reassure me about the ongoing monitoring we will undertake and the proactive work we will do with trusts to reduce the number of such incidents?
Mr Hunt
As my hon. Friend knows, I have met the parents of Sam Morrish—Scott and Sue Morrish—on a number of occasions. They described how when their son died, all the shutters came down. I met them only a few months after I became Health Secretary, and that engraved itself on my memory because it was so awful to hear about what they were doing.
My hon. Friend raises a rather sensitive issue, which I tried to talk about in my statement. I expect, as a result of the changes, the number of reported avoidable deaths to increase. If that happens, I do not think that it will necessarily mean that patient care is suffering. We have to be very careful, in this House and with our local newspapers, to say that if trusts start to report an increased number of avoidable deaths, it might mean that they have a more transparent culture and are being more open. Their standards about what is expected and what is unexpected may start to change as they realise that things could have been done to prevent a death that they might previously have described as expected. We have a duty, as Members, to encourage responsible reporting of this new openness, and that, in turn, will help staff.
Tracy Brabin (Batley and Spen) (Lab)
I want to pick up on a point made by my hon. Friend the Member for Chesterfield (Toby Perkins). A constituent of mine who is an agency nurse told me that she had been left in charge of 24 fragile patients, some of whom had the norovirus, on a ward that she did not know very well, with only two healthcare professionals working with her. Given that, will the Secretary of State now commit to the National Institute for Health and Care Excellence publishing safe nursing staffing levels, as recommended by the Francis report?
Mr Hunt
NICE has published its staffing levels for wards. I recognise the problem, and it is exactly what we were dealing with in the Francis report. We now have 10,000 more full-time nurses on our hospital wards than we had three years ago. We are making significant progress, but there is still huge pressure on hospital wards. We have developed a new methodology that more accurately makes sure that patients get the care that they need, whether it is from a nurse, a healthcare assistant or whoever else in the hospital. I am happy to write to the hon. Lady and tell her what that guidance is.
Mr Alan Mak (Havant) (Con)
I thank the Secretary of State for his statement. The families of those who died in the care of Southern Health in Hampshire have played a vital role in campaigning for transparency and improvements, and they include the family of David Hinks from Havant. Will the Secretary of State join me in commending the families for their work in the most distressing of circumstances?
Mr Hunt
I absolutely do so. I know that the family of David Hinks have campaigned very strongly on this matter. The key point about families is that they are often the people who know best what happened to individuals when something went wrong, because they saw the care at every single stage. Whether the care took place in a care home, hospital or a GP surgery, families are likely to have seen the whole thing, and can really help us to understand what might have gone wrong. They are therefore a positive force in this process.
John Woodcock (Barrow and Furness) (Lab/Co-op)
I am so pleased that the Secretary of State took the time to praise James Titcombe and other campaigners in my constituency who have done so much to help to break down the culture of secrecy and cover-up that has afflicted too many of our trusts. The right hon. Gentleman deserves real credit for his determination, and I hope that the tone he has struck today will last and that we do not go back to the accusatory and vindictive tone that, I am afraid, too often marred discussions about this during the last Parliament. Finally—thank you for your indulgence, Mr Speaker—will the Secretary of State say more about the tension between the families’ desire for individual accountability and the need to encourage a culture of openness in which people can come forward?
Mr Hunt
In fairness to the hon. Gentleman, he makes two important points. I know that he worked very closely with James Titcombe, who is one of his constituents.
We are now learning the right way to deal with the tension between accountability and having a learning culture. Essentially, this boils down to an understanding that 98% of the time a mistake is made because of a systems problem—a structure or a framework that did not enable a doctor or a nurse to operate to the best of their ability—while 2%, 1% or perhaps even less of the time it is a case of genuine negligence by an individual that deserves full accountability. When we understand it in that way, we start to realise that the first thing to ask is what could be changed in the system, but if we uncover bad behaviour by individuals—there are 1.3 million people in the NHS, so it is obviously going to happen at some stage—then there of course needs to be full accountability.
On the tone of these exchanges, let me say something optimistic: I really do believe that the NHS can become the safest, highest-quality healthcare system in the world. That would be welcomed by the Labour party, as the party that was in power when the NHS was set up, and we would welcome it as part of our absolute commitment to higher standards in public services. There is no country in the world that is even considering what we have announced today, which is to ask hospitals to publish the number of their avoidable deaths on a quarterly basis. It is a very big step that can happen in a system built around public service.
Tom Pursglove (Corby) (Con)
Kevin, the son of my constituent Desmond Watts, suffered from very significant learning difficulties and was neglected in a care home in the county, which led to his tragic death. This was completely avoidable. Des has never seen justice for Kevin, but I know that he would want my right hon. Friend to consider whether it is possible to apply to social care some of the principles that he has set out today. I join the right hon. Member for Slough (Fiona Mactaggart) in encouraging him to do that.
Mr Hunt
My hon. Friend makes a really important point. I will have discussions with the Minister responsible for social care, the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), about what we can do in the social care field. I am optimistic that we can do something, because if we make this part of the framework of the new CQC inspection regime—obviously, that has to happen with the consent of the CQC—we can create a very strong incentive for adult social care providers to do what we want and to follow what is happening in the NHS.
Liz McInnes (Heywood and Middleton) (Lab)
I, too, want to raise the issue of the appalling neglect in medical care at Pennine Acute. The report—the extremely damning report—only came to light following the persistence of Jennifer Williams, a journalist on the Manchester Evening News, and the bravery of a whistleblower at the trust. I know that the Secretary of State will do what he can to protect whistleblowers, but how will he enforce a no-blame culture and a culture of openness in a trust such as Pennine Acute that appears to have tried actively to suppress this extremely damning report?
Mr Hunt
There should be no hiding place for managers who neglect their legal responsibility, which is the duty of candour that we in this place passed into law in 2014. That is my first point. It is also important to be realistic about the ability to impose a culture on organisations by ministerial diktat, but we can achieve that because this is something that NHS staff want. In some ways, what is most worrying about Pennine is that Salford Royal, one of the best hospitals in the NHS, is virtually next door to it, but the transmission of learning at Salford Royal did not seem to penetrate even into a neighbouring hospital. That is why we must get much better at sharing learning between hospitals.
Mark Pawsey (Rugby) (Con)
Will the Secretary of State say more about how the additional and extra information he has mentioned, which will be so important for patient groups in judging rates of progress, will be made available?
Mr Hunt
I am happy to do so. We will lay down in regulations in the House that the information must be published for all trusts on a quarterly basis. I draw my hon. Friend’s attention to what I said in the statement, which is that it is not legitimate to compare the numbers in different trusts, because trusts will have different levels of reporting. In fact, our better trusts may actually have higher levels of reported avoidable deaths because they are better at picking up these things.
Derek Twigg (Halton) (Lab)
One of the recommendations says:
“Greater clarity is needed to support agencies working together to investigate deaths and to identify improvements needed across services and commissioning.”
How is that going to happen?
Mr Hunt
This is a very complex issue, but it is a very important one, particularly for people with learning disabilities who are users of the services of multiple organisations. The National Quality Board will put together guidance before the end of March, so that we can roll this out across the whole NHS during next year.
Jim Shannon (Strangford) (DUP)
I welcome the Secretary of State’s statement, and indeed his commitment to retraining and his recognition of its importance. Does he acknowledge the finding that the families, whom we must remember will be grieving, are not always treated with kindness, respect and sensitivity, which is unacceptable? Does he agree that those handling review cases involving deaths must have compassion and the ability to empathise with families, and that those must be among the qualifications of that job?