Infected Blood

Jeremy Hunt Excerpts

Wednesday 25th March 2015 Written Statements

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

In January 2011, my predecessor, my right hon. Friend the Member for South Cambridgeshire (Andrew Lansley), recalled with sadness how what happened during the 1970s and 1980s, when thousands of patients contracted hepatitis C and HIV from NHS blood and blood products, is one of the great tragedies of modern health care. I would like to say on behalf of this Government how sorry we are for what happened, and express my sympathy for the pain and grief suffered by many infected people and their families.

Since 1988, the Government have established a number of schemes to provide financial support to people affected by that tragedy. The system has evolved in an ad hoc and incremental manner, now comprising five infection-focused schemes that operate according to their own individual criteria. In January 2011, this Government acknowledged the system then had shortcomings and introduced a number of improvements. Despite these improvements, there have been continued criticisms of the system, as reflected in the reports produced earlier this year by my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and by the all-party parliamentary group (APPG) for haemophilia and contaminated blood, and described by hon. Friends and Members across the House during the Backbench Business Committee debate held on 15 January 2015.

From listening to a range of views on the current system, it is apparent that there might be some people who are experiencing significant ill health which may result from their infection(s) who feel they are not well supported by the existing system. However, it is important to recognise there are elements of the current system which do find favour among the beneficiary community. The challenge for any future Government will be to identify the most appropriate way of targeting financial assistance, while ensuring that any system can be responsive to medical advances and is sustainable for Government in financial terms.

I thank both my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and the APPG for their reports, both of which we are considering carefully. It is with frustration and sincere regret that our considerations on the design of a future system have been subject to postponement while we awaited publication of Lord Penrose’s final report of his inquiry in Scotland. We had hoped to consult during this Parliament on reforming the ex-gratia financial assistance schemes, considering, among other options, a system based on some form of individual assessment. However, I felt that it was important to consider fully Lord Penrose’s report before any such consultation. Given its publication today, we clearly are not in a position to launch a consultation, on one of the last sitting days of this Parliament.

However, Lord Penrose’s report has now been published. It can be found on the inquiry website at: http://www.penroseinquiry.org.uk. While it will be for the next Government to consider all of Lord Penrose’s findings, I would hope and fully expect proposals for improving the current complex payment system to be brought forward, with other UK health departments.

In the meantime I am pleased to announce that I will be allocating up to an additional one-off £25 million from the Department of Health’s 2015-16 budget allocation to support any transitional arrangements to a different payment system that might be necessary in responding fully to Lord Penrose’s recommendations. We intend this to provide assurances to those affected by these tragic events that we have heard their concerns and are making provision to reform the system.

Finally I can formally announce that, in line with our consistent policy of openness, we are now preparing for transfer to the National Archive remaining Department of Health documents relating to blood safety for the period from 1986 to 1995. These documents, which will be open for public scrutiny, will be followed by subsequent tranches of documents covering later years.

While I recognise that this statement does not immediately fulfil the desires of all who campaign on this matter, I hope that it signposts this Government’s positive direction on these matters.

[HCWS480]

Review Body on Doctors' and Dentists' Remuneration

Jeremy Hunt Excerpts

Thursday 12th March 2015 Written Statements

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

I am responding on behalf of my right hon. Friend the Prime Minister to the 43rd report of the Review Body on Doctors’ and Dentists’ Remuneration (“the review body”). The report has been laid before Parliament today (Cm 9028). Copies of the reports are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

We thank the review body for its 43rd report and note its recommendations and observations. General practitioners and primary care staff more widely are at the centre of the NHS, and have an important role in ensuring the sustainability of the health service for future generations. That is why we have announced additional funding for primary care and why we are working to increase the size of the general practice workforce. It is also why we were pleased to be able to accept the DDRB’s recommendation of a 1% increase to GP pay.

Subject to the views of consultees, therefore, we intend:

in respect of general medical practitioners, to accept the review body’s recommendation for an increase of 1% to general medical practitioners' income. As the review body only made recommendations in respect of general medical practitioners’ income net of expenses, we intend to use the methods employed by the review body in previous years to calculate the overall contract uplift. The staff expenses element of the formula will be the maximum possible under public sector pay policy. The non-pay expenses element will be uplifted in line with the retail price index, excluding mortgage interest payments (RPIX). On this basis, therefore, the uplift equates to 1.16% uplift to the overall value of general medical services contract payments for 2015-16; and

in respect of general dental practitioners , to accept the review body’s recommendation for an increase of 1% to general dental practitioners’ income. As the review body only made recommendations in respect of general dental practitioners’ income net of expenses, we intend to use the methods employed by the review body in previous years to calculate the overall contract uplift. The staff expenses element of the formula will be the maximum possible under public sector pay policy. The non-pay elements will be uplifted in line with either the retail price index (RPI) or the retail price index excluding mortgage interest payments (RPIX). On this basis, therefore, the uplift equates to 1.34% uplift to the overall value of general dental services contract payments for 2015-16.

As stated in our evidence to the review body and recommended in the review body’s report, the minimum and maximum of the salary range for salaried general medical practitioners will be increased by 1% for 2015-16.

[HCWS405]

Maternity Services (Morecambe Bay)

Jeremy Hunt Excerpts

Tuesday 3rd March 2015 Commons Chamber

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

With permission, Mr Speaker, I would like to make a statement on the independent investigation into the care of mothers and babies at the University Hospitals of Morecambe Bay NHS Foundation Trust, which is being published today.

I commissioned this report in September 2013 because I believed there were vital issues that needed to be addressed following serious incidents in maternity services provided by the trust dating back to 2004.

There is no greater pain for a parent than to lose a child, and to do so knowing it was because of mistakes that we now know were covered up makes the agony even worse. Nothing we say or do today can take away that pain, but we can at least provide the answers to the families’ questions about what happened and why, and in doing so try to prevent a similar tragedy in the future.

We can do something else, too, which should have happened much earlier—and that is, on behalf of the Government and the NHS, to apologise to every family who have suffered as a result of these terrible failures. The courage of those families in constantly reliving their sadness in a long and bitter search for the truth means that lessons will now be learned so that other families do not have to go through the same nightmare. We pay tribute to those brave families today.

I would especially like to thank Dr Bill Kirkup and his expert panel members. This will have been a particularly difficult report to research and write, but the thoroughness and fairness of their analysis will allow us to move forward with practical actions to improve safety, not just at Morecambe Bay, but across the NHS.

I know that before we discuss the report in detail the whole House will want to recognise that what we hear today is not typical of NHS maternity services as a whole, where 97% of new mothers report the highest levels of satisfaction. Our dedicated midwives, nurses, obstetricians and paediatricians work extremely long hours providing excellent care in the vast majority of cases. Today’s report is no reflection on their dedication and commitment, but we owe it to all of them to get to the bottom of what happened so we can make sure it never happens again.

The report found 20 instances of significant or major failings of care at Furness general hospital, associated with three maternal deaths and the deaths of 16 babies. It concludes that different clinical care would have been expected to prevent the death of one mother and 11 babies.

The report describes major failures at almost every level. There were mistakes by midwives and doctors, a failure to investigate and learn from those mistakes and repeated failures to be honest with patients and families, including the possible destruction of medical notes.

The report says that the dysfunctional nature of the maternity unit should have become obvious in early 2009, but regulatory bodies including the North West strategic health authority, the primary care trusts, the Care Quality Commission, Monitor and the Parliamentary and Health Service Ombudsman failed to work together and missed numerous opportunities to address the issue.

The result was not just the tragedy of lives lost, but indescribable anguish for the families left behind. James Titcombe speaks of being haunted by “feelings of personal guilt” about his nine-day-old son who died. “If only”, he says, “I had done more to help Joshua when he still had a chance”. Carl Hendrickson, who worked at the hospital and lost his wife and baby son, told me that he was asked to work in the same unit where they had died and even with the same equipment that had been connected to his late wife. Simon Davey and Liza Brady told me that the doctor who might have saved their son Alex was shooed away by a midwife, with no one taking responsibility when he was tragically born dead.

In short, it was a second Mid Staffs, where the problems—albeit on a smaller scale—occurred largely over the same period. In both cases perceived pressure to achieve foundation trust status led to poor care being ignored and patient safety being compromised, and in both cases the regulatory system failed to address the problems quickly. In both cases families faced delay, denial and obfuscation in their search for the truth, which in this case meant that at least nine significant opportunities to intervene and save lives were missed. To those who have maintained that Mid Staffs was a one-off “local failure”, today’s report will give serious cause for reflection.

As a result of the new inspection regime introduced by this Government, the trust was put into special measures in June 2014. The report acknowledges improvements made since then, which include more doctors and nurses, better record keeping and incident reporting, and action to stabilise and improve maternity services, including a major programme of work to reduce stillbirths. The trust will be re-inspected this summer when an independent decision will be made about whether to remove it from special measures. Patients who use the trust will be encouraged that the report says it

“now has the capability to recover and that the regulatory framework has the capacity to ensure that it happens”.

The whole House will want to support front-line staff in their commitment and dedication during this difficult period.

More broadly, the report points to important improvements to the regulatory framework, particularly at the Care Quality Commission which it says is now

“capable of effectively carrying out its role as principal quality regulator for the first time…central to this has been the introduction of a new inspection regime under a new Chief Inspector of Hospitals”.

As a result of that regime, which is recognised as the toughest and most transparent in the world, 20 hospitals—more than 10% of all NHS acute trusts—have so far been put into special measures. Most have seen encouraging signs of progress, with documented falls in mortality rates. There remain many areas where improvements in practice and culture are still needed. Dr Kirkup makes 44 recommendations—18 for the trust to address directly, and 26 for the wider system. The Government received the report yesterday and will examine the excellent recommendations in detail before providing a full response to the House.

There are, however, some actions that I intend to implement immediately. First, the NHS is still much too slow at investigating serious incidents involving severe harm or death. The Francis inquiry was published nine years after the first problems at Mid Staffs, and today’s report is being published 11 years after the first tragedy at Furness general hospital. The report recommends much clearer guidelines for standardised incident reporting, which I am today asking Dr Mike Durkin, director of patient safety at NHS England, to draw up and publish. I also believe that the NHS could benefit from a service similar to the air accidents investigation branch of the Department for Transport. Serious medical incidents should continue to be investigated and carried out locally, but where trusts feel that they would benefit from an expert independent national team to establish facts rapidly on a no-blame basis, they should be able to do so. Dr Durkin will therefore look at the possibility of setting up such a service for the NHS.

Secondly, although we have made good progress in encouraging a culture of openness and transparency in the NHS, the report makes it clear that there is a long way to go. It seems that medical notes were destroyed and mistakes covered up at Morecambe Bay, quite possibly because of a defensive culture where the individuals involved thought that they would lose their jobs if they were discovered to have been responsible for a death. Within sensible professional boundaries, however, no one should lose their job for an honest mistake made with the best of intentions; the only cardinal offence is not to report that mistake openly so that the correct lessons can be learned.

Recent recommendations from Sir Robert Francis on creating an open and honest reporting culture in the NHS will begin to improve that, and I have today asked Professor Sir Bruce Keogh, medical director of NHS England, to review the professional codes of both doctors and nurses, and to ensure that the right incentives are in place to prevent people from covering up instead of reporting and learning from mistakes. Sir Bruce led the seminal Keogh inquiry into hospitals with high death rates two years ago that led to a lasting improvement in hospital safety standards and has long championed openness and transparency in health care. For this vital work he will lead a team that will include the Professional Standards Authority for Health and Social Care, the General Medical Council, the Nursing and Midwifery Council, and Health Education England, and he will report back to the Health Secretary later this year.

The report also exposed systemic issues about the quality of midwifery supervision. While the investigation was under way, the King’s Fund conducted a review of midwifery regulation for the NMC, which recommended that effective local supervision needs to be carried out by individuals wholly independent from the trust they are supervising. The Government will work closely with stakeholders to agree a more effective oversight arrangement, and will legislate accordingly. I have asked for proposals on the new system by the end of July this year.

For too long the NMC had the wrong culture and was too slow to take action, but I am encouraged that it has recently made improvements. Today it has apologised to the families affected by events at Morecambe Bay, and it is investigating the fitness to practise of seven midwives who worked at the trust during that time. It will now forensically go through any further evidence gathered by the investigation, to ensure that any wrongdoing or malpractice is investigated. Anyone who is found to have practised unsafely or who covered up mistakes will be held to account, which for the most serious offences includes being struck off. The NMC also has the power to pass information to the police if it feels that a criminal offence may have been committed, and it will not hesitate to do so if its investigations find evidence to warrant that. The Government remain committed to legislation for further reform of the NMC at the earliest opportunity.

The report expresses a “degree of disquiet” over the initial decision of the Parliamentary and Health Service Ombudsman not to investigate the death of Joshua Titcombe. I know the Public Administration Committee is already considering these issues, and will want to reflect carefully on the report as it considers improvements that can be made as part of its current inquiry.

Finally, I expect the trust to implement all 18 of the recommendations assigned to it in the report. I have asked Monitor to ensure that that happens within the designated time scale, as I want to give maximum reassurance to patients and families who are using the hospital that no time is being wasted in learning necessary lessons. We should recognise that despite many challenges, NHS staff have made excellent progress recently in improving the quality of care, with the highest ever ratings from the public for safety and compassionate care. The tragedy we hear about today must strengthen our resolve to deliver real and lasting culture change so that these mistakes are never repeated. That is the most important commitment we can make to the memory of the 19 mothers and babies who lost their lives at Morecambe Bay, including those named in today’s report: Elleanor Bennett, Joshua Titcombe, Alex Brady-Davey, Nittaya Hendrickson and Chester Hendrickson. This statement is their legacy, and I commend it to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his well-judged statement, and echo entirely the sentiments he expressed. Families in Barrow and the wider Cumbria area were badly let down by their local hospital and by the NHS as a whole. The Secretary of State was right to apologise to them on behalf of the Government and the NHS, and today I do the same on behalf of the previous Government.

It is hard to imagine what it must be like to lose a child or partner in such circumstances, but to have that suffering intensified by the actions of the NHS is inexcusable. Bereaved families should never again have to fight in the way that these families have had to fight to get answers. The fact that they have found the strength and courage to do so will benefit others in years to come, and I pay tribute to them all, and particularly to James Titcombe.

This report finally gives the families the answers that they should have received many years ago. It explains in detail what went wrong, the appalling scale of the failings and, as the Secretary of State said, the opportunities missed to identify those failings and put them right.

I echo the Secretary of State’s praise for Dr Bill Kirkup, his investigation team and the panel that assisted them. The report’s analysis is thorough, and its recommendations are powerful but proportionate. The Opposition support all the recommendations made today. I understand that the Secretary of State will want to take time to consider each individually, but he can rely on our full support in introducing them at the earliest opportunity.

People’s first concern will be whether local services are safe today. The report identifies the root cause of the failures as a dysfunctional local culture and a failure to follow national clinical guidance. There are suggestions in the report that that culture has not entirely disappeared. The report finds:

“we…heard from some of the long-standing clinicians that relations with midwives had not improved and had possibly deteriorated over the last two to three years…we saw and heard evidence that untoward incidents with worryingly similar features to those seen previously had occurred as recently as mid-2014.”

I am sure the fact that problems have been acknowledged means that there has already been significant improvement, but will the Secretary of State say more about those findings, and about what steps he is taking to ensure that the trust now has the right staff and safety culture?

After safety, people will rightly want accountability, as the Secretary of State said, not just for the care failings, but for the fact that the problem was kept hidden from the regulators and the public for so long. When information came to light, it was not acted on. Lessons were not learned, and problems were not corrected. The investigation recommends that the trust formally apologises to those affected. The whole House will endorse that call, and will want it done both appropriately and immediately. Further, will the Secretary of State ensure that any further referrals to the GMC and NMC are made without delay? Will he also ensure that any managerial or administrative staff found guilty of wrongdoing are subject to appropriate action? A number of staff have left the trust in recent years, many with pay-offs. Will he review those decisions in the light of the report and take whatever steps he can to ensure that those who have failed are not rewarded?

One of the central findings of the investigation is on the challenges faced by geographically remote and isolated communities in providing health services. The investigation warns of the risks of a closed clinical culture in which

“practice can ‘drift’ away from standards and procedures found elsewhere”.

Is not the report right to recommend a national review of maternity care and paediatrics in rural and isolated areas, and will the Secretary of State take that forward? Alongside that, there are concerns about the sustainability of the Cumbrian health economy. My hon. Friend the Member for Copeland (Mr Reed) has today written to the chief executive of NHS England to call for a review of the specific challenges it faces. I hope the Secretary of State will be sympathetic to that call.

On the CQC, the role of the regulator has always been to oppose poor care and challenge practice, but it is clear that it failed in its duty in this case. Given what was known, the decision to register the trust without conditions in April 2010 was inexplicable, as was the decision to award foundation trust status later in 2010, as was the decision to inspect emergency care pathways but not maternity services—in so doing, it failed to act on specific warnings. As the report states, there was and remains confusion in the system over who has overall responsibility for monitoring standards, with overlapping regulatory responsibilities. The Opposition support moves to make the CQC more independent, but does the Secretary of State agree that the journey of improvement at the regulator needs to continue, and that there is a need for further reform? Will he ensure that NHS England draws up the recommended protocol on the roles and responsibilities for all parts of the oversight system without delay, and does he agree that the CQC should take prime responsibility?

I want to close by focusing on two proposals that I believe get to the heart of the matter before us. I have thought carefully about how we truly do justice to the families’ campaign and learn the lessons of both this investigation and the Francis report. In my view, the answer is a much more rigorous system of the review of all deaths in the community and in hospitals than currently exists.

First, is the reform of death certification and the introduction of a new system of independent medical examination well overdue? The Kirkup report echoes findings that go back as far as Dame Janet Smith’s inquiry into the Shipman murders, which were repeated recently by Sir Robert Francis in his two reports on Mid Staffordshire. The previous Government legislated for those reforms and made provision for the independent scrutiny by a medical examiner of all deaths that are not referred to a coroner. That has been piloted and proven to be effective. The investigation says that those reforms could have raised concerns at Morecambe Bay before they eventually became evident.

The second point is that we need a better system for scrutinising deaths in hospital. The report recommends mandatory reporting and investigation of serious incidents of all maternal deaths, stillbirths and unexpected neonatal deaths. Is there not a case to go further, including by looking at moving to a mandatory review of case notes for every death in hospital, and at how we can use a standardised system of case note review to support learning and improvement at every trust?

To help to guide the Opposition’s new approach to quality improvement, Professor Nick Black has agreed to advise us and inform the review, which will be concluded by the end of the month. In our view, that reform is much needed, because rather than looking at a sample of deaths to avoid harm, we would look at every single death to learn lessons, which means that every single person matters. Ideally, the review should be cross-party. I hope the Secretary of State feels able to endorse the review I have announced, which will make recommendations that the next Government can act on immediately. Is that not the best way to do justice to the issues that the families have fought to raise, and to ensure that the legacy of their campaign is to ensure that no others go through what they have gone through?

[Mr Hunt]

I thank the right hon. Gentleman for his measured tone. I am sure he is absolutely sincere in wanting to learn from this tragedy. I thank him for his moving words and for his apology. He will understand that there is nervousness among the families because, in the past, when the Government have talked about rooting out poor care, we have been accused of running down the NHS. We have had a different tone today, and I welcome it.

To answer the right hon. Gentleman’s specific points on the quality of care at the hospital currently, the best person and people to make that judgment are the new CQC and chief inspector of hospitals, Professor Sir Mike Richards. He has said that, in his view, the care at the maternity unity in Furness general hospital is good, and indeed safe—it is more than safe; it is good. That should reassure many people who are using the hospital. He is also very clear that there are many, many improvements to make, and his overall rating for the trust is not good. The report highlights many areas that still need to be addressed, but it is important to give that reassurance.

On death certification, I assure the right hon. Gentleman that we fully support that policy. As he knows, it was recommended in January 2005, so it has taken a long time for both Governments to address. We fully support the policy and have had successful trials. We are committed to introducing it as soon as possible and we want to go further. There may be some common ground, because we, too, have been talking to Professor Nick Black about case note reviews. The latest advice I have had is that it would be technically very difficult to review the case notes of all the 250,000 deaths every year in NHS hospitals, because of the resource implications and the doctors’ time it would take. I asked whether it would be possible to do that. I was advised that, if we looked at case notes hospital by hospital, there would be a risk of trusts getting into big disputes about whether or not a death was avoidable. I asked Professor Black to help me to devise a methodology so that we can assess the level of avoidable deaths by hospital trust. We would be the first health economy in the world to do that. I hope we will have his full support as we take that forward.

On the decision to give the trust foundation trust status, the report makes it clear that Ministers were advised that they had no locus to intervene, because the process had already been set in train—the decision had been deferred but not stopped, so they were not able to intervene. It is clear that the level of knowledge in the Department of Health, as in the rest of the system, was wholly inadequate given what was happening in that hospital.

I should like to make one other point, on a comment made by Labour this morning that the report would say that the failings were very localised. In fact, the report says the opposite. I want to read what Dr Kirkup says in the introduction to the report:

“It is vital that the lessons, now plain to see, are learnt and acted upon, not least by other Trusts, which must not believe that ‘it could not happen here’.”

It is important that we take that lesson from the report extremely seriously.

I would like to finish on a note of consensus. I appreciate that it is not always easy for Oppositions to support the Government publicly as they put right policy mistakes that they have inherited, but I think there is one thing where we can make common ground: the need for culture change in the NHS. Policies can be changed over one Parliament, but culture change takes a generation. What the families who have suffered so much want to know more than anything else is that Members on all sides of the House are committed to that, so that we never again go back to the closed ranks and institutional self-defence that piled agony on to their tragedies, and that, once and for all, we all make the commitment that patients will always come first.

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

As a Member of Parliament for an area covered by the trust, I assure the Secretary of State that many thousands of workers in the NHS in my area do a really good job in very difficult geographical circumstances.

I was newly elected to Parliament in 2010. My experience, alongside that of colleagues whom I see in the House, as a constituency MP dealing with the huge institution that is the NHS has been that it is difficult to find out who is responsible, where and for what. Like everybody else, my heart goes out to the parents. I do not know how they have struggled on, with their loss and with being confronted with what almost seems like a professional or administrative closing of ranks and doors to their pleas for some information on what happened. It is just unbelievable.

My constituents do not understand why—this is mentioned in the report—a major incident in 2004 was not looked at. There were five more major incidents in 2006-07 and another five in 2008, yet still nothing was done. What will the Secretary of State do to reassure my constituents that when a major incident happens again—as presumably it could in any NHS hospital across the country—it will be acted on?

[Mr Hunt]

I am happy to do that. In fact, I can not only tell my hon. Friend what we are going to do, I can tell him what we have done. The main purpose of the new CQC inspection regime, with a chief inspector of hospitals and a special measures regime, is to make sure that these issues come to light much more quickly. The new regime has been very active: 20 trusts—more than 10% of all trusts in the NHS—have gone into special measures. We have seen dramatic improvements.

I would like to make a broader point to my hon. Friend’s constituents. He speaks very wisely when he says that this is not about the dedication and commitment of front-line staff. He is absolutely right. The Royal Lancaster infirmary is not the main focus of the Kirkup report, but of course as part of the same trust it suffered from the same management failings. There are Members of this House who have had problems at the Royal Lancaster infirmary and found that they were not listened to when they made complaints, because proper management was not in place. That will have affected his constituents. I hope they will take encouragement from the changes that have happened recently in that regard.

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

I thank the Secretary of State for the dignified and fitting way in which he was able to name some of the grieving parents and the babies they lost. We cannot escape the painful conclusion from the report that our hospital was compromised by some shocking failures in care and a deeply inappropriate defensiveness from certain individuals. Does he agree that the scale of failure laid out in the report may well serve to reopen the criminal investigation? Will he support the healing process that is now needed in our community, with resources if necessary, so that we can move on from this? Finally, will he set out a timetable by which he will look through all the recommendations and report back to the House on whether the Government will accept them? Will that be before the election?

--- Later in debate ---

[Mr Hunt]

I do not know the answer to the last question because we have received the report only very recently, but we will do this work as soon as possible. Indeed, if we have cross-party support, it may be that we can expedite the process. The hon. Gentleman worked very closely with James Titcombe and is absolutely right to talk about the seriousness of what happened. As with the Francis report, however, I would caution against the idea that this problem will be solved if a few more nurses are struck off. We need accountability—that is incredibly important—and where there is wrongdoing, people must be fully held to account. The big lesson is the lack of openness, transparency and trust. It is quite possible that the reason some people did not speak out about poor care is that they were frightened of the consequences of doing so. They thought they would not be listened to. Other industries, such as the nuclear industry in which James Titcombe worked or the airline industry, have managed to create a culture of trust where people on the front line who make mistakes feel able to speak out and be supported if they do so. That is the most important lesson we need to learn from today’s report.

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

I, too, want to the thank the Secretary of State and the shadow Secretary of State for their entirely appropriate contributions, both the statement and the response, on this immensely sensitive and deeply personally upsetting series of circumstances. I want especially to pay tribute to the families who lost loved ones as a result of what Dr Kirkup referred to as

“serious failures of clinical care”.

He refers to the report as a damning indictment.

The dignity and determination of parents such as James Titcombe and Carl Hendrickson have led to this awful truth being laid bare today. Those parents are an inspiration to me, and they should be to all of us. I want to pick up on one point in particular that was raised during the Secretary of State’s statement. Dr Kirkup expresses disquiet that the NHS and the parliamentary ombudsman chose not even to investigate what has now been shown to be the needless deaths of at least 11 babies and at least one mother. May I press the Secretary of State to go further than he has in his statement and do everything in his power to ensure that the watchdog for patients is not a lapdog for senior managers? Patients need a powerful, effective independent investigator who listens to those who grieve, like the Morecambe Bay families, and not one who dismisses them without even an investigation.

[Mr Hunt]

My hon. Friend is absolutely right. There were, clearly, very serious flaws in the way the Parliamentary and Health Service Ombudsman operated, particularly in the case of Joshua Titcombe. My hon. Friend will know that the PHSO is accountable to this House through the Public Administration Committee, and not through the Government and the Department of Health. The Public Administration Committee is considering this issue in a great deal of detail to see what lessons need to be learned. I think one of the issues is the level of expertise within the PHSO and, with the greatest of respect, a certain lack of confidence in its ability to understand when there has been a clinical failure. I think everyone agrees that one of the things we need to do is to ensure that it can draw on medical expertise. It needs to make sure that its culture is as open and transparent as the culture it would like to see inside the NHS.

[Kevin Barron (Rother Valley) (Lab)]

The Secretary of State said that the fitness to practise of seven midwives is currently being considered by the National Midwifery Council. Given that this matter goes back over a decade, were any health professionals, either doctors or nurses, referred to their regulatory bodies during any of the incidents he outlined earlier?

[Mr Hunt]

I am not aware that they were. If that turns out to be the case, that would be extremely worrying. Since Dr Kirkup started his investigation, he has been in touch with the regulatory bodies throughout the process. He has not waited until today to refer back to them any names of people where he thinks there may be a concern.

[David Morris (Morecambe and Lunesdale) (Con)]

I thank my right hon. Friend for his deep and meaningful statement. In my constituency, the effects of what has happened in our trust have been deeply felt. I would also like to reach out to my hon. Friend outside the Chamber, the hon. Member for Barrow and Furness (John Woodcock). We have to put everything behind us. In my constituency, there is a campaign which says that the hospital is closing. The staff and the new management are beside themselves on this particular issue. Does my right hon. Friend agree that this has now got to stop? Hospitals and A and Es were never going to close down. At the end of the day, the staff are the only people who are going to suffer in all this.

[Mr Hunt]

I think this is a time when the whole House needs to unite behind the staff in that trust, who are working very hard to turn the situation around; indeed, they have made great progress. I had to call Nicola Adam of The Visitor to reaffirm the point that there are absolutely no plans to close the hospital. I hope the whole House will recognise that statement for what it is and that hon. Members will reiterate it in all their communications with their constituents.

[Grahame M. Morris (Easington) (Lab)]

I thank the Secretary of State and my right hon. Friend the Member for Leigh (Andy Burnham) for the tone of the statement and the Opposition’s response. I want to ask the Secretary of State about the point he made in his statement about the relationship between clinicians and midwives, which Dr Kirkup identified as having deteriorated over the last two or three years. He said that there was evidence of untoward incidents, with worryingly similar features to those that had previously occurred, as recently as last year. The Secretary of State mentioned extra numbers, but is he confident that the relationship between midwives and doctors is now resolved and that we have safe care at that hospital and elsewhere?

[Mr Hunt]

I think we can trust the CQC’s view that the care in the maternity unit is safe, but the hon. Gentleman is absolutely right to draw attention to the issue of the barriers between doctors and midwives, which is striking. That goes back a very long time: there seemed to be a kind of macho culture among the midwives to do with not letting the doctors in, which probably led to babies needlessly dying, which is the great tragedy. Making sure that that culture is changed, so that the patient’s needs are always put first, is obviously a massive priority. I know that the trust has made great strides in that area, but we all understand too that it takes time to change culture, and we need to support it as it goes on that journey.

[Dr Sarah Wollaston (Totnes) (Con)]

I join the Secretary of State in paying tribute to James Titcombe and all the families who have fought so long for answers. I also thank Dr Kirkup for his excellent report. I welcome the action that the Secretary of State has announced today, but can he add to that list by saying whether we can bring forward having medical examiners to look into the cause of death before the end of this Parliament and, if not, say what the barriers to introducing that much overdue reform are? Will he also touch on recommendations 20 and 21 in the report, which refer to the need for a national review of maternity and paediatric services in areas that are remote, isolated and hard to recruit to? Indeed, the report goes further and says that the problem extends beyond those services. This is an issue we need to address to improve safety without deterring recruitment in these areas.

[Mr Hunt]

I am afraid I can only commit now to us introducing independent medical examiners as soon as possible. We are wholeheartedly committed to this. It is incredibly important for relatives, because where they have a concern about a death and possibly a mistake being made in someone’s care in their final hours, the availability of an independent examiner has been shown in the trials we have run to be very effective, so we are committed to doing that.

I should have answered the shadow Health Secretary on the point about a review of maternity services, because he raised it as well. NHS England is doing that review; we have already announced that to this House. Today it is publishing the terms of reference of that review. That is important, because there has been a big debate inside the health service—a debate with which many people will be familiar—about what the minimum appropriate size for maternity and birthing units is, and we need to get to the bottom of the latest international evidence.

[Ann Clwyd (Cynon Valley) (Lab)]

During the period when I was writing the report on complaints in hospitals, I met Mr Titcombe. I was impressed by his persistence, because persistence is what anyone who is trying to tackle a complaint needs. I understand what he means when he says he is haunted by personal grief: I think of all those parents and relatives who have waited all this time to try to get some answers to their questions. The length of time it takes to answer people’s complaints is still not satisfactory. I myself have waited over two years and three months and I still do not have answers—I know that is not in his bag, but it is generally true of the whole of the United Kingdom. I support what my right hon. Friend the shadow Secretary of State said in calling for the medical scrutiny of all deaths that are not referred to a coroner. That is an important point. I want to ask the Secretary of State again: will he ensure that achieving the highest standard of complaints handling is included in the next NHS mandate?

[Mr Hunt]

No one has done more than the right hon. Lady to try to improve the standard for complaints, with the excellent work she did with Professor Tricia Hart. We are in the process of implementing her recommendations, but as the right hon. Lady knows, with the fifth largest organisation in the world, it is one thing to make a commitment in this place, but another to make it happen on the ground. There is definitely much work to do.

I also agree with the right hon. Lady’s comments about James Titcombe. This is a man who gave up his job working in the nuclear industry to come down to London and work in the CQC so that he could actively be part of the culture change that he wanted to see in the NHS. I do not think anyone could have done more than that. It is truly remarkable.

As the right hon. Lady has mentioned Wales, let me say that we have put 20 trusts into special measures in England and it is inconceivable that there will not be trusts with similar problems in Wales. I urge her to encourage the Labour party in Wales to look at introducing a special measures regime and a chief inspector of hospitals in Wales, because that has had such a powerful effect on improving standards of care in England.

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

I thank my right hon. Friend for his statement and Dr Bill Kirkup for his excellent report. Let me reassure him and the House that the Public Administration Committee is also preoccupied with the failings of the parliamentary and health service ombudsman in the conduct of these cases. I, too, have met James Titcombe on many occasions and have been extremely impressed by his extraordinary commitment to making sure that he is heard so that so many others can be heard.

May I also point out that the report reeks of the confusion that exists between CQC and the PHSO about what their respective responsibilities are? If we are talking about accountability, what we need is an organisation that is accountable for investigating clinical incidents in the NHS, whether they are down to particular local problems or broader systemic problems—by which we mean not that that is an excuse for what goes wrong; rather, it is so those systemic problems can be put right. I therefore very much welcome what my right hon. Friend has mooted will be the task of Sir Mike Durkin: to look at how that capacity can be developed, in the same manner, perhaps, as the air accidents investigation branch of the Department for Transport.

[Mr Hunt]

Dr Mike Durkin will be delighted that he has been promoted and given a knighthood for his wonderful work on patient safety, but it has not happened yet, even though he certainly deserves it. I thank my hon. Friend for his understanding of the complexity of these issues and the importance of the need for culture change. The work of his Committee has not been to scratch around the surface; it has tried to think hard about the solution. He is absolutely right that we need to end regulatory confusion. We now have a strong CQC, which is doing incredible inspections and is trusted across the system. However, we need a system in which people can get independent external advice quickly, which is why he was right to alert me to the potential of an air accidents investigation branch equivalent. I hope that is something that could be helpful for the ombudsman as well.

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

I am pleased that the Secretary of State has declared his intention to implement the medical examination review. The president of the Royal College of Pathologists, Dr Suzy Lishman, has said that introducing such a system would

“improve patient care whilst reducing harm and saving money”.

She went on:

“If bereaved relatives get the answers that they need around the time of death, if all their questions are answered then, then they don’t feel the need to sue the NHS to get the answers they deserve.”

She has also said that it is “incomprehensible” that the recommended changes have not been implemented. Will the Secretary of State explain why there has been so much delay? From his answer to a previous question, I understand that he is not able to commit to implementing the reforms during the time of this Government.

[Mr Hunt]

With the greatest respect, I say to the hon. Lady that if she is suggesting that we have done nothing on this important issue over the last few years, nothing could be further from the truth. We have been trialling the right system; we think the trials have worked; and we want to make sure that we implement this in a way that is consistent with the many other things we are doing to improve patient safety, including proper case-note reviews of deaths in order to understand the level of avoidable hospital deaths and what we can do to bring the rates down. This is a priority for the Government, and we remain wholly committed to it.

Jimmy Savile (NHS Investigations)

Jeremy Hunt Excerpts

Thursday 26th February 2015 Commons Chamber

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

With your permission, Mr Speaker, I will make a statement on the NHS investigations into Jimmy Savile.

This morning, a further 16 investigations into the activities of Savile in the NHS were published. Those include the main report from Stoke Mandeville hospital and reports from 15 other hospitals. One report relates to Johnny Savile, the older brother of Jimmy Savile.

Although no system can ever be totally secure from a manipulative and deceitful predator such as Savile, we learned last year that there were clear failings in the security, culture and processes of many NHS organisations, allowing terrible abuse to continue unchecked over many years.

Some victims are sadly no longer with us and others continue to suffer greatly as a result of what happened. I apologised to them last June on behalf of the Government, and today I repeat that apology: what happened was horrific, caused immeasurable and often permanent damage, and betrayed vulnerable people who trusted us to keep them safe. We let them down. As one of the Stoke Mandeville victims said:

“There are so many messed up lives—although people have built up lives, you have children, you make a life, it ruins everything, your relationships with another human being—the things you are supposed to have.”

Today, we must show by our deeds as well as our words that we have learned the necessary lessons.

The new reports, like those released last year, make extremely distressing reading. In total, 177 men and women have come forward with allegations of abuse by Jimmy Savile, covering a period beginning in 1954 and lasting until just before his death in 2011. At least 72 people who gave evidence were children at the time of the abuse, the youngest only five years old. The allegations include rape, assault, indecent assault and inappropriate comments or advances.

Allegations have been made not in one or two places, but in over 41 acute hospitals—almost a quarter of all NHS acute hospitals—as well as in five mental health trusts and two children’s hospitals. Further investigations have happened at a children’s convalescent home, an ambulance service and a hospice. Three new investigations are under way at Humber NHS Foundation Trust, Mersey Care NHS Trust and Guy’s and St Thomas’ NHS Foundation Trust. Any further allegations that are received will, of course, be investigated as serious incidents.

In addition, the Department for Education has today published 14 reports on investigations in children’s homes and educational settings, and the review by Dame Janet Smith into Savile’s activities at the BBC is ongoing.

The investigations have been deeply harrowing for the victims, but also for the investigators. I put on the record my thanks to everyone involved, particularly Kate Lampard and those at the NHS Savile Legacy Unit, who have provided robust oversight and assurance in an incredibly difficult job.

I now turn to Stoke Mandeville—the hospital with which Savile was most closely associated. The report published today reveals some shocking abuse of 60 victims that took place over more than 20 years between 1968 and 1992. From the brave victims who have come forward, we know that Savile’s activities there included groping, molestation and rape of patients, staff and visitors. The victims were predominantly, but not exclusively, female. Twenty of them were vulnerable patients who were disabled with severe spinal injuries. One was a child as young as eight. Savile deliberately exploited those people because he understood their reliance on specialist care that they might only be able to receive at Stoke Mandeville, making it even harder for them to speak up. It was calculating behaviour of the most abhorrent kind. Victims included 26 visitors and six staff. Six victims reported being raped, one as young as 11 or 12. Most victims were too frightened to come forward, but there were nine informal complaints and one made formally. None was taken seriously.

There is no suggestion that Ministers or officials knew about those activities, but accepted governance processes were not followed in the decision to allow Savile to acquire and maintain a position of authority at the hospital. In particular, Ministers made the expedient decision to use Savile not just to raise funds to redevelop Stoke Mandeville’s national spinal injuries centre but to oversee the building and running of the centre, even though he had no relevant experience. Because of his celebrity and useful fundraising skills, the right questions—the hard questions—simply were not asked. Suspicions were not acted on, and patients and staff were ignored. People were either too dazzled or too intimidated by the nation’s favourite celebrity to confront the evil predator we now know he was. Never again must the power of money or celebrity blind us to repeated, clear signals such as those that suggested that some extremely vulnerable people were being abused.

I spoke last June about how changes to processes, policies and laws over the past 30 years have made it much less likely that a predator like Savile would be able to perpetrate these crimes today. Charity legislation is much tougher and sets out specific requirements for the auditing and examination of NHS charities’ accounts. The safeguarding system now in place is significantly improved. The Children Act 1989, the first child sex offenders register, Criminal Records Bureau checks and the Disclosure and Barring Service have all provided further protection. The Care Act 2014 will put adult safeguarding on a legal footing for the first time from 1 April, and safeguarding adults boards will ensure that local safeguarding arrangements act to help and protect adults. We have enshrined the right to speak up in staff contracts, and we are amending the NHS constitution and changing the law to make employers responsible if whistleblowers are harassed or bullied by fellow employees. We are also consulting on how best to implement the recommendations in Sir Robert Francis’s whistleblowing review.

However, proper policies and processes will not succeed if they do not go hand in hand with a change in culture whereby patients and staff alike feel able to speak out with any concerns, and can be confident that they will be listened to. It is particularly important that children and those with physical and mental illnesses are listened to, because they are the most vulnerable. Although we are proud to live in a society in which people are innocent until proven guilty, we have a collective responsibility to investigate all serious allegations properly in a way that simply did not happen time after time.

In the light of these disturbing reports, I also asked Kate Lampard to outline key themes across all the NHS investigations and to consider any further action that needs to be taken. She considered the extent to which Savile was a product of the culture of his time and concluded that although he was “a one-off”, there are important improvements that need to be made to protect patients today. Hers is a thoughtful and comprehensive report, and I am today accepting in principle 13 recommendations that she makes, including on access, volunteering, safeguarding, complaints and governance. Trusts should develop policies on visits by celebrities, and on internet and social media access across hospitals. They should review voluntary service arrangements, safeguarding resources and the consistency of employment practices, ensuring clear executive responsibility. They should consider whether policies on the impact of volunteers on a trust’s reputation are adequate.

The Department, with its arm’s length bodies, will examine the possible development of a forum for NHS voluntary service managers, the raising of awareness of safeguarding referrals among NHS employers, and to what extent NHS trust staff and volunteers should undergo refresher training in safeguarding.

I know that some trusts that produced reports last summer have started to make improvements. One trust has already encouraged staff to raise concerns, updated its whistleblowing and complaints policy and published a policy on the recruiting and management of volunteers. It is that kind of sensible, swift action that I want to see across the NHS. I have therefore asked the chief executives of Monitor and the Trust Development Authority 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 at each trust. Those plans will be fed into the Government’s ongoing work to tackle child sexual exploitation.

One welcome practice that Kate Lampard’s report highlights is the growth in volunteering to support the work of the NHS. Overall across the NHS we estimate there are 78,000 volunteers, including 1,500 at just one trust—King’s—in London. They do a magnificent job in improving patient care every single day throughout the NHS. We welcome that civic revolution, and today need to ensure that any safeguards put in place support its future growth by helping to protect the reputation of volunteering as well as the safety of patients. Hard cases make bad law, and it would be the ultimate tragedy if Savile’s legacy was to hold back the work of the NHS’s true heroes who give so much to their local hospital by volunteering their time.

While I agree that all volunteers working in regulated activity—typically close or unsupervised contact with patients—should have an enhanced Disclosure and Barring Service check, I am not today accepting the recommendation that that should apply to all volunteers. As Kate Lampard acknowledges in her report, such a system may not in itself have stopped Savile. Instead, trusts should take a considered approach to checks on all volunteers, particularly using the enhanced DBS service if there is a possibility that someone will be asked at a future date to work closely with patients. They should also ensure that proper safeguarding procedures are in place locally, as well as the DBS process, because it would be wrong to rely on a national database as a substitute for local common sense and vigilance.

The report recommends that DBS checks are redone every three years. I believe the report is correct to say that trusts must ensure that their information on volunteers is up to date, but they can achieve that through asking volunteers to make use of the DBS update service that enables trusts to check DBS information regularly, and avoids volunteers having to go through the DBS process multiple times. We will be advising all trusts to do that.

Finally, I intend to take action in one area of great concern that the report highlights, namely the responsibility and accountability of staff working with vulnerable people to take appropriate action when alerted to potential abuse. As the report recognises, the Government have substantially strengthened safeguarding arrangements since these dreadful events, but it is clear that there should have been a much stronger incentive on staff and managers to pass on information so that a proper investigation took place. That is clearly unacceptable, and the Government have already said that we will consult on introducing a new requirement for the mandatory reporting of abuse of children and vulnerable adults. The outcome of such a consultation must take full account of the need to avoid unintended consequences.

Let me conclude with a tribute to the victims who have had the courage to come forward, because without them these investigations would not have been possible: it is our society’s shame that you were ignored for so long, but it is a tribute to your bravery that today we can take actions to prevent others from going through the misery you have endured. As a result, our NHS will be made safer for thousands of children and vulnerable adults as we learn the uncomfortable lessons from this terrible tragedy. I commend this statement to the House.

--- Later in debate ---

[Mr Hunt]

I thank the shadow Health Secretary for his constructive comments. I think the whole House will unite to ensure that all the necessary lessons are learned. I echo the right hon. Gentleman’s praise for the 44 very thorough reports that involved such painstaking and difficult work, and the superb job done by Kate Lampard and Ed Marsden in bringing together all those reports and thinking about the lessons that needed to be learned.

As the right hon. Gentleman observed, Kate Lampard has stated very clearly that while she does not think that there will be another instance of this kind in the future, elements of it could come about. It would be a mistake to say that this is all about stopping another Savile. We need to think more broadly about how abuse could take place in a modern context, and ensure that we learn broader lessons—which, indeed, we are learning in the context of what has happened in Rotherham, in Rochdale and elsewhere.

The right hon. Gentleman is right about the role of accountability, which clearly needs to be greatly improved. Let me answer, very directly, his question “Why was nothing done?” I think the report makes clear why nothing was done, and this is the tragedy. It was Savile’s importance, because of his fundraising, to institutions such as Stoke Mandeville in particular, as well as his celebrity, that made people afraid to speak out—and we should remember that, in all likelihood, many people have still not spoken out—but also made it less likely that something would be done when they did speak out, and that is what must never, ever be allowed to happen again.

The report does not directly criticise Ministers and civil servants for the abuse. It says there is no evidence that they had any knowledge of it. We must recognise, however, that the system itself was flawed, which is why the fact of the abuse never reached the ears of Ministers and others who were making decisions about Savile’s influence. What the report does say is that it was questionable whether processes should have been overridden, particularly in respect of financial propriety. The role that Savile was given in the construction of the new spinal injures centre at Stoke Mandeville was smoothed over as quickly as possible, because people thought that he would be able to bring a lot of money to the table, and that he would “walk”—that was the word used by the civil servants—if any bureaucratic obstacles were put in his way. That was wrong, and we can see that. It is vital for us to learn the lessons.

The right hon. Gentleman asked about the value of the Savile estate. A total of £40 million remains under management in his charities. That money will be made available to meet claims made by Savile’s victims, and if it is not enough, the Government will meet any further claims through the NHS Litigation Authority. I can also confirm that any counselling that the victims need will be made available to them by the NHS.

I do not think that there is any disagreement in principle on the issue of mandatory reporting, but it is important for a proper consultation to take place, which is why it would not have been right to pass a law as early as last week. We all want there to be a proper, strong incentive for those who are responsible for the care of vulnerable adults and children to report any concerns that are raised with them, and to ensure that something is done if any allegations are made. However, we also want to avoid the unintended consequences that might follow if legislation were badly drafted. It is particularly important for us to protect the ability of professionals to make judgments based on their assessment of what is actually happening.

We want to avoid the risk that the processes that are followed, and the ultimate decisions that are made, will not be in the best interests of the children or vulnerable adults concerned because people are following a legalistic process rather than doing what is right on the ground. No one would want that to happen, which is why it is so important for us to get the legislation exactly right. I can tell the right hon. Gentleman, however, that following the consultation—which we will carry out as soon as possible—we will legislate if necessary.

It is also important to say that there is a role for the professional codes in this area; this is about the correct professional ethics. We changed the professional codes for doctors and nurses following the Francis report, to encourage them to speak out, and there may well be lessons that need to be learned in that regard.

On the operation of the disclosure and barring system, we will of course look closely at what the shadow Home Secretary is suggesting, but a big improvement has been made to the new DBS arrangements, compared with the old Criminal Records Bureau system, in the form of the update service. Volunteers can subscribe to that service, and we are recommending today that all trusts ask volunteers to do so as a condition of their volunteering—

[Mr Speaker]

Order. These are extremely important matters of the highest sensitivity, and I appreciate the solicitousness with which the Secretary of State is treating them, but we have two heavily subscribed debates to which we have to progress and, before them, a statement from the hon. Member for Maldon (Mr Whittingdale), who chairs the Culture, Media and Sport Select Committee. The Front-Bench exchanges have so far taken up half an hour, and that is too long. I should therefore be most grateful for the co-operation of the Secretary of State. If he could pithily draw his remarks to a close so that we can get on to the questioning by hon. Members from the Back Benches, that would be a great advance for the House and possibly for civilisation.

[Mr Hunt]

Thank you, Mr Speaker. I did want to give a full response to the shadow Health Secretary, but I am happy to address any other concerns he has at a later stage.

[Dr Sarah Wollaston (Totnes) (Con)]

The Secretary of State has set out in the starkest terms the extent of the vile abuse perpetrated by Savile. It is also chilling to note in Kate Lampard’s excellent report that between 60% and 90% of child abuse is still going unreported. Those who perpetrate it are adept at adapting their mechanisms, and recommendation 9 in the report mentions the extent to which abusers use social media to abuse children on hospital sites. Can the Secretary of State tell the House whether he is going to implement recommendation 9, and if so, how that will happen?

[Mr Hunt]

Yes, we are; that is very important. We absolutely accept the principle that all hospitals must have explicit policies on the use of social media. We must do everything we can. It is difficult to stop people going on to Facebook, for example, but when it comes to internet access by children, there are things that we can do, and we will absolutely be implementing that recommendation.

[Fabian Hamilton (Leeds North East) (Lab)]

I was Savile’s Member of Parliament and, as the Secretary of State can imagine, Leeds North East has its fair share of his victims. One such victim approached me recently in great distress. He had been abused as a child by Savile and had given his story to the police after decades, but it was not a complete story. When he was subsequently interviewed by NHS staff, they did not believe his story because it was inconsistent, owing to the fear that he had felt over the decades following the abuse. Will the Secretary of State reassure my constituent and the many others like him that they will not become victims twice?

[Mr Hunt]

The hon. Gentleman makes an important point, and I have great sympathy for his constituent. The information was not collated centrally. There were a number of reports about which we might have been sceptical if we had read them in isolation, but when we read them together with other reports, we see a pattern and we can conclude, as the investigation has done, that those incidents did indeed take place. That is one of the big learning points: we have to collate information that different victims provide at different times, to ensure that proper judgments can be made and that action can be taken.

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

It has been truly sickening to read in the report that over two decades, money, influence, celebrity and people being star-struck could allow Savile the licence serially to abuse so many people, particularly in our local Buckinghamshire hospital at Stoke Mandeville. I really welcome the apologies from the Secretary of State and from our local chief executive officer, Anne Eden, who has given a heartfelt apology and praised the courage of those who have come forward. May I press the Secretary of State further on mandatory reporting? It is exceedingly important that we start that consultation as rapidly as possible. It was obvious that the proposed clause in the Serious Crime Bill was flawed in many ways. When will he start the consultation, and when will the terms of reference be available? Will he now undertake to legislate as soon as the consultation has produced results?

[Mr Hunt]

I can certainly give that undertaking: we will start the consultation as soon as possible and if the conclusion is for legislation, we will legislate as soon as possible. I hope that my right hon. Friend understands that there is a great deal of complexity involved in getting this right. It is very important to talk to victims and to people who are looking at the evidence on mandatory reporting, which happens in other parts of the world, with very mixed results. Most importantly, we want to avoid the unintended consequence of a decision being taken against the interests of a child or vulnerable person because people are following a legalistic process which undermines the proper professional judgment made on the ground.

[Kerry McCarthy (Bristol East) (Lab)]

The sheer scale of this—the number of assaults, and the range of victims and locations—is just horrific, as I am sure everyone will agree. As has been said, the report states that 60% to 90% of current assaults on children are probably going unreported. Does the Health Secretary not think that better—indeed, compulsory—sexual relationships education in schools would mean that children are more likely to come forward and, importantly, that once they have gone through that education at school their parents would be more likely to believe them?

[Mr Hunt]

I do think it is very important to have good sex education in schools and that we make sure that all children understand when a boundary has been crossed and when they need to speak out. That is an important lesson from this report.

[Robert Jenrick (Newark) (Con)]

May I draw the House’s attention to another report published today, that concerning Rampton hospital in my constituency? Jimmy Savile was given almost unrestricted access to one of the UK’s most highly secure hospitals, which adds another layer to the matter. Rampton hospital contains some of the UK’s most dangerous patients. One of the most concerning issues in the Rampton report is that for staff his activities were described as an “open secret” but that management may not have known about them. If that finding is credible—it does not ring true with colleagues at the hospital I have spoken to—and is to be believed, would the Secretary of State give thought and resources to how we deal with whistleblowing and reporting in these most closed and secretive environments, where it seems to be the most important to have an open culture?

[Mr Hunt]

My hon. Friend speaks wisely. There were four separate disclosures of sexually inappropriate behaviour by Savile in separate incidents, not with patients, but with other people, including a young child. My hon. Friend is right: it is not just about mandatory reporting; it is also about making sure that when that reporting is done by a member of staff, something actually happens. That is part of the reason we need to do this consultation properly, because it is about making sure that the right actions are taken by people who are able to take those actions. That clearly did not happen in this case.

[Paul Flynn (Newport West) (Lab)]

On 11 different occasions, Savile attended new year’s eve parties at 10 Downing street. He was honoured, knighted and lionised by the establishment. They might not have known, but the unanswered question is: why did the intelligence and security services not warn? Why did they constantly give him clearance, allowing him not only to mix with Prime Ministers and royalty, but to prey on these defenceless innocents?

[Mr Hunt]

The reason, I think, is that the security services would not have known about this. What the report makes clear is that where people did speak out about concerns, nothing was done. That is what is so unacceptable and what we have to change. Savile was a national celebrity, who was treated as such by the establishment at the time, the establishment not having any idea of this evil abuse that was happening.

[Mr Dominic Grieve (Beaconsfield) (Con)]

I am very grateful to hear the Secretary of State’s statement, and I am sure it will provide reassurance in my constituency, which is also served by Stoke Mandeville hospital, that these terrible events and the underlying issues will be properly addressed. May I urge the Secretary of State on one point that emerges from the report, which is that common sense was suspended in this period? We may consider putting in systems, be it enhancing vetting or trying to make sure that volunteers are properly screened, but none of those will ultimately make a difference unless the overall culture that is there for the promotion and protection of the patient is so well ingrained that people exercise common sense in ensuring that that protection is provided. The most worrying aspect of this report is the way in which that was totally lost over a prolonged period.

[Mr Hunt]

My right hon. and learned Friend is right. That is why, if we change the law on mandatory reporting in any way, we need to be careful that we do not inadvertently give licence to the suspension of common sense. It is why we decided not to accept only one recommendation—the mandatory disclosure and barring checks on all volunteers in hospitals, even if they are not in close contact with patients. We believe that common sense and vigilance at local level will be one of the key ways in which we stop this happening again.

[Tim Loughton (East Worthing and Shoreham) (Con)]

The Savile revelations never cease to amaze and shock, but are they in some respects a distraction from the bigger issues? The vast majority of abusers are not celebrities. Does my right hon. Friend agree that the bigger issues are the mindset that said, when concerns were raised, “Oh, it’s just Jimmy”, the fact that police were told to turn a blind eye, and suggestions that other doctors and clinicians were also active paedophiles and were complicit in the abuse in some way? Is not the bigger issue the institutional conspiracy to abuse? How will this report feed into the essential inquiry now under way with Justice Lowell Goddard?

[Mr Hunt]

What we are announcing today will be closely fed into the report that the Home Office is currently overseeing. My hon. Friend makes an important point. Clearly, some things in the report would not happen today. We can be confident that the culture across the NHS and social services has changed significantly in a positive way. There is much greater awareness of safeguarding issues. However, the report also said that elements of other things that it highlighted could happen today. That is why it is so important that we learn the necessary lessons.

[Duncan Hames (Chippenham) (LD)]

The reports make it clear that Ministers’ appointment and use of Savile was improper and often contrary to advice from clinicians and officials. Former Minister Edwina Currie is quoted as telling the investigation last year:

“He knew how to pin people to the wall and get from them what he wanted. … he’d had a look at everything he could use to blackmail the POA … I thought it was a pretty classy piece of operation.”

Ministers Vaughan and Jenkin appointed Jimmy Savile to oversee the rebuilding of the national spinal injuries centre, contrary to advice, we are told in today’s report, from officials who thought that it would be better for those funds to be spent on centres of expertise around the country. Is it not critical that we understand the governance failures in this sorry saga, and that that insight feeds into the work of the Goddard inquiry?

[Mr Hunt]

Of course it is important that we learn the governance lessons, but the report is careful. It does not use the word “improper” in relation to the behaviour of Ministers or civil servants. It says that they acted reasonably. It raises some important questions, and I hope that the tone of my statement will reassure my hon. Friend that I do not seek to duck the fact that there are clearly questions about whether Ministers and civil servants behaved in the appropriate way. It is important that we learn the lessons from what went wrong.

[Dr Phillip Lee (Bracknell) (Con)]

I represent the constituency that is home to Broadmoor hospital, and I worked at Stoke Mandeville for two years in the early part of this century, so I have taken a deep personal interest in the investigation. I find it difficult to comprehend or accept that senior managers and clinicians were not aware of the allegations. I can find no mention in the Stoke Mandeville report of any clinician by name as yet. Can the Secretary of State assure me that looking to the future, named individuals will be given the responsibility to prevent this from happening, and if they fail there will be an impact on them, their career, their pension and the like?

[Mr Hunt]

The report clearly says that every trust must have a named director who is responsible for safeguarding. One can draw one’s own conclusions about whether senior management knew or not. The report was unable to find evidence that that was the case, but nor did it say that it was not the case. One comes away with the clear suspicion that senior management may not have wanted to hear the things that they were being told because of Savile’s importance in fund raising and possibly his celebrity status. That is what we must make sure never happens again.

[Steve Baker (Wycombe) (Con)]

With Stoke Mandeville serving my constituents, I was reassured to hear that in the present culture these appalling circumstances are not likely to be repeated. Can my right hon. Friend reassure me that it is now far more likely that we will see prosecutions within the lifetime of perpetrators rather than this horrific clean-up exercise after a perpetrator’s death?

[Mr Hunt]

I do believe that that is the case. I want to put it on record that Buckinghamshire Healthcare NHS Trust, which includes Stoke Mandeville, has made huge progress in turning round and improving its culture. It came out of special measures last year and the staff and management are to be congratulated. His constituents can be confident that, although things are not perfect, huge progress has been made to improve standards.

[Tessa Munt (Wells) (LD)]

I welcome the report. I support mandatory reporting and I look forward to seeing some serious progress in this respect. Staff and volunteers in all sorts of settings need the ability to report outside their organisation. Where the state is a corporate parent or a carer, or a provider of an extended home setting, it is important that young and vulnerable people can find some way of reporting outside. Is the Secretary of State willing to strengthen the role, in conjunction with other Secretaries of State, of the local authority designated officer? Already we know that people in schools and colleges can go to the LADO, but surely that is also appropriate for health and care settings, homes, prisons, the armed forces and anywhere else where there are young and vulnerable people. The benefit is that the LADO is perceived as independent and is someone outside the employer’s strict reporting guidelines. It would give a better chance for victims to be heard, action to be taken and lessons to be learned.

[Mr Hunt]

I am happy to look into that, but hospitals have a responsibility to go to the LADO if there is an incident affecting one of their volunteers or staff. The report makes it clear that they should exercise that responsibility with great diligence, but I am happy to look into the idea that patients should have that access as well.

[Dr Matthew Offord (Hendon) (Con)]

This morning a legal representative of the survivors group said that she had evidence that it had been reported to senior management that Savile had committed offences at Stoke Mandeville. Can the Secretary of State advise whether that opens up the NHS to compensation claims? Can he ensure that any damages claims fall on the Savile estate?

[Mr Hunt]

We have already paid compensation claims. Initially, those claims will be taken from the Savile estate and the money left in the Savile charities, but if those funds prove not to be enough we would pay from the NHS Litigation Authority. The report is not able to confirm the extent to which senior management knew or did not know about the allegations, so it is difficult to make progress on the specific points, but that does not stop people being able to make a claim and receive compensation.

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

I echo the Secretary of State’s praise from those involved in this meticulous investigation and report, but does he acknowledge the concern that the cases of many victims of sexual abuse in other organisations and institutions have not involved a celebrity? I have in my possession a letter from 1993 sent from a Barnardo’s project worker in Leeds to Leeds city council, which blames a constituent of mine for her own rape. Nothing was done to protect her. The abuse continued, and that offence was not reported to the police. Clearly, that would not happen now, but there are still victims whose cases are not being looked at and are not getting justice. What can be done about that?

[Mr Hunt]

A lot of things, and that is what this morning is all about. Mandatory reporting so that the reporting of incidents becomes the norm and not the exception is clearly an area where culture has to change. We have to find the right way to do that. Also, if we get this culture right, we should be able—this must be the ultimate objective of all this work—to stop such incidents happening in the first place. If people had acted earlier on their suspicions about Savile, a lot of victims would have been spared the torment that they subsequently had to endure. The biggest tragedy of all this is that it happened over decades and nothing was done. That is what we need to make sure never happens again.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 24th February 2015 Commons Chamber

[Mr Robin Walker (Worcester) (Con)]

13. What assessment he has made of the implications for his policies of the most recent rates of cancer survival.

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

This Government inherited the worst cancer survival rates in western Europe and, as we have just heard, we have invested a record £450 million in improving early diagnosis, which means that record numbers of people are being tested and record numbers of people are being treated.

[Paul Uppal]

I thank the Secretary of State for his response. Last year, I met cancer patients and carers with the aim of looking at how we can improve cancer survival rates so that they are among the best in western Europe. The main observation was that early diagnosis is key. Does my right hon. Friend agree that it is absolutely crucial that we support GPs to find and identify the early signs and symptoms of cancer so that we can improve survival rates?

[Mr Hunt]

That is absolutely right. What is said by everyone who has been wrestling with this problem about why our survival rates are not as good as we want them to be is that early diagnosis and access to the latest drugs are the two critical things. My hon. Friend will be pleased that 9,000 people in his region have accessed the cancer drugs fund and that, in his constituency, 300 more people every year are now being treated for cancer than was the case four years ago.

[Mark Menzies]

The excellent progress made in cancer survival rates is great news across the UK and in my constituency in Fylde. A lot of that is down to the increase in availability of diagnostic tests. Statistics from Blackpool’s NHS trust show that just under 33,000 more diagnostic tests were carried out in 2014 compared with 2010. With that in mind, will my right hon. Friend commit to increasing the availability of diagnostic tests?

[Mr Hunt]

We absolutely can. In fact, we are carrying out about half a million more diagnostic tests for cancer every year than we were four years ago. The result is that, over the course of this Parliament, 700,000 more people are being admitted for cancer treatment in our hospitals than was the case in the previous Parliament, saving 12,000 lives every year.

[Mr Walker]

I welcome the Secretary of State’s answers. Improvements in radiotherapy have been a key factor in improving cancer survival rates and quality of life for patients. This month, Worcestershire is celebrating the delivery of a state-of-the-art radiotherapy centre at Worcestershire Royal hospital. I visited that £25 million oncology centre last week. With some of the most advanced equipment in the country and eight new consultants recently recruited, does my right hon. Friend agree that the centre will be a key asset in taking forward the fight against cancer?

[Mr Hunt]

Absolutely. It was a fantastic development for Worcestershire Royal hospital. My hon. Friend campaigned very hard for it, and it is fantastic for his constituents. Cancer treatment is expensive, which is why we can only fund developments in cancer if we have a strong economy. That is what this Government are committed to doing for our NHS.

[Grahame M. Morris (Easington) (Lab)]

May I draw the Secretary of State’s attention to an excellent debate we had in the Chamber on 5 February under the auspices of the all-party group on cancer? May I also draw his attention to the uncertainty surrounding the funding of the national cancer peer review group programme? That programme has recently been reviewed and the Minister had indicated that the funding would continue. Will he take the opportunity to give a commitment to funding that peer review group, because there seems to be some doubt among the 17 national cancer charities that support its work.

[Mr Hunt]

Let me reassure the hon. Gentleman that we are absolutely committed to furthering and improving peer review as a way of winning the battle against cancer. The NHS is committed to that programme, and it is just looking at how it can be improved. [Interruption.]

[Derek Twigg (Halton) (Lab)]

On the early detection of cancer, will the Secretary of State consider putting more resources into socially deprived areas such as Halton where the incidence of cancer is higher?

[Mr Hunt]

We are putting more resources into Halton. In fact, we are putting more resources into the NHS across the country. We are carrying out 21,000 more diagnostic tests, including cancer tests, every year compared with four years ago, and I hope that that is something the hon. Gentleman will welcome.

[Mr John Baron (Basildon and Billericay) (Con)]

The all-party group on cancer and the wider cancer community have commended the Government on introducing the one-year survival rates for cancer into the delivery dashboard from April of this year as a means of driving forward earlier diagnosis. But what can the Secretary of State tell us about the work that is being undertaken to ensure that the levers of accountability are in place to push under-performing clinical commissioning groups into raising their standards on behalf of patients?

[Mr Hunt]

I congratulate my hon. Friend on his understanding of the importance of transparency. He will welcome the fact that we are now saving 1,000 more lives a month as a result of focusing on the five-year survival rates. But that transparency must apply to CCGs as well, and discussions are ongoing with NHS England as to the best way to do that for lots of things, including cancer.

[Liz Kendall (Leicester West) (Lab)]

Last week, we learned that the 62-day target for cancer treatment has been missed for a full 12 months:

“This isn’t just about missed targets–consecutive breaches mean thousands of patients are being failed. These targets exist to ensure swift diagnosis of cancer and access to treatment, which is vital if we’re serious about having the best survival rates in the world.”

Those are not my words; they are an exact quote from Cancer Research UK. Which bit of it does the Secretary of State disagree with?

[Mr Hunt]

I do not disagree with it, but I will tell the hon. Lady why we are missing that one target. Incidentally, we are hitting the seven other targets. We are treating and diagnosing so many more people, with 560,000 more diagnoses every year. That means that in this Parliament we are treating 700,000 more people than were treated in Labour’s last Parliament, saving 1,000 more lives a month. If the hon. Lady looks at some of the other things that Cancer Research UK says, she will see that it welcomes that strongly.

[Dr Sarah Wollaston (Totnes) (Con)]

7. What assessment he has made of the implications for his policies of Her Majesty’s Treasury’s costing of free social care at the end of life.

--- Later in debate ---

[Sir Nick Harvey (North Devon) (LD)]

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

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

At the end of this Parliament, and before returning, I trust, to the same side of this Chamber in late May, I am pleased to update the House on NHS work force numbers. On the back of a strong economy, our NHS now has more doctors, nurses and midwives than ever before in its history, including 7,500 more nurses and 9,500 more doctors. The result is 9 million more operations during this Parliament than the previous Parliament, fewer people waiting a long time for their operations, and a start in putting right the scandal of short-staffed wards that we inherited and were highlighted by the Francis report. Indeed, last year the Commonwealth Fund said that under this Government the NHS has become the safest, most patient-centred and overall best health care system in any major country.

[Mr Speaker]

Let me point out that topical questions and answers should be brief. It is a rank discourtesy—[Interruption.] Order. It is a rank discourtesy to the House to expatiate at length and thereby to deny other Members the chance to put their questions. It will not happen. Simple, short, factual answers are what is required.

[Sir Nick Harvey]

In the past couple of days, a number of Devon and Cornwall hospitals have declared black alert status, meaning, essentially, that they are full and cannot cope with any more demand. Do Ministers therefore understand the public concern that the clinical commissioning group is considering closing beds in community hospitals, including Ilfracombe and South Molton in my constituency? Can anything more be done to help rural health economies that are trying to restructure but already struggling to cope with existing demand?

[Mr Hunt]

We do understand those concerns. It is absolutely essential that CCGs make sure that they have the right bed capacity to deal with the pressures of winters.

[Andy Burnham (Leigh) (Lab)]

Let me take the Secretary of State back to a subject he likes to avoid—NHS privatisation. He tries to deny that it is happening on his watch, but we heard earlier about the ideological privatisation of cancer scanning in Cheshire and Staffordshire, despite its being more expensive than the NHS bid—and now it could get much worse. On the Friday before the recess, the Government sneaked out the public contracts regulations, which require NHS contracts worth over €750,000 to be opened up to full EU competition. Will the Secretary of State confirm that that is indeed the case in these regulations, and can he explain what mandate he has from the public to open up the NHS to private bidders across Europe?

[Mr Hunt]

Since the last time the right hon. Gentleman and I met, the King’s Fund has published its assessment of the NHS reforms over the past few years, and its words were:

“Claims of mass NHS privatisation were and are exaggerated”.

He knows perfectly well that outsourcing grew at double the rate under the previous Labour Government than it has grown under this Government.

[Andy Burnham]

The King’s Fund report said that as a result of the Secretary of State’s reforms there is

“greater marketisation of the NHS”.

People will notice that he failed to answer my question. That is because he wants to sneak these plans through under the radar. I serve notice on him today that we will fight him all the way, right to the very last day of this Parliament. If passed, these regulations will mean that almost every NHS contract will be forced to be advertised across Europe, shattering the promise he made to protect the NHS from EU competition law. Is it not now abundantly clear that he has forfeited the public’s trust on the NHS, and that five more years of this Government will lead to huge acceleration in NHS privatisation?

[Mr Hunt]

I repeat:

“Claims of mass NHS privatisation were and are exaggerated”.

If the right hon. Gentleman does not like the reforms, let us look at a country that did not have them—Wales. The number of people waiting too long for A and E is nearly double that in England, the number of people waiting too long for urgent ambulances is nearly double that in England, and the number of people waiting for operations is 10 times that in England. That is our record—it is a record of success.

[Glyn Davies (Montgomeryshire) (Con)]

T3. Not enough GPs want to practise in rural Wales. I am told that one of the reasons is that GPs registered in England have to go through a bureaucratic process to be able to work in Wales. Will my hon. Friend the Minister work with the Welsh Government to ensure that we have a common registration process so that GPs can move between England and Wales without having lengthy, time-wasting new bureaucracy?

[Karl Turner (Kingston upon Hull East) (Lab)]

T2. A recent Ashcroft poll shows that only 15% of the public think that this Government have the best approach to running the NHS. Will the Secretary of State stand up at the Dispatch Box and apologise for his top-down reorganisation of the NHS and his Tory privatising Health and Social Care Act, and accept that the public will never trust the Tories with the NHS?

[Mr Jeremy Hunt]

I will tell the hon. Gentleman what the public think about the NHS: last year, under this Government, dissatisfaction was at its lowest ever level and satisfaction jumped the highest among Labour voters. And where did satisfaction go down? In Wales.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

T5. I have previously made Ministers aware that there are no beds for females in Dorset who need intensive psychiatric care. Our local newspaper, the Daily Echo, reports that such places will not be provided in Dorset for another three years. Meanwhile, patients are being sent as far away as Bradford. Do Ministers regard that as satisfactory? Are there enough resources coming to Dorset, or is it a local organisational issue?

[Mr David Crausby (Bolton North East) (Lab)]

T6. Bolton’s accident and emergency department has been in crisis recently, partly because the clinical commissioning group closed the town’s walk-in centre. Will the Secretary of State support my petition calling for its reinstatement, or will he say, more predictably, “It’s not me, guv; I’m just the Secretary of State for Health”?

[Mr Jeremy Hunt]

I am accountable for what happens in the NHS, so let me tell the hon. Gentleman what is actually happening in Bolton: compared with four years ago, 2,756 more people are being seen at A and E within four hours. That is a record of investment and success.

[Duncan Hames (Chippenham) (LD)]

What alternatives do clinical commissioning groups have to a full-scale commercial procurement when their existing contracts for community health services approach the time when they have run their course?

--- Later in debate ---

[Robert Jenrick (Newark) (Con)]

May I commend the Government on raising the priority for dementia in their announcement last week? Will the Secretary of State and the Department of Health put all their resources behind towns such as Newark, which are trying to establish themselves as dementia-friendly towns and are working with shopkeepers, banks and the business community to make it easier for older people with dementia to lead fulfilling lives?

[Mr Jeremy Hunt]

I commend my hon. Friend on his work in that area. People with dementia want to lead as normal a life as possible, and being able to go out to the shops is one very important thing they want to continue to do. We now have 1 million dementia friends in this country. That is a great step forward, and with his help we will do even more.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

When does the Secretary of State expect NHS England to confirm a date for the national tariff for the supply of prosthetic services and equipment? The lengthy and, quite frankly, unacceptable delay on his watch is now causing really serious issues for those who need prosthetics, as well as for those who want to deliver the services.

[Mr Hunt]

I am happy to look into that issue and get back to the hon. Lady.

[Jeremy Lefroy (Stafford) (Con)]

In addition to the work that Monitor does on tariffs for individual pathways, what work has it done to assess the base funding that acute hospitals need to maintain core services, which are so interdependent?

[Mr Hunt]

Monitor has done extensive work on this issue, but my hon. Friend is absolutely right to talk about it. If we are to meet the financial challenge that the NHS faces over the next five years, we need to have a very sensible discussion about what realistic efficiency gains need to be made, and I am sure that he will engage in those discussions.

[Mark Reckless (Rochester and Strood) (UKIP)]

Medway clinical commissioning group is looking at putting GPs at the front of our accident and emergency department to help relieve pressures on emergency doctors. Do Ministers believe that that is a promising way forward?

[Sarah Newton (Truro and Falmouth) (Con)]

Will my right hon. Friend update the House on what steps he is taking to prevent avoidable deaths from sepsis?

[Mr Jeremy Hunt]

I am absolutely happy to do that. Overall, we have 1,000 avoidable deaths every month by some estimates, and a number of those are from sepsis. We have launched a big campaign to prevent those deaths. Indeed, we will shortly have the results of the Morecambe Bay inquiry, from which I think we will hear more about the issue. I want to thank my hon. Friend for her campaigning and her work with the all-party group on sepsis to raise awareness of this very important issue.

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

GPs across the north-east say that they are facing a work force crisis, with falling numbers of family doctors. Does the Secretary of State not recognise the connection between people being unable to get an appointment to see their GP and the rising and major pressure on our A and E department?

Trust Special Administrators

Jeremy Hunt Excerpts

Thursday 12th February 2015 Written Statements

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

I am today publishing revised “Statutory Guidance to Trust Special Administrators appointed to NHS Trusts”, in accordance with section 65N of the National Health Service Act 2006 (the 2006 Act). The document comprises guidance for trust special administrators (TSAs) to which they must have regard in carrying out their duties under chapter 5A of the 2006 Act, referred to by Government as the trust special administrator’s regime. It replaces the version published on 5 July 2012.

The TSA’s regime was introduced by the Health Act 2009 and set out under chapter 5A of the 2006 Act. It offers a time-limited framework to deal with urgent issues affecting the ability of an NHS trust or foundation trust to deliver patient care, whether for clinical or financial reasons, or both. A TSA must make recommendations to the Secretary of State, or in the case of a foundation trust, to Monitor, about actions to secure into the future the delivery of quality, safe and financially sustainable essential services of the trust under administration.

I stress that the regime is a measure of last resort. It is likely to be considered only when all other processes at a local level to deal with the challenges of hospitals have been exhausted. Since 2009, the regime has been used only twice.

Last year, we asked the right hon. Member for Sutton and Cheam (Paul Burstow) to chair a committee of MPs, Peers and others to review the development of updated guidance to TSAs. The committee considered the guidance I am publishing and revised “Statutory Guidance for Trust Special Administrators appointed to NHS Foundation Trusts” to be published by Monitor. Meetings took place between July 2014 and January 2015. I am pleased to have been able to accept the recommendations the committee made to me and believe the guidance I am publishing is significantly improved as a result. I would like to place on record my thanks to the right hon. Member for Sutton and Cheam, the right hon. Member for Rother Valley (Kevin Barron), the hon. Member for Stourbridge (Margot James), Baroness Finlay of Llandaff, Matt Tee and Dr Johnny Marshall from the NHS Confederation and Jeremy Taylor from National Voices, for the dedication and rigour with which they considered the issues before the committee. Letters from the committee and notes of its meetings will be published alongside the committee’s terms of reference which are available at: https://www.gov.uk/government/groups/committee-to-consider-statutory-guidance-for-trust-special-administrators

I have consulted the Care Quality Commission (CQC) as I am required to do before publishing my guidance, under section 65N of the 2006 Act. My Department also consulted a range of key stakeholders on the draft guidance.

The guidance incorporates the new powers and requirements in the Care Act 2014 to strengthen the TSA’s regime. These include:

enabling a TSA to take a view of the local health economy and, where it is necessary for and consequential upon action recommended at the trust in administration, permitting the TSA to make recommendations which may affect services at other trusts;

matching the TSA’s widened legal remit with a requirement to consult those other trusts, their staff and their commissioners who would be affected by the recommendations;

strengthening the representation of patients and local populations through a requirement on the TSA to consult local authorities and local healthwatch organisations during the statutory public consultation on the recommendations, in all the areas whose services would be affected by them;

requiring the TSA to consult the CQC; and,

giving the TSA more time to develop recommendations and consult on them.

In accordance with my duty under section 65N of the 2006 Act, the guidance addresses matters required by that section, such as the persons to be consulted and factors to be taken into account in the preparation of the TSA’s draft report, the publication of notices and statements, and the arrangements for a TSA at an NHS trust to seek support from commissioners for his or her recommendations and on involving NHS England. The latter replicates the substance of the statutory provisions in the regime for foundation trusts. A TSA at an NHS trust should therefore ensure the involvement of local commissioners of all affected trusts, and take fully into account the need to protect essential NHS services of the NHS trust under administration and of any other potentially affected trust.

The guidance is clear that the TSA should engage with the public, patients, NHS staff and other relevant stakeholders in a meaningful way from the earliest possible point. It covers other areas including the independent nature of the TSA’s role and his or her relationship with national bodies, clinical engagement, engaging other providers, the role of the CQC, taking into account marginalised or hard-to-reach groups, cross-border patients and equality legislation. We have endeavoured to ensure consistency as between this guidance and Monitor’s revised “Statutory Guidance for Trust Special Administrators appointed to NHS Foundation Trusts”. This latter is expected to be published by Monitor shortly.

NHS England, Monitor and the NHS Trust Development Authority are developing a “success regime” intended to help create the conditions for success in the most challenged health economies^1.. The guidance I am publishing today also gives examples of measures to tackle failings in NHS trusts before use of the TSA’s regime would be expected to be considered. However, it remains that the TSA’s regime is available to address those rare but very significant failures in the health service in a swift and effective way, ultimately, for the protection of NHS patients and the public, and NHS staff who would otherwise suffer.

A copy of the revised “Statutory Guidance to Trust Special Administrators appointed to NHS Trusts” has been placed in the Library. It can be found at: https://www.gov.uk/government/publications/statutory-guidance-for-trust-special-administrators-appointed-to-nhs-trusts

^1. Referred to in the NHS planning guidance for 2015-16 (The Forward View into action: planning for 2015-16)

[HCWS282]

Francis Report: Update and Response

Jeremy Hunt Excerpts

Wednesday 11th February 2015 Commons Chamber

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

With your permission, Mr Speaker, I would like to make a statement on the Government’s response to today’s report on NHS whistleblowing by Sir Robert Francis, and on progress to date in implementing previous recommendations from his public inquiry into the failures of care at Mid Staffordshire NHS Foundation Trust.

I asked Sir Robert to carry out a follow-up review because of my concerns that, despite good progress in implementing his original recommendations, the NHS was still not making fast enough progress in creating an open and transparent culture in which staff feel supported to speak out on worries about patient care. As a result, I was concerned that changes are still necessary if the NHS is to protect patients properly by adopting a transparent, no-blame, learning culture as is common in other sectors such as the nuclear, oil or airline industries.

Sir Robert has confirmed the need for further change in his report today. He said he heard again and again of horrific stories of people’s lives being destroyed—people losing their jobs, being financially ruined, being brought to the brink of suicide and with family lives shattered—because they had tried to do the right thing for patients. Eminent and respected clinicians had their reputations maligned. There are stories of fear, bullying, ostracisation and marginalisation, as well as psychological and physical harm. There are reports of a culture of “delay, defend and deny”, with “prolonged rants” directed at people branded “snitches, troublemakers and backstabbers”, who were then blacklisted from future employment in the NHS as the system closed ranks.

We of course recognise the high standards of care day in, day out in much of the NHS, and we know that many staff feel supported in raising concerns about patient care, with many dedicated managers going out of their way to address those concerns. However, the whole House will be profoundly shocked at the nature and extent of what has been revealed today. The only way we will build an NHS with the highest standards is if the doctors and nurses who have given their lives to patient care always feel listened to when they speak out about patient care. The message must go out today that we are calling time on bullying, intimidation and victimisation, which have no place in our NHS.

Before outlining the Government’s response to today’s report, I want to update the House on the progress made in implementing previous Francis recommendations. I have today laid in the House of Commons Library a report showing progress on all 290 recommendations originally made by Sir Robert, as well as the progress made in implementing other recommendations by Professor Don Berwick on safety, by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart in their complaints review, by Camilla Cavendish in her work on health care assistants and by the NHS Confederation on reducing bureaucratic burdens. The progress was recognised this morning by Sir Robert, who said that the priority that must be given to safety, compassion and quality of care is now better recognised and acted on.

I want to highlight the impact of Professor Sir Bruce Keogh’s review of hospitals with high mortality rates. The special measures regime that followed introduced the toughest and most transparent hospital turnaround regime anywhere in the world, with 19 hospitals—more than 10% of NHS acute trusts—having been put into special measures so far. Among the vast array of improvements since the start of the process, those trusts have recruited 109 additional doctors and 1,805 additional nurses, and have made 129 board-level changes. The independent research company Dr Foster estimated this week that excess deaths in those trusts had fallen by 450 in less than a year. That means that between them, they may have saved as many lives as some estimated were tragically lost at Mid Staffs between 2005 and 2009.

We have moved from a system that tolerated or denied high mortality to one that, while it is by no means perfect, seeks out problems, shares them with the public, takes action and saves lives. Today I can announce that the Care Quality Commission, Monitor and the NHS Trust Development Authority have published a new memorandum of understanding to enshrine and further improve the special measures process.

The other measures that we have introduced include giving the CQC, under its new leadership, legal independence and the legal powers that it needs for its chief inspectors to root out failure and highlight excellence. The chief inspector of hospitals has inspected more than half of acute trusts and will have inspected them all by the end of the year.

We have introduced criminal sanctions for those who wilfully neglect patients and those who provide false or misleading information. The new duty of candour for institutions and professionals means that when mistakes are made, patients or their families must be told. Fundamental standards are now in place to ensure that all providers are required to treat people with dignity and respect. All acute hospitals are now asking patients if they would recommend the care that they receive to friends or members of their family. That is being rolled out to other parts of the NHS, including primary care. Two thirds of hospitals are now implementing the “name above the bed” initiative to ensure that hospital care is better joined up. More than 200 organisations have joined the “sign up to safety” campaign, which involves a commitment to halve avoidable harm and save 6,000 lives by 2017.

The entire NHS is now committed to patient-centred culture change as a key part of the “Five Year Forward View” plans that were put forward by NHS England last autumn. In that plan, we recognise the important point that safe care and efficient use of resources go hand in hand: doing the right things first time in health care saves lives and money.

In respect of whistleblowing, the Government have taken significant steps to protect NHS staff, such as enshrining the right to speak up in staff contracts, amending the NHS constitution, issuing joint guidance with employers and trade unions, extending the national helpline to social care staff, and changing the law to make employers responsible if whistleblowers are harassed or bullied by fellow employees.

Today, Sir Robert makes it clear that there is more to do, and I am extremely grateful to him and his team for their work. He sets out 20 principles and a programme of action. I confirm today that I accept all his recommendations in principle and will consult on a package of measures to implement them.

The recommendations include asking every NHS organisation to identify one member of staff to whom other members of staff can speak if they have concerns that they are not being listened to. Drawing on the inspirational work of Mid Staffs whistleblower Helene Donnelly, those “freedom to speak up” guardians will report directly to trust chief executives on the progress in stamping out the culture of bullying and intimidation that Sir Robert today says is still too common. We will consult on establishing a new independent national whistleblowing guardian as a full-time post within the CQC to review the processes that have been followed in the most serious cases where concerns have been raised about the treatment of whistleblowers.

Because too often the system has closed ranks against whistleblowers, making it impossible for them to find another job, I can announce today that the Government will legislate to protect whistleblowers who are applying for NHS jobs from discrimination by prospective employers. With Opposition support, those necessary regulation-making powers could be on the statute book in this Parliament.

We will provide practical help through Monitor, the NHS Trust Development Authority and NHS England to help whistleblowers find alternative employment. Those three bodies have agreed a compact for action on this issue, and will publish detailed arrangements later this year. We will ensure that every member of staff, NHS manager and NHS leader has proper training on how to raise concerns and how to treat people who raise concerns. As a vital last resort, the right of whistleblowers to contact the press with any concerns they have must always be safeguarded, although it should not have to come to that. Today I will write to every trust chair to underline the importance of a culture where front-line staff feel able to speak up about concerns without fear of repercussions. In addition, Monitor and the TDA will write to trust chief executives today to ask them to ensure that all managers discuss these issues as a matter of urgency with those who report to them.

There must be consequences for trusts that fail to develop a culture of openness, so today I am publishing consultation options to ensure that where hospitals are found to have knowingly withheld information from patients, the NHS Litigation Authority can impose financial sanctions such as reducing the indemnity it offers against litigation awards. The final decision on how we implement these recommendations will be made after proper consultation with NHS providers, whistleblowers and patient groups to ensure that we honour the spirit of what Sir Robert has recommended, and to avoid unnecessary layers of bureaucracy or financial burden. There is no reason for individual trusts not to get on with implementing Sir Robert’s recommendations right away, particularly in ensuring that staff have an independent person with whom they can raise concerns.

A further foundation of a safe and open culture is one where the NHS and the public have access to meaningful and comparable information about the performance of local NHS organisations. The new MyNHS website has already kick-started a transparency revolution by making the NHS in England the first health care system in the world to offer key, up-to-date safety information on every major hospital, including open and honest reporting, nurse staffing levels in every ward, and the number of falls and hospital-acquired infections. Some estimate that we have as many as 1,000 avoidable deaths in the NHS every month, so by the end of March 2016 the NHS will become the first health care system in the world to publish an annual estimate of avoidable deaths by hospital trust, based on case note reviews and the safety record of those trusts.

I will strengthen the accountability of trusts by asking the chair of every trust to write a letter to the Secretary of State by the end of May each year, outlining what measures they will be taking to reduce the number of avoidable deaths in their trust. In all cases we will make it clear that this is not a process of naming and shaming but one of learning and improving so that our NHS becomes the first health care system in the world to adopt system-wide the safety standards that would be considered normal in other industries. We must also better understand avoidable mortality outside hospital settings, and whether we can adapt the methodology to identify avoidable harm as well as avoidable death. I therefore announce today that the Department will fund a national study to establish the extent of avoidable death in community settings, and the feasibility of developing locally attributable death rates.

We will be taking steps to hard-wire transparency into the health and care system, and I am publishing a transparency architecture with plans for further information to be released on MyNHS. That will include comprehensive reporting on the friends and family test, data on residential care home admissions, and a new balanced scorecard on the work of CCGs and health and wellbeing boards. The Care Quality Commission and the National Information Board have confirmed to me that, starting this year, they will report annually and in public to the Secretary of State and the Health Select Committee on the progress of the transparency architecture, and on any recommendations about how we can improve it. The Secretary of State will report to Parliament annually on progress, and today I am publishing for consultation changes that will enshrine that right in the NHS constitution.

One of the biggest causes of poor care is when no one takes responsibility for a vulnerable patient and the buck is passed. That leads to greater costs and numerous personal tragedies as people are passed unnecessarily around the system. The “name above the bed” initiative has strengthened accountability in hospitals, as has bringing back named GPs outside hospitals, but there is still not enough clarity on the role of professionally accountable clinicians, particularly in community settings. Today I can therefore announce that the Academy of Medical Royal Colleges has agreed to develop guidelines for meaningful clinical accountability outside hospitals. It will publish its findings this spring, and before the end of the next financial year all CCGs will publish how many of their patients with long-term conditions are being looked after by clinically accountable community clinicians in the meaningful way the academy will define. Proper proactive care for our most vulnerable patients will not only reduce hospital costs but reduce avoidable harm and improve the quality of compassionate care.

We can fund the NHS with a strong economy, we can put in place new models of integrated care to support an ageing population and we can champion innovation, but if we do not get the culture in the NHS right, we shall never deliver the ambitions that everyone in this House has for our NHS. Today is about tackling that culture challenge head-on so that we build an NHS that supports staff to deliver the highest standards of safe and compassionate care and that avoids the mistakes that have led to both unacceptable waste and unspeakable tragedy. If we succeed, we will be the first country anywhere to put its entire health care system firmly on the path to eliminating avoidable harm and death. Our NHS deserves no lesser ambition, so I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

I welcome the Secretary of State’s statement and his obvious commitment to improve the culture of tackling poor care in the NHS; there is plenty of common ground between us. We endorse the principles laid out in Sir Robert Francis’s new report and we will work with the Secretary of State to get new safeguards on the statute book in the remainder of this Parliament, as he requested.

It was the Labour Government who, in 1998, introduced the first legal protection for whistleblowers in the Public Interest Disclosure Act 1998, reinforced in the NHS constitution in 2008. Sir Robert’s new principles build on those foundations. We thank him and the review team for their work and praise every whistleblower who has had the courage to come forward.

Our shared aim must be to create a climate in which every NHS worker feels able to raise concerns and feels confident that they will be listened to, that appropriate action will be taken and that they will not face mistreatment as a result. Sir Robert’s report will help achieve that. We particularly welcome the call for whistleblowers worried about losing their jobs to be offered alternative employment and for training in whistleblowing for all staff. Those measures are overdue. Will the Secretary of State say more about how Sir Robert’s principles will be enforced across the NHS and about the timetable for implementation? Will he confirm that they will apply equally to all providers of NHS services, including voluntary and private providers?

That brings me to an issue of major substance not covered in Sir Robert’s report. As he points out, his remit did not apply to any form of social care. That is a major concern, given that it could be argued that some of the poorest care provided in England today is in social care settings or in people’s own homes. Only at the weekend, a BBC investigation found that one in five care homes for older people is failing to meet standards for safety. Should we not today, across this House, establish the firm principle that Sir Robert’s recommendations should apply equally to all places where people receive care?

Let me turn to the recommendation for an external organisation that staff can approach for advice and support. In response to the first Francis report in February 2010, I established an expert group to update whistleblowing guidance. It reported in June 2010, and the Secretary of State’s predecessor announced plans for a “safe and independent authority” to which staff could turn when their organisations were not acting on concerns. Will the Health Secretary say why that has not progressed since then and assure us that there will be no further delays now that Sir Robert has reinforced that recommendation?

Although I believe that the Secretary of State’s commitment to improve the culture in the NHS is genuine, he will no doubt be concerned by Sir Robert’s findings that it might have got worse in recent years. In his report, he said about the cases he examined:

“Many were relatively recent or current. This is not about a small number of historic high profile cases from a time when organisations might argue the culture was different. We had a significant number of contributions about cases in 2014.”

The report specifically references figures from the latest NHS staff survey, which shows that reports of bullying have increased from 14% of staff in 2011 to 22% in 2013. Over the same period, the percentage of staff who feel able to speak out about poor care or to report errors or near misses has fallen from 98% in 2011 to 94% in 2013. Those figures suggest that things are getting worse, not better. Will the Secretary of State explain why he thinks that is and whether he will investigate the reasons further? That underlines the importance of any moves to improve the culture being introduced in the right spirit and being supportive rather than punitive, so that they do not reinforce the wrong culture and have the opposite effect to that which the Secretary of State is obviously trying to achieve.

At the weekend, the Secretary of State proposed fines and jail sentences for failure to be open about poor care. Although we support his zero-tolerance approach, is he certain that how this is perceived on the ground will not create a climate of fear and have the opposite effect?

Those concerns also apply to the new inspection regime introduced since the Francis report. In advance of today, I was contacted by a whistleblower who works in a hospital about a Care Quality Commission inspection planned for later this month and about the growing practice of hospitals running mock inspection days in advance of the CQC’s arrival, as schools have come to do with Ofsted. The whistleblower’s letter states:

“I enclose a document that invites us for a mock inspection to show us what to do and say when the CQC comes. Is this the correct thing to do? I think not. I cannot reveal my name as I would be instantly dismissed. Can you help?”

I am sure that the Secretary of State will be as concerned as I am to hear that and I will forward the information to him this afternoon.

I turn now to the Secretary of State’s update on the Francis report on Mid Staffordshire. Both sides of this House supported Sir Robert’s original recommendations and we give credit to the Secretary of State for making significant progress with their introduction, but gaps remain where progress has not been made and that is a concern when standards overall in the NHS are recorded to be falling, not rising.

In particular, there is a long-standing need to reform the system of death certification which goes back to Dame Janet Smith’s inquiry into the Harold Shipman murders. I took a personal interest in that as a Minister on the back of concerns raised by my hon. Friend the Member for Denton and Reddish (Andrew Gwynne)and James Purnell, the former Member for Stalybridge and Hyde. I legislated for reforms of death certification in the Coroners and Justice Act 2009, which made provision for the independent scrutiny by a medical examiner of all deaths that are not referred to the coroner.

Following successful pilots, Sir Robert Francis reinforced Dame Janet Smith’s recommendation. Dr Suzy Lishman, the president of the Royal College of Pathologists, says that introducing these reforms will

“improve patient care whilst reducing harm and saving money”.

It will therefore be a cause of great concern to a great many people, not least the families of the victims of Harold Shipman, that those reforms appear to be stuck in the long grass. Chris Bird, whose mother Violet was one of those victims, recently told the “Today” programme that

“it is criminal that the Government is stalling on implementing something like this that could save lives.”

I have been informed by senior officials in the Secretary of State’s own Department that he personally is holding up this reform. Can he say whether that is true, and if so why? If it is not true, which I am prepared to accept, will he today set out a clear timetable for the introduction of this vital reform?

Alongside that, we need better arrangements in hospitals for reviewing case notes when patients have died, as the Secretary of State mentioned in his statement. Over the weekend, the Government announced plans to introduce an annual review from a sample of patients. Although that will help us to develop a more accurate measure of avoidable deaths than mortality rates, does the Secretary of State think it goes far enough? Should not the NHS learn from all serious failings? Will he give consideration to our suggestion that every death in hospital should be subject to an appropriate level of review?

We welcome the renewed focus on staff numbers since the Francis report, but we also remind the House that in the first three years of this Parliament almost 6,000 nurses were lost and, with record numbers of people in hospital, nurse-patient ratios have not kept pace with demand and there are fewer nurses per head of population now than in 2009-10. One of the problems with having made so many permanent staff redundant is that, post Francis, recruitment has been heavily reliant on agency staff. As Robert Francis warns today, that has made it even harder to get the culture right. We welcome the Secretary of State’s recent focus on nurse numbers, but will he concede that it was a mistake to cut staff so heavily? Will he back Labour’s plan to bring down the agency bill by recruiting 20,000 more nurses?

We welcome the progress made at some hospitals in special measures, but may I caution the Secretary of State on his use of statistics? Is he aware of the graph on page 8 of the Dr Foster report, which shows that mortality rates at the Keogh trusts fell faster between 2006 and 2010 than between 2010 and 2014? There was never a tolerance or denial of high mortality, as he seemed to suggest in his statement.

On openness and transparency more broadly, the Secretary of State will be aware that the King’s Fund delivered a damning verdict on the Government’s reorganisation, concluding that it had damaged patient care. That is consistent with a survey of NHS staff, which found that 69% said the reorganisation had harmed patient care, with only 3% saying it had improved. It is suggested that the Government’s own risk register on the reorganisation warned that reorganising the NHS at a time of financial stress would damage front-line care. So that any future Government can learn the lessons of the past few years, will the Secretary of State publish the risk register, as recommended by Sir Robert Francis?

In conclusion, as I have always said, the lessons from Mid Staffordshire need to continue to be learned if the NHS is to be what we all want it to be: the safest and best health care system in the world. The Secretary of State has today taken some important steps towards that goal, but I hope he will respond fully to the serious questions I have raised.

[Mr Hunt]

I welcome the broadly constructive tone that we have heard today. May I say, in that spirit, that I hope that that represents a change in substance from some of the other exchanges we have had on these topics? The right hon. Gentleman tried to vote down the legislation that set up the new chief inspectors and he opposed the holding of a public inquiry into Mid Staffs. If we are to have constructive agreement across the House, I do think we need to agree on substance as well as on tone. Let me just take the individual points he mentioned.

We are completely committed to death certification. That was recommended in the wake of the Shipman inquiry. The right hon. Gentleman’s Government took a very long time to do anything on this and we have been trying hard to do it. It is a complicated thing to get right. On the question of looking properly at avoidable deaths, I just want to say this. It is very difficult, when one looks at case notes, to work out whether a death was avoidable or not, but we think we have a methodology to do that. It is more difficult to relate that to individual trusts, but we want to try to achieve that as well. I was disappointed at the weekend that when we announced that, his response was that it was unambitious. Two weeks earlier, he had published Labour’s 10-year plan for the NHS, which did not actually mention reducing avoidable deaths at all. What we are proposing is the most ambitious thing that any health care system has proposed anywhere in the world, and I hope it will have his full support.

On the right hon. Gentleman’s comments about not generating a climate of fear, he is absolutely right; it is really important, in getting the culture right, to make sure that people are supported to speak out and that there is not, as an unintended consequence, the kind of bullying and intimidation that Sir Robert says is all too common today. I suggest to him that one of the reasons for that climate of fear has been over-dependence on top-down targets as a way of running the NHS. That is what has created the fear in managers that sometimes has led them to treat their staff in the wrong way. What would be very constructive would be a recognition from Labour that that top-down targets culture did go too far, and that we need to rely on transparency as a way of improving performance as a much better tool than endless new targets.

In anything we do—this is something else where I agree with the right hon. Gentleman—we must look very closely at making sure that we learn these lessons in the social care sector as well. That is particularly clear when we look at the scandal of what happened in Rotherham. That is why, when we introduced the new CQC inspection regime following the original Francis public inquiry, we did not just set up a chief inspector for hospitals but set up a chief inspector for general practice and for adult social care. We are now getting the same Ofsted-style transparent rankings of how good care is in care homes, and indeed in domiciliary care. I know that he, like me, is concerned about 15-minute care visits. I think those inspections will help to root out those problems.

With respect to nurse numbers, I really do think that is something on which, if the right hon. Gentleman wants to be constructive, he should commend the Government’s efforts. We have 8,000 more nurses in our hospital wards than we had four years ago. Of course, as a short-term response a lot of hospitals are employing nurses through agencies. That must only be a short-term response. We need proper long-term commitment to institutions, which we do not get with agency staff, but I commend hospitals that have said, “While we try and get enough staff in place for the long term we are not going to wait, because we need to make sure that patients are safe today.” They want to do what it takes to do that.

Finally, on the risk register, I simply remind the right hon. Gentleman that when he was Secretary of State he blocked the publication of the risk register. As a Minister, he said:

“This would inhibit the free and frank exchange of views about significant risks and…management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]

More broadly, I just want to say this. There are many patients and whistleblowers looking at today’s exchanges and wanting to see constructive agreement on the way forward. I think we can get a measure of that. What they say they want is not just words, but actions.

As we put staff and patients first in England, will Labour do the same for patients in Wales and today commit to a Keogh review of high mortality hospitals, commit to a chief inspector of Welsh hospitals and commit to protect staff who speak out in Wales, as we want to do in England? Will he commit to putting right a top-down culture that prioritised the needs of the system over the needs of individuals? Will he, as we do, recognise that that is always the danger of treating the NHS as a political possession and not as a service for patients? Patients must always come first. Staff who want to do the right thing for patients should always be heard. Our NHS deserves nothing less.

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

May I endorse the Secretary of State’s remarks on Wales, having seen it at first hand? Having seen at first hand a constituent who was a whistleblower, and how her career and her family life have been so badly affected after she did the right thing, I know that what the Secretary of State has done today will be widely welcomed.

On the Public Administration Committee, we took evidence from the CQC and others, and it became very obvious that there is still a major problem with complaints procedures for patients and their relations. Patients often tell me that they are afraid to complain about the way that they are being treated in whatever NHS establishment they are in. Is there some way in which the Secretary of State can ensure that there are clear instructions in all NHS establishments on how patients and their relations can raise their valid concerns without their worst fears being realised?

[Mr Speaker]

Order. The right hon. Lady, whom I know extremely well as a Buckinghamshire colleague, rather like Treebeard does not believe in unnecessary or undue haste, but if I could suggest to colleagues that questions could be pithy rather than too leisurely I think we would all profit from that. The same goes, of course, for the Secretary of State, from whom we expect characteristically pithy, succinct responses.

[Mr Hunt]

As indeed we learn from you, Mr Speaker.

I welcome the question from my right hon. Friend, who is a former Secretary of State for Wales. People will want to know that these lessons will be learned in Wales. In the original Francis response, we set out clear plans for the way in which hospitals should make it clear, in every ward of every hospital, how one can complain not just directly to the trust, but to independent external organisations, such as the ombudsman, if necessary.

[Frank Dobson (Holborn and St Pancras) (Lab)]

May I warn the Secretary of State not to think that because he has decided something and because a circular has been issued, something has happened? In 1998, against a lot of opposition, I insisted that the whistleblowing law should apply to the NHS. I also issued a circular banning the use of gagging clauses. As I said in my discussion with Sir Robert Francis on this whole issue, it clearly did not work.

[Mr Hunt]

I thank the right hon. Gentleman for what he did when he was Health Secretary. I am well aware that in the world’s fifth-largest organisation, nothing happens just because someone issues a circular, which is why some of what we have announced goes beyond what Sir Robert precisely recommended. For example, by publishing avoidable death rates by hospital trust, we want to make the energy for change come from inside trusts, not from their being told to do things by Ministers. However, I welcome what he did as Secretary of State, and I hope we can do some other positive things.

[Sir William Cash (Stone) (Con)]

May I commend my right hon. Friend for his nuts-and-bolts approach and Sir Robert Francis for what is clearly an extremely good report? My right hon. Friend will know that Helene Donnelly is a constituent of mine, and that I read out a letter from her in Westminster Hall when I called for an inquiry under the Inquiries Act 2005—an inquiry that this Government set up, despite its having been refused by the previous Government and successive Secretaries of State. Will he bear in mind the need to dismiss any chief executive who does not take account of lessons learned and the fact that anyone who puts a whistleblower at risk does not deserve to hold their job?

[Mr Hunt]

I thank my hon. Friend because without his work and that of some of his Staffordshire colleagues we would not have had a public inquiry into Mid Staffs in the first place. Helene Donnelly has been a great inspiration to everyone who has thought hard about this subject. She had the courage and guts to stand up for patients at Mid Staffs, and she experienced terrible bullying as a result, which is why I am delighted that she is helping us. In fact, I think she is the inspiration for Sir Robert’s recommendation on “freedom to speak up” guardians. My hon. Friend is absolutely right that managers and chief executives must be completely accountable for delivering on this agenda, but we also need to send a signal to them that success for a chief executive means more than meeting A and E or 18-week targets; it is about the quality and safety of patient care.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

May I support the suggestion from my right hon. Friend the Member for Leigh (Andy Burnham) to extend to social care the measures recommended by Sir Robert Francis? I know from my own casework how hard it is for a whistleblower in social care working for a small organisation to reveal issues of bad care. In addition, the Health Select Committee pointed out that many whistleblowers suffer in their careers, including in social care, lose their job and find it hard to find a new post, and it recommended that whistleblowers who are vindicated receive an apology and practical redress. Does the Secretary of State agree?

[Mr Hunt]

I agree with the hon. Lady’s argument. Just as poor care has been identified in hospitals, so we have seen terrible examples of things happening in residential care and of inadequate domiciliary care. It is more complex, because the delivery of social care is more diffuse, but one way to deal with this is through the proper integration of health and social care and the proper assessment of quality based on the entire package of care that people receive, not just in individual institutions but across the board. We are doing a lot of work on that.

[Andrew George (St Ives) (LD)]

Like others, I welcome the report, but may I urge my right hon. Friend to reconsider the issue of safe staffing levels on acute hospital wards? I know that Robert Francis pointed to issues of culture and standards, but those are areas of interpretation and disputation. If we had the measuring stick of safe standards, particularly where a ward has less than one registered nurse to seven acutely ill patients—the level recommended by the Safe Staffing Alliance—whistleblowers would be able to point to a clear failing and service risk, which is especially important if the Secretary of State is worried about avoidable hospital deaths.

[Mr Hunt]

The hon. Gentleman makes an important point, but I hope I can reassure him, because NICE has published guidelines on safe staffing levels, although they are different for different parts of a hospital: in intensive care, it is 1:1; for less severe illnesses, it is one nurse to eight patients; and in other parts of a hospital, it is one nurse to four patients. Those are all published, and I hope they will help whistleblowers in Cornwall and elsewhere.

[Valerie Vaz (Walsall South) (Lab)]

What support will the Secretary of State give to trusts to ensure that safe staffing levels are implemented, given that they might need extra resources?

[Mr Hunt]

We have protected—indeed increased—the NHS budget in real terms at the time of the biggest financial crisis since the second world war, so I think the Government have done what they can to make resources available. However, improving care is not always about money, and some hospitals manage to staff their wards safely and achieve financial balance. In fact, hospitals that practise safe care tend to be in a better financial position than ones that do not, so safe care and good finances actually go together.

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

I commend my right hon. Friend for his statement and thank Sir Robert Francis for his excellent report, which, as the Secretary of State knows, goes to the heart of the Public Administration Committee’s inquiry into clinical incident investigation. It comes as no surprise that we still have severe problems in the NHS. Perhaps the “freedom to speak up” guardian role needs to provide complete legal protection for people speaking up, immunity from freedom of information requests so that the information and the names cannot be exposed maliciously, and the capacity to investigate what is reported to them on a completely independent basis. We look forward to his giving evidence to our Committee.

[Mr Hunt]

I thank my hon. Friend for his interest in the issue of culture change, including at his local hospital, which I visited last week and where I was pleased to see a change in culture happening, despite some very severe problems. It is excellent that PASC is doing this inquiry, and his suggestions sound very worth while. We will consider them as part of our consultation—in fact I would encourage his Committee to submit them formally, to ensure that we give meaning to these “freedom to speak up” guardians.

[Grahame M. Morris (Easington) (Lab)]

I welcome the report by Sir Robert Francis and the Secretary of State’s commitment to changing the culture around the protection of whistleblowers—the Health Committee recently published a report making specific recommendations about such protections. May I draw the Secretary of State’s attention to the actions of the General Medical Council, which wrote to the employer of a whistleblower who gave evidence to the Committee after he had expressly stated that he was acting in a personal capacity in raising questions and providing evidence of financial inducements being paid by private health care companies to secure referrals?

[Mr Hunt]

I am happy to look into that case carefully, if the hon. Gentleman will supply me with the details.

[Mr Laurence Robertson (Tewkesbury) (Con)]

rose—

[Mr Robertson]

Thank you, Mr Speaker.

A good friend of mine, a consultant cardiologist, had his career ended and his life completely disrupted after he blew the whistle on the unnecessary deaths of patients at a hospital he worked at. It has taken him more than 12 years to win his case at a tribunal, and he still awaits compensation. These cases often manifest themselves in employment disputes, with trumped-up charges brought against the individual. What can the Secretary of State do to ensure that such things never happen again?

[Mr Hunt]

I add my congratulations to my hon. Friend, who makes an important point. The heart of the problem of whistleblowing is the confusion between employment law and patient safety. We need to divorce those two things and put in place a proper procedure to ensure that the right thing happens if someone raises a concern about patient care, and that it can be externally investigated to ensure that the trust did the right thing. Issues of employment law and someone’s professional behaviour should be pursued on a completely different track—those things are rightly and properly a matter for the courts. It is precisely because of the kind of issue he talks about that people are afraid to speak out. They worry that if they do, even if they win at an employment tribunal, they might never get a job again. For that reason, we welcome the shadow Secretary of State’s commitment to work with us and put on the statute regulation-making powers making it illegal for NHS organisations to discriminate against former whistleblowers.

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

The Secretary of State and I spoke last week about the importance of the upcoming Kirkup report. Grieving families in my constituency want to be able to move on from the tragedies they have suffered and see proper change in the culture at Morecambe Bay. What happened was not right and is still under criminal investigation. Will the improvements the right hon. Gentleman has announced today be in place when the report is published, and does he agree that the response to it must be neither whitewash nor witch hunt? If he does, how can he help make it happen?

[Mr Hunt]

I thank the hon. Gentleman for the close interest he has shown in this issue and the constructive way in which he has engaged with families locally to try to get to the bottom of a really terrible tragedy. He puts it better than I could. We need to implement the recommendations in a tangible and real way so that something actually changes, but we do not want to do it in a way that has unintended consequences. That is why the focus of what Sir Robert is saying this time is not about new criminal sanctions. Although the law has a role—we changed the law on wilful neglect, for example—this is about creating a supportive culture through which people want to listen and learn when others speak out. Of course, if people do not, there should be sanctions, but that should not be the primary motivator.

[Sir Bob Russell (Colchester) (LD)]

I was pleased to be with the Secretary of State last Thursday when he visited Colchester general hospital—one of 19 in special measures—and I am sure he will want to join me in praising the hard-working medical and support staff for all they are doing. He referred in his statement to the “entire NHS” being “committed to patient-centred culture change”, and observed that no one takes responsibility for a vulnerable patient so that the buck gets passed. I suggest that Sir Robert Francis would do well to look at the silo mentality—the reality rather than the rhetoric—in the case of the Haven Project in Colchester, to which the hon. Member for Harwich and North Essex (Mr Jenkin) and I have drawn attention. That is a classic case where the reality does not match the rhetoric.

[Mr Hunt]

Yes, and I remember the conversation I had with the hon. Gentleman about that issue. I will look into the case carefully. I am not saying that the NHS culture is changing today, because I think it is a very long journey. That is why it is important to have cross-party agreement. This is something that will take decades to happen. If we look at the best hospitals in the world, in England or abroad, we find that they get their culture right over decades. We must understand that. Breaking down those silos, putting patients first and making sure that that is not compromised, whatever the external pressures—that is the heart of the matter.

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

When Pauline Lewin, a whistleblower, came forward in Hull to raise concerns about the then chief executive, Phil Morley, she found herself subject to hostility and bullying and has not been able to return to work—despite corroboration from a damning Care Quality Commission report, an ACAS report that established bullying and an independent KPMG report on financial irregularities. Meanwhile, the chief executive has moved on to another such post, earning £170,000 a year. I listened carefully to what the Secretary of State said—that he was “calling time on bullying…and victimisation” in the NHS—so will he reassure me that that will apply to this case, which his Department is currently investigating?

[Mr Hunt]

I remember the good meeting I had with the hon. Lady and the former Secretary of State about that issue, which we are looking into. I hope she will understand that it would not be right for me to comment on that individual case, but let me say that it seems to exemplify exactly how things have gone wrong. That is why we need to look into it very carefully. We need to create a culture through which the management actually want to listen to their staff. I do not want managers to do so because of something I say; I want them to feel that they want it happen. It is as much about making sure that organisational priorities are correctly set from the centre, as it is about changing the law.

[Charlotte Leslie (Bristol North West) (Con)]

Culture change is a big tanker to turn, and senior managers under pressure from targets and headlines need significant sanctions and incentives to reveal rather than smother or downplay difficult truths. Doctors have the General Medical Council, although it needs improvement, but managers have no regulatory body to make them accountable. Will the Secretary of State consider doing something about that?

[Mr Hunt]

I thank my hon. Friend, whom I know has thought extremely hard about this issue. Indeed, we talked yesterday about getting the fit and proper persons test to work properly. It is still in the early stages, so it is difficult to assess whether it is having the impact we want. We certainly hope it will have some impact. There is an unfairness about the fact that a clinician as a chief executive of a hospital is accountable to the GMC as a doctor, whereas a chief executive who is not a doctor is not accountable. We actually want more doctors to become chief executives. On the whole, they do a really good job, and we should give further consideration to that.

[Clive Efford (Eltham) (Lab)]

It will take a great deal to change the culture. I have spoken to a senior hospital manager who would like to express his concern about the lack of qualified nurses, forcing him to advertise posts abroad. I have spoken to two A and E nurses who are concerned about the critical situations occurring at their unit every day. One of them has become an agency nurse so she can limit the number of hours she is forced to work. Then there is an ambulance worker who is concerned about the 12-hour shift and the lack of time he is given to clean his ambulance between dealing with patients. They would all like to come forward to express their concerns, but they do not feel that anyone above them would listen. What can the Secretary of State say today to reassure those people?

[Mr Hunt]

I can say that we are consulting on making a big change that would mean they would have someone independent in their organisations to whom they could talk and raise their concerns. They could say, “I want to say this, but no one is listening to me”. That is what Sir Robert Francis calls “freedom to speak up” guardians, whom he wants in every organisation. It is what Helene Donnelly is championing in her work. That is the way forward to address those concerns.

[Andrew Stephenson (Pendle) (Con)]

East Lancashire Hospitals NHS Trust was placed in special measures, following the Keogh review, in July 2013, and it successfully exited that regime in July 2014. The trust has employed an additional 201 nurses and nursing support staff and 26 more doctors since June 2013, taking the total increase since May 2010 to 391 additional nurses and 40 additional doctors. In January 2014, the Royal College of Midwives named the maternity services unit the maternity service of the year. Will my right hon. Friend join me in paying tribute to the dedicated staff at East Lancashire hospitals for working with the new tougher regime and turning my local hospital trust around?

[Mr Hunt]

I absolutely will. This is a great example, and I would like to thank my hon. Friend for the interest he has shown in this issue. For one hospital to have 390 more nurses over four years is remarkable. It may interest my hon. Friend to know that those numbers do not include agency staff, so if the hospitals have any such staff, they will be counted on top of those figures. This is a dramatic turnaround for the quality of patient care, which we all welcome. That just shows that if we get the incentives right from the centre, trusts do want to do the right thing. We did not instruct the trust to employ a single extra nurse; rather, we set up a new inspection regime and special measures regime, and what my hon. Friend said shows it has worked.

[Steve Rotheram (Liverpool, Walton) (Lab)]

I, too, welcome the report. In his statement, the Secretary of State committed to the view that the new measures are not about “naming and shaming”. Does he therefore agree with the Prime Minister, who said:

“Francis does not blame any specific policy. He does not blame the last Secretary of State for Health. And he says we should not seek scapegoats”?

[Mr Hunt]

I do not think we should seek scapegoats, but I do think we need to understand where policies have inadvertently led to the wrong outcomes. Sir Robert talks clearly about the dangers of an excessive focus on targets, which is one of the things that have driven the wrong culture. On that, I hope to get cross-party agreement.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

As my right hon. Friend will be aware, one reason why Basildon hospital came out of special measures so quickly is that under the new chief executive, openness and transparency are is encouraged at every level. Does he therefore agree that it should be incumbent on all of us to be open, transparent and honest? Why does he think the Opposition are tweeting that the numbers of doctors and nurses at Basildon hospital are down, when I have just checked with the chief executive and found that the reality is that the numbers are up?

[Mr Hunt]

It is very important that everyone uses the right figures. What has happened at Basildon hospital is an inspiration to other trusts in special measures. In just a few months, it moved from being in special measures to being rated “good” by the CQC. The trust has an inspiring new chief executive, Clare Panniker, who really does listen to staff. I have been there and been told by staff how they feel that they are being listened to. We all have an obligation to make sure that the right information goes out to local communities, so that they understand where things really are getting better.

[Derek Twigg (Halton) (Lab)]

Most, if not all, hospitals are very concerned about next year’s proposed 3.8% efficiency saving. They fear that it will have an impact on access to and quality of services, and hence on patient safety. In the spirit of the openness and transparency that we now want to see, may I ask whether the Secretary of State was aware of those concerns, and whether, if he was not, he will find out why?

[Mr Hunt]

I am glad to note that this is rapidly becoming one of the most open and transparent exchanges of questions and answers we have had in the Chamber. I am, of course, aware of trusts which say that they will find it difficult to meet stretching efficiency targets, but I would say to them that if they look at some of the safest hospitals in the world—such as Salford Royal in England and Virginia Mason in Seattle—they will find that they have the lowest costs. It is not a choice between cost and safety; better safety leads to lower cost.

[Mr Marcus Jones (Nuneaton) (Con)]

Will my right hon. Friend join me in welcoming the progress that has been made at George Eliot hospital since the Keogh review? The employment of 91 extra doctors and nurses has certainly helped, but does he agree that we cannot be complacent and must continue to root out bad practice wherever it exists, in a very open and transparent fashion?

[Mr Hunt]

Absolutely. I have visited George Eliot hospital, and observed a few beds in the A and E department. One of the most inspiring things about it is that it came out of special measures by developing a strong link with University Hospitals Birmingham NHS Foundation Trust—under the leadership of Dame Julie Moore—which enabled it to learn very quickly what changes were needed. The “buddying” of trusts in difficulty with high-performing trusts is one of the measures that have worked the best.

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

I am pleased that the report mentions support for the right of NHS workers to speak up. When I was a Unite workplace rep in the NHS, I spent much of my time giving support and advice to workers who asked about blowing the whistle on malpractice. Does the Secretary of State recognise the vital advisory and supportive role provided by trade unions in the NHS, and will the Government cease their attacks on trade union facility time?

[Mr Hunt]

I agree that unions have an important role, but this should not have to be about unions. Regardless of whether a hospital has unions, people should be able to contact someone independent if they feel that their concerns about poor care are not being listened to, and that person should be enthusiastic about listening to what they say.

[Jackie Doyle-Price (Thurrock) (Con)]

This morning I was contacted about a patient at Basildon hospital who was suffering from Parkinson’s disease and who, on asking for assistance to go to the toilet, was told by nurses that they were too busy, so he had to use his pad. He was left in some distress, and suffering from nappy rash. Does my right hon. Friend agree that, when we are developing a patient-centred culture in the NHS, such behaviour should not be tolerated?

[Mr Hunt]

I do agree, and I have had many discussions with my hon. Friend about how local health care services can be improved. It shows real courage to raise a concern about patient care at one’s own local hospital. Basildon is a fantastic hospital—it is very well run, and it has really turned a corner—but that does not mean it is perfect, as I am sure its chief executive would be the first to accept. It is possible to have a sensible debate about improving care while being honest about the problems. That is the big change we need to make, and my hon. Friend has given us an example.

[Sarah Champion (Rotherham) (Lab)]

I welcome the focus on whistleblowers and the support package, but the Francis report also said that patients’ complaints should be viewed as the canary for failing hospitals. What support is the Secretary of State giving to patients who make complaints, and can he reassure us that the hospitals and the Care Quality Commission will take the issue very seriously?

[Mr Hunt]

Yes. We have set out new guidelines. The right hon. Member for Cynon Valley (Ann Clwyd) helped us a great deal when we were looking into how to improve the NHS complaints procedure, in particular advising people about how to complain and ensuring they knew that they could talk to someone independent if they needed to. I try to look at a letter of complaint about something that has gone wrong in the NHS every day before I start my work, and I make sure that the trusts are aware of that.

[Martin Horwood (Cheltenham) (LD)]

Before Christmas, I alerted Ministers to attempts by Gloucestershire Hospitals NHS Trust to prevent a governor from expressing concern to the local media about the care of local people. Does the Secretary of State agree that gagging governors is also unacceptable, and that the new spirit of openness should apply to governors and board members as well as staff?

[Mr Hunt]

I do, and I think it important to bear in mind the role of the press as a last resort for whistleblowers. Many of the problems of which we are aware have come to light because people have spoken to the press, and that is to be welcomed, but I think we would all agree that it is a real shame if things have to reach that stage. We need a culture in which people are listened to straight away. That governor should have felt that he or she could talk to someone in the hospital who would do something about the problem, rather than having to go to the press.

[Kate Green (Stretford and Urmston) (Lab)]

The Secretary of State has said that trusts are becoming more transparent in relation to data, and of course that is welcome, but data alone may not provide full information for patients. In 2011, Trafford general hospital had very poor standardised mortality figures, but, thanks to the assiduity of my constituent Mr Dennis Wrigley, we now know that they were due to a recording error. How will the Secretary of State encourage trusts not just to provide raw data, but to contextualise the data and tell patients what they might mean?

[Mr Hunt]

I hope the hon. Lady will be pleased to know that we have now made it a criminal offence to supply false or misleading information, but let me respond to the broad point that she has made, because I think it is important.

The publication of data is indeed welcome, but we do not want it to cause the entire NHS to focus on gaming the system, or changing the way in which data are collected in order to make its organisation look better. The purpose of data is to identify issues. The CQC then makes rounded judgments on the performance of institutions, which are based not just on data but on visits and conversations with patients, doctors and nurses. I think that that system can provide us with the best understanding of how well those institutions are actually doing.

[Chris Skidmore (Kingswood) (Con)]

As the Secretary of State will know, my hon. Friend the Member for Bristol North West (Charlotte Leslie) and I wrote to him about Southmead hospital after a large number of our constituents had written to us about poor quality care there. Today the CQC published its report on North Bristol NHS Trust and Southmead, which states that the urgent and emergency services are inadequate and causing a

“serious risk to patients’ safety”,

and also states:

“Several staff told us they were ‘ashamed’ of the standard of care”

at Southmead.

I have just received a letter from the chief executive of North Bristol trust, which makes no mention whatsoever of the fact that Southmead A and E had been declared inadequate. Instead, she simply refers to

“some teething problems which are being dealt with”.

Does that letter not illustrate the overall culture problem in the NHS, namely that there is active denial among some chief executives who will not admit what is going wrong in their local hospitals?

[Mr Hunt]

I have not seen the letter, so I hope that my hon. Friend will understand if I do not comment on it, but I strongly agree with his broader point. Any chief executive or manager in the NHS needs to understand that the best way in which to reassure the public, and to reassure Members of Parliament who speak out for their constituents, is to be honest about the problems.

My local trust was the first in the country to be given an “outstanding” rating. When I last went to see its chief executive, I said that I had three constituency problems, and I raised all three of them with him. He said, “Yes—we were wrong on that one; we should not have done that; and we were wrong on that one.” One of the best trusts in the country was being totally honest about its problems, and wanted to do better. We need to make managers understand that that is the right thing to do, and that we will back them if they do it.

[Robert Flello (Stoke-on-Trent South) (Lab)]

Longton cottage hospital had to close because the local trust could not recruit enough nurses to ensure its safe operation, yet the Government slashed nurse training places. Now the Department refuses to release the secret KPMG report on “distressed” health economies. The people of Stoke-on-Trent deserve to know what is happening to their local hospitals and to local health care. The Secretary of State rightly says that we need to stop secrecy and have openness, but when will he whistleblow his Department’s own report? The Department is setting a very bad example when it comes to openness and transparency.

[Mr Hunt]

I will look into the issue that the hon. Gentleman raises, but let me deal now with the issue of nurse training places. The cuts began under the Labour Government, and we have been gradually reversing them. The main point, however, is that, in all parts of the House, there was a lack of understanding of the importance of safe staffing in wards before the Francis report, which is why successive Secretaries of State made mistakes in their projections of what was needed.

We have 8,000 more nurses in our hospital wards, including those at Stoke, and I hope the hon. Gentleman welcomes that.

[Andrew Percy (Brigg and Goole) (Con)]

The Secretary of State will want to congratulate North Lincolnshire and Goole NHS Foundation Trust on getting out of special measures and employing more nurses and doctors. On the issue of “freedom to speak up” guardians, will he ensure there is one in every hospital, because in my trust staff in the smaller hospital sometimes feel their voice is not heard by the two big district general hospitals, which are up to 60 miles away?

[Mr Hunt]

That is a very good point. I had a great visit to my hon. Friend’s local hospital and saw a knee operation which was quite gory but looked to me to be a very good example of safe care. He makes a good point and I will certainly feed into the consultation the idea that it should be easy to contact somebody who works in the same hospital or building, rather than someone who is a long way away.

[Mr Ronnie Campbell (Blyth Valley) (Lab)]

When I entered this House in 1987 I was put on a Select Committee for the parliamentary ombudsman, which dealt with the health service and complaints within it. In bad cases, we would bring chief executives, chief nurses and chairmen of the trust concerned before us. That was a good deterrent. Why not bring it back?

[Mr Hunt]

All these things should be looked at, but through the Select Committee on Health we do now get chief executives of trusts to be accountable to Parliament. The Public Administration Committee is looking at the role of the ombudsman to make sure that works as well as it can, and we should wait for its recommendations.

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

Following on from the question of the hon. Member for Barrow and Furness (John Woodcock) about Morecambe Bay trust, has the Secretary of State had a chance to look at yesterday’s “Better Care Together” future plans report by the trust, which finally puts to bed the wild allegations locally of hospital and A and E closures and also sets a road map for eliminating the pre-2010 deficit, provided we get some recognition of the difficult geography of our area?

[Mr Hunt]

I know geography is a big issue, and the driving distance between Morecambe bay and Lancaster is a big challenge for the trust. I will look closely at that report, and I think Members in all parts of this House would welcome a commitment to avoiding scaremongering about local hospital services in the run-up to the election.

[Glyn Davies (Montgomeryshire) (Con)]

I represent a constituency in Wales, and look with some envy at the commitment to openness and transparency on both sides of this Chamber, and indeed the commitment to transparency and openness throughout the NHS in England following the Francis report and the Keogh review. What discussions can my right hon. Friend initiate, perhaps with the Opposition, to introduce the same level of transparency and openness in Wales so that my constituents in Montgomeryshire can also benefit?

[Mr Hunt]

I think it is very simple—there is a lot of agreement between us about what needs to happen. I recognise that the shadow Secretary of State is not personally responsible for what happens in Wales, but his party is, and a Keogh review of high mortality hospitals, a chief inspector of hospitals for Wales and a commitment to the whistleblowing measures announced today would do a lot to allay the concerns of my hon. Friend’s constituents that the lessons about openness are not being learned across the border.

[Charlie Elphicke (Dover) (Con)]

Does the Secretary of State recall that the Care Quality Commission found that in East Kent hospitals senior management and the front line were disconnected, there were problems with bullying and harassment, and people would not say how things could be improved, including in terms of clinical risk? Does that not indicate that this is not just about whistleblowers, but that it is important that management sets a culture of openness, and listens and hears the staff voice?

[Mr Hunt]

My hon. Friend is absolutely right, and I thank him for his interest in his local hospitals and his campaign for them. In the end, culture comes from the top. When people start a job they look at the values of their direct line manager and they copy them, because they think that is what it takes to get on, and the line manager looks to the chief executive and the chief executive in the end looks up to the Secretary of State, so it is very important—[Interruption.] I grant that that may not be the best thing. It is important that right from the top we set the right example about these issues.

[Robert Halfon (Harlow) (Con)]

I thank my right hon. Friend for the work he has done on this and for his forthcoming visit to Princess Alexandra hospital in Harlow. Further to the question on trade unions, we have outstanding trade union representatives in the Princess Alexandra hospital and they do a huge amount of work on these issues. Can my right hon. Friend confirm that these guidelines will also include trade union workers, so that they are covered by his recommendations?

[Mr Hunt]

That is an interesting point and we should certainly reflect on it in the consultation. I am looking forward to visiting my hon. Friend’s trust in March. On many of the visits I have made to hospitals in special measures, which his hospital is not, I have met union representatives and they have an important contribution to make, because nine times out of 10 the real problem is that the people on the front line feel they are not being listened to, and when that is put right the other things start to be solved as well.

[Steve Baker (Wycombe) (Con)]

As a former airworthiness engineer, may I strongly endorse my right hon. Friend’s direction of travel? Will he confirm that Buckinghamshire Healthcare NHS Trust, having exited special measures after the Keogh review, has enjoyed a fantastic transformation, which I believe he saw when he visited Wycombe hospital?

[Mr Hunt]

I had a fantastic visit there. This was a hospital that, putting it bluntly, was one of the worst in the country, and it is now on its way to becoming one of the best. The motivation and excitement not just of the management team but also the staff there, were palpable, and I think a huge number of good things are happening. What has worked there is the sense that what we are asking of the hospital is the same thing that they want to deliver for their patients—safe, compassionate care—and that must remain the focus.

NHS Major Incidents

Jeremy Hunt Excerpts

Wednesday 28th January 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on what guidance has been issued by NHS England on declaring a major incident.

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

As you know, Mr Speaker, I am always happy to come to the House to discuss the NHS, but today we have been brought here to discuss a local operational issue that, regrettably, the Opposition have tried to spin as part of their policy to “weaponise the NHS.”

As I said to the House earlier this month, a major incident is part of the established escalation process for the NHS, and has been since 2005. It enables trusts to deal with significant demands, putting in place a command and control structure to allow them to bring in additional staff and increase capacity. It is a temporary measure taken to ensure that the most urgent and serious cases get the safe, high-quality care they need.

The decision to declare a major incident is taken locally, and there is no national definition. We must trust the managers and clinicians in our local NHS to make these decisions and support them in doing so by ensuring that there is sufficient financial support available to help them to deal with additional pressures. The document that has been questioned this morning by the Opposition Health spokesman was issued by the local NHS in the west midlands. That was done to help its clinical commissioning groups to work with local NHS organisations to deal with the unprecedented pressures they have been facing this winter. The chief operating officer of NHS England, Dame Barbara Hakin, has said this morning that this was a local decision and neither the responsibility of Ministers nor the result of pressure by Ministers.

Let me finish by praising the NHS for coping well with the unprecedented pressures. Performance against the A and E standard improved to 92.4% last week, which is testament to hard-working staff, and this Government will support them, not try to turn their efforts into a political football.

[Andy Burnham]

In the first week of January, at least 14 trusts across England declared major incidents, including three in the west midlands. Official figures show that pressure continued into the second and third weeks of January, with only seven A and Es out of 140 meeting the Government’s target. There were ambulance diverts, and even an A and E closure, but no further major incidents were declared. On 7 January, when the Health Secretary was called to the House to answer an urgent question, he said:

“The decision to declare a major incident is taken locally—there is no national definition”—[Official Report, 7 January 2015; Vol. 590, c. 273.]

He has just repeated that now, and called this a “local operational issue”, but that does not appear to be entirely accurate. Let me quote from the guidance that was sent in the middle of January. It is headed “NHS England” and it states:

“Major incidents should be agreed with…the Director on call for NHS England”.

Will the Secretary of State now withdraw his earlier statement to the House and confirm that this decision is not purely local, in that it has to be approved by NHS England?

Let me turn to the impact that this has had on trusts. There are 17 enhanced criteria set out, including requirements that may cause serious time delays for trusts in an emergency. For instance, there is a requirement on the on-call CCG manager to visit the trust and undertake a review. Let me tell the Secretary of State how those new rules were perceived by senior managers. I shall quote from an e-mail sent by the head of operations at one trust, who said that the requirement had been

“introduced by NHS England to effectively stop trusts from calling a major incident…Our hands will be tied in most cases if they wish to call a major incident for capacity reasons”.

Is the Secretary of State confident that the new enhanced criteria are not unduly burdensome and will not cause unnecessary delays for a trust in an emergency situation? Is he satisfied that this guidance is consistent with good practice at national level and safe to be left in place?

The Secretary of State has used the word “local” many times today, and spoken of the only consideration being relieving pressure on hospitals facing severe demand. However, his claim that this matter is purely local is called into serious question right now by this 86-page document headed “NHS England”—[Interruption.] He says it is from the local team, but this is a regional function of the national body, NHS England. The local claim will not wash, I am afraid.

I will tell the Secretary of State what the guidance tells trusts to take into account. He says that it concerns only operational matters, but section 7.2.3 is headed “Politics”, and subsection (a) asks:

“Is there increasing involvement of senior command and control tiers, political involvement or excessive media coverage?”

Subsection (c) asks:

“Is there a risk of reputational damage?”

Does not this muddy the waters hugely? Will it not distract doctors whose sole focus should be on the emergency situation, and not on media and political considerations that should form no part of their judgment? If the Secretary of State agrees with me on that, will he today instruct NHS England to withdraw this guidance and issue more appropriate instructions to the NHS in the region? The NHS remains under serious pressure, and it needs the clearest of instructions based on what is best for patients. Will he act today, so as to leave the NHS in no doubt that that must be its paramount and only concern at all times?

[Mr Hunt]

In the right hon. Gentleman’s desperate desire to weaponise the NHS, I am afraid that Labour has sunk to new depths today. He said in the media this morning that the Government had put news management over patient safety. That is ironic coming from him, given that so many officials testified to Francis about the pressure they were put under not to come out with bad news when he was Health Secretary. Even the head of the Care Quality Commission was roasted because she wanted to publish details of the problems that were happening in the NHS under Labour and he did not want that to happen when he was Health Secretary. That news management stopped the moment he walked out the door, and those days are over.

As confirmed by NHS England this morning, this was an operational decision; it was nothing to do with Ministers. This was the local NHS doing its best to get good guidelines out in a tough winter. [Interruption.] It is a local decision. The right hon. Gentleman is the man who talks—he did not deliver this in office—a lot about integration. It is absolutely right that a local hospital should talk to the rest of the local NHS to check about the impact of any decision it makes on major incidents, to make sure that patients are treated safely—is he now saying to this House that local hospitals should not talk to the rest of the NHS? That is what these guidelines say. This was a period when we had 16 major incidents, but that number has gone right down because performance on accident and emergency is significantly—[Interruption.] This is the underlying point, because the reason we have fewer major incidents is that A and E performance has got better. This is the week when we discovered that public satisfaction with the NHS jumped five points last year. This is the week when NHS unions have put patients first by suspending their strike, and Labour focuses not on patients, but on politics. On patients, he did not want to talk about the Welsh ambulance service publishing its worst ever figures, although the Labour leader says that we should be looking at what is going on in Wales.

Let us be clear: where Labour runs the NHS we have double the number of people waiting at A and E; double the number of people waiting too long for ambulances; and 10 times the number of people waiting for their operations. We have seen Labour today in Wales and Labour before covering up around Mid Staffs, ignoring patients and weaponising the NHS for political advantage—has the right hon. Gentleman not proved today that Labour is still not fit to run the NHS?

[Dr Sarah Wollaston (Totnes) (Con)]

Our hard-working NHS staff and, more importantly, patients need to have absolute confidence that the Secretary of State will never lean on operational decision making in these circumstances and will always allow that decision making to take place at the appropriate local level, backed, if necessary, by national guidance.

[Mr Hunt]

My hon. Friend is absolutely right to say that. It is why many people in the NHS will be so astonished to hear the shadow Secretary of State, who presided over a culture where precisely that kind of leaning from on high happened, making it difficult for people to make those local operational decisions in the interests of patients, now trying to make a political point. This was a local decision and it was confirmed today that Ministers had no involvement in it, and Labour should stop trying to score political points.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

This Government caused confusion about decision making and accountability because of their reckless and expensive restructuring of the NHS. Now, to achieve what the Secretary of State wants to achieve, he has to resort to the sorts of measures we are discussing. We have had two major incidents declared in local hospitals in Salford in one week recently, and I have great concerns that this sort of guidance means that it is harder for clinicians to take the steps necessary to resolve the A and E crisis. They should not have to think about the issues listed in this document: politics and whether there is a risk of reputational damage. I do not want Salford Royal hospital and the Royal Bolton hospital thinking, “We can’t do this because of reputational damage.” This should be done entirely on the basis of clinicians’ reasoning.

[Mr Hunt]

That advice was issued in the west midlands, and not in Salford. The hon. Lady talked about the reorganisation. Well, that reorganisation means that we have been able to afford 82 more hospital doctors and 589 more nurses in her area, which is helping her constituents. Salford is one of the best examples of integrated care in the country, which is why any hospital declaring a major incident should think about the impact on the rest of the NHS locally. That is what the guidance says.

[Mr Peter Bone (Wellingborough) (Con)]

The shadow Secretary of State is a very honourable gentleman, but he might live to regret this political football stuff. In north Northamptonshire, my hon. Friend the Member for Kettering (Mr Hollobone), the hon. Member for Corby (Andy Sawford) and I are working together on local decisions about our A and E. Surely that, and not political football, is the way forward.

[Mr Hunt]

My hon. Friend is absolutely right. I have spoken to the chief executive of Northamptonshire county council and I have heard about the excellent integration of services that is now starting to happen between the local authority and the local hospital. That is the way forward. The guidance simply says that trusts must pay attention to the impact on the local health economy before they make a local decision. It is time that Labour stopped playing politics with something that they know is a disgrace.

[Grahame M. Morris (Easington) (Lab)]

Is the Secretary of State satisfied that the new guidance with its 17 criteria, to which my right hon. Friend referred, will not have the effect of making it less likely that NHS hospital trusts in the west midlands or in my region declare an emergency plan?

[Mr Hunt]

Declaring a major incident is the decision of the local hospital trusts, and that is right. But it is important that, before they make that decision, they should take proper account of the impact on the rest of the local health economy. That is what every responsible hospital wants to happen, and that applies to the hon. Gentleman’s area as well as everywhere else.

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

Following the declaration of a major incident at the accident and emergency unit of Colchester hospital, we now await the Care Quality Commission report into that incident, which will be published very shortly. We want the report to tell the truth, but it is harder to tell the truth in a political atmosphere where there are people who want to gloat over these challenges to get votes.

[Mr Hunt]

My hon. Friend is absolutely right. I have spoken to the chief executive of the hospital, and I must say that she and her staff are doing a good job in turning around a very difficult situation. What they want is support. We have issued sensible guidance that tells hospitals that if they declare a major incident, they must take account of the impact on the rest of their local health economy. A responsible Opposition would support such guidance, and not to try to turn it into a political football.

[Valerie Vaz (Walsall South) (Lab)]

The Manor hospital had to declare a major incident due to inordinate pressure from the closure of Stafford A and E. That is not a local issue, but a national one. When will the Secretary of State provide the hospital with the extra money to absorb the closure of Stafford A and E?

[Mr Hunt]

I can reassure the hon. Lady that we have provided a huge amount of extra money to deal with the problems in the wake of what happened at the former Mid Staffs Trust. We are continuing to give every support we can to Walsall and Stoke and other trusts. We have more doctors and more nurses and major changes are happening. The problem in Mid Staffs went on for four long years, and we do not want to wait that time before sorting out the problems.

[Paul Burstow (Sutton and Cheam) (LD)]

Clearly, patient safety must be paramount. We must ensure that any guidance supports the ambition that exists on both sides of this House for a more integrated system that takes into account the capacity across the whole service. Does the Secretary of State agree that what we also need is clarity and certainty over how the NHS and social care will be funded over the life of the next Parliament so that we realise the ambition and potential of the Care Act 2014 and we deliver Simon Stevens’s NHS plan?

[Mr Hunt]

I totally agree with the right hon. Gentleman. I am sure, too, that he will agree with me that the best way to give the NHS certainty over funding in the future and the increase in funding that it needs to implement the five-year forward view is a strong economy, and it is only this Government who are able to deliver that.

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

According to some statistics, I have more medics per square mile in my constituency than any other MP. I also have the University Hospitals Birmingham NHS Foundation Trust on my patch and a lot of people who work across the west midlands and in Birmingham. The Secretary of State’s operational guidance, as he has interpreted it, is not perceived in the way that he thinks it is. A and E consultants tell me that they are not just overworked and overstretched, but unsafe. If he thinks the guidance is purely operational without any political interference, will he follow the call of the shadow Secretary of State and say that he will issue a new set of guidance that makes that clear, because it is not how it is seen on the ground?

[Mr Hunt]

I have great respect for the hon. Lady, so I hope she will understand this: when people are worried about political influence over operational guidance, I do not then issue some political guidance. The only thing that I, as Health Secretary, say in respect of instructions going out is that patient safety must always be the priority, and that is what I have said time after time. But then the actual decision about whether to declare a major incident must be taken by people locally. Julie Moore, the chief executive of UHB, is fantastic and absolutely able to make those decisions, and those decisions should not be second-guessed by politicians.

[Sarah Newton (Truro and Falmouth) (Con)]

Does my right hon. Friend agree that it is really important to let NHS England’s local teams—in our case the Devon and Cornwall area team—make decisions with local leaders of hospitals? So many people in the north of Cornwall live closer to Derriford in Devon than they do to Treliske in my constituency. It is only right that NHS England staff closest to the clinicians make those decisions.

[Mr Hunt]

That is absolutely right, but Members on the two sides of the House hold different views. We believe in devolving power locally and we want local decision-making. We accept that that might mean that sometimes services are slightly different in one part of the country compared with another, but the benefit is that we do get that local knowledge. In the past few weeks, I have spoken to South Western ambulance service, which had particular pressures over Christmas, to ask whether there is anything we can do from the centre. What I want to ensure is that the decisions that keep my hon. Friend’s constituents safe are made locally, because they are likely to be better than any that I could make in Whitehall.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The Secretary of State is very reassuring when he says that, under him, the NHS is free from political news management. If that is the case, why does he not free it from the constraints of election purdah, and allow these officials to get on with their jobs without having to second-guess the consequences of some of the decisions?

[Mr Hunt]

We are not in election purdah. The point is that during election purdah we will continue to publish the weekly A and E performances and other figures from the Office for National Statistics, and that has always been the system. But there is a difference between what is happening in the run-up to this election and what happened in the run-up to the previous election. This time, the CQC is free to speak up, without fear or favour, about the quality of care in every single hospital in this country, and it will continue to do so.

[Mr Marcus Jones (Nuneaton) (Con)]

The Leader of the Opposition and the shadow Secretary of State visited the George Eliot hospital on Monday. The Leader of the Opposition praised the hospital for its progress under this Government. If we consider that, and then look at the way the Opposition come to this House and make political point scoring their No. 1 aim, we can see not only that they are hypocritical but that they want to put politics before patients.

[Mr Hunt]

I commend my hon. Friend for the support he gives to his local hospital. I visited it and did part of a shift in the A and E department. This was a hospital that, under the previous Government, had one of the highest mortality rates in the country. We introduced a new special measures regime and independent inspections. Labour tried to vote them down, but the result is that that hospital has come out of special measures, forged a strong new partnership with UHB and gone from strength to strength. Things are getting better because we are being honest about poor care, and did not sweep it under the carpet.

[Mr David Winnick (Walsall North) (Lab)]

The Manor hospital in Walsall was one of the very first in the west midlands to have to declare a major incident—a level 4 incident. I visited the hospital and saw the number of people on trolleys waiting for more than four hours. I want to pay tribute to the dedicated staff at the hospital—medical and non-medical—for all that was done. But the Secretary of State should not minimise the situation that has occurred. He should recognise that it is a matter not of playing politics but of genuine concern for our constituents.

[Mr Hunt]

I entirely agree with the hon. Gentleman. He should be reassured that because of those real pressures, which I would never seek to minimise, we put in an extra £4.5 million of funding to his local area, paying for more doctors, more nurses, more community staff and more beds. As he says, we should congratulate the staff in that hospital on their work, and also recognise that, despite those pressures, they have made real progress in improving the quality of compassionate care for the patients in that hospital. They have been very well led by the chief executive, whom I have also met.

[Robert Halfon (Harlow) (Con)]

Last week, the hon. Member for Leicester West (Liz Kendall) came to Harlow and attempted to weaponise the local NHS and scare local residents. A day later an interview was published in which she said that she supported privatisation in the NHS. Does my right hon. Friend agree that the best way to help the Princess Alexandra hospital in Harlow deal with major incidents is to do what the Government are doing, with £5 million extra last year for our A and E, and £4 million extra to help the NHS this year?

[Mr Hunt]

Indeed, across the country we have put in £700 million, which has paid for 6,400 additional beds in the system. All that is possible because we have a strong economy and we can put extra funding into the NHS. What those people in my hon. Friend’s hospital want most of all is support from Members in all parts of the House, and not to see their efforts turned into a political football.

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

Does the Secretary of State agree that Calderdale and Huddersfield trust was, until 2010, one of the most successful trusts in the country? I have a letter embargoed, ironically until 1 pm today, telling me of serious financial problems—not a major incident—caused by the reforms that his Government have introduced in the NHS. I remind him that it is my job as a member of the Opposition to weaponise—to use as a weapon—the disgraceful policies that his Government have introduced that are destabilising and destroying the national health service in my town and constituency, and up and down the country. I am a member of the Opposition, I will use this as a political weapon, and I will do so until the election, which we will win.

[Mr Hunt]

I am afraid that the trouble is that there are just too many people on the Labour side who think exactly like that. I suggest that the hon. Gentleman go and talk to people working in Calderdale and Huddersfield NHS Foundation Trust and ask them whether they want him to use the NHS as a political weapon in that way. They have improved their performance over the past few years and are seeing more people within four hours—every year, 4,000 more people within four hours than when Labour was in office—and MRSA cases are down. There are 79 fewer clostridium difficile cases; 525 more people are treated for cancer every year; and there are 6,200 more operations every year. Those are real improvements making a real difference to his constituents. He should celebrate them, not try to run them down.

[Henry Smith (Crawley) (Con)]

East Surrey hospital, which is the A and E department that covers my constituency, not least because Labour closed Crawley hospital’s A and E in 2005, has not had a major incident. Can my right hon. Friend confirm that major incidents have decreased because of the extra investment that he has put into the NHS, in stark contrast to Labour-controlled Wales, which has cut the budget?

[Mr Hunt]

I have been to East Surrey hospital, which is a good example. It, too, has had its share of problems with care, but it has addressed them head on. Standards in the hospital are getting better, and it is encouraging to see that refreshing openness and honesty. We have put more investment into the NHS. Welsh patients are angry, because they can see that openness and transparency about results, combined with strong financial support, not cuts from central Government, lead to better service. Rather than try to create a political weapon in England, Labour should act where they can do something about it—in Wales.

[Rosie Cooper (West Lancashire) (Lab)]

I was recently told by staff in Aintree hospital on Merseyside that, in the interests of patients and patient safety, executives should have declared a major incident. Although the execs teetered on the brink, they feared the political consequences of making that decision rather than doing the right thing. What genuine help and advice can the Secretary of State give execs who face that situation on the front line and help them to do the right thing for patients?

[Mr Hunt]

If executives did not declare a major incident because they were worried about the political consequences, they were wrong, but I would have to be persuaded that they would do that, because every NHS executive I speak to wants to put patients first, with patient safety paramount. On the practical things that we are doing, there are 60 more doctors, and 41 more nurses since 2010, and £4.5 million to help them through this winter. We are doing a lot of practical things to help the NHS in the hon. Lady’s area through the winter.

[Andrew Stephenson (Pendle) (Con)]

Many major incidents have their roots in things that happened some time ago. Blackburn’s A and E department has been struggling to cope with demand since Burnley’s A and E department was downgraded under Labour in 2007—a decision that the right hon. Member for Leigh (Andy Burnham) defended several times in the House, including on 19 November 2009, when he said:

“‘This is saving lives; I will stand by it’”.—[Official Report, 19 November 2009; Vol. 501, c. 236.]

On behalf of the residents of Pendle, I urge the Secretary of State to take no lessons from Labour on the management of our NHS.

[Mr Hunt]

That is it, and that is why it is not working for the Opposition politically when they try to put the NHS centre stage. They can see people who downgraded or closed 12 A and E departments across the country during their time in office now coming to Prime Minister’s questions and trying to criticise this Government when similar things have happened. The answer on all these occasions is to put patients first, do the right thing for patients, be honest about the problems and sort them out, and that is what the Government are doing.

[Mike Gapes (Ilford South) (Lab/Co-op)]

The hard-working and dedicated staff at Barking, Havering and Redbridge trust, at King George hospital in my constituency and Queen’s hospital in Romford, know, because their trust is in special measures, that there has been a lot of reputational damage. On 5 January, elective operations were cancelled—in my personal case, at two hours’ notice; I was not the only constituent who had to go through that—because of A and E pressures in the trust. Can the Secretary of State explain whether hospitals in special measures have a special requirement so that they do not need to declare that they are in the position of hospitals that have made the decision to say that there is a major incident, or is it just coincidental that although operations were cancelled on a large scale on 5 January no major incident was declared at Barking, Havering and Redbridge?

[Mr Hunt]

I can confirm that there is no difference in any guidelines issued for hospitals in special measures and for hospitals not in special measures. This is a good example of a trust with deep, pronounced problems over many years. There was a terrible tragedy in 2007, I think, when someone gave birth sitting on a toilet seat. This Government have said that we are going to tackle those problems and put the trust into special measures. It has more doctors and nurses: 230 more hospital nurses in the past four years in that trust. We are making a real difference—we have a new management team—and I think that things are beginning to get better in that trust in a way that has not been the case for many years. I hope that the hon. Gentleman would welcome that.

[Stephen Mosley (City of Chester) (Con)]

The shadow Secretary of State called on the Secretary of State to intervene to stop political interference in the NHS. May I ask my right hon. Friend to ignore such siren voices and rely instead on local doctors and local health professionals to make the best choices for our local NHS?

[Mr Hunt]

My hon. Friend eloquently points out the great irony in what we have heard from the Opposition Front Bench. We do not want an NHS in which every single operational decision is made from behind the Secretary of State’s desk. We want to trust people on the ground. Why do we want to do that?

[Andy Burnham]

Politics.

--- Later in debate ---

[Mr Hunt]

Exactly. We do not want politics to get in the way of what is right for patients, which is what happened when the right hon. Gentleman was Health Secretary. It will not happen while I am Health Secretary.

[Mark Reckless (Rochester and Strood) (UKIP)]

Do we have sufficient measures, short of declaring a major incident, to help to relieve hospitals such as Medway, where there has been an ongoing problem of excessive waiting times at A and E?

[Mr Hunt]

Yes, we have other measures in place. At every stage, trusts should do what is right for patients. Sometimes they declare an internal major incident, sometimes it is an external major incident, but what is important is that they take account of the impact on the rest of the local health economy. At Medway hospital, which the hon. Gentleman mentioned, things are getting better. It has been through a difficult period. We have been honest about the problems, we have given it a lot of external support, and I hope that the news will continue to get better.

[Richard Drax (South Dorset) (Con)]

As we know, one cap does not fit all. That applies to the NHS as much as to anything else. In Dorset the clinical commissioning group is reviewing health services and looking for local solutions to local problems. Does my right hon. Friend agree that that is the long-term solution for the NHS, rather than politicians sticking their noses in where, frankly, they should not be?

[Mr Hunt]

I absolutely agree with that. What I will not do is go round the media and say that the problems that the NHS is facing in Dorset, as it faces everywhere, are due to the fact that the area is very rural, which is the excuse that we heard over the weekend from the shadow Health Secretary for the poor performance of the NHS in Wales. We want local solutions and the highest possible standards—what we can do is give guidance and funding from the centre and make sure that patients are always put first.

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

In his attempt to gag hospitals over the growing accident and emergency crisis, the Secretary of State has sanctioned guidance that “we must avoid reputational damage”. Whose reputation? His reputation? Does the right hon. Gentleman not accept that his reputation on the national health service is damaged beyond repair?

[Mr Hunt]

I will take no lessons in stamping out news stories on poor care because I am worried about the impact on reputation. That is what happened when the shadow Health Secretary was behind my desk, and it was totally unacceptable. That is why we had a clutch of hospitals where poor care was swept under the carpet year in, year out because a Labour Government did not want bad news to come out in the run-up to an election. It was a disgrace and this Government are putting it right.

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

Two weeks ago I asked the Secretary of State about a comment that had been made to me by a senior clinician in Hull that the trust in Hull at Hull royal infirmary had been on internal major incidents on and off since December. The Secretary of State told me that that was not really an issue and that it was down to the trust, but the documents that have been produced today show that the real reason is that it is politically much more expedient to have an internal incident than to declare one externally and get all the bad publicity and reputational risk mentioned in the document to which my right hon. Friend the shadow Secretary of State referred to. That is the case, is it not?

[Mr Hunt]

Let me make two points to the hon. Lady. When I talk to the House about the number of major incidents, we make no distinction between internal and external incidents. We talk about them all as major incidents. There is no benefit, if one looks at it in that way, to Ministers from it being either an internal or an external incident. What matters is the right thing for patients. Rather than trying to politicise the issue and turning it into a political football, the Opposition should listen to Dame Barbara Hakin, chief operating officer of the NHS, who said clearly today that the decision was nothing to do with Ministers, they did not know about it and it was not taken at the request of Ministers. Labour should concentrate on supporting the NHS where it could do with its help—in Wales today.

[Chris Williamson (Derby North) (Lab)]

The Secretary of State singularly failed to answer the question from my hon. Friend the Member for Easington (Grahame M. Morris) when he asked whether it would be more or less likely that a major incident would be declared as a result of the new guidance. Clearly, if it is less likely, that is bound to have an impact on patient safety. Can the Secretary of State confirm whether this issue was raised in his meeting with NHS England on Monday?

[Mr Hunt]

It was not raised by NHS England on Monday because I did not know about this local guidance, as I had absolutely nothing to do with it.

[Clive Efford (Eltham) (Lab)]

Can the Secretary of State explain why in the incident response plan from NHS England there is an entire paragraph headed “Politics” under the principles for considering an escalation response? In the House on 7 January he said:

“The decision to declare a major incident is taken locally—there is no national definition”—[Official Report, 7 January 2015; Vol. 590, c. 273.]

However, the guidance issued in the middle of January says that major incidents

“should be agreed...with the Director on call for NHS England”.

If it is not political, the Secretary of State owes the House an explanation of NHS England’s involvement and the meaning of that paragraph.

[Mr Hunt]

The hon. Gentleman has quoted selectively; he has not quoted the whole guidance. If he looks at the whole guidance, he will see that it clearly states that a responsible trust, before it declares a major incident, which is its decision, must make sure that there is not going to be a negative impact on the rest of the economy, because patients must always come first. He is also not saying what Dame Barbara Hakin said this morning —that none of this guidance was anything to do with Ministers.

National Health Service

Jeremy Hunt Excerpts

Wednesday 21st January 2015 Commons Chamber

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

What utter, disgraceful nonsense! I will rebut every single thing that the right hon. Member for Leigh (Andy Burnham) has said.

This has been a tough winter for the NHS, and I first want to pay tribute to the hard work of staff on the front line who have been working exceptionally long hours in very challenging circumstances. What they want right now is practical help, a vision for the future and a sensible plan to get there—all of which this Government are delivering. They do not want to be turned into a political football. The public have noted that while Labour Front Benchers sometimes sound restrained in parliamentary debates, they are the opposite in the TV studios, where they do everything possible to whip up panic and a sense of crisis. That is not the behaviour of a responsible Opposition.

As NHS England and the King’s Fund have said, the NHS is coping well under real pressure and, in the words of Dr Cliff Mann, president of the College of Emergency Medicine, trying to weaponise it for political purposes is “toxic”. Indeed, Professor Chris Ham, of the King’s Fund, said this week:

“This is a long-term issue not to do with this particular government—the previous government faced many of the same challenges...patients who are really poorly will still get a very good and very quick service.”

[Angie Bray (Ealing Central and Acton) (Con)]

In contrast to what we have heard from the Opposition, will my right hon. Friend join me in welcoming the seven-day-a-week GP surgeries opening up across Ealing and Acton and the plans for the new walk-in health centre for Acton? Will he join me in condemning the Labour-led council’s decision last night to cut the public health budget?

[Mr Hunt]

That is the reality: there are new and improved services for the NHS up and down the country, but what we get from the Labour party in my hon. Friend’s constituency is scaremongering leaflets saying that hospitals are being closed when they are not. Labour should apologise for scaring very vulnerable people. It claims to stand up for them, but by scaring them it is doing the exact opposite.

[Mr Marcus Jones]

Unfortunately, the right hon. Member for Leigh (Andy Burnham) did not do me the courtesy of giving me a right of reply when he mentioned the walk-in centre in my constituency. Does the Secretary of State not think that it was completely irresponsible for the right hon. Gentleman to make such comments, given that the issue was raised by a whistleblower and that the information does not come from the clinical commissioning group that is considering walk-in centres in my constituency?

[Mr Hunt]

Exactly. My hon. Friend makes the point very well, and I will tell him something else about the hospital in his constituency. The George Eliot hospital was a failing hospital with very high mortality rates, and its deeply entrenched problems were swept under the carpet by the previous Labour Government, but this Government have turned it around and it is now a successful hospital. It is doing incredibly well because we faced up to the problems that Labour ignored.

[Angela Smith]

Sickness-related absence is going up around the country. In Barnsley, it has gone up by two percentage points in the past two weeks. A one percentage point increase equates to £1 million a year. Not only will that hit budgets, but it is a real sign that the NHS is under severe pressure.

[Mr Hunt]

The NHS is under pressure, so the hon. Lady will welcome the fact that Barnsley Hospital NHS Foundation Trust in her constituency has 34 more doctors and 74 more nurses, and that we are currently doing about 2,000 more operations every year for her constituents. Yes, there is pressure, but this Government are investing on the back of a strong economy so that we can put more money into the NHS and give her constituents a better service.

[Barbara Keeley]

rose—

[Frank Dobson (Holborn and St Pancras) (Lab)]

rose—

[Mr Hunt]

I am going to make progress, but I will give way later.

I want to look at the pressures that the NHS is facing, because the right hon. Member for Leigh asked about the direct causes. There are more than 1 million more over-65s than there were four years ago. Many older people become particularly vulnerable when it is cold, which is why winters are always difficult for the NHS. The truth is that over successive decades, we have made older people more dependent on emergency care by under-investing in primary and community care, reducing the responsibility of GPs for out-of-hours care, removing the personal responsibility for patients from GPs, and failing to integrate health and social care.

The right hon. Gentleman spoke as if that was nothing to do with Labour. However, he knows what damage was caused by the GP contract changes in 2004, he knows that his Government failed to integrate health and social care for 13 years, and he knows that where Labour runs the NHS today—in Wales—the performance is even worse. Instead of debating constructively, he chose to start this year by putting up a scaremongering poster that implied that the NHS would cease to exist if this Government were re-elected. That is not good enough. The whole country can see that, for him, it is not about the ward, but the weapon; it is not about the patients, but the politics. For this Government, it is about the patients.

[Mr Redwood]

Does my right hon. Friend understand Labour’s attack on privatisation? Under Labour, the NHS always had private-sector contractors as GPs— and nothing has changed; and it always bought all its pharmaceuticals from competitive, profit-making pharmaceutical companies—and nothing has changed. What is the shadow Secretary of State’s grievance?

[Mr Hunt]

Privatisation is one of the most pernicious fears that Labour is seeking to stoke up—not least because, as Secretary of State, the right hon. Member for Leigh allowed the decision to go through that Hinchingbrooke hospital should be run by the private sector. He has been running away from that decision faster than anything that anyone has seen before, because he is still trying to curry favour with the unions.

The companies on the shortlist for Hinchingbrooke hospital were Circle, Serco and Ramsay Health Care. He could have stopped that as Secretary of State, but he did not. He knows—[Interruption.] Those were the three bidders—the private sector-led bids. He could have stopped that process when he was Secretary of State, but he chose not to. That makes my point very well.

[Barbara Keeley]

The Secretary of State and the right hon. Member for Wokingham (Mr Redwood) asked what had changed. Under Labour, we did not have tendering for £1.2 billion of cancer and palliative care services, as we are seeing now in Staffordshire and Stoke, where the majority of those tendering are private companies. We did not have that.

[Mr Hunt]

What the last Government did, that was right, was to say that—[Interruption.] I am just saying what the last Government did right. The hon. Member for Worsley and Eccles South (Barbara Keeley) might want to hear this, because I do not usually compliment the last Government.

To bring waiting times down to 18 weeks, the last Government said that they would support the NHS by allowing the private sector to do some operations. We have continued that policy, not changed it. The result, the hon. Lady will be pleased to know, is that 6,000 more operations are happening every year in her constituency under this Government than in 2010.

For this Government, it is about the patients. That is why we increased the NHS budget; why we hired 9,000 more doctors and 6,000 more hospital nurses; why we are doing nearly 1 million more operations a year than four years ago, with fewer long waits than ever; why we have increased cancer referrals by half, saving an estimated 1,000 lives every single month; and why we have learned the lessons of Mid Staffs by putting in place safe staffing, having independent inspections and turning around six failing hospitals.

Patients say—[Interruption.] The right hon. Member for Leigh should listen to what patients say, because he did not do that when he was Secretary of State. Patients say that their care is safer and more compassionate than ever, with the independent Commonwealth Fund saying that under this Government, the NHS has become the best health care system in the world.

[Frank Dobson]

rose—

[Mr Hunt]

I give way to the former Secretary of State.

[Frank Dobson]

Will the Secretary of State confirm that the only reason why he has been able to recruit British doctors is that the previous Government increased recruitment into medical schools by 35%?

[Mr Hunt]

I welcome the fact that the previous Government increased training places, but as the right hon. Gentleman will know, having been Secretary of State, those doctors have to be paid for. The NHS budget has not been cut, as the shadow Secretary of State wanted, so we can afford to pay for those doctors. There are 219 more doctors serving the constituents of the right hon. Gentleman because of the decision that this Government took to protect the NHS budget.

Even more important than what we have done for patients in this Parliament is the fact that, under this Government, the NHS has developed its own plan for the next five years, the “Five Year Forward View”. Because we have a strong economy, we can back that forward view with a record £2 billion extra for the NHS front line next year alone.

Part of our commitment to the NHS—this is a real difference between the Government and the Opposition—is that we face up to difficult decisions, including on pay. No one wants to be more generous to staff who work long hours than I do, but the official advice that I received as Secretary of State was clear: the cost of accepting the pay review body’s recommendation would be £450 million, which would mean that hospitals might lay off between 6,000 and 14,000 nurses.

It is easy for Labour to support a pay strike, but it is deeply cynical if it cannot pay for its promises, as it knows it cannot. Labour claims to stand up for staff, but will it today stand up for patients by condemning the strike right in the middle of winter, which was supported by only 4% of NHS workers, or do the votes and financial support of the unions matter more? The test of a party that aspires to govern is not the easy decisions that it makes, but the tough ones. We have seen nothing brave or principled from Labour today.

[Andy Burnham]

I have a direct question and I would appreciate a direct answer. If the agency bill in the NHS was the same as the one I left behind, would not the Secretary of State be able to afford the modest, below-inflation increase that the Chancellor promised to all NHS staff?

[Mr Hunt]

Let me tell the right hon. Gentleman why the agency bill has gone up. It has gone up because hospitals are trying to recruit doctors and nurses to tackle the problems of Mid Staffs that he left behind. As they improve their staffing, they will gradually get more full-time nurses, but in the short term, they do not want to put patients’ lives at risk.

I want to return to the situation this winter. To relieve the immediate pressures, we have given the NHS a record £700 million, which has allowed it to recruit an extra 796 doctors, 4,700 nurses and 3,094 other staff, making a total of 8,590 additional staff, and to increase bed capacity by 6,400. We have more staff, more beds, more GP appointments and more GPs in A and E than ever before for winter.

What is the impact of the extra support that we have given the front line? The target is to see and treat people in A and E within four hours. Compared with the last full year for which Labour was in office, 3,000 more people are being seen, treated and discharged within four hours every single day. The mean time that people wait for a first assessment has fallen from 77 minutes to 30 minutes, and nine out of 10 people, even under the pressure of the additional visits, continue to be helped within four hours. That performance is better than anywhere else in the United Kingdom—and, indeed, better than in Canada, Australia, New Zealand, Sweden and any other country in the world that measures A and E performance.

While the NHS is straining every sinew to meet high standards, the public will not accept the cynical politics that demands that we call it a crisis in England, while refusing to call it a crisis in Wales, where Labour is in charge and the problems are far worse. According to the House of Commons Library, in Wales, double the number of people are kept waiting in A and E, and nearly double the number of people wait too long for an urgent ambulance. For Labour, poor care matters only when there is a political point to be scored. For a party that aspires to run the NHS, that is simply not good enough. How Nye Bevan would turn in his grave if he knew that the party that founded the NHS was turning its back on patients with such contempt in his own back yard!

[Mark Field (Cities of London and Westminster) (Con)]

Although I appreciate that there will inevitably be a battle between the two parties to a certain extent in this debate, the Secretary of State is at his strongest—this is what I hear from all the health care professionals in my constituency—when he talks about his patient-centred vision for the health service of the 21st century and when he looks away from the here and now and towards the future that we all know is desperately needed by all our constituents: a patient-centred NHS. I hope that he will say a little more about that.

[Mr Hunt]

I will, and that is what this is about—putting patients first. That is why we need important reforms such as ensuring that every vulnerable older patient has a named accountable doctor—I will mention that later in my remarks—and why we must remove barriers between the health and social care systems.

[Sir Hugh Bayley (York Central) (Lab)]

It has been well known in the NHS for decades that an ageing population means that more needs to be spent in real terms each year on the NHS than in the year before. In 2010, when the Government came to power, 8.2% of our gross national income was spent on the NHS, but that has now fallen to 7.9%. How can that possibly be an increase in the Conservative party’s commitment to the NHS?

[Mr Hunt]

Because the only way we could return the economy to growth was by tackling the deficit left by the Labour party—the worst deficit in the developed world. Labour left us with that problem; we have sorted it out and are turning the country round. If the hon. Gentleman wants to increase spending on the NHS, as I do, the only way to do that is through a strong economy, which is what the Government are delivering.

[Several hon. Members]

rose—

[Mr Hunt]

Let me make some progress. In A and E, as everywhere in our hospitals, it is important that whatever the pressures, people are given safe, compassionate care. Our NHS is one of the safest systems in the world, but we still have around 1,000 avoidable deaths every month. We still put the wrong prosthesis on someone once a fortnight, operate on the wrong part of someone’s body once a week and leave a foreign object in someone’s body twice a week. Just five years ago, we had the tragedy at Mid Staffs, which, we should never forget—[Interruption.] I am quite shocked that people are laughing when we are talking about harm that happens in the NHS every month and about what happened at Mid Staffs. We must not forget that Mid Staffs was hitting its A and E targets for much of the period that that same department was tolerating the most horrific care. Whatever the pressure to hit targets, the Government want every vulnerable person to be treated safely and with the highest standards of dignity and respect.

Two years ago, we introduced the toughest inspection regime anywhere in the world. The result was over 6,000 more nurses on our hospital wards, cases of MRSA and clostridium difficile halved over this Parliament and more than 200 NHS organisations have signed up to halve avoidable harm and avoidable death over the next three years. Care is getting safer. While we lead the NHS through that painful process, what is the reaction from Opposition Front Benchers? They criticise us for running down the NHS and still maintain—as the right hon. Member for Leigh did in December—that it was a mistake to hold a public inquiry into Mid Staffs. He talked about listening to patients, but this is what Julie Bailey, a Mid Staffs campaigner whose mother was a patient at Mid Staffs said about his comments in December:

“The message he is sending out is that it is better to cover things up than to criticise the NHS, however bad things are. The inquiry uncovered huge failings in the NHS and he thinks it shouldn’t have taken place at all. It is very worrying because if he becomes Health Secretary again at the election it is clear we would go straight back to the bad old days of covering up.”

[Bob Stewart (Beckenham) (Con)]

One problem last month in my local hospital, the Princess Royal university hospital, was the lack of space, and ambulances were backed up. It is not just a staffing problem; it is a spatial problem. Does the Secretary of State agree that if we had more space in A and E departments, we could get people off the streets?

[Mr Hunt]

Space is a problem in some A and Es, which is why we have expanded A and E capacity. Other places have different problems, but the long-term solution is to have improved capacity outside hospitals in community care. That is the real challenge and what the “Five Year Forward View” is about.

[Andy Burnham]

Given what the Secretary of State has just said, may I gently remind him that I was the Secretary of State who appointed Robert Francis QC to inquire into what happened at Mid Staffs, against the advice of the Department of Health, and that report was published before the last election. If he is being fair, he should bear that in mind at all times.

The Secretary of State reeled off a list of things that are wonderful in the NHS today—everything has got better; everything is fine; and it is the best in the world. At the beginning of the debate, I reeled off cases of people waiting hours or even dying while waiting for ambulances, or being treated in cupboards. I hope that he will not conclude his remarks without addressing the very real suffering and poor care that is happening across England right now.

[Mr Hunt]

If the right hon. Gentleman did such a wonderful job and wants to talk about Mid Staffs, why are patient campaigners so outraged by his comments and feel that he did everything he could to brush those problems under the carpet?

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I will give way to the former Secretary of State in a moment, but I want to finish—[Interruption.] Exactly. I have read the Francis report and I have acted on it. [Interruption.] I have just listed what we have done: £700 million, 4,700 more nurses and 800 more doctors.

[Andy Burnham]

It’s not working.

[Mr Hunt]

But the right hon. Gentleman’s constituency has more doctors and more nurses who are seeing more people every year within four hours and doing 4,000 more operations every year. That is working for his constituents, but there is pressure out there and we need to support people through a difficult winter.

The right hon. Gentleman mentions stories that are, of course, very tragic, but never once has he brought up stories about the problems happening in Wales. Too often, we get the impression that, for Labour Members, poor care under a Labour Government—whether in Wales today or Mid Staffs previously—does not matter as much as poor care under this Government when they can make a political point. A party that really cared about the NHS would be as outraged about problems when they are in power as they are when in opposition. For this Government, poor care is poor care, and we will deal with it wherever and whenever it happens.

[Alan Johnson]

Does the Secretary of State remember the words of the Prime Minister when he stood at the Dispatch Box and presented the report from Stafford? He said that what happened at Stafford was not the fault of any previous Secretary of State, including my right hon. Friend the Member for Leigh (Andy Burnham). The Prime Minister was a statesman on that occasion; it is a shame that the statesmanship has slipped since.

[Mr Hunt]

I have a great deal of respect for the former Secretary of State, but if he had followed the debates on Mid Staffs in this Chamber he would know that my disagreement with the shadow Health Secretary is over the reaction to Stafford and whether we will learn from those mistakes. When I have made speeches talking about the problems of poor care in the NHS today, he goes straight out to the TV studios and says that that is running down the NHS. That is not acceptable when we are taking difficult decisions to turn round failing hospitals and face up to problems in exactly the way suggested by the Francis inquiry.

[Several hon. Members]

rose—

[Mr Hunt]

I will make some progress because I want to answer some of the questions asked by the right hon. Member for Leigh. One reason for the pressure I have outlined is that people increasingly expect to get medical care 24/7, just as they are able to bank, shop and book their holidays 24/7. The NHS cannot be King Canute and try to stop that—I am not blaming patients, but that is how patient expectations are changing, and we need to give them better alternatives to turning up in A and E.

Over the past two years, we have expanded weekend and evening GP appointments for more than 5 million people. We have also rolled out the 111 service, which now handles—these are the facts—three times more calls every year than its predecessor, NHS Direct. The right hon. Gentleman criticised 111, so let us look at the facts. Of those who call 111, 30% say they would have gone to A and E but decided not to as a result—that is 2 million journeys to A and E and around 600,000 ambulance call-outs avoided because of 111. Unlike NHS Direct, one third of all 111 centres can now access a summary of people’s GP records, and that will apply to nearly all 111 centres this year. Not only can people talk to a doctor or nurse, as they did with NHS Direct, but if they give consent they can do something that they could never do under NHS Direct and talk to someone who knows about them and their medical history.

Another big challenge facing A and Es is the increasing complexity of the illnesses that people are presenting with, including many older people with conditions such as dementia, diabetes or asthma. Such people often end up being admitted to hospital rather than treated and sent home, and that is not just challenging for the system; it is often wrong for the individual. A busy A and E can be the worst possible place for a frail, older person with dementia, which is why in our vision for the NHS every vulnerable person has a doctor who is continually responsible for their care, whether or not they are in hospital, and who ensures that they have proper care wrapped around them, thereby reducing the likelihood of emergency hospital admissions. Too often, that does not happen. Too often, the buck stops with no one. That is why, this year, we reversed the 2004 decision and brought back named GPs with personal responsibility for everyone aged 75 and over. That is helping 4.5 million people. With 800,000 of the most vulnerable people, we are going even further, giving them guaranteed rights to prompt and proactive care from their GP.

On social care, for too long, some of the most vulnerable people in our country have suffered from disjointed care with NHS and social care systems that, rather than talk to each other, constantly try to pass the buck. For the first time from this April, we have required all local authorities and NHS organisations to work together to plan care in a joined up and seamless way, as part of the better care programme.

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

Will the Secretary of State give way?

[Mr Hunt]

I am going to make progress.

When that happens, we should see, for the first time ever, not an increase but a reduction in emergency hospital admissions. For patients, that will mean something important: a doctor or nurse will be in charge of every person in the social care system; medical records will be shared, so that people get safer and more joined-up care; and joint teams will work together across the NHS and social care systems, rather than the silos and boundaries that have plagued the system till now.

The Government have never pretended that the challenges facing the NHS are straightforward, but with more doctors, more nurses, more operations and safer care than ever before, we have shown our commitment to that most precious institution. We have put our money where our mouth is, with protection for the NHS budget during cuts, financial help this winter and support for the NHS’s plan for the future. More important than the money are the values behind it: our passion for the highest standards of compassionate care for every person who needs the NHS. Good care, not clever politics, is the future for our NHS.

[Several hon. Members]

rose—

Ambulance Service: England

Jeremy Hunt Excerpts

Friday 16th January 2015 Written Statements

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

Today I am announcing that NHS England is to pilot a possible change to the way ambulance services respond to 999 calls, based on clinical advice that this will improve the chances of survival for patients, especially those with the most serious conditions.

In light of the unprecedented increase in demand for ambulance services in the last two months, I asked NHS England to consider whether there were any changes which could be brought forward quickly in order to help ambulance services maintain, and perhaps even improve, clinical outcomes for patients.

I have now received and considered NHS England’s advice. A copy of the letter from Professor Keith Willett, the National Director for Acute Care at NHS England, with his recommendations, is attached and has been placed in the Library of the House. I agree with his advice that there is significant evidence to suggest that giving call handlers extra assessment time to make the right decision for the patient could improve clinical outcomes and improve their chances of survival. At present, ambulance services are allowed only 60 seconds before the clock starts to decide what the right course of action is for that individual patient. This sometimes leads to ambulances being dispatched unnecessarily, so that fewer ambulances are available for patients who really do need emergency assistance.

In the interests of patient safety, I therefore agree that giving call handlers very limited extra assessment time would ensure that ambulances are better deployed to where they are most needed and would allow a faster response time for those patients who really need it.

I have agreed to two local pilots where call handlers will be allowed up to a maximum of an additional 120 seconds for assessment, before the clock starts, for all 999 calls. This will not include those calls which are immediately life threatening (categorised as Red 1 calls). The pilot will therefore allow for a maximum of 180 seconds to assess a call, in order to reach a more detailed diagnosis and send the most appropriate response.

In these pilot sites, a small number of potentially life threatening conditions, such as overdoses and certain types of gunshot wounds, will also be upgraded from the Red 2 category into the Red 1 category so they receive a faster response than is currently the case.

The two pilot sites will be South West Ambulance Service NHS Trust and the London Ambulance Service NHS Trust—one running the NHS Pathways triage system and one running the Advanced Medical Priority Dispatch System. The pilots will start in February and will jointly cover a patient population of around 13 million people.

During the pilot, ambulance targets for all other areas will not be changed. We will continue to publish national data as normal, and the pilot data will be published alongside this in the interests of transparency. Given the pilots will only be affecting two ambulance services for a very limited period of time at the end of the reporting year, we do not anticipate that this will have a significant impact on the overall national data.

The pilot will be subject to rigorous and independent external evaluation which will be published. I will not support any extension of this pilot more widely unless the following three tests are met:

There is clear clinical consensus that the proposed change will be beneficial to patient outcomes as a whole, and will act to reduce overall clinical risk in the system.

There is evidence from the analysis of existing data and piloting that the proposed change will have the intended benefits, and is safe for patients.

There is an associated increase in operational efficiency. The aim is to reduce the average number of vehicles allocated to each 999 call and the ambulance utilisation rate.

After the evaluation has been published, I will consider the outcomes of the three tests and the findings of this external evaluation before making any decisions to implement these changes throughout England.

The letter from Professor Keith Willet can be viewed online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2015-01-16/HCWS201

[HCWS201]