Mental Health
Jeremy Hunt Excerpts(9 years, 6 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(9 years, 7 months 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(9 years, 7 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 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?
National Health Service Funding
Jeremy Hunt Excerpts(9 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Jonathan Ashworth
In a few moments.
We have spotted the Secretary of State’s conjuring act because we have seen this Tory trick before—robbing Peter to pay Paul. The result of this trick is cuts and underfunding, more pressures flowing through to the frontline, and, as the NAO said,
“Financial stress…harming patient care”.
In all our constituencies we see ever-lengthening queues of the elderly and the sick waiting for treatment. Across the board, we see the worst performance data since records began.
Jonathan Ashworth
What world is the Secretary of State living in? Half a million patients have waited for four hours or more in A&E in the past three months—the worst performance for this time of year for more than a decade—and he says it is nonsense. Some 350,000 of our constituents are waiting longer than the promised time for elective treatment—some have been waiting more than a year—and he says it is nonsense. Delayed discharges from hospitals are at record levels, and he says it is nonsense. The number of people waiting for 12 hours or more on trolleys has increased by over 700% since 2011-12.
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move an amendment, to leave out from “House” to the end of the Question and add
“welcomes the Government’s investment, on the back of a strong economy, of significant additional funding and resources each year for the NHS during the 2015 Parliament; notes that this settlement was frontloaded at the specific request of the NHS in NHS England’s own plan to deliver an improved and more sustainable service, the Five Year Forward View; and further notes that the NHS will receive a real terms increase in funding in each year of the Spending Review period, while the Labour Party’s Manifesto at the last election committed to only an extra £2.5 billion a year by 2020, far less than the NHS requested.”.
As I did in last week’s debate on social care, I start by recognising the fantastic work done by NHS staff up and down the country. This autumn, I met a mental health nurse who told me how she had had to cope with the pressure of one of her patients throwing himself off a bridge the day after a consultation. I am sure that all Members have stories of the incredible dedication of NHS staff—not just people doing their jobs, but people putting their heart and soul into their work, staying late, going the extra mile, and sacrificing home time and holidays to be there for patients. As I did last week, I also recognise the 50,000 NHS staff from EU countries, including 26,000 low-paid staff, who do a brilliant job. Today we have heard concerns about funding, A&E—
Paul Farrelly (Newcastle-under-Lyme) (Lab)
Will the Secretary of State give way?
Mr Hunt
I will give way in a moment, but I just want to finish this sentence, if I may.
We have heard concerns about funding, A&E performance, waiting times and morale, and I want to answer them all. There are many pressures in the NHS, but I also want to recognise some successes, because one of the things that is most damaging to morale is not giving credit where it is due.
Paul Farrelly
Can the Secretary of State explain why he has made scores of redundancies in north Staffordshire? In my 15 years as an MP, I have never seen the local NHS in such a meltdown, with a scorched-earth policy of cuts and closures, and more to come with next year’s still-secret STP. When will the Government realise that pressures on social care and the NHS are such that those services are unsustainable without decent further funding and investment?
Mr Hunt
As the hon. Gentleman knows, those things would certainly be unsustainable if we had followed the Labour party’s investment plans at the time of the previous general election. If he wants to know what is happening to staff, let me tell him that in the period I have been Health Secretary, we have got 5,000 more doctors and 10,000 more nurses. That is what happens when we have a Government who are prepared to invest in the NHS.
The shadow Health Secretary talked about A&E—he is right to say that we are not hitting the target, and we are doing something about that—but he did not tell the House that, since Labour left office, we have recruited 1,200 more doctors for A&E departments, which is a 25% increase, including a more than 50% increase for consultants. Every day, we are seeing 2,500 more people within four hours.
Dr Rosena Allin-Khan (Tooting) (Lab)
Will the right hon. Gentleman give way?
Dr Allin-Khan
I am a junior doctor in A&E, of which the right hon. Gentleman speaks, and I can say that morale is at an absolute all-time low. We have a recruitment and retention crisis in A&E. We are losing all the fantastic staff whom we have been able to recruit because this Government are not recognising and accepting the fantastic workforce on our A&E frontline. All the doctors are leaving.
Mr Hunt
With respect, the hon. Lady might be on the wrong side of the House, because I started my speech by recognising the brilliant work done by doctors and nurses, something that the shadow Health Secretary conspicuously failed to do. Let us look at her own hospital: since 2010, St George’s has—[Interruption.] I do not know whether she is interested in hearing my response to her intervention. Since 2010, her hospital has had 884 more nurses and 240 more doctors, and her CCG had a £10 million funding increase this year.
Dr Allin-Khan
I thank the right hon. Gentleman for allowing me to speak again. I shall refer at length to St George’s hospital in my speech, but it is very unfair of him to bring it into this debate. It is because of this Government that St George’s hospital is operating at a £50 million deficit. It is because of this Government that we are now in special measures. It is—
Madam Deputy Speaker (Natascha Engel)
Order. The hon. Lady is hoping to catch the eye of the Chair later in the debate. As it is, there will be a five or four-minute time limit, so Members who intervene must do so very briefly and not very frequently. If they do not do so, I am afraid that they may not be called to speak.
Mr Hunt
The shadow Health Secretary also did not talk about cancer. In 2010, we had the lowest cancer survival rates in western Europe. Since then, we have referred for cancer tests 2,200 more people every day, and 100 more people are starting cancer treatment every day. The cancer charities say that this is saving 12,000 lives a year. On mental health, he did not mention the fact that we are treating 1,400 more people every day, with record dementia diagnosis rates.
Mr Jackson
Would not Opposition Members be a little more straightforward and honest about the wider context if they admitted the demographic challenge that this Government face, as they would have faced? The number of over-60s will increase by 50% in the next 15 years. Should they not also admit that the private finance initiative was an appalling millstone—£64 billion —to bequeath to this Government? That has had an impact on frontline care.
Mr Hunt
My hon. Friend is absolutely right to raise that point. People will be astonished to hear Labour Members wasting their time talking about a privatisation of the NHS that is not happening when they were responsible for PFI, the worst possible privatisation that has done such enormous damage.
Another point that the shadow Health Secretary did not mention was the quality and safety of care in our NHS that Labour left behind. The Francis report revealed massive problems—short staffing, a culture of denial and cover-ups—and they were not just at Mid Staffs but, as we now know, at Basildon, Morecambe Bay and many other trusts. Since we have been in office we have changed that. We have put 31 hospitals into special measures, which is more than 10% of hospitals across the entire NHS, and we have recruited record numbers of doctors and nurses.
I want to tell the House about one hospital that was put into special measures. Care was unsafe at Wexham Park in Slough—so much so that fewer than half the hospital staff were prepared to recommend the care provided there to their own friends and family—but it has gone from having six of its eight clinical areas rated as requiring improvement or inadequate, to having all eight of them rated as good or outstanding. It has come out of special measures, as have 15 hospitals in total, and we should all commend the staff who have worked incredibly hard to turn around those hospitals.
Jenny Chapman (Darlington) (Lab)
The right hon. Gentleman has the nerve to talk about the inheritance from a previous Administration, when what we inherited in 1997 was people dying on waiting lists of more than 18 months for heart operations.
Mr Hunt
I have often from this Dispatch Box been prepared to praise some of the achievements of the last Labour Government. They did bring down waiting times, but they did not focus on the quality and safety of care.
What we now know from the CQC’s new regime, which has just finished its first round of inspections, is that 56% of our hospitals are good or outstanding. One could say that it is disappointing to know that 44% of hospitals are not, but to those who would use that as a political weapon I say this: we are the only country in the world brave enough to set up an independent inspection regime, and if we want to have the safest, highest quality care, the first thing we need to know is where it is good and where we need to improve it. I thank the chief inspector of hospitals, Professor Sir Mike Richards, for his outstanding work in raising quality.
Joan Ryan
The right hon. Gentleman talks about the inspection regime, but I think I am right in saying that it was not something he and his Government introduced. The Care Quality Commission was introduced by a Labour Government, as far as I am aware. As I know from North Middlesex hospital, hospitals end up in special measures because they are underfunded and under-supported, and cannot get the doctors they need.
Mr Hunt
The right hon. Lady is right that the Care Quality Commission was set up by the last Labour Government, but it did not have independence from the Government in its inspection reports. When we legislated for that, Labour tried to vote it down. We got it through and changed the inspection system, and it is working extremely well.
I want to move on to the substance of the debate, which is about the funding of the NHS. I congratulate the hon. Member for Leicester South (Jonathan Ashworth) on his courage—indeed, his chutzpah—in confronting the issue of funding, despite inheriting a Labour policy to cut NHS funding by £5.5 billion a year by the end of the Parliament. He is right that there has never been greater financial pressure—we have had the financial crisis in 2008, the deficits and the growth in demand from the ageing population—but he must accept that that makes it all the more extraordinary that Labour wanted to cut the NHS budget in 2010 and to cut it from the current levels in 2015. I simply say that we could, as a Government, have chosen to cut NHS funding from this year’s level by £1.3 billion, as under Labour’s plans, but we would have had to lay off 11,000 doctors or 40,000 nurses.
Andy Burnham (Leigh) (Lab)
The problem with the Conservatives’ script is that they talk about NHS funding, but they completely neglect social care. There can be no debate about the fact they have cut social care every year for the last six years, taking support away from half a million older people, many of whom are now trapped in hospital beds. Greater Manchester says that it has a shortfall of about £80 million in social care; the figure is £1 billion nationally. Has the Secretary of State raised this issue with the Chancellor? Has he made an emergency bid for funding? Will there be more money for social care this year?
Mr Hunt
That is not the problem with our script; it is the problem with the right hon. Gentleman’s script, because as shadow Health Secretary he sanctioned a policy that would have given the NHS £1.3 billion less this year, and at the last election the then shadow Chancellor said he would give not a penny more to local authorities, whereas we are seeing social care funding go up by £600 million this year. More money is going into the NHS and the social care system under a Government who are committed to funding them both.
What is especially wrong with the argument made by the shadow Health Secretary, whom I welcome to his place for his first Opposition day debate, is his suggestion that the Government have not honoured their promises to the NHS. What did the independent commentators say at the time of last year’s spending review? Simon Stevens, whom he quoted, said
“our case for the NHS has been heard and actively supported.”
NHS Providers, which he quoted, said it was
“a good settlement for the NHS.”
The King’s Fund, which he quoted, said it was
“a good settlement for the NHS”.
In fact, because of the Government’s commitment to the NHS, we are spending 10% more on it as a proportion of GDP than the OECD average—that is more than Norway, Finland, Korea, Australia and New Zealand.
Sir Simon Burns
Does my right hon. Friend agree that without that investment since 2009-10 to last year there would not have been the 1.6 million more operations within the NHS that benefit all our constituents?
Mr Hunt
My right hon. Friend is right. I congratulate him, because he was part of the shadow Health team that persuaded the then shadow Chancellor and Leader of the Opposition that we needed to make that investment, thanks to which the NHS is doing 5,000 more operations every single day.
Michael Gove
My right hon. Friend has been very gracious in taking interventions from all sides, and also in citing independent voices. Has not the independent King’s Fund also pointed out that the sustainability and transformation plans that he is overseeing are the “best hope” of securing long-term improvement for both health and care in this country? Does he agree that the Opposition should pay rather more attention to those independent experts, rather than repeating their own press releases?
Mr Hunt
My right hon. Friend is right that just occasionally we should listen to experts—but only very occasionally. In the spirit of listening to experts, and as the Leader of the Opposition is here, I will tell my right hon. Friend something else the King’s Fund has said that he will agree with, which is that
“claims of mass privatisation were and are exaggerated.”
Let us not go chasing down rabbit holes.
The result of this Government’s commitment to the NHS is that real-terms spending per head has gone up by 4.6%, which is double the rate in Scotland and three times the rate in Wales. The hon. Member for Leicester South also mentioned the National Audit Office. He did not mention that the numbers quoted in the NAO report are last year’s figures. He chose not to mention this year’s numbers, which were published last week. They show that 40 fewer trusts are in deficit. Yes, a year ago, half of trusts were missing their financial plans, but now 86% are hitting those plans.
The latest figures, from Friday, show that the deficit will fall 73% from last year, and even lower than the year before. Why is that? It is because of a sustained effort by the NHS to tackle the problem. [Interruption.] The Opposition do not want to hear this, but the truth is that the NHS is gripping the very problem the shadow Health Secretary called a debate on. Agency spend, one of the biggest challenges, is on track to go down from £3.7 billion to less than £3 billion. The rates paid for agency nurses are down 18% on a year ago, and for locum doctors they are down 13%. Our procurement changes are on track to save half a billion pounds. The money we raise from international visitors is up three times, from £84 million to £289 million.
Keith Vaz (Leicester East) (Lab)
It is important that we focus not just on the level of spending but on where we spend the money. With long-term conditions such as diabetes, is it not essential to focus on preventive work, which in the long term will save the national health service a huge amount of money?
Richard Drax (South Dorset) (Con)
I congratulate my right hon. Friend on the calm and dignified way he is dealing with this debate, as compared with the Opposition. May I put in a plug for local community hospitals, not just in my constituency but right across the country, and how vital their retention is for good quality care in the future?
Helen Goodman
Since the Secretary of State thinks community hospitals are so important, will he guarantee that the Richardson in Barnard Castle will stay open?
Several hon. Members rose—
Mr Hunt
I will make some progress, but I will find time to give way to hon. Friends who I know want to come in.
I want to pick up on a particularly extraordinary comment made yesterday by the shadow Health Secretary. He said:
“aggressive efficiency targets have contributed to deficits”.
That is a curious thing to say, first because his own spending plans would have meant £5.5 billion more efficiencies. If he thinks our plans are aggressive, I just wonder how he would describe Labour’s approach. Secondly, I know we are all Corbynistas now, but basic economics suggests that efficiency plans do not increase deficits, but reduce deficits. That is what we need to do in the NHS, because we want the money to go to patient care.
There is another danger in the shadow Health Secretary’s argument, a trap that is very easy not just for him but for many commentators to fall into: the suggestion that this is a uniform problem across the NHS that it is powerless to grip without further Government intervention. The reality is that there is huge variation across the system. The deficits at good or outstanding trusts are five times less than the deficits at other trusts. If all trusts had the same financial performance as the good or outstanding ones, we would have a surplus of nearly half a billion pounds. Half the deficits are from just 22 trusts. We see this variation on a very specific level. For example, the amount paid for a pair of surgical gloves, which are very important to all hospitals, is £1.27 in some hospitals and just 50p in others. As for waiting lists, of 1,000 people who are waiting more than a year for their treatment, which is unacceptable, there is just one person from an outstanding trust who has been waiting that long. Some 93% are from trusts that require improvement or are inadequate. This is why we have a huge programme to support and improve those trusts and deal with the challenges they face.
Alex Chalk (Cheltenham) (Con)
On financial management, does the Secretary of State recognise that in Labour-run Wales agency staff spend has increased 60% in the past year? That compares with the tough measures taken in England to crack down on wasteful spending.
Andy Burnham
The Secretary of State is trying to blame hospitals for the deficit, but the point is that the spend on agency staff has ballooned in England over the past six years. The reason is that the Government, and their predecessor, cut nurse training places and left hospitals in the grip of private staffing agencies. It is therefore simply not fair of the Secretary of State to stand at the Dispatch Box and blame hospitals for a problem of the Government’s making.
Mr Hunt
I am not blaming hospitals. We are supporting hospitals to deal with the problem. The root cause of the problem, set out in the Francis report, was hospitals covering up bad problems. We said no to that and said that we were going to sort it out by having more nurses on our wards. That is why, in the four years that I have been Health Secretary, we have had 10,000 more nurses on our wards.
Simon Hoare (North Dorset) (Con)
Does my right hon. Friend agree that the public are finally starting to see through the usual Labour smokescreen that is high on rhetoric and low on alternative solutions, with very patchy and poor delivery when Labour is given the chance? My right hon. Friend’s approach to the health service—a quiet delivery of change and proper funding—is what the public are looking for.
Mr Hunt
It is noticeable that the two potential solutions we have heard have been from Opposition Back Benchers—the right hon. Member for Leicester East (Keith Vaz) and the former shadow Chief Whip, the right hon. Member for Doncaster Central (Dame Rosie Winterton)—and not from the Opposition Front Bench. My hon. Friend makes an important point.
The shadow Health Secretary is right to hold the Government to account for the funding of the NHS and the social care system, but it is a big mistake to distil all issues around the NHS into the simple issue of money. That subcontracts the responsibility for safe, high-quality care to politicians. If we are going to be the safest and the best quality system in the world, that has to be everyone’s job, everyone’s focus and everyone’s commitment—politicians, yes, but managers, doctors, nurses, porters, healthcare assistants and every single person working in NHS.
On the way forward, we first need to move to accountable care organisation models and the “Five Year Forward View”, including the STP process. The shadow Health Secretary called STPs “secret plans”, but in fact 28 of the 44 have been published and the rest will be published before Christmas. Many in the House, on both sides, objected to the Health and Social Care Act 2012 because they felt it did not do enough to support integrated care. Well, now we have a process that is bringing together the NHS and the social care system, acute trusts and primary care, at a local level. That is a big prize and we should support it, not try to make political capital out of it.
Robert Flello
In Stoke-on-Trent, the CCGs sit on the STP group. We have still not seen the report, but we have seen an executive summary. When the STP group suggests one thing, the CCG undermines it by closing community hospitals and cutting community beds. They are not working together; they are working against each other.
Mr Hunt
That is exactly what we need to sort out. We have the STP process to stop people doing their own thing, instead of having a co-ordinated, well-planned strategy. If we stick with this process, embrace innovation and technology and retain a relentless focus on safety and quality of care, in this Parliament we will see a million more people accessing mental health treatment every year; 5,000 more doctors working in general practice and a transformation of services through GPs; a new four-week cancer waiting time standard that will save 30,000 lives a year; more failing hospitals turned around; the weekend effect tackled; more doctors and nurses; and an NHS staying true to the promise made to patients in 1948 that safe, high-quality care would be there for everyone, regardless of income. That is what this Conservative Government will deliver, and I urge the House to support the amendment.
Several hon. Members rose—
Social Care
Jeremy Hunt Excerpts(9 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“welcomes the Government’s Spending Review settlement for health and social care, which ensures that the amount of money available to local authorities for adult social care services will rise significantly across the Parliament, and ensures that up to £3.5 billion more will be available by 2020; commends the work and dedication of those in the social care sector; and further welcomes the introduction by the Government of the social care precept which allows local authorities greater autonomy in making decisions about how they best meet their local communities’ needs for social care.”.
I too want to start by paying tribute all those working in the social care system; there are few jobs that are more important to our society. They work with some of the oldest and most vulnerable people in our society, many of whom have dementia. That is a growing population, with the number of over 90-year-olds having increased by more than a quarter. Life expectancy is up by a whole year since Labour left office. While I would like to claim credit for every Government achievement, that is a demographic change and no thanks to this Government. It also places huge pressure on the system. Every older person is a dad, a mum, a grandparent or a neighbour, and Members on both sides of the House, whatever our disagreements, want them to be treated with the utmost standards of dignity and respect.
Jack Dromey (Birmingham, Erdington) (Lab)
There are none so noble as those who care, and they include the Castle Vale carer I met who buys Easter eggs out of her own pocket to give out in her own time to those she cares for. Does the Secretary of State understand the despair being felt by carers who are told that they have only 15 minutes per visit, the despair being felt by those being cared for because they no longer have the contact they once had, or the despair being felt by the family and friends of those who built this country and who now deserve better in the twilight of their years?
Mr Hunt
I absolutely agree with the hon. Gentleman. It is the hallmark of a civilised society that we treat all older citizens with dignity and respect. I totally disapprove of 15-minute visits. I find it impossible to understand how anyone could really look after someone’s needs in a 15-minute visit. I hope that, like us, he is proud of the introduction of the national living wage, which is helping the people who do this very important work. It will help 900,000 people working in the social care system by paying all over-25s a minimum hourly rate of £7.20 from this April.
Paul Blomfield (Sheffield Central) (Lab)
The Secretary of State will know that Ministers have acknowledged that illegal non-payment of the national minimum wage is rife in the care sector. Does he agree that Her Majesty’s Revenue and Customs should publish the results of the investigations it launched two years ago into the six big providers? Where employers are found to be non-compliant in relation to an individual care worker, does he agree that HMRC should carry out a full investigation into that employer to see how widespread that non-compliance is?
Mr Hunt
We are absolutely determined to clamp down on employers who do not pay the national living wage. If the hon. Gentleman or any other hon. Member has any evidence at all of that happening, they should let HMRC know. HMRC has a policy of naming and shaming employers who do not do the right thing and rightly so.
Wes Streeting
It is welcome that the minimum wage will increase and that money will hopefully reach the workers we are discussing. Will the Secretary of State acknowledge, however, that the consequence of the increase is that the precept that local authorities charge residents for social care will be eaten up by the wage increase—even in local authorities such as the London Borough of Redbridge, of which I am still an elected member? What will he do to alleviate the very real financial burden on my local authority and others to ensure that everyone gets the quality of care they need?
Toby Perkins
The Secretary of State is being generous in giving way. He started his peroration by talking about the importance of care for the elderly and he is absolutely right about that. Does he agree that we are also talking about caring for people with learning and physical disabilities? The care debate is often entirely about the elderly, but it is much wider than that.
Mr Hunt
I will give way shortly, but I want to finish my point about the critical role played by care staff. In total, 1.5 million people work in the social care sector, and I want to mention one group in particular: the 90,000 who come from the EU. They do a brilliant job and we value their contribution to the sector.
If the House will forgive me, I want to share one story from early in my time as Health Secretary about an absolutely brilliant manager, who is Polish, of a dementia care home in Swiss Cottage. The people at the home had advanced dementia and many were unable to talk or move, so the atmosphere in the home was challenging to say the least. I asked the lady how she motivated her staff every day, and she said, “If I can get a resident to smile, they won’t remember it the next day, but I do, and I go home with a smile on my face.” The care that was being provided was, to be frank, completely remarkable. This is a moment for all of us to reaffirm what the Prime Minister said today at Prime Minister’s questions: we want these people to remain and we are confident and optimistic that we will be able to get them to remain.
Norman Lamb
I totally share the sentiment that EU workers are welcome in our country and that we must guarantee their future as soon as possible.
Does the Secretary of State ever feel that he is confronted by a pretty fundamental choice? He can either preside over a system that deteriorates with an increasing number of failures of care, which I know he cares passionately about, or he can be the politician in government who confronts that, who works with other parties and who comes up with a sustainable long-term solution. It is one or the other. I urge him to take the latter course.
Mr Hunt
I absolutely want to be someone in this role who confronts poor care and does everything possible to fight for the highest standards. That is exactly why I am doing this job. Poor care comes in different forms and, yes, funding is an issue. As the health and social care system goes through perhaps its most financially challenging period since the founding of the NHS, I particularly want to ensure that we protect the high standards that the right hon. Gentleman cares about.
Andy Burnham
I heard the Secretary of State’s earlier words about EU carers. I am sure that they were genuine, but words are not good enough for them. The longer the Government leave them in limbo, the greater the risk is that they will leave. Our national health service and our care system could not cope with losing all those staff, so what more is he doing? Is he petitioning the Prime Minister for a decision now that will give them leave to stay and properly respects their contribution to our society?
Mr Hunt
With respect to the right hon. Gentleman, with whom I have enjoyed many debates in this House, neither he nor I wanted the Brexit vote to happen, but now that it has, we have to cope with a very changed world. The Prime Minister said that she is confident of getting an early agreement. I hope that what we are saying in this House this afternoon will resonate with people and make them understand just how valued they are.
Several hon. Members rose—
Mr Hunt
I want to conclude the section about the role of social care staff.
Whatever disagreements we have in this afternoon’s debate, I want the message to go out loud and clear to all social care staff that Members from all parts of the House recognise the work that they do, and that they value it and support them to do that work better. That is part of the definition of a civilised society.
Helen Whately
On the point about the need for a long-term sustainable health and social care system, is it not the case that the Secretary of State is driving through work in devolution deals and sustainability and transformation plans, which aim to achieve exactly that—bringing together health and social care to create a much more sustainable system?
Mr Hunt
My hon. Friend is absolutely right. Although this afternoon’s debate is about the social care system, the sustainability and transformation plans are a critical part of the long-term solution for financial efficiency and for improving the quality of care.
I congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on introducing this debate, which is the first Opposition day debate that she has led. I also pay tribute to the fact that she has had a long-standing interest in these issues. She has asked me questions about the social care system on many occasions. She was particularly right to focus on the impact on the NHS, which is real, and on the impact on family carers, which is also real. She talked about Susan and about the impact on people who are finding that they are giving more hours of care than they were planning or are sometimes even able to give. That is something of which we must all be aware. She asked me to answer a direct question: do I recognise the scale and seriousness of the issues faced by the social care system? The answer is, yes, I do. I want to try to address, as comprehensively as I can, some of the substantive issues faced in the social care system.
Let me start by saying that, although today’s debate and the majority of the hon. Lady’s comments were around funding, the issue is not only about funding. The hon. Member for Chesterfield (Toby Perkins) mentioned that social care is not just about older people. In 2011, we had the shock of what was uncovered at Winterbourne View by a BBC “Panorama” programme. We have had a number of examples of horrific abuse at care homes. The Ash Court Care Home case in Kentish Town was one that came to light in 2012. The abuse there was filmed by a relative on a hidden camera. Those issues were primarily not about funding, but about cruelty—a strong word—that we have tolerated in our system. We have had some very significant policy responses since then, which are making a real difference. The first is that this Government, under the coalition, introduced the toughest system of care home inspection in the world.
We often talk in this House about the work of the chief inspector of hospitals, but I wish to pay tribute today to the work done by the chief inspector of adult social care, Andrea Sutcliffe, and her team. She has completed the inspection of nearly 90% of care homes and domiciliary care services. It is encouraging that, despite the pressures that we have been talking about this afternoon, 72% of the places that she inspected were good or outstanding. More importantly, the 28% that are not are the 28% that we know about and are therefore able to do something about.
I take issue with the way the shadow Health Minister presented her findings. She said that a quarter of the inadequate places were unable to improve following re-inspection. However, the reality is that more than three quarters of places that got an inadequate inspection did improve, which is a huge step forward from where we were a few years ago when we did not know where those places were and when there was no change happening at all.
John Woodcock (Barrow and Furness) (Lab/Co-op)
The Secretary of State is right to highlight the need to improve standards and the need for a rigorous inspection regime, but—taking on board what his former ministerial colleague, the right hon. Member for North Norfolk (Norman Lamb), said—does he accept that even if every single care home in the country reached the appropriate standard, there would still be a care crisis? There is not sufficient funding in the system to make it work. Will he agree to work with all parties to do what we should have done many years ago—before the general election in 2010, as he will recall—and get a grip on the issue and, as a country and as a House, try to sort it out?
Mr Hunt
I am more than happy to work with people of all parties to come to a sensible consensus. The one thing that unites all the major parties is a commitment to the NHS and social care system. With respect to the other issues, it is not just about rooting out poor care. It is also about something that the hon. Member for Worsley and Eccles South mentioned earlier—giving a career structure to people who work in the care system and giving them recognition. That is why in April last year we introduced the care certificate, which is based on achieving 15 standards. It is a voluntary system, but the CQC inspects against it, so there is a strong incentive for care providers to get their staff enrolled for the care certificate. I pay tribute to the work done by Camilla Cavendish, who did a lot of thinking and had a long-standing interest in this issue in her time as a journalist and at No. 10, and on whose proposals we are basing our work in this area.
Huw Merriman (Bexhill and Battle) (Con)
I am grateful that my right hon. Friend has mentioned the CQC and also touched on wages. When I met the south-east director of the CQC, it was clear that there is an issue of staff not being paid properly and then moving around the care home sector for a small amount of extra money, which is vital to them. Does my right hon. Friend agree that the living wage will stop that occurring and result in more people staying in jobs for longer?
Mr Hunt
That is a very important point. We have heard suggestions that the Government have been about words, not action, but the national living wage will do an enormous amount to help keep people in jobs for longer and help them to start to think about their jobs as a career, with potential progression into other parts of the health and care system, such as nursing. I commend my hon. Friend for the work that he does on this in Sussex.
Mr Betts
The Secretary of State said that the issues in social care were not only about funding, but it seems that funding is the only issue that he does not want to talk about. The Communities and Local Government Committee is taking evidence on social care. We have had evidence from local councils, including Conservative councils, council directors, unions, care providers in the private sector, care receivers, carers, academics and research institutions, all of whom say that there is a funding crisis in social care. Does the Secretary of State think he might just be wrong in being the only person to deny that such a funding crisis exists?
Mr Hunt
With great respect to the hon. Gentleman, I was coming on to talk about funding. I just wanted to make the point that the issue is not just about funding.
I respectfully disagree with some of the suggestions made by the shadow Health Minister in her comments earlier that this is essentially about party political choices, for the simple reason that at the last election, Labour promised less for social care and would have spent less than we are spending. I gently remind Opposition Members that Ed Balls as shadow Chancellor was absolutely explicit in 2015. He said that he would not reverse funding cuts to local government—indeed, he would have made further cuts. Under this Government, those cuts have started to be reversed. Spending on adult social care increased—[Interruption.] These are the facts. Spending on adult social care increased by around £600 million in the first year of the Parliament and is set to increase further because of the spending review, which will mean that up to an additional £3.5 billion can be spent during this Parliament.
Liz Kendall (Leicester West) (Lab)
I am afraid the Secretary of State is living in cloud cuckoo land. My council has to make £55 million of cuts on top of the £100 million it has already made. There is a funding crisis, and we will not solve it unless he admits there is a crisis. He cannot continue to be in denial, and we cannot have a Prime Minister who constantly says that the NHS and social care have the funding they need. We need cross-party agreement on this long-term issue, but, first, he has to acknowledge that there is a problem.
Mr Hunt
I have great respect for the hon. Lady, but Leicester Council actually increased its adult social care budget by 7%. Overall, there was an increase in the adult social care budget last year, and that was made possible by the new social care precept, which is being used by 144 out of 152 councils. That will raise £382 million this year and up to £2 billion a year by 2019-20.
Liz Kendall
My council has had to cut other vital local services to fulfil its statutory obligations. The social care precept will not even pay for the increase in the minimum wage—the council is going to have to move money from elsewhere. The Secretary of State is living in denial. You cannot solve a problem unless you admit there is one. People are willing to work across the House to deliver a long-term solution, but he has to admit that there is a problem.
Mr Hunt
With the greatest respect, I do not know whether the hon. Lady heard what I said just a few moments ago, but I answered very directly what the shadow Health Minister said. Do I recognise the scale and seriousness of the issues? Yes, I do, and I am coming on to explain what I think the solutions are. The point I am making is, yes, the budget—the amount spent on social care—was cut in the last Parliament, as a result of the very difficult economic situation we faced after the financial crisis in 2008, but it is starting to go up again in this Parliament. We need to look at what we can do to try to turn that into a sustainable improvement in the care received by all our constituents.
A crucial point was missing from the shadow Health Minister’s opening speech. There was a suggestion that the issues in social care are essentially caused entirely by decisions made by central Government. We need to salute the efforts made by councils of all colours to deal with the pressures in social care, because those are very tough. Middlesbrough Council, for example, increased its social care budget by 11%—it is the most improved council in England. My own council, Surrey, which is an affluent area, but has a large number of elderly people to look after, has battled enormous odds to expand provision.
However, the fact is that there is enormous variation in the way local authorities have responded to these challenges. If we look at the impact on the NHS, and at the delayed transfers of care that are attributable to social care, we can see that the best councils, such as Peterborough, Rutland, Newcastle and Torbay, have virtually no delays in hospital discharges attributable to social care. That can be compared with Birmingham, Manchester, Reading and Southampton where there are between 14 and 21 days of delayed transfers attributable to social care per 10,000 of population every working day. That is a difference of 20 times between the best and the worst councils, and we cannot say that there is a 20-times difference in funding between the best and the worst councils.
Mr Jim Cunningham (Coventry South) (Lab)
Members have alluded to the fact that local authority budgets are under the hammer at the moment. More importantly—I have raised this with the Secretary of State before—one of the big problems is having the social workers to get people a care package when they leave hospital to go home, and that creates bed blocking, so we are in a vicious circle. The last Labour Government looked at an offer from the then Conservative Opposition to get together and have a properly funded national care service. Why have we not looked at that?
Mr Hunt
The hon. Gentleman is absolutely right to say that the presence of social workers in hospitals is vital in discharging people, but I think he will be quite shocked to know that 50% of all the delayed transfers of care in the entire NHS happen in just 20 local authority areas. There are many places that are doing these things well, even in the current challenging financial circumstances, but there are others that, frankly, could do a lot better.
Overall, what we see is a picture where the best councils have expanded funding and provision. For example, last year, Windsor and Maidenhead increased its spend by 6.4%, and the number of people accessing long-term care is up by 8%. That was a Conservative council, but the Labour council in Doncaster also chose to increase its social care budget by 10%—nearly £8 million—and it is looking after nearly 7% more people.
This is not just about funding; it is also about the speed of health and social care integration and about local leadership. Where such leadership exists, important changes are happening even now. For example, in Cheshire East, dedicated workers are supporting people with early-stage dementia, saving more than £4,000 a year per client in social care costs while improving the service for patients. Milton Keynes is another good example: its innovative pilots have cut delayed days attributable to social care by nearly three quarters.
Others, regrettably, have chosen to cut funding and provision. There are many reasons for that, but the one thing that is difficult to explain to the public is why, at times of such challenge, local authority reserves have increased by nearly £10 billion since 2010. The hon. Member for Worsley and Eccles South made a fair point when she said that there has never been greater financial or operational pressure on all councils. Like the NHS, there is huge pressure, but unlike the NHS, it has not been possible to protect their budget since 2010.
What is the way forward in this very difficult situation? I think that it is a combination of the right financial decisions locally and recognition by local authorities and the NHS that they are part of the same team. That is why, as has been said, the sustainability and transformation plan process is so important.
It is easy to knock a process whereby local areas come together to have yet more meetings, which we are pretty good at doing in the NHS and social care system, and it is also easy to characterise those meetings as secret, but the fact is that people do not want to publish their plans until they are ready, and they will all be published by the end of this year. Many Members on both sides of the House criticised the Health and Social Care Act 2012 because they felt that it did not do enough to promote integrated care, but now we have a process to do that. That is massively important for the social care system, as this is the first time that local authorities are properly involved in NHS planning. Indeed, four of the STPs—namely those for Greater Manchester, Norfolk and Waveney, Nottinghamshire, and Birmingham and Solihull—are headed by local authority leads. On Monday, the head of operations at NHS England told me that there was not one STP meeting that he had been to where a local council was not represented. At the moment, it is a planning process and it needs to be delivered, but planning needs to happen collaboratively. It is a significant change for the NHS and social care system, but it is finally happening.
Robert Flello
So why is it that Stoke-on-Trent City Council tells me that no council officers or councillors have been involved in the Staffordshire STP? Given that it covers the whole of Staffordshire, the more deprived areas of Stoke-on-Trent and north Staffordshire will, in effect, subsidise south Staffordshire, because it has greater debts. Why cannot MPs have input into the plan? It is absolutely disgraceful.
Mr Hunt
Everyone will have input into the plan, but the hon. Gentleman might want to ask his council why it is complaining about pressures on the social care system when it has refused to use the social care precept and raise extra money, which could be desperately used for social care. That would make a real difference to his constituents.
Where councils and local NHS organisations are working together, we are seeing some real financial savings that are having a big impact. For example, Northumberland has saved £5 million through integrated services with Northumbria NHS Trust, and there has been a 12% reduction in demand for residential care as a result. In Oxfordshire, where the local authorities, clinical commissioning groups and trusts are all working together, discharge delays are down 40% in six months, and those due to social care have more than halved.
Karin Smyth
We are having an interesting tour of various councils around the country. I referred earlier to the fact that people have been let down after the 2015 Conservative manifesto, which promised them that they would be secure in their own homes. The proposal to that effect in the Care Act 2014 was postponed because so many councils put pressure on the Government to delay. The Public Accounts Committee has been told that the proposal will be introduced in April 2020. What work is happening in the Department to ensure that that proposal will come forward so that people will be secure in their own homes?
Mr Hunt
We are doing work, and I would simply say that we have also delivered on that promise because we have introduced the deferred payment scheme, which means that no one will need to sell their home because of social care costs.
I will wind up now, because I know that many hon. Members want to speak. When we have local authorities and the NHS working together, what is our objective from that process? We want a seamless transition for patients between the health and social care system. We want shared electronic health records so that patients are not asked the same questions time after time. We want a single assessment system so that people are not assessed twice by different organisations trying to get different results. We want to see the pooling of budgets, we want to get rid of delayed transfers of care, and we want multidisciplinary teams. Most importantly, we want there to be a single plan for every vulnerable person, to which everyone who is involved in their care adheres. Those are the objectives.
In the face of enormous pressure, the best solution for local authorities and local NHS organisations that are finding things challenging right now is not to slow down those vital changes, but to accelerate the pace of change, so that we eliminate waste and improve patient care at the same time. Councils that do so will have the full support of the Government. I urge the House to support the Government’s amendment.
Madam Deputy Speaker (Natascha Engel)
Before I call the next speaker, I will have to impose a seven-minute limit. I have to warn Members that the more interventions that are taken, the more that limit will have to come down.
Andy Burnham
I am very grateful to the hon. Gentleman for his intervention and the spirit in which he made it. He is absolutely right: that set everything back and meant that there was no possibility of a cross-party approach. There will have to be such an approach if we are to fix social care and, indeed, to give the NHS what it needs, because they will both need more funding during this Parliament. That is the real shame. I did not make my point about Andrew Lansley for political reasons; I just want people to understand what happened, so that the current generations of politicians might do something different.
The answers we have since had from the Government are wholly inadequate. We have heard today that the precept does not raise enough money, particularly for poorer councils. It is no answer; in fact, it just cynically devolves the responsibility for the whole issue to local government, even though councils did not create the problem. I still favour an all-in system. I will say it: I favour a system in which we ask older people to pay a set contribution, so that they have peace of mind in later life, with all their care costs covered.
Mr Jeremy Hunt
I am listening very carefully to the right hon. Gentleman. In the spirit of wanting to rise above party politics, will he agree that it was totally wrong of him to suggest at any stage in the last Parliament that the Government wanted to privatise the NHS, when we have never had the intention to do so? It was wholly irresponsible to scare the public about that.
Andy Burnham
In a week when Virgin Care is taking on a huge community care contract, I do not think the Secretary of State should be making that point—particularly the Secretary of State who privatised ambulance services in Greater Manchester. I honestly do not think we need to go there.
The point that I am making is about funding social care. The Conservatives claimed that we were introducing a new inheritance tax. Do people not understand that just 3.4% of estates in this country attract inheritance tax? Why is that? Because the vast majority of estates are whittled down by the costs of care—tens of thousands of pounds, or hundreds of thousands of pounds for some people. That is not fair and it is not sustainable. We must be able to do better.
I feel so strongly about this because I saw my grandmother go through the care system in England 20 years ago and, frankly, it was nowhere near good enough. I arrived here saying that I would do something about it. I tried to do something about it, but we have not got anywhere near a solution to the scale of the challenge. People will need to put party politics aside and find common ground. The point scoring and failure to grasp big issues have led to a situation where people have low regard for this place.
We are left with a malnourished, privatised care system in England that is sinking lower as we speak. A culture of slap-dash 15-minute visits is entrenched, in which staff do not get properly treated, trained or respected. Standards in care homes have slipped even further, and stories of neglect and abuse abound—we hear them all the time. Countless vulnerable people and their families still have to pay these cruel dementia taxes, which have risen under this Government, losing everything they have worked for and going into later life with everything on the roulette table: home, pension, savings—the lot. That is not the care system we should have in 2016 in this country. At what point are we going to say, “Enough is enough,” and actually do something about it?
Mr Jeremy Hunt
Just before my right hon. Friend wraps up, I want to put on record my thanks to him for his outstanding work in my Department, both in mental health and in social care, and for his real commitment to the voluntary organisations and the patients and service users in those areas.
Oral Answers to Questions
Jeremy Hunt Excerpts(9 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Sir Henry Bellingham (North West Norfolk) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
In the past four years, 31 trusts have been put into special measures, more than one in 10 of all NHS trusts. Of those, 15 have now come out and I particularly congratulate the staff of Sherwood Forest, Wye Valley, and Norfolk and Suffolk trusts which have come out of special measures in the past month.
Sir Henry Bellingham
Does the Secretary of State agree that the sustainability and transformation plan for Norfolk and Waveney is a vital part of the Queen Elizabeth hospital’s future as it successfully moves out of special measures? Although there is overwhelming support for integrating health and social care, will he confirm that there will be full consultation with different patient groups on the STP?
Mr Hunt
I can absolutely give that assurance. Through my hon. Friend I congratulate the staff of King’s Lynn hospital who have turned things around there. It was a great privilege for me to visit it and see the work that they have done. My hon. Friend is right—the next step is to integrate the work done in acute hospitals with what happens in the community and the social care system. That is why the open and transparent STP process is so important.
Heidi Alexander (Lewisham East) (Lab)
I do listen carefully to the Health Secretary and sometimes I end up wondering what planet he is living on. There are as many trusts in special measures now as there are trusts that have come out of special measures. Just because different people in different places are experiencing poor care does not make the overall picture any better. When will the right hon. Gentleman accept that the overall amount of resource going into the system is simply inadequate if he wishes to provide high quality, timely care for all?
Mr Hunt
Let me tell the hon. Lady that what is different now is that we have a special measures regime. When Labour was in power, the problems were swept under the carpet and not dealt with. Now they are being dealt with because we want every NHS patient to have confidence that we will not have another Mid Staffs. That is why we are making very good progress. With respect to funding, may I respectfully tell her that had we followed her party’s spending plans, the NHS would have £1.3 billion less this year?
Mr Ben Bradshaw (Exeter) (Lab)
The Secretary of State will know that with depressing regularity the same hospitals come up on that list that he has just referred to. Sustainability and transformation plans provide the opportunity to address some of the unsustainable elements of local health economies, but only, as my hon. Friend the Member for Lewisham East (Heidi Alexander) says, if the money is there. With the health service facing its tightest financial settlement in its history, these plans are just not deliverable.
Mr Hunt
The right hon. Gentleman understands health extremely well, both from his ministerial position and from being on the Select Committee. If he looks at the hospitals going into special measures, he will see that we are beginning to succeed in moving hospitals out of special measures, but because we have an independent inspection regime, sometimes other ones go in. That is how it should be. That is what works very well in the education sector and is beginning to work well in driving up standards in health care as well.
To go back to my answer to the hon. Member for Lewisham East (Heidi Alexander), £1.3 billion more in the NHS this year compared with what would have been put into the NHS if Labour had won the last election means 30,000 nurses, 13,000 doctors or 200,000 hip replacements that we are able to do because of this Government’s funding of the NHS.
Peter Dowd (Bootle) (Lab)
The Secretary of State for Health (Mr Jeremy Hunt)
Because of the 2008 financial crisis, all political parties committed to reducing the proportion of GDP spent on health in 2010, but because this Government chose to protect the NHS, the proportion fell from 6.4% to 6.2%, a drop of just 0.2% of GDP.
Peter Dowd
While welcome, that creative response does not answer the question. The fall in GDP spent on health is worrying. To mitigate that fall, when can my constituency expect its share of the Brexit NHS bonus to be injected into its health economy, which would bring in £30 million a year?
Mr Stewart Jackson (Peterborough) (Con)
I thank the Secretary of State for taking time last week to visit the Peterborough City hospital and to praise the magnificent staff there, who are labouring under a £35 million annual private finance initiative millstone. Is the wider context not that we would have a lot more money to spend on front-line care if we did not have to deal with a poisonous legacy from Labour of £64 billion of appalling PFI contracts in the NHS?
Mr Hunt
My hon. Friend is absolutely right. I was incredibly impressed with the staff I met at Peterborough hospital—there was incredible commitment to patients and some fantastic work going on in the oncology and renal departments, which I visited. He is right: PFI was a disastrous mistake, saddling hospitals up and down the country with huge amounts of debt, which cannot now be put into front-line patient care. We are doing everything we can to sort that out and not repeat those mistakes.
David Tredinnick (Bosworth) (Con)
My right hon. Friend will be aware that the NHS spends only about £400 million a year on homeopathic medicine and treatments through the 400 doctors who have trained in homeopathy and are members of the faculty. If he wants to reduce antibiotic prescribing, may I suggest that he increases that budget, because there are very good scientific trials now showing that upper respiratory tract infections can be treated using homeopathic medicine? May I write to him about that?
Mr Hunt
May I commend my hon. Friend for his great persistence in flying the flag for homeopathic medicine? While we must always follow the science in the way we spend our money on medicines, as I know he agrees, he is right to highlight the threat of antibiotic resistance and the need to be open to every possible way of reducing it.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
Today I publish my first annual report as Chair of the Public Accounts Committee, in which I conclude that there is a sustainability crisis in the funding of the NHS. Surely the Secretary of State will agree—he has made some comments in the media that suggest he is becoming aware of this—that he will need to lobby the Chancellor for a better settlement in the autumn statement. Will he update the House on his negotiations?
Mr Hunt
I am sorry to disappoint the hon. Lady but I do not update the House on Government discussions which happen in the run-up to every Budget and autumn statement. What I would say to the hon. Lady is that I am not someone who believes that the financial pressures that undoubtedly exist in the NHS and social care system threaten the fundamental model of the NHS. What they remind us all of is that what we need in this country is a strong economy that will allow us to continue funding the NHS and social care systems as we cope with the pressures of an elderly population. That, for me, is the most important challenge—the economic challenge that will allow us to fund the NHS.
David T. C. Davies (Monmouth) (Con)
Will my right hon. Friend confirm that, under his tenure as the Minister, there has been a real-terms increase in spending on the NHS in England, unlike in Wales, where, over the last few years, we have seen real-terms cuts under the Labour party?
Mr Hunt
As ever, my hon. Friend speaks wisely. Thanks to this Government, health spending in England is up by 10.1% in cash terms—4.6% in real terms—since 2010. That is double the cash increase in Scotland and three times the cash increase in Wales. Other parties talk about funding the NHS, but Conservatives say that actions speak louder than words.
Jonathan Ashworth (Leicester South) (Lab)
But we have seen public health budgets cut and social care budgets cut, and I can now tell the House that the maintenance budgets have been cut. In fact, the backlog of high-risk maintenance facing the NHS has soared by 69% in the past year. In London alone, the high-risk backlog has grown by £338 million; across the country the figure is nearly £5 billion. NHS finances are so stretched that even the most urgent repairs are being left undone. Is this what the Secretary of State meant when he said that he is giving the NHS the money it asked for?
Mr Hunt
I know that the hon. Gentleman has only been shadow Health Secretary for a while, but may I ask him to cast his mind back to 2010, when the party that wanted to cut the NHS budget was not the Conservative party but Labour? In 2015, his party turned its back on the five year forward view and said it would increase funding not by £8 billion but by just £2.5 billion. It is not enough to found the NHS—you have got to fund it.
Mr Speaker
Order. These exchanges, not untypically, are taking far too long, and part of the reason for that is that the Secretary of State keeps dilating on the policies of the Labour party. If he does so again, I will sit him down straight away. [Interruption.] Order. There are a lot of colleagues who want to ask questions. We want to hear about Government policy, not that of the Opposition. I have said it, it is clear— please heed it.
Jonathan Ashworth
Thank you, Mr Speaker.
If everything is so rosy with the NHS’s finances, why did Simon Stevens say just a couple of weeks ago that
“2018-19 will be the most pressurised year for us, where we will actually have negative per-person NHS funding growth in England”—
in other words, that NHS spending per head will be falling? The number of patients waiting longer than four hours in A&Es has increased. The number of days lost to delayed discharge has increased. The number of people waiting more than 62 days to start cancer treatment following referral has increased. Should not the Secretary of State do his job and make sure that next week’s autumn statement delivers the money that the NHS urgently needs?
Mr Hunt
Unlike other parties in this House, we have been increasing funding for the NHS. Thanks to that, we are now funding the NHS in England at a 10% higher proportion of GDP than the OECD average, and we are in line with the western European average because of our commitment. These are difficult financial times and there is financial pressure, but this Government have been saying that despite that financial pressure we must make sure that the NHS continues to offer safe, high-quality care—and that is our focus.
Henry Smith (Crawley) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
Last month, I launched the safer maternity care action plan, which is part of our ambition to halve the rates of stillbirths, neonatal deaths, maternal deaths and brain injuries by 2030.
Henry Smith
I am grateful to my right hon. Friend for that answer. In 2001, the then Labour Government closed the maternity unit at Crawley hospital. Longer journeys to East Surrey hospital have been a safety concern. Will the Department look at reintroducing midwife services to Crawley hospital and GP surgeries in Crawley?
Jeff Smith (Manchester, Withington) (Lab)
Paul Blomfield (Sheffield Central) (Lab)
The Secretary of State for Health (Mr Jeremy Hunt)
I am pleased to report to the House something I was not sure I would ever be able to say: last week, the British Medical Association called off its industrial action and committed to working with the Government on the implementation of new contracts for junior doctors. This will make a significant contribution to our commitment to a safer, seven-day NHS, and the Government will work constructively with junior doctors to address their concerns, because they are a vital and valued part of our NHS.
Paul Blomfield
The South Yorkshire and Bassetlaw STP sets out some very positive ambitions, but it warns that there will be a financial shortfall for health and social care services in our area of £571 million by 2020-21. Those ambitions are unachievable unless the Government address the shortfall. What is the Secretary of State going to do about it?
Mr Hunt
We are working very carefully with all STP areas to make sure that their plans are balanced so that we can live within the extra funding we are putting into the NHS—an extra £10 billion—by 2020-21. We will look at that plan and do everything we can to help to make sure that it works out.
Andrew Selous (South West Bedfordshire) (Con)
Mr Hunt
I am happy to do that, and I would like to pass on my congratulations to Dr O’Toole, who obviously does a fantastic job for my hon. Friend’s constituents. We are investing significantly in general practice, with a 14% increase in real terms over this Parliament and our ambition to provide an extra 5,000 doctors working in general practice. This will mean that the need for locums will become much less and we can have much more continuity of care for patients.
Julie Cooper (Burnley) (Lab)
The Secretary of State and the Minister will be aware that Capita has wreaked havoc in GP surgeries across the land, placing extra pressures on already overstretched NHS staff, compromising patient safety and breaching confidentiality. Last week, I met a group of practice managers who told me that some patient records have been missing for months, while others have turned up apparently half-eaten by mice. Given that this contract was introduced to save the NHS money, will the Minister tell us how much it is costing to rectify the mess and what steps she is taking to compensate GPs for the expenses they have incurred as a result of ill-conceived and poorly implemented contracts?
Robert Neill (Bromley and Chislehurst) (Con)
Mr Jeremy Hunt
I thank my hon. Friend for bringing up that issue. Everyone recognises, on both sides of the House, that the health and social care sectors need to work together. That happens very well in some parts of the country, but not in others. I think all hon. Members have a job to make sure that people behave responsibly in their constituencies.
Chris Law (Dundee West) (SNP)
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
The number of nurses working in mental health has fallen by 15% since 2010, from 45,384 to 38,774. Why is that, and does the Secretary of State believe that it will achieve real parity of esteem for mental health in our country?
Mr Jeremy Hunt
What I can tell the hon. Lady—who, I know, rightly campaigns hard on mental health—is that we are treating 1,400 more people in our mental health services every day than we did in 2010, and we will be treating a million more people every year when we have implemented the taskforce report. We are investing more, and we are making good progress.
Matt Warman (Boston and Skegness) (Con)
Shared care allows GPs to provide complex prescriptions for drugs such as methotrexate, but in my constituency the Beacon surgery recently withdrew from those arrangements. Can the Secretary of State assure me that the Department will support not only patients who now face potentially longer round trips, but GPs themselves, so that they can continue to provide those vital services?
John Cryer (Leyton and Wanstead) (Lab)
Is the Minister satisfied that the National Institute for Health and Care Excellence procedures for the approval of anti-cancer drugs are sufficiently speedy, because the waiting times for approvals can be months or even years, and there is a widespread feeling that that is too slow?
Mr Jeremy Hunt
We have tried to speed this up with the cancer drugs fund, which helped 84,000 people in the last Parliament, but we always keep the NICE procedures under review and I take on board what the hon. Gentleman says.
Bob Blackman (Harrow East) (Con)
We recently had an excellent debate in Westminster Hall on the Government’s tobacco control strategy. When will they publish the new strategy, which was promised for publication this summer?
NHS Funding
Jeremy Hunt Excerpts(9 years, 8 months ago)
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Jonathan Ashworth (Leicester South) (Lab)
(Urgent Question): To ask the Secretary of State if he will make a statement on NHS funding.
The Secretary of State for Health (Mr Jeremy Hunt)
Compared with five years ago, the NHS is responsible for 1 million more over-75s. In five years’ time, there will be another 1 million over-75s. Our determination is to look after each and every NHS patient with the highest standards of safety and care, but there is no question but that the pressures of an ageing population make this uniquely challenging.
I welcome the chance to remind the House of this Government’s repeated commitment to supporting our NHS. The NHS budget has increased in real terms every year since 2010. NHS spending has increased as a proportion of total Government spending every year since 2010, and is 10.1% higher per head in real terms than when we came to office. The OECD says that our spending is 10% higher than the OECD average for developed countries. At 9.9% of GDP, it is about the same as that in other western European countries, for which the average is 9.8%.
Given the particularly challenging current circumstances, in 2014 the NHS stepped back and for the first time put together its own plan for the future. It was an excellent plan, based on the principle that because prevention is better than cure, we need to be much better at looking after people closer to or in their homes, instead of waiting until they need expensive hospital treatment. The plan asked for a minimum increase of £8 billion in NHS funding over five years. It asked for this to be front-loaded to allow the NHS to invest in new models of care up front.
Following last year’s spending review, I can confirm to the House that the NHS will in fact receive an increase of £10 billion in real terms over the six years since the “Five Year Forward View” was published. In cash terms, that will see the NHS budget increase from £98.1 billion in 2014-15 to £119.9 billion in 2020-21. That rise is highly significant at a time when public finances are severely constrained by the deficit that this Government regrettably inherited. Because the NHS’s particular priority was to front-load the settlement, £6 billion of the £10 billion increase comes before the end of the first two years of the spending review, including a £3.8 billion real-terms increase this year alone. That £3.8 billion represents a 52% larger increase in just one year than the Labour party was promising over the lifetime of this Parliament.
Jonathan Ashworth
This morning the Chair of the Health Committee and her colleagues on that Committee said that the Government’s NHS spending claims were “inaccurate” and “false”. The Opposition agree with that analysis. Ministers—and the Secretary of State has just done this again—tell us that they are investing £10 billion more in the NHS, but it has now been confirmed that that figure is
“not only incorrect but risks giving a false impression that the NHS is awash with cash.”
Is not the reality that the Government have cut adult social care, the public health budget and the NHS capital budget? Now we learn that the average amount we spend on healthcare for each person in this country will fall in 2018-19. Does that not raise serious questions about the claims that Ministers, and, indeed, Prime Ministers, have been making from that Dispatch Box? In fact, the only way the Government’s figures could be further discredited is if the Secretary of State slapped them on the side of a bus and got the Foreign Secretary to drive it.
Will the Secretary of State admit that the Government have not actually given the NHS the money it needed? Will he give us an accurate account of spending plans for the NHS? Will he tell us when the Chancellor is going to respond to the Health Committee’s letter, and what representations he himself is making to the Chancellor ahead of the autumn statement?
We have also learned today from Health Service Journal that one in three local areas intend to close or downgrade A&E departments within 18 months, one in five expect to close consultant-led maternity services, and more than half plan to close or downgrade community hospitals. Will the Secretary of State confirm whether those reports are accurate? How many A&E departments, maternity units and community hospitals does the Secretary of State expect to close or be downgraded within the next year and a half? Our constituents want those answers.
Before the last election, the Secretary of State told us he was “confident” about delivering the money the NHS needed. Today that confidence has been exposed as utterly misplaced. Tory promises are completely in tatters. Rather than defending the Prime Minister’s spin on the £10 billion figure, why does the Secretary of State not stand up for patients and staff, and deliver the funding that the NHS and our social care sector desperately need?
Mr Hunt
I start by welcoming the hon. Gentleman to his first urgent question in his new role. As I am a relative old timer in my role, I hope he will not mind me reminding him of some of the facts about health spending.
First, the hon. Gentleman said that the Government did not give the NHS what it asked for. Let me remind him that Simon Stevens, a former Labour special adviser—I know for new Labour, but he was none the less a Labour special adviser—said at the time of the spending review settlement last year that
“our case for the NHS has been heard and actively supported”
and that the settlement
“is a clear and highly welcome acceptance of our argument for frontloaded NHS investment. It will…kick start the NHS Five Year Forward View’s fundamental redesign of care.”
I will tell the hon. Gentleman who did not give the NHS what it asked for: the Labour party. At the last election, it refused to support the NHS—[Interruption.] I know this is uncomfortable for the new shadow Health Secretary, but the reality is that the party on whose platform he stood refused to support the NHS’s own plan for the future. As his question was about money, I will add that the Labour party also refused to fund it. The NHS wanted £8 billion; Labour’s promise was for additional funding of £2.5 billion—not £6 billion or £4 billion, but £2.5 billion, or less than one third of what the NHS said it needed. Even if we accept the numbers of the Chair of the Select Committee—and, as I will go on to explain, I do not—Labour was pledging over the course of the Parliament only around half of what this Government have delivered in the first year of the spending review.
The hon. Gentleman used other choice words, one of which was “spin”. I will tell him what creates the most misleading impression: a Labour party claiming to want more funding for the NHS when, in the areas where they run it, the opposite has happened. Indeed, in the first four years of the last Parliament, Labour cut NHS funding in Wales when it went up in England—[Interruption.] Yes, it did. Those are the official figures. That is in a context in which the Barnett formula gives the Government in Wales more than £700 more per head to spend on public services, so there is more money in the pot.
The hon. Gentleman talked about social care. May I remind him of what the shadow Chancellor at the time of the last election—Ed Balls, who is now sadly no longer of this parish—said? During the election campaign, he said of funding for local councils “not a penny more”. We are giving local councils £3.5 billion more during the course of this Parliament.
The hon. Gentleman talked about other cuts that he alleges will happen in A&E departments and other hospital services. I simply say to him that we have to make efficiency savings. I do not believe they will be on the scale he talked about, but how much worse would they have to be if the NHS got a third of the money it currently gets?
If the hon. Gentleman and his party think the NHS is underfunded, they need to accept that the policies that they advocated in the past two elections were wrong —they advocated spending less than the Conservatives. Until they are serious about changing their policy, no one will be serious about listening to their criticisms.
Dr Sarah Wollaston (Totnes) (Con)
I agree with the Secretary of State that prevention is better than cure, but he will know that achieving the aims of the five year forward view was dependent on a radical upgrade in public health and prevention. He will know that it was also dependent on adequate funding for adult social care. In addition, there are continuing raids on the NHS capital budget, and we need to put in place the kind of transformation that he and our sustainability and transformation partnerships wish to achieve.
Will the Secretary of State therefore confirm that he recognises the serious crisis in social care and the effect it is having on the NHS, and the effect that taking money from public health budgets is having? Although I accept that he does not agree with the Health Committee’s appraisal of the £10 billion figure, I am afraid I stick by those figures.
Mr Hunt
I have enormous respect for my hon. Friend. I respect her passion for the NHS, her knowledge of it and her background in it, so I will always listen carefully to anything she says. I hope she will understand that just as she speaks plainly today, I need to speak plainly back and say that I do not agree with the letter she wrote today, and I am afraid I do think that her calculations are wrong.
The use of the £10 billion figure was not, as she said in her letter, incorrect. The Government have never claimed that there was an extra £10 billion increase in the Department of Health budget. Indeed, the basis of that number has not even come from the Government; it has come from NHS England and its calculations as to what it needs to implement the forward view. As I told the Select Committee, I have always accepted that painful and difficult economies in central budgets will be needed to fund that plan. What NHS England asked for was money to implement the forward view. It asked for £8 billion over five years; in fact, it got £10 billion over six years, or £9 billion over five years—whichever one we take, it is either £1 billion or £2 billion more than the minimum it said it needed.
I think my hon. Friend quoted Simon Stevens as saying that NHS England had not got what it asked for. He was talking not about the request in the forward view, but in terms of the negotiations over the profile of the funding we have with the Treasury. The reason that the funding increases are so small in the second and third year of the Parliament is precisely that we listened to him when he said that he wanted the amount to be front- loaded. That is why we put £6 billion of the £10 billion up front in the first two years of the programme.
I fully accept that what happens in the social care system and in public health have a big impact on the NHS, but on social care we have introduced a precept for local authorities combined with an increase in the better care fund—[Interruption.] This is a precept, which 144 of 152 local authorities are taking advantage of. That means that a great number of them are increasing spending on social care. It will come on top of the deeper, faster integration of the health and social care systems that we know needs to happen.
On public health, I accept that difficult economies need to be made, but it is not just about public spending. This Government have a proud record of banning the display sale of tobacco, introducing standardised packaging for tobacco, introducing a sugary drinks tax and putting more money into school sports. There are lots of things that we can do on public health that make a big difference.
On capital, I agree with my hon. Friend about the pressure on the capital budget, but hospitals have a big opportunity to make use of the land they sit on, which they often do not use to its fullest extent, as a way to bridge that difficult gap.
Martyn Day (Linlithgow and East Falkirk) (SNP)
With some 80% of trusts in deficit and only 4% meeting accident and emergency targets, I am grateful to the Health Committee for flagging up the dire financial state of the NHS in England, as evidenced by its letter to the Chancellor. We learn from that document that the £10 billion figure is a bit of a fallacy. In Scotland, the SNP Government are committed to investing an additional £2 billion by 2021, but any reduction in new money for the NHS from the UK Government would have an impact on Barnett consequentials. Given that the UK Government have already slashed Scotland’s budget by 10% between 2010 and 2020, they need to be honest and transparent about what that reduction will mean for Scotland’s funding. With the Department of Health having accidentally not adjusted its books for an extra £417 million from national insurance contributions, and having broken its control total by £207 million, will the devolved Governments get any share of that additional £624 million?
Mr Hunt
Many people in Scotland will be somewhat surprised by the hon. Gentleman’s comments, because in the last Parliament spending on the NHS in England went up by 4%, whereas in Scotland it fell by 1%. The IFS confirmed that at the time of the independence referendum, saying:
“It seems that historically, at least, Scottish Governments in Holyrood have placed less priority on funding the NHS in Scotland…than governments in Westminster have for England”.
In this Parliament, the hon. Gentleman’s party has already lost a vote on NHS cuts in the Scottish Parliament and been criticised by Audit Scotland for its performance. When the SNP has the courage to increase NHS spending in Scotland by the amount we are increasing it in England, we will listen, but until then it should concentrate on looking after Scottish NHS patients in Scotland.
Several hon. Members rose—
Mr Philip Hollobone (Kettering) (Con)
People in Kettering appreciate plain speaking. Can the Health Secretary tell the House what the NHS budget was in 2014-15, what it will be in 2020-21 and what the difference is between the two numbers?
Norman Lamb (North Norfolk) (LD)
Is there not an urgent need to be straight with the British public about the resources we will need to maintain both the NHS and the care system, and to confront the fact that we will all have to pay a bit more to ensure that our loved ones get care when they need it?
Mr Hunt
When the right hon. Gentleman and I worked in government, we both campaigned hard on many occasions for more funding for the NHS, including mental health—a particular priority for both of us. The answer to his question is yes, and that is why we are putting in more money in this Parliament. My own view is that in future Parliaments we will need to continue to increase the amount of funding going in to the NHS. The only point I would make is that what funds the NHS is a strong economy, so we have to make sure that increases in NHS funding are sustainable and compatible with a strong economy. That is something that this Conservative Government have a very good track record of delivering.
Mrs Cheryl Gillan (Chesham and Amersham) (Con)
The plans to achieve savings from community pharmacies are causing a great deal of concern in my constituency. The patients group at the John Hampden surgery and residents in and around Prestwood believe that the plans may result in the closure of our excellent rural pharmacy in Prestwood. What reassurances can the Secretary of State give to my constituents today that no pharmacies will close that are more than a mile from any other pharmacy? Will he make sure that he takes into account the implications for GPs’ workloads when looking at pharmacies?
Mr Hunt
First, the people of Prestwood are lucky to have such an assiduous MP to campaign for their interests in Parliament today; indeed, my right hon. Friend always does so. I can give her that reassurance, because in the package of efficiencies we set out—it is right that we ask pharmacies to make efficiencies in the way they are run, just as we are asking the rest of the NHS to make efficiencies in the way it is run—we are protecting all pharmacies that are a mile or more from any other pharmacy. In that sense, we are absolutely determined to protect provision for her constituents and all our constituents who depend on rural pharmacies.
Tracy Brabin (Batley and Spen) (Lab)
If the Government had stood by their word and invested the promised £10 billion in the NHS, does the Secretary of State agree that the downgrade of Dewsbury A&E might not have been necessary?
Mr Hunt
First, may I welcome the hon. Lady to her place in this House? I am sure that she will make an extremely important contribution. Yes, she is filling very big boots, but, if I may say so, she has made a very good start.
On what happens with A&E departments, changes in the pattern of the services we provide have been a feature, both when the hon. Lady’s party has been in power and when my party has been in power, because the needs of the people who use the NHS also change. We therefore need to strike the right balance between reassuring people that services are provided near where they live, while ensuring that they receive the right care when they get there. For strokes, that does not always mean going to the nearest hospital, but somewhere with 24/7 stroke care and the greatest chance of saving the patient’s life. If the hon. Lady has concerns about Dewsbury hospital, I am very happy to talk to her further.
Michael Gove (Surrey Heath) (Con)
At a time when every Department, with the exception of the Department for International Development, has to reduce public expenditure, it seems a remarkable feat of political skill to have secured an increase for the NHS bigger than either the Home Office budget or that of the Ministry of Justice. Will the Secretary of State tell me whether there are parts of the United Kingdom where health expenditure is not rising as fast as in England? If there are, which political parties are in charge there?
Mr Hunt
I thank my right hon. Friend, whose passion and commitment to higher standards for the constituents he serves have inspired me in this job, just as I know they have inspired many others in the education field. There are indeed parts of the United Kingdom that allow us to make a very good comparison of the commitment to and funding of the NHS. In Wales, funding went down in the first four years of the previous Parliament. In Scotland, funding went down over the course of that Parliament. Both the Scottish National party and the Labour party like to talk about the NHS, but when it comes to writing the cheques, they are nowhere to be seen.
John Cryer (Leyton and Wanstead) (Lab)
Can the Secretary of State guarantee that every A&E department in north-east London, with a rapidly rising population, will remain open for the rest of this Parliament? If he cannot guarantee that, how many will close and which ones? What is his hit list?
Mr Hunt
What I can guarantee is that the decisions about the future of A&E departments will be taken locally by clinicians who have the best interests of their patients at heart. I think that the hon. Gentleman and I would be able to agree that these decisions are not best taken by Secretaries of State. It is much better that they are taken by people who do not have any party political axe to grind. Any decision to change service provision at an A&E has the opportunity, if it is so wished, to be reviewed by the Secretary of State when it goes through an independent process. That is exactly what would happen in north-east London, were the local community to wish it.
Andrew Stephenson (Pendle) (Con)
Under the previous Labour Government, Burnley general hospital lost its A&E department and a number of key services. Under the coalition Government, a new £9 million urgent care centre opened and just last week the trust submitted plans for a £15 million development of the hospital. Does that not perfectly demonstrate the unprecedented investment in the NHS since Labour left government?
Mr Hunt
It absolutely does. I much enjoyed visiting with my hon. Friend some health facilities in his constituency during the general election campaign. The difference between Conservative Members and Labour Members is that we recognise that every penny of the NHS budget has to come from a strong economy. We know that if we take that for granted, we end up having to cut the NHS budget, which is what has happened in Spain, Italy, Greece, Portugal and many other countries that have lost control of their national finances. That is something that Labour Members would do well to remember.
Mr Ben Bradshaw (Exeter) (Lab)
The Government have been well and truly found out on this issue. Rather than quote selectively from Simon Stevens, the head of the NHS, will the Secretary of State confirm that among the conditions that Mr Stevens put down to the Government as part of the five-year review was an increase in public health spending, not a 20% cut, and a policy of maintaining spending on social care? Will he also confirm—he was there in Simon Stevens’ presence before the Select Committee—that Mr Stevens made it quite clear that those conditions and others had not been met?
Mr Hunt
Actually, what Mr Stevens said—I was there—was that social care and, indeed, public health provision needed to be maintained. We are increasing the social care budget by £3.5 billion over this Parliament. Although I accept that difficult cuts are being made to the public health budget, we are doing other things that do not cost money to make sure that we continue to improve this country’s excellent record on public health.
Anna Soubry (Broxtowe) (Con)
We all want a well-funded NHS. I congratulate the Secretary of State on making sure that we now have record spending in England. Last night, the A&E department of the Queen’s medical centre was tweeting that it effectively could not cope. We all of course congratulate and thank the hard-working staff in A&E, but the problem was demand. Does my right hon. Friend agree that the NHS can do much more to improve the way it signposts people? It was urging people to go to the urgent care centre, which does stitching and mends broken bones, all of which was news for many people in Greater Nottingham.
Mr Hunt
My right hon. Friend is absolutely right. That, of course, is why all parts of the NHS in England are embarking on the sustainability and transformation programme, which is designed to do precisely what my right hon. Friend says—to find smart ways to reduce demand. That will include, for example, better use of pharmacies, better use of GPs, more mental health provision—[Interruption.] Opposition Members are shouting, but why were they not prepared to put the money into the NHS to help us implement these plans? There would be no sustainability and transformation plans on the thin gruel that they promised for the NHS at the last election.
Rob Marris (Wolverhampton South West) (Lab)
I was always against the private finance initiative. This Government have set up a £1.5 billion bail-out fund for PFI. I put it to the Secretary of State that that is to rewarding past profligacy and penalising frugal trusts such as the Royal Wolverhampton NHS Trust. When will the Secretary of State redress this imbalance, stop rewarding profligacy and reward frugality?
Mr Hunt
I am getting more and more impressed with the hon. Gentleman’s questions. Last time, he accused me of being a Corbynista, and today he is criticising me for profligacy, when the general tone of most Members seems to be that we are being rather too parsimonious with the NHS. I completely agree with him that private finance initiatives were an utter disgrace, leaving the NHS with over £70 billion-worth of debt by 2010. Unfortunately, there does not seem to be a strong correlation between shiny new buildings and good care for patients, as can be seen in a number of Care Quality Commission reports. We are doing everything we can to unwind that very difficult problem.
Several hon. Members rose—
Sir Desmond Swayne (New Forest West) (Con)
How much more would the Secretary of State have had to spend per year by 2021 if the Chancellor had taken the Labour party’s advice?
Mr Hunt
If the Chancellor had taken the Labour party’s advice, the NHS would have had £5.5 billion less to spend every single year. I just ask Members who are worried about their A&E departments, worried about mental health and worried about GP provision on which of those services the axe would have had to fall if we had followed Labour’s spending plans?
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Since the 2010 general election, we have lost over 1,500 mental health beds, there are 5,000 fewer mental health nurses and over 400 fewer doctors working in mental health. The pledge that the Secretary of State made at that Dispatch Box on 9 December—that every clinical commissioning group would increase its spend on mental health—lies in tatters. When will this Government’s rhetoric on equality for mental health be matched with adequate resources?
Mr Hunt
I will tell the hon. Lady when that rhetoric became reality. We now have the highest dementia diagnosis rates in the world, according to some estimates. We are treating three quarters of a million more people with talking therapies every year than we were in 2010. Every single day, we are treating 1,400 more mental health patients. By the end of this Parliament, because of our spending plans, we will be spending £1 billion more on mental health every single year, treating 1 million more people. I think that that is pretty good.
Andrew Selous (South West Bedfordshire) (Con)
Is not one way to help the NHS to deal with its financial pressures by focusing on improving quality and using proper data? Professor Tim Briggs’s report, “Getting it Right First Time” is already improving patient outcomes and saving the NHS money.
Mr Hunt
I thank my hon. Friend for bringing Professor Briggs to meet me. He is an extremely inspiring man. He has established that every time someone has an infection during an orthopaedic operation, it costs the NHS £100,000 to put it right, but that is happening 0.5% of the time in the case of some surgeons and 4% of the time in the case of others. Dealing with variation of that kind is a way not just to reduce costs, but to avoid enormous human heartache.
Kate Green (Stretford and Urmston) (Lab)
NHS managers in Greater Manchester have made it clear that the pressures on the NHS are a function of pressures on the social care system and that costs are rising because of increases in the national living wage and the need to fund overnight cover. What is the Secretary of State doing to address those financial pressures on social care, given that the precept does no more than scratch the surface?
Mr Hunt
I agree that there are real pressures, although I should add that many Members were worried about some of the poor working conditions of people in the social care system and that 900,000 people on low pay in the system will benefit from the introduction of the national living wage. However, I agree that leaving people parked in hospitals when they should be being looked after in the community is financial nonsense. What is happening in Greater Manchester is one of the most impressive examples of health and social care integration in the country, and that must be the long- term answer.
Tom Pursglove (Corby) (Con)
I am very proud of the Government’s funding record, but does my right hon. Friend agree that it is also crucial to make the right strategic decisions? For example, it was a Conservative-led Government with a Conservative Health Secretary who delivered the urgent care centre in Corby, which has transformed health opportunities in our area and taken pressure off our A&E.
Karin Smyth (Bristol South) (Lab)
Representatives of the Department of Health and NHS England have appeared before the Public Accounts Committee eight times so far this year. We have taken a detailed look at the Department’s accounts, following the Comptroller and Auditor General’s unprecedented explanatory note, and I am glad that the Health Committee has said that it will examine the issue further.
The Secretary of State said that prevention was better than cure. The “General Practice Forward View” refers to a £2.4 billion increase in investment by 2020. Can the Secretary of State assure us that that crucial investment in primary care will be protected and not used to plug hospital deficits?
Mr Hunt
It is a vitally important investment. The first speech that I made as Health Secretary after the last election was made to GPs, and I said then that we wanted to deliver an extra 5,000 doctors working in general practice. It is vital that we eliminate hospital deficits, but we are making good progress in doing so.
John Howell (Henley) (Con)
Does my right hon. Friend agree that, when it comes to funding the forward view, the treatment of patients in their homes is not principally about cost-cutting but is part of a radical change in health provision for the future on which clinicians agree?
Mr Hunt
Absolutely. The simple principle for those of us who are not doctors is that it is much cheaper to nip illnesses in the bud than to wait until they progress. Treating someone at stage 1 or 2 of cancer is not only cheaper for the NHS, but much more likely to lead to a full cure. That is the whole foundation of the strategic change that we are making in the NHS.
Ms Angela Eagle (Wallasey) (Lab)
My constituents who are watching these exchanges will think that the Secretary of State is living in a parallel universe. The sustainability and transformation programme in Merseyside is reputed to be tackling a £1 billion deficit. The way in which it has decided to tackle it in Wirral, in my area, is to draw up plans to close Clatterbridge, our cancer hospital, to close Arrowe Park, our acute hospital, to close the Countess of Chester hospital, and to create some new hospital in Ellesmere Port at some time in the future. No one believes the blather from this Secretary of State.
Mr Hunt
I do not recognise the plans the hon. Lady is talking about, but I say to her that we do need to change our service provision; we are dealing with many more older people, and her constituents need better care at home and in the community than they are currently getting. Any big changes will be subject to a proper consultation, and would indeed go before the Independent Reconfiguration Panel and if necessary end up on my desk. I also say to the hon. Lady that setting her face against all changes may be—
Richard Drax (South Dorset) (Con)
Does my right hon. Friend agree that patients get better in a cosy environment in community hospitals, and can he give me an assurance that he will love and maintain them for as long as he is in post?
Mr Hunt
I am sure that no one could do a better job of loving and maintaining community hospitals than my hon. Friend. Community hospitals have an important role to play. I have three excellent ones in my constituency. At best, they represent the change we need to see in the NHS, which is personalised care closer to home, but that does also mean that they sometimes need to change the way they deliver services within a building even if the NHS logo remains firmly on the outside of that building.
Emma Reynolds (Wolverhampton North East) (Lab)
I was proud to sign the cross-party letter to the Chancellor on NHS funding, in which we quote the Care Quality Commission saying that
“adult social care…is approaching a tipping point”
and that is having an impact on those who rely on it and on “the performance” of the NHS. Does the Secretary of State recognise that this Government’s cutting social care funding by over a third was a false economy, that there will still be a gap in social care funding even if all councils took up the precept and that, for as long as we have that, we will have hospital deficits and delays?
Mr Hunt
I do recognise the pressures in the social care system, but, in an era of very constrained national finances, funding for the social care system is going up by £3.5 billion a year by the end of this Parliament, which is a significant and important rise. I say to the hon. Lady that it is this Government who have set the CQC free to tell us the honest truth about the quality of care in our hospitals, GP surgeries and social care system, and it is because of that that we are able to have the kinds of questions and answers we are having today.
Helen Whately (Faversham and Mid Kent) (Con)
This Government have shown their commitment to the NHS, promising and delivering increases in funding, unlike the Opposition parties. My right hon. Friend recognises the connections between health and social care and is driving the integration of those two areas. May I urge him to continue looking at both the funding and performance of health and social care in the round?
Mr Hunt
I congratulate my hon. Friend on her excellent question. I absolutely agree with her, as someone who worked in healthcare before she came to this House, that it is vital to nurture the links between the health and social care systems if we are to deal with some of the issues that concern Members on both sides of the House. There are some very good examples of where this is working well, but it is not happening in as many places as it needs to, and we all must focus on that.
Daniel Zeichner (Cambridge) (Lab)
The Secretary of State was in Cambridge on Friday. Did he have an opportunity to notice that at Addenbrooke’s, the hospital that serves Cambridge, the number of over-85s coming into A&E has risen by almost 12% year on year, and on Friday there were 100 over-85s in that hospital who should have been out in the community? Does he agree that that is proof perfect of the failure of this Government’s policies on social care, which are the root cause of the problems in our NHS?
Mr Hunt
The hon. Gentleman is looking at the record of this Government: we have 1,200 more doctors in our A&E departments, who are treating within four hours 2,500 more people every single day. We are also putting more money into the NHS and into the social care system. Addenbrooke’s is a hospital under great pressure, but it is determined to co me out of special measures and do its best for patients, and I salute all the staff, whom I much enjoyed meeting there on Friday. The one thing they would not want is the NHS budget to be cut from current levels.
Robert Jenrick (Newark) (Con)
The Secretary of State knows that over 50% of the deficit at my local trust, Sherwood Forest Hospitals NHS Foundation Trust, and 25% of all its annual revenue goes on paying off its PFI premium. Will the Secretary of State take this opportunity to look again at my trust and others? Will he also remind the House which party left that toxic legacy for my constituents?
Mr Hunt
I am happy to remind the House, as my hon. Friend requests, that we inherited this situation from the Labour party in 2010. Despite that toxic legacy, the people working in the Sherwood Forest hospitals have done an incredible job of turning the trust around since it was put into special measures a few years ago. I commend them on their progress, which I hope will bear fruit and allow the trust to come out of special measures soon.
Mr Speaker
I would like to conclude these exchanges by 4.30 pm because there is other pressing business. If people take a long time, they are preventing their colleagues from contributing. I am sorry, but it is as simple as that.
Derek Twigg (Halton) (Lab)
Does the Secretary of State believe that there is a need for additional funding for adult social care over and above that which has been already allocated?
Mr Hunt
We are putting extra money into adult social care, and local authorities have the ability to increase their funding to adult social care through the new precept. In an ideal world, everyone would like more money to go into the NHS and social care system, but Government Members know that those systems are powered by a strong economy and that we can increase our budget only at a rate that the economy can afford. The past six years show that if we take care of the economy, we can increase the NHS and social care budget, and that is what we are doing.
Michael Fabricant (Lichfield) (Con)
Is it not the case that there will never be enough money to go into the NHS? Does the Secretary of State, like me, find the sanctimonious finger-wagging from the Opposition Front-Bench team utterly nauseating given that Carwyn Jones in Wales said that the Labour Government there would make an 8% cut to the NHS in Wales? That is the legacy of Labour.
Mr Hunt
That is absolutely the point. In Wales, people wait twice as long to have a hip replaced and the figure on A&E is about 10% lower than in England. The consequences for patients in Wales are horrific. That is why everyone watching today’s exchanges will take them with a big pinch of salt.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
The Health Committee has been quite clear that of the actual £4.5 billion being spent by the Government on increased funds—not the £8 billion or the £10 billion mentioned by the Secretary of State— £3.5 billion comes from cuts to public health and to education and training. The Secretary of State can come to the Dispatch Box and twist it all he likes, but he has been found out. Every health sector worker in this country has his number and knows him to a tee—we know exactly what he is doing.
Mr Hunt
I just do not agree with the hon. Gentleman. I stand by the numbers. I am afraid that, on this occasion, the Health Committee got its numbers wrong. The figure of £10 billion did not come from the Government; it was a figure that the NHS said that it needed. In fact, it needed less than £10 billion and we are delivering more than was asked for—something that the Labour party was not prepared to do.
Matt Warman (Boston and Skegness) (Con)
The Secretary of State has taken an interest in the rurality and sparsity that hospitals in Lincolnshire wrestle with. Will he confirm that it is because this Government are spending half a trillion pounds on the NHS over the course of this Parliament that workers and patients at Pilgrim hospital, for example, can be confident about the hospital’s future?
Mr Hunt
All NHS facilities in my hon. Friend’s constituency and across the country can be confident that the NHS has a bright future. In fact, if we are to deliver the NHS plan, more rural and remote places are precisely where we must pay most attention to keeping people healthy and well in their homes. That is why not only community hospitals, but GP surgeries and all the places upon which rural communities depend are a vital part of the NHS’s future.
Tristram Hunt (Stoke-on-Trent Central) (Lab)
I wrote to the Secretary of State over the summer because trollies were bumper to bumper in the corridors of Royal Stoke University hospital. This was not mid-winter but high summer. Since then, there have been more hospital bed closures in cottage hospitals, so I repeat my invitation and ask the Secretary of State to come to Stoke-on-Trent and see for himself the crisis in the funding settlement, which is hitting some of those with the most chronic health conditions.
Mr Hunt
I am happy to visit the hon. Gentleman’s local hospital, as I have been concerned about it for some time. I know that things have been particularly challenging there in the wake of what happened in neighbouring Mid Staffs, which has created its own pressures on the hospital. I also know that its staff work extremely hard in very challenging circumstances, so, yes, I will visit that hospital.
Edward Argar (Charnwood) (Con)
Does my right hon. Friend agree that achieving improvements in public health comes down not simply to the amount of money spent by the Government on it, but to a range of factors, including how it is spent, regulation, education and individuals’ choices?
Mr Hunt
I absolutely agree with that. This House should be very proud of the fact that, according to the UN, when it comes to public health this is the fifth healthiest country on the planet—after Iceland, Andorra, Singapore and Sweden, if my memory serves me correctly. That is a record we want to continue.
Mr Dennis Skinner (Bolsover) (Lab)
A lot of figures have been bandied about today. For the record, when Labour inherited office in 1997 the amount spent on the NHS was £33 billion, whereas by the time we left office in 2010, 13 years later, the figure had gone up to £100 billion. It is an easy figure to calculate: three times more in real terms. We can contrast that with this Secretary of State for Health, who is coming here today fiddling figures and shutting Bolsover hospital.
Maggie Throup (Erewash) (Con)
It is clear to me that the NHS cannot rely solely on the Government to achieve financial sustainability; nor should it be used by some as a political football. Does my right hon. Friend agree that there is a responsibility on all NHS stakeholders to work together to cut waste where it exists, and towards a long-term sustainable social care programme?
Mr Hunt
My hon. Friend is absolutely right about that, which is why we need to make difficult efficiency savings—around £22 billion during this Parliament. We made about £18 billion to £19 billion-worth of savings in the previous Parliament, so I think it is doable. It will not be easy, but she is right in what she says.
Wes Streeting (Ilford North) (Lab)
If things are as rosy as the Secretary of State is making out, why is the London Borough of Redbridge, where I am an elected Member, suffering from public health cuts and, even while charging the social care precept, is still barely able to cover the costs of wage increases, let alone improve the service? He should have been lobbying the Chief Secretary this afternoon, not painting this ridiculously unjustifiable rosy picture.
Mr Hunt
I do not think the hon. Gentleman was listening to my statement, which said clearly that the NHS is under unbelievable pressure. It does not really work for the Labour party to campaign for increases in the minimum wage, which we read about today, and then to criticise the increasing costs in the adult social care system caused by the national living wage that was introduced by this Government.
Jason McCartney (Colne Valley) (Con)
Will the Secretary of State look at splitting the Calderdale and Huddersfield NHS Foundation Trust, so that the disastrous PFI deal at Halifax, where we will pay £700 million for a hospital that cost £64 million, will stop dictating the closure and downgrading of services at Huddersfield?
Mr Hunt
I salute my hon. Friend for the campaign he is leading at the moment, standing up for his constituents. He is right to point to PFI as one of the principal causes, and we now have to find a way to deal with that issue in a way that improves and does not detract from the quality of care offered to the people he represents.
Andy Slaughter (Hammersmith) (Lab)
According to Sir Richard Sykes, the chair of Imperial College Healthcare NHS Trust, “the problem is funding”, we are “killing” NHS staff by making them work 18 hours a day, and it is not in a position to close any more accident and emergency facilities in north-west London because there is not the capacity to do so. How is the NHS in north-west London supposed to save £1.3 billion over the next four years, as its sustainability and transformation plan proposes?
Andy Slaughter
Give a serious answer to a serious question—you’re a buffoon! [Hon. Members: “Ooh!”]
Mrs Anne Main (St Albans) (Con)
It is regrettable that the Chair of the Select Committee, my hon. Friend the Member for Totnes (Dr Wollaston), has led this attack on a Government who are doing so much. Will my right hon. Friend tell me what more is being done to recoup the money that should have been clawed back from those who had health insurance and who should not have used our system?
Mr Hunt
My hon. Friend is right to point out that problem. For years, under the previous Government, there was a total resistance anywhere in the NHS to ensuring that the only people who received care free at the point of use were people paying for the NHS through the taxes that they or their families pay. That is something to which we will put a stop. There is much more work to be done. We have the second biggest aid budget in the world. That is the way that we help developing countries, but we cannot have an international health service.
Lilian Greenwood (Nottingham South) (Lab)
NHS trusts’ deficits are now the worst that they have ever been, with 85% of acute hospitals unable to balance their books. That situation will be made even worse as the falling value of the pound raises the cost of imported medicines and equipment. What assessment has the Secretary of State made of the extra funding needed to protect the NHS from the devaluation of sterling following the Brexit vote? What will he do to support trusts, such as Nottingham University Hospitals NHS Trust, which are already in deficit?
Mr Hunt
There are indeed a number of cost pressures in the NHS, but the NHS also has the advantage of being the single largest purchaser of healthcare products—equipment and medicine—in the world, and therefore we have huge scope to get better prices for those things than we currently get. We are supporting hospitals such as the one in the hon. Lady’s constituency by centralising procurement and bearing down on the cost of agency staff and locum staff. Given that pay accounts for more than 70% of the typical hospital trust, that will help.
Chris Davies (Brecon and Radnorshire) (Con)
Labour in my home area of Wales has cut the NHS by 8%. Can my right hon. Friend confirm to this House that he will never follow its example?
Mr Hunt
It is not just the money that Labour has cut. It has refused to set up an independent inspectorate of hospitals such as we did in England, which is the sure way of knowing that we never have a repeat of what happened at Mid Staffs. I urge the Welsh Government to think again about their approach to that.
Jenny Chapman (Darlington) (Lab)
Darlington’s A&E is among the one in three earmarked for closure or downgrading. In his opening response to what is an urgent question, not a statement, the Secretary of State said that he did not accept that figure of one in three. How many A&Es will be downgraded, or does he not know?
Mr Hunt
Those plans come up from local areas. The NHS is not projecting that we will have significant reductions in the need for emergency care over the next few years. What matters is that we make sure that, yes, people can get to an A&E near them, but that when they get there, they get the right expert care, and that is what local areas are working on.
Clive Efford (Eltham) (Lab)
In my constituency, a nurse-led practitioner service has been closed because of a lack of resources. Similarly, stroke rehab has been cut because of a lack of resources. Our A&Es are not meeting waiting times, and are now under threat because their orthopaedic services have been privatised and handed out to Circle, which may not contract back to their local healthcare trust, thereby undermining the capacity to maintain those A&Es. Does the Secretary of State accept responsibility for any of that?
Margaret Greenwood (Wirral West) (Lab)
I am particularly concerned that the Government are cutting supply in public health to create demand for a private healthcare market, which means that, like the United States, we will have a two-tier system. I was very concerned by the vague response that the Secretary of State gave to my hon. Friend the Member for Wallasey (Ms Eagle). Will he guarantee this afternoon that there will be no closures of Arrowe Park hospital, Clatterbridge hospital or the Countess of Chester?
Mr Hunt
With respect to local service provision, these things are decided locally. If the hon. Lady wants to dig up the old chestnut about the privatisation of the NHS, let me say that the outsourcing of services to the private sector increased much faster under her Government than under this Government. If we did have those malign motives for the NHS, increasing its budget by £10 billion over the course of this Parliament and increasing doctor training by one of the biggest increases in its history would be a strange way of going about it.
Health Service Medical Supplies (Costs) Bill
Jeremy Hunt ExcerptsMonday 24th October 2016
(9 years, 9 months ago)
Commons ChamberRead Full debate Health Service Medical Supplies (Costs) Act 2017 View all Health Service Medical Supplies (Costs) Act 2017 Debates Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move, That the Bill be read a Second time.
This is a short and focused Bill which is vitally important not only for the NHS but for patients. NHS spending on medicines is second only to staffing costs. The Health and Social Care Information Centre—now NHS Digital—estimated that the NHS in England spent over £15.2 billion on medicines during 2015-16, a rise of nearly 20% since 2010-2011. With advances in science and our ageing population, those costs can only continue to grow.
Medicines are of course a vital part of patient care in the NHS, both in hospitals and in the community. Thanks to the research and development efforts of the life sciences industry—an industry which contributes £56 billion and tens of thousands of jobs to the UK economy every year—our understanding of diseases and the best way to treat them has improved dramatically over the past 20 years. Who would have thought for instance that UK work pioneering superconducting magnets would result in MRI scanners—scanners which would save hundreds of lives each year through the early detection of breast cancer—or that the remarkable research by our National Institute for Health Research into translational medicine would lead to scientific breakthroughs in areas such as gene therapy being taken from the lab to the clinic? In a six-year period this has led to 340 patents, generating over £80 million from intellectual property.
This Government are committed to ensuring that patients get access to innovative and cost-effective medicines as quickly as possible. I pay tribute to the work carried out by my hon. Friend the Member for Mid Norfolk (George Freeman), who worked tirelessly in government to promote the life sciences industry, and who established the accelerated access review to provide clear recommendations on how the Government, the NHS and the industry can work together to ensure patients benefit from transformative new products much more quickly. That review was published today and is an excellent document which challenges everyone in the medicines system to up their game.
Our mission is to continue our progress in ensuring patients get rapid access to life-changing and cost-effective medicines. However, we also need to ensure that we are getting the best value for the NHS, which is why we have brought this Bill before the House.
The purpose of the Bill is to clarify and modernise provisions to control the cost of health service medicines and to ensure sales and purchase information can be appropriately collected and disclosed. These provisions will align the statutory and voluntary cost control mechanisms currently in existence, allow the Government to control the cost of excessively priced unbranded generic medicines, and ensure we have comprehensive data with which to reimburse people who dispense medicines. Taken together, these measures will enable us to secure better value for money for the NHS from its spend on medicines.
James Cartlidge (South Suffolk) (Con)
I congratulate my right hon. Friend on this effort. I recently received a written answer saying that last year GPs spent £85 million prescribing paracetamol. A packet of 500 mg paracetamol costs 19p in Asda, and I wonder whether this Bill will enable us to look those costs and whether such prescribing is appropriate.
Mr Hunt
I am grateful to my hon. Friend for raising that issue. Although the measures he mentions are not directly covered in this Bill, he reminds the House that the business of getting value for money from our drugs business is everyone’s business throughout the NHS. There is a huge amount of prescribing of medicines that is not strictly necessary. Indeed, we had further evidence of that from the Academy of Medical Royal Colleges this morning. My hon. Friend makes an extremely important point: this Bill is part of the effort to get better value for money from our medicines budget, but initiatives such as the one he talks about are equally important.
Steve McCabe (Birmingham, Selly Oak) (Lab)
Further to that question, I can see how the Bill will deal with the issue of debranding, and that is very welcome, but I understand there are three other areas of concern. There is the question of price delay, which the Competition and Markets Authority has been looking at, and there are the problems of tying and bundling and so-called loyalty schemes, all of which act to inflate the cost of medicines to the NHS artificially. Will the Bill also deal with those areas?
Mr Hunt
It will deal with some of those concerns, and we will listen to all the concerns raised by hon. Members during the progress of the Bill. On the particular issue the hon. Gentleman raises, the CMA is already investigating the behaviour of pharmaceutical companies in certain situations, but it has become clear to us that there is a particularly unethical and unacceptable practice of drugs companies getting control of generic drugs for which they command a monopoly position and then hiking the prices. There was one product whose price increased by 12,000% between 2008 and 2016, and if the price had stayed the same as before the increase, the NHS would have spent £58 million less. The Government’s conclusion is that the simplest and quickest way to sort this out is through new legislation, but I will happily take the hon. Gentleman’s other concerns offline and look into them further.
John Glen (Salisbury) (Con)
I welcome the provisions of the Bill that will close a loophole and deal with terrible examples of where the NHS is in effect exploited, but can my right hon. Friend point to the future in light of the suggestion that the drugs bill will increase to £20 billion by 2020—a much more significant increase than can be afforded under the projected expenditure in the NHS? What bigger measures need to be put in place for us to deal substantively with that bigger problem?
Mr Hunt
My hon. Friend is right in that we see demand for NHS services, which includes treatment and drugs, increasing by a total of around £30 billion over the next five-year period, which is a huge amount and certainly more than we as a country can afford without changing practice. That is why we are implementing a very challenging series of efficiency reforms designed to make sure that we can afford to continue current levels of NHS service on the £10 billion increase this Government are putting in. Part of that is indeed measures such as those in this Bill to control the drugs bill. My hon. Friend is also right that going forward over the next 25, rather than five, years we will be seeing the bigger issue of the accelerating pace of innovation in science. That provides great opportunities for the NHS, but potentially great pressures for the budget, and I am sure we will continue to discuss those issues extensively in this House.
Dr Andrew Murrison (South West Wiltshire) (Con)
What assessment has my right hon. Friend made of the impact this Bill might have on the parallel trade in pharmaceuticals, which he will know has both costs and benefits for the NHS and for patient care?
Mr Hunt
My hon. Friend obviously knows about these matters in a great deal of detail and should be reassured that this Bill should prevent people who are part of the current voluntary pharmaceutical price regulation scheme—PPRS—from parallel-importing through European subsidiaries, which currently under single market rules we are not able to do anything about. That loophole will be closed.
The first element of the Bill relates to controls on the cost of branded medicines. For many years the Government have had both statutory and voluntary arrangements in place with the pharmaceuticals industry to limit the overall cost of medicines to the NHS. Companies can choose to join either the voluntary scheme or the statutory scheme. Each voluntary scheme typically lasts for five years before a new scheme is negotiated.
The current voluntary scheme is the 2014 PPRS. The objectives of that agreement include keeping the branded health service medicines bill within affordable limits while supporting the availability and use of effective and innovative medicines. For industry, the PPRS provides companies with the certainty and backing they need to flourish both in the UK and in the global markets.
The current PPRS operates by requiring participating companies to make a payment to the Department of Health of a percentage of their NHS sales revenue when total sales exceed an agreed amount. So far the PPRS has resulted in £1.24 billion of payments, all of which have been reinvested back into the health service for the benefit of patients.
Rob Marris (Wolverhampton South West) (Lab)
The early part of the Bill appears incredibly tortuous, because it relates to whether something is under the voluntary scheme or the statutory scheme and to switching back and forth between the two. Is that because we have a voluntary scheme which started in 2014 and will run until 2019, and the Government intend not to renew it? If the Government are minded to consider renewal in 2019, why have parallel schemes making the whole thing much more complex than it needed to be?
Mr Hunt
The hon. Gentleman makes an important point. It will be for this House and the Government to reflect prior to 2019 on whether it is worth carrying on with two schemes, which has been the arrangement for many years. Successive PPRS voluntary agreements have covered the vast majority of sales to the NHS and the statutory scheme has been a back-up for people who do not want to participate in the voluntary scheme. Recently, however, there has been an element of gaming the system whereby more and more firms have been moving from the voluntary scheme into the statutory scheme. The Bill will remove the incentives for them to switch between schemes and will make the benefits to the NHS essentially the same whichever scheme people choose. It will be for this House to reflect on and for the Government to consider whether the dual structure is right going forward.
Daniel Zeichner (Cambridge) (Lab)
The Secretary of State tells us that £1.24 billion has come back through the rebate, but many are puzzled about where that money has been spent. Can the Secretary of State tell us?
Mr Hunt
Absolutely. The money comes back to the Department of Health and is invested in the NHS. Indeed, it would be wonderful if it was more than £1.24 billion, because there is an awful lot of need on the NHS frontline right now; the funds are much needed. Our concern is that companies have been exploiting the differences between the voluntary and statutory schemes, particularly the loophole, which the Bill seeks to close, that if companies have drugs in both schemes, we are unable to regulate at all the prices of the drugs that would ordinarily fall under the statutory scheme. That is why the Bill is so important.
Kit Malthouse (North West Hampshire) (Con)
Notwithstanding the Bill’s objectives, which I can see are admirable, does the Secretary of State accept that hundreds of millions of pounds could be saved in the drugs budget if there was better analysis of NHS prescription patterns? I have called before for the appointment of analytical pharmacists to look at the balance between prescription efficacy and cost and at trying to increase the use of biosimilars. Some of that £1.24 billion could be invested in that greater analysis.
Mr Hunt
Yes. My hon. Friend makes an important point. The third part of the Bill will provide for much better data collection to allow that analysis to take place. We are also seeking to break down the barriers between the pharmacy sector and general practice. During this Parliament, we will be financing 2,000 additional pharmacists to work in general practice so that we can learn exactly those sorts of lessons.
Dr Sarah Wollaston (Totnes) (Con)
Further to that important point about biosimilars, and in welcoming this legislation and the opportunity to create savings for the NHS, will the Secretary of State also address the long-standing issues around Lucentis and Avastin? The hon. Member for Mid Norfolk (George Freeman) updated the House about the barriers in both domestic and European legislation that prevent the use of Avastin—it is not licensed for wet age-related macular degeneration—but the scale of savings could be so vast that there is a case for introducing measures in the Bill to allow for such issues to be addressed.
Mr Hunt
I am happy to look into that—some of my own constituents have been affected by that issue. I am not aware that there is scope to consider that important point in the Bill, but we should reflect on what we can do to deal with some of the anomalies in the drug licensing regime that lead to the unintended consequences that my hon. Friend talks about.
We have a statutory scheme for companies that are not in the PPRS that is based on a cut to the list price of products, rather than a payment mechanism on company sales. Since the introduction of the rebate mechanism in the PPRS, the volumes of drugs going through it have been lower than estimated. At the same time, the statutory scheme has delivered lower savings than predicted. The inequity between the two schemes has led to some companies making commercial decisions to divest products from the PPRS to the statutory scheme, further reducing the savings to the NHS.
Last year, the Government consulted on options to reform the statutory medicines pricing scheme by introducing a payment mechanism, in place of the statutory price cut, broadly similar to that which exists in the PPRS. Our clear intention was to put in place voluntary and statutory schemes that were broadly comparable in terms of savings. Of course, companies are free to decide which scheme to join and may move from one to the other depending on the other benefits they offer, but the savings to the NHS offered by both schemes should be broadly the same.
NHS respondents to the consultation supported our position, but the pharmaceutical industry queried whether the Government had the powers to introduce a statutory payment system. Following a review of our legislative powers, we concluded that amendments should be made to clarify the existing powers to make it clear that the Government do have the power to introduce a payment mechanism in the statutory scheme. The Bill does that by clarifying the provisions in the NHS Act 2006 to put it beyond doubt that the Government can introduce a payment mechanism in the statutory scheme. The Bill also amends the 2006 Act so that it contains essential provisions for enforcement action. Payments due under either a future voluntary or statutory scheme would be recoverable through the courts if necessary. That would include the power to recover payments due from any company that leaves one scheme to join the other.
The powers proposed in the Bill to control the cost of medicines are a modest addition to the powers already provided for in the 2006 Act to control the price of and profit associated with medicines used by the health service. The powers are necessary to ensure that the Government have the scope and flexibility to respond to changes in the commercial environment. The intended application of the powers will, of course, be set out in regulations. We will provide illustrative regulations to reassure the House that we will be fair and proportionate in exercising the powers.
Rob Marris
I voted for the 2006 Act, but I have to say to the Secretary of State that profit controls are pretty draconian, particularly for a Conservative Government. The Government appear to be extending them when we have historically dealt with what society refracted through this House as excessive profits through taxation, such as the windfall tax on banks and so on. The Secretary of State now proposes to extend profit controls to a major part of the economy, which would no doubt be loved by the Leader of Her Majesty’s Opposition. To a socialist such as me, a Conservative Secretary of State doing that seems a bit counterintuitive. Could he say a bit more about why he is extending profit controls?
Mr Hunt
Our march on to the centre ground carries on apace. [Laughter.] In response to the hon. Gentleman’s fascinating point, I gently reassure him that our approach will be fair and proportionate. This is not about bringing in wide profit controls. It is important to say that we recognise—our view is shared across the House—the pharmaceutical industry’s incredibly important role in medical advances, and we want Britain to be its European centre of operations post-Brexit. Many Members have campaigned about dementia and we hope that we can get a cure—it could happen in this country—and we recognise that profits are what fund the research that makes such remarkable changes possible.
It is important, however, that we are able to see what profits are being generated from a company’s choice between the PPRS scheme and the statutory scheme as a clue to whether the company is being fair to the NHS, which is funded by taxpayers. That is why the Bill’s measures strike the right balance.
Mark Field (Cities of London and Westminster) (Con)
I hope that not only the Opposition but Government Members are reassured by those comments in response to the hon. Member for Wolverhampton South West (Rob Marris). Will the Secretary of State take this opportunity to emphasise the great contribution that the pharmaceutical industry makes not only in this country but as a global player? As he says, the profit motive is important to ensuring the competition that allows for reform and the new drugs that will transform our lives and the lives of future generations.
Mr Hunt
I am happy to give that reassurance. As I said, this industry contributes £56 billion to the UK economy, with tens of thousands of jobs. When the Prime Minister talks about where she sees our competitive advantage, she talks, first, about financial services, and life sciences is the very next industry she mentions. I completely agree with right my hon. Friend about its incredible importance, not just to this country but to the future of humanity. That is why we seek in this Bill to establish a fair relationship between the NHS, which we have to represent as we are funding it through the tax system, and the pharmaceutical industry. It is also fair to say that there have been times when some pharmaceutical companies’ practices have been disappointing, and because we want to make sure that that does not happen and that we can continue with a harmonious and productive relationship we are proposing this Bill to the House.
Kevin Foster (Torbay) (Con)
We agree that this is not about profit controls—about having a fair return for investment made—but about tackling an emerging business model that could almost be seen as profiteering.
Mr Hunt
My hon. Friend is right about that. The nice way of putting it is that we are closing a loophole. If one were being less polite, one might say that it is a shame we are having to do that. None the less, it is important to do what we are proposing to the House.
We recognise that it has been some time since the Government consulted on the options, and I wish to reassure hon. Members and those companies in the statutory scheme that we will consult further on the implementation of a payment mechanism in the statutory scheme, including the level of the payment mechanism, before the regulations come into force. We estimate that 17 companies would be affected by the introduction of a payment mechanism, with the 166 companies that are currently members of the PPRS not being affected. Our proposals would save health services across the UK an estimated £90 million per year.
The second key element of this Bill amends the 2006 Act to strengthen the Government’s powers to set prices of medicines where companies charge unreasonably high prices for unbranded generic medicines. We rely on competition in the market to keep the prices of these drugs down. That generally works well and has, in combination with high levels of generic prescribing, led to significant savings. However, we are aware of some instances where there is no competition to keep prices down, and companies have raised their prices to what looks like an unreasonable and unjustifiable level. As highlighted by the investigation conducted by The Times earlier this year, there are companies that appear to have made it their business model to purchase off-patent medicines for which there are no competitor products. They then exploit a monopoly position to raise prices. We cannot allow this practice to continue unchallenged. My Department has been working closely with the Competition and Markets Authority to alert it to any cases where there may be market abuse and provide evidence to support this, but we also need to tackle it within our framework for controlling the cost of medicines and close the loophole of de-branding medicines. Although the Government’s existing powers allow us to control the price of any health service medicine, they do not allow controls to be placed on unbranded generic medicines where companies are members of the voluntary PPRS scheme. Today, most companies have a mixed portfolio of branded medicines and unbranded generic medicines. For that reason, all the manufacturers of the unbranded generic medicines mentioned in the investigation by The Times are able to use their PPRS membership to avoid government control of their prices.
It should be said that that practice is not widespread, but a handful of companies appear to be exploiting our freedom of pricing for unbranded generic medicines where there is no competition in the market, leaving the NHS with no choice but to purchase the medicine at grossly inflated prices or to transfer patients to other medicines that are not always suitable. Alongside the Government, many in the industry would also like to see this inappropriate behaviour stamped out.
Norman Lamb (North Norfolk) (LD)
I very much agree with the point that the Secretary of State has just made. He talked about collaboration with the CMA. Can he give any indication as to whether he expects action to be taken on abuse in the marketplace, given that a small number of companies have behaved appallingly?
Mr Hunt
I cannot give the right hon. Gentleman that indication because, as he will know, the CMA operates completely independently, and I therefore do not know what its findings are going to be. Of course, I would support any action that it recommended. I do, however, think that this Bill can give us some security in the House that if the CMA is unable to find evidence in the specific cases it has before it, we will be able to take action as a Government, provided the House is willing to support the Bill.
Mike Wood (Dudley South) (Con)
Has my right hon. Friend made any assessment of how the prices of the drugs quoted in the article in The Times compare with those paid in other health services and by healthcare providers in other western European countries?
Mr Hunt
We have made some assessments of those things, but, in essence, our concern is that, even without comparisons with what is happening in other countries, we are talking about totally unreasonable behaviour. I mentioned one example earlier, but I can give another of a medicine whose price increased by 3,600% between 2011 and 2016. I just do not think we can justify that. Given that we want to have strong, harmonious, positive relationships between the NHS and the pharmaceutical industry, we need to eliminate the possibility of that kind of behaviour happening in the future.
This Bill therefore amends the 2006 Act to allow the Government to control prices of these medicines, even when the manufacturer is a member of the voluntary PPRS scheme. We intend to use the power only where there is no competition in the market and companies are charging the NHS an unreasonably high price. We will engage with the industry representative body, which is also keen to address this practice, on how we will exercise this power.
The final element of the Bill will strengthen the Government’s powers to collect information on the costs of medicines, medical supplies and other related products from across the supply chain, from factory gate to those who supply medicines to patients. We currently collect information on the sale and purchases of medicines from various parts of the supply chain under a range of different arrangements and for a range of specific purposes. Some of these arrangements are voluntary, whereas others are statutory. The Bill will streamline the existing information requirements in the 2006 Act relating to controlling the cost of healthcare products. It will enable the Government to make regulations to require all those involved in the manufacture, distribution or supply of health service medicines, medical supplies or other related products to record, keep and provide on request information on sales and purchases. The use of this information would be for defined purposes: the reimbursement of community pharmacies and GPs, determining the value for money that the supply chain or products provide; and controlling the cost of medicines. This will enable the Government to put the current voluntary arrangements for data provision with manufacturers and wholesalers of unbranded generic medicines and manufactured specials on a statutory footing. As the arrangements are currently voluntary, they do not cover all products and companies, which limits the robustness of the reimbursement price setting mechanism.
A statutory footing for these data collections is important so that the Government can run a robust reimbursement system for community pharmacies. I know that some colleagues have raised concerns about the implications of our funding decisions for community pharmacies, and today I want to reassure the House that this Bill does not impact on those decisions, nor does it remove the requirement for consultation with the representative body of pharmacy contractors on their funding arrangements in the future. However, the information power will give us more data on which to base those discussions and decisions, rather than relying on data only available to us under voluntary schemes and arrangements. The information power would also enable the Government to obtain information from across the supply chain to assure themselves that the supply chain is, or parts of it are, delivering value for money for NHS patients and the taxpayer—we cannot do that with our existing fragmented data.
Mrs Flick Drummond (Portsmouth South) (Con)
In this regard, will my right hon. Friend be giving consideration to asking pharmacies that can prepare their own medicines—aqueous cream and things—as tremendous sums could be saved for the NHS? Will he be considering that in the overall scheme of getting information on the medicines they are providing?
Mr Hunt
The information we collect might make it possible for us more robustly to analyse issues such as the one my hon. Friend rightly brings to the House’s attention. Even if it does not, we should consider the issue, and I am happy to write to her to see whether we can make more progress in that area.
I also wish to reassure the House about the application of the information power to the medical technology industry. More than 99% of the companies supplying medical technologies to the NHS are small and medium-sized enterprises. Their products may be less high profile than the latest cancer medicine, but they are no less innovative or vital for patients. We have no interest in placing additional burdens on those companies.
The 2006 Act already provides powers for the Government to require suppliers of medical technologies to keep and provide information on almost any aspect of their business. This Bill will clarify and modernise those powers, and I am committed to exercising them in a way that is fair and proportionate to companies, to the NHS and to taxpayers who rightly demand value for money from the supply chain. Companies are currently required to hold information on their income and sales for six years for tax purposes. We will work closely with industry to ensure that the requirement to keep and record data does not significantly increase this burden.
My officials have already been in discussion with all parties across the supply chain—for both medicines and medical devices—about these powers to ensure that their implementation is robust but proportionate. We will provide illustrative regulations to aid debate on these provisions. I also want to reassure colleagues that, following Royal Assent, a full and open consultation will take place on the regulations specifying the information requirements.
I thank Ministers and their officials in the devolved Administrations for their constructive input and engagement with my Department on the Bill. Although many of its provisions are reserved in relation to Scotland and Wales, some information requirements that currently apply to England only could also apply in the territories of the devolved Administrations.
We intend to propose amendments to the Bill to reflect the agreement between the Government and the devolved Administrations, so that information from wholesalers and manufacturers can be collected by the Government for the whole of the UK and shared with the devolved Administrations. That avoids the burden created by each country collecting the same information.
The Welsh Government have also asked me to enable them to obtain information from pharmacies and dispensing GPs—a power that the Scottish Government and the Northern Ireland Executive already have. The Government will therefore propose an amendment to the Bill to amend the NHS (Wales) Act 2000 so that Welsh Ministers can obtain information from pharmacies and dispensing GPs.
Medicines are a vital part of the treatment provided by our NHS. Robust cost control and information requirements are key tools to ensuring that NHS spending on medicines across the UK continues to be affordable. They also help to deliver better value for taxpayers and to free up resources, thereby supporting access to services and treatments. This Bill will ensure that there is a more level playing field between our medicines pricing schemes while ensuring that the decisions made by the Government are based on more accurate and robust information about medicines’ costs. It will be fairer for industry, fairer for pharmacies, fairer for the NHS, fairer for patients and fairer for taxpayers, and I commend it to the House.
Accelerated Access Review
Jeremy Hunt Excerpts(9 years, 9 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
This morning Sir Hugh Taylor has published the final report of the accelerated access review (AAR). The AAR was tasked with making recommendations to the Government on reforms to accelerate access for NHS patients to innovative medicines, medical technologies, diagnostics and digital products. The report sets out a framework of recommendations to streamline and accelerate the pathway for new products from development to their use with patients and to enable widespread adoption across the NHS.
The Government welcome Sir Hugh’s final report and are grateful to him, Sir John Bell, the external champions and the external advisory group for their excellent work, which draws upon contributions from many individuals and organisations from patient groups, the NHS, industry, academia and clinicians. We are grateful for the important input that this review has had from NHS England NICE, the MHRA and NHS Improvement.
The report provides us with a strong basis to make the right decisions about how the health system can be adapted to meet the challenges of the future, attract inward investment, grow our thriving life sciences industry and use innovation to improve patient outcomes in the context of the financial pressures on the NHS. It will be important to implement this report in a way that is affordable for the NHS. The Government will now consider the proposals in detail with our partners and will provide a fuller response in due course.
The Government remain strongly committed to the life sciences and to building a long-term partnership with industry. It is determined to help the UK become the best place in the world to produce new drugs and products that can transform the health of patients, where the research, development, regulatory, commercialisation and investment infrastructure enable innovation to flourish and thrive while improving patient’s lives.
AAR Final Report (AAR final.pdf) can be viewed online at: http://www.parliament.uk/business/publications/ written-questions-answers-statements/written-statement/Commons/2016-10-24/HCWS209/.
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Healthcare Safety Investigations
Jeremy Hunt Excerpts(9 years, 9 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
“There is a culture within many parts of the NHS which deters staff from raising serious and sensitive concerns and which not infrequently has negative consequences for those brave enough to raise them”
(Sir Robert Francis QC, Freedom to Speak Up report - http://webarchive.nationalarchives.gov.uk/2015021815 0343/https:/freedomtospeakup.org.uk).
The NHS has an excellent track record in recruiting and developing the very best—the brightest, the most dedicated and the most caring. Our staff have a passion for providing the highest quality care that they can, and a commitment to continuously improving their knowledge and their skills. We must not forget that what staff learn through the experience of giving care is at least as valuable as what they are taught in the lecture theatre. Learning through experience is the key to improving the quality of people's care. This includes learning from mistakes.
We need to create the right conditions to enable staff to learn from their experiences, including their mistakes. All too often, they tell us that there is a culture of blaming, not learning. That is why the Government want to change the atmosphere in which NHS staff work.
There is a strong connection between ‘psychological safety’ and a culture of learning within an organisation. In a true culture of learning, staff can feel confident they will be treated fairly, and patients and families can be assured that errors and the causes of them will be fully explored. Creating and sustaining this broader culture of psychological safety and learning is down to leaders and managers in the system. For them to be able to do so, the Department of Health, as steward of the health system, needs to set the right conditions for such a culture to flourish.
Recent inquiries have illustrated that staff need to feel more confident that the information they give to safety investigations, which have the sole function of learning from errors, will not be used unfairly. That is why we are proposing to create a “safe space”—a statutory requirement that information generated as part of a safety investigation will be kept confidential and will not be shared outside the investigation’s boundaries, except in a number of limited circumstances.
This is used currently by the Air Accident Investigation Branch (AAIB), where investigators are able to offer this safe space to those they speak to, thanks to the robust statutory framework in which they work, arising from regulation-making powers in primary legislation. A key aspect of this statutory framework is the duty not to share information given in the course of an investigation with any other individual or body, unless (usually) there is a High Court order.
The proposal outlined in this consultation is to create a statutory prohibition on the disclosure of material obtained during certain health service investigations unless the High Court makes an order permitting disclosure, or in a limited number of other circumstances.
This broadly mirrors the regime followed in the area of air accidents investigations. It would allow the investigator to say to staff involved in incidents:
“This investigation is not to attribute blame. The information you give me as part of this investigation will not be passed on to those not involved in the investigation unless there is a High Court order, or if the information you provide demonstrates to me there is an active and ongoing threat to patient safety represented by the practice or actions of one or more individuals that requires action”.
The safe space approach is designed to improve patient safety standards over time, by enabling clinicians to discuss openly and honestly their experiences, including aspects of care that ought to be improved. These are valuable lessons that others can learn from, and will improve standards, potentially across the whole system. By concentrating on finding these more widely applicable lessons, safe space investigations will address themes rather than re-examine specific cases. But should the investigation uncover evidence of immediate risks to patient safety, criminal activity, serious misconduct or seriously deficient performance then the police or relevant professional regulator will be informed and will take the appropriate immediate action.
Creating a safe space is also a difficult balance to achieve—between reassuring staff that the information they give will not be passed on, while also reassuring patients and families that they have the full facts of their, or their loved one, care. We all want the standard of that care to get better and better each year. The purpose of this consultation is to seek the views of patients, the public and the professionals who work in the NHS about our proposed approach. In particular, we want to find out from them about what needs to be changed, added, or strengthened in order to achieve the learning not blaming culture that will underpin quality improvement in the NHS.
Attachments can be viewed online at: http://www.parliament. uk/business/publications.
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