NHS: Learning from Mistakes

Jeremy Hunt Excerpts

Wednesday 9th March 2016 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, Madam Deputy Speaker, I would like to update the House on the steps that the Government are taking to build a safer, seven-day NHS. We are proud of the NHS and what it stands for and proud of the record numbers of doctors and nurses working for the NHS under this Government, but with that pride comes a simple ambition: our NHS should offer the safest, highest-quality care anywhere in the world. Today, we are taking some important steps to make that possible.

In December, following the problems at Southern Health NHS Foundation Trust, I updated the House about the improvements that we need to make in reporting and learning from mistakes. NHS professionals deliver excellent care to 650,000 patients every day, but we are determined to support them to improve still further the quality of that care, so this Government have introduced a tough and transparent new inspection regime for hospitals, a new legal duty of candour to patients and families who suffer harm, and a major initiative to prevent lives from being lost through sepsis. According to the Health Foundation, the proportion of people suffering from the major causes of preventable harm has dropped by a third in the last three years, so we are making progress, but we still make too many mistakes. Twice a week in the NHS we operate on the wrong part of someone’s body and twice a week we wrongly leave a foreign object in someone’s body. The pioneering work of Helen Hogan, Nick Black and Ara Darzi has estimated that 3.6% of hospital deaths have a 50% or more chance of being avoidable, equating to over 150 deaths every week.

Despite that, we should remember that our standards of safety still compare well with those in many other countries. However, I want England to lead the world in offering the highest possible standards of safety in healthcare. Therefore, today I am welcoming Health Ministers and healthcare safety experts from around the world to London for the first ever ministerial-level summit on patient safety. I am co-hosting the summit with the German Health Minister, Hermann Gröhe, who will host a follow-up summit in Berlin next year. Other guests will include Dr Margaret Chan, director general of the World Health Organisation, Dr Gary Kaplan, chief executive of the renowned Virginia Mason hospital in Seattle, Professor Don Berwick, and Sir Robert Francis QC.

We will discuss many things, but in the end all the experts agree that no change is permanent without culture change. That change needs to be about two things: openness and transparency about where problems exist; and a proper learning culture to put them right. With the new inspection regime for hospitals, GP surgeries and care homes, as well as a raft of new information now published on My NHS, we have made much progress on transparency, but as Sir Robert Francis’s “Freedom to speak up” report told us, it is still too hard for doctors, nurses and other front-line staff to raise concerns in a supportive environment.

Other industries, in particular the airline and nuclear industries, have learned the importance of developing a learning culture, not a blame culture, if safety is to be improved. Too often, the fear of litigation or professional consequences inhibits the openness and transparency we need if we are to learn from mistakes.

Following the commitment I made to Parliament at the time of the Morecambe Bay investigation, we will from 1 April set up our first ever independent healthcare safety investigation branch. Modelled on the air accidents investigation branch that has been so successful in reducing fatalities in the airline industry, it will undertake timely, no-blame investigations. As with the air accidents investigation branch, I can today announce that we will bring forward measures to give legal protection to those who speak honestly to investigators. The results of such investigations will be shared with patients and families, who will therefore get to the truth of what happened much more quickly. Unlike at present, however, those investigations will not normally be able to be used in litigation or disciplinary proceedings, for which the normal rules and processes will apply. The safe space that they will therefore create will reduce the defensive culture too often experienced by patients and families, meaning that the NHS can learn and disseminate lessons more quickly, so that we avoid repeating mistakes.

My intention is to use the reform to encourage much more openness in how the NHS responds to tragic mistakes: families will get the full truth faster; doctors will get support and protection to speak out; and the NHS as a whole will become much better at learning when things go wrong. What patients and families who suffer want more than anything else is a guarantee that no one else will have to re-live their agony. The new legal protection will help us to promise them, “Never again.” Fundamental to the change is getting a strong reporting culture in hospitals under which mistakes are acknowledged, not swept under the carpet.

Today, NHS Improvement has also published a “learning from mistakes” ranking of NHS trusts, drawing on data from the staff survey and safety incident reporting to show which trusts have the best reporting culture and which need to be better at supporting staff who want to raise concerns. It will be updated every year in a new Care Quality Commission state of hospital quality report, which will also contain trusts’ own annual estimates of their avoidable mortality rates and have a strong focus on learning and improvement. Furthermore, the General Medical Council and the Nursing & Midwifery Council guidance is now clear: where doctors, nurses or midwives admit what has gone wrong and apologise, the professional tribunal should give them credit for that, just as failing to do so is likely to incur a serious sanction.

The Government remain committed to further reform to allow professional regulators more flexibility to resolve cases without stressful tribunals. The culture change must also extend to trust disciplinary procedures, so NHS Improvement will ask for a commitment to openness and learning to be reflected in all trust disciplinary procedures and ask all trusts to publish a charter for openness and transparency, so that staff can have clear expectations of how they will be treated if they report clinical errors.

Finally, from April 2018, the Government will introduce the system of medical examiners that was recommended in the Francis report, which will make a profound change to our ability to learn from unexpected or avoidable deaths, with every death either investigated by a coroner or scrutinised by a second independent doctor. Grieving relatives will be at the heart of the process and will have the chance to flag any concerns about the quality of care and cause of death with an independent clinician, meaning that we get to the bottom of any systemic failings much more quickly. The NHS is one of the largest organisations in the world and learning from mistakes and becoming the world’s largest learning organisation is how we will offer the safest, highest-quality standards of care. I commend the statement to the House.

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[Heidi Alexander]

Thank you, Madam Deputy Speaker. I ask the Health Secretary: how can he stand here and say that he wants the NHS to deliver the highest-quality care in the world when the people he depends upon to deliver that care for patients have said, “Enough is enough”? How can he talk about patient safety when he knows that his £22 billion-worth of so-called “efficiency savings” in the next four years will lead to job cuts and will heap more pressure upon a service that is about to break?

I know the Health Secretary has been shy about visiting the NHS front line in the past few months, but if we speak to anyone who has any contact with the NHS, the message we will hear is clear: the financial crisis facing the NHS is putting patient care at risk. The independent King’s Fund recently said:

“Three years on from Robert Francis’s report into Mid Staffs, which emphasises that safe staffing was the key to maintaining quality of care, the financial meltdown in the NHS now means that the policy is being abandoned”.

That is simply not good enough. For those people who have experienced failures of care and for those staff working in environments so pressurised that they fear for the quality of care they are able to deliver, the Health Secretary needs to get his head out of the sand. I say this to him: measures to investigate and identify harm are all well and good but there needs to be action to prevent harm from happening in the first place—fund the NHS adequately, staff it properly and you might just give it a fighting chance.

[Mr Hunt]

The hon. Lady had the chance to be constructive. I do welcome her commitment to a safer NHS, but we need actions and not just words from the Labour party if its conversion to improving patient care is to be believed. She mentioned the junior doctors’ strike. Patients and their families will have noticed that, when it came to the big test for Labour—whether to back vulnerable patients, who need a seven-day NHS, or the British Medical Association, which opposes it—Labour has chosen the union. She brought up the topic, so let me just remind the House of what Nye Bevan, the founder of the NHS, said about the BMA:

“this small body of politically poisoned people have decided to…stir up as much emotion as they can in the profession…they have mustered their forces on the field by misrepresenting the nature of the call and when the facts are known their forces will disperse.”—[Official Report, 9 February 1948; Vol. 447, c. 36-39.]

Bevan would have wanted high standards of care for vulnerable people across the whole week and so should she.

The hon. Lady also challenged the Government on safety, so let us look at the facts. Under this Government: MRSA down 55%; clostridium difficile down 42%; record numbers of the public saying that their care is safe; the proportion suffering from the major causes of preventable harm down by a third during my period as Health Secretary; and 11 hospitals with unsafe care put into special measures and then taken out of special measures, with up to 450 lives saved according to that programme. Before she gets on her high horse, she should compare that with Labour’s record: avoidable deaths at Mid Staffs, Morecambe Bay, Basildon and many other hospitals; care so bad we had to put 27 hospitals into special measures; the Department of Health under Labour a “denial machine”, according to Professor Sir Brian Jarman; and contracts that reduced weekend cover in our hospitals passed by the last Government. They made a seven-day NHS harder—we are trying to put that right. The hon. Lady mentioned money, but she stood on a platform to put £5.5 billion less into the NHS every year than this Government. On the back of a strong economy, we are putting more resources into the NHS. A strong NHS needs a strong economy, and Labour had better remember that.

Let me look at some of the other points the hon. Lady raised. What I said in my statement about the GMC and NMC guidance was that, having said it would change, that guidance has changed and it is now clear that people are going to be given credit in tribunals for being open and honest about things that have gone wrong. She challenged me about the timing for the introduction of medical examiners, so let me remind her of the facts: the Shipman inquiry third report recommended medical examiners in 2003, Labour failed to implement that over seven years, and in six years we are implementing it, which is what I announced today. I am confident that there will not be additional burdens on local government.

The hon. Lady talked about the issue of supporting trusts that do not have the right reporting culture, and that is exactly what we are doing today, because we have published the names of not only the trusts that do not have a good reporting culture, but the names of those that do have a good reporting culture—trusts such as Northumbria Healthcare NHS Foundation Trust, Oxleas NHS Foundation Trust and many others. The trusts that are struggling with this can learn from them.

The hon. Lady says that I need to do more, but, with respect, let me say that the measures we have taken on openness, transparency and putting quality at the heart of what the NHS does and needs to stand for go a lot further than anything we saw under the last Labour Government. I say to her that it says rather a lot that, on a day when this Government have organised a summit, with experts from all over the world, on how to make our hospitals safer, the Labour party is lining up with unions against safer seven-day services. I urge her to think again and to choose the more difficult path of backing reform that will help to make our NHS the safest healthcare system in the world.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

What a shame that the hon. Member for Lewisham East (Heidi Alexander) did not take the opportunity today to condemn the strikes. Supporting unions and not patients will not impress anyone.

May I welcome my right hon. Friend’s excellent statement, join him in paying tribute to the people who work in our NHS, and particularly welcome the setting up of the healthcare safety investigation branch and the system of medical examiners, which will contribute to better results and better outcomes in the health service?

The Secretary of State has taken a personal interest in sepsis, particularly by responding to the UK Sepsis Trust and Dr Ron Daniels, the Mead family, who tragically lost their son, William, and other relatives of patients who have died of sepsis. He knows that the ombudsman report of September 2013 contained many recommendations, including a request for a public awareness campaign, which could save lives. Will the Secretary of State tell us what progress he has made with that, because the relatives who are campaigning seem to have been waiting a long time for this public awareness campaign that they believe will help greatly?

[Mr Hunt]

I thank my right hon. Friend for her campaigning work on sepsis. Indeed, I have met the Mead family with her. She does a fantastic job with the all-party parliamentary group on sepsis. We announced a plan in January last year as this is a major area where we need to increase knowledge both inside the NHS and among the general public. As I mentioned a couple of weeks ago at a meeting organised by the all-party group, we are now looking at putting in place a public information campaign. We need to establish whether that should be about just sepsis, or whether it should be a more general public information campaign to help parents to understand when they need to worry about a fever, which is very common among small children and might be due to reasons other than sepsis, with meningitis being an obvious one. We are doing that detailed work now and we want to get this absolutely right, but I commend her persistence in ensuring that we deliver our commitments in this area.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome the statement from the Secretary of State, particularly with regard to the establishment of medical examiners, which we have had in Scotland since last year. I, too, ask why there is a delay of another two years before that comes on stream. As a doctor, the thing that always seemed obvious to me was what might have made a difference with Shipman. Of all the things that have been enacted, someone reviewing deaths might have made that difference. I do not underestimate the importance of audit, and learning from routine audit, rather than depending on just whistleblowing.

In Scotland, we had an audit of surgical mortality in the 1990s. The first thing that that showed was the people dying who had not had a sufficiently senior surgeon involved in their case. That was discussed with the profession, and practice changed. Future years identified a situation with a consultant surgeon at the front line and a junior anaesthetist, but that, too, changed. The audit identified the lack of high-dependency nursing units for the sickest patients. I suggest that working with such an audit and the profession, as we have done for coming up to 20 years, would have allowed the evolution of a stronger, safer seven-day emergency service. I again call on the Secretary of State to commit to looking at a surgical approach, the things that are missing—access to scans and radiology—and perhaps more senior review and senior involvement. This is not about junior doctors and it is not blanket.

We also need to look at the ratio of staff. Francis and other research have shown the importance of nursing staff. Staff who do not have a minute to stop and think will make mistakes, and will not have time to report them. We need to make this easy. There must be a culture in which people have the time to minimise mistakes.

I have a final plea. The Secretary of State is offering more support to whistleblowers, but a review and reconciliation for those who have been badly treated in the past might give people more confidence that, if they step up and report something significant, they will not be hung out to dry, as has been the case previously.

[Mr Hunt]

I contrast the tone of the hon. Lady’s response with that of the shadow Health Secretary. Although I by no means agree with everything she said, she does make some important points.

It is not the case that we have delayed the medical examiners scheme. In the previous Parliament, we had pilots so that we could understand exactly how the examiners would work. That is relevant to the hon. Lady’s other point about audit, with which I completely agree. One thing that medical examiners will be able to do is to look for unexpected or unexplained patterns in deaths. Obviously, the vast majority of deaths are routine, predictable and expected, but those examiners will be able, looking at audit tools, to identify where there are things to worry about, which is why this is an important next step.

With respect to whistleblowers, I will reflect on what the hon. Lady says. We are trying to eliminate the need for things ever to get to the point where someone has to become a whistleblower. We want to ensure that people are supported to speak out about mistakes they have seen or made and concerns that they have, and that they are confident that they will be listened to. We are publishing a table today about the quality of the reporting culture. Much of the raw data that allow us to rank trusts on the quality of reporting data come from the NHS staff survey, which asks staff how valued they think they are, and how safe and easy it is to raise concerns. That is why this is a big step forward.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my right hon. Friend for his statement and for taking forward so many of the recommendations that were made a year ago in the Public Administration Committee’s report on investigating clinical incidents in the NHS. I particularly thank him for implementing the creation of a safe space, which has been a controversial and difficult subject because some people think that this is about hiding stuff, when in fact it is about getting people to speak much more openly and freely. Will he say something about how that will be implemented without primary legislation?

[Mr Hunt]

I thank my hon. Friend for his question. He and I have talked many times and thought very hard about how we can learn lessons from the air industry. He is one of the people who came to me first to say that if we want to set up an equivalent to the air accidents investigation branch, we need to give people in the healthcare world the same legal protections that others have when they are speaking to that branch, and that is at heart of the statement that I have made to the House today.

The point about safe space is very, very important. This is not about people getting off scot free if they make a terrible mistake. There is no extra protection here for anyone who breaks the law, commits gross negligence or does something utterly irresponsible. Patients still have those protections. What they gain is the comfort that we will get to the truth and learn from mistakes much more quickly. Every single patient and bereaved family says that the most important thing is not money, but making sure that the system learns from what went wrong. We will ensure that we construct the safe space concept, and I do not rule out extending that beyond the investigations of the healthcare safety investigation branch.

[Kevin Barron (Rother Valley) (Lab)]

In welcoming the statement, may I say that, in my experience on the General Medical Council and on the Health Committee, the biggest cloud that hangs over the culture of non-reporting in the national health service is litigation? Last year it cost the British taxpayer £1.1 billion, £395 million of which went on legal costs alone. Should we not be looking at a no-fault liability scheme inside the national health service so that we can really encourage cultural change?

[Mr Hunt]

The right hon. Gentleman is absolutely right that the fear of litigation has a very pernicious effect, which we see across the NHS. Litigation is a huge drag on costs and we are reforming how it works. We have looked at what happens in other countries. In Sweden, for example, the creation of a no-blame culture has had the dramatic impact of reducing maternity and neo-natal injury. I hope that today’s statement is a step towards that, but we will consider other reforms to the litigation process as well.

[Sir Edward Garnier (Harborough) (Con)]

The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), and I had a useful debate this morning in Westminster Hall about clinical negligence cases, and what the Secretary of State has said this afternoon clearly touches on that. I might be being obtuse, but the statement seems to relate to the internal investigation of the poor or mistaken conduct of doctors by the disciplinary system, and not to the resistance to, or the conduct of, clinical negligence cases. I hope I am wrong about that, because we do not want, despite the best of intentions of the Secretary of State, as identified in the statement, to make the settlement of just clinical negligence cases more difficult, more expensive and more sclerotic. I read in the papers this morning that there would be a need for a court to give consent to the use of particular information. It might well be that this morning’s trails were inaccurate and do not reflect what the Secretary of State intends, but I wonder whether he could disentangle internal and external reactions to poor conduct.

[Mr Hunt]

I shall do my best for my right hon. and learned—and eminent—Friend. We do not want to affect the legal rights of anyone who wishes to litigate against the NHS because they feel they have been treated badly. Those rights must remain, and we will protect them, but we want to make it easier to get to the truth of what happened so that we can learn from mistakes. The information uncovered by a healthcare safety investigation branch investigation could not be used in litigation proceedings without a court order. However, my belief is that having those investigations carried out by the branch is quite likely to speed up court processes, because I think it will establish on all sides, in greater likelihood, agreement about what actually happened in any particular situation. I hope that that will be beneficial, but if anyone wants to use the evidence in litigation, they will have to re-gather it, because we are concerned that, if doctors are worried that anything that they say could be used in litigation, they may be hesitant about speaking openly, and that represents the defensive culture that we are trying to change.

[Norman Lamb (North Norfolk) (LD)]

I welcome the measures set out in the statement. The Secretary of State will not be surprised to hear that I want to focus on safety in mental health. The statement seems to be quite focused on acute hospitals. At the summit taking place today, will there be a specialist focus on safety in mental health? The Secretary of State will remember that the Government announced last February an ambition to achieve zero suicide, but he will be aware that there has been a significant increase in serious incidents and in the reporting of unexpected deaths and suicides. I do not know where that project has got to, but would he be prepared to meet me to discuss how we can develop the zero-suicide ambition, which has achieved such a reduction in deaths in the city of Detroit in the United States? The same can happen here if we have the same focus and ambition.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Before the Secretary of State answers that important question, I remind the House that we have a lot of business to get through today. Shorter questions and correspondingly shorter answers would be welcomed by those who are waiting to take part in other debates.

[Mr Hunt]

As ever, I commend the right hon Gentleman’s interest in mental health. May I reassure him that this is very much about what happens in mental health and also the area of learning disabilities? In fact, some of the thoughts were prompted by what happened at Southern Health. It is absolutely vital that we investigate unexpected deaths in mental health as much as we do in physical health. The measures we take will go across those areas, and I am more than happy to meet him to discuss the very laudable aim of zero suicides.

[Dr Tania Mathias (Twickenham) (Con)]

May I applaud the Secretary of State for this culture of safety and learning? Will he consider increasing the use of exit interviews in the NHS? I have worked in the NHS, aid organisations and charities, and the NHS is the only one where I have not had an exit interview. May I suggest that decreasing the use of agency and locum staff, as we hope to do, provides an opportunity to learn from good staff about sharing good practice and avoiding bad practice? I absolutely applaud the world summit on patient safety, and I very much hope the Secretary of State has invited St John of Jerusalem eye hospital, from East Jerusalem. If that was somehow forgotten, please will he ensure that it is invited to the Berlin summit next year?

[Mr Hunt]

I feel prompted by my hon. Friend’s question to investigate what I am sure is excellent practice at St John of Jerusalem eye hospital. If I may, I will take away her very good point about exit interviews. We also heard a good point about agency staff. Part of the thing that inhibits a learning culture is if a large percentage of staff are in an organisation only on a provisional or temporary basis, rather than being part of regular teams and therefore not being able to transmit lessons learned. That is why we have to deal with the virus of an over-reliance on agency staff in some parts of the NHS.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

May I gently ask that the Secretary of State, if he is going to list Morecambe Bay in a litany of things to bash the previous Government over the head with, to do so while also acknowledging that the situation continued for some time under his Government and is still taking some time to turn around?

I wholeheartedly welcome the Secretary of State’s focus on patient safety and his overall approach, and I pay tribute again to the Morecambe Bay campaigners, who have done so much to trigger this improvement. However, does he share my concerns about trusts such as Morecambe Bay being forced, for a number of reasons, including for safety, to use a large number of agency staff, and about the difficulty in changing culture when that staffing situation persists?

[Mr Hunt]

Let me commend the staff at Morecambe Bay, who have been through a very difficult patch. The trust has now exited special measures, which is a very exciting step for the trust, and there has been a huge amount of work to make that possible. It feels to me that they really have turned a corner at Morecambe Bay, and we should support the staff, who have done a great job in that respect.

The hon. Gentleman raises an important point about agency staff. In particular, it is challenging to get permanent recruitment to more geographically isolated places—we find that that is a problem not just at Morecambe Bay, but across the country. However, sometimes, it can be false comfort to get in large numbers of agency staff, as not only are they extremely expensive, but they cannot offer the continuity of care that is at the heart of a safer culture, so we have to find better ways to support places such as Morecambe Bay further to improve safety.

[David Tredinnick (Bosworth) (Con)]

I congratulate my right hon. Friend on a range of initiatives, including the independent healthcare safety investigation branch, but I remind him that some of the problems that we face are staring him in the face, not least the difficulties in Leicestershire with the ambulance service. I thank the Under-Secretary of State for Health, the hon. Member for Ipswich (Ben Gummer), for seeing the right hon. Member for Leicester East (Keith Vaz) and me to discuss the problems that occur when 15 out of 25 ambulances in the county are queuing to discharge patients. The Under-Secretary talked about bringing in troubleshooters to resolve problems. Will the Secretary of State enlighten the House on what he proposes to do about these very evident problems? They require little investigation; they require action.

[Mr Hunt]

We do have a system-wide problem in Leicestershire and we are looking into it urgently. I thank my hon. Friend for raising the issue. He is absolutely right that when we talk about safety and being open about mistakes, that has to apply to the ambulance service as much as to every other part of the NHS.

[Jim Shannon (Strangford) (DUP)]

May I also welcome the Secretary of State’s statement to the House? In particular, I welcome the commitment to building a safer, seven-day NHS. In Northern Ireland, we have just announced 1,200 new nurses, 300 new professionals, extra money for autism and mental health care and, just this week, extra money to address waiting lists to build a safer, seven-day NHS—that is what we want.

The Secretary of State referred to learning from mistakes, the need for an extension of trusts’ disciplinary procedures, openness to learning and a charter for openness and transparency. What discussions has he had with the Northern Ireland Assembly Minister, Simon Hamilton, about ensuring that that system can be replicated in Northern Ireland and by regional Assemblies and Administrations across the whole of the United Kingdom of Great Britain and Northern Ireland?

[Mr Hunt]

My colleague, the hospitals Minister, will have those discussions with the Northern Ireland Health Minister. However, the hon. Gentleman is right that if we are going to have a learning culture, it needs to be across the UK, not just in England. That is why I welcome the discussions we have with the Scottish NHS and the Welsh NHS. There are things that we can learn from each other, and we should be very open-minded in doing so.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

We must all strive to improve safety and quality in the NHS, but the Health Foundation report that the Secretary of State referred to stated that 40% of patients said there were too few nurses to care for them—this is three years after the Francis report. The Government say that the NHS must learn more, but what are they doing to learn from the inquiries that have been held?

[Mr Hunt]

Well, quite a lot. For example, we have increased the number of nurses by more than 10,000 since the Francis report was published, to ensure that we do not have a problem with safety on our wards. We recognise that it is incredibly important not to have short-staffed wards, and we are making more reforms in this Parliament to ensure that we recruit even more nurses. It would be good to have some support from Labour on that.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate my right hon. Friend on his statement, although I hope that it draws on experience from other healthcare economies, as well as on the aerospace sector. When things go wrong, it is right that the NHS is frank about it and, where necessary, compensates people for what may be long-term management issues. Currently, negligence settlements are based on provision in the private sector and do not necessarily anticipate that people will be treated and managed in the NHS, which means that the service effectively pays twice for mistakes. As the Secretary of State seeks to close the Simon Stevens spending gap, perhaps he will reflect on that. I would be grateful if he could say to what extent he thinks that excessive negligence claims are influenced by the rather perverse way in which they are currently calculated.

[Mr Hunt]

Someone looking at our current system independently might say that some things are difficult to understand, including the point raised by my hon. Friend and the fact that we tend to give bigger awards to wealthier families because we sometimes take into account family incomes when we make them. We are considering that area, but we are cautious about reducing the legal rights of patients to secure a fair settlement when something has gone wrong. In the end, this is about doing the right thing for patients, and the most effective way of reducing large litigation bills—I know my hon. Friend will agree with this—is to stop harm happening in the first place, and that is what today is about.

[Mr Dennis Skinner (Bolsover) (Lab)]

If anybody should be learning from mistakes in the health service, it is the Secretary of State for Health. I have been down to the picket line today, as I have on every occasion, and I can tell him that it is hardening. There are more people on that picket line down at St Thomas’ today than I have seen in all the months since the strike began. I am a bit of an expert on picket lines; I know what it is like. Quite frankly, the biggest mistake that the Secretary of State has made is to think that he can get away with imposing a seven-day week on hospital doctors and everybody else who works in the health service, because he wants to avoid proper premium payments. When I worked in the coal mines, miners got double pay on Sundays, and they got time and a half all day Saturday. It is time he recognised that not just hospital doctors but nurses, radiologists and all the others who will have to work a seven-day week should be paid the proper money. Otherwise, pack the job in, and then he’ll be doing a service to the whole national health service.

[Mr Hunt]

Under our proposals, doctors will receive higher premium rates than lower paid nurses, paramedics and healthcare assistants. I thought the hon. Gentleman campaigned for the lower paid! The day that I stop this job will be the day that I stop doing the right thing for patients. He has constituents who need a seven-day NHS, as do I, and this Government will be there for them and will do the right thing.

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[Maria Caulfield]

Thank you, Madam Deputy Speaker. People are fed up with the NHS being talked down by Labour Members, and there was a plea to showcase the good work that is taking place in our NHS today.

[Mr Hunt]

It is so good to have someone with nursing experience in the House, and I hope that my hon. Friend will make an important contribution for many years to come. She knows what it is like on the front line, and why it is important to get this culture change. She also knows how important it is not to run down the NHS, which is doing extremely well.

[Paula Sherriff (Dewsbury) (Lab)]

Last week I received an email that was frankly heartbreaking. My constituent’s 84-year-old father, a proud and dignified man, was admitted to hospital with symptoms of a stroke, and he had to wait 14 hours for a bed. She went to visit him later that day and found him in bed wearing clothes on only his top half. He needed the toilet, and she was given a bottle to help him urinate.

[Paula Sherriff]

That was no dignified way to treat that man. Will the Secretary of State agree to an urgent investigation into safe staffing levels at Mid Yorkshire Hospitals NHS Trust, because the nursing staff told my constituent that they did not have time to fulfil her father’s basic nursing needs?

[Mr Hunt]

I am more than happy to look into that case, which is exactly the kind of thing that we are trying to stop with the measures we are bringing forward today.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

I congratulate my right hon. Friend on once again ensuring that patient healthcare and outcomes are at the forefront of his thinking, and that of professional health service workers who do such a brave job and can sometimes be caught in the crossfire. Does he agree that comments from people on the front line supporting the doctors strike—such as Mr Usman Ahmed, who started a post on Facebook by saying:

“I’ve always hated the Conservatives—a complete and utter bunch of…”;

I shall leave it there as I would not like to offend you, Madam Deputy Speaker—show that they do not care about healthcare and are more interested in their own political gain?

[Mr Hunt]

This, I am afraid, is the problem with some elements in the BMA, who are putting politics ahead of patients. As we have heard today, that is the problem in the Labour party as well.

[Rachael Maskell (York Central) (Lab/Co-op)]

Action on Sir Robert Francis’s “Freedom to Speak up” review is very welcome. There are so many cases I could cite, but when a senior junior doctor reported unsafe levels of care in an intensive therapy unit, he was subject to unacceptable behaviour such as bullying and blacklisting, and now can only work as a locum. When he wrote to the Secretary of State, the Secretary of State refused to engage, listen and learn from his experience. Learning cultures have to start at the top with the Secretary of State. Will he set out how he will address retrospective cases of whistleblowing when people have been subject to discrimination?

[Mr Hunt]

I hope that the hon. Lady is not quoting selectively from my reply to the person concerned, because when people raise issues of patient safety with me, I usually refer them to the CQC, which is able to give a proper reply. I would be very surprised if I had not done that in this case. Retrospective cases are particularly difficult, and much as we want to help, it is difficult constitutionally to unpick decisions made by courts. We are trying to separate employment grievances from safety grievances and make that the way that we solve these difficult situations.

[Mr Robin Walker (Worcester) (Con)]

Like many MPs, I have come across cases where this approach would help enormously, and I thank the Secretary of State for his statement. The same CQC report that praised staff and clinicians at Worcestershire Acute Hospitals NHS Trust for their good and outstanding care, also raised concerns about the management and safety at the hospitals. That was partly a result of too many interim managers, and a lack of ability to address and learn from mistakes made. I urge the Secretary of State to do everything in his power to work with the relevant organisations to put long-term permanent management in place at that trust, so that we take things forward and make our patients safer.

[Mr Hunt]

My hon. Friend speaks very wisely. Let me say that one thing that has been a mistake of successive Governments is a short-termist approach to NHS managers. We ourselves have looked for a scapegoat when something has gone wrong—an A&E target missed or whatever—and not backed people making long-term transformations. That is something we need to think hard about.

[Jeremy Lefroy (Stafford) (Con)]

I thank the Secretary of State for his statement and for all the work he has done on this. I pay tribute to all those who have campaigned to bring patient safety to the fore, many from tragic experiences that they have had. What work is being done to ensure that medical schools and nursing schools have patient safety right there on the curriculum?

--- Later in debate ---

[Mr Hunt]

We have looked at the curriculum very carefully. In particular, we want to make sure that people understand their responsibilities to speak out if they see mistakes or things going wrong, and to help people to understand that this may not be the prevailing culture in the hospital they go to. We are looking to a new generation of doctors and nurses to help us in changing the culture for the better.

[Amanda Milling (Cannock Chase) (Con)]

I, too, welcome my right hon. Friend’s statement. Having met the parents, he will be aware of the tragic death of three-year-old Jonnie Meek at Stafford hospital. They have been looking for answers to their questions for some time. Will he confirm that the new healthcare safety investigation branch he has announced today will give families like Jonnie’s the opportunity to find the answers they have been looking for much more quickly?

[Mr Hunt]

I thank my hon. Friend for her support for Jonnie’s parents. This is a very sad case. The independent investigator in the case talked about the closed culture he encountered at two different trusts. Indeed, that is a very good example of the change in culture we need. I have worked with them. I hope we can secure a second inquest into Jonnie’s death, so we can get to the truth. I am afraid it will be too late, but we want to get there eventually.

[Jason McCartney (Colne Valley) (Con)]

As the Secretary of State is aware, my local clinical commissioning group starts a 14-week consultation next Wednesday on proposals to downgrade A&E at Huddersfield Royal Infirmary. Does he agree that patient safety must be the priority in those decisions, not the ruinous PFI deal signed by Halifax hospital in 1998, which is the backdrop to these appalling plans?

[Mr Hunt]

No one fights harder for his constituents on healthcare matters than my hon. Friend, and I commend him for that. The process he talks about will be led by clinicians. He is absolutely right that patient safety must be of paramount importance.

[Will Quince (Colchester) (Con)]

My right hon. Friend is aware that we have one of the worst stillbirth rates in the developed world. Every stillbirth is a tragedy, and with more than 3,600 a year we must do all we can to avoid them, especially when half are preventable. I am co-chair of the new all-party group on baby loss. Does my right hon. Friend agree that it is only by looking at every single stillbirth and learning the lessons from them that we can get that number down by 20% by the end of this Parliament and by half by 2030?

[Mr Hunt]

My hon. Friend is absolutely right. I thank him for his work in this area. Maternity—stillbirths, neonatal deaths, neonatal injuries and maternal deaths—is the area where I hope we make the most rapid early progress in developing this new learning culture. There is so much to be gained. We can be the best in the world, but the truth is that we are a long way down international league tables in this area. None of us want that for the NHS. There is a real commitment to turn that around and I thank him for his support.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The prize for perseverance and patience goes to Mr Mark Spencer.

[Mark Spencer (Sherwood) (Con)]

I am grateful, Madam Deputy Speaker, even if my knees are not.

I congratulate the Secretary of State on providing a protected space for doctors, so they will be able to be honest and upfront when things go wrong, and on striking the right balance so that relatives and people who suffer wrongs in the NHS get to the bottom of what went wrong, why it went wrong and why it will not happen again.

[Mr Hunt]

I thank my hon. Friend. That is the heart of what we want to do. He of course has been very closely involved in the improvements we are trying to make at his local trust. If his knees are in pain, I can recommend a very good GP surgery in his constituency, one he very kindly showed me during the election campaign.

NHS Learning Culture

Jeremy Hunt Excerpts

Wednesday 9th March 2016 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I would like to inform the House of the steps the Government are taking to make the NHS the safest healthcare system in the world. Perhaps the single most important thing we can do is to create a learning rather than a blame culture, so that clinicians feel supported to speak out when things go wrong.

NHS Improvement is today publishing a “Learning from mistakes league”. This draws on data from the staff survey and safety reporting data to set out a league table for NHS provider organisations. This will provide information to the providers themselves as well as to the wider public about how well different organisations are learning, and how open and honest they are. The information in the league will be published on an annual basis as part of the CQC’s report on hospital care quality.

Later this month, NHS Improvement will also publish estimates by trust of avoidable mortality, and information relating to this will then be published as part of an annual CQC report on care quality in hospitals.

In addition to greater and more intelligent transparency, a culture of learning means we need to create an environment in which clinicians feel able to speak up about mistakes. We will therefore bring forward measures for those who speak honestly to investigators from the healthcare safety investigation branch to have the kind of “safe space” that applies to those speaking to the air accident investigation branch.

The General Medical Council and the Nursing and Midwifery Council have made it clear through their guidance that where doctors, nurses or midwives admit what has gone wrong and apologise, the professional tribunal should give them credit for that, just as failing to do so is likely to incur a serious sanction. The Government remain committed to legal reform that would allow professional regulators more flexibility to resolve cases without stressful tribunals.

NHS Improvement will ask for the commitment to learning to be reflected in all trust disciplinary procedures and ask all trusts to publish a charter for openness and transparency so staff can have clear expectations of how they will be treated if they witness clinical errors.

From April 2018, the Government will introduce the system of medical examiners recommended in the Francis report. This will bring a profound change in our ability to learn from unexpected or avoidable deaths, with every death either investigated by a coroner or scrutinised by a second independent doctor. Grieving relatives will be at the heart of the process and will have the chance to flag any concerns about the quality of care and cause of death with the independent clinician.

NHS England is working with the Royal College of Physicians to develop and roll out across the NHS a standardised method for reviewing the records of patients who have died in hospital.

These measures, along with the professionalism and dedication of NHS staff will help the NHS to achieve its aim of becoming the world’s largest learning organisation.

[HCWS597]

NHS Pay Review Body

Jeremy Hunt Excerpts

Tuesday 8th March 2016 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am responding on behalf of my right hon. Friend the Prime Minister to the 29th report of the NHS Pay Review Body (NHSPRB). The report has been laid before Parliament today (Cm 9210).

Copies of the report are available to hon. Members from the Vote Office, to noble Lords from the Printed Paper Office and is also available online. I am grateful to the Chair and members of the NHSPRB for their report.

We welcome the 29th report of the NHS Pay Review Body. The Government are pleased to accept its recommendations in full.

We will take forward NHSPRB’s suggestions for how we can continue to improve our support for its important work.

Report of NHSPRB (Cm 9210) (54488 Cm 9210 NHSPRB 2016), can be viewed online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-03-08/HCWS589/.

[HCWS589]

Doctors' and Dentists' Remuneration Report

Jeremy Hunt Excerpts

Tuesday 8th March 2016 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am responding on behalf of my right hon. Friend the Prime Minister to the 44th report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The report has been laid before Parliament today (Cm 9211). Copies of the report are available to hon. Members from the Vote Office, to noble Lords from the Printed Paper Office and is attached. I am grateful to the Chair and members of the DDRB for their report.

We welcome the 44th report of the Review Body on Doctors’ and Dentists’ Remuneration. The Government are pleased to accept the recommendations in full.

We will take forward DDRB’s suggestions for how we can continue to improve our support for its important work.

Report of the DDRB (Cm 9211) (54290 Doctors and Dentists Pay Review 2016), can be viewed online at: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-03-08/HCWS590/.

[HCWS590]

Junior Doctors Contracts

Jeremy Hunt Excerpts

Thursday 11th February 2016 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

Nearly three years ago to the day, the Government first sat down with the British Medical Association to negotiate a new contract for junior doctors. Both sides agreed that the current arrangements, drawn up in 1999, were not fit for purpose and that the system of paying for unsocial hours in particular was unfair. Under the existing contract, doctors can receive the same pay for working quite different amounts of unsocial hours; doctors not working nights can be paid the same as those who do; and if one doctor works just one hour over the maximum shift length, it can trigger a 66% pay rise for all doctors on that rota.

Despite the patent unfairness of the contract, progress in reforming it has been slow, with the BMA walking away from discussions without notice before the general election. Following the election, which the Government won with a clear manifesto commitment to a seven-day NHS, the BMA junior doctors committee refused point blank to discuss reforms, instead choosing to ballot for industrial action. Talks finally started—under the Advisory, Conciliation and Arbitration Service process—in November, but since then we have had two damaging strikes, which have resulted in about 6,000 operations being cancelled.

In January, I asked Sir David Dalton, chief executive of Salford Royal, to lead the negotiating team for the Government. Under his outstanding leadership, for which the whole House will be immensely grateful, progress has been made on almost 100 different points of discussion, with agreement secured with the BMA on approximately 90% of them. Sadly, despite this progress and willingness from the Government to be flexible on the crucial issue of Saturday pay, Sir David wrote to me yesterday advising that a negotiated solution was not realistically possible. Along with other senior NHS leaders and supported by NHS Employers, NHS England, NHS Improvement, the NHS Confederation and NHS Providers, Sir David has asked me to end the uncertainty for the service by proceeding with the introduction of a new contract that he and his colleagues consider both safer for patients and fair and reasonable for junior doctors. I have therefore today decided to do that.

Tired doctors risk patient safety, so in the new contract the maximum number of hours that can be worked in one week will be reduced from 91 to 72; the maximum number of consecutive nights doctors can be asked to work will be reduced from seven to four; the maximum number of consecutive long days will be reduced from seven to five; and no doctor will ever be rostered consecutive weekends. Sir David believes that these changes will bring substantial improvements to both patient safety and doctor wellbeing. We will also introduce a new guardian role within every trust. These guardians will have the authority to impose fines for breaches to agreed working hours based on excess hours worked. These fines will be invested in educational resources and facilities for trainees.

The new contract will give additional pay to those working Saturday evenings from 5 pm, nights from 9 pm to 7 am and all day on Sunday, and plain time hours will now be extended from 7 am to 5 pm on Saturdays. However, I said that the Government were willing to be flexible on Saturday premium pay, and we have been: those working one in four or more Saturdays will receive a pay premium of 30%. That is higher on average than that available to nurses, midwives, paramedics and most other clinical staff, and also higher than that available to fire officers, police officers and those in many other walks of life.

None the less, the changes represent a reduction compared with current rates, but that is necessary to ensure that hospitals can afford additional weekend rostering, and because we do not want take-home pay to go down for junior doctors, after updated modelling, I can tell the House that these changes will allow an increase in basic salary not of 11%, as previously thought, but of 13.5%. Three quarters of doctors will see a take-home pay rise, and no trainee working within contracted hours will have their pay cut.

Our strong preference was always for a negotiated solution. Our door remained open for three years, and we demonstrated time and again our willingness to negotiate with the BMA on the concerns it raised. However, the definition of negotiation is a discussion where both sides demonstrate flexibility and compromise on their original objectives. The BMA ultimately proved unwilling to do this.

In such a situation, any Government must do what is right for both patients and doctors. We have now had eight independent studies in the last five years identifying higher mortality rates at weekends as a key challenge to be addressed. Six of these say staffing levels are a factor that needs to be investigated. Professor Sir Bruce Keogh describes the status quo as

“an avoidable weekend effect which if addressed could save lives”,

and has set out the 10 clinical standards necessary to remedy this. Today, we are taking one important step necessary to make this possible.

While I understand that this process has generated considerable dismay amongst junior doctors, I believe that the new contract we are introducing, shaped by Sir David Dalton, and with over 90% of the measures agreed by the BMA through negotiation, is one that in time can command the confidence of both the workforce and their employers. I do believe, however, that the process of negotiation has uncovered some wider and more deep-seated issues relating to junior doctors’ morale, wellbeing and quality of life that need to be addressed.

These issues include inflexibility around leave; lack of notice about placements that can be a long way from home; separation from spouses and families; and sometimes inadequate support from employers, professional bodies and senior clinicians. I have therefore asked Professor Dame Sue Bailey, president of the Academy of Medical Royal Colleges, alongside other senior clinicians, to lead a review into measures outside the contract that can be taken to improve the morale of the junior doctor workforce. Further details of this review will be set out soon.

No Government or Health Secretary could responsibly ignore the evidence that hospital mortality rates are higher at the weekend or the overwhelming consensus that the standard of weekend services is too low, with insufficient senior clinical decision makers. The lessons of Mid Staffs, Morecambe Bay and Basildon in the last decade are that patients suffer when Governments drag their feet on high hospital mortality rates, and this Government are determined that our NHS should offer the safest, highest-quality care in the world.

We have committed an extra £10 billion to the NHS this Parliament, but with that extra funding must come reform to deliver safer services across all seven days. This is not just about changing doctors contracts. We also need better weekend support services such as physiotherapy, pharmacy and diagnostic scans; better seven-day social care services to facilitate weekend discharging; and better primary care access to help tackle avoidable weekend admissions. Today, we are taking a decisive step forward to help deliver our manifesto commitment, and I commend this statement to the House.

--- Later in debate ---

[Heidi Alexander]

I am grateful to you, Mr Speaker.

What impact does the Secretary of State honestly think an imposed contract will have on recruitment and retention? Earlier this week, a poll found that nearly 90% of junior doctors would be prepared to leave the NHS if a contract were imposed. How does the Secretary of State propose to deliver seven-day services with one tenth of the current junior doctor workforce? How can it possibly be right for us to be training junior doctors and the consultants of tomorrow, only to export them en masse to the southern hemisphere? The Secretary of State needs to stop behaving like a recruiting agent for Australian hospitals, and start acting like the Secretary of State for our NHS.

What advice did the Secretary of State take before making this decision? He may not want to respond to my letters, but what does he say to the Royal College of Surgeons, the Royal College of Obstetricians and Gynaecologists, and the Royal College of Paediatrics and Child Health, all of which have urged him not to impose a contract? What legal advice has he taken about how an imposed contract would work in practice? What employment rights do junior doctors have in this context, and what will happen if they simply refuse to sign?

The Secretary of State has been keen to present a new junior doctors contract as the key that will unlock the delivery of seven-day services, but that is a massive over-simplification, and he knows it. Although research shows that there is a higher mortality rate among patients who are admitted to hospital at weekends, there is absolutely no evidence to show that it is specifically caused by a lack of junior doctors. Will the right hon. Gentleman state, for the record, that he accepts that?

One of the real barriers to more consistent seven-day services is the consultants contract. Until now, at least, the BMA and the Government were making progress in those negotiations. Could not a decision to impose a new junior doctors contract put the consultant negotiations at risk, and make the delivery of seven-day services even harder? Will the Secretary of State also make it clear how the definition of unsocial hours will need to change in other contracts in order for seven-day services to be delivered, and which groups of staff that will apply to?

What we heard from the Secretary of State today could amount to the biggest gamble with patient safety that the House has ever seen. He has failed to win the trust of the very people who keep our hospitals running, and he has failed to convince the public of his grounds for change. Imposing a contract is a sign of failure, and it is about time the Secretary of State realised that.

[Mr Hunt]

The hon. Member for Lewisham East (Heidi Alexander) has made a number of incorrect statements with which I shall deal with later, but what the country will notice about her response is more straightforward. When we have a seven-day NHS, in a few years’ time, people will say that it was obviously necessary and the right thing to do. They will remember that it was not easy to get there, and they will also remember—sadly—the big call that she made today for short-term political advantage to be placed ahead of the long-term interests of patients.

Previous reforming Labour Governments might have done what we are doing today. Let me say to the hon. Lady that she has vulnerable constituents—we all have vulnerable constituents—who need a true seven-day NHS, and those are precisely the people that the NHS should be there for. Sorting this out should not be a party issue; it should be something that unites the whole House, and she will come to regret the line that she has taken today.

Let me address some of the hon. Lady’s particular points. She has said today and on other occasions that this has been badly handled. If she wants to know who has handled contract negotiations badly, it was the party that gave consultants the right to opt out from weekend work in 2003 and that gave GPs the right to opt out of out-of-hours care in 2004. Is it difficult to sort out those problems? Yes. Are we going to be lectured by the people who caused them? No, we are not.

The hon. Lady also questioned whether there was support for imposition. Let me just read her exactly what the letter that I got from Sir David Dalton says. He states that, on the basis of the stalemate,

“I therefore advise the government to do whatever it deems necessary to end uncertainty for the service and to make sure that a new contract is in place which is as close as possible to the final position put forward to the BMA yesterday.”

And what does Simon Stevens, chief executive of NHS England, say?

“Under these highly regrettable and entirely avoidable circumstances, hospitals are rightly calling for an end to the uncertainty, and the implementation of the compromise package the Dalton team are recommending.”

The hon. Lady talked about the impact on morale. Perhaps she would like to look at the hospitals that have implemented seven-day care, including Salford Royal, Northumbria and one or two others. They have some of the highest morale in the NHS, because morale for doctors is higher when they are giving better care for patients. She also says that we should not impose the contract, but what she is actually saying is that if the BMA refuses point blank to negotiate on seven-day care, we should give up looking after and doing the right thing for vulnerable patients. What an extraordinary thing for a Labour shadow Health Secretary to say. She also said that we were conflating the junior doctors contract with seven-day working. Well, let us look at what the Academy of Medical Royal Colleges said in 2012. It said:

“The weekend effect is very likely attributable to deficiencies in care processes linked to the absence of skilled and empowered senior staff”.

Most medical royal colleges say that junior doctors with experience qualify as senior staff.

The NHS has made great strides in improving the quality of care. Since I have been Health Secretary, avoidable harm in hospitals has nearly halved, nearly 20% of acute hospitals have been put into a new special measures regime—and we are turning them round—and record numbers of members of the public say that their care is safe and that they are treated with dignity and respect. The seven-day NHS is not just a manifesto commitment; we are doing this because we are willing to fight to make the NHS the safest, highest quality healthcare system in the world. Today we have seen that the Labour party is not prepared to have that fight. Does not this prove to the country that it is the Conservatives who are now the true party of the NHS?

[Mr Kenneth Clarke (Rushcliffe) (Con)]

I congratulate my right hon. Friend on taking this clear and correct decision, because it is quite obvious that after three years, the BMA was prepared to let the whole thing drag on with talks and days of action until he either abandoned the seven-day service or gave the junior doctors an enormous pay settlement in order to buy their agreement to do it. In future discussions, will he keep concentrating, as he has, on the essential public interest, which is to meet the rising and remorseless demand on the service resulting from an ageing population and clinical advance? Will he also use the extra resources that the NHS is getting at the moment to deliver a better service to patients and not allow it to be taken away, as so often happened in the past—including a little more than 10 years ago in 2003—by very large pay claims by the various staff unions, as that would lessen his ability to give us the modern NHS that he is talking about?

[Mr Hunt]

My right hon. and learned Friend speaks with great wisdom and also great experience. Many Members will remember how, when he was Health Secretary, the BMA put posters of him up all over the country saying “What do you call a man who ignores medical advice?”, and there he was, smoking his cigar. I am sure that there have been Labour Health Secretaries who have had similar treatment. He makes an important point, however. Under the new Labour Administration of Tony Blair, huge amounts of extra resources were put into the NHS but, unfortunately, because of the impact of contract changes in 1999, 2003 and 2004, weekend care actually became less effective, not more effective. Now, thanks to the tough decisions we have taken on public spending and turning the economy around, we have been able to give the NHS a funding settlement next year that is the sixth biggest in its entire nearly 70-year history. We are absolutely determined that, if we are putting that extra money into the NHS, it should come with reform that leads to better care for patients. That is the Conservative way, and we will not be deflected from it.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I should like to pick the Secretary of State up on some aspects of his statement. On Monday, I challenged the Under-Secretary of State for Health, the hon. Member for Ipswich (Ben Gummer) to step away from the term “weekend deaths”. The Freemantle paper does not show that; it shows increased 30-day mortality in people admitted at the weekend, and there is actually a lower mortality rate at weekends. The junior Minister said that the Secretary of State was really careful, but he has made that suggestion twice in his statement today, and I think that that is very misleading.

What should have come from the Freemantle paper and others is an attempt to understand why these things happen. The only study that gives a clear answer and backs up the Francis report is the Bray paper on 103 stroke units, which showed that the single most important factor was the ratio of registered nurses. We should know what the problem is before we try to fix it. The one group of staff that is there, along with the nurses, is the junior doctors. They are not the barrier to achieving the 10 standards.

I welcome the progress that has been made since last November. In a debate in this Chamber in October, the Secretary of State seemed relatively unwilling to go to ACAS, but progress has been made since the negotiations started, and particularly since Sir David Dalton became involved in the past month. I therefore found it incredible to see on the BBC this morning that, having achieved 90% agreement and following a tweet at 4 minutes past 8 saying that we should now get both sides back to the table, the Secretary of State was going to impose the contract.

The problem with the recognition of unsocial hours might increase the difficulty that we already have in recruiting people to the acute specialties: A&E, maternity and acute medicine. They are already struggling, and this might well make things worse. I also still have concerns about the role of the guardian. The problem is that a junior doctor at the bottom of a hierarchy will have to go and complain, and we can imagine how difficult that might be in a hierarchical system and how easily that doctor could be labelled a troublemaker. So there are still things to be dealt with. I welcome the progress that has been made in the last month, but this is absolutely not the time to pour petrol on the fire and then throw in the towel.

[Mr Hunt]

I welcome the tone of the hon. Lady’s comments. I do not agree with everything that she has said, and I shall explain why, but they were immensely more constructive than the comments that we have heard from other Opposition spokesmen. She is right to say that the studies talk about mortality rates for people admitted at weekends. There have been eight studies in the past five years, or 15 since 2010 if we include international studies. She is right to say that we need to look at why we have these problems.

The clinical standards state that when someone is admitted, they should be seen by a senior decision-maker within 14 hours of admission. They will be seen by a doctor before then, but they should be seen by someone senior within 14 hours. The standards also state that vulnerable people should be checked twice a day by a senior doctor. Now, across the seven days of the week, the first of those standards is being met in only one in eight of our hospitals and the second in only one in 20. That is why it is important that junior doctors should be part of the group of people who constitute those senior decision-makers—consultants are also part of it—and that is why contract reform is essential.

The hon. Lady is right to say that this is also about nurse presence, and the terms that we are offering today for junior doctors are better on average than those for the nurses working in the very same hospitals, and better than those for the midwives and the paramedics. That is why Sir David Dalton and many others say that this is a fair and reasonable offer.

With respect to A&E recruitment, the impact of the contract change we are proposing is that people who regularly work nights and weekends will actually see their pay go up, relatively, compared to the current contract. These are the people who are delivering a seven-day NHS and we must support them every step of the way.

[Dr Sarah Wollaston (Totnes) (Con)]

I know colleagues across the House will want to join me in thanking junior doctors for the valuable work they do for patients across the NHS. [Hon. Members: “Hear, hear.”] I hope that they will look very carefully at the improvements in the offer, with a 13.5% increase in the basic rate and the very important safeguard that will discourage over-rostering at weekends by giving them premium rates if they have to work more than, or including, one in four weekends. I hope the BMA will also recognise and welcome the very important appointment of Professor Dame Sue Bailey to lead an inquiry into all the other aspects that lead to discontent with junior doctors. I wonder if the Secretary of State agrees that what we now need is to move forward in a positive spirit that brings this dispute to an end, takes the temperature down and recognises that we all want the same thing: safety for patients.

--- Later in debate ---

[Mr Hunt]

I thank my hon. Friend for her very constructive comments. She is right. A 13.5% increase in basic pay is very significant, because, unlike overtime and premium pay, it is pensionable. It will help when applying for a mortgage and will mean more money on maternity leave. I think it will be much better for junior doctors.

The review that Dame Sue Bailey is doing, which was much-derided by the Opposition when I mentioned it in my statement, is actually very significant. One of the things that has gone wrong in training is that since the implementation of the European working time directive, we have moved away from the old “firm” system, which would mean that junior doctors were assigned to a consultant, who they would see on a regular basis and who was able to coach them on a continuous basis over weeks and months. That has been lost and many people think that that has led to much lower morale. We want to see what we can do to sort that out.

Finally, I want to echo what my hon. Friend said about going forward in a positive and constructive spirit. When, as a Government, we took the decision to proceed with implementing new contracts, we had the choice of many different routes, because, essentially, we can decide exactly what to choose. We have chosen to implement the contract recommended by NHS chief executives as being fair and reasonable. That is different from our original position. We have moved a considerable distance on most of the major issues, but it is what the NHS thinks is a fair and reasonable contract and we need to move forward.

[Barry Gardiner (Brent North) (Lab)]

The Secretary of State, I am sure, has the grace to acknowledge that the application rate for specialty training has fallen since the Government put forward their proposals last year, but does he have the logic to accept that if he gets fewer junior doctors the problem he is trying to solve will only get worse?

[Mr Hunt]

We now have 10,600 more doctors working in the NHS than we did five years ago and we are investing record amounts going forward. There has been a lot of smoke and mirrors about what is actually in our contract proposals. I hope all trainees and medical students will look at the proposals and see that independent people have looked over them and believe they are fair and reasonable—actually better—for junior doctors, and that we will continue to be able to recruit more doctors into the NHS.

[Sir Edward Leigh (Gainsborough) (Con)]

As one, like myself, gets a bit older—some might say clapped out—one relies on the NHS more and more. People like me—I have just had an operation and might have another coming up—get worried about strikes. I hope the Secretary of State will try, from now on, to build the morale of junior doctors. Surely the NHS is not for the Conservative party, the Labour party, doctors or nurses, but for the people? Why should people like me, who are admitted to hospital on a Saturday, have a greater chance of dying? He has to take on the vested interests and stand up for the people.

[Mr Hunt]

My hon. Friend is absolutely right. Indeed, if we look at the change happening in global healthcare, the big movement is towards putting patients in the driving seat of their own healthcare. If we want the NHS to be the best in the world, we have to be confident that we are giving patients the best care in the world. That is why I completely agree with him and why I said in my statement that there is no reason why this could not be something the whole House can unite behind. What we cannot do, however, is look at eight studies in five years and say that we will act on this just as soon as we can get a consensus in the medical profession. We have been trying to get that consensus now for over three years. There comes a time when you have to say, “Enough is enough” and do the right thing for patients.

[Mr David Anderson (Blaydon) (Lab)]

I know the Secretary of State does not usually listen to people with a bit of experience, but, as somebody who has spent 40 years dealing with trade disputes and their aftermath, may I ask him how he expects industrial relations to improve when he has imposed a contract, accused the negotiators of lying, and effectively said that the members were fooled by their own negotiators? He has now told us today that he will build into the contract a differential between the antisocial payments paid to these professionals and those paid to other professionals working next to them. That is a recipe for disaster. Will he put in the Library a full list of what he believes are the so-called lies that were told by the leaders of the BMA? Will he explain how he expects to get things back on an even keel, something that was asked for by the Chair of the Health Committee?

[Mr Hunt]

As someone who I fully concede may have more experience of industrial relation disputes than me, let me just say this: it is very clear that we are able to progress when there is give and take from both sides; when both sides are prepared to negotiate and come to a deal that is in the interests of the service and in the interests of the people working in the service. That was not possible. It is not me who is saying that; that is was what Sir David Dalton, a highly respected independent chief executive, said in the letter he wrote to me last night.

Some of the things that the BMA put out about the offer—for example, it put up on its website a pay calculator saying that junior doctors were going to have their pay cut by 30% to 50%—caused a huge amount of upset, anger and dismay, and were completely wrong. I do not think it would be very constructive for me to put in the House of Commons Library a list of all those things, when what I want to try to do is build trust and confidence. The differential between doctors and other workers in hospitals is what the BMA was seeking to protect. It still exists, but we have reduced it from what it was before because we think it is fairer that way and better for junior doctors.

[Dr Julian Lewis (New Forest East) (Con)]

May I add to what my long-time comrade, my hon. Friend the Member for Gainsborough (Sir Edward Leigh) said by delving into a bit of history? In 1977, I was knocked off a motorcycle by a careless driver on a Sunday. Because staff were not in the hospital, the wound could not be cleaned until it was x-rayed and because the wound could not be cleaned, I got an infection. This is not just about increased mortality rates; it is about the prolongation and exacerbation of small or routine episodes and injuries. Will the Secretary of State, in his calm and measured way, say again to the House that when we look back on this episode people will be very surprised that it took nearly 40 years—from my accident—to bring about this long-overdue reform?

--- Later in debate ---

[Mr Hunt]

My right hon. Friend is absolutely right. He talks about x-rays, which illustrates the point that this is not just about doctor presence but the presence of those who are able to do x-rays, MRI scans, CT scans, get results back from laboratories and so on. A whole suite of things are necessary for seven-day care. He is also right to point out that there are huge savings if we get this right. For example, if someone gets an avoidable pressure ulcer because they have not had the care that they should have received over a weekend, they are likely to have to stay in hospital for over 10 days longer. That will cost the NHS several thousand pounds more and that is why, in the end, this is the right thing to do economically as well as ethically.

[Tom Brake (Carshalton and Wallington) (LD)]

There are huge pressures everywhere in the NHS. For instance, GP out-of-hours services are under an incredible strain and cover is very limited in some parts of the country. What is the Secretary of State doing about those pressures and the additional strain that could be triggered by an exodus of doctors, following the imposition of the doctors’ contract? Will he entertain the idea of a commission, as advocated by my right hon. Friend the Member for North Norfolk (Norman Lamb) and by others on both sides of the House, to find a long-term consensual solution to the growing health and care challenges that we face?

[Mr Hunt]

The trouble with commissions is that they tend to take rather a long time to come up with their conclusions, and we need to sort out these problems now. That is why the Chancellor promised an extra £3.8 billion for the NHS next year, and why we said that we want 5,000 more GPs working in general practice, which will help out-of-hours services. We have a five-year plan that the NHS has the funding to implement, and that will transform out-of-hospital services. I hope that those developments will address the right hon. Gentleman’s concerns.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my right hon. Friend for his patience and resolution in bringing this matter to a conclusion. Does he share the real sadness that so many of us feel that these wonderful young people who come into the health service to be doctors with such high ideals are caught up in this terribly debilitating and damaging dispute? I ask him to reinforce his efforts to engage and speak directly with junior doctors and the medical profession as a whole and not allow the disruptive behaviour of the British Medical Association to destroy the relationship that we need to have with our doctors.

[Mr Hunt]

My hon. Friend is right. There was absolutely no reason to have this dispute, because the things that we are trying to sort out—seven-day care and safer care for patients—are what every doctor wants to happen. Indeed, they choose medicine as a profession from the highest of ethical motives, and we want to support them. I share his sadness that it has come to this, but given that the counter-party in the situation is not willing to budge, we have to take action to remove uncertainty and to do the right for patients and for doctors. I will certainly continue to engage. The new commission headed up by Professor Dame Sue Bailey will also look at wider issues of morale, which will make a big difference.

[Several hon. Members rose—]

--- Later in debate ---

[Kevin Barron (Rother Valley) (Lab)]

I had a further email on this subject from a doctor in my constituency this morning. He thanked me for forwarding replies from the Department, although he did say that they were disappointing. He said that the BMA had proposed a contract that met the Government’s cost-neutral requirements, but that it had been rejected. Is that true?

[Mr Hunt]

I will be pithy, Mr Speaker. This is not just about cost-neutrality, but about dealing with weekend care, which is why that proposal was not accepted.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

May I congratulate my right hon. Friend on always having at the forefront patient care and the wellbeing of young doctors? Did it not give the game away when the BMA said that this was a blow against austerity? Will he remind the House how much extra money has gone into the NHS, by contrast to what happened under the Labour party?

[Mr Hunt]

My hon. Friend is absolutely right. I am afraid that, regrettably, there are some political elements inside the BMA. The great irony is that, without the austerity measures that those same people opposed in the previous Parliament, we would not have been able to give the NHS its sixth biggest funding increase ever.

[Dawn Butler (Brent Central) (Lab)]

When I watched the Secretary of State on the TV on Sunday, two things struck me: first, he got paler as the letters from junior doctors were read out; and secondly, he made it clear that it was the senior doctors not being present that was the barrier to a full seven-day NHS. Why is it then that he is picking a fight with junior doctors?

[Mr Hunt]

We need senior decision-makers to be present. They are the most important people when it comes to delivering seven-day care. Most of the medical royal colleges accept that a junior doctor who has had a substantial amount of training does qualify as a senior decision-maker, which is why we need them more.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

The BMA has taken the oversubscribed political sub-speciality of spin doctoring to a whole new level. May I express my admiration for the Secretary of State for his ability to keep his cool under the sort of provocation that he has had, and ask how a 13.5% increase in pensionable pay could possibly lead to problems with recruitment and retention?

[Mr Hunt]

My hon. Friend speaks with personal knowledge. One of the things that has been wrong with junior doctors’ contracts for many years is that basic pay is too low. They therefore feel under huge pressure to boost basic pay by premium working, and that has led to some of the distortions that we see. So, yes, it is a significant increase in basic pay, which will be a very big step forward.

[Jack Dromey (Birmingham, Erdington) (Lab)]

I have spent 30 years in the world of work, representing employees, conducting negotiations and solving disputes. I have seldom seen a sense of grievance so grotesquely mishandled, insulting the intelligence of junior doctors by telling them that they do not understand what is on offer. Does the Secretary of State not feel a sense of shame that his handling of this dispute should have so poisoned relationships with junior doctors, who are the backbone of the national health service?

[Mr Hunt]

The hon. Gentleman can do a lot better than that. We have been willing to negotiate since June. It was not me who refused to sit round the table and talk until December; it was the BMA, which, before even talking to the Government, balloted for industrial action. What totally irresponsible behaviour that is. If Labour were responsible, it would be condemning it as well.

[Wendy Morton (Aldridge-Brownhills) (Con)]

I thank my right hon. Friend for his statement today and for all the work that he is doing to deliver a truly seven-day-a-week NHS, which we all really want for our constituents. Will he confirm that the BMA, the royal colleges, the Government and the wider NHS are all now agreed on the need to improve weekend care, which, as Professor Sir Bruce Keogh has said, is both a clinical and a moral cause?

[Mr Hunt]

My hon. Friend is absolutely right. There is a huge amount of support for doing the right thing for patients, which is why it is so extraordinary that the BMA has chosen to defend the indefensible, not to sit round and talk about how we can do this, as any reasonable doctor would have done and—to go back to the earlier question—to put out deeply misleading comments to its own members that have inflamed the situation and made it far worse than it needed to be.

[Mike Kane (Wythenshawe and Sale East) (Lab)]

The Royal College of General Practitioners has reacted to the decision to impose the contract by saying that it is shocked and dismayed. The Royal College of Psychiatrists has said that the decision will exacerbate the recruitment and retention issues that the NHS currently faces. Why does the Health Secretary ignore the concerns of those two royal colleges?

[Mr Hunt]

When those colleges have had a chance to look carefully at our proposal, they will find much that they can commend. For both psychiatrists and GPs, we are putting in a premium to attract more people into those specialties, which will be immensely important both for them and for the NHS.

[Antoinette Sandbach (Eddisbury) (Con)]

Will the Secretary of State draw to the shadow Secretary of State’s attention the research in the Netherlands that has shown that seven-day working has dramatically cut stillbirth rates—by 6.8% in the Netherlands—and has the potential to have a real impact on survival rates for young babies?

[Mr Hunt]

I commend my hon. Friend for her campaigning on that issue. She could not be more right. Just before Christmas, a report by Professor Paul Aylin said that the mortality rates for neonatal children were 7% higher at weekends, which underlines just how important it is to get this right.

[Rachael Maskell (York Central) (Lab/Co-op)]

On 5 December 2011, the Government tried to cut unsocial hours for “Agenda for Change” staff. At a time when morale right across the NHS is so low, will the Secretary of State guarantee that he will not bring forward cuts, because the reason behind the unsocial hours cut that I mentioned was to introduce seven-day working?

[Mr Hunt]

We have no plans to do so, but I cannot be drawn any further, except to say that we do have to deliver our manifesto commitments. The specific issues that we have identified with respect to seven-day working relate to consultant and junior doctor presence, and that is what we are focused on putting right.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

I thank my right hon. Friend for the very clear way in which he has kept the House up to date on the progress of all this. It is very important not only that we free up beds in hospitals, most certainly at weekends, but that we should be making much greater use of our pharmacies to deliver better healthcare within the community. Will he explain how that might happen?

[Mr Hunt]

I believe my right hon. Friend the Minister of State is with the pharmacists now discussing that precise issue. My hon. Friend raises this issue regularly and rightly: pharmacists have a very important part in the future of the NHS.

[Paul Flynn (Newport West) (Lab)]

On Sunday, I witnessed the seven-day working at a Welsh hospital, where a clinic was held in Nevill Hall for the convenience of patients and to get maximum use of an expensive gamma camera. The Secretary of State constantly denigrates the work of the Welsh health service, but will he pause to congratulate the Welsh and Scottish Governments, who avoided the misery of the strike and will also avoid the poisonous legacy of resentment that he will face from junior doctors?

[Mr Hunt]

The Welsh and Scottish Governments may have avoided the difficult decision that we are taking in the NHS in England, but the longer they go on avoiding the issue, the longer they will have higher mortality rates at weekends, which we are determined to do something about.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement. If we do not have enough junior doctors, patient safety cannot be guaranteed. In his statement, he referred to reducing the number of hours, nights, days and rostered weekends for doctors. Does he believe that that will ensure that there will be no strike? What safeguards are in place for patients, nurses and senior doctors if an agreement cannot be reached?

[Mr Hunt]

It is because an agreement cannot be reached that we have to take the measures that we are taking today. The bits of the new contract to which the hon. Gentleman draws attention are the bits that will have the biggest impact on the morale of junior doctors, because we are saying that we do not think it is right for hospitals to ask them to work five nights in a row or to work six or seven long days in a row. We are putting that right in the new contract. That will lead to less tired doctors and better care for patients.

[Jeff Smith (Manchester, Withington) (Lab)]

I met a large group of junior doctors in my constituency to discuss the new contract. They were highly professional and totally committed to the NHS, but for the first time some of them were considering working abroad. One of them told me that, although she loved her job, she would never let her daughter train as a junior doctor now. Does that not demonstrate that the low morale—the despair, frankly—and the likely flight of junior doctors as a consequence of imposition is a huge threat to the future of our NHS?

[Mr Hunt]

The biggest threat to morale for doctors is not being able to deliver the care that they came into the profession to deliver. That is why we are sorting out a proper seven-day NHS, particularly for junior doctors who work in A&E departments at weekends, where they often do not have the support they would get during the week and do not have as many consultants around as there would normally be. That is what we are trying to put right. I appreciate that it is very difficult when the counter-party in the dispute does not want to negotiate, but in the end Governments have to decide what is right for patients and what is right for the service, as well as what is right for doctors.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Hull has traditionally struggled to recruit doctors in specialties such as A&E, general practice and psychiatry. I am concerned about the royal colleges’ warning that the imposition of the contract will have a detrimental effect on staff morale and staff retention in the NHS. Will this not make things even more difficult for areas such as Hull, which struggle to recruit in the first place?

[Mr Hunt]

We want more doctors and more nurses in the NHS, but in the end, if we are putting extra money in to recruit these extra doctors and nurses, it is fair to the public who are paying for their salaries to have reforms that mean their care gets better. That will apply to the hon. Lady’s constituents in Hull, who want a seven-day NHS, just as my constituents in Surrey do.

[Paula Sherriff (Dewsbury) (Lab)]

The Health Secretary repeatedly accuses the BMA of misleading junior doctors, yet 98% of them voted for industrial action. Without exception, every doctor I have spoken to said that the last thing they wanted to do was to go out on strike. Doctors are some of the brightest and most intelligent people we have in our country. Does the right hon. Gentleman really believe that they cannot make up their minds for themselves?

[Mr Hunt]

It is interesting that when that vote was held, the BMA had not sat down and talked to the Government, despite repeated invitations. I personally met Johann Malawana, the leader of the junior doctors committee, and invited him to talks. Despite those repeated invitations, they refused to talk; they decided to ballot for industrial action. How serious are people about reaching a negotiated settlement if that is what they do?

[Liz McInnes (Heywood and Middleton) (Lab)]

Can the Secretary of State clarify something in his statement for me? He says that “those working one in four Saturdays or more will receive a pay premium of 30%. That is higher on average than that available to nurses, midwives, paramedics and most other clinical staff”. The staff he cites will be employed on bands 4 to 9 under “Agenda for Change” terms and conditions. If they work Saturdays, they receive plain time plus 30% for working then, so can the Secretary of State tell me how he has calculated an average? I do not understand his mathematics.

[Mr Hunt]

I am happy to do that. The contract that we are going to implement gives junior doctors who work more than one in four Saturdays—so one in three Saturdays —a higher premium of 50%, so when taken on average, it is a higher premium for working on a Saturday.

[Huw Irranca-Davies (Ogmore) (Lab)]

As has been pointed out by my hon. Friend the Member for Newport West (Paul Flynn), there were no strikes in Wales yesterday. However, on the point made by the hon. Member for Central Ayrshire (Dr Whitford), there was an increase of 10% in the budget, equivalent to 135 places for nurse training, which is so critical for cover. That may be what led to a communication that I received from a junior doctor in England who said, “Could we have your Minister for Wales, please?” What does it say about morale in the NHS in England when, in football and rugby parlance, the Minister has lost the confidence of the changing room?

[Mr Hunt]

I think that is the first time in living memory in this House that a Welsh MP has got up and said that they think things are better in the Welsh NHS. Just look at the waiting times that people face for basic operations on the NHS in Wales—far, far longer than in England. We will take no lectures about how to run the NHS from Labour in Wales.

[Paul Blomfield (Sheffield Central) (Lab)]

I represent three fine hospitals and one great medical school, and I spend a lot of time listening to junior doctors and medical students. The Secretary of State talks about the crisis in morale in the NHS among junior doctors. Does he not recognise that his handling of the dispute has done so much to enhance that crisis, and that today’s announcement will make it so much worse?

[Mr Hunt]

Not at all. The choice I had was to do something about mortality rates at weekends or to duck the issue. Under the Conservatives, we do not duck issues about mortality rates. We do the right thing for patients. After Labour’s record, I should have thought the hon. Gentleman would be a little more circumspect.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 9th February 2016 Commons Chamber

[Nigel Huddleston (Mid Worcestershire) (Con)]

12. What progress his Department has made on improving the performance of hospital trusts in special measures.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Eleven out of 27 hospitals have now exited special measures, having demonstrated sustainable improvements in the quality of care. Overall, trusts put into special measures have recruited 1,389 more doctors and 4,402 more nurses, with one estimate saying this has reduced mortality rates by 450 lives a year.

[Rehman Chishti]

Following the recent Care Quality Commission report on the Medway hospital, the staff and new chief executive are working hard to turn around long, historic and deep problems. What further support can the Secretary of State and the Government offer the hospital to help turn it around and get it out of special measures? I thank the Secretary of State and his Department for the support they have given to the hospital so far.

[Mr Hunt]

I thank my hon. Friend for his enormous support for that hospital, which has been through a very difficult patch. I had a long meeting with the chief inspector of hospitals about the Medway yesterday. My hon. Friend will be pleased to know that, over the past five years, we got 106 more doctors and 26 more nurses into the trust. We now have a link with Guy’s and St Thomas’s that is beginning to bear fruit. There is a lot more to do, but we are determined to ensure that we do not sweep these problems under the carpet and that we deal with them quickly and deliver safer care for my hon. Friend’s constituents.

[Daniel Kawczynski]

My right hon. Friend will know of some of the terrible problems experienced in Shropshire with respect to clinical commissioning groups and the trust, particularly over the future fit programme and A&E services in the county. The Royal Shrewsbury hospital covers a huge area—not just Shropshire, but the whole of mid-Wales. Will my right hon. Friend give me an assurance that he will do everything possible to support me and the residents of Shrewsbury to guarantee that A&E services remain at the Royal Shrewsbury hospital?

[Mr Hunt]

First, I thank my hon. Friend for his campaigning on behalf of the Royal Shrewsbury; no one could do more than he has over many years. I encourage him to engage carefully with the future fit programme. In the end, it is incredibly important to get the right answer for patients. My hon. Friend has been supportive of the process, but like him, I would like to see it concluded sooner rather than later.

[Nigel Huddleston]

Will the Secretary of State set out for my Worcestershire constituents what impact the putting of trusts into special measures is likely to have this year and what improvements can be expected when the trust exits special measures?

[Mr Hunt]

The advantage of the special measures programme is that we tend to make much faster progress in turning round hospitals in difficulty than used to happen in previous years. My hon. Friend will know that, in the past five years, his local trust gained nearly 50 more doctors and more than 100 more nurses. We are making progress, but we need to do it much faster. The hospital will have my full support in getting these problems dealt with quickly.

[Valerie Vaz (Walsall South) (Lab)]

Walsall NHS trust has been placed into special measures, so what immediate action can the Secretary of State take to ensure that the Manor hospital can recruit the vital staff in paediatrics and A&E that it now needs—not agency staff, but long-term fully employed staff?

[Mr Hunt]

The hon. Lady is absolutely right that one thing that can tip hospitals into special measures is having too high a proportion of staff from agencies so that a trust cannot offer the continuity of care that other trusts can. There have been an extra 83 full-time doctors at Walsall Healthcare NHS Trust over the past five years, along with 422 full-time nurses. An improvement director started this week and we are looking to find a buddy hospital, which is what I think will help most. When it comes to turning hospitals round the fastest, we have found that having a partner hospital can have the biggest effect, as with Guy’s and St Thomas’s for the Medway.

[Keith Vaz (Leicester East) (Lab)]

Despite having a football team at the top of the premier league, the hospitals of Leicester are in need of urgent assistance. The worry for Leicester is that they will slip into special measures, particularly regarding A&E. What steps can the right hon. Gentleman take to ensure that our hospitals perform as well as Leicester City football club?

[Mr Hunt]

We want to them to be as outstanding as Leicester City football club, but we recognise that there is some way to go. There is pressure on A&E departments, as the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), has acknowledged in the House, and we are giving careful thought to what we can do to support them. Leicester will be one of the first trusts in the country to offer full seven-day services from March or April 2017 onwards, so important improvements are being made, but we will do all that we can to ensure that they happen quickly.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Calderdale and Huddersfield trust is not in special measures, but it is in trouble, and we are likely to lose our A&E service—in one of the biggest towns in Britain—if we follow the recommendations of the CCG. Does the Secretary of State agree that when hospitals and trusts get into trouble, it is usually because of poor management? What can we do to improve the management of hospitals, and, in particular, what can we do about people who, because they are GPs, think that they are managers?

[Mr Hunt]

The hon. Gentleman has made an important point. I think that there are some things that we just need to do differently. For instance, we should allow managers to remain in their posts for longer. If the average tenure of NHS chief executives is only about two years, their horizons will inevitably be very short-term, so we need to give them enough time to turn their organisations around. The chief executive of the latest trust to be given an “outstanding” measure, Frimley Park Hospital NHS Foundation Trust, has been there for 26 years, and I think there is a connection. We can ensure that managers have the necessary resources. I think we can also make sure that we identify their problems quickly, and give them support before those problems turn into a crisis.

[Dame Angela Watkinson (Hornchurch and Upminster) (Con)]

Barking, Havering and Redbridge University Hospitals NHS Trust is working extremely hard to improve its services and has already achieved considerable success, but although there are 250 spare home beds in the London borough of Havering, there are still a great many frail elderly patients in hospital who are no longer clinically ill. Has any research been done on the reasons for delayed discharge, and to what extent does patient choice play a part in it?

[Mr Hunt]

Unfortunately, it sometimes plays a part, but the main way to tackle the problem is to establish better co-ordination between what local authorities do, what the CCGs do and what the trusts do. That applies not just to my hon. Friend’s local trust, but to trusts throughout the NHS. I do, however, commend her local trust. At its last inspection, the CQC found that it had made significant progress. It has more doctors, more nurses and, in my view, an excellent chief executive, and I am very confident about its future.

[Heidi Alexander (Lewisham East) (Lab)]

Sixteen trusts across the country are currently in special measures, nine out of 10 hospitals are failing to fulfil their own safe staffing plans and waiting time targets are being missed so often that failure is becoming the norm. Does the Secretary of State think that that might explain why, as we learned yesterday, a King’s Fund survey has found that dissatisfaction with the NHS increased by eight percentage points in 2015? That is the largest single-year increase since the surveys began in 1983.

[Mr Hunt]

The hon. Lady might want to look more closely at that King’s Fund report before turning it into a political football. According to page 6, satisfaction rates in Wales—run by her party—are six percentage points lower than those in England.

Let me tell the hon. Lady exactly what is happening with the special measures regime. We are being honest about the problems and sorting them out, rather than sweeping them under the carpet, which is what caused the problems that we experienced with Mid Staffs, Morecambe Bay and a range of other hospitals. At the same time, we are putting more money into the NHS and helping it to deal with its deficits, we are treating more people, and public confidence in the safety and dignity of the care that people are given is at record levels.

[Heidi Alexander]

It is clear that the Secretary of State does not want to talk about his record in England. His own Back Benchers are queueing up to tell him about the problems in their NHS areas of Medway, Shropshire and Worcestershire, but he seems not to understand the extent of those problems.

Let us return to what the public think. Satisfaction with the NHS has fallen by five percentage points; dissatisfaction has risen by eight percentage points; satisfaction with GP services is at the lowest rate ever recorded; and satisfaction with A&E stands at just 53%. We know that the Secretary of State has lost the confidence of doctors, but is that not the clearest sign yet that he has lost the confidence of patients, too?

[Mr Hunt]

What my Back Benches are queueing up to say is, “Thank you for sorting out the problems that Labour swept under the carpet for years and years.” What did Professor Brian Jarman of Imperial College say about the Department of Health under the last Labour Government? He said that it was a “denial machine”, with all the problems in hospitals being swept under the carpet and not dealt with. What is happening under this Government? Every day, 100 more people are being treated for cancer, 2,000 more people are being seen within four hours at A&E departments and 4,400 more operations are being carried out. There are record numbers of doctors and nurses, and the NHS is safer than ever in its history. We are proud to be the party of the NHS.

[Ian Lavery (Wansbeck) (Lab)]

3. What estimate he has made of the number of patients who went to A&E after having been unable to make an appointment with their GP in the most recent period for which figures are available.

--- Later in debate ---

[Derek Twigg (Halton) (Lab)]

5. What proportion of hospital trusts are in deficit?

[The Secretary of State for Health (Mr Jeremy Hunt)]

Trusts reported a net deficit of £1.6 billion for the first half of this financial year, with 75% of trusts reporting a deficit, which is why, last week, we launched the Carter efficiency programme in which Lord Carter confirmed that hospitals can save £5 billion annually by making sensible improvements to procurement and staff rostering.

[Derek Twigg]

Almost every acute trust will be in deficit in the coming year, including Warrington and Halton Hospitals NHS Foundation Trust and Whiston and St Helens hospitals, which cover my constituency. The fact is that the Government have been slow in dealing with one of the causes of the deficit, which is the employment of great numbers of agency staff. They also want to cut the tariff, which is based on efficiency savings, leaving hospitals such as Whiston and St Helens, which are among the most efficient in the country, struggling to make greater efficiencies. Will the Secretary of State look at that matter again?

[Mr Hunt]

The hon. Gentleman should give a slightly more complete picture of what is happening in his hospitals. There are nearly 2,000 more operations every year, 7,000 more MRI scans, and 7,000 more CT scans than there were five years ago. When it comes to the issue of deficits, we are tackling the agency staff issue. That happened because trusts were responding to the Francis report into what happened in Mid Staffs. Rightly, they wanted to staff up quickly, but it needs to be done on a sustainable basis. I simply say to him that if we were putting £5.5 billion less into the NHS every year, as he stood for at the previous election, the problems would be a whole lot worse.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Does my right hon. Friend not agree that running costs in the NHS, which vary from £105 to £970 per square metre per year as highlighted by Lord Carter, are wholly unacceptable, and that the concept of a model hospital to bring the worst up to the standard of the best, which was also highlighted by Lord Carter, has great merit?

[Mr Hunt]

My hon. Friend knows about these things from his own clinical background, and he is absolutely right. We are now doing something—it is probably the most ambitious programme anywhere in the world—to identify the costs that hospitals are paying. From April, we will be collecting the costs for the 100 most used products in the NHS for every hospital. That information will be shared. We are the biggest purchaser of healthcare equipment in the world, so we should be paying the lowest prices.

[Margaret Ferrier (Rutherglen and Hamilton West) (SNP)]

Barts Health NHS Trust, the UK’s largest hospital trust, is set to run up a £135 million deficit this year. That would be by far the greatest ever overspend in the history of the NHS. When will the Minister accept the sheer scale of the austerity-driven crisis facing the NHS?

[Mr Hunt]

It is stretching things a bit to call that an austerity-driven problem when, next year, we are putting in the sixth biggest increase in funding for the NHS in its entire 70-year history. There are some severe problems at Barts, but we will tackle the deficit. We also need to ensure that we improve patient safety and patient care.

[Jeremy Lefroy (Stafford) (Con)]

The staff of the University Hospitals of North Midlands to whom my right hon. Friend entrusted the care of County Hospital in Stafford and the Royal Stoke University Hospital have done a great job both in improving the quality of care and in bringing down the deficit. Will he ensure that a long-term approach is taken to the finances of that trust so that we do not make rapid decisions that could result in difficult situations in the future?

[Mr Hunt]

As ever, my hon. Friend speaks very wisely. When we are reducing these deficits and costs, the trick is to take a strategic approach and not to make short-term sacrifices that harm patients. That is why, at the weekend, we announced a £4.2 billion IT investment programme, which will mean that doctors and nurses spend less time filling out forms and more time with their patients.

[Mims Davies (Eastleigh) (Con)]

6. What further steps he plans to take to improve access to GPs.

[The Secretary of State for Health (Mr Jeremy Hunt)]

By 2020, everyone will be able to get GP appointments at evenings and weekends. By March this year, a third of the country—18 million people—will have benefited from improved access to GP services.

[Mims Davies]

There is a concerning recruitment issue for GPs in my constituency, Eastleigh, which has led to patients experiencing significant delays in getting non-urgent appointments. Will my right hon. Friend look into promoting more agile working structures for GPs, especially women? This was highlighted by my CCG on Friday as vital for recruiting and retaining the extra GPs we need.

[Mr Hunt]

I know that West Hampshire CCG is providing extra space and capacity to take on more trainees, and across the country we plan to have 5,000 more doctors working in general practice by the end of this Parliament. This will be the biggest increase in GPs in the history of the NHS. It builds on the extra 1,700 GPs we have working in the NHS since 2010. It does take too long to get to see a GP. We are committed to sorting that out, and the record investment in the NHS five year forward view will make that possible.

[Colleen Fletcher (Coventry North East) (Lab)]

Wyken medical centre in my constituency is due to close in March. This will leave more than 2,000 of my constituents needing to find a new GP, at a time when it is practically impossible to get a prompt GP appointment, never mind register at a new GP surgery. Can the Secretary of State therefore assure me that he will co-ordinate with NHS England to ensure that it manages the situation appropriately and does all it can to assist each of my constituents affected, particularly the vulnerable and elderly, to get access to a new GP as soon as possible?

[Mr Hunt]

I am happy to do that. The hon. Lady is right to make those points. It is to care for the vulnerable people with long-term conditions that we need to see the biggest support given to GPs, because strengthening their ability to look after people proactively will mean that those people are kept out of hospital and kept healthier, and costs are kept down for the NHS.

[Kelly Tolhurst (Rochester and Strood) (Con)]

In Rochester, we are facing the closure of two single-handed GP practices owing to a retirement and a suspension, with no long-term replacements, making it more difficult for our growing population to access these vital services. Will my right hon. Friend outline the steps he is taking to maintain appropriate access to local GPs?

[Mr Hunt]

I am absolutely prepared to do that and I have met a number of GPs in my hon. Friend’s area. We are reversing the historic underfunding for general practice, with an increase of more than 4% a year in funding for primary care and general practice for the rest of this Parliament. That will give hope to the profession, whose members are vital to the NHS.

[Jim Shannon (Strangford) (DUP)]

Northern Ireland has the lowest number of GPs per capita across the United Kingdom. In order to access GPs, we need to have GPs. In the whole of the United Kingdom of Great Britain and Northern Ireland 25% of GPs are aged over 55, and that is going to get worse. What steps have been taken to train more GPs and to ensure that they stay in the NHS and do not go overseas, where there are better wages and conditions?

[Mr Hunt]

We have plans, as I mentioned, to have 5,000 more doctors working in general practice, and there is a big interviewing process. We need to increase the number of GPs going into general practice by 3,250 every year and I am happy to liaise with the Province to see how we can work together on these plans.

[Mr Speaker]

I call next the medal-wearing member of the team which won the parliamentary pancake race this morning, against the peers and against the press.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Significant progress has been made in our negotiations with the British Medical Association on a new contract for junior doctors, but agreement has not been reached on the issue of Saturday pay, despite previous assurances from the BMA that it would negotiate on that point. So, regrettably, 2,884 operations have been cancelled ahead of tomorrow’s industrial action, which will affect all non-emergency services. I urge the BMA to put the interests of patients first and to reconsider its refusal to negotiate.

[Rosie Cooper]

At Prime Minister’s questions in February 2014, I raised with the Prime Minister my very serious concerns about the dangerous bullying culture at Liverpool Community Health NHS Trust. I understand that the Capsticks inquiry into parts of that is now complete, so will the Secretary of State, in the spirit of honouring his stated commitment to openness and transparency, ensure that that report is made available, perhaps via the NHS Trust Development Authority, if necessary, to the public trust board on 23 February?

[Mr Hunt]

I will happily look into that matter. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), has held a round table on bullying and harassment. I thank the hon. Lady for raising the issue, because over the past decade—none of us should be proud of this—the number of NHS staff who say they are suffering from bullying and harassment has gone up from 14% to 22%. If we are going to deliver safer care, we have to make it easier for doctors and nurses on the frontline to speak out without worrying about being bullied or harassed.

[Several hon. Members rose—]

--- Later in debate ---

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Today’s The Independent reports that a potential deal on the junior doctor contract was put to the Government that would have resolved junior doctors’ concerns without costing any more money and potentially avoided tomorrow’s industrial action. A source close to the negotiations told the newspaper:

“The one person who would not agree was Jeremy Hunt. Even though the NHS Employers and DH teams thought this was a solution he said no”.

So let me ask the Health Secretary a very direct question: have the Government at any point rejected a cost-neutral proposal from the BMA on the junior doctor contract—yes or no?

[Mr Jeremy Hunt]

The only reason we do not have a solution on the junior doctors is the BMA saying in December that it would negotiate on the one outstanding issue—pay on Saturdays—but last month refusing to negotiate. If the BMA is prepared to negotiate and be flexible on that, so are we. It is noticeable that despite 3,000 cancelled operations, no one in the Labour party is condemning the strikes.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

T6. Will my right hon. Friend update us on the progress in decriminalising dispensing errors for pharmacists?

[Tommy Sheppard (Edinburgh East) (SNP)]

T2. The Secretary of State will be aware that Maximus is recruiting junior doctors to perform work capability assessments in the Department for Work and Pensions. The company is offering £72,000 a year, which is up to twice the salary that junior doctors would get in the health service. Is he concerned that that will result in inexperienced medical staff making judgments that relate to people’s livelihoods? Is he not also concerned that it will result in a drain of staff resources out of the NHS and out of providing general healthcare for the public?

[Mr Jeremy Hunt]

As a result of the changes the Government have made on welfare reform, we have 2 million more people in work and nearly 500,000 fewer children growing up in households where nobody works. Part of that is making important reforms, including having independent medical assessments of people who are in the benefit system. I think everyone should welcome that.

[David Tredinnick (Bosworth) (Con)]

T8. Comparative research has shown that proton therapy is as effective as radiotherapy for certain cancers, but has fewer side effects. Do Her Majesty’s Government accept the use of comparative evidence in deciding the availability on the NHS of emerging treatments such as proton therapy?

--- Later in debate ---

[David T. C. Davies (Monmouth) (Con)]

T9. Has the Secretary of State seen the comments of Professor Angus Dalgleish, who is widely reported in the papers today as suggesting that EU rules are forcing us to spend billions of pounds treating health tourists and preventing us from undertaking important clinical trials? Has the Secretary of State made any assessment of Professor Dalgleish’s comments?

[Mr Jeremy Hunt]

The Government have made a huge and significant assessment of the cost of overseas people using the NHS, and we think that there are £500 million of recoverable costs that we do not currently recover. When it comes to the EU, the biggest problem that we have is that we are able to reclaim the costs of people temporarily visiting the UK, but we do not do so as much as we should because the systems in hospitals are not as efficient as they need to be. We are sorting that out.

[Liz McInnes (Heywood and Middleton) (Lab)]

T5. Despite the prevalence of pancakes in Parliament today, I am pleased to be asking a food-related question. A recent opinion poll performed by Diabetes UK showed that three quarters of British adults think food and drink manufacturers should reduce the amount of saturated fat, salt and sugar in their products. Does the Minister support introducing mandatory targets for industry to reformulate food and drink products to help people to eat more healthily, and will that form part of the Government’s childhood obesity strategy?

--- Later in debate ---

[Greg Mulholland]

Leeds has a shortage of integrated care beds and pressure on acute services. Will the Secretary of State—[Interruption.] That was a comma, Mr Speaker. Will the Secretary of State please intervene, so that Leeds Teaching Hospitals NHS Trust can open wards at Wharfedale hospital, which it wants to do, while the clinical commissioning group provides the money?

[Mr Jeremy Hunt]

I am very happy to look at that.

[Mr Speaker]

Well done.

[Andrea Jenkyns (Morley and Outwood) (Con)]

By refusing to condemn the junior doctors strike, the hon. Member for Lewisham East (Heidi Alexander) has shown that she has little regard for patient safety. [Interruption.] Will my right hon. Friend repeat his condemnation of this strike, which will seriously endanger patient safety, and assure me that he will continue to press for the new contracts, which will guarantee safer patient care and a better contract for doctors?

[Mr Hunt]

I think my hon. Friend got a bit of a reaction with those comments. The Labour party is saying that if a negotiated settlement cannot be reached, we should not impose a new contract—in other words, we should give up on seven-day care for the most vulnerable patients. There was a time when the Labour party spoke up for vulnerable patients. Now it is clear that unions matter more than patients.

[Several hon. Members rose—]

Government Response to Lord Carter of Coles' Report

Jeremy Hunt Excerpts

Friday 5th February 2016 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I should like to make a statement on the final report of operational productivity in English NHS acute hospitals carried out by Lord Carter of Coles. His detailed analysis of acute hospitals across the NHS has revealed unwarranted variations across a whole number of areas from workforce productivity, medicines choice, procurement, through to the costs of running the estate. His report identifies far-reaching opportunities for improving productivity and efficiency across the NHS. Lord Carter’s report makes 15 recommendations for tackling unwarranted variation in the productivity and performance of trusts which could release around £5 billion in efficiency savings. They cover how to improve efficiencies in areas across:

Clinical staff and clinical resources

Non-clinical resources

Leadership and people management

IT

Hospital collaboration

Regulation and support management

The House will be fully aware that the Government have committed to a further £10 billion investment in the NHS over this Parliament, but as the NHS’s plan for the future has made clear, significant savings must continue to be made. So I was keen to know what could be done to make existing budgets go further which is why I asked Lord Carter to undertake this review. His findings are revealing in that there is inexplicable and unwarranted variation across our hospitals in the way they manage their resources. This must be tackled and I welcome his proposals for addressing this.

Lord Carter proposes and has already developed the first iterations of a model hospital with metrics and benchmarks for measuring productivity and efficiency across a whole range of costs. He also proposes a single integrated performance framework for hospitals—one version of the truth—that will help trusts set baselines for improvement and provide them with the tools to manage their resources daily, weekly, monthly, yearly. He recommends NHS Improvement should become the organisation to host performance management and to provide the skills and expertise to help trusts improve. I welcome Lord Carter’s non-executive director role at NHS Improvement and look forward to his ongoing input into the implementation of his review.

In the light of Lord Carter’s report, I can now announce that we will act upon all his recommendations and have asked Lord Carter to report back on progress with implementation by spring 2017.

I attach a copy of the final report and it is available on gov.uk. I asked Lord Carter in June 2014 to undertake his review and I am extremely grateful to him and his team for all their time, expertise and professionalism.

Attachments can be viewed online at: http://www. parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-02-05/HCWS515/

[HCWS515]

William Mead: 111 Helpline

Jeremy Hunt Excerpts

Tuesday 26th January 2016 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement about NHS England’s report on the death of William Mead and the failures of the 111 helpline.

[The Secretary of State for Health (Mr Jeremy Hunt)]

This tragic case concerns the death of a one-year-old boy, William Mead, on 14 December 2014 in Cornwall. While any health organisation will inevitably suffer some tragedies, the issues raised in this case have significant implications for the rest of the NHS, from which I am determined that we should learn. First, however, I want to offer my sincere condolences to the family of William Mead. I have met William’s mother, Melissa, who spoke incredibly movingly about the loss of her son. Quite simply, we let her, her family and William down in the worst possible way through serious failings in the NHS care that was offered, and I want to apologise to them, on behalf of the Government and the NHS, for what happened. I also want to thank them for their support for, and co-operation with, the investigation that has now been completed. Today NHS England published the results of that investigation—a root cause analysis of what had happened. The recommendations are far-reaching, with national implications.

The report concludes that there were four areas of missed opportunity on the part of the local health services, where a different course of action should have been taken. They include primary care and general practice appointments made by William's family, out-of-hours telephone conversations with their GP, and the NHS 111 service. Although the report concluded that they did not constitute direct serious failings on the part of the individuals involved, if different action had been taken at those points, William would probably have survived.

Across those different parts of the NHS, a major failing was that in the last six to eight weeks of William’s life, the underlying pathology, including pneumonia and chest infection, was not properly recognised and treated. The report cites potential factors such as a lack of understanding of sepsis, particularly in children; pressure on GPs to reduce antibiotic prescribing and acute hospital referrals; and, although this was not raised by the GPs involved, the report also refers to the potential pressure of workload.

There were specific recommendations in relation to NHS 111 which should be treated as a national, not a local, issue. Call advisers are trained not to deviate from their script, but the report says that they need to be trained to appreciate when there is a need to probe further, how to recognise a complex call and when to call in clinical advice earlier. It also cites limited sensitivity in the algorithms used by call-handlers to red-flag signs relating to sepsis.

The Government and NHS England accept these recommendations, which will be implemented as soon as possible. New commissioning standards issued in October 2015 require commissioners to create more functionally integrated 111 and GP out-of-hours services, and Sir Bruce Keogh’s ongoing urgent and emergency care review will simplify the way in which the public interacts with the NHS for urgent care needs.

Most of all, we must recognise that our understanding of sepsis across the NHS is totally inadequate. This condition claims around 35,000 lives every year, including those of around 1,000 children. I would like to acknowledge and thank my hon. Friend the Member for Truro and Falmouth (Sarah Newton), who—as well as being the constituency MP of the Mead family—has worked tirelessly to raise awareness of sepsis and worked closely with UK Sepsis Trust to reduce the number of avoidable deaths from sepsis. In January last year I announced a package of measures to help to improve the diagnosis of sepsis in hospitals and GP surgeries, and significant efforts are being made to improve awareness of the condition among doctors and the public, but the tragic death of William Mead reminds us there is much more to be done.

[Heidi Alexander]

No one who watched the courageous interviews that Melissa Mead gave this morning could fail to be moved by this tragic case. I pay tribute to Melissa and her husband Paul, who have fought to know the truth about their son’s death and who are now campaigning to raise awareness and improve the care of sepsis. It is right that we should express our sorrow at what has happened, and the Health Secretary was right to apologise on behalf of the NHS. They key now is to ensure that the right lessons are learned and that action is taken. As the Secretary of State noted, the report found a catalogue of failures that contributed to William’s death, including four missed opportunities when a different course of action should have been taken. I want to press the Health Secretary on those areas.

First, the report states that William saw GPs six times in the months leading up to his death, but that none spotted the seriousness of the chest infection that cost him his life. Ministers were warned about poor sepsis care back in September 2013, when an ombudsman’s report highlighted

“shortcomings in initial assessment and delay in emergency treatment which led to missed opportunities to save lives.”

Will the Secretary of State tell us what action was taken following that report? Why was it only in December 2015, more than two years later, that NHS England finally published an action plan to support NHS staff in recognising and treating sepsis?

Secondly, the report found that the NHS 111 helpline failed to respond adequately to Melissa’s call. It concluded that if a doctor or nurse had taken her call, they would probably have seen the need for urgent action. The replacement of NHS Direct, which was predominantly a nurse-led service, with NHS 111 means the service relies on call-handlers who receive as little as six weeks’ training. So when will the Health Secretary review the training call-handlers receive, and will he consider increasing the number of clinically trained staff available to respond to calls?

The report says the computer programme that call-handlers are using did not cover some of the symptoms of sepsis, including a drop in body temperature from very high to low. Does the Health Secretary have confidence that the 111 service is fit to diagnose patients with complex, life-threatening problems who may not always fit the computer algorithm call-handlers have to rely on?

Finally, may I ask the Secretary of State what he is doing to raise awareness of the symptoms of sepsis so that treatment can begin as quickly as possible? I know this is an issue that Melissa and Paul feel particularly strongly about and we owe it to them to implement the recommendations of the NHS England report and do all we can to ensure the failures in this tragic case are never, ever repeated.

[Mr Hunt]

I hope I can reassure the shadow Health Secretary on all the points she raised.

First, there has been a sustained effort across the NHS since September 2013 to improve the standard of safety in the care we offer in our hospitals. An entirely new inspection system was set up that year. It has now nearly completed inspections of every hospital, and it has caused a sea change in the attitudes towards patient safety. Sepsis is one of the areas that is looked at. In particular it is incredibly important that when signs of sepsis are identified in A&E departments the right antibiotic treatment is started within 60 minutes. That is not happening everywhere, but we need to raise awareness urgently to make that happen, and that inspection regime is helping to focus minds on that.

On top of that—I will come to the issues around 111, and I agree that there are some important things that need to be addressed—a year ago I announced an important package to raise awareness of sepsis. It covers the different parts of the NHS. For example, in hospitals a big package on spotting it quickly has been followed from December 2015, with NHS England publishing the cross-system sepsis programme board report, which is looking at how to improve identification of sepsis across the care pathway.

The hon. Lady is right to raise the issue of faster identification by GPs. That is why, in January 2015, I announced that we will be developing an audit tool for GPs, because it is difficult to identify sepsis even for trained clinicians, and we need to give GPs the help and support to do that. We are also talking to Public Health England about a public awareness campaign, because it is not just clinicians in the NHS, but it is also members of the public and particularly parents of young children, who need to be aware of some of those tell-tale signs.

So a lot is happening, but the root cause of the issue is understanding by clinicians on the frontline of this horrible disease, and it does take some time to develop that greater understanding that everyone accepts we need. I can reassure the hon. Lady, however, that there is a total focus in the NHS now on reducing the number of avoidable deaths from sepsis and other causes, and that is something the NHS and everyone who works in it are totally committed to.

With respect to 111, there are some things that we can, and must, do quickly in response to this report, but there is a more fundamental change that we need in 111 as well. One thing we can do quickly is look at the algorithms used by the call-handlers to make sure they are sensitive to the red-flag signs of sepsis. That is a very important thing that needs to happen. NHS 111 has in some ways been a victim of its own success: it is taking three times more calls than were being taken by NHS Direct just three years ago—12 million calls a year as opposed to 4 million—and nearly nine of out 10 of those calls are being answered within 60 seconds.

When it comes to the identification of diseases such sepsis, we need to do better and to look urgently at the algorithm followed by the call-handlers. Fundamentally, when we look at the totality of what the Mead family suffered, we will see that there is a confusion in the public’s mind about what exactly we do when we have an urgent care need, and the NHS needs to address that. For example, if we have a child with a high temperature, we might not know whether they need Calpol or serious clinical attention.

The issue is that there are too many choices, and that we cannot always get through quickly to the help that we need. We must improve the simplicity of the system, so that when a person gets through to 111, they are not asked a barrage of questions, some of which seem quite meaningless, and they get to the point more quickly and are referred to clinical care more quickly. We must simplify the options so that people know what to do, and that is happening as part of the urgent emergency care review. It is a big priority, and this tragic case will make us accelerate that process even faster.

[Dr Sarah Wollaston (Totnes) (Con)]

I join colleagues from across the House in sending deepest condolences to William’s parents. I welcome the Secretary of State’s response that he will put into action the recommendation from today’s report. May I draw out one aspect that has not been touched on so far, which is the comment in the report that out-of-hours services did not have access to William’s clinical records, and that had they been able to do so they would have seen how many times a doctor had been consulted, and that that would have been a clear red flag? Will he reassure me that that matter will be addressed across the NHS, so that all services have access to patients’ clinical records—of course with their consent?

[Mr Hunt]

My hon. Friend is absolutely right. There is so much in this report, but we must not let some very important recommendation slip under the carpet, and that is one of them. We have a commitment to a paperless NHS, which involves the proper sharing of electronic medical records across the system. We have also instructed clinical commissioning groups to integrate the commissioning of out-of-hours care with the commissioning of their 111 services to ensure that those are joined up. It is a big IT project, and we are making progress. Two thirds of A&E departments can now access GP medical records, but she is absolutely right to say that it is a priority.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Like others, I add my condolences to the family. It is hard to imagine anything worse for a family to face. Like many deaths in the NHS, it is always sad to look back and see that it was a catalogue of missed opportunities and errors. One thing I should like to pick up on is the fact that young children are very hard to assess. It is quite hard for a doctor to assess them when they are actually seeing them; they can be running round one minute and then keeling over half an hour later. It is particularly hard to pick up clues about their health over the phone. When NHS Direct services were started throughout the UK, they were based in local out-of-hours GP centres, which meant that the nurse could just pass the phone and say, “Can you come and chat, because I am not sure.” We had rules in our local one that if a young child was involved, they got a visit from our mobile service. Instead of such cases being put through call centres, I hope that the Secretary of State will agree in this review to have some dissemination back to a local system, so that these cases can be accelerated easily to a clinician.

[Mr Hunt]

I agree with the broad thrust of the hon. Lady’s remarks. Of course she speaks with the authority of an experienced clinician herself. In this case, the tragedy was that there was actually a doctor who spoke to the Mead family on the night before William died, and he did not spot the symptoms. It is not simply a question of access to a doctor, but ensuring that doctors have the training necessary. However, as she says, dealing with cases such as this can be very difficult. The doctor’s view on that occasion was that, because the child was sleeping peacefully, it was fine to leave him until morning when, tragically, it was too late. Other doctors would say that that is a mistake that could easily have been made by anyone, which is why the report is right to say that it is about not individual blame, but a better understanding of the risks of sepsis. She is right in what she says. As we are trying to join up the services that we offer to the public, it is a good principle to have one number that we dial when we need advice on a condition that is not life-threatening or a matter for a routine appointment with a GP, and 111 is an easy number to remember. However, we need to ensure that there is faster access to clinicians when that would count, and that those clinicians can see people’s medical records so that they can properly assess the situation.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

As chair of the all-party group on sepsis, may I also pay tribute to the Mead family, who are now campaigning to ensure that no other child suffers in the same way as William? The Secretary of State has taken a great deal of interest in the UK Sepsis Trust and the work that it has been doing with the APPG. He will know that we are pressing for a campaign similar to the F.A.S.T campaign for strokes, as early diagnosis can save lives. Will he now consider very seriously funding such a campaign for sepsis, because there are thousands of deaths that could be prevented by a campaign that makes everyone aware of the signs of sepsis?

[Mr Hunt]

I am happy to undertake that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), will look urgently into whether such a campaign would be right. I can reassure my right hon. Friend that the package that we put together and announced last January did contain what most people felt was necessary, but we can always look at whether more needs to be done. I commend her for her campaigning on the issue of sepsis. On a more positive note, when the NHS has decided to tackle conditions such as MRSA and clostridium difficile, it has been very successful. In the past three years, the number of avoidable deaths from hospital-acquired harms—the four major ones—has nearly halved, so we can do this. We should be inspired by the successes that we have had to make sure that we are much, much better at tackling sepsis.

[Mr Ben Bradshaw (Exeter) (Lab)]

One reason why the number of calls to 111 has trebled is that people find it impossible to get to see their GP. As well as the shocking failings of this family’s GP, is it not the case that the Government were warned of the consequences of abolishing the popular and successful NHS Direct and of replacing it with a non-clinician led service? Will the Secretary of State look personally at the performance of 111 in the south-west, which has been bedevilled by failings ever since it was set up?

[Mr Hunt]

I gently say to the right hon. Gentleman that when 111 was set up it had the support of the Opposition. The shadow Health Secretary at the time looked at the risk register. The number of calls has increased dramatically partly because demand for NHS services has increased dramatically. That does not mean to say that there are not important things that need to be improved. We need to look honestly at what went wrong. The 111 service was one of the four areas where we should have done better. I am happy to look carefully at what is happening with 111 in the south-west. One improvement is that, in many areas, we are integrating the commissioning of 111 with the Ambulance Service, and that is something that happens in the south-west. On the whole, that has been a positive experience, but I know that there have been problems in the south-west, and I am happy to look further at them.

[Mr Robin Walker (Worcester) (Con)]

May I associate myself with those who have paid tribute and expressed condolences to the Mead family? Given the seriousness of this case, which we learned about today, what more can the Secretary of State do to reassure us about the clinical input and expert oversight of the NHS 111 service and its methods?

[Mr Hunt]

All 111 services have clinicians present at call centres, so it is about not the availability of clinicians, but the speed with which they are involved in cases where they can make a difference. It is also about the training of those clinicians so that they can recognise horrible infections such as sepsis quickly. It is a combination of things. The important thing here is that if we are to give the public confidence in a simpler system where they have a single point of contact—albeit a phone line or a website—they need to be confident that if they are not immediately speaking to someone who is clinically trained they will be put through to such a person if it is necessary. We have not earned that confidence yet, which is why it is so important that we learn lessons from what happened in this tragic case.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

I was the Minister who set up NHS Direct, and one of the first cases that caused us to review the algorithms was a meningitis case. May I therefore say to the Secretary of State that just looking at the algorithms used by call-handlers will not be sufficient? It is clinically exceptionally difficult, and his review is too limited to address the problem.

[Mr Hunt]

I understand what the right hon. Lady is saying, and of course I would listen to her because of her experience, but I reassure her that that is not the only thing that we are doing; we are doing lots of other things. The report makes many recommendations, one of which is to look at the algorithms that the call-handlers use to make sure that they are more sensitive to some of the red-flag signs of sepsis, meningitis and other conditions. There are lots of other recommendations. They include earlier access to clinicians where appropriate, and recommendations on the training of clinicians in the out-of-hours service, the training of GPs and the training of people in hospitals. So we will be undertaking a much bigger body of work as a result of this review.

[Chloe Smith (Norwich North) (Con)]

I welcome my right hon. Friend’s commitment to support CCGs to commission the 111 service and the out-of-hours service together where appropriate. He may be aware of some concerns in Norfolk about our out-of-hours service. What else is he doing to recruit, retain and support GPs in providing the round-the-clock care that people clearly need?

[Mr Hunt]

I have said before at this Dispatch Box that successive Governments of both parties have under-invested in general practice, and that is part of the reason why it takes too long for many people to get a GP appointment. It is why we have said that we want to have about 5,000 more doctors working in general practice by the end of this Parliament. That is an important part of what we want to do.

The other side is improving our offer to the public. When you have a child with a fever, and you are not sure, and it is the weekend, very often you have a choice between an out-of-hours GP appointment, a weekend appointment at your GP surgery, calling 111 or showing up at an A&E department. It is just confusing to know the right thing to do. If we are to improve standards of care, we need to standardise safety standards across the NHS, including for spotting potential sepsis cases, and that means a much simpler system.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

My hon. Friend the Member for Lewisham East (Heidi Alexander), the shadow Secretary of State for Health, commented on the concerns expressed in the report about the quality and effectiveness of the tools at the disposal of call-handlers at the 111 service. How many other cases have been misdiagnosed by the 111 service?

[Mr Hunt]

We believe from the independent case note analysis that has been done across the NHS, not just for sepsis but for hospital deaths, that there are around 200 avoidable deaths every week. That is something we share with other health systems; it is not just an NHS phenomenon. It is why we are asking hospitals to publish their estimated avoidable death rates, and we are having an international summit on that next month.

We think there are about 12,000 avoidable deaths from sepsis every year, and that is as a result of a combination of different parts of the NHS—GP, hospital or the 111 system—not spotting the signs earlier. That is what we are determined to put right.

[Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)]

Looking across the NHS at how we ensure that learning and behaviour change, can the Secretary of State update the House on how the hospital payment system is changing to incentivise new diagnosis and better outcomes?

--- Later in debate ---

[Mr Hunt]

My hon. Friend is right to say that we are doing that for hospitals. When I talk about 200 avoidable deaths every week, that is hospital deaths, not deaths as a result of problems in the 111 service. It is much harder to quantify avoidable deaths outside hospital, but we are determined to do that, and we are going further and faster than any other country that I am aware of as part of our commitment to make the NHS the safest system anywhere in the world.

[Clive Efford (Eltham) (Lab)]

The Secretary of State said that the report was

“far-reaching, with national implications.”

I have to say that this should have been a statement, not an urgent question. The right hon. Gentleman did not answer the question about the number of misdiagnoses on the 111 system. He needs to give more detail. The report suggests that other deaths of young children may be associated with misdiagnosis by 111. How many other cases are under investigation?

[Mr Hunt]

No one could have done more than this Government to tackle the issue of avoidable deaths across the NHS. It is much harder to identify when a death was avoidable when it happens outside hospital. As part of our work on reducing the number of avoidable deaths in the wake of what happened at Mid Staffs, we are looking at how we could improve primary care generally. Our first priority is to reduce the number of avoidable deaths in hospital and to learn from reports such as this one when they point to improvements that need to be made in the 111 service.

[Victoria Atkins (Louth and Horncastle) (Con)]

I join in the condolences that have been expressed in the House. By way of tribute to Mr and Mrs Mead’s campaign to raise awareness of sepsis and its symptoms, I wonder whether each and every parent can take a small but practical step today and google the symptoms of sepsis so that we know when things are not right with our children and are better armed to tackle doctors when we are not getting the answer that we need. I did exactly that this morning after hearing Mrs Mead’s very moving interview on the radio.

[Mr Hunt]

I thank my hon. Friend for that important intervention. If we are going to deal with the 1,000 tragic sepsis deaths among children every year, it needs a sustained effort from all of us, not just the NHS. I will take away the action of looking at what Public Health England is doing to raise public awareness. The Minister for Public Health, my hon. Friend the Member for Battersea (Jane Ellison), will look at what health visitors can do to boost awareness of sepsis, but in the end we all have a responsibility to understand the symptoms better.

[Peter Kyle (Hove) (Lab)]

Last November, I contacted the Minister because the South East Coast Ambulance and 111 service carried out a trial that failed through poor governance, putting patients at risk. It turned out that the Department for Health heard about this only after Monitor contacted it. Is not his Department becoming reactive and simply not proactive enough to tackle these issues before they end up becoming statements and urgent questions in this House?

--- Later in debate ---

[Mr Hunt]

Not at all. I gently urge Opposition Members not to fall into the trap of trying to make political capital when tragedies such as this happen. In the wake of the Francis report on Mid Staffs, this Department has done more than any Government have ever done to improve the safety of care in the NHS. If you take the four most common harms—urinary tract infections, venous thromboembolisms, pressure ulcers and falls—the number of deaths in hospitals has fallen by 45% in the past three years. We are making sustained progress in improving the level of safety and care in the NHS, but we are never complacent, which is why are taking so seriously the report issued today.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

This is a tragic case, and our thoughts today are with the Mead family. Reluctance to prescribe antibiotics due to the dangers of antimicrobial resistance played a key part in this tragedy. Does the Secretary of State agree that this is a significant global problem, and we need to commit significant investment to it?

[Mr Hunt]

I am grateful to my hon. Friend for raising that issue, which has not been raised so far this afternoon. He is right. We have a pressing global need—not just a UK need—to reduce the inappropriate prescribing of antibiotics. That is why training of clinicians is so important. In the case of sepsis, not only is the prescribing of antibiotics appropriate but it is essential and it is essential to do it quickly. We need to make sure that, as we train GPs to reduce their prescribing of antibiotics so that we do not develop the resistance to antibiotics that could be so disastrous for global health, they do not avoid prescribing them when they are absolutely essential.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Health Secretary said that NHS 111 was a victim of its own success. I agree with what my right hon. Friend the Member for Exeter (Mr Bradshaw) said, which is that it is used because it is so difficult to see a doctor. On 2 January, the Hull Daily Mail reported that Hull Royal Infirmary was telling people not to come to A and E but to use services such as NHS 111. In the light of the findings of this investigation, which have national implications, does the Secretary of State agree that there should be more clinicians at NHS 111?

[Mr Hunt]

I do agree that we need more clinicians in primary care. We also need to invest in secondary care, which is why the hon. Lady has a new A&E centre opening in Hull, which I am sure she welcomes. We need more clinicians in primary care so that we can deal with these issues more quickly, before people need hospital care and to spot conditions such as sepsis. This Government are investing £10 billion in the NHS annually in real terms in order to step up the improvement in the services that we offer.

[Nic Dakin (Scunthorpe) (Lab)]

So will the Secretary of State put a higher proportion of clinicians in 111?

[Mr Hunt]

We will certainly look at whether we need to have more clinicians in 111. We do have clinicians available in 111. My own view is that it is the separation of the out-of-hours services and the 111 service that is at the heart of the problem that we are looking to deal with, but as part of the review we will look at the availability of clinicians in 111.

[Greg Mulholland (Leeds North West) (LD)]

I, too, add my condolences to the Mead family. I can only imagine their anguish at having been told “not to worry” and that this was “nothing serious”. There was a catalogue of failures, not just with 111. Is consideration being given to the decision by GPs not to take William’s heart rate, as clearly should have happened? Is there in any sense a reluctance to refer young patients to the acute sector? If that is the case, advice to GPs needs to be changed.

[Mr Hunt]

I can reassure the hon. Gentleman that we are looking at all these things. As with the issue of the prescribing of antibiotics raised by my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), of course we want GPs to avoid inappropriate referrals to secondary care, but it is vital that where a referral is needed, it happens. We see this not just in cases of sepsis, but in cases of cancer. It is vital that we get better at catching cancers earlier if there is to be a successful outcome to the treatment, so the hon. Gentleman is absolutely right. That will be looked at.

[Jenny Chapman (Darlington) (Lab)]

I commend the shadow Secretary of State on securing this urgent question. Earlier, the Secretary of State said that he felt that people had confidence in 111 because of the high call volumes, and that those had increased. I do not think that is the case. Confidence in 111 is shaky at best and this case could well shatter that confidence even further, unlike the confidence that we all felt in NHS Direct when we had young children. What is he going to do to make sure that as well as listening to the people whom he has mentioned already, he involves patients in determining what they need in 111 to give them back the confidence that we need them to have in order to avoid some of the pressure on the rest of the service?

[Mr Hunt]

The hon. Lady is right about the importance of involving patients when such tragedies occur, and I said in my response to the urgent question how grateful I was to the Mead family for their co-operation. One of the things the report identifies as important is earlier involvement and more listening to parents and families in such situations. I caution the hon. Lady against a blanket dismissal of the service offered by 111. There are many clinicians and call-handlers who work extremely hard and who deal with about a million calls a month, and the vast majority of those cases have satisfactory outcomes. But does that mean that there are not significant improvements that we need to make to that service? No, it does not. Of course there are things that need to be done better and we must learn the lessons from this terrible report.

[Rachael Maskell (York Central) (Lab/Co-op)]

My thoughts, too, are with the Mead family today. The diagnosis of conditions, including sepsis, must be carried out by those with the highest level of clinical skills. Triage by algorithms is unsafe. Can the 111 system be put back into the hands of highly trained clinicians, those trained to drill down in diagnosis, instead of non-qualified staff?

--- Later in debate ---

[Mr Hunt]

I think that is a misrepresentation of what happens with 111. There are clinicians in every 111 call centre. There are not physically enough doctors and nurses to have doctors and nurses answering every single call, and indeed the advice from the clinicians in the NHS responsible for the 111 service is that that would not be appropriate. If we are to do the triage that the hon. Lady talks about, what matters is that where a clinician needs to be involved, they are involved more quickly than happened in the current case. That is the lesson that this Government are determined to learn.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 5th January 2016 Commons Chamber

[Scott Mann (North Cornwall) (Con)]

2. What progress his Department is making on increasing access to GP services.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Welcome back, Mr Speaker. As part of our commitment to a seven-day NHS, we want all patients to be able to make routine appointments at their GP surgeries in the evenings and at weekends, and 2,500 out of 8,000 surgeries are currently running schemes to make that possible.

[Scott Mann]

Many working people are asked to phone their GP surgeries very early in the morning to book appointments, but that is not always convenient when they are going about their day-to-day work. Will my right hon. Friend tell me whether priority will be given at weekends to people who are working during the week?

[Mr Hunt]

My hon. Friend is absolutely right. That system does not work for people who have to go to work, and we want to make it easier for people to book appointments online or using an app on their phone. We also want to make it easier for people living in rural areas such as his constituency of North Cornwall to have telehealth appointments where appropriate, so that they can see someone without actually having to go to the surgery.

[Mr Ben Bradshaw (Exeter) (Lab)]

Given the increasing difficulty that members of the public are having in getting an appointment with their GP quickly and at a time that is convenient to them, does the Secretary of State believe that his predecessor was wrong when, as one of his first acts, he scrapped Labour’s 48-hour GP access guarantee?

[Mr Hunt]

No I do not, because that had perverse consequences. When that target was in place, the number of people waiting to see a GP increased rather than decreased. In the last Parliament, the number of GPs went up by around 1,600—a 5% increase in the workforce—and we have plans to increase it by 13%, which would be one of the biggest-ever increases in the GP workforce in the history of the NHS, on the back of a strong economy.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

The Secretary of State will be aware from personal experience of the excellent work being done by GPs in Herefordshire, who won one of the first seven-day-a-week pilots. Can he assure me that this work will continue to be funded, as it is doing an extraordinarily good job in helping my constituents?

[Mr Hunt]

We are very pleased with the progress that is being made in Herefordshire and in many other areas, and we are looking at how to maintain funding for those areas. Already, 16 million people are benefiting from enhanced access to GPs in the evenings and at weekends, and we would not want to see the clock being turned back on that.

[Fiona Mactaggart (Slough) (Lab)]

Today I received a letter from the chair of Slough’s clinical commissioning group, in which he bemoaned the fact that GP practices were making 95% of patient contacts yet receiving only 8% of the NHS’s resources. He also claimed that there had been a 30% reduction in GP partners’ incomes in the past five years, and said that more and more GPs in Slough were turning to private practice. I have noticed that they are also resisting the creation of new GP practices. What is the Secretary of State doing to ensure that under-doctored areas such as mine get more GPs?

[Mr Hunt]

First, may I ask the right hon. Lady to congratulate, on my behalf, GPs in Slough, who have benefited from the Prime Minister’s challenge fund? Alongside a number of other schemes, it has had a significant impact on reducing emergency admissions in her area. The answer to the point she makes is that we are investing an extra £8 billion in the NHS over the course of this Parliament—it is £10 billion when we include the money going in this year. We have said that we want more of that money to go into general practice, to reverse the historical underfunding of general practice, which I completely agree needs to be reversed.

[Anna Turley (Redcar) (Lab/Co-op)]

3. What proportion of hospital trusts are in deficit.

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[John Stevenson (Carlisle) (Con)]

6. What progress his Department has made on improving the performance of hospital trusts in special measures.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Eleven of the 26 hospitals that have been put into special measures have exited that regime because of good clinical progress, the most recent being Morecambe Bay NHS Foundation Trust, which exited in December 2015.

[John Stevenson]

Given that North Cumbria University Hospitals NHS Trust has been in special measures for two and a half years, that there are now serious concerns about the wider health economy in north Cumbria, and that we have the success regime in place, will the Minister now give a commitment that the Government will ensure that the acquisition of the trust will happen?

[Mr Hunt]

First, I thank my hon. Friend for the campaigning he does for his local hospital. He knows that I very much support that merger and hope that it will go ahead. It is worth paying tribute to the staff at the trust, who have brought down mortality rates to within the NHS average. The Care Quality Commission says that plans to improve safety are working well. We should celebrate the fact that even the trusts in special measures have hired 700 more doctors and 1,800 more nurses and are making real progress in improving patient safety.

[Rob Marris (Wolverhampton South West) (Lab)]

Private finance initiatives are costly and damaging; they always have been and always will be. Can the Secretary of State tell us what percentage of hospitals in special measures have had significant PFI funding?

[Mr Hunt]

I can write to the hon. Gentleman with the details, but I can tell him now that the Government inherited £70 billion of PFI debt, which has caused enormous pressure throughout the NHS.

[Suella Fernandes (Fareham) (Con)]

Although Southern Health NHS Foundation Trust is not in special measures, its performance has been criticised in an independent report, particularly in relation to poor investigation of deaths of people with learning disabilities and mental illness. I welcome the Secretary of State’s rapid action and his announcement of a CQC inquiry. Will he update the House on the progress of the inquiry and when it is expected to report?

[Mr Hunt]

The inquiry has only just started, but I thank my hon. Friend for her interest in it. The important conclusion that we have drawn from what happened at Southern Health is that this issue is much broader than one trust. We are not as good as we need to be at investigating unexpected mortality in the NHS. Southern Health is perhaps an extreme example, but the problem is much more widespread. A cultural change is needed, and we are determined to do something about it.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Will the Secretary of State undertake to support Morecambe Bay, the other hospital trust in Cumbria, as it moves out of special measures, by confirming the commitment made by the coalition Government to underwrite the capital costs of a radiotherapy unit at Westmorland general hospital and to support the uplift in tariff needed to sustain that unit?

[Mr Hunt]

I will happily look into that. I cannot give the hon. Gentleman the answer now, but we would want to do everything we can to support that trust. It has been through a very difficult time and has made huge progress. We want to help it on its way.

[Mr Peter Bone (Wellingborough) (Con)]

8. What his policy is on making docetaxel available as a treatment for prostate cancer.

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[John Pugh (Southport) (LD)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Yesterday evening the British Medical Association regrettably decided to walk away from the talks on a new junior doctors’ contract and announced plans for strike action. We had made significant progress in negotiations on 15 of the 16 areas of concern, including doctors’ hours and patient safety, and will now do everything we can to make sure that patients are safe. We promised the British people we would deliver truly seven-day services and, with study after study telling us that hospitals have higher mortality rates than should be expected at weekends, no change is not an option.

[John Pugh]

I thank the Secretary of State for that response. He will recall the 3 million lives telehealth programme. Since then, it has all gone rather quiet on telehealth. What is the Government’s current strategy on telehealth and what pump-priming funding is there for it?

[Mr Hunt]

I thank the hon. Gentleman for his consistent interest in telehealth. The technology landscape has changed significantly since the 3 million lives programme was launched in 2012. We are absolutely committed to it, but we do not want to isolate a few individuals who we think would particularly benefit from it, because we think everyone could benefit from being able to talk to their GP via video conferencing or whatever. The plans we will announce for technology in the next few months will show how we can roll it out to an even wider audience.

[Michael Tomlinson (Mid Dorset and North Poole) (Con)]

T4. Following the assisted dying debate, will the Department set out what steps it is taking to improve end-of-life care, and will Ministers join me in praising local hospices such as Forest Holme hospice in Poole, which serves my constituents?

[Heidi Alexander (Lewisham East) (Lab)]

It is a sad state of affairs when a new year starts with the prospect of industrial action in the NHS. Nobody wants strikes, not least the junior doctors, but they feel badly let down by a Health Secretary who seems to think that contract negotiations are a game of brinkmanship. When will he admit that changing the definition of unsocial hours and the associated rates of pay for junior doctors is a forerunner to changing a whole load of other NHS staffing contracts to save on the NHS pay bill? That is what all this is really about, isn’t it?

[Mr Jeremy Hunt]

No, it isn’t. May I start by wishing the hon. Lady every success in retaining her post in the shadow Cabinet? It would be a shame to lose her, having started to get to know her.

This is a difficult issue to solve, but at least the country knows what the Government are trying to do. The hon. Lady, on the other hand, has spent the last six months avoiding telling the country what she would do about these flawed contracts. Now is her chance. Would she change the junior doctors contract to improve seven-day services for patients—yes or no?

[Heidi Alexander]

Junior doctors do not need warm words from me, stood at the Opposition Dispatch Box; they need action from the Secretary of State to stop the strikes and give patients the care they deserve.

Not content with alienating one group of staff, the Health Secretary now has another target: student nurses. The disastrous decision in the first half of the last Parliament to cut nurse training places has driven the rise in the agency staff bill. We all know that we need more nurses to be trained, but why should a trainee nurse who spends half their degree caring for patients not receive a bursary? If they are on a ward at 3 o’clock in the morning, why should they be expected to pay for the privilege?

[Mr Hunt]

The hon. Lady cannot have it both ways. She cannot stand here and criticise cuts in nurse training but oppose the Government’s changes that mean we will be able to train 10,000 more nurses over the course of this Parliament. Let me tell her why there are 8,500 more nurses in our hospital wards since I became Health Secretary. It is because of the Francis inquiry into Mid Staffs. It is this Government that recognise the importance of good nursing in our wards. We did not sweep the problems under the carpet. She should give us credit where it is due.

[Matt Warman (Boston and Skegness) (Con)]

T7. In Boston in my constituency, as many as one in four children are classified as obese. Will the Minister reassure me that in the forthcoming obesity strategy, the Government will acknowledge that they are allowing families and, indeed, children the opportunity to take the control of their own lifestyles that will fix this problem, rather than seeking to do it for them?

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Con)]

Nobody wants to return to the days of exhausted junior doctors being forced to work excessive hours, and the Secretary of State will know that that is why junior doctors have expressed concern about the potential impact of removing financial penalties from trusts. Will the Secretary of State set out what has happened during the negotiations to reassure the public and doctors about patient safety?

[Mr Jeremy Hunt]

I hope I can reassure my hon. Friend, because we have said that we will not remove financial penalties when doctors are asked to work excessive hours. To quote from the letter that I received from the chief negotiator about our offer to the British Medical Association:

“Any fines will be paid to the Guardian at each Trust, allowing them to spend the money on supporting the working conditions or education of doctors in training in the institution.”

[Paul Blomfield (Sheffield Central) (Lab)]

T6. Before Christmas the Chancellor pledged to match the charitable fundraising of Great Ormond Street hospital to a maximum of £1.5 million, using money from outside the health budget. The Secretary of State will know that Great Ormond Street is one of only four specialist children’s hospital trusts in the UK, and one of the other three is in my constituency. Does he agree that the Government’s matched funding should be extended to all four trusts, and will he join me in making that case to the Chancellor?

[Mr Hunt]

I am happy to look charitably on the wishes of the hon. Gentleman, without, of course, making any guarantees.

[Nigel Adams (Selby and Ainsty) (Con)]

Nicole, the daughter of a constituent of mine, is currently suffering from mental health issues. She has been held in a transparent police cell overnight after self-harming, with drunks on either side, as there are no other facilities available near York. Clearly, police stations are not appropriate places for secure care. What is the Minister doing to ensure that adequate places are available locally, and that police, should they need to become involved, know how to provide a less traumatic experience for mental health patients?

--- Later in debate ---

[Mr Speaker]

Project, man, project! We wish to hear the full gist of what the hon. Gentleman has to say to the House.

[Mr Jeremy Hunt]

We absolutely will work with the medical profession to have proper seven-day services throughout the NHS in England. I hope that the hon. Gentleman and Scotland, which has the same issues with weekend mortality rates, will follow the lead of NHS England.

[Mr Robin Walker (Worcester) (Con)]

May I thank the Minister for his helpful answer to my hon. Friend the Member for Wyre Forest (Mark Garnier)? Further to that question, having recently met the clinical leadership at Worcester Royal hospital, they are adamant that they want permanent management in place at the hospital. The Care Quality Commission report said that the number of interim directors was one reason why it was put into special measures. Can the Minister reassure me that he will be doing everything he can to put in place permanent long-term management at the Worcestershire Acute Hospitals NHS Trust as quickly as possible?

--- Later in debate ---

[Graham Jones (Hyndburn) (Lab)]

What demographic impact assessment has the Secretary of State’s Department made of the potential withdrawal from the European Union on health and social care, and the consequent result it would have on demands for its services?

[Mr Jeremy Hunt]

None whatever.

[Ben Howlett (Bath) (Con)]

In the previous Parliament, many people who suffer from a rare disease were pleased with the publication of the Government’s rare diseases strategy. What progress is the Minister making on publishing the ultra-rare diseases strategy?

Southern Health NHS Foundation Trust

Jeremy Hunt Excerpts

Thursday 17th December 2015 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

NHS England will today publish the Mazars report on Southern Health NHS Foundation Trust. It will be available on the NHS England website at:

https://www.england.nhs.uk/south/our-work/ind-invest-reports. I want to update the House on the action that the NHS will be taking in response.

The report describes, as I set out to the House on 10 December (Official Report, Col 1141-2), a lack of leadership, focus and sufficient time spent in the trust on carefully reporting and investigating unexpected deaths of mental health and learning disability service users. The report found that there had been no effective, systematic management and oversight of the reporting of deaths and the investigations that follow.

I am determined that we learn the lessons of this report, and use it to help build a culture in which failings in care form the basis for learning for organisations and for the system as a whole.

As a first step, I am announcing a number of measures today to address both the local issues at Southern Health NHS Foundation Trust and the systemic issues raised in the report:

The Care Quality Commission will undertake a focused inspection of southern healthcare early in the new year, looking in particular at the Trust’s approach to the investigation of deaths. As part of this inspection, the CQC will assess the Trust’s progress in implementing the action plan required by monitor and in making the improvements required during their last inspection, published in February of this year.

Avoidable mortality—understanding, action and improvement. The report reinforces the point that we need to do more across providers to understand and tackle the problem of avoidable mortality. Bruce Keogh and Mike Durkin are therefore writing to medical directors to describe the offer of help to providers (the mortality audit tool, case-note review methodology and reiterating the Government’s commitment to delivering medical examiners) setting out how to use the audit tool to supply data to support understanding and improvement.

Learning Disability and mortality—The learning disability mortality review will support improvement by acting as a repository for anonymised reports pertaining to people with learning disabilities from a variety of sources, in particular anonymised copies of serious case reviews and Ombudsman Reports. This project will start in January 2016.

The Care Quality Commission will also be undertaking a wider review into the investigation of deaths in a sample of all types of NHS trust (acute, mental health and community trusts) in different parts of the country. As part of this review, we will assess whether opportunities for prevention of death have been missed, for example by late diagnosis of physical health problems.

I will continue to update the House on progress in each of these areas. I will place a copy of the report in the Library of both Houses once it has been published by NHS England.

[HCWS421]