Government’s Mandate to NHS England 2016-17
Jeremy Hunt Excerpts(8 years, 4 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today the Government have laid before Parliament the mandate to NHS England for 2016-17. This mandate has been produced following public consultation, and will take effect from 1 April 2016.
The mandate sets the Government’s objectives for NHS England, as well as its budget. In doing so, the mandate sets direction for the NHS, and helps ensure NHS England is accountable to Parliament and the public. In accordance with the Health and Social Care Act 2012, the Secretary of State must publish a mandate each year, to ensure that NHS England’s objectives and any underpinning requirements remain up to date.
This mandate confirms this Government’s commitment to increase spending on the NHS in real terms every year in this Parliament. The NHS will receive £10 billion more per year in real terms by 2020-21 than in 2014-15. This investment backs in full the NHS’s own five year forward view and will mean patients receive seven-day health services, with hospitals providing the services people need at the weekend and people able to access a GP at evenings and weekends.
This mandate was produced following engagement with the statutory consultees, NHS England and Healthwatch England, and public consultation. We are grateful to those who responded. The public response was significantly higher than in previous years with approximately 127,400 responses received, providing a rich source of feedback that has helped shape the final mandate. The Government’s full response to the consultation, including a summary of what we heard and what we have changed in the mandate, has also been published today.
The new mandate sets out the priorities this Government believe are central to delivering the changes needed to ensure that free healthcare is always there whenever people need it. This mandate therefore sets NHS England the following objectives:
to improve local and national health outcomes and reduce inequalities through better commissioning, supported by the new assessment framework for clinical commissioning groups;
to help create the safest, highest quality health and care services seven days a week, including improved early diagnosis, services and outcomes for cancer patients;
to balance the NHS budget and improve efficiency and productivity;
to lead a step change in the NHS in preventing ill health and supporting people to live healthier lives, including improvement in the quality of care and support for people with dementia and increased public awareness;
to maintain and improve performance against core standards;
to improve out-of-hospital care, including reducing the health gap between people with mental health problems, learning disabilities and autism and the population as a whole; and
to support research, innovation and growth.
We are also laying before Parliament today a revised mandate for 2015-16 to take account of changes to NHS England’s budget, including additional funding announced in the spring Budget statement for children and young people’s mental health, and the transfer of commissioning responsibility for 0-5 year olds to local authorities from 1 October 2015.
Copies of both documents will be available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Attachments can be view online at: https://www. parliament.uk/writtenstatements.
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Southern Health NHS Foundation Trust
Jeremy Hunt Excerpts(8 years, 5 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Heidi Alexander (Lewisham East) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the report of the investigation into deaths at Southern Health NHS Foundation Trust.
The Secretary of State for Health (Mr Jeremy Hunt)
The whole House will be profoundly shocked by this morning’s allegations of a failure by Southern Health NHS Foundation Trust to investigate over 1,000 unexpected deaths. Following the tragic death of 18-year-old Connor Sparrowhawk at Southern’s short-term assessment and treatment unit in Oxfordshire in July 2013, NHS England commissioned a report from audit providers Mazars on unexpected deaths between April 2011 and March 2015.
The draft report, submitted to NHS England in September, found 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. Of 1,454 deaths reported, only 272 were investigated as critical incidents, and only 195 of those were reported as serious incidents requiring investigation. The report found that there had been no effective, systematic management and oversight of the reporting of deaths and the investigations that follow.
Prior to publication, or indeed showing the report to me, NHS England rightly asked the trust for its comments. It accepted failures in its reporting and investigations into unexpected deaths, but challenged the methodology, in particular pointing out that a number of the deaths were of out-patients for whom it was not the primary care provider. However, NHS England has assured me this morning that the report will be published before Christmas, and it is our intention to accept the vast majority, if not all, of the recommendations it makes.
Our hearts go out to the families of those affected. More than anything, they want to know that the NHS learns from tragedies such as what happened to Connor Sparrowhawk, and that is something we patently fail to do on too many occasions at the moment. Nor should we pretend that this is a result of the wrong culture at just one NHS trust. There is an urgent need to improve the investigation of, and learning from, the estimated 200 avoidable deaths we have every week across the system.
I will give the House more details about the report and recommendations when I have had a chance to read the final version and understand its recommendations, but I can tell the House about three important steps that will help to create the change in culture that we need. First, it is totally and utterly unacceptable that, according to the leaked report, only 1% of the unexpected deaths of patients with learning disabilities were investigated, so from next June, we will publish independently assured, Ofsted-style ratings of the quality of care offered to people with learning disabilities for all 209 clinical commissioning group areas. That will ensure that we shine a spotlight on the variations in care, allowing rapid action to be taken when standards fall short.
Secondly, NHS England has commissioned the University of Bristol to do an independent study of the mortality rates of people with learning disabilities in NHS care. This is a very important moment at which to step back and consider the way in which we look after that particular highly vulnerable group.
Thirdly, I have previously given the House a commitment to publishing the number of avoidable deaths, broken down by NHS trust, next year. Professor Sir Bruce Keogh has worked hard to develop a methodology to do this. He will write to medical directors at all trusts in the next week explaining how it works, and asking them to supply estimated figures that can be published in the spring. Central to that will be establishing a no-blame reporting culture across the NHS, with people being rewarded, not penalised, for speaking openly and transparently about mistakes.
Finally, I pay tribute to Connor’s mother, Sara Ryan, who has campaigned tirelessly to get to the bottom of these issues. Her determination to make sure the right lessons are learned from Connor’s unexpected and wholly preventable, tragic death is an inspiration to us all. Today, I would like to offer her and all other families affected by similar tragedies a heartfelt apology on behalf of the Government and the NHS.
Heidi Alexander
These are truly shocking revelations that, if proven, reveal deep failures at Southern Health NHS Foundation Trust. The BBC has reported that the investigation found that more than 10,000 people died between April 2011 and March 2015. Of those 10,000 deaths, 1,454 were not expected. Only 195 of those unexpected deaths—just 13%—were treated by the trust as a serious incident requiring investigation. Perhaps most worryingly, it appears that the likelihood of an unexpected death being investigated depended hugely on the patient: for those with a learning disability, just 1% of unexpected deaths were investigated, and for older people with a mental health problem, just 0.3%.
We obviously await a full response from the Government when the report of the investigation is published, but a number of immediate questions need answers today. First, does the Health Secretary judge services at the trust to be safe? A recent Care Quality Commission report found that
“inadequate staffing levels in community health services was impacting on the delivery of safe care.”
What advice can he give patients, and the families of patients, currently in the care of Southern Health?
Secondly, the Health Secretary confirmed in his reply that NHS England received the report in September, but can he explain why it still has not been published, and can he provide a specific date on which the final report will be made publicly available?
Thirdly, when was the Health Secretary first made aware of concerns about Southern Health, and what action did he take at that time? What does he have to say to the relatives and friends of people who have unexpectedly died in the care of the trust and who, today, will be reliving their grief with a new anxiety?
The issue raises broader questions about the care of people with learning disabilities or mental health problems. Just because some individuals have less ability to communicate concerns about their care, that must never mean that any less attention is paid to their treatment or their death. That would be the ultimate abrogation of responsibility, and one which should shame us all. The priority now must be to understand how this was allowed to happen, and to ensure this is put right so it can never happen again.
Mr Hunt
I agree with what the shadow Health Secretary says. She is absolutely right in both the tone of what she says, and in the seriousness with which she points to what has happened. It is important to say that this is only a draft report. To put the hon. Lady’s mind at rest, I am completely satisfied that NHS England took this extremely seriously from the moment we understood that there was an issue about the tragic death of Connor Sparrowhawk. David Nicholson, the then chief executive of NHS England, and Jane Cummings, the chief nurse, met the family and ordered the independent investigation. It is a very thorough investigation.
As the hon. Lady will understand, when there is an investigation about something as serious as avoidable mortality, we have to give the trust the chance to correct any factual inaccuracies and challenge the methodologies. It has taken from September until now to get to the point in the process where the report is ready to be published. I have been assured by Jane Cummings this morning that it will be published before Christmas. We will not allow any further arguments about methodologies to stand in the way of the report being published before Christmas, as was always planned.
On the hon. Lady’s very important question about whether services are safe at Southern Health, we have the expert view on that, because we set up a new chief inspector of hospitals and a new inspection regime. There was an inspection of Southern Health, and it got a “requires improvement”. The inspectors were not saying that its services were as safe as they should be, but that its services, along with those of many other trusts in the NHS, needed to become safer. She was right to draw attention to some of the failings alluded to in the report.
The hon. Lady can draw comfort from the fact that this matter has been taken seriously. NHS England commissioned a report, which is, by all accounts, hard-hitting. I have been following the situation since we first understood the issues around Connor Sparrowhawk’s tragic death, and so has NHS England. That is why we have a report that I think will lead to important changes.
The fundamental question on which we all need to reflect is why we do not have the right reporting culture in the NHS when it comes to unexpected deaths. We have to step back, be honest and say that there are reasons, good and bad, for that. People are extremely busy, and there is a huge amount of pressure on the frontline. People have an understandable desire to spend clinical time dealing with the patients who are standing in front of them, rather than going over medical notes and trying to understand something that went wrong. Sometimes, there will be prejudice and discrimination. The whole House will unite in saying that we must stamp that out. Sometimes, people do not speak out because they are worried that they will be fired or penalised. We have to move away from a blame culture in the NHS to a culture in which doctors and nurses are supported if they speak out, which too often is not the case.
The whole House will want to unite in supporting the leaders of the NHS who want to change that culture. It is unfinished business from Mid Staffordshire NHS Foundation Trust; it is important to get it right, and I know that the NHS is determined to do just that.
Dr Sarah Wollaston (Totnes) (Con)
The allegations in the draft report about Southern Health are deeply disturbing, and I welcome the steps that the Secretary of State has announced. In particular, I am pleased that he will not treat this as an isolated incident. The key findings of the draft report show that in nearly two thirds of the investigations, there was no family involvement. Will he immediately send the message out to all trusts that it is vital to involve family members, particularly when we are talking about those who cannot speak for themselves?
Mr Hunt
I will do that, and I am very grateful to my hon. Friend for giving me the opportunity to do so. We see this situation all too often. There was a story in the Sunday newspapers about a family being shut out of a very important decision about the unexpected death of a baby. It is incredibly important to involve families, even more so in the case of people with mental health problems or learning disabilities. The family may be the best possible advocates for someone’s needs.
We need to change the assumption that things will become more difficult if we involve families. More often than not, something like litigation will melt away if the family is involved properly from the outset of a problem. It is when families feel that the door is being slammed in their face that they think they have to resort to the courts, which is in no one’s interests.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I echo what the Secretary of State said about family involvement, which should be routine in investigating an adverse event. It definitely takes the heat out of the situation.
There are two issues here. One is the shocking difference between 30% of adult deaths being investigated, and just 1% of deaths of people with learning disabilities, and Connor represents the human face of that, which is frightening. The second issue is about individual trusts being left to decide what and how much they investigate, and what they produce, because a much more systematic consideration of the data is required. NHS England publishes annual mortality figures. Strikingly, 16 trusts that were identified with higher than expected mortality levels also had higher than expected mortality the year before, yet it appears that no action was taken. The benchmark appears to be “average”, but if we have poor performance, that average is lower. We should set our aspirations higher than that.
Mr Hunt
The hon. Lady is absolutely right. The 30% figure was for people with mental health conditions, not for all adults, but I question why we are investigating only 30%—the highest figure at Southern Health NHS Trust—of unexpected deaths. These were not just deaths; they were unexpected deaths, and it is the duty of medical directors in every trust to satisfy themselves that they have thought about every unexpected death. We must reflect on these serious matters.
The hon. Lady is right about the need to systematise processes when there is an unexpected death, so that we do not have a big variation between trusts. The exercise that Sir Bruce Keogh is doing, going around all the trusts, is about trying to establish a standardised way of understanding when a death is or is not preventable. The hon. Lady has been a practising clinician, so I am sure she will understand that at the heart of this issue is the need to get the culture right. Clinicians should not feel that a trust will take the easy route and blame it all on them, rather than trying to understand the system-wide problems that may have caused a clinician to make a mistake in an individual instance, and that is what we must think about.
Jeremy Lefroy (Stafford) (Con)
Behind each statistic is a person and a family, and the Secretary of State is right to say that finger-pointing should not be directed at clinicians alone; it is more important to consider the whole system and the culture in a trust. Will he encourage all trusts, and all medical and nursing schools, to make the Francis report on Mid Staffordshire compulsory reading? There is so much in there that could prevent such occurrences in future.
Mr Hunt
No one knows more about the Francis report than my hon. Friend, because of the direct impact that it had on his local hospital, and he is right to talk about that culture change. There is an interesting comparison with the airline industry: when it investigates accidents, the vast majority of times, those investigations point to systemic failure. When the NHS investigates clinical accidents, the vast majority of times we point to individual failure. It is therefore not surprising that clinicians feel somewhat intimidated about speaking out. People become a doctor or nurse because they want to do the right thing for patients, and we must support them in making that possible.
Norman Lamb (North Norfolk) (LD)
The coalition Government rightly established a public inquiry to look into the appalling care at Stafford hospital, and the Secretary of State has pointed to the challenge to the culture that the Francis report engendered following that scandal. Is this the moment to consider something similar for people with learning disabilities, or those with severe and enduring mental ill health, who too often continue to be treated as second-class citizens in our NHS? Sara Ryan, Connor Sparrowhawk’s mother, has called for a public inquiry. Will the Secretary of State consider that? It seems that it is time to shine a light on what is going on.
Mr Hunt
I am happy to consider that. The right hon. Gentleman and I are completely on the same page on these issues. My only hesitation is that a public inquiry will take two, three or four years, and I want to ensure that we take action now. I hope I can reassure him and the House that by, for example, publishing Ofsted-style ratings for the quality of care for people with learning disabilities across every clinical commissioning group, we will shine a spotlight on poor care in the way that the Francis report tells us that we must. I do not see the treatment of people with learning difficulties as distinct from the broader lessons in the Francis report, but if we fail to make progress, I know that the right hon. Gentleman will come back to me, and rightly so.
Caroline Nokes (Romsey and Southampton North) (Con)
Many of my constituents are service users of Southern Health, or the family members of service users. They are looking for reassurance from the Secretary of State that there will not simply be an immediate intense spotlight but an ongoing one, so that they can have confidence that the scrutiny and oversight, particularly for young people with learning difficulties, will be ongoing.
Mr Hunt
I can absolutely give that assurance to my hon. Friend’s constituents. I hope they will consider the tone of my earlier remarks and realise that we are not looking at this simply as an issue for Southern Health. Clearly, important changes must happen there and must happen quickly, and we will do everything we can to make sure that they happen. I also think, however, that there is a systemic issue in relation to the low reporting of avoidable and preventable deaths and harm, and the failure to develop a true learning culture in the NHS, which in the end is what doctors, nurses and patients all want and need.
Mr Ben Bradshaw (Exeter) (Lab)
I thank the Secretary of State for his statement and congratulate NHS England on what sounds like a very thorough report. I remind him that challenging the methodology was exactly the same first line of defence used by the now disgraced management at Mid Staffs hospital. Will he answer the specific question my hon. Friend the Member for Lewisham East (Heidi Alexander) asked as to when Ministers first knew about problems in the trust, which we hear go back to 2011, and what action they took as a result?
Mr Hunt
I thank the right hon. Gentleman for his comments. I hope I did address that by saying that the first time was when we realised there were issues around the tragic death of Connor Sparrowhawk. That is what started the process and led to the independent investigation. Because NHS England wanted it to be very thorough, that investigation went right back to 2011 and up to 2015. It looked at all unexpected deaths in that period, and at the reporting culture and lessons that had or had not been learned as a result. A lot of action has been taken. I can also reassure the right hon. Gentleman that during that period we have been implementing the recommendations of the Francis report, which has meant that throughout the NHS there is a much greater focus on, and transparency in, patient safety.
It is important to give the NHS credit. During the past three years, we have actually seen a 25% increase in the number of reported incidents. I think people are treating this much more seriously than in the past, but there is much more to do.
Mrs Cheryl Gillan (Chesham and Amersham) (Con)
I, too, welcome my right hon. Friend’s statement and the news that he plans to accept the recommendations of this very sobering report. Will he reassure the House that anyone found to have been deliberately contributing to patient neglect or failing to investigate avoidable deaths will be held to account both by the professional regulators and the full weight of the law?
Mr Hunt
I can of course give my right hon. Friend that assurance, but there is a note of hesitation in my response. That is partly because professional standards, as my right hon. Friend knows, are not a matter for politicians—they have to be set independently by the General Medical Council and the Nursing and Midwifery Council—and partly because if we are going to improve the reporting culture, which in the end is what the report is about, we have to change the fear that many doctors and nurses have that if they are open and transparent about mistakes they have made or seen, they will get dumped on. That is a real worry for many people. Part of this is about creating a supportive culture, so that when people take the brave decision to be open about something that has gone wrong they get the support that they deserve.
Mark Durkan (Foyle) (SDLP)
As well as asking the Secretary of State how the learning on this very important issue will be shared with the devolved Administrations, may I ask whether all other trusts are being advised that they will now probably receive approaches from families —no doubt Members may be contacted in this regard, too—who have questions about their own experiences? Will he ensure that they will be sensitive to such approaches about possible historical cases?
Mr Hunt
I can give the hon. Gentleman that reassurance. Trusts understand that that is already happening and has been happening. All trusts will have families that have been in touch with them with concerns about potentially avoidable or preventable deaths. I hope that this will be a reminder to all trusts that they need to take those concerns very seriously indeed.
Dr Andrew Murrison (South West Wiltshire) (Con)
The disparity in excess deaths between vulnerable groups at Southern Health is truly shocking, but of course responsibility for looking after the people in question spans health and social care. Is my right hon. Friend content that we have in place the informatics that will allow outliers to be identified, and therefore rectification to be under way? One assumes that that could easily be done by NHS England, but at the moment the informatics seem to be problematic in this respect.
Mr Hunt
My hon. Friend is absolutely right. That is why Professor Sir Bruce Keogh is developing a methodology to help us understand the number of avoidable deaths and the reporting culture at a trust level. We have a good methodology for understanding the number of avoidable deaths on a national level. The Hogan and Black analysis says that about 3.6% of deaths have a 50% or more chance of being avoidable. However, we will not get real local action until we localise it, and that is the next step.
Diana Johnson (Kingston upon Hull North) (Lab)
Is the Secretary of State satisfied that families seeking truth and justice for their loved ones are having to rely on pro bono lawyers for advice and representation, and on crowdsourcing to get legal advice?
Mr Hunt
I am afraid that that probably does happen. We all, in all parts of the House, passionately believe in and support the NHS. It should never come down to lawyers. When there is a problem, we need a culture where the NHS is totally open and as keen as the families are themselves to understand what happened, whether it could be avoided, and what lessons can be learned. If nothing else, that is the big lesson that we need to make sure we act on as a result of today’s leaked report.
Bob Blackman (Harrow East) (Con)
It is clear from my right hon. Friend’s statement that there is a cultural problem in Southern Health and across the NHS. Does he agree that far too often NHS management and clinicians are far too defensive and end up arguing about the data rather than addressing the underlying causes, which would fix the problem in the first place?
Mr Hunt
My hon. Friend is right. It is quite heartbreaking that when these things happen we seem to end up having an argument about methodology and statistics, and whether it is this many thousand or that many thousand, rather than looking at the underlying causes. We have to ask ourselves why people feel that they need to be defensive in these situations. We have to recognise that everyone is human, but, uniquely, doctors are in a profession where when they make mistakes, as we all do in our own worlds, people sometimes die. The result of that should not automatically be to say that the doctor was clinically negligent. Ninety-nine times out of 100, we should deduce from the mistake what can be learned to avoid it happening in future. Of course, where there is gross negligence, due process should take its course, but that is only on a minority of occasions. That is where things have gone wrong.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Not many people are as grateful to the NHS as I am, having just returned to full health thanks to the intervention of the wonderful team at Guy’s hospital, so any criticism I make of the NHS is in the generality. Many of us have known for a long time that there is a problem with access to full NHS treatment for people with learning difficulties. In particular, speaking as a member of the newly formed Autism Commission I can say that many people on the autism spectrum have poor communication skills and finish up with inadequate access to the health service. I do not particularly want a public inquiry; I want fast action to change the culture now. The Secretary of State is absolutely right about that.
Mr Hunt
I am delighted that the hon. Gentleman was looked after by Guy’s and St Thomas’s, where my mother was a nurse and where I was born, so I have connections to that trust as well. He is right about making sure that we get the culture right. It is about creating a more supportive environment for people who do a very, very tough job every day of the week. When we have a conversation along those lines with patients and with our constituents, they understand that as well. More than anything else, they want to know that lessons are going to be learned and acted on.
Mr Andrew Turner (Isle of Wight) (Con)
Was it necessary to delay the report’s publication for two or three months—a week or two I could understand—and will it now be published not in a fortnight’s time, before Christmas, but next week, when we will be here?
Mr Hunt
I hope the report will be published next week. The commitment I have from NHS England is that it will be published before Christmas. I am confident that, whenever it is published, it will generate huge media interest, rightly so and partly thanks to the shadow Health Secretary’s urgent question. When the draft report was sent to the trust, it came back with 300 individual items of concern, and it was right for NHS England, in the interests of accuracy and justice, to consider fully all those concerns. It has given me an assurance, however, that, whether or not it can reach an agreement with the trust about its contents, the report will be published before Christmas.
Mr Jim Cunningham (Coventry South) (Lab)
What will the Secretary of State do about whistleblowers? As most Members know, we have had problems over the years with whistleblowing and people being victimised by the NHS after raising concerns.
Mr Hunt
Sir Robert Francis’s report “Freedom To Speak Up”, which I received and presented to Parliament just before the election, looked specifically at this issue and the difficult problems people face when they speak out about a problem in their trust. Sadly, on occasions, not only are they hounded out of that trust but they find it difficult to find a job anywhere else in the NHS, because word gets round on the old boys’ network. I think, however, that if we need whistleblowing at all, we have failed. We need a culture where, when people raise concerns, they are confident they will be listened to. That is a big statement to make, but other industries have managed it, including the airline, nuclear and oil industries. I do not think any health care service in any other country has managed to get this right. Individual hospitals—Salford Royal in this country, Virginia Mason in Seattle—have fantastic learning cultures, but I want the NHS to be the first whole health economy to get that culture right.
Rehman Chishti (Gillingham and Rainham) (Con)
I welcome the Secretary of State’s answer to the urgent question. I speak as a Member with a hospital in special measures that had the seventh-highest mortality rate in the country in 2005-06. Does he agree that to address this problem we need tough CQC inspections, good local leadership—Medway hospital now has an excellent chief executive—and the right support from the Government?
Mr Hunt
My hon. Friend is absolutely right. It seems wrong to draw any crumbs of comfort from the awful things in the draft report, but we can draw some comfort from the fact that the NHS itself is commissioning hard-hitting reports that do not pull any punches—the new CQC inspection regime does exactly that. I commend all the staff at Medway hospital who have worked so hard to raise the standard of care over the last few years. I know it has not been easy for them.
Liz McInnes (Heywood and Middleton) (Lab)
The Secretary of State has not yet mentioned the role of the medical examiner. Does this latest tragedy not illustrate that the introduction of a national system of medical examiners, as recommended by the Shipman, Mid Staffs and Morecambe Bay public inquiries and supported by the Royal College of Pathologists, is now long overdue?
Mr David Nuttall (Bury North) (Con)
People will be both saddened and dismayed that after Mid Staffs and the new CQC inspection regime such problems can still arise. Does the Secretary of State agree that, although there is no simple solution, the solution certainly does not lie in trusts adopting and relying on a tick-box approach to safety?
Mr Hunt
My hon. Friend is absolutely right. It is worth saying that the tragedy that sparked this report happened before the new CQC inspection regime had got under way. The old CQC regime was rather a tick-box approach, partly because the people doing the inspections were often not doctors who could make peer-review judgments about the quality of services. If someone is not a doctor, there is a tendency to want to tick yes or no in reply to a question rather than to deal with the underlying issues. Having judgment in our inspections will be a very important step forward.
Ruth Cadbury (Brentford and Isleworth) (Lab)
This investigation would not have happened if it had not been for the tenacity and work of Sara Ryan, Connor Sparrowhawk’s mother. Is it right that the family’s legal representation was funded by crowdsourcing?
Mr Hunt
I think it is tragic when anyone has to resort to the courts to get justice. Sara Ryan is one of many who have had to go to huge out-of-pocket expenses to get justice and the truth with respect to their loved ones. Last week, I went to the launch of James Titcombe’s book. He campaigned for years and years to get justice and the truth about the death of his son, Joshua. That is exactly what we have to change.
Mrs Flick Drummond (Portsmouth South) (Con)
Will the Secretary of State confirm that the draft report also covers the Southern Health Foundation community-based mental health services for adults? That received a “good” in the CQC report published in February 2015. Is my right hon. Friend satisfied that the CQC report was rigorous enough?
Mr Hunt
I believe it does cover the mental health services for adults, but I will check and write to my hon. Friend. When the CQC does its inspections, it is important for it to inspect individual elements of what a trust does, and it gives different ratings to different parts. We need to recognise that even within one trust it is possible to have big variations in the quality of care. As I say, I will look further into this and write to my hon. Friend.
Peter Kyle (Hove) (Lab)
The Secretary of State rightly mentions the fact that the culture needs to change so that people can be more uninhibited about talking about the problems they face within trusts and hospitals. May I remind him that the culture is set from the top? I therefore invite him to come to the Dispatch Box again and inform the families and the House when Ministers first knew that there were problems in this trust.
Mr Hunt
I think this is now the third time I have said it, but the answer is that Connor Sparrowhawk’s tragic death happened in July 2013. Sara Ryan then campaigned bravely. As always on these occasions, it started with a local process where concerns were raised with the trust. The matter was escalated to NHS England in early 2014 when David Nicholson, the chief executive, and Jane Cummings, the chief nurse, got involved. Ministers were kept informed throughout, and that was the point at which Mazars—[Interruption.] I have just said that Ministers were kept informed of what NHS England was doing throughout, but that was the point at which the report by Mazars was commissioned. It is a very thorough report, and we will see it when it is published before Christmas.
Mental Health
Jeremy Hunt Excerpts(8 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I congratulate the shadow Minister on securing this debate. She spoke powerfully about the shortcomings in mental health provision, and although she was reluctant to recognise the progress being made, she deserves credit for having secured her first debate on her new portfolio.
President Obama recently talked of the need to bring mental health out of the shadows, and I would like to start by congratulating hon. Members on both sides of the Chamber on their bravery in doing exactly that. I recognise the bravery of my hon. Friend the Member for Broxbourne (Mr Walker), who has spoken powerfully about his obsessive compulsive disorder and its impact on his family life; of the hon. Member for Barrow and Furness (John Woodcock), who has talked about his treatment for depression; of the hon. Member for North Durham (Mr Jones), who has also spoken bravely about his battle with depression; and of my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), who is part of the new cross-party campaign, and who opened up about his mental health challenges during a difficult period in his life.
I also thank my hon. Friend the Member for Croydon Central (Gavin Barwell) for his private Member’s Bill, supported by the Government, that repealed the laws preventing people with mental health conditions from being Members of Parliament, jurors or company directors. I also thank my hon. Friends the Members for Vale of Clwyd (Dr Davies) and for Eastleigh (Mims Davies). I thank the hon. Member for Ashfield (Gloria De Piero) for her leadership of the all-party group, and I thank the right hon. Member for North Norfolk (Norman Lamb)—no one has done more in the House to campaign for mental health. In particular, I would like to recognise the bravery of his son, Archie, who spoke about his mental health challenges. Anyone who saw the joint interview on ITV News will have been extremely moved. I would also like to recognise someone who is not a Member and is not usually praised by Conservative Members: Alastair Campbell is a very powerful advocate for mental health; his bravery and openness is a reminder to us all that depression affects people in all walks of life.
Hon. Members have sent a strong message to the public: when it comes to mental health conditions, you are not alone. One in four adults experiences mental health problems every year. They affect everyone, including our elected representatives. By speaking out, hon. Members send a message to other parliamentarians who may be suffering in silence. Despite the incredible privilege of working in this place, public life can be incredibly stressful. It can destroy not just people’s hopes but their marriages, relationships and families. Being an MP does not make us immune to the pressures that affect everyone. With the support of wonderful campaigning organisations such as Mind, Rethink, the Samaritans and Young Minds, this kind of courage has made a real difference.
In the past couple of years, we have seen huge determination from those on both sides of the House to improve mental health provision. One reason for that is that society’s understanding has improved a huge amount in the past decade. We should celebrate the fact that we know much more than we ever did before about the workings of the brain, the causes, treatment and prevention of mental ill health, and links to other societal issues, such as debt, unemployment and family breakdown. As a result, between 70% and 90% of those treated for serious mental illness see a reduction in their symptoms and an improved quality of life. That percentage is even higher if the illness is caught earlier. The best example is early intervention for psychosis, which can reduce suicide risk from 15% to just 1%.
We should also recognise the progress made on depression. The World Health Organisation describes depression as more disabling than angina, arthritis, asthma or diabetes, but we know it can be treated as successfully as any of them. The BMJ’s research, published today, mentions that talking therapies for moderate and severe depression can be as effective as drugs. Our own programmes of talking therapies have a 50% recovery rate, post-treatment.
Norman Lamb
I appreciate the way the Secretary of State is addressing this subject. We are all on a journey on this. He will remember that last October we published a document that painted a vision of achieving genuine equality by 2020; that was not rhetoric. Central to that was introducing comprehensive waiting times standards, so that there was a complete equilibrium of rights: the same right to access timely treatment for both physical and mental health problems. Does he remain committed to that absolutely critical principle?
Mr Hunt
I am committed to that principle. As the right hon. Gentleman knows—we have discussed this many times—access to treatment is vital, but so, too, is the quality of treatment at the start of the process. We need to make sure that we keep a close eye on both. I think it was right to ask Paul Farmer of Mind to lead an independent review of the best way to make progress towards parity of esteem during this new Parliament. I want to wait and see Paul Farmer’s recommendations before we decide how to implement the vision that the right hon. Gentleman played such an important part in developing.
Caroline Flint (Don Valley) (Lab)
We all know that one Department’s policy can cause pressures on another area. I read today that the Secretary of State for Justice is announcing a reduction in prison sentences, with more people perhaps serving their sentences in the community. I would not necessarily disagree with that, but will there be discussions with the Department of Health about what pressure that would put on community mental health services? Mental health issues, as well as addiction issues, are often behind offenders’ criminal behaviour. I implore him to look at how one Department’s policy will have a knock-on effect on an already pressurised mental health service.
Mr Hunt
The right hon. Lady makes a very important point. I reassure her that there are very good and close ongoing discussions with the Ministry of Justice. The mental health of the prison population is another area in which we have failed to do as much as we need to. There are so many obvious things that we could do that would be of huge benefit, not just to the individuals concerned, but to the rest of society through reducing reoffending rates. We are absolutely committed to making real, tangible progress on that.
Set against improvements in the potential of mental health treatment are troubling societal changes that increase the demand and need for mental health support. Globally, there has been an 80% increase in those living alone since the turn of the century. In the UK, the percentage of households in which people live alone has risen to nearly a third. For children and young people, there is not just exam pressure and insecurities around body image, but the risks of social media. The Office for National Statistics found a clear association between more time spent on social networking sites and child mental health problems. Children who spend more than three hours a day on social media are twice as likely to suffer poor mental health.
Rushanara Ali (Bethnal Green and Bow) (Lab)
The Secretary of State talks about the pressures on children. One in five children is in need of treatment and is being turned away, including from A&E. There is a real crisis in service provision, with £200 million reduced from the mental health budget. As he reflects on how big a challenge this is, does he not think his Government’s response is completely inadequate? That is not good enough, despite the good efforts being made. He needs to step up and improve the situation, particularly for young people.
Mr Hunt
I accept that we need to improve the provision of mental health services for children, but I do not accept the hon. Lady’s characterisation. She will know that in the final Budget before the general election, the previous coalition Government committed £1.25 billion over this Parliament to improving child mental health provision and perinatal mental health support. That has been honoured by this Government, and we are in the process of working out how to roll that out. It is something that the Minister for Community and Social Care, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), spends a lot of time thinking about.
Before we discuss precisely what things need to happen—I think they should be done in a bipartisan spirit—we should recognise that really important progress has been made in recent years. I want to start with some of the achievements made by the previous Labour Government, who increased funding for the NHS and, within that, for mental health services. They oversaw a significant expansion of the mental health workforce and big improvements in in-patient care, with 70% of mental health patients being seen in private rooms. They increased the use of new drugs and therapies, including psychotherapy. Those were important steps forward.
Under the coalition Government in the previous Parliament, we saw a record investment of £11.7 billion in mental health services at a time of huge pressure on public finances. We passed the parity of esteem clause in the Health and Social Care Act 2012, something we Conservative Members are incredibly proud of. The first access targets were set for talking therapies for psychosis. We are starting to end the distortion that the right hon. Member for North Norfolk talked about, which saw targets for physical health access sucking resources away from local mental health provision over a sustained period.
We have seen particular progress in two areas. It is important to mention them; it provides encouragement that when we decide to focus on improving specific areas of mental health provision, we can make real progress. First, on talking therapies, the NHS is now recognised as a world leader. The number of people getting help from talking therapies quadrupled from 182,000 people starting treatment in 2009-10, to 800,000 starting treatment last year. The total number of people helped in the previous Parliament was 3 million, compared with just 226,000 people helped in the Parliament before that—a thirteenfold increase.
We are hitting the new access target to reach 15% of those needing it, although we are not quite hitting the recovery target; I hope we can put that right soon. That model is being looked at very closely by Scandinavian countries, and a pilot, based on what we have done here, is starting in Stockholm. We can be very proud of that important progress.
The last Parliament saw a 50% increase in dementia diagnosis rates, up from 41% at the start of the Parliament to 67% at the end of the Parliament—the highest dementia diagnosis rate in the world. We have 1.3 million dementia friends and 120 dementia-friendly communities. We have seen a doubling in funding for dementia research, with a new ambition to find a cure or disease-modifying therapy by 2025. In the spending round, the Prime Minister announced funding for a new dementia research institute; that will be another important step forward.
James Morris
The Secretary of State talks about the amount of money put into dementia research for very good reasons, but is there not a strong argument for building a research and evidence base around mental health? We need a commensurate investment in research on mental health, so that we can understand more about prevalence.
Mr Hunt
My hon. Friend is absolutely right, and I commend him for the work he does on the all-party group. The truth is that it is still early days when it comes to a proper understanding of mental illness. According to the latest Times Higher Education league table, this country has five of the top 10 health research universities worldwide, so we have a huge contribution to make to that research; he is absolutely right to make that point.
Debbie Abrahams
I have already mentioned the 590 suicides associated with the work capability assessment. In addition, the Royal College of Psychiatrists has raised concerns about the cut to the employment and support allowance work-related activity group, given that many of those affected have mental health or behavioural disorders. According to the RCP, there is potential for exacerbating mental health issues and self-harming, and even for people to take their own lives. Will the right hon. Gentleman meet the Secretary of State for Work and Pensions to deal with this matter?
Mr Hunt
We have close working relations with the Department for Work and Pensions, which I shall come on to explain. I would urge caution, however, on the issue of suicide rates. The BMJ study said that no conclusions could be drawn about cause and effect from it. When it comes to work, we need to remember the many studies that talk about the improved health and wellbeing that comes from being in work, and the tremendous progress made, with 2 million additional jobs created over the last Parliament.
Mr Ivan Lewis
I acknowledge the progress made, but let me tell the Secretary of State that what really winds up people outside this place is the rhetoric-reality gap. When they hear politicians on all sides making grand statements about access to treatment, but the reality is different, it damages the integrity of politics. There are two options for the Secretary of State. The first is using political will at a national level to say to local commissioners that they have to prioritise mental health and close the gap in terms of parity of esteem. The second is to address the fact that commissioners on the ground do not have adequate resources; they have to make impossible choices because sufficient resources are not being made available.
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. Before the Secretary of State answers the intervention, let me say that long interventions are not appropriate on a day when so many Members wish to speak. If Members wish to make a speech, they may do so, but an intervention has to be short.
Mr Hunt
If the hon. Gentleman has listened to what I have been saying, he will know that I have been very honest about the problems and about the gap between what we want to deliver and what we are delivering. I shall come on to talk about some solutions, but it is important that Opposition Members recognise that we have had a real and specific focus on mental health over the last five years, during which very important progress has been made. If we continue to broaden out our focus, we hope we can make progress in other areas as well.
Let me talk openly about where more progress needs to be made. First, we have far too much variation in the quality of services across the country, and opacity about where services are good and where they are unsatisfactory. It is wrong that I, as the person responsible for the health service, cannot tell people in simple terms the relative quality of mental health provision in North Shropshire versus South Shropshire or in Cirencester versus Sheffield. We need to know that. We know from other areas of the health service that once we can be transparent about the variations in care, people will measure themselves against their peers and huge improvement can be made.
Mr Mitchell
My right hon. Friend deserves great praise for not only the content but the tone of his speech. Further to the point made by the hon. Member for Bury South (Mr Lewis), does my right hon. Friend agree that while any gap between reality and rhetoric is to be regretted, what really irritates our constituents is the making of bogus party political points on the subject? I hope that he will ensure that his tone and his content are reflected by his Department. I wish him every success in working with the hon. Member for Liverpool, Wavertree (Luciana Berger), who clearly cares deeply about this matter, to ensure that we have an all-party approach to it.
Mr Hunt
My right hon. Friend is, of course, absolutely right, and I think we do a great disservice to the many people suffering from mental health conditions if we allow this to become a partisan issue. Of course Oppositions must hold Governments to account for their promises, but we should never try to suggest that one side of the House cares more about this issue than the other or that the efforts on one side have somehow been compromised by a lack of interest in or commitment to the issue. It is clear from the number of Members of all parties speaking in today’s debate that the determination to improve mental health provision is shared right across the House.
We urgently need to address other issues, including the increase in eating disorders such as anorexia, which can be a killer. Between 5% and 20% of anorexia sufferers tragically die, and we have to do something urgently about that. We need to deal, too, with the pressures on child and adolescent mental health services, with which all Members will be familiar through their constituency surgeries. Referrals were up 11% last year, and we need to make sure that CAMHS is able to deal with that extra demand, as well as looking at what can be done to improve early intervention so that we reduce the increase in those referrals.
Mr Hunt
Let me make some progress, and I shall give way later.
We need to look at the use of police cells, which has often been spoken of here. We have seen a 55% reduction in the use of police cells over the last three years, but they were still used 4,000 times last year. Particularly for children, that is totally inappropriate, and it is often inappropriate for adults, too. Out-of-area placements for non-specialist care are another issue, and the Minister for Community and Social Care is working extremely hard and is committed to implementing a plan to turn this around by March next year.
Neil Coyle (Bermondsey and Old Southwark) (Lab)
The Secretary of State talked about cross-party support for action to tackle suicide and related issues. In our debate on assisted dying, there was a lot of support for doing more to tackle the problems of anyone who suggested that they wished to commit suicide. Why, then, does the right hon. Gentleman refuse to acknowledge the impact of benefit cuts and changes in assessment processes, as mentioned by my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams)?
Mr Hunt
The BMJ was very clear in saying that conclusions about cause and effect should not be drawn, but let me make a broader point about suicide. Suicide rates—under the last coalition Government and the previous Labour Government—have been above and below the 20-year long-term average, but I think they are an important bellwether of the effectiveness of mental health services. I think we should be bold and ask whether we could have a zero-suicide ambition. No country in the world has delivered that, and it would require a big rethink of the way we approach mental health services. Nevertheless, I think that we should be bold and ambitious and think in terms of that objective, and then think about all the factors that may contribute to people being in a highly distressed state and unable to get the support that they want.
Mr Hunt
We are working very closely with the Department for Work and Pensions to improve mental health provision for people who are looking for work—not just those who are experiencing difficulty in finding work because of stigma and bias among employers, but those who are in work but may fall out of the workforce because of a mental health condition.
We cannot do everything, in this area of health provision as in others, but that does not mean that we should not make tangible and measurable progress towards the ambitions that are shared by Members in all parts of the House. The first important step involves funding. The Chancellor delivered a record settlement for the NHS in the recent spending review, confirming a £10 billion real-terms increase in its funding over the course of this Parliament. That is very significant for mental health, because not only will there be a rise in the baseline funding of the clinical commissioning groups that hold local health budgets, but those CCGs are committed to increasing the proportion of their funding that goes into mental health.
Mr Hunt
I will proceed with my speech for a little longer, if I may.
We are seeing the prospect of very real progress, and we as a Government need to give careful thought to which areas to prioritise. We do not have a monopoly of wisdom in this area, which is why we set up the independent mental health taskforce that is led by Paul Farmer, the chief executive of Mind. We will receive its report early in the new year. It will follow a successful independent report produced by the cancer taskforce, chaired by Harpal Kumar. I think that it is a good way of uniting the Government, Members in all parts of the House, and the mental health campaigning charities, so that we can decide together on the key areas that we want to transform in the coming years.
We are still working on the detailed planning, but we have already announced the provision of £2 billion of additional mental health funding over the course of this Parliament, which will benefit CAMHS, perinatal mental health treatment, the treatment of eating disorders, and talking therapy. Some of that funding is a result of promises made by the coalition Government which we have said we will honour, and some is a result of promises that we ourselves have made.
I agree with the hon. Member for Liverpool, Wavertree that as we increase investment in mental health, we need greater transparency in respect of the way in which that money is spent. I am pleased to say that next June, following consultation with the King’s Fund, there will for the first time be independently assured Ofsted-style ratings that will tell us very simply, CCG area by CCG area, whether mental health provision in the health economy as a whole is outstanding, is good, requires improvement, or is inadequate. As far as I know, ours is the first country in the world to do that. The hospital sector underwent the same process in the wake of Mid Staffs, and, on the basis of that experience, I believe that it will lead to a dramatic reduction in variation and an improvement in care as people are given independent information about how their services compare with those of their peers. That increased transparency will also mean the development of a new mental health data set, which will enable us to collect more and better data and then share them with the House, debate them, and learn what needs to be learnt.
Jonathan Reynolds
I recognise the thoughtful case that the Secretary of State is making in saying that things are not good enough but they are getting better, but I must say to him—in a non-partisan way—that when it comes to funding, the stories about funding in my area do not match what we are hearing from him today. There is a story on the Manchester Evening News website about a £1.5 million cut in Greater Manchester.
Mr Hunt
We, as a Government, make commitments and choices in terms of where we want resources to go, and we then have a duty to ensure that they are followed up locally. As we know from our experience of the health service, sometimes—under all Governments—that advice is followed, and sometimes it is not. The introduction of proper independent ratings, area by area, will enable us to expose the areas that are not making the commitment to mental health that they should be making. As has been pointed out many times by Members in all parts of the House, failing to invest what is needed in mental health is a false economy. It stores up problems for accident and emergency departments and for the providers of mental health services, because late intervention means more expensive intervention, and it is of course a very real human tragedy for the individuals concerned.
Luciana Berger
I thank the Secretary of State. Will he clarify the commitment that he has just made? Does it extend to ensuring that we will be shown a clear picture of mental health spending in every area?
Mr Hunt
I believe that we will be able to do that, but I will write to the hon. Lady to clarify exactly what we think we are able to do. I am certainly committed to ensuring that the House is given information about the quality of provision throughout the service, and investment is a factor in determining whether the standard of that provision can be as high as we want it to be.
The hon. Lady rightly spoke of the importance of cross-Government work. We have established an innovative unit with the Department for Work and Pensions, and have set up a series of pilots to help people with mental health conditions to get back to work. We urgently need to do more to reduce the stigma perceived by employers. According to the findings of one survey, up to 40% of employers would avoid hiring someone with a mental health problem. We also want to help those who are at risk of leaving work because of mental health problems. We are working closely with the Department for Education as well. We have launched a pilot programme to create a single point of contact for schools that are concerned about pupils with mental health challenges. It now covers 22 areas and 27 CCGs.
If we are to tackle this issue, however, we need to achieve something that the Government alone—indeed, the House alone—cannot deliver. We need further progress throughout society in reducing that stigma. Bill Clinton once said:
“Mental illness is nothing to be ashamed of, but stigma and bias shame us all.”
Let me end by paying tribute to the Time to Change movement, founded by Mind and Rethink, and the Dementia Friends movement, led by the Alzheimer’s Society. I also pay tribute to Members in all parts of the House who have participated in mental health campaigns, and reassure them that they have the Government’s full support as we try to change attitudes on this vital mission. Someone once said that the greatest cruelty was our casual blindness to the despair of others. Let us resolve today that when it comes to mental health, no one can ever say that about the House of Commons.
NHS: Charging Overseas Visitors and Migrants
Jeremy Hunt Excerpts(8 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
The visitor and migrant National Health Service cost recovery programme was established in July 2014 to design and implement improvements in the systems for charging patients who are not resident of the United Kingdom. The programme has focused so far on improving identification and cost recovery from chargeable patients in hospitals.
I am pleased to announce the Department of Health will now be seeking the public’s views on extending charging of overseas visitors and migrants who use the National Health Service. We have proposed a number of changes to enable overseas visitors and migrants to be charged for NHS healthcare they receive, in addition to the existing system for cost recovery for hospital treatment. The proposed extension of charging will not affect free healthcare at the point of use for permanent residents of the UK.
The consultation seeks opinions on proposals affecting:
Primary Medical Care
NHS Prescriptions
Primary NHS Dental Care
Primary NHS Ophthalmic Services (Eye Care)
Accident and Emergency (A&E)
Ambulance Services
Assisted Reproduction
Non-NHS providers of NHS Care and Out-of-Hospital Care
NHS Continuing Healthcare
EEA National’s residency definition
Overseas visitors working on UK-registered ships
The consultation also seeks views on any further areas that could be considered for charging.
The proposals explored within the consultation aim to support the principle of fairness by ensuring those not resident in the United Kingdom who can pay for National Health Service care do so. The proposals we are consulting on do not intend to restrict access, but aim to ensure everyone makes a fair contribution for the care they receive.
We propose that the most vulnerable people, including refugees, remain exempt from charging. Furthermore, the National Health Service will not deny urgent and immediately necessary healthcare to those in need, regardless of residency. We also propose that exemptions from charging will also remain in place for illnesses that pose a risk to public health.
The potential income generated through the extension of charging will contribute towards the Department of Health’s aim of recovering up to £500 million per year from overseas migrants and visitors by the middle of this Parliament (2017/18). The recovery of up to £500 million per year will contribute to the £22 billion savings required to ensure the long-term sustainability of the National Health Service.
Attachments can be view online at:
http://www.parliament.uk/writtenstatements.
[HCWS360]
Junior Doctors Contract
Jeremy Hunt Excerpts(8 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr. Speaker, I would like to update the House on the junior doctors’ strike. Earlier this month, the union representing doctors, the British Medical Association, balloted for industrial action over contract reform. Because the first strike is tomorrow, I wish to update the House on the contingency plans being made.
Following last week’s spending review, no one can be in any doubt about this Government’s commitment to the NHS, but additional resources have to be matched with even safer services for patients. That is why, on the back of mounting academic evidence that mortality rates were higher at weekends than in the week, we made a manifesto commitment to deliver truly seven-day hospital services for urgent and emergency care. However, it is important to note that seven-day services are not just about junior doctor contract reform. The Academy of Medical Royal Colleges noted:
“The weekend effect is very likely attributable to deficiencies in care processes linked to the absence of skilled and empowered senior staff in a system which is not configured to provide full diagnostic and support services seven days a week.”
So our plans will support the many junior doctors who already work weekends with better consultant cover at weekends, seven-day diagnostics and other support services, and the ability to discharge at weekends into other parts of the NHS and the social care system. But reforming both the consultants’ and junior doctor contracts is a key part of the mix, because the current contracts have the unintended consequence of making it too hard for hospitals to roster urgent and emergency care evenly across seven days.
Our plans are deliberately intended to be good for doctors: they will see more generous rates for weekend work than those offered to police officers, fire officers and pilots; they protect pay for all junior doctors working within their legal, contracted hours, compensating for a reduction in antisocial hours with a basic pay rise averaging 11% and average pay maintained; they reduce the maximum hours a doctor can work in any one week from 91 to 72, and stop altogether the practice of asking doctors to work five nights in a row; and, most of all, they will improve the experience of doctors working over the weekend by making it easier for them to deliver the care they would like to be able to deliver to their patients.
Our preference has always been a negotiated solution, but the House knows that the BMA has refused to enter negotiations since June. However, last week I agreed for officials to meet it under the auspices of the Advisory, Conciliation and Arbitration Service—ACAS. I am pleased to report to the House that, after working through the weekend, discussions led to a potential agreement early this afternoon between the BMA leadership and the Government. This agreement would allow a time-limited period during which negotiations can take place, and during which the BMA agrees to suspend strike action and the Government agree not to proceed unilaterally with implementing a new contract. This agreement is now sitting with the BMA junior doctors executive committee, who will decide later today if it is able to support it.
However, it is important for the House to know that right now strikes are still planned to start at midnight, so I will now turn to the contingency planning we have undertaken. The Government’s first responsibility is to keep their citizens safe. That particularly applies to those needing care in our hospitals, so we are making every effort to minimise any harm or risks caused by the strike. I have chaired three contingency planning meetings to date, and will continue to chair further such meetings for the duration of any strikes. NHS England is currently collating feedback from all trusts, but we estimate that the planned action will mean up to 20,000 patients may have vital operations cancelled—these include approximately 1,500 cataracts operations, 900 skin lesion removals, 630 hip and knee operations, 400 spine operations, 250 gall bladder removals and nearly 300 tonsil and grommets operations.
NHS England has also written to all trusts asking for detailed information on the impact of the strikes planned for the 8 and 16 December, which will involve the withdrawal of not just elective care but of urgent and emergency care as well. We are giving particular emphasis to the staffing at major trauma centres and are drawing up a list of trusts where we have concerns about patient safety. All trusts will have to cancel considerable quantities of elective care in order to free up consultant capacity and beds. So far the BMA has not been willing to provide assurances that it will ask its members to provide urgent and emergency cover in these areas where patients may be at risk, and we will continue to press for such assurances.
It is regrettable that this strike was called even before the BMA had seen the Government’s offer, and the whole House will be hoping today that the strike is called off so that talks can resume. But whether or not there is a strike, providing safe services for patients will remain the priority of this Government as we work towards our long-term ambition to make NHS care the safest and highest quality in the world. I commend this statement to the House.
Mr Hunt
What an interesting response from someone who has never championed seven-day services and has never been prepared to stand up for patients and do the right thing, however difficult it might be.
The hon. Lady asked about ACAS, so let me respond to her comments. We did not respond immediately—incidentally, our response was not to rule it out but to say that we would consider it and that we did not rule it out—because I made a private approach to the head of the British Medical Association to see whether there was enough common ground to make an approach to ACAS worth while. I wanted to give time for that private approach to bear fruit.
The hon. Lady asked about the brain drain. I will tell her what we are doing to stop the brain drain: there will be £3.8 billion of extra resources for the NHS next year. That is £1.3 billion more than Labour promised at the last election. That is a commitment that we can make on the back of a strong economy, which all doctors know that the Labour party would never be able to deliver.
The hon. Lady has repeatedly called for the Government to remove the threat of contract imposition. Let me tell her why we cannot do that. It would give the BMA a veto over a manifesto commitment that has been endorsed by the British people—[Interruption.] She is making noises from her seat, but let me tell her what we have actually said. We will suspend proceeding to the new contracts during the period in which negotiations happen—a short, time-limited period—and in return the BMA will suspend the threat of strikes for that time-limited period. Removing the threat of imposition permanently has not been agreed in any other part of the NHS or any other part of the public sector. The Government must balance the needs of patients, doctors and taxpayers and giving one of those groups a veto over any new contract would make it impossible to make that judgment.
The hon. Lady talked about the way in which I have approached this. Being intemperate and unreasonable is a quality that I appear to share with every Minister of Health the BMA has met; those are not my words but those of Nye Bevan, the person who founded the NHS. Had he listened to the BMA, he would have not been able to set up the NHS; it would have had to be set up by the Conservative Government who followed that Labour Government.
This junior doctors contract is not the only thing we need to do to have seven-day services, but contract reform is what hospitals say is the most important thing of all. It is based on independent research. The 2013 report from the Academy of Medical Royal Colleges had 10 clinical standards, on which we have based our proposals. We have also based them on the seven studies we have now had over five years that talk about the problems of the weekend effect. We have also had the independent research by the pay review body on which we based the bulk of our proposals.
I gently want to say to the hon. Lady that when it came to the biggest issue of patient safety in the NHS in recent years she did not speak out against the strike. She did not support the Government’s moves to seven-day services and when it came to avoidable mortality she preferred to pick holes in the data rather than make the moral case for action. The British public have noticed.
Mr Kenneth Clarke (Rushcliffe) (Con)
I congratulate my right hon. Friend on his steady and patient pursuit of a seven-day service for patients in the face of the extraordinarily militant tactics of the BMA. As one of his predecessors, I can reassure him that the tendency to personalise any dispute against the Secretary of State is a long-standing tradition of this trade union that goes back to Lloyd George, when it resisted panel doctors. It was ferocious in its opposition to Nye Bevan and the establishment of the NHS and every Secretary of State of every party since that time has had exactly the same experience in a dispute. If my right hon. Friend succeeds in getting the negotiations under way on a time-limited basis, as he rightly said, will he approach the BMA—of course, in a reasonable way—and insist that it make it clear that it supports a seven-day service, which would be of benefit to the country, and will not turn this into a demand for large amounts of extra pay? I think the British medical profession is among the best paid in Europe, if not the best paid. Everyone should concentrate on how to raise standards of service to ordinary patients up and down the country and how to get rid of higher mortality rates at weekends?
Mr Hunt
I thank my right hon. and learned Friend for his robust support. I seem to remember that when he was Health Secretary posters were put up all over the country saying, “What do you call a man who ignores doctors’ advice”, with a picture of my right hon. and learned Friend. He knows exactly what this is all about. It is not just Conservative Health Secretaries: Nye Bevan and Alan Milburn went through this.
My right hon. and learned Friend is absolutely right: we will all be delighted if the strike is postponed. Incidentally, it begins at 8 o’clock tomorrow morning, not midnight—I must correct that. He is right: the Government’s focus is unremittingly on improving patient care. We have made it clear that any settlement has to be within the current pay envelope. The great sadness is that the vast majority of doctors are passionate about doing something about seven-day services. If only we had had the chance to negotiate from June, we could have avoided the situation we are in.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I, too, welcome the fact that the Secretary of State has been to ACAS and made the change to plain hours that would have resulted in hours between 7 o’clock to 10 o’clock on a Saturday being counted in the same way as the equivalent period during the week. That would particularly punish people who already work at weekends such as acute medical staff and doctors working in accident and emergency—the very people we need.
I welcome the fact that the Secretary of State has made that change. I should be grateful for clarification of whether the threat of imposition is there or not. The statement says that it has been removed, but in his reply to the shadow Secretary of State he implied that it has not been removed. It would be helpful if he clarified the position.
We keep talking about more people dying at the weekend. May I again stress that it is not excess deaths at weekends, implying that hospitals look like the Mary Celeste? It is excess deaths of people admitted at the weekend, who may die on any day of the week. Junior doctors already cover weekends. It is the additional services to diagnose and get people on their journey that we are discussing. We need to focus on that. Unfortunately, the Secretary of State, in previous statements, has moved from talking about excess deaths to talking about the consultant opt-out clause, which applies only to routine work—I am sorry, a toenail clinic on a Sunday will not save lives—but he needs to focus on strengthening the seven-day service for urgent cases, in which people are ill and where existing provision leads to excess deaths. Hopefully, we can make progress. I join the Secretary of State and everyone in the House in hoping that there is not a strike tomorrow.
Mr Hunt
The hon. Lady is right that this is about the excess mortality rates of people admitted at the weekend—not of people who are already in hospital at the weekend. I am afraid that she is mistaken in her characterisation of the rest of the Government position. Clinical standards are clear: people admitted at the weekend, or at any time, should be seen by a consultant within 14 hours, but that is true in only one in eight hospitals across seven days of the week, which is why sorting out the consultant contract for urgent and emergency care matters. Although the opt-out in the consultant contract applies only to elective work, half as many consultants are available in A&E on Sunday as are available during the week, although Sunday is one of the busiest days of the week, so it is not just about junior doctors. However, if we are going to make life better for junior doctors, we need to make sure that they have more senior cover and do not feel clinically exposed, which is what independent studies have said they feel.
Governments of any party must have the right to set the terms and conditions of an employment contract. That is a right that no part of the public sector has moved away from, and it is a vital right for all employers. I have simply said that I will not move towards any new contract while negotiations are happening during this time-limited period. That was what my statement clearly said, and the BMA for its part has said that if this agreement is honoured, it will remove the threat to strike during that period.
Mrs Cheryl Gillan (Chesham and Amersham) (Con)
I congratulate the Secretary of State on coming here today on this very important matter. All parts of the House support him in trying to find a negotiated solution to this knotty problem. However, if the strike goes ahead—although we very much hope that the BMA will see sense and agree to the terms so far put on the table—I understand that the BMA has not been willing to provide assurances that it will ask its members to provide urgent and emergency cover in areas where patients may be at risk. What more can the Secretary of State do to encourage the BMA to make that statement? That is what will be worrying patients out there.
Mr Hunt
On the overall picture, we must be clear that this is not about asking junior doctors to work a lot of extra hours for free. We expect that as we have increased take-up of seven-day services and more people working antisocial hours, particularly on Sundays, that might lead to a higher pay bill, but we need to make sure that the proposals for the workforce that we have at present protect average pay and mean that as we move to seven-day services, they are affordable by hospitals. To answer my right hon. Friend’s question, we respect the right of doctors to strike, even though it is very disappointing when they choose to do so, but they have said on this occasion, in a way that is quite unprecedented, that they will withdraw urgent and emergency care on 8 and 16 December. All we have said to them is that if there are areas where we are not able to make alternative arrangements for urgent and emergency care by, for example, using other front-line clinicians, we would like their support in those specific areas, not across the whole country, in asking junior doctors to step in on those cases in the interests of patient safety. We have not yet had those assurances, but we very much hope we will get them.
Several hon. Members rose—
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)
When the Secretary of State chaired his three contingency meetings, did he take account of the fact that last year we had about 43,900 excess winter deaths, which were avoidable and largely caused by almost toxic overcrowding of emergency departments? What provisions has he made to avoid the excess deaths that we had last year and to make sure that that is not made even worse by the present situation?
Mr Hunt
The hon. Lady is right to be concerned by the much higher than normal excess winter deaths that we had, but I would not characterise the reason for those excess deaths as she did. We think they were largely caused by the ineffectiveness of the flu vaccine that was recommended by the World Health Organisation last year but proved not to be as effective as it normally is. The early signs are that this year’s flu vaccine will be more effective. Those excess deaths are deaths at home and throughout the system, not just in hospitals, but of course we are doing everything this winter, as we did last winter, to make sure that we minimise the possibility of excess deaths.
Several hon. Members rose—
Helen Whately (Faversham and Mid Kent) (Con)
Thank you, Mr Speaker.
I welcome the fact that the BMA is returning to talks and that there is a potential agreement on the table. The dispute has focused on pay and hours, but I think that its roots might go deeper. For instance, juniors often do not feel valued or part of the team. Does my right hon. Friend agree that the best way to improve the situation for juniors is for them to engage in talking, rather than striking, and that talking, which they are doing, is the right choice by juniors, who are the future leaders of the NHS?
Mr Hunt
I agree with my hon. Friend, who has great knowledge of NHS matters. I simply say to junior doctors that this is not just about contracts and pay; it is also about training. Having consultants more available at weekends will help improve training for junior doctors. We will also need to look at continuity of training, which I think has been undermined in recent decades. If junior doctors are looking for a visible reflection of this Government’s commitment to the NHS, they should look at last week’s spending review statement and the extra resources we are putting into the NHS in very tight circumstances. This Government are backing the NHS, and we are doing everything we can to back junior doctors as part of that.
Valerie Vaz (Walsall South) (Lab)
Thank you, Mr Speaker—I was standing.
The Secretary of State referred in his statement—in the last line of page 1 of the copy we have been given—to a “time-limited period” during which negotiations will take place. Is that a day, a week or a month? Will the contract be imposed after that?
Mr Hunt
I hope that the hon. Lady will understand that, because I very much hope that the BMA’s junior doctors executive committee will agree to go ahead with the agreement we have made with its negotiators, I do not want at this stage to go into further details about its contents. Obviously, the agreement will be published as soon as it is made, but I think that I would be pre-empting that decision by going into detail. It is a reasonable period of time for negotiations to take place.
Ben Howlett (Bath) (Con)
Thank you, Mr Speaker—it appears that I need to bob more often.
I am pleased to hear that all parties might be back around the table. I join the Secretary of State in hoping that the strike action is called off. Following a meeting with Bath junior doctors this weekend, it was clear to me that they, too, will be delighted. Will he confirm that safeguards will be a central part of the renegotiation?
Mr Hunt
Absolutely. We want to reduce the number of doctors working unsafe hours and make sure that we have binding ways of ensuring that hospitals cannot ignore the intention of any agreement we make and ask doctors to work extra hours that they do not want to work and that might be unsafe, or indeed to trade on the good will that means many doctors work extra hours unpaid. That is an important part of the discussions that I hope we will now be able to enter into.
Catherine West (Hornsey and Wood Green) (Lab)
I have received a number of emails from constituents about this matter. What impact does the Secretary of State believe this fiasco will have on the long-term morale of staff in the national health service?
Mr Hunt
I am afraid that I do not agree with the hon. Lady’s characterisation of the situation as a “fiasco”. We are making really important changes that will save patients’ lives by eliminating the weekend effect that we have seen in the NHS for some time, which I think any responsible Government need to deal with. The way to improve morale in the NHS is by making it easier for doctors to give their patients the care they want to give, and at the moment that is very difficult in many places at the weekend. We want to put that right.
Craig Whittaker (Calder Valley) (Con)
We have heard about the 20,000 cancelled operations and the inconvenience caused to patients by the planned strikes, but I wonder whether my right hon. Friend could report to the House how serving the needs of patients features in the negotiations with junior doctors so that patients can get the same level of care seven days a week?
Mr Hunt
That is the reason we have had this whole dispute with the BMA, and it is disappointing that, rather than it negotiating with us on something that I think every doctor understands we need to address, it has come to the eleventh hour like this. In the end, my hon. Friend is absolutely right that doing the right thing for patients is also doing the right thing for doctors, because doctors go into medicine because they want to look after patients.
Jim Shannon (Strangford) (DUP)
I thank the Secretary of State for his statement. None of us wants to see a new contract imposed on doctors; that would be the worst possible outcome. It is very important that we have the seven-day process in the NHS. The BMA represents many doctors in Northern Ireland, where health is a devolved matter, so what discussions has he had with the Health Minister in Northern Ireland to address the issue and find a solution?
Mr Hunt
We are keeping in regular contact with our counterparts in the devolved Assemblies and Parliaments. As this is a devolved matter, it is obviously up to them to decide what they do, but I hope they will be encouraged by the progress that I think we are beginning to make in the argument for seven-day services.
Nigel Adams (Selby and Ainsty) (Con)
There are no winners on either side whenever there is a strike, so I wish the Secretary of State well with the negotiations. What answer does he have for the doctors I have met who believe that this contract change forces junior doctors to work even longer for less?
Mr Hunt
I would like to reassure categorically those doctors that that is not the intention of the changes we are making. We have made it clear that we will protect the pay of anyone working within the legal contracted hours, and in fact three quarters of junior doctors will see their pay rise as a result of these changes. We want to deliver safer care. If we are able to go ahead with the negotiations with the BMA that I hope we can in the coming weeks, I hope we will be able to put in place very strong safeguards that all sides agree will reassure my hon. Friend’s constituents.
Clive Efford (Eltham) (Lab)
The Secretary of State has to accept his responsibility in bringing about the cancellation of operations, because if he had been prepared to go to ACAS at the outset, all this would have been avoided. Does he accept that he is going to have to change his attitude towards negotiating with these junior doctors if we are to get the satisfactory outcome that we all want?
Mr Hunt
My attitude is very straightforward: I need to do the things that will make patients in the NHS safer, and I want to negotiate reasonably with anyone where there is a contractual issue that needs to be resolved. I think that the Government’s position has been reasonable. The vast majority of doctors will see their pay go up, and the pay for everyone else working legal contracted hours will be protected. This is a very reasonable offer that does a better job for patients, but it has been difficult to get through to the BMA. I urge the hon. Gentleman to talk to his friends at the BMA and to urge them to be reasonable and talk to the Government, whereby we could have avoided some of the problems.
Jeremy Lefroy (Stafford) (Con)
I thank the Secretary of State and the BMA for their work over the past few days in bringing this matter—I hope—to a resolution, and encourage that spirit in moving forward. May I suggest that the main way in which morale can be restored is to see that both sides are acting in the interests of patients and, in particular, patient safety, which is so vital to doctors and to all of us?
Mr Hunt
No one knows more about campaigning for patients than my hon. Friend, as he has done in his constituency, and I congratulate him on that. He is right. There does not need to be an argument on a matter such as this, because it unites the Government in what we want to do to make the NHS the provider of the safest care in the world with what doctors themselves want to do. The best way forward is to put aside suspicion and for both sides to recognise that we are trying to do the right thing for patients, for doctors, and for the NHS.
Dawn Butler (Brent Central) (Lab)
The Secretary of State has failed. He has failed patients, he has failed junior doctors, and he has failed his Government. He says that people should put aside suspicion. I suspect that the reason he did not agree to meet ACAS sooner was so that he could sneak in the announcement during the autumn statement.
Mr Hunt
Let me tell the hon. Lady what the failure was: it was setting up a contract for junior doctors in 2003 that has made it impossible for hospitals to roster proper care at weekends. The duty of a Secretary of State is to put right those historical wrongs so that patients are safe.
Paul Scully (Sutton and Cheam) (Con)
Tomorrow I am due to go to St Helier hospital to meet some of the doctors on the picket line. I am sure that we all agree that it would be far better if tomorrow, instead, the doctors were there working and their representatives were talking to Government representatives. Does my right hon. Friend agree that in talking to the BMA, there is genuine room for negotiation and agreement on many of the details?
Mr Hunt
I have always believed that a negotiated agreement will be better for doctors, patients and the NHS, because I am sure that the BMA has value that it can add in the negotiating process to make sure that we implement the spirit and not just the letter of what the Government want to do. I agree with my hon. Friend, and I hope that we can enter into constructive, serious negotiations.
Alison McGovern (Wirral South) (Lab)
I have watched my hon. Friend the Member for Lewisham East (Heidi Alexander) fight night and day, and for seven days a week, for services in her constituency, so I would counsel the Secretary of State against saying that she has not fought for seven-day-a-week services. May I help the Secretary of State? In order to restart the process with trust, will he confirm that he has heard from junior doctors—as I have heard from junior doctors who are constituents of mine—that their primary concern is for nothing but patient safety?
Mr Hunt
I do think that that is the primary concern of the vast majority of junior doctors, which is why I think it was wrong for the BMA to refuse even to sit down and discuss with the Government how we were going to implement a manifesto commitment. I now hope we can get past that, so I will not say any more other than that I think it is now possible to get a better agreement for the NHS, and I hope we will now be able to do that.
Huw Merriman (Bexhill and Battle) (Con)
Having been fortunate enough to hear both from junior doctors in my constituency and from the Secretary of State, it is clear to me that both parties are talking the same language but that the communication has not quite filtered through via the BMA. Once this matter is, I hope, resolved, will the Secretary of State think of ways in which dialogue can be improved directly between the Department of Health and junior doctors?
Mr Hunt
My hon. Friend is absolutely right: we have had some very unfortunate megaphone diplomacy over recent months, but I hope we can now put that behind us and that lessons will be learned. As he rightly says, we have never wanted to do anything other than what I think is good for doctors, as well as what is good for patients, and that is what the proposals were about.
Greg Mulholland (Leeds North West) (LD)
It should not have come to this and, of course, there will be a cost implication as a result. I welcome the involvement of ACAS to get to this stage and I hope the strike will be averted. Could the Secretary of State assure me that the specific concerns of anaesthetists are taken into consideration, given that they are on site all the time and are essential in making sure that hospitals are safe?
Mr Hunt
Anaesthetists have an absolutely vital role to play in providing proper seven-day services. In the highest-risk operations it is obviously very important for consultant anaesthetists also to be present, to give their very important judgments. I absolutely give the hon. Gentleman that assurance.
Mr Peter Bone (Wellingborough) (Con)
If this disaster is avoided, we have an opportunity to move forward and the hon. Member for Lewisham East (Heidi Alexander), who represents the Opposition, has offered her support. One of the crucial failings in seven-day care is social care. Would it be possible for Members on both sides of the House to work together to find a solution to that real problem?
Mr Hunt
I hope we can do that. The Opposition have talked regularly about social care, and rightly so. The fact is that both Labour and Conservative-run councils are responsible for the social care system, and being able to discharge into the social care system is a very important part of seven-day services. We are now about to enter a period of important reform in NHS and social care integration, so I see no reason why that approach could not be bipartisan.
Andy Slaughter (Hammersmith) (Lab)
Last Friday, 321 consultants at Imperial College Healthcare NHS Trust gave their full support to the junior doctors. That is just the latest indication that the Secretary of State has called this dispute wrong from the start. He now has an opportunity to rebuild trust. Does he accept that that is not helped by him coming to the House and denigrating junior doctors and their representatives again, as he has done today, and by continuing to conflate routine seven-day services with mortality rates? That just is not helpful.
Mr Hunt
I am afraid the hon. Gentleman is, as ever, completely wrong. First of all, I have not denigrated junior doctors. I have spent a lot of time praising their absolutely vital contribution as the backbone of the NHS. Secondly, I have not conflated routine services with mortality rates. In fact, I have done specifically the opposite. In answer to the hon. Member for Central Ayrshire (Dr Whitford), I confirmed that we are talking about urgent and emergency care and making sure that services are consistently delivered for urgent and emergency care across the week. That is our priority and that does link to mortality rates.
John Howell (Henley) (Con)
As the chairman of the alternative dispute resolution all-party group, may I confirm that it is always right to identify common ground before going into a negotiation at ACAS? I do not think that anyone should underestimate the amount of common ground that the Secretary of State has achieved in getting the ACAS talks going. What will it now take to get the BMA to call off the strike?
Mr Hunt
My hon. Friend is absolutely right. What is the common ground between the Government and junior doctors? We want to make sure they are working safe hours; we do not want to cut their pay; we want safer services for patients; and we want to make sure that the many junior doctors who do work weekends get proper consultant support and training opportunities at weekends as well as during the week. I think that that is enough on which to come to a deal.
Angela Smith (Penistone and Stocksbridge) (Lab)
In his approach, the Health Secretary has implied that the current junior doctors contract arrangements compromise patient safety, so will he tell us which hospital chief executives have confirmed to him that that is the case?
Tom Pursglove (Corby) (Con)
What assessment has the Secretary of State made of both the cost and the wasted NHS resources that will result from any strike action?
Mr Hunt
I cannot provide my hon. Friend with that information this afternoon, because we do not yet know whether the strike will go ahead tomorrow, and how many operations will end up being cancelled in advance of it because of the late notice, but I am happy to get that information for him when we have an estimate.
Marie Rimmer (St Helens South and Whiston) (Lab)
This junior doctors dispute is not just about pay. We are very fortunate to have such marvellous junior doctors. My concern, and I know that it is their concern, is about the change to the training of junior doctors in the proposed imposed contract, which will have such a negative impact on the research and development that makes our national health service the greatest in the world. Will you comment on the impact that the change in the contract will have on training and research? Will that be altered, and if not, will you please look at it again, because that is absolutely essential?
Mr Speaker
I will do neither of those things, but we will soon discover whether the Secretary of State wishes to do either.
Mr Hunt
I hope that the hon. Lady will be reassured by the Government’s November offer, which has specific protection for junior doctors doing research that the NHS needs them to do to ensure that they are not disadvantaged by doing any such research. I am happy to write to her about the plans we have outlined.
Michael Tomlinson (Mid Dorset and North Poole) (Con)
Does the Secretary of State agree that, rather than treating this issue as a political football, which Labour Members appear to want to do, they should take the advice of my hon. Friend the Member for Wellingborough (Mr Bone), which is that both sides should sit down and treat the statement with a cautious welcome? Does the Secretary of State agree that my constituents in Mid Dorset and North Poole are more concerned about patient safety and ensuring adequate 24/7 care than playing politics with our NHS?
Mr Hunt
I do agree. I think that improving seven-day services across the NHS should unite both sides of the House and, indeed, should unite the Government and the medical profession. It is extremely unfortunate that we have got into this position, but there is now an opportunity to put things right and I hope that that happens.
Chris Heaton-Harris (Daventry) (Con)
I welcome the statement, and I very much welcome the conversations that are going on. Many vulnerable and sick people have had letters from their local hospitals today saying that their operation tomorrow has been cancelled. Should we get good news later this evening, is it too late to allow those operations to take place, bearing in mind that in many rural constituencies—and city constituencies —transport has to be arranged for those patients?
Mr Hunt
My hon. Friend is right to bring this back to patients, which we should always do in health debates. Sadly, I fear—even if the strike is called off, as I hope it is—that in the majority of cases it will be too late to rebook people for tomorrow. We in the NHS will do everything we can to rebook people as quickly as we can. He is right that this is one of the very sad things that happens if people do not sit around the table and talk.
Savile Investigations: NHS
Jeremy Hunt Excerpts(8 years, 5 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I am today publishing an update on the Government’s response to the recommendations set out in Kate Lampard’s report on the themes and lessons learnt from NHS investigations into matters relating to Jimmy Savile. A copy of the update report can be found online.
On 26 February 2015, Official Report, columns 483-486, I advised the House that the Government accepted in principle 13 of the 14 recommendations in Kate Lampard’s excellent report, including on access, volunteering, safeguarding, complaints and governance. I also asked the chief executives of Monitor and the Trust Development Authority, now brought together in NHS Improvement, to ensure that all trusts review their current practice against the recommendations within three months, and then to write back to me with a summary of plans and progress.
The update report published today provides a summary of actions taken in response to the 13 recommendations for the NHS, Department of Health and wider Government. All NHS trusts and foundation trusts have responded and those responses have been collated by Monitor and TDA, now NHS Improvement.
In summary, progress has been made against all the accepted recommendations. The vast majority of trusts have already taken action in response to the recommendations or are in the process of doing so. For individual recommendations, at least 80% of providers planned to have implemented them by September 2015, with the remainder due to complete their action by the end of the year.
It is vital that trusts continue to be vigilant against the dangers of child sex abuse. NHS Improvement are currently reviewing CQC’s well-led framework and how it applies to trusts, setting out expectations of NHS provider boards and their oversight of the organisations they are responsible for. Well-run boards should be able to assure themselves that their organisations have processes in place to ensure effective safeguarding, training and recruitment practices. NHS Improvement will consider how best to reflect the recommendations in this framework in an appropriate fashion.
Attachments can be viewed online at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2015-11-26/HCWS330/
[HCWS330]
Oral Answers to Questions
Jeremy Hunt Excerpts(8 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
By 2020, all patients admitted to hospital in an emergency will have access to the same level of consultant assessment and diagnostic tests, whichever day of the week they are admitted.
Michael Tomlinson
With mortality rates at weekends suggesting that there is an increased risk of dying, does the Secretary of State recognise the importance for Dorset of getting right the proposal for a new emergency hospital in the Poole and Bournemouth area and ensuring that there are specialist consultants 24/7?
Mr Hunt
I thank my hon. Friend for raising that issue, which is incredibly important for his constituents and for Dorset as a whole. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who has responsibility for hospitals, will be going there very soon. The clinical standard says that anyone admitted to hospital in an emergency should be assessed by a consultant within 14 hours. Across every day of the week and all specialties, that happens in only one in eight of our hospitals. That is why it is so important to get this right.
Rachael Maskell (York Central) (Lab/Co-op)
Bootham Park mental health hospital and York’s place of safety shut with four working days’ notice, so York no longer has a seven-day service, nor even a one-day service in our hospital. That would have been totally avoidable if one NHS body had overarching responsibility for patient safety. Will the Secretary of State agree to meet me and to have an independent inquiry so that mental health patients are not put at serious risk again and we can have a full seven-day service before 2020?
Mr Hunt
Obviously, I am very concerned to hear what the hon. Lady says. I know that my right hon. Friend the Minister of State has been looking at this issue and is very willing to talk to her about it. Alternative provision has been made, but she is right to make sure that her constituents have access to urgent and emergency care seven days a week.
Dr Andrew Murrison (South West Wiltshire) (Con)
Does my right hon. Friend agree that full hospital services does not mean full services in every hospital, and that if we are to achieve our ambition of driving down excess weekend deaths, we will have to look again at concentrating services in regional and sub-regional centres, and, in addition, make sure that we network properly among smaller hospitals, where they exist?
Mr Hunt
My hon. Friend speaks very wisely on this issue. Yes, this is not about making sure that every hospital is providing every service seven days a week. It is about making sure that in an urgent or emergency situation, people can access the care they need and that, for example, high dependency patients are reviewed twice a day, even at the weekends, by consultants. That happens across all specialties in one in 20 of our hospitals, which is why it is so important to get this right.
Ms Margaret Ritchie (South Down) (SDLP)
What assessment has the Department made of the impact of reduced accident and emergency hours, and what effect will that have on the implementation of a seven-day work plan?
Andrea Jenkyns (Morley and Outwood) (Con)
Over the weekend we learned of the close links between the leadership of the British Medical Association and the Labour party. It seems that the BMA is more interested in pushing its own political agenda than in securing the best deal for its members. Can my right hon. Friend assure me that he will hold his nerve and deliver the seven-day NHS that will make the NHS safer for our patients?
Mr Hunt
I can absolutely give my hon. Friend that assurance. This is essential for the constituents of all hon. Members, whichever side of the House they sit on, and this Government will always stand on the side of patients. The weekend mortality rates are not acceptable. That is why we are doing something about them.
Daniel Zeichner (Cambridge) (Lab)
Given the acute pressures on the national health service, we are a long way from the vision that the Secretary of State wants to achieve. I met the Indian Workers Association this morning. Thousands and thousands of care workers of Indian origin are trained nurses and could be in our NHS, but the bar for the language test has been set so high that they are excluded. Will the Secretary of State look again at the test?
Mr Hunt
I commend the extraordinary contribution made by NHS front-line workers of Indian origin. I have met the Indian doctors association, the British Association of Physicians of Indian Origin, and have had many discussions on that front. It is very important, however, that people speak good English if they are providing care in the NHS. There are real issues for clinical safety when the standard of English is not high enough. We have a lot of fantastic support from immigrants who do a great job on the NHS frontline, but good English is an absolute pre-requisite.
Maggie Throup (Erewash) (Con)
3. What steps the Government are taking to improve diagnostic testing in primary care.
Caroline Lucas (Brighton, Pavilion) (Green)
9. What plans he has to introduce a new contract for junior doctors.
The Secretary of State for Health (Mr Jeremy Hunt)
Junior doctors are the backbone of the NHS. It is highly regrettable that their union has let them down by refusing to negotiate a new contract that will be fairer for doctors and safer for patients, and deliver the truly seven-day services we all want.
Oliver Colvile
I thank my right hon. Friend for that answer, but has he had an opportunity to speak to medical schools about the new contract for junior doctors, especially the Peninsula medical school in my Plymouth, Sutton and Devonport constituency?
Mr Hunt
NHS Employers has regular discussions with the Medical Schools Council, which represents the Peninsula medical school. Although the training of doctors is not the specific contractual dispute that is in the headlines, it is something on which we could make significant improvements. We want to use this opportunity to work with medical schools and the royal colleges to see whether we can bring back some of the continuity of training that used to be such an important feature of junior doctors’ training.
Caroline Lucas
The person who has let down junior doctors is none other than the Secretary of State. Does he recognise how insulting it is to those doctors to imply that they are not already working seven days? Crucially, will he listen to the professionals—junior doctors and their senior counterparts who support them—and drop his threat to impose the contract so that meaningful talks can take place?
Mr Hunt
What exactly would the hon. Lady say to her constituents who are not receiving the standard of care that they need seven days a week, and will she stand side-by-side with them, or with a union that has misrepresented the Government’s position? We have been clear that there are no preconditions to any talks, except that if we fail to make progress on the crucial issue of seven-day reform, we of course reserve the right to implement a manifesto commitment. That must be the way forward, and I urge the British Medical Association to come and negotiate rather than grandstand, so that we get the right answer for everyone.
Dr Sarah Wollaston (Totnes) (Con)
I am deeply concerned about the impact on patient care caused by the proposed three days of industrial action, including two days of a full walk-out. Will the Secretary of State say what advance preparations are taking place to ensure patient safety? Will he reassure the House that there are no preconditions that will act as barriers and to which the BMA has to agree before negotiations can take place?
Mr Hunt
I absolutely give my hon. Friend that reassurance. There are no preconditions, and this morning I wrote again to the BMA to reiterate that point. Of course, if we fail to make progress we have to implement our manifesto commitments, but we are willing to talk about absolutely everything. I agree strongly with my hon. Friend that it will be difficult to avoid harm to patients during those three days of industrial action. Delaying a cancer clinic might mean that someone gets a later diagnosis than they should get, and a hip operation might be delayed when someone is in a great deal of pain. It will be hard to avoid such things impacting on patients, and I urge the BMA to listen to the royal colleges—and many others—and call off the strike.
Dr Philippa Whitford (Central Ayrshire) (SNP)
It is 40 years since the last junior doctor strike—before I even started medical school. Given the ballot tomorrow, does the Secretary of State regret the antagonistic approach that he took before the summer towards senior and junior doctors? Should he instead have worked with them and not threatened to impose a contract so as to reach a stronger emergency seven-day service?
Mr Hunt
I do not know what the hon. Lady thinks is antagonistic about holding reasonable discussions with doctors for three years to try to solve the problem of seven-day care. Those discussions ended with the BMA, after two and a half years, walking away from negotiations last October. We made a manifesto commitment to have a seven-day NHS and to do the right thing for patients, and we simply asked the BMA to sit round the table and talk to us about it. I am confident that we can find a solution.
Dr Whitford
Claiming in July that senior doctors do not work outside 9 to 5 was perhaps felt to be antagonistic. Contrary to the figures quoted by the hon. Member for Dudley North (Ian Austin) last Monday, A&E figures for NHS England are 5% below those in Scotland. With such disappointing figures before we even get into winter or face a work-to-rule, and in the presence of eye-watering deficits, how does the Secretary of State plan to support hospital trusts through the winter?
Mr Hunt
I urge the hon. Lady to correct for the record her wholly untrue statement that I ever said that doctors do not work outside 9 to 5. That is exactly the kind of inflammatory comment that makes the current situation a whole lot worse than it needs to be. I have always recognised the work that doctors do at weekends, but I also recognise that we have three times less medical cover at weekends, which means that mortality rates are higher than they should be. On A&E performance, we are taking extensive measures to ensure that the NHS is prepared for winter. It will be a tough winter, but unnecessary and wholly avoidable industrial action by the BMA will make it worse.
Sir Simon Burns (Chelmsford) (Con)
17. Does my right hon. Friend agree that the failed attempt by the BMA to get an injunction against the General Medical Council to stop it issuing guidance on how doctors should behave responsibly towards patients if there were to be a strike undermines the BMA’s claim that it is putting patient safety first? Will he assure the House that the BMA will have no veto on a seven-day NHS? That was a Conservative party manifesto commitment and it is what the vast majority of people in this country want.
Mr Hunt
My right hon. Friend championed the cause of patients when he was a Health Minister, and we must continue to do the right thing for patients, which is also the right thing for doctors. It is wholly inexplicable that the BMA should try to gag the GMC and stop it issuing guidance to doctors about their professional responsibilities. Whatever the disagreements over the contract, the most important thing is to keep patients safe.
Justin Madders (Ellesmere Port and Neston) (Lab)
I am sure that both sides of the House genuinely appreciate the excellent work done by all staff in our NHS, which at a time of unprecedented strain relies more than ever on the goodwill of its employees to keep going. We have to support and value our staff, not criticise them and provoke them when there is disagreement. Calling junior doctors militant is not the way to end a dispute, and we have heard more of the same rhetoric this morning. Industrial action is always a last resort when negotiations have failed. Does the Secretary of State accept any responsibility for that failure?
Mr Hunt
I accept total responsibility for doing the right thing to save patients’ lives. I have to say that I think that any holder of this office would be doing wholly the wrong thing if they were to try to brush under the carpet six academic studies that we have had in the last five years that say we have higher mortality rates at weekends than we should expect. This Government are on the side of patients and we will do something about that.
Philip Davies (Shipley) (Con)
10. If he will take steps to reduce the number of children born with genetic problems due to marriages between first cousins.
Kate Hollern (Blackburn) (Lab)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
On Friday, I announced an ambitious plan to halve the rates of maternal deaths, neonatal harm and injury and still births by 2030 by learning from best practice in this and other countries. Following the tragic events in Paris, I know the House would also like my reassurance that we regularly review and stress test the NHS’s preparedness for responding rapidly to terrorist attacks. I have written to Madame Marisol Touraine, my French counterpart, to offer our solidarity and support. Vive la France!
Kate Hollern
Just after the election, the Health Secretary called childhood obesity a national scandal and made tackling health inequalities one of his key priorities. How will a flat-rate cut in the public health grant across all authorities, regardless of specific health challenges, as well as a further projected cut, under the reformulation, of £3 million in my constituency, help him to achieve his mission?
Mr Hunt
I gently say to the hon. Lady that we have to find efficiencies in every part of the NHS, and we are asking the public health world to find the same efficiencies as hospitals, GP surgeries and other parts of the NHS, but that should not be at the expense of services. I completely agree with her about childhood obesity, on which we will announce some important plans shortly.
Mr Speaker
Forgive me colleagues, but what we need at Topical Questions is short inquiries, without preamble, if we are to make progress. Let us be led in this exercise by Fiona Bruce.
Heidi Alexander (Lewisham East) (Lab)
On Sunday, independent experts, the King’s Fund, the Nuffield Trust and the Health Foundation, had this to say about the coming winter:
“Expect the inevitable: more people dying on lengthening waiting lists; more older people living unwell, unsupported and in misery; and a crisis in Accident and Emergency.”
Are they all wrong?
Mr Hunt
They are right about the pressures on the NHS, which is why we are investing £5.5 billion more into it than Labour promised. Those pressures will be made a lot worse by the forthcoming strike, so will the hon. Lady clear something up once and for all: does she condemn the strike—yes or no?
Heidi Alexander
Let us be clear: if junior doctors vote for industrial action, one person will be to blame, and that person is the Health Secretary.
The Health Secretary does not want to admit that NHS funding is not keeping pace with demand and that over the last five years, his Government’s deep cuts to social care have left the NHS bleeding. Will he guarantee that every penny of the money his Department had set aside for implementing the now-postponed cap on care costs will go directly into funding social care?
Ruth Cadbury (Brentford and Isleworth) (Lab)
T2. I strongly associate myself and my colleagues with the remarks of the Secretary of State about the atrocities in France this weekend. What assessment has the right hon. Gentleman made of the impact of housing problems on the difficult task of recruiting and retaining clinical staff, particularly nurses in London and London’s NHS?
Julian Sturdy (York Outer) (Con)
T8. Can the Secretary of State assure me that the NHS funding review that is currently under way will deliver a fairer formula for my constituents and many others across York and North Yorkshire by putting age and rurality—some of the biggest drivers of health costs—at the heart of this long overdue review?
Margaret Greenwood (Wirral West) (Lab)
T4. Can the Health Secretary explain how cutting £200 million from public health budgets is consistent with the emphasis on prevention and public health as set out in the five-year forward view?
Mr Hunt
I have already explained that, but I hope the hon. Lady will understand that we also need the Labour party to explain why it is committed to £5.5 billion less for the NHS over this Parliament than this Conservative Government, on the back of a strong economy that her party has never been able to deliver.
Mrs Flick Drummond (Portsmouth South) (Con)
T9. Some of our GP surgeries are finding it difficult to attract new GPs. What plans do the Government have to train new GPs and encourage them to work in areas where it is difficult to recruit?
Heidi Allen (South Cambridgeshire) (Con)
For the avoidance of doubt, will the Secretary of State please repeat again that he will enter into completely open-minded, non-preconditional negotiations with the British Medical Association? The public need to see that we are approaching this matter with an open mind.
Mr Hunt
I am happy to confirm that we are willing to talk about absolutely anything with the BMA to avoid a dispute that would be very damaging to patients. We do, of course, reserve the right to implement our manifesto commitment to seven-day reforms if we fail to make progress in the negotiations, but at this time, in the interests of patients, the right thing to do is sit round the table and talk rather than refusing to negotiate and going ahead with the strikes.
Simon Danczuk (Rochdale) (Lab)
T7. Rochdale infirmary now has fantastic dementia provision which really meets the needs of local people. Will the Secretary of State observe the good practice there, and look into how it could be shared more widely?
Mr Hunt
I shall be happy to do that. We have made great progress in tackling dementia, and there are some very good examples all over the country, but we can still do a lot better. We now need to concentrate not just on dementia diagnosis, but on the quality of the care that we give people when they have been given such a diagnosis.
Norman Lamb (North Norfolk) (LD)
Is the Secretary of State doing everything he can to ensure that we secure extra dedicated investment in mental health in the spending review? He will know that introducing the access rights that everyone else already enjoys requires hard cash. I am sure he will agree that we must end the outrageous discrimination against those who suffer from mental ill health.
Mr Hunt
I congratulate the right hon. Gentleman on his timing, given that the Prime Minister is now present. I assure him that we are committed to putting extra resources into the NHS, and to ensuring that we increase the proportion of those resources that go into mental health. I also congratulate the right hon. Gentleman on the mental health award that he received last week, which was extremely well deserved.
Junior Doctors Contract
Jeremy Hunt Excerpts(8 years, 6 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
This Government are completely committed to the values of the NHS—the same values that encourage aspiring doctors to take up a career in medicine.
Junior doctors are the backbone of the NHS, but the current contract has failed to prevent some working unsafe hours, and does not reward them fairly. We know also that they feel unsupported because consultants and diagnostic services are not always available in the evenings and at weekends.
Today a firm offer for a new contract has been published by NHS Employers. The new contract will be fairer for doctors, safer for patients and juniors alike, better for training, and will better support a seven day NHS.
This offer builds on the cast-iron guarantees that I have previously offered the British Medical Association (BMA) including that we would not remove a single penny from the junior doctors’ pay bill, and we would maintain average earnings for junior doctors. The proposals offer an 11% increase to basic pay, with further increases linked to progressing through training and taking on roles with greater responsibility—instead of being based on time served.
Our ambition for the NHS to be the safest healthcare system in the world is underpinned by reducing, not increasing, the number of hours junior doctors work each week. Juniors will be supported by improved contractual safeguards—the best protection junior doctors have ever had against working long, intense and unsafe hours. For example, no junior will be required to work more than a weekly average of 48 hours without consent and those who opt out of that legal limit in the European working time directive will not be able to work more than a weekly average of 56 hours. The number of hours that can be worked in any single week by any junior will be limited to 72, down from 91; there will be a 13 hour limit on shifts; and there will be no more than five consecutive long days or four consecutive nights, compared to the current contract which permits seven consecutive night shifts or up to 12 consecutive day shifts.
Putting patients first is the responsibility of employers and staff. Where doctors are asked to work in conditions that they believe are unsafe, including being asked to work patterns that put patient safety at risk, they will be asked to use reporting mechanisms available to them to raise the issue with the board of their trust, and reporting data will now be available for the Care Quality Commission (CQC) to use during inspections. We would expect trust boards to look at any such report and decide how to respond to it; and we would expect the CQC, when it carries out an inspection, to look at how the board has responded to this and other data reporting safety incidents and concerns—a tough new measure to ensure safe working.
In order to better support a seven day NHS, basic pay will increase by 11 % to compensate for an extension in plain time working on Saturdays during the day and on weekday evenings, and there will be enhanced rates for hours worked at nights, on Saturday evenings and Sunday. The Government have also decided that plain time will be extended only to 7pm on Saturdays, instead of 10pm on Saturdays, and want to improve training and ensure better clinical supervision from consultants as well.
We will offer new flexible pay premia for those training in hard-to-fill training programmes where there is the most need, such as general practice, emergency medicine and psychiatry, and we will protect the salaries of those who return or switch to training in these programmes. Junior doctors who take time off for academic research that is part of their NHS training, or which contributes to the wider NHS and improvements in patient care, will get additional pay premia to make sure they do not lose out.
Today, I have also written to all junior doctors in England confirming that no junior doctor working legal hours will receive a pay cut compared to their current contract during transition. Around three quarters will see an increase in pay and the rest will be protected. The exception to this is those who currently receive up to a 100% salary boost as compensation for working unsafe hours. Instead, new contractual safeguards will ensure they are not required to work unsafe hours at all. To see how the offer affects them, junior doctors can now log on to a pay calculator published by NHS Employers where they can calculate projected take home pay.
Our preference throughout has been, and continues to be, to reach agreement through negotiations. We have maintained that, in reforming the contract, we must put patients right at the heart of everything the NHS does every day of the week. A fair, sustainable contract with stronger safeguards, together with the greater availability of consultants at the weekends and evenings, is good for patients and good for junior doctors.
The details published today represent the Government’s offer in England, which will be for doctors and dentists in postgraduate training programmes overseen by health education England.
Since they withdrew from negotiations in October 2014—despite agreeing the need for change as far back as 2008—the BMA have refused to return to the table. In light of today’s announcement we hope that the BMA will now agree to return to negotiations.
[HCWS288]
NHS England: Mandate
Jeremy Hunt Excerpts(8 years, 6 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today I am launching a consultation on the mandate to NHS England to 2020. The consultation will close on Monday 23 November, in preparation for the publication of a new mandate to NHS England following the Government’s spending review, to take effect from April 2016.
The mandate to NHS England sets the Government’s objectives for NHS England, as well as its budget. In doing so, the mandate sets direction for the NHS, and helps ensure the NHS is accountable to Parliament and the public. In accordance with the Health and Social Care Act 2012, the Secretary of State must publish a mandate each year, to ensure that NHS England’s objectives remain up to date.
This consultation document sets out, at a high level, how the Government propose to set the mandate to NHS England for the course of this Parliament. The mandate will be finalised in light of consultation responses and subject to the outcome of the Government’s spending review.
The new mandate will be based on the priorities this Government believe are central to delivering the changes needed to ensure that free healthcare is always there whenever people need it most. Our priorities for the health and care system as a whole are:
creating the safest, high quality health and care service in the world by securing high quality health and care services and seven day care to improve clinical outcomes;
maintaining and improving performance against core standards of access while achieving financial balance;
transforming out-of-hospital care to ensure services outside hospital settings are more integrated and accessible, and that every patient has routine access to a GP in the evenings and at weekends, as well as effective 24/7 access to urgent care. We will also strive to reduce the health gap between people with mental health problems and the population as a whole;
driving improvements in efficiency and productivity by reducing waste and inefficiency to ensure every penny delivers the maximum possible benefit to patient care;
improving and reducing variation in outcomes and quality of care at a national and local level;
preventing ill health and supporting people to live healthier lives by tackling obesity and improving quality of life for people with long term conditions such as diabetes and those with dementia; and
supporting research, innovation and growth, and influencing global health priorities.
The Government welcome views on the proposals and invite comments through the consultation process. The consultation document can be accessed online at:
http://www.gov.uk/government/consultations/setting-the-mandate-to-nhs-england-for-2016-to-2017.
[HCWS274]
Junior Doctors’ Contracts
Jeremy Hunt Excerpts(8 years, 6 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“welcomes the Government’s commitment to delivering seven-day hospital services and saving lives by combating the weekend effect; notes the British Medical Association’s (BMA) decision to walk away from negotiations to reform a contract which all sides acknowledge is not fit for purpose; further notes the Government’s proposed introduction of new contractual limits which protect staff from working unsafe hours and the commitment that average junior doctors’ pay will not fall; and calls on the BMA to put patient care first, to choose talks over strikes, and to return to negotiations.”.
I warmly welcome the hon. Member for Lewisham East (Heidi Alexander) to her post at her first Opposition day debate.
One Saturday in April 2006 a 20-year-old man called John Moore-Robinson was out mountain biking with his friends in Cannock Chase when he fell off his bike and the handlebars hit his stomach. His friends dialled 999 and he was rushed to hospital. Although the paramedic who took him to hospital thought he had life-threatening internal bleeding, instead of being treated he was left for 50 minutes, apart from a brief examination. Then he was told he had bruised ribs and sent home. In fact, he had a ruptured spleen and tragically died later that Saturday night.
Tragedies happen in any healthcare system, and despite such stories I am fiercely proud of our NHS and the brilliant care given by our doctors and nurses seven days a week. The hon. Lady was right to thank each and every one of them. Anyone who uses such stories to denigrate the NHS should remember that last year the Commonwealth fund rated us the best healthcare system of 11 major countries—better than France, Germany, Australia or the US—and rated our A and E departments —[Interruption.] It was the Opposition who called this debate, so they might want to listen to some of the arguments. This is a very important issue about the lives of NHS patients, and I am saying that the tragedies and the problems we have should not be used to denigrate the NHS or our A and E departments.
Part of being the best in the world is being honest about where we need to improve, and the fact remains that in our hospitals today we have around three times less medical cover at weekends. In our manifesto in May this Government committed to a truly seven-day NHS so that we prevent a repeat of the tragedy that happened to John Moore-Robinson.
Ms Gisela Stuart
The Secretary of State is absolutely right that we need to address the fact that there seems to be less cover at the weekends. He is trying to circle that square without expanding the number of doctors and the services. He is thinning the service on Monday to Friday to bring more cover to the weekends. That does not solve the problem.
Mr Hunt
I am happy to deal with that. We went into the election in May saying that on the back of a strong economy we were prepared to commit £10 billion extra to the NHS in real terms over the course of this Parliament. That was £5.5 billion more than the hon. Lady’s party was prepared to commit. In the last Parliament, when the increase in NHS spend was half that amount, we increased the number of doctors by 9,000, so we are increasing the number of doctors, but as we do so we need to ensure that we give the right care to patients.
I want to give a word of caution to the shadow Secretary of State. The tragedy of John Moore-Robinson, the gentleman I have mentioned, happened not only on a Saturday, but at Mid Staffs. The last time the House discussed the difference between excess and avoidable deaths was under a Labour Government, when they tried to brush the problems at Mid Staffs under the carpet, saying that we should not take the figures on excess deaths too seriously because they were a statistical construct and different from avoidable deaths. I would have hoped that the Labour party learned the lessons of Mid Staffs and would not make the same mistakes again. [Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The hon. Member for Islington South and Finsbury (Emily Thornberry) may shake her head, but I expect voices in the Chamber to be a little quieter. I want to hear the Secretary of State, and I think all our constituents do. I understand that you might not agree.
Mr Hunt
Let us look at some of the facts. What is the most important thing for people admitted to hospital at the weekend? It is that they are seen quickly by a consultant. Currently, across all key specialties, in only 10% of our hospitals are patients seen by a consultant within 14 hours of being admitted at the weekend. Only 10% of hospitals provide vital diagnostic services seven days a week. Clinical standards provide that patients should be reviewed twice a day by consultants in high-dependency areas but, at weekends, that happens in only one in 20 of our hospitals across all key services.
Helen Whately (Faversham and Mid Kent) (Con)
Is the Secretary of State shocked, as I am, that the shadow Health Secretary seemed to say that the NHS should continue as it is, and that she appears to deny the weekend effect, which means that people are dying unnecessarily?
Mr Hunt
Yes, I am shocked. I am really shocked about the suggestion that there is a difference between what is right for patients and what is right for doctors. The shadow Secretary of State spent a lot of time talking about morale. The worst possible thing for doctors’ morale is their being unable to give their patients the care they want to give.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
Does the Secretary of State not see anything perverse in making the case for a seven-day NHS—he has repeatedly done so—while drawing up a junior doctor contract that financially penalises doctors who already work evenings and weekends? How can that make any sense?
Mr Hunt
The contract will not do that. The contract we are proposing will give more reward to people who work the most antisocial hours. I will explain the details of that later.
The shadow Secretary of State talked about academic studies, so let us look at what the academic studies on the weekend effect say. The Freemantle study, published in the British Medical Journal, which is owned, incidentally, by the British Medical Association, said in September that the mortality rate for those admitted to hospital on a Sunday is 15% higher than for those admitted on a Wednesday. It said the weekend effect equated to 11,000 excess deaths. Let us be clear about what that means. It does not mean that every one of those 11,000 deaths is avoidable or preventable—it would be wrong to suggest that. It means that there are 11,000 more deaths than we would expect if mortality rates were the same as they are on a Tuesday, Wednesday or Thursday. Professor Sir Bruce Keogh, the NHS England medical director, called it
“an avoidable ‘weekend effect’ which if addressed could save lives.”
It is not just one study. In the past five years, we have had six independent reviews. Another study in the British Medical Journal, by Ruiz et al, states:
“Emergency patients in the English, US and Dutch hospitals showed significant higher adjusted odds of deaths…on Saturdays and Sundays compared with a Monday admission.”
The Academy of Medical Royal Colleges—the body that represents all the royal colleges—said in 2012 that deficiencies in weekend care were most likely linked to the absence of skilled and empowered senior staff and the lack of seven-day diagnostic services.
Norman Lamb
During my travels across the country, I recently spoke with the chief executive and the chair of an acute trust. They said that they have no difficulty at all with junior doctors and ensuring that there is cover at weekends; their problem is with consultants—and the Secretary of State has just made that point. Has he not chosen the wrong target?
Mr Hunt
Chief executives of trusts and NHS employers have been very clear that this is about reform of contracts for both consultants and junior doctors, because the reduction in medical cover at weekends happens with both the consultant and the junior doctor workforces. Also, as I will go on to say, it puts huge pressure on junior doctors at the time when they do not have senior support and the ability to learn from it, and that is exactly what we want to sort out.
Junior doctors are not to blame for the weekend effect. The situation would actually be far worse without them, because they perform the lion’s share of medical evening, night and weekend work. In many ways, they are the backbone of our hospitals. However, the BMJ study this year showed that there is evidence that junior doctors felt clinically exposed at weekends, and nothing could be more demotivating for a doctor than not being able to give the standard of care they want for a patient.
Mary Creagh (Wakefield) (Lab)
The right hon. Gentleman has prayed in aid the weekend effect and quoted Sir Bruce Keogh, his own NHS medical director. Is he aware that Professor Keogh has also said that
“it is not possible to ascertain the extent to which these excess deaths may be preventable; to assume they are avoidable would be rash and misleading”?
Mr Hunt
Yes, and I agree with that, but it would be equally rash and misleading to say there are no avoidable deaths. Professor Keogh was saying that lives could be saved if we tackled this. All these studies are saying that 15% more people die than we would expect if we had the same level of cover at weekends as we have during the week. Therefore, as he says, the moral case for action is unanswerable.
Jeremy Lefroy (Stafford) (Con)
The hospital to which my right hon. Friend referred earlier is in my constituency. The accident and emergency department has improved hugely over the past few years—well over 95% of patients are seen within four hours—and one reason for that is that it has consultant cover all the time. It is not open 24/7—we want it to be—but for the 14 hours a day that it is open, it has consultant cover all the time.
Mr Hunt
I am going to make some progress before taking any further interventions.
The question for a Government and for a Health Secretary is this: when we are faced with this overwhelming evidence—six studies in five years—should we take action or ignore it? We are taking action. That is why in July I announced that we will be changing the contracts for both consultants and junior doctors as part of a package of measures to eliminate the weekend effect. If we believe in the NHS, and if we want it to be there for everyone, whatever their background or circumstances, we must be able to offer every NHS patient the promise of the same high-quality care, whichever day of the week they need it.
Let me set out for the House what I have proposed. We announced ambitious plans to roll out seven-day services across the country, with better weekend staffing across medical, diagnostic and support services in hospitals, as well as better integration with social care and seven-day GP access. That will reach a quarter of the population by March 2017, and the whole country by 2020. For consultants, we proposed an end to the right to opt out of weekend working, replacing it with a maximum obligation to work one weekend in four. To its credit, the BMA’s consultants committee has agreed to negotiate on that.
For junior doctors, we proposed to reduce the high overtime and weekend rates, which prevent hospitals from rostering enough staff at weekend, and increase basic pay to compensate. We have made a commitment that the pay bill as a whole would not be reduced, and today I can confirm that not a single junior doctor working within the legal limits for hours will have their pay cut, because this is about patient care, not saving money. Incidentally, I made it clear to the BMA at the beginning of September that that was a possible outcome of negotiations, in an attempt to encourage it to return to the negotiating table. Rather than negotiating, it chose to wind up its own members and create a huge amount of unnecessary anger.
Mark Spencer (Sherwood) (Con)
Given the Secretary of State’s assurance, is there any reason why the BMA should not come back to the table and negotiate with him to solve this problem so that patients are safer at weekends?
Emily Thornberry
Is the right hon. Gentleman going to continue with his plan to change the rules so that trusts that insist on doctors working unsafe hours can no longer be fined for doing so? It will help if he can assure us that those rules will continue and trusts will be fined if they break them.
Mr Hunt
They are not fines; they are perverse incentives to doctors to work unsafe hours. We want to go one better than that. We propose to stop hospitals requiring doctors to work five nights in a row or six long days in a row, and to bring down the maximum number of hours that hospitals can ask a doctor to work in any one week. On top of that, we have imposed the toughest hospital regime of any country anywhere in the world that comes down very hard on hospitals that are not providing safe care.
Norman Lamb
I want to ensure that I fully understand the commitment that the Secretary of State gave about not a single doctor losing out. I think he said that that is “provided they are working within maximum legal hours”. Does that mean people working up to 48 hours, which is the maximum working week under the working time directive? What about doctors who have opted out of that and are working 60 or 70 hours? Could they lose out?
Mr Hunt
It applies to all doctors working within the legal limit. If they opted out of the working time directive, it would apply up to 56 hours. For people who are working more than the legal limits, even after opting out, the right answer is to stop them working those extra hours because it is not safe for patients. But yes, that is the commitment to people even if they have opted out.
Mr Hunt
I am going to make some progress, if I may.
As well as reducing the maximum hours a doctor can be asked to work from 91 to 72 in any week—a significant reduction—and banning hospitals from requiring doctors to work five nights in a row or six long days in a row, as hospitals can currently make them do, we propose to ban the routine use of fixed leave arrangements that mean that some doctors have to give up to three months’ notice before taking leave, meaning that they miss out on vital family or personal occasions.
We did not, and do not, seek to impose a new contract; rather, we invited the BMA to negotiate a new contract so that we could end up with a solution that was right for doctors and right for patients. However, because we had recently won an election in which a seven-day NHS was a manifesto commitment, we said that having tried to negotiate this unsuccessfully for two and a half years, we would ask trusts to introduce new contracts if we were unable to succeed in negotiations.
Lady Hermon
I have a specific point about Northern Ireland. Of course, health is devolved to the Northern Ireland Assembly, but I can assure the Health Secretary that junior doctors in Northern Ireland are absolutely furious about the proposed changes to their contracts. It would help if he could confirm that he is in regular direct dialogue with the Health Minister in the Stormont Assembly, Simon Hamilton MLA. I ask him not to reply that officials talk to each other regularly, because “Minister to Minister” is what I would like to hear.
Mr Hunt
We do have regular dialogue. I suggest that the reason doctors in Northern Ireland might be angry is that they have been listening to misinformation about what the Government in England are proposing, which has, very disappointingly, made doctors all over the UK very angry. I hope that the assurances I am giving, which I gave to the BMA last month and the month before, face to face and in letters, will encourage the hon. Lady to report to the doctors she mentions that the right thing for the BMA to do is to come and talk to the Government. Regrettably, the BMA’s junior doctors committee has refused to negotiate since last June. Instead, it put up a pay calculator on its website that scared many doctors by falsely suggesting that their pay could be cut by between 30% and 50%. It has now taken that pay calculator down, but the damage to morale as a result of it continues.
Rachael Maskell (York Central) (Lab/Co-op)
Will the Secretary of State give way?
Mr Hunt
I will make some progress. Some people say that this is a battle between the interests of patients and those of doctors, but that is profoundly wrong. Doctors who are happy and supported in their jobs provide better care to patients, and the link between a motivated workforce and high-quality care is proven in many studies, as well as in hospitals such as that in Northumbria, where staff have become the greatest advocates for seven-day services since their introduction. Our proposed new system is intended to provide better support to doctors who work weekends, and make seven-day diagnostics more widely available across the NHS.
Simon Hoare
Given the clarity with which my right hon. Friend has addressed the principal concerns of junior doctors, does he expect the BMA’s junior doctors Committee to change its stance, come to the Department and restart negotiations, or will it continue to stall?
Rachael Maskell
This debate is reminiscent of 12 months ago and the “Agenda for Change”, when the Government refusal to negotiate with 1 million NHS staff caused industrial action and a strike. The same thing seems to be happening again. Will the Secretary of State take the shackles off the negotiations and enable the professionals to put their case on the table? Will he listen to them and let them lead negotiations?
Mr Hunt
That is exactly what I would like to happen, but it can happen only if members of the BMA walk through my office door—it is open—and sit down and start negotiating, which they have refused to do since last June. Just as it is wrong to pit doctors against patients, it is also wrong for the Labour party to pit the Government against doctors. In the previous Parliament, Labour wanted to cut the NHS budget, but we protected it. In May’s election we promised £5.5 billion more for the NHS than Labour did, and in the last Parliament a Conservative-led Government delivered 9,000 more doctors to the NHS, 1 million more operations a year, and 600,000 more people were referred for urgent suspected cancer every year.
Because we are not stopping at that, and because we are passionate that the NHS should offer the highest standards of care available anywhere in the world, the Government have also been honest about the problems facing the NHS. Two hundred avoidable deaths every week is too many—it is the equivalent of a plane crash every week. Nor is it acceptable that twice a week we operate on the wrong part of someone’s body, or allow other “never events” to happen. In many of those areas the NHS is performing at or better than international norms, but that does not make such things any more acceptable. We want the NHS to be the first healthcare system in the world to adopt standards of safety that are considered normal in the airline, nuclear or oil industries.
Rehman Chishti
The Secretary of State said that we are open to problems being highlighted. May I thank him for what he did by putting hospitals into special measures? Medway Maritime hospital had the seventh highest mortality rate in 2005, yet nothing was done. Support is now being given to that hospital to turn it around. We are highlighting problems, but we are also introducing measures to fix those problems.
Mr Hunt
I thank my hon. Friend for his consistent support for his local hospital. It has had many troubles, but it is beginning to show signs of turning a corner. If we want to turn things around, we must first be honest about the problem.
I welcome the shadow Health Secretary to her place. Her predecessor tried to minimise the care problems that took place under a previous Labour Government, and he described our attempts to put them right as trying to “run down the NHS”. I hope that she does not do the same. Labour used to be the party that stood up for ordinary men and women; it cared enough about them to set up the NHS, so that no one had to worry about getting good medical care, whatever their circumstances. People need to know that they can depend on our NHS seven days a week. Instead of making mischief about a flawed doctors contract that was introduced by a Labour Government in 2000, the hon. Lady should stand with us as we sort out this problem. Be the party not of the unions but of the patients who depend on high quality care, day in, day out. Professor Bruce Keogh talked about the moral and professional case for concerted action. Surely in that context, she might reconsider this rather ill-judged attempt to make party political capital out of a very real problem.
Everyone who cares about the NHS should want the same thing. The hon. Lady should tell the BMA to get around the negotiating table, something she conspicuously failed to do. In doing so she would stand alongside the many independent voices calling on the BMA to return to the table and discuss a solution with the Government—the Royal College of Surgeons, the Royal College of Physicians, NHS providers and the Academy of Medical Royal Colleges. If she does not do that, the British people will draw their own conclusion about which party is backing the NHS with the resources it needs, which party is supporting hospitals to become safer at the weekends, and which party is standing four-square behind doctors and nurses in their ambition to deliver high quality standards of care for patients. There is only one party that can be trusted, one true party of the NHS, and that is the Conservative party.
Mr Deputy Speaker (Mr Lindsay Hoyle)
There will be a four-minute limit on Back Bench speeches.
Dr Whitford
I totally agree. I also agree with the Secretary of State about patient safety. There is no one in the profession who does not want a seven-day emergency service that is strong and responsive to the needs of unwell patients, but we keep moving from people who are ill to routine services. He has said we must not call them avoidable, yet he just referred to 200 avoidable deaths a week, which is exactly what Bruce Keogh described as “rash and misleading”, and people object to that. There are no excess deaths at the weekend; the issue is with people admitted at the weekend, usually for radiology or investigation. Scotland has been moving on this for the last decade, by working with the profession, not pulling out the pin and throwing a grenade.
Mr Jeremy Hunt
For the sake of clarity, the 200 avoidable deaths are not about the weekend effect specifically, but come from the Hogan and Black analysis, which found that 3.6% of hospital deaths in England had at least a 50% greater chance of having been avoidable, which is separate from the weekend effect—the higher mortality rate among people admitted at weekends. None the less, where there are avoidable deaths—where death rates look higher than they should be—we have an obligation to do something.
Dr Whitford
I agree that it is important to investigate, but it is also important to understand the cause of the problem. A lot of the problem at Mid Staffs was the ratio of registered nurses to patients. That was echoed by Bray in his review of 103 stroke units, which showed that additional consultant ward rounds at weekends had no impact on death rates, while a better ratio of registered nurses reduced them by a third. We need to know the problem before spending billions trying to solve the wrong thing.
Andrew Gwynne
I do not have time to give way, I am afraid.
I echo those sentiments of sincere thanks, but we have heard of junior doctors who already work weekends, already work nights, already work holidays and give their all for their patients. Despite all this, the junior doctors now face a situation that has left them feeling deflated, demoralised and devalued.
Patient safety has been a key theme of today’s debate. Some Members have valiantly leapt to the Health Secretary’s defence, but those voices have been far outnumbered by Members who are deeply concerned that this contract is unsafe for doctors and unsafe for patients.
Members have argued that the removal of the financial penalties that apply to hospitals that force junior doctors to work unsafe hours risks taking us back to the bad old days of overworked doctors, too exhausted to deliver safe care. The BMA says this safeguard, which is built into the current contract, has played an important role in bringing dangerous working hours down. Removing this financial disincentive to overworked junior doctors is extremely alarming, especially at a time when junior doctors are already coming under an enormous amount of pressure and strain. If the Health Secretary would just listen, he would hear junior doctors shouting loudly and clearly that they cannot give any more.
Many Members highlighted the protests and marches that have taken place throughout the country in recent weeks. We had only to catch a glimpse of the placards that were waved as thousands of junior doctors marched against the contract to understand that those doctors now fear for their own health and well-being. I was struck by one banner which read, “I could be your doctor tomorrow, or I could be the patient”, and those doctors’ concerns have been echoed by many Members today. How can the Secretary of State possibly say that he is acting in the interests of patient safety if the very people who work in the NHS say he is putting safety at risk?
Another argument that has been advanced today is that the contract is necessary to ensure that our NHS works seven days a week. Not only does that argument do a huge disservice to our NHS staff who already provide care seven days a week and 24 hours a day, and reveal just how out of touch some Conservative Members are with the realities of working on the frontline in our NHS, but it is wholly inaccurate. If this junior doctor contract were imposed in its current form, it would have the opposite effect, as many independent clinical voices have warned.
It is a bitter irony that the problems that the new junior doctor contract was supposed to be trying to address when it was originally proposed back in 2012—the need to introduce better pay and work-life balance—are the very problems that will be made worse should the contract go ahead in its current form. In letters to the Secretary of State, the presidents of a number of royal colleges and faculties have made it very clear that they share those concerns, but he presumably thinks that they too have been misled.
The Secretary of State said that he did not intend to cut the pay of any junior doctor, but his sums simply do not add up, and everyone can see through the spin. No one with a GCSE in maths can believe that no doctor will be worse off as a result of the new contract. Let the right hon. Gentleman come to the Dispatch Box in the minute that I have left, and answer this question. To what percentage of junior doctors currently working within the legal limits will what the Secretary of State has said today apply? Is it 50%? Less than a quarter? What is it?
Andrew Gwynne
In that case, I ask the Secretary of State to explain this. If the pay envelope is not increasing, and if the pay is not being reduced, how can these sums add up? They just do not add up, and I suggest that he go back to night school and learn some basic arithmetic.
We know that the BMA has been conciliatory today: it has offered to speak to the Secretary of State again. I ask him, please, let us take this down a notch. Let us get him talking to junior doctors again. The simple fact is that these are the junior doctors who work in our A & E; these are the junior doctors who work in every department of every hospital on the frontline. They come in early and leave late, they already provide care for seven days a week, 24 hours a day, and they deserve a lot better than this Government.