NHS Leadership
Jeremy Hunt Excerpts(9 years, 11 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I have published today “Learning not blaming” (CM9113), which sets out the Government’s position on the freedom to speak up consultation, the Public Administration Select Committee report “Investigating Clinical Incidents in the NHS”, and Dr Bill Kirkup’s independent report on the Morecambe Bay investigation; and, in a separate document, Lord Rose’s report on NHS leadership.
The three reports cover distinct areas, and the accompanying document addresses the points and recommendations raised in each report. The “freedom to speak up” review by Sir Robert Francis QC, focused on whistle blowing; the Public Administration Select Committee report “Investigating Clinical Incidents in the NHS”; and, the investigation into university hospitals Morecambe Bay NHS Foundation Trust, conducted by Dr Bill Kirkup CBE. There are, however, some themes common to each report, including the importance of:
openness, honesty and candour;
listening to patients, families and staff;
finding and facing the truth;
learning from errors and failures in care;
people and professionalism.
In considering points made in these reports, the Government have been guided by the need to build on the work we and the NHS have done in recent years to improve the way in which the NHS treats patients and families, by developing capabilities locally to respond to patients’ and families’ concerns and to exercise proper oversight of care quality.
In recognition of this, the NHS’s own Five Year Forward View emphasises the need for care to be both safe and sustainable over the long term. For each of the reports, we therefore propose specific actions to address the immediate issues they raise, and in doing so make clear that the NHS must develop an improved approach to patient safety and complaints. Our response therefore sets out a strong expectation that we want nothing less than a renewed culture that values learning, not blaming; compassion, not defensiveness; and putting patients and families before systems and institutions.
In summary, we will:
put in place freedom to speak up guardians in each trust to build up capability and capacity locally, at the frontline of service provision;
ensure that every local NHS provider provides training in raising and listening to concerns;
remove the Nursing and Midwifery Council’s current responsibility and accountability for statutory supervision of midwives in the United Kingdom. (The NMC will of course remain responsible for the regulation of midwifery, but the supervision of midwives will be brought into line with the arrangements for other clinical professions);
review the professional codes of doctors, nurses and midwives and ensure that the right incentives are in place to encourage people to report openly, and to learn from mistakes;
set up a new patient safety investigation function to be fully operational from 1 April 2016—the independent patient safety investigation service. An expert advisory group will convene shortly in order to develop the structure, governance and operating model of this new service.
Freedom to Speak Up
The Government have consulted on a package of measures to implement the principles and actions set out in Sir Robert Francis QC’s report. In light of the consultation responses, I can now announce that the role of independent national officer will be hosted by the Care Quality Commission, who intend to have them in place by December 2015. I can also announce that freedom to speak up guardians will be appointed in all NHS Trusts, to build up capability and capacity locally, at the frontline of service provision, following guidance published by the independent national officer.
Robert’s report also called for training on raising and hearing concerns in every local NHS provider organisation. The relevant national bodies will now be working on a package that would include the following content:
the inclusion of content on raising concerns in induction training for all staff;
the inclusion of good practice regarding the raising of concerns for healthcare professionals as part of their professional codes, followed up through continuing professional development;
the regular use of reflective practice, through for example team meetings or Schwartz rounds, to review particular examples when concerns have been raised or not raised and how this might be improved in future;
the inclusion of content on raising concerns in other specific packages of training that NHS workers are expected to undertake or which NHS employers have included in annual training priorities; and
the inclusion of content on raising concerns in initial education and training undertaken by those learning to become healthcare professionals. This is already being considered and developed by health education England.
Morecambe Bay investigation
The Government have accepted all the recommendations of this report.
The recommendation for an independent patient safety investigation service is explained in more detail in our response to the Public Administration Select Committee report.
We will use secondary legislation to remove the Nursing And Midwifery Council’s current responsibility and accountability for statutory supervision of midwives in the United Kingdom. The NMC will of course remain responsible for the regulation of midwifery, but the supervision of midwives will be brought into line with the arrangements for other clinical professions. This will improve the local oversight and accountability for midwifery. Existing arrangements will remain in place until alternative arrangements are introduced.
In addition, I have asked Professor Sir Bruce Keogh to review the professional codes for all regulated staff in the NHS and to ensure that the right incentives are in place to encourage reporting and learning from mistakes, and prevent covering up.
In response to recommendations 25 and 42 in the report, I am proposing to review the regulations that set out statutory requirements for notifications to the Care Quality Commission and Monitor during 2015-16 with the intention of addressing Dr Kirkup’s recommendation that trust boards should openly report the findings of any reviews of care to relevant external bodies.
We would also like to extend this to the commissioning of any such reviews. We will consult on any changes.
In response to recommendation 20, NHS England has established a national review of maternity services, independently chaired by Baroness Cumberlege. It is anticipated that the review will publish proposals on safe and efficient models of maternity care at the end of the year. The review will pay particular attention to the challenges of achieving this objective in more geographically isolated areas.
Public Administration Select Committee report
We accept the recommendations of this report.
Our response sets out the Government’s decision to set up a new independent patient safety investigation service, to be operational from 1 April 2016. IPSIS will operate independently and it will be brought under the single leadership of Monitor and the NHS Trust Development Authority.
We have also set up an expert advisory group to advise on the scope, governance and operating model of this new service. The membership of this group includes:
Dr Mike Durkin, National Director for Patient Safety
Keith Conradi, Chief Inspector of the Air Accidents Investigations Branch
James Titcombe OBE, Morecambe Bay campaigner and currently working as a patient safety adviser to CQC
Prof Jonathan Montgomery, Professor of Healthcare Law at University College London
Julian Brookes, advisor on clinical governance for the Morecambe Bay Investigation, deputy chief operating officer Public Health England
Carl Macrae, Independent Quality Improvement Expert
Prof Martin Marshall CBE, Professor of Healthcare Improvement at University College London
Dame Eileen Sills DBE, Chief Nurse and Director of Patient Experience, Guy’s and St Thomas’ NHS Trust
Dr Bill Kirkup CBE, Chairman of the Morecambe Bay Investigation
Kate Lampard CBE, barrister and NHS strategic health authority chairman who provided oversight on the NHS’s Savile investigations.
PASC also recommended that, “draft legislation should be published for scrutiny early in the next Parliament” as part of the establishment of this new function. We will ask the expert group to consider whether the work of the independent patient safety investigation service would benefit from having any legal powers to fulfil its duties effectively.
I am confident that the new service will help to transform the state of patient safety.
Rose
I have today also published the report of Lord Rose’s review of National Health Service (NHS) leadership, “Better leadership for tomorrow”. A copy can be found online at: http://www.parliament.uk/writtenstatements. This is an important report making recommendations for the creation of a single NHS vision, improving training, performance management, reducing bureaucracy and improving management support.
I asked Lord Rose early in 2014 to consider what might be done to attract and develop talent from inside and outside the health sector into leading positions in the NHS and to recommend how strong leadership in hospital trusts might help transform the way things get done. Following the publication of the NHS’s Five Year Forward View, I requested him to extend his remit to consider how best to equip clinical commissioning groups to deliver the vision outlined within that report.
I welcome Lord Rose’s report and his 19 recommendations, all of which I have accepted in principle.
I am announcing today that the Government accept fully the recommendation to transfer responsibility for the NHS leadership academy from NHS England to health education England (HEE).
The Government also accept the need to do more to manage talent in the NHS and I can announce today that talent management for our brightest and best will become a formal responsibility for the single leadership of Monitor and the NHS Trust Development Authority.
My Department will work with the health and care system to develop plans to implement each of the other recommendations to the extent possible, subject to an assessment of proportionality, cost-effectiveness and affordability.
[HCWS113]
NHS Remuneration: Doctors and Dentists
Jeremy Hunt Excerpts(9 years, 11 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I am responding on behalf of my right hon. Friend the Prime Minister to the seven-day services reports of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) and the NHS Pay Review Body (NHSPRB). The reports have been laid before Parliament (CM9107 and CM9108). Copies of the reports are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
This Government are committed to creating a seven-day health service fit for the 21st century with patients receiving the hospital care they need seven days a week by 2020. Patients expect and should receive high-quality, safe care every single day. It is simply wrong that mortality rates are higher for patients admitted to hospital at the weekend than during the week. 6,000 lives are lost needlessly, each year, as a result, making this manifesto commitment a clinical priority and a moral cause.
Last year, I asked the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) and the NHS Pay Review Body (NHS PRB) for their observations on how contract reform for directly employed NHS staff in England might be required to support the delivery of seven-day services.
The DDRB was asked to make observations on proposals for reforming the consultant contract to better facilitate the delivery of healthcare services seven days a week, taking account of proposals for pay progression to be linked to responsibility and patient care, and for reforming clinical excellence awards. It was also asked to make recommendations on a new contract for doctors and dentists in training, including a new system of pay progression.
Similarly, the NHS PRB was asked to make observations on the barriers and enablers of seven-day services within national employment contracts for staff employed under the agenda for change pay framework—AfC which applies to non-medical staff—with particular reference to the impact of premium pay rates for working unsocial hours, incremental pay progression and any transitional arrangements.
I am grateful to the chairs and members of the review bodies for producing these reports.
The case for seven-day services
I am pleased that all those who responded to the PRBs’ calls for evidence accept the compelling case and support the vision for seven-day services with its primary aim of putting patients first and reducing mortality rates at the weekends.
How seven-day services are delivered on the ground must be informed by the clinical needs of local communities; one size cannot fit all. Some trusts are already delivering services across seven days as the PRBs observed, but this is by no means universal. The DDRB said,
“We also investigated the position in healthcare systems elsewhere in the world and it is our understanding that outside of accident and emergency services most international public healthcare systems are not providing a comprehensive twenty-four hour, seven-day service. We therefore conclude that the proposed new NHS arrangements would be trailblazing within healthcare systems.”
The NHS PRB concluded that the agenda for change pay system was not a barrier to the delivery of seven-day services and that more work should be undertaken to understand in more detail how services might be delivered in the future, the workforce implications and transitional arrangements. They also observed that the right of consultants to opt out of non-emergency work in the evenings and at weekends is a contractual barrier to the delivery of seven-day services and the DDRB also observed that,
“the role of consultant presence at weekends to make a difference to patient outcomes is accepted.”
It was noted that this is a contractual protection which is enjoyed by no other NHS professionals or by any other areas of the public sector workforce. DDRB said,
“In our view, the current ‘opt-out’ clause in the consultant contract is not an appropriate provision in an NHS which aspires to continue to improve patient care with genuinely seven-day services, and on that basis, we endorse the case for its removal from the contract.”
The PRBs’ views on the proposals
The independent DDRB concluded that the key principles proposed by the Government and NHS Employers are reasonable—to improve patient outcomes across the week and to reward greater responsibility and professional competence. They acknowledged the case for changing the contract for doctors and dentists in training (juniors) and concluded that the proposals made are fair, and that removal of the consultant opt-out clause is,
“an opportunity to smooth the transition between the junior doctor grade, which is routinely rostered for weekend working, and the consultant grade, which can choose whether to be rostered or not.”
They found that the core principles for reforming the consultant contract look right; that the proposals should be viewed as a total package of reform across the two contracts; and that there is scope for progressing some elements of consultant reform at different speeds, including early removal of the consultant opt-out. The DDRB endorsed changes to the antiquated approach for time served mainly annual incremental progression in both contracts.
I am particularly pleased that the NHS PRB agreed that contract reform should work for staff and patients and that any reform of the system of premium pay for working unsocial hours should not be done in isolation, but as part of a wider package of reform.
The NHS PRB observed that premium pay rates may not be out of line with comparator industries, but that there is a case for some adjustment to unsocial hours pay, for example, extending plain time working further into the evenings—from 7/8pm currently to 10pm—and noted the move, in some sectors, to plain time working on Saturdays. The DDRB suggested that the night window for juniors and consultants should start at 10pm.
The DDRB supported the proposed approach to the pay package for juniors; while it noted that the rates for unsocial hours and other elements were for the parties to agree, it also noted that total pay for juniors compares favourably with comparator groups and that, given the cost-neutral pre-condition for negotiations, that position will continue. It acknowledged the proposal to undertake further modelling on unsocial hours rates for consultants, while noting that some other professionals working across seven days do not receive any such payments but are expected to work any necessary additional hours as part of professional salary arrangements.
The DDRB recommended a common definition should be applied across all NHS groups, or a rationale for not doing so should be provided. The NHSPRB recommended that this be considered as part of a wider review of AfC, including reform of incremental pay progression so that there is a much stronger link between pay and performance.
We agree with the DDRB that contractual safeguards are necessary. These formed a core part of the proposals for consultants and juniors.
Supported by good staff engagement strategies, it is the overall employment offer, not just pay, that helps the NHS to attract and keep the staff it needs.
The DDRB also said,
“We support the continuation of national CEAs, and given the separation of local CEAs (to be reformed as performance pay, or payments for excellence), that the value of national CEAs will need further consideration.”
Next steps
Given the priority placed on seven-day services by medical leaders and patient groups, I was hugely disappointed that the BMA union walked away from negotiations at such a late stage last October when proposals had been developed. The DDRB has stated that its recommendations and observations,
“provide a roadmap on what could and should be achievable in the interests of everyone with a true stake in the NHS.”
We have lost a year in which we could have been moving towards changes that are in the interests of patients, doctors and the NHS. We cannot afford any more delays.
That is why I am now asking the British Medical Association (BMA) to engage with us rapidly over the summer and to tell me, by mid-September, whether they will work with us, without delay, to introduce modernised professional contracts for engagement and for training, focused on outcomes, on the basis of the recommendations and observations in DDRB’s report.
While we remain prepared to discuss a staged approach to changes for consultants, as recommended by the DDRB, we would be seeking immediate removal of the consultant opt-out, early implementation of new terms for new consultants from April 20160—moving existing consultants across by 2017—and the introduction of a new juniors’ contract from the August 2016 intake. We will also introduce a new performance pay scheme, replacing the outdated local clinical excellence awards so that we reward those doctors who are making the greatest contribution to patient care—the DDRB recommends that these be termed “awards for achieving excellence”. I will consult on removal of the current local scheme in the autumn, alongside proposals for a reformed national clinical excellence award scheme based on the recommendations previously made by the DDRB. We will be mindful of the importance of recognising those doctors who have national leadership roles in the NHS and the substantial contribution made by clinical academics.
The case for change, in the interests of all, is made. We would prefer to agree changes in partnership, as recommended by the DDRB and acknowledging its observation of the need to build mutual trust and confidence; but we will take forward change, in the absence of a negotiated agreement.
The NHSPRB said that the areas of agreement between the parties,
“should provide a positive basis for future discussions and progress on the expansion of seven-day services.”
I welcomed the agreement of the NHS trade unions earlier in the year to enter into talks on contract reform. The NHS trade unions have already agreed to a timetable seeing change beginning to be implemented from April 2016. I am now inviting the AfC trade unions to enter into formal negotiations with NHS employers, to that timetable, to agree a balanced package of affordable proposals for reform.
These reforms need to enable trusts to recruit, retain and motivate the staff they need to deliver high-quality safe care over seven days. All trusts must make the very best use of their pay bill, making every penny work for patients. I know most trusts prefer to use national pay frameworks provided they are affordable and fit for purpose. I recognise that, if national contracts cannot be reformed, it is likely that employers will feel that they need to use the employment freedoms they already have to take contract change forward.
In addition, my right hon. Friend the Chancellor of the Exchequer has made clear in the Budget that the Government will continue to examine pay reforms and modernise the terms and conditions of public sector workers. This will include a renewed focus on reforming progression pay, and considering legislation where necessary to achieve the Government’s objectives.
I therefore want these negotiations to build on the 2013 agreement on AfC pay progression and remove virtually automatic annual incremental progression from the NHS pay system—as is also proposed for consultants and junior doctors. Pay progression must be related to performance rather than time in the job and those who make the greatest contribution should see that rewarded in the pay system.
[HCWS114]
Oral Answers to Questions
Jeremy Hunt Excerpts(9 years, 11 months ago)
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Bridget Phillipson (Houghton and Sunderland South) (Lab)
2. What recent estimate he has made of the proportion of patients who waited for at least one week for a GP appointment in the past 12 months.
The Secretary of State for Health (Mr Jeremy Hunt)
While we do not record the proportion of patients waiting a week for their GP appointment, the latest GP patient survey results show that 85% of patients reported that they were able to get an appointment to see or speak to someone, and only a very small percentage ended up not speaking to or seeing someone.
Bridget Phillipson
Unfortunately, many of my constituents would not recognise the picture that the Secretary of State seeks to paint. The British Medical Association recently said that waits of one to two weeks were becoming the norm for patients. Why is it becoming harder, on his watch, to get a GP appointment?
Mr Hunt
If I may gently say so, the under-investment in general practice has been going on for decades, according to the BMA and the Royal College of GPs. We have announced that we are putting that right with our plans to recruit 5,000 more GPs during this Parliament. That is the biggest increase in the number of GPs in the history of the NHS, with £1 billion going to upgrade GP and primary care premises, and 18 million people by the end of this financial year benefiting from evening and weekend appointments. That is a big, positive change, and I hope the hon. Lady would welcome it.
David Tredinnick (Bosworth) (Con)
Has my right hon. Friend had a chance to read the report by the Professional Standards Authority for Health and Social Care, which says that pressure would be taken off doctors and nurses if greater use were made of the 63,000 practitioners that it regulates on 17 separate registers covering 25 occupations? Will he look at the report and write to me?
Mr Hunt
I am very happy to do that. My hon. Friend is right to point out that the solution to the problem is not just about expanding the number of appointments offered by GPs, although we are doing that; it is also about looking at the very important role that pharmacists and other allied health professionals have to play in out-of-hospital care.
Dr Philippa Whitford (Central Ayrshire) (SNP)
The Secretary of State mentions recruiting 5,000 extra GPs, but I note in a recent speech that that was downgraded from a guarantee to a maximum. With 10% of trainee posts unfilled and the BMA’s recent survey suggesting that a third of GPs will leave in the next five years, is that not going to be difficult? Has the Secretary of State had any consultation with the BMA and the royal college to ask why they are leaving?
Mr Hunt
It will be difficult. The commitment has never been downgraded: we always said that we needed about 10,000 more primary care staff, about half of whom we expected to be GPs. We have had extensive discussions about the issues surrounding general practice, such as burn-out, the contractual conditions and bureaucracy. We are looking at all of those things. The commitment is to increase the number of GPs by about 5,000 during the course of the Parliament, and that is a very important part of our plan to renew NHS care arrangements.
Dr Whitford
I assume the Secretary of State is aware that two of the pilot sites for the seven-day, 8 till 8 working—one in north Yorkshire and the other in County Durham—have abandoned the project owing to poor uptake by patients, with only 50% of appointments used on a Saturday and only 12% on a Sunday. Given that they found that it had a detrimental effect on recruiting cover for out-of-hours GP urgent services, does not he feel that this needs a rethink and that consultation with the profession and looking at cover would be of most benefit?
Mr Hunt
The hon. Lady is presenting only a partial picture. In Slough there are about 900 more appointments every week as a result of the initiative for evening and weekend appointments. Birmingham has dramatically reduced the number of no-shows and Watford has reduced A&E attendance measurably. Some really exciting things have happened, but of course we will continue to consult the profession to make sure that the programme works.
Johnny Mercer (Plymouth, Moor View) (Con)
Radical and innovative steps were taken in Plymouth this April to integrate not only front-line health and social care services in the city, but all the council and clinical commissioning group resources into a single fund. Will my right hon. Friend describe how the success regime in the Plymouth and Devon area will build on those achievements?
Mr Hunt
Absolutely; I had the pleasure and privilege of visiting Plymouth during the election campaign to see some of the radical changes being offered in community care. There is huge enthusiasm for transforming the situation in Devon. It is a very challenged economy, but by bringing together the health and social care system and by putting more resources into primary and out-of-hospital care we will be able to give a better service to my hon. Friend’s constituents, which I know he will welcome.
Andy Burnham (Leigh) (Lab)
Ten years ago, this great city lived through one of the darkest days in its history. Our thoughts today are with all those who were affected and we pay tribute to the heroic staff of London’s NHS, who did so much to help them.
The latest GP patient survey is important for the simple reason that it covers the first full year of the Government’s GP access challenge fund. The results do not make good reading for the Secretary of State. The percentage of patients dissatisfied with their surgery’s opening hours has increased and patients found it harder to get appointments last year than the year before. Will the Secretary of State admit that his policies are simply not working and that GP services are getting worse on his watch?
Mr Hunt
First, I echo the right hon. Gentleman’s comments about the extraordinary bravery of the emergency services, particularly the London Ambulance Service, in response to the terrible tragedy of 7/7.
I do not accept the picture the right hon. Gentleman paints of general practice. The Prime Minister’s challenge fund has been extremely successful: by the end of this year, 18 million people will be benefiting from the opportunity to have evening, weekend and Skype appointments with their GP. We have also announced the biggest increase in the number of GPs in the history of the NHS. The Labour party left us with a GP contract that ripped the heart out of general practice by removing responsibility for evening and weekend care and by getting rid of personal responsibility by GPs for their patients. The right hon. Gentleman should show a little contrition and modesty about Labour’s mistakes.
Andy Burnham
People who have been ringing surgeries this morning unable to get appointments will not be convinced by what they have just heard. The truth is that the disarray in the Secretary of State’s primary care policy goes much deeper. Not only has he made it harder for people to get a convenient appointment, but he now wants to charge people who miss the appointments they are able to get. We all want to reduce waste, but there are many reasons why people do not turn up, including family emergencies. That is presumably why No. 10 slapped him down. He will have worried people, so for the avoidance of doubt, will he today confirm that he will not return to that idea in this Parliament?
Mr Hunt
There are no plans to charge people who have missed appointments. That is precisely the sort of scaremongering that the British public rejected at the last election. The right hon. Gentleman put the NHS on the ballot paper, and the country voted Conservative; he might want to think about the lessons from that. Missed appointments cost the NHS £1 billion a year. We want that money to be spent on doctors and nurses. Labour spent billions on wasted IT contracts and the private finance initiative, and did not spend enough on front-line staff. We are putting that right.
Harry Harpham (Sheffield, Brightside and Hillsborough) (Lab)
3. What steps he is taking to ensure that clinical commissioning groups routinely fund cough-assist machines for people with muscle-wasting conditions when a clinical need has been identified.
Heather Wheeler (South Derbyshire) (Con)
10. What progress the Government have made on improving safety in hospitals in special measures.
The Secretary of State for Health (Mr Jeremy Hunt)
The 21 hospitals that have been put into special measures under the new inspection regime have recruited 458 more doctors and 1,012 more nurses, and all of them have made good progress, including the Medway and Burton hospitals.
Rehman Chishti
I thank the Secretary of State for the support that he has given Medway Maritime hospital. Will he welcome the appointment of a chief quality officer at Medway hospital? It is one of only two trusts to have done that, and it is helping to improve safety and bring Medway out of special measures. Will he join me in paying tribute to the brilliant staff at Medway hospital, who are working day and night to turn things around?
Mr Hunt
I do pay tribute to them, and I welcome Dr Trisha Bain to that post. Ten years ago, that hospital had one of the worst mortality rates in the country. Since then, it has recruited nearly 100 more doctors and 83 more nurses, and has teamed up with Guy’s and St Thomas’. There is a culture of transparency and honesty about failings and a rigorous focus on improvement that were not there before. I hope that the whole House will welcome that change in culture.
Heather Wheeler
My local hospital, Queen’s hospital in Burton, has worked closely with Monitor to improve while it has been in special measures. Does the Secretary of State agree that, although spending four nights in ward 7 was not the best way for me to start the general election campaign, all the staff should be congratulated on the way they have approached the need to improve?
Mr Hunt
I am sorry that my hon. Friend had to go to hospital at the start of the election campaign, but I congratulate her on being probably the only Member of the House to have launched their campaign from an NHS hospital ward. I trust that all the nurses voted for her as a result.
Inexplicably, the trust that my hon. Friend talked about was made a foundation trust in 2008, despite a number of problems that were not recognised. Since then, it has made dramatic improvements in its care, with more doctors and more nurses. I am delighted that it is on track to deliver better care.
Valerie Vaz (Walsall South) (Lab)
How many of the hospitals in special measures have implemented recommendation 13 of the final Francis report on fundamental standards?
Mr Hunt
I would expect that all trusts have done so. If they have not, they will not come out of special measures. That is the benefit of a rigorous, independent inspection regime. Seven trusts have come out of special measures. I hope that the others will come out in due course, but that is not a decision for me; rightly, it is a decision for the chief inspector of hospitals.
Sue Hayman (Workington) (Lab)
The NHS in my constituency has moved beyond special measures into the success regime. Will the Secretary of State consider innovative models of care, because my constituency is very different from others and the trust will not achieve success without looking at how it can deliver safety in different ways?
Mr Hunt
The hon. Lady is absolutely right. The big change that we need in the NHS is to move away from the dependence on hospital care as the only way to deliver safe, effective care. That is why we put £200 million into the vanguard programme last year, which is looking at such models. I hope that the success regime will hasten the innovation in her area.
Amanda Milling (Cannock Chase) (Con)
20. Now that the Mid Staffs trust board has been dissolved, will my right hon. Friend advise me on which is the appropriate body to deal with historic complaints against the previous trust, not only to provide answers for patients and family members, but to ensure that lessons are learned to improve patient safety?
Mr Hunt
In the first instance, patients who are concerned about safety should contact the trust concerned, even though it is a different trust legally from the one that was there before. The CQC is there to ensure that any lessons about the safety of care are disseminated throughout the NHS. That is an important part of the transparency culture that we are introducing.
Matthew Pennycook (Greenwich and Woolwich) (Lab)
6. What progress the Government have made on achieving parity of esteem for physical and mental health services.
Margaret Greenwood (Wirral West) (Lab)
8. Whether he expects that the efficiency savings identified in NHS England’s most recent “Five Year Forward View” will entail a reduction in staff numbers.
The Secretary of State for Health (Mr Jeremy Hunt)
The “Five Year Forward View” is about meeting increasing demand through new models of care, not cutting staff numbers. In fact, we are planning an additional 10,000 staff in primary and community settings, including around 5,000 doctors.
Margaret Greenwood
The Secretary of State will be aware that Sir Robert Francis specifically recommended that the National Institute for Health and Care Excellence provide guidance on safe staffing levels because it is independent and can establish guidance based on the needs of patients. The Government’s decision to suspend that work and transfer responsibility to NHS England has been met with criticism from patients’ groups right across the NHS. Will the Secretary of State please explain why he thinks NHS England is better placed than NICE to carry out that vital work?
Mr Hunt
The important thing is that that work happens. NICE did a very good job in delivering safe staffing guidance for acute wards. It is important to recognise that that guidance was interpreted as being about simply getting numbers into wards, but the amount of time that doctors and nurses have with patients is as important. The work will continue and we are proud of the fact that we are dealing with the issue of badly staffed wards. We will continue to make progress.
Dr Sarah Wollaston (Totnes) (Con)
In trying to reduce waste as part of the drive for efficiency savings identified in the “Five Year Forward View”, the Secretary of State spoke recently about the possibility of putting a price label on high-value items in prescriptions alongside a label saying that they are paid for by the taxpayer. Will he reassure the House that such a measure would be carefully piloted and evaluated first, so that we can avoid any unintended consequences for those who might consider discontinuing very important medication?
Mr Hunt
We will look at all the evidence. The evidence we have seen from other countries is very encouraging. Apart from ensuring that NHS patients and the public understand the cost of NHS care, one of the main reasons why we want to do that is to improve adherence to drug regimes by making people understand just how expensive the drugs are that they have been prescribed. We will of course look at all the international evidence.
Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)
16. NHS England consulted in the last Parliament not just once but twice on downgrading the economic deprivation part of the funding formula, which would have had the effect of taking some £230 million per year out of the primary care budget for the north-east and Cumbria. Will the Secretary of State give the House a commitment—we got one from the Minister in the last Parliament—that he will not downgrade the economic deprivation part of the funding formula?
Mr Hunt
I give an absolute commitment that economic deprivation will be a very important part of the funding formula, but the right hon. Gentleman will appreciate that things such as the number of older people in a particular area is as important in determining levels of funding. We are committed to reducing health inequalities, but that also means making sure that similar levels of care are available in similar parts of the country. That has not always been the case.
David T. C. Davies (Monmouth) (Con)
Does my right hon. Friend agree that the efficiency savings our Government are introducing have led to the lower waiting lists and the better access to cancer drugs for patients in England that are the envy of my patients in Wales? What can I tell them about how we can get greater access and better standards in Wales while the NHS in Wales is run by Labour?
Mr Hunt
My hon. Friend can tell them that when Labour Members opposed the Health and Social Care Act 2012, we were doing the right thing for patients, with 18,000 fewer managers, 9,000 more doctors and 8,500 more nurses, whereas the Labour party was posturing. We can see the results of that posturing in Wales, where more people wait for A&E, more people wait for their cancer operation, and 10 times more people are waiting for any kind of operation.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Secretary of State talks about having similar levels of care, but we do not have similar levels of safe staffing around the country. Peter Carter has said about the decision on NICE:
“If staffing levels are not based on evidence there is a danger they will be based on cost.”
Is my hon. Friend the Member for Wirral West (Margaret Greenwood) not right? NHS England should reverse that decision and let the independent body be the judge of safe staffing levels.
Mr Hunt
I gently say to the hon. Lady that we will not take any lessons in safe staffing from the party that left us with the tragedy of Mid Staffs. We have recruited 8,000 more nurses into our hospitals because we have learned the lessons of the Francis report. The important lesson in the report is that it is not simply about the number of nurses; it is about the culture in hospitals and making sure that nurses are supported to give the best care. We want to learn those lessons as well.
Mr Peter Bone (Wellingborough) (Con)
In reference to the “Five Year Forward View”, the Secretary of State talked about new modes of working. A very simple thing that could be done is for women’s smear test results to refer to the fact that it is not a test for ovarian cancer, and to then list the symptoms of that cancer. That would not cost any money, but it would save lives.
Mr Hunt
I am very happy to look into that. The general direction of travel my hon. Friend is talking about is right. We need to empower patients. We need patients to become expert patients, so that they take responsibility for their own healthcare. That means giving them much more information to help them to make the right decisions.
Liz Kendall (Leicester West) (Lab)
The Secretary of State is trying to avoid the question asked by my hon. Friend the Member for Wirral West (Margaret Greenwood). It was a key recommendation of the Francis review into Mid Staffs that safe staffing guidelines should be drawn up independently from Government and NHS managers to make sure people are confident that they are based on what is best for patients, not budgets. Why has he gone against Francis? What was wrong with what NICE was doing? He has published no new criteria for NHS England and no process or timetable for action. Will he now commit to doing that, so that patients, staff and Members of this House can be confident that this is not just a cover for cuts?
Mr Hunt
We will not take any lessons from the Labour party about what needs to be learned from Mid Staffs. Labour Members should be ashamed of the state of hospital care they left behind. There are 8,000 more nurses in our hospitals as a result of the changes that this Government have made. They should welcome that, not criticise it.
Helen Jones (Warrington North) (Lab)
9. What recent discussions he has had with NHS England on the future of district general hospitals; and if he will make a statement.
Rachael Maskell (York Central) (Lab/Co-op)
12. What changes in funding he plans to make to address the NHS funding shortfall forecast in NHS England’s most recent “Five Year Forward View”.
The Secretary of State for Health (Mr Jeremy Hunt)
We have committed to providing additional funding to the NHS of at least £8 billion by 2020-21, over and above inflation. This is in line with the funding identified in the NHS England “Five Year Forward View” and in addition to the £2 billion extra for NHS front-line services this year.
Rachael Maskell
With trust deficits reaching £822 million at the end of the last financial year, commissioners, chief executives and NHS professionals are saying that it is impossible to achieve £22 billion of efficiency savings without cutting services, staff numbers or staff pay or even stripping out the market. Which will the Secretary of State choose?
Mr Hunt
Of course, it will be very challenging to find those savings, but I gently remind the hon. Lady that Labour’s manifesto at the last election promised £5 billion a year less for the NHS than we promised, and that was because of our confidence in a strong economy, which is what the NHS needs.
Kevin Hollinrake (Thirsk and Malton) (Con)
The five-year forward plan will need to deal with the outstanding issue of the contaminated blood scandal, as a result of which one of my constituents suffered devastating consequences, including having to take the terrible decision to terminate their unborn child. When might we expect a statement and final resolution on this matter?
Mr Jamie Reed (Copeland) (Lab)
The House will have seen that the pitch is being carefully rolled by the Secretary of State today for future service closures around the country. Last week, a former care Minister was reported as saying that the £22 billion of efficiency savings the Government had signed up to were “virtually impossible” to achieve and that everyone knew it. Given that he is one of the few people to have seen the detail of the efficiency savings, this does not fill anybody with confidence. Will the Secretary of State now commit to publishing the details of the efficiency savings so that Members, the public at large, patient groups and medical professionals can have a proper and open debate about what it means?
Mr Hunt
We will of course publish how we are going to make these efficiency savings. We have already started with a crackdown on agency spend and a crackdown on consultancy spend, and with the work that Lord Carter, a Labour peer, has done to improve hospital procurement and rostering.
Let me gently say to the hon. Gentleman, however, that he went into the election promising £2.5 billion more for the NHS—£5.5 billion less than we did—and most of that was from the mansion tax that Labour now says was a bad idea. So there would have been nearly £8 billion more of efficiency savings under Labour’s plans than under this Government’s plans, and he should recognise the progress we are making.
Bill Esterson (Sefton Central) (Lab)
13. What recent assessment he has made of the implications for his policies of guidance from the chief medical officer on the consumption of alcohol by pregnant women.
Vicky Foxcroft (Lewisham, Deptford) (Lab)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
The Government’s priority for the NHS this Parliament is to put Mid Staffs behind us by transforming the NHS into the safest healthcare system in the world, and in particular, through seven-day hospital care so that we end the tragedy of up to 6,000 lives lost because people do not have access to consultants or diagnostics at weekends. It means recognition that safer care costs less, not more, which is why we are cracking down on expensive agency staff who cannot give the continuity of care that is best for patients.
Vicky Foxcroft
Almost two years ago, Lewisham took the Secretary of State to court over the closure of Lewisham A&E and maternity services—and won. In the light of the new report, “Our Healthier South East London”, can the Secretary of State promise me that any further shake-up of the NHS in south-east London will not involve the closure of services at Lewisham Hospital?
Mr Hunt
What I can assure the hon. Lady is that we inherited deep-seated problems in the old South London Healthcare Trust and we have dealt with them. We have more doctors and nurses looking after her constituents, and care is getting better as a result of the difficult decisions we have taken.
Maria Caulfield (Lewes) (Con)
T2. Part of my constituency is served by Eastbourne District General Hospital, which is run by East Sussex Healthcare NHS Trust. The trust was recently deemed “inadequate” by the Care Quality Commission. Residents are obviously concerned, and both East Sussex County Council and Polegate Town Council have gone on record as saying that they have lost confidence in the hospital’s management. Will the Minister look into the matter urgently, in order to reassure my constituents?
Andrew Gwynne (Denton and Reddish) (Lab)
We have heard a number of fair questions from Opposition Members, and, I am afraid, nothing but woeful and inadequate answers from Ministers so far. Let me try again by asking the Secretary of State about GPs. As we have already heard, before the election he promised that there would be an additional 5,000 GPs by 2020. However, now that the election is over, he says that that promise requires “some flexibility”, and he was similarly evasive in an earlier answer. Given that there is, in the words of the Government’s own taskforce, a “GP work force crisis”, will the Secretary of State now clear things up? By 2020, will there be 5,000 extra GPs—on today’s figures—as he promised, or is this yet another example of the Conservatives not being straight with people on the NHS?
Mr Jeremy Hunt
I think that those were woeful and inadequate questions. What I said after the election was exactly the same as what I said before the election, which was that a number—[Interruption.] Yes, we will have about 5,000 more GPs by the end of the Parliament, which is just what I said before the election. I said that a total of 10,000 more people would be working in primary care. I also said before the election that the woeful problems in general practice would be dealt with only if we unpicked the terrible mistakes made by Labour in the GP contract. That is why this year we are bringing back named GPs for every single NHS patient.
Mr Christopher Chope (Christchurch) (Con)
T4. Does the Secretary of State accept the verdict of the Competition Commission, which decided recently that it would be against the interests of patients for Royal Bournemouth General Hospital and Poole Hospital to merge? The clinical commissioning group has responded by saying that one of the hospitals will have to give up all its services.
Mr Hunt
I think that we must respect the independent view of the Competition and Markets Authority, but I also think that there are lessons to be learned by the NHS more generally from the way in which that process was conducted. There will have to be changes on the ground if we are to give patients the care that they need in the very constrained financial circumstances in which we operate.
Paul Blomfield (Sheffield Central) (Lab)
T3. In March this year I had a very useful meeting involving Devonshire Green & Hanover Medical Centres in my constituency and the then Under-Secretary of State, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who recognised the threat posed to practices that serve patients with complex, demanding, and therefore costly needs by the withdrawal of the minimum practice income guarantee. The hon. Gentleman promised to follow up that meeting, but since then we have heard nothing. Will the Secretary of State guarantee that no practice will close as a result of the withdrawal of MPIG, and what will he do to ensure that that is the case?
Richard Burgon (Leeds East) (Lab)
T8. Millions of people are worried about the privatisation of our national health service, so it is a real concern that the health sector remains part of the negotiations on the Transatlantic Trade and Investment Partnership. Tomorrow the European Parliament votes on TTIP, but the European Commission has already said it will not remove health from those negotiations, so can the Government confirm that they will defend the NHS and support the removal of health and other public services from future TTIP negotiations?
Mr Jeremy Hunt
Really, the Labour party has got to stop this scaremongering that it did so much of, and to so little effect, at the election. Privatisation is not happening, but I will tell the hon. Gentleman what is happening: at his hospital, 85 more doctors in the last five years, 185 more nurses, 7,700 more operations, 20,000 more people being seen within four hours at A&E—progress in the NHS with a strong economy.
Helen Whately (Faversham and Mid Kent) (Con)
In the last Parliament we made great strides using transparency to drive improvement in the quality of patient care. Does my right hon. Friend agree that we can and should go further, particularly on the transparency of performance in primary and community care?
Mr Jeremy Hunt
My hon. Friend is absolutely right and has great experience in this area. We are now having a lot of transparency at an institutional level, but individual doctors and nurses in primary and secondary care are still finding it too hard to speak out if they have concerns. Getting that culture right has to be a big priority for this Parliament.
Mr Speaker
Emulating Strangford brevity, perhaps, I call Mr Greg Mulholland.
Mr Peter Bone (Wellingborough) (Con)
Does the Secretary of State agree that hospital parking charges are unfair?
Ms Margaret Ritchie (South Down) (SDLP)
Will the Secretary of State outline when compensation will be made available to those who were infected by contaminated blood products in the 1970s and 1980s?
Jason McCartney (Colne Valley) (Con)
When will the Secretary of State be making a full statement in response to the Penrose inquiry into those affected by contaminated blood?
Oral Answers to Questions
Jeremy Hunt Excerpts(10 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mrs Emma Lewell-Buck (South Shields) (Lab)
1. What assessment he has made of recent trends in ambulance waiting times.
The Secretary of State for Health (Mr Jeremy Hunt)
As you said, Mr Speaker, we shall have those tributes tomorrow, but I should like very briefly to echo your comments, because I know that the whole House is shocked and deeply saddened by the umtimely passing of Charles Kennedy. He was a giant of his generation, loved and respected in all parts of the House. Our thoughts are particularly with Liberal Democrat Members who knew him well, and to whom he was a very good friend over many years. We shall all miss him as a brave and principled man who had the common touch, and who proved that it is possible to be passionate and committed without ever being bitter or bearing grudges. Our thoughts are with his whole family.
I can tell the hon. Member for South Shields (Mrs Lewell-Buck) that the ambulance service is performing well under a great deal of pressure. Although a number of national targets are not being met, the service is responding to a record number of calls, and is making a record number of journeys involving all categories of patients.
Mrs Lewell-Buck
I echo the comments made about the late Member for Ross, Skye and Lochaber. He was one of the kindest Members of the House, and he will be greatly missed by many of us.
As for the Secretary of State’s response to my question, I think that his assessment was a bit off. When my constituent Malcolm Hodgson’s son-in-law broke his leg in a local park, he waited in agony for 50 minutes for an ambulance, and then waited a further five days for an operation. Can the Secretary of State explain how our ambulance and health services were allowed to fall into such a dire state over the past five years, and will he apologise to that young man for the delay and the pain that he suffered on the right hon. Gentleman’s watch?
Mr Hunt
I take responsibility for everything that happens on my watch. [Interruption.] I think it is a little early to ask the Secretary of State to resign—but maybe not. The ambulance service is under great pressure, but across the country we have 2,000 more paramedics than five years ago, we are recruiting an additional 1,700 over the next few years, and from March this year, compared with March the previous year, the most urgent calls—the category A red 1 calls—went up by 24% and the ambulance service answered nearly 2,000 more calls within the eight-minute period. There is a lot of pressure, we have a plan to deal with it, but we need to give credit to the ambulance service for its hard work.
Mr James Gray (North Wiltshire) (Con)
I stood against Charles Kennedy in 1992 in Ross, Cromarty and Skye and will take the opportunity tomorrow of remembering what a very happy occasion it was and how very glad I was to lose to Charles at that election.
I strongly opposed the creation of the South Western Ambulance Service because I believed the Wiltshire Ambulance Service did a better job on its own. I know the Secretary of State has been monitoring the calls received by the South Western Ambulance Service—one of the two trial areas. Will he tell the House whether response times in the south-west have improved or got worse in recent years?
Mr Hunt
NHS England will be updating the House on the results of that trial. It was a very important trial because it was designed to stop the dispatch of ambulances to people who did not need one within eight minutes, in order to make sure ambulances were available for people who did need one. South Western was very helpful in taking part in that trial and we will update the House shortly on the results of it.
Clive Lewis (Norwich South) (Lab)
Yesterday 400 people in my region expected to begin a paramedics course put on by the East of England Ambulance Service only to discover that there is no course and they are now £4,000 out of pocket. That is because the University of East Anglia and Anglia Ruskin University could not get accreditation for the courses. Does the Secretary of State think this event is going to help the ambulance service in the east of England where staff are already overwhelmed? It is a critical service—a vital service. Does he think this will contribute to hitting those targets, which at the moment are being inadequately met?
Mr Hunt
I welcome the hon. Gentleman to his place. It is important that we train more paramedics. It is one of the most challenging jobs in the NHS and I will take up the issue he raises with the Secretary of State for Business, Innovation and Skills to understand precisely what the problem was and to try to resolve it as quickly as possible.
Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
Will the Secretary of State consider reviewing the protocol, which is unique to the ambulance service in terms of our emergency services, that breaks cannot be broken into even if there is a category A incident in the area? We had the loss of a young man in Berwick recently; the ambulance which was in post in the ambulance station a mere four minutes down the road was not called and the boy died. That is the cause of enormous distress across the rural areas of Northumberland.
Caroline Nokes (Romsey and Southampton North) (Con)
2. When he expects NHS England to reach a decision on access to Translarna for the treatment of Duchenne muscular dystrophy; and if he will make a statement.
Jeremy Lefroy (Stafford) (Con)
3. What progress he has made on the implementation of the trust special administrators’ proposals following the dissolution of Mid Staffordshire NHS Foundation Trust.
The Secretary of State for Health (Mr Jeremy Hunt)
We are putting the terrible tragedy of the old Mid Staffs behind us, and I congratulate my hon. Friend and the staff at the hospital on their superb efforts under a great deal of pressure. We are also investing over £300 million in the Staffordshire health economy, and the local trust and commissioners are making good progress on implementing the recommendations made by the trust special administrators.
Jeremy Lefroy
I thank my right hon. Friend for his reply. He will have seen the reports over the weekend on the severe pressure on accident and emergency services at the Royal Stoke University hospital, while Stafford’s County hospital A&E often meets the 95% four-hour target. The trust special administrators assured us that the Royal Stoke would have the capacity to cope with additional patients from Stoke and Stafford. Given that that is not the case, will the Secretary of State ensure that A&E in Stafford is reopened to operate 24/7 as soon as is clinically possible?
Mr Hunt
I share my hon. Friend’s concern about what is happening at the Royal Stoke. Some of the care there was totally unacceptable; there should be no 12-hour trolley waits anywhere in the NHS. I have said that I support a full 24/7 A&E service at County hospital as soon as we can find a way of doing it that is clinically safe, and I will certainly work hard to do everything I can to make that happen.
Valerie Vaz (Walsall South) (Lab)
Will the Secretary of State ensure that other local hospitals, such as the Manor hospital, which have had to take up the slack following the closure of A&E and maternity services also get some support?
Stephen Phillips (Sleaford and North Hykeham) (Con)
4. What steps he is taking to reduce the burden of administration on GPs.
Graham Evans (Weaver Vale) (Con)
5. What steps he plans to take to improve dementia diagnosis and care.
The Secretary of State for Health (Mr Jeremy Hunt)
Following a sustained effort to improve dementia diagnosis rates in the last Parliament I am pleased to report that in England we now diagnose 61.6% of those with dementia, which we believe is the highest diagnosis rate in the world. But there is much work to be done to make sure that the quality of dementia care post diagnosis is as consistent as it should be.
Graham Evans
I thank my right hon. Friend for his answer. A long-standing Weaver Vale constituent, Mrs Gladys Archer, successfully looked after her husband for many, many years at home until he was admitted to hospital for a routine operation. Following a misdiagnosis, he has had to go into a care home with all the personal cost and trials and tribulations that that involves. Will my right hon. Friend look into that case, and highlight what measures are in place and how we can improve matters so that we can stop patients with Alzheimer’s or dementia suffering when they are admitted to hospital?
Mr Hunt
I thank my hon. Friend for raising that case and I will happily look into it. That is a perfect example of why we need to change the way we look after people with long-term conditions, such as dementia, out of hospital. If we can improve the care that we give them at home and give better support to people such as that man’s wife, we can ensure that the kind of tragedy my hon. Friend talks about does not happen.
Barbara Keeley (Worsley and Eccles South) (Lab)
Unpaid family carers play a key role in the care of people with dementia, many with heavy caring workloads of 60 hours a week or more. Can the Health Secretary understand how fearful carers now are of talk of cutting their eligibility for carer’s allowance and will he fight any moves within his Government to do that?
Mr Hunt
I absolutely recognise the vital role that carers play and will continue to play, because we will have 1 million more over-70s by the end of this Parliament, and we need to support them. I hope that she will recognise that we made good progress in the previous Parliament with the Care Act 2014, which gave carers new rights that they did not have before.
Michael Tomlinson (Mid Dorset and North Poole) (Con)
18. Two weeks ago, it was dementia friendly care week and I had the pleasure of spending a part of that at a picnic in the village of Corfe Mullen in Mid Dorset and North Poole. Does my right hon. Friend agree that although much progress has been made in diagnosis, there is still a long way to go in terms of care, especially for those individuals in Mid Dorset and North Poole?
Mr Hunt
I welcome my hon. Friend warmly to his place; he hits the nail on the head. We had a big problem with diagnosis—less than half of the people who had dementia were getting a diagnosis—and we have made progress on that. It is still the case that in some parts of the country, although I hope not in Mid Dorset, when someone gets a diagnosis not a great deal happens. We need to change that, because getting that support is how we will avoid tragedies such as that in Weaver Vale, which we heard about earlier.
Andrew Gwynne (Denton and Reddish) (Lab)
The Secretary of State knows that the availability of social care for vulnerable older people has a big impact on the NHS, especially for people with dementia, yet 300,000 fewer older people are getting help compared with 2010. Given that the Secretary of State has said that he wants to make improving out-of-hospital care his personal priority, can he confirm that there will be no further cuts to adult social care during this Parliament, which would only put the NHS under even more pressure?
Mr Hunt
I can confirm that we agree with the hon. Gentleman and the Opposition that we must consider adult social care provision alongside NHS provision. The two are very closely linked and have a big impact on each other. I obviously cannot give him the details of the spending settlement now, but we will take full account of that interrelationship and recognise the importance of the integration of health and social care that needs to happen at pace in this Parliament.
Ms Margaret Ritchie (South Down) (SDLP)
6. What recent discussions his Department has had with the Royal College of Emergency Medicine on the recruitment of additional middle-grade doctors for NHS hospitals.
Neil Carmichael (Stroud) (Con)
7. What steps he is taking to increase access to GPs’ surgeries.
The Secretary of State for Health (Mr Jeremy Hunt)
The Government have committed to make sure GPs can be accessed when needed seven days a week, ensuring that people are able to access primary medical care when they need to.
This is already being rolled out through the GP access fund, which will enable 18 million patients to benefit from improved access to their local GP, including extended hours, telephone or Skype consultations.
Neil Carmichael
Does the Secretary of State agree that the news he brings will be of great comfort to elderly people in particular, but in addition the signposting of people towards GPs rather than acute hospitals will be very important and a very useful addition to our policy?
Mr Hunt
My hon. Friend makes an important point. It is partly the availability of services seven days a week, which we need to provide because illnesses do not happen on only five days a week and we need to respond to changing consumer expectations; but it is also about the signposting. That is absolutely critical, so that people know where to go and do not overburden A&E departments, which should be there for real emergencies.
Emily Thornberry (Islington South and Finsbury) (Lab)
The right hon. Gentleman talks about access to GPs. Will he wait a moment and think about Islington South, where this month we have three GP surgeries closing because our GPs have all resigned? Given the changes in the funding formula that this Government have overseen, will he meet a group of inner-London MPs to talk about our grave concerns about the change to funding and the lack of resources available to GPs?
Mr Hunt
I am happy to ensure that inner-London MPs have a meeting with the Minister to discuss those issues. The underfunding of general practice has been an historical problem, because we have had very strong hospital targets, which have tended to suck resources into the acute sector and away from out-of-hospital care. We want to put that right.
Mr Philip Hollobone (Kettering) (Con)
The problem in Northamptonshire is that because of rapid population growth, the gap between the appointments required of GP surgeries and the slots available is one of the biggest in the country. There are 333 Northamptonshire GPs at the moment; Healthwatch Northamptonshire estimates that another 183 will be required within the next five years. How are we going to fill that gap?
Dr Philippa Whitford (Central Ayrshire) (SNP)
How does the Minister intend to find the 5,000 extra GPs when many surgeries throughout the United Kingdom cannot fill the spaces that they have, and how does he plan to fund it? The proposals appear to only fund the setting up of seven-day-a-week, 8 till 8 GP services and not running costs—and these are big running costs.
Mr Hunt
I welcome the hon. Lady to her place. We do need to find these extra GPs and we will do that by looking at GPs’ terms and conditions. We need to deal with the issue of burnout because many GPs are working very hard. We also need to raise standards in general practice. In the previous Parliament, an Ofsted-style regime was introduced, which is designed to ensure that we encourage the highest standards in general practice. That is good for patients but also, in the long run, good for GPs as well.
Dr Whitford
Just so that the Secretary of State is aware, it takes 10 years to produce a GP, so that will not be an immediate response. The £8 billion that the Conservatives have suggested they will add by 2020 was just to stand still, not to fund a huge expansion, and as change, which the NHS requires, costs money, can the Secretary of State perhaps give us an indication of what extra we may expect in the next two years?
Mr Hunt
Well, I can, but may I gently say that under this Government and under the coalition we increased the proportion of money going into the health budget, whereas the Scottish National party decreased the proportion of money going into the NHS in Scotland? The £8 billion is what the NHS asked for to transform services, and that will have an impact, meaning that more money is available for the NHS in Scotland. I hope the SNP will actually spend it on the NHS and not elsewhere.
Jake Berry (Rossendale and Darwen) (Con)
I thank the Secretary of State for personally intervening to enable the Ilex View medical centre in Rawtenstall to open for longer hours, despite that being precluded under its private finance initiative lease of that building. Will he update the House on what steps can be taken to ensure that where GPs are in a building that is subject to a PFI lease, he will be able to intervene to ensure that they can truly open seven days a week and for extended hours?
Mr Hunt
This is one of the main reasons why the Chancellor allocated £1 billion to modernise primary care facilities in the autumn statement. We recognise that many GP premises are simply not fit for purpose. If we are going to transform out-of-hospital care, we need to find ways to help GPs move to better premises, to link up with other GP practices, and that will be a major priority for this Parliament.
Liz Kendall (Leicester West) (Lab)
The 2010 Conservative manifesto promised every patient seven-day GP access from 8 am to 8 pm, but access has got worse and almost half of all patients now say they cannot see a GP in the evenings or at weekends. Five years on, the Conservatives made the exact same promise. Can the Secretary of State tell us why he has failed?
Mr Hunt
I welcome the hon. Lady back to her place, although I know she hopes it will be for only a brief time, and say to her that we have not failed. We made very good progress delivering seven-day access to GP surgeries for nearly 10 million people during the last Parliament, and we have committed to extending that to everyone during this Parliament. I think the hon. Lady said that what is right is what works, and what works is having a strong economy so we can put funding into the NHS that will mean more GPs.
Andy Slaughter (Hammersmith) (Lab)
8. What effect the implementation of the Keogh urgent and emergency care review will have on type 1 A&E departments in England.
Helen Jones (Warrington North) (Lab)
12. What estimate he has made of the anticipated levels of deficits in hospital trusts for the current financial year.
The Secretary of State for Health (Mr Jeremy Hunt)
The NHS faces significant financial challenges this year and beyond. That is why we have now committed £10 billion extra for the NHS—£2 billion for this year and at least £8 billion more by 2020. Individual trust plans for 2015-16 are still being worked up but, with concerted financial control from providers, we expect to deliver financial balance in 2015-16.
Helen Jones
But does the Secretary of State accept that in trusts such as mine, which anticipates a £15 million deficit this year, that cannot be done without cuts to staff, beds and services? What happened to the Prime Minister’s pledge on a bare-knuckle fight to protect district general hospitals, when trusts such as mine are facing such circumstances?
Mr Hunt
I will tell the hon. Lady what has happened to the Prime Minister’s pledge to protect hospitals: an extra £10 billion that we have promised for the NHS, which her party refused to promise. Her local hospital has 88 more doctors since 2010, and it is doing an extra 2,000 operations for her constituents year in, year out. I will tell her what makes the deficit problem a lot worse: the heritage of the private finance initiative, which means £73 billion of debt that her party bequeathed to the NHS.
Mr Jonathan Djanogly (Huntingdon) (Con)
In 2004 the then Huntingdonshire primary care trust said that it would give Hinchingbrooke hospital a grant of £8 million towards the cost of a new PFI treatment centre. Shortly before the PCT’s demise, it changed without discussion the terms of the grant and made it a loan, which has since been treated in its accounts as a deficit. If I write to my right hon. Friend, will he look into that patently unfair treatment?
Andy Burnham (Leigh) (Lab)
On behalf of everyone on the Opposition Benches, I echo the Secretary of State’s warm tribute to Charles Kennedy. I cannot have been the only person this morning wondering why politics always seems to lose the people it needs most. Charles was warm, generous, genuine and principled. We will miss him greatly. We send our love and deepest sympathy to his family.
I congratulate the Secretary of State on his reappointment, but I commiserate with him on the financial position in the NHS that he inherits from himself. He told The Daily Telegraph today that the NHS has enough money, but that is not true. The deficit in the NHS last year was nearly £1 billion. Can he tell the House what the projected deficit is for the whole of the NHS for this year?
Mr Hunt
I welcome the right hon. Gentleman to his place. We have seen many feisty disagreements on health policy, and that is just in the shadow Health team. Perhaps he no longer believes his mantra about collaboration, not competition—we know that the shadow care Minister has disagreed with that for some time. To answer his question directly, there is a lot of financial pressure in the NHS, and that is because NHS hospitals took the right decision to respond to the Francis report into Mid Staffs by recruiting more staff to ensure that we ended the scandal of short-staffed wards. As a temporary measure it recruited a lot of agency staff, which has led to deficits, and that is what we are tackling with today’s announcement about banning the use of off-framework agreements for recruiting agency staff.
Andy Burnham
It is a new Parliament, but there are the same non-answers from the Secretary of State. He did not answer; he never does. I will give him the answer: NHS providers are predicting the deficit to double this year to more than £2 billion. Why has financial discipline been lost on his watch? It is because early in the previous Parliament the Government cut 6,000 nursing posts. They cut nurse training places and, when the Francis report came out, they left hospitals with nowhere to turn other than private staffing agencies. The Bill for agency nurses has gone up by 150% on his watch. He even admitted on the radio this morning that it was a mess of their making. Will he now apologise for this monumental waste of NHS resources and get our hospitals out of the grip of private staffing agencies by recruiting the 20,000 nurses that the NHS needs?
Mr Hunt
I have here the figures on nurse training placements, which started to go down in 2009-10, by nearly 1,000. Who was Secretary of State at the time? I think it was the right hon. Gentleman. [Interruption.] I have the figures here, and they show that planned nurse training places went down from 21,337 to 20,327. He talks about apologies, but where is the apology for what happened at Mid Staffs, which led to hospitals having to recruit so many staff so quickly? That is the real tragedy, and that is what this Government are sorting out.
Andrea Jenkyns (Morley and Outwood) (Con)
14. What the NHS’s criteria are for dispensing eculizumab.
The Secretary of State for Health (Mr Jeremy Hunt)
During the previous Parliament I made it my priority to ensure that NHS hospitals learned from the tragedy of Mid Staffs to transform themselves into the safest hospitals anywhere in the world. That work will continue. Today NHS England has announced measures to ensure that even more funding is available to improve the quality of care. These include restrictions on the use of agency staff and management consultancies, and on senior pay. It is right that the NHS takes every possible measure to direct resources towards improving patient care.
Andrew Stephenson
I thank the Secretary of State for supporting the bid by East Lancashire Hospitals NHS Trust for £15.6 million to improve the surgical centre, opthalmology and out-patient services at Burnley General hospital, on which I lobbied him extensively. Thanks to the hard work of the trust’s staff, it has exited special measures. What progress has been made on improving safety in hospitals via the special measures regime?
Mr Speaker
Order. I remind the House at the start of the Parliament—this might be of particular benefit to new Members—that topical questions are supposed to be significantly shorter than substantive questions: the shorter the better, and the more we will get through.
Mr Jamie Reed (Copeland) (Lab)
The Secretary of State has said that safe care and good finances go together, but clinical negligence claims are up by 80% since 2010, while trusts are posting huge deficits. Does he think that finances have deteriorated because care quality has deteriorated or that care quality has deteriorated because finances have deteriorated?
Mr Hunt
The evidence is very clear that safer hospitals end up having lower costs, because one of the most expensive things that can be done in healthcare is to botch an operation, which takes up huge management time as well as being an absolute tragedy for the individual involved. My message to the NHS is this: the best way to reduce your costs and deliver these challenging efficiencies is to improve care for patients. Our best hospitals, like Salford Royal and those run by University Hospitals Birmingham NHS Foundation Trust, do exactly that.
Derek Thomas (St Ives) (Con)
T2. Bringing health and social care together in meaningful integration is a priority for me and my constituents in St Ives. What can the Secretary of State do to help achieve this for the good people of west Cornwall and the Isles of Scilly? Will he accept an invitation to come to west Cornwall to discuss this challenge and see some of the good work that is already being done?
Heidi Alexander (Lewisham East) (Lab)
T3. For the first time in recent history, many of London’s more prestigious teaching hospitals—King’s College, University College London, Guys and St Thomas’s, and the Royal Free—are all forecasting deficit budgets. Apart from crossing his fingers and hoping the economy picks up to fund investment, what exactly is the Secretary of State going to do to tackle this problem?
Mr Hunt
I would not expect the hon. Lady to want to listen to me on the “Today” programme, but I have been talking a lot today about the measures, including in my topical statement. I will tell her exactly what we are doing: this week we are announcing measures to restrict the use of agency staff, which was an important, necessary short-term measure in response to what happened at Mid Staffs. We need to move beyond that. Later in the week we will be helping trusts reduce their procurement costs and taking a number of measures, so a lot is happening. There are a lot of challenges, but I know that NHS trusts can deliver.
Christopher Pincher (Tamworth) (Con)
T5. Burton hospital trust and the Heart of England foundation trust are discussing how they can make better use of the facilities at the Sir Robert Peel hospital. Will colleagues on the Treasury Bench encourage both trusts to make better use of the facilities, provide new facilities and services at the hospital, and make sure that local people are properly consulted?
Ian Lavery (Wansbeck) (Lab)
T4. The Secretary of State has admitted this morning that under his watch the NHS and the taxpayer have been ripped off to the tune of somewhere in the region of £1.8 billion for temporary workers and £3.3 billion for agency workers. How many fully qualified NHS nurses could have been employed with that type of finance?
Mr Hunt
I will tell the hon. Gentleman what we have done: on my watch, there are 8,000 more nurses in our hospitals to deal with the tragedy of the legacy of poor care left behind by his party. That is what we have done. As part of that, trusts also recruited temporary staff. They have become over-dependent on them, which is why we have taken the measures we announced this morning.
Mr Simon Burns (Chelmsford) (Con)
T6. What measures are being taken to improve A and E departments such as that at Broomfield hospital in Chelmsford?
Emily Thornberry (Islington South and Finsbury) (Lab)
T8. I am very grateful to the right hon. Gentleman for agreeing to meet me and some inner- London MPs to discuss the crisis of GPs in Islington and the surrounding area. In preparation for that meeting, will he look very carefully at the funding formula? It has changed, which means that resources have moved out of inner London to areas such as Bournemouth, where there are more older people. We need to look very carefully at that. Three surgeries have closed in Islington.
Andrea Jenkyns (Morley and Outwood) (Con)
T7. The rate of hospital-acquired infections improved dramatically and halved in the last Parliament. Having lost my own father to a hospital-acquired infection, I am fully aware of the challenges we face. Will the Secretary of State look into ensuring that surgical site infections are included in all future statistics? In doing so, we can work on eradicating them, as they are a common way to catch an infection.
Mr Hunt
May I start by saying that it was an incredible privilege to work with the right hon. Gentleman on the Government Benches on mental health issues over many years? He was a great inspiration to many people in the mental health world for his championing of that cause. It is my absolute intention to ensure that his legacy is secure and that we continue to make real, tangible progress towards the parity of esteem that we both championed in government.
Mr Nigel Evans (Ribble Valley) (Con)
I welcome the expansion of GP services to seven days a week. Will the Secretary of State remember rural areas such as Ribble Valley when GP services are expanded? Funnily enough, people who live in rural areas also get ill at the weekends.
Jim Shannon (Strangford) (DUP)
With almost 82,000 people living with diabetes in Northern Ireland over the age of 17, does the Minister agree that this ticking time bomb needs more research into better treatments? One way of doing that would be to ensure that there is sufficient funding for Queen’s University in Belfast, in the hope of providing a superior treatment for the many who are affected and living with that disease.
Jack Dromey (Birmingham, Erdington) (Lab)
With the accident and emergency crisis, over which the Secretary of State has presided, more and more police officers are queuing outside fewer A&E departments in ever-lengthening queues. Last year, there were 1,000 incidents in the Metropolitan police alone. In Liverpool, Patrick McIntosh died after waiting for an ambulance for an hour. Does the Secretary of State accept that after 17,000 police officers have been cut by his Government, this is the worst possible time to ask the police service to do the job of the ambulance service, and that he is guilty of wasting police time?
Mr Hunt
I think that is harsh. Let me tell the hon. Gentleman some of the progress that was made under the last Government, and that this Government will continue, to reduce the pressure on police, particularly with regard to the holding of people with mental health conditions in police cells. We are in the process of eliminating that; it has seen dramatic falls. We recognise that the NHS needs to work more closely with the police, particularly in such circumstances, and he should recognise the progress that has been made compared with what happened before.
Mr Speaker
Order. I am genuinely sorry that some colleagues were disappointed today; I ran things on a bit, but we need to move on. In one respect, Health questions is analogous to the national health service, under whichever Government, in that demand always exceeds supply, but I have noticed colleagues who were trying to take part today and I will seek to accommodate them on a subsequent occasion.
Health and Social Care
Jeremy Hunt Excerpts(10 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
It is an honour to speak about health and social care in our debates on the Gracious Speech, because nothing matters more to this Government than providing security for all of us at every stage of our life, and nothing is more critical to achieving that than our NHS.
I start by welcoming the right hon. Member for Leigh (Andy Burnham) and his colleagues back to their positions. I will not take it personally that two of them want to break from debating with me to go elsewhere. However, it is a topsy-turvy world when the shadow Health Secretary who was the scourge of private sector involvement in the NHS now wants to be the entrepreneurs’ champion. As one entrepreneur to another, may I put our differences to one side and on behalf of the whole Conservative party wish him every success in his left-wing leadership bid? This is perhaps the only occasion in history when my party’s interests and those of Len McCluskey are totally aligned.
That is not to mention the hon. Member for Leicester West (Liz Kendall), who is, in her own way, a kind of insurgent entrepreneur, taking on the might of the Labour establishment, in the mould of Richard Branson or Anita Roddick. Sadly, I fear that she will demonstrate that pro-business, reform-minded, centre-ground policies are as crushed inside today’s Labour party as they would have been in the country if Labour had won the election.
The shadow Health Secretary said countless times during the election campaign that the NHS would be on the ballot paper. He was right—the NHS was indeed the top issue on voters’ minds—but not with the result he had intended. So, just as he has now done significant U-turns on Labour’s EU referendum policy, economic policy and welfare policies, I gently encourage him to do one on Labour’s health policies too.
The Queen’s Speech committed the Government to the NHS’s Five Year Forward View and the £8 billion that the NHS says it needs to fund it. The shadow Health Secretary refused to put such a commitment in Labour’s manifesto, and I hope today he will change that policy so that we can have cross-party consensus on this important blueprint for the NHS.
James Morris (Halesowen and Rowley Regis) (Con)
Does the Secretary of State agree that one of the biggest challenges we face is to achieve parity of esteem between mental health and physical health in the NHS, and that the way to achieve that parity is by ensuring that mental health services are properly funded and that we have a culture change in the NHS that means that physical health and mental health are treated as the same?
Mr Hunt
My hon. Friend is absolutely right, and I want to thank him for his tireless campaigning on parity of esteem for mental health in the last Parliament. One in 10 children aged five to 16 has a mental health problem, and it is a false economy if we do not tackle those problems early, before they end up becoming much more expensive to the NHS as well as being extremely challenging for the individual involved. We are absolutely determined to make progress in that area.
Philip Davies (Shipley) (Con)
The Secretary of State has quite rightly said that the NHS needs to become more efficient. May I encourage him to visit Advanced Digital Institute Health, based in Saltaire in my constituency, so that he can see at first hand the wonderful work it is doing using modern technology to improve the quality of healthcare in our communities and to make it much more efficient, helping NHS resources go as far as we need them to go?
Mr Hunt
I would be delighted to visit my hon. Friend as soon as I can find the time, but I have already seen some great technology at Airedale hospital, which I think is in or near his constituency. It had some incredibly innovative connections with old people’s care homes, where people could talk to nurses directly, so there is some fantastic technology there, and I congratulate his local NHS on delivering it.
In the election campaign, the right hon. Member for Leigh talked constantly about NHS privatisation that is not actually happening. Now that he is the entrepreneurs’ champion, will he speak up for the dynamism that thousands of entrepreneurs bring to the NHS and social care system, whether they be setting up new dementia care homes, researching cancer immunotherapy, developing software to integrate health and social care or providing clinical services in the way he used to approve of when, as Health Secretary, he privatised the services offered at Hinchingbrooke hospital?
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
I am glad that the right hon. Gentleman is getting to the meat of the debate. My constituents and people around the country want to know whether the big issues will be tackled, and the big issues are difficult ones, such as tackling the royal colleges about the training of medical people, from nurses, doctors and other A&E professionals right the way through the system. Is it not time we had a radical approach to how we train our medical staff in this country?
Mr Hunt
We do need to make important changes to the training of medical staff, and I shall give the hon. Gentleman one example of where that matters: creating the right culture in the NHS so that doctors and nurses feel able to speak out if they see poor care. In a lot of hospitals they find that very difficult, because they are working for someone directly responsible for their own career progress, and they worry that if they speak out, that will inhibit their own careers. We do not have that culture of openness. The royal colleges have been very supportive in helping us make that change, but yes, medical training is extremely important.
David Tredinnick (Bosworth) (Con)
To build on the point made by the hon. Member for Huddersfield (Mr Sheerman), is not a critical aspect—something that the Health Committee has looked at—what doctors are learning now? More needs to be done about prevention. Has my right hon. Friend seen early-day motion 1 about reducing levels of obesity, and is not reducing the amount of sugar in fizzy drinks a key challenge for him?
Mr Hunt
My hon. Friend is absolutely right. The big change we need to see in the NHS over this Parliament is a move from a focus on cure to a focus on prevention. In this Parliament, we will probably see the biggest single public health challenge change from smoking to obesity. It is still a national scandal that one in five 11-year-olds are clinically obese, and I think we need to do something significant to tackle that in this Parliament.
Andy Burnham (Leigh) (Lab)
There is a big difference between the Secretary of State’s view of the health service and mine—he believes in a market; I do not. It is as simple as that. But I want to correct him on something. He just said that privatisation was not happening, but I will not let him stand at that Dispatch Box and claim that black is white any more. Figures show that as many contracts are going to private sector organisations as to NHS organisations. Will he confirm that that is the case and stop giving wrong information to the people of this country?
Mr Hunt
I gently say to the right hon. Gentleman that I believe in exactly the same use of the independent sector in the NHS as he did when he was Health Secretary; there is no difference at all. What has happened is that for whatever reason—I dare not think what—since he became shadow Health Secretary, he has changed his tune. The facts on privatisation are that it increased from 4.9% at the start of the last Parliament to 6.2% towards the end of the Parliament. That is hardly a massive change. Our approach is to be neutral about who provides services but to do the right thing for patients.
Paula Sherriff (Dewsbury) (Lab)
I worked on the front line of the NHS, in a service providing exemplary care, for more than 11 years. Just over two years ago that same service was privatised, and it has proved to be very damaging for patients, staff and the taxpayer alike. Will the Secretary of State continue to allow companies such as Virgin Care, which exists purely to make profits out of ill people, to continue to bid for NHS services?
Mr Hunt
May I welcome the hon. Lady to her place and say that I welcome to this place as many people with experience of working in the NHS as possible, because every Parliament has important debates on the NHS? Let me gently say to her that the biggest change made in the last Parliament was to take the decision about whether services should be provided by the public sector or the private sector out of the hands of politicians who might have an ideological agenda, and give it to local GPs so that the decision can be taken in the best interest of patients.
I happen to agree with the shadow Health Minister—the hon. Member for Leicester West (Liz Kendall)—but not the shadow Health Secretary that what is best is what works. Where it is best for patients to use charities or the independent sector, I support that, but I do not think it should be decided for ideological reasons by politicians.
Mr Hunt
Let me make some more progress, and I shall give way later.
The Queen’s Speech also talked about a seven-day NHS as part of our determination to make the NHS the safest healthcare in the world. When the right hon. Member for Leigh was Health Secretary, things were different, and he knows that we had a culture of targets at any cost and a blind pursuit of foundation trust status, which led to many tragedies. I hope he will today accept that if we are to make the NHS the safest and most caring system in the world, we must support staff who speak out about poor care, and stop the bullying and intimidation of whistleblowers that happened all too often before.
Finally, I hope we can agree on something else today—namely, that with the election behind us, we all use more temperate language in our health debates. There are many pressures on the NHS from an ageing population, tight public finances and rising consumer expectations, but the one pressure people in the service can do without is constantly being told by politicians that their organisation will not exist in 24 hours, 48 hours, one week, one month or whatever. It is a toxic mix of scaremongering and weaponising that is totally demoralising for front-line staff.
Paul Farrelly (Newcastle-under-Lyme) (Lab)
The Secretary of State has said that privatisation is not happening, but in Staffordshire the £1 billion end-of-life cancer care contract is up for tender, threatening the hospital finances at Royal Stoke even further. Before the election, my right hon. Friend the Member for Leigh (Andy Burnham) gave a commitment to the Royal Stoke University Hospital that it would be the preferred provider for this contract. Will the Secretary of State give that commitment today?
Mr Hunt
As I said earlier, I do not think these decisions should be made by politicians; I think they should be made by GPs on the ground, on the basis of what is best for the hon. Gentleman’s constituents. That is a dividing line between me and the shadow Health Secretary, if not the shadow Health Minister, because I think there is a role for the independent sector when it can provide better or more cost-effective services to patients. It appears that the Labour party, under the leadership of the right hon. Member for Leigh, would rule that out in all circumstances.
Andy Burnham
The right hon. Gentleman said right there that there is a role for the independent sector and that he is neutral about it but wants to see it increase. Then he says that privatisation is not happening. Is he trying to take everybody for mugs? He needs to come to this Dispatch Box and be quite clear about what is happening. Section 75 of his Health and Social Care Act 2012 does not give discretion to doctors; it forces NHS services out on to the open market. That is why we are seeing privatisation proceeding at a pace and scale never seen before in the NHS.
Mr Hunt
I am afraid that this is exactly the sort of distortion and scaremongering that got the right hon. Gentleman nowhere in the election campaign. He knows perfectly well that the 2012 Act does nothing different from what the EU procurement rules required under the primary care trusts when he was Health Secretary. Yes, I do believe that there is a role for the independent sector in the NHS, but I think the decision whether things should be done by the traditional NHS or the independent sector should be decided locally by GPs doing the right thing for their patients. That is the difference between us.
Andrew Percy (Brigg and Goole) (Con)
The Secretary of State is spot on with regard to the use of language. In the last Parliament the Health Select Committee saw an attempt to paint a picture of privatisation as equalling the provision of private health care. Will my right hon. Friend confirm that under the previous Government private sector activity in foundation trusts fell and the rate of privatisation was slower than in the preceding five years—something that the Committee noted in a report that was blocked by Labour members of the Committee?
Mr Hunt
Yes, I will. The figures that my hon. Friend cites are right. I will tell him something else. Half a million fewer people took out private health insurance in the previous Parliament because the quality of care that they could get on the NHS was rising. The Government are committed to the NHS. If the right hon. Member for Leigh does not want to believe what I am saying about privatisation, perhaps he will believe the respected think-tank the King’s Fund, which is clear that his claims of mass privatisation were and are exaggerated.
Jesse Norman (Hereford and South Herefordshire) (Con)
My right hon. Friend spoke eloquently about the importance of supporting mental health care, of parity of esteem and of technology. Does he share my view that the NHS has a strong embedded interest in the spread of fast broadband in rural areas, which would allow people better access to telemedicine and online psychotherapy?
Mr Hunt
Absolutely. I had a good visit to my hon. Friend’s county hospital, but I also remember seeing at Airedale hospital how reassuring it was for a vulnerable old lady to be able to press a red button on her armchair, be connected straight through to the local hospital and talk to a nurse within seconds. With that kind of service, that person is less likely to need full-time residential care. That is much better for her and more cost-effective for the NHS.
Gareth Johnson (Dartford) (Con)
Much has been made of finances during this debate. I do not know whether my right hon. Friend is aware of this, but Darent Valley hospital in my constituency underspent by some £250,000 last year while providing the best services in Kent. The challenge that it is still dealing with today is the legacy of the private finance initiative that created the hospital in the first place.
Mr Hunt
My hon. Friend has an excellent hospital, which I hope to visit at some stage. A third of the hospitals that are in deficit have PFI debts that make it much harder to get back into surplus. That is a persistent problem, and we are doing everything we can to help them deal with it.
The reality is that hard-working NHS staff have made terrific progress in incredibly tough circumstances in recent years. More than a million more operations were performed last year compared with five years ago, yet fewer people are waiting more than 18 weeks for their operation. Seven hundred thousand more people were treated for cancer in the last Parliament than the one before. Despite winter pressures, we have the fastest A&E turnaround times of any country in the world that measures them. There is more focus on safety than anywhere in the world post Mid Staffs, with 21 hospitals in special measures, seven that have exited special measures, and improvements in quality and safety at all of them.
There are more doctors and nurses than ever before in the history of the NHS. Public satisfaction with the NHS was up 5% last year; dissatisfaction is at its lowest ever level. The independent Commonwealth Fund found that under the coalition the NHS became the top performing health system of any major country—better than the US, Australia, France and Germany. That is not to say that there are not huge challenges, including the fact that by the end of this Parliament we will have a million more over-70s, so we need important changes, especially a focus on prevention, not cure. That means much better community care for vulnerable people so that we get help to them before they need expensive hospital treatment. Part of that is the integration of health and social care, which the right hon. Member for Leigh deserves credit for championing. It also means transformed services through GPs, including the recruitment of more GPs to expand primary care capacity, and a new deal that puts GPs back in the driving seat for all NHS care received by their patients.
Kate Green (Stretford and Urmston) (Lab)
The Secretary of State is right to emphasise the need for greater resourcing and support for GPs. What steps is he taking to help GPs with earlier diagnosis of complex cancers? Early diagnosis leads to more effective treatment and less need for hospitalisation.
Mr Hunt
The hon. Lady is right. This week we saw the results of the international cancer benchmarks study, which showed that our GPs take longer than GPs in Norway, Sweden, Canada and Australia to diagnose cancers, and we still have a survival rate that lags. This needs urgent attention. The chief executive of Cancer Research UK is putting together a cancer strategy for the Government that I hope will address this issue. We will bring the results of that to the House.
John Woodcock (Barrow and Furness) (Lab/Co-op)
Does the Secretary of State accept that the Better Care Together report on future services in Morecambe Bay put precisely that innovative focus on primary care and prevention, but that recognition of Morecambe Bay’s unique geography and extra funding are needed to implement it? The right hon. Gentleman said that he was sympathetic to that before the election. Has he now concluded that it is the way forward?
Mr Hunt
I will just make some progress.
Prevention also means transforming mental health services. I paid tribute earlier to my former colleague the right hon. Member for North Norfolk (Norman Lamb), who did a terrific job. I welcome in his place my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), the Minister for Community and Social Care, who I know will build on his legacy. It also means a big focus on public health, especially tackling obesity and diabetes. It remains a scandal that so many children are obese. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), is working hard on a plan to tackle those issues.
We must continue to make progress on cancer. We have discussed some of the measures that we need to take, but independent cancer charities say that we are saving about 1,000 more lives every month as a result of the measures that have already been taken. We want to build on that.
We have also talked about technology a number of times today. It will remain a vital priority to achieving the ends that I have described. In the last Parliament, I said that I wanted the NHS to be paperless by 2018. In this Parliament, I would like us to go further and be the first major health economy to have a single electronic health record shared across primary, secondary and social care for every patient. Alongside that, our plans to be the first country to decode 100,000 genomes will keep us at the forefront of scientific endeavour, ably championed by the Minister for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman).
Andrew Stephenson (Pendle) (Con)
I welcome what my right hon. Friend is saying about transforming services. He has mentioned Airedale hospital twice. I thank him for visiting Pendle a few weeks ago, and visiting Marsden Grange, one of my local care homes, where he saw the telemedicine service from the care home perspective. Will he say more about how telemedicine and improved technology in the NHS can help improve patient care?
Mr Hunt
Yes, I absolutely can. Let me give him one specific example. A couple of years ago, I noted a statistic that showed that 43 people died because they were given the wrong medicine by an NHS doctor or nurse. That problem could be avoided if doctors and nurses had access to people’s medical records so that they could see whether patients had allergies and give them the right medicine. The previous Labour Government had a crack at electronic health records. It was not successful, but they were right to try. We have to get it right if we are to have the best health service in the world. I am committed to that.
Steve Rotheram (Liverpool, Walton) (Lab)
The Secretary of State will know that prevention is better than cure. He spoke about parity of esteem for mental health services. I wrote to him last year about a teenager who was threatening to commit suicide. He had been given a counselling appointment through his GP four weeks ahead, even though the kid was saying that he was going to kill himself that day. What will the Secretary of State do about improving counselling services to stop young people wanting to take their life because their appointment is many months away?
Mr Hunt
The hon. Gentleman is right to raise that issue. The previous Minister with responsibility for mental health set up the crisis care concordat, which he got all parts of the country to sign up to, to provide better care. There is a big issue with the quality of child and adolescent mental heath services provision. We want to cut waiting times for people in urgent need of an appointment, so I recognise the problem and I hope that the hon. Gentleman will give us some time to bring solutions to the House.
Bill Esterson
The Secretary of State has spoken of the importance of people’s ability to secure hospital appointments. The same applies to GP services, but when I wrote to him about my constituents’ difficulties in securing appointments with their GPs, he told me that that was the responsibility of NHS England, not his Department. Will he now recognise that he must take responsibility for dealing with the problems of GP surgeries, so that my constituents, and those of every other Member, can make appointments with their family doctors when they need them?
Mr Hunt
I absolutely do recognise that. One of my key priorities is to deal with the issues of GP recruitment and the GP contract, and to make general practice an attractive profession again. If we are to deal with prevention rather than cure, vulnerable older people in particular will need more continuity of care from their GPs, and we must help GPs to provide it.
None of those big ambitions will be achieved, however, if we do not get the culture right for the people who work in the NHS. One of the reasons that Mid Staffs—and, indeed, so many other hospitals—was in special measures was the legacy which, for too long, put targets ahead of patients. We should never forget that Mid Staffs was hitting its A&E targets for most of the time during which patients in the hospital were experiencing appalling care. In that context, Sir David Nicholson used the phrase “hitting the target and missing the point”.
Through the toughest inspection regime in the world, we are slowly changing the culture to one in which staff are listened to and patients are always put first. However, although we identify hospitals that are in need of improvement much more quickly, we are still too slow in turning them around. I know that the new hospitals Minister, my hon. Friend the Member for Ipswich (Ben Gummer), will be looking closely at that, and I warmly welcome him to my team. Like me, he believes it is wrong that we have up to 1,000 avoidable deaths every month in the NHS, that twice a week we operate on the wrong part of someone’s body, that twice a week we leave foreign objects in people’s bodies, that almost once a week we put on the wrong prosthesis, and that people die because they are admitted on a Friday rather than a Wednesday.
We will leave no stone unturned in our quest to make a seven-day NHS the safest healthcare system in the world. Nye Bevan’s vision was not simply universal access or healthcare for all. The words that he used at this Dispatch Box nearly 70 years ago, in 1946, were “universalising the best”, which meant ensuring that the high standards of care that were available for some people in some hospitals were available to every patient in every hospital. Our NHS can be proud of going further and faster than anywhere in the world to universalise access, but we need to do much more if we are to complete Bevan’s vision and universalise quality as well. The safest, highest-quality care in the world, available seven days a week to each and every one of our citizens: that must be the defining mission of our NHS, and this Conservative Government will do what it takes to deliver it.
Andy Burnham
That is exactly the point. When we are in a crisis like this, short-term, knee-jerk cuts are made, which make the situation wrong in the long term.
When I raised these deficits in the election campaign, the Secretary of State said I was scaremongering, but just two weeks after the election the truth emerged. [Interruption.] He says I was, but we now know the truth. There was an £822 million deficit in the NHS last year, a sevenfold increase on the previous year. [Interruption.] The Secretary of State says he is dealing with it. That is not good enough. That is appalling mismanagement of the NHS. Financial grip in the NHS has been surrendered on this Secretary of State’s watch, and things are looking even worse this year. Far from scaremongering, these issues are real and should have been debated at the last election. The NHS is now facing a £2 billion deficit this year. As my hon. Friend the Member for Warrington North (Helen Jones) said earlier, that will mean cuts to beds, to staff and to services.
Mr Jeremy Hunt
The right hon. Gentleman talks about appalling mismanagement. Why did we have that growth in deficits? We had it because those hospitals were, in the wake of the Francis report and the appalling tragedy at Mid Staffs, desperately trying to make sure they did not have a crisis of short-staffed wards. If there was any appalling mismanagement, it was when the right hon. Gentleman was Health Secretary; he left behind an NHS where there were too many wards and too many hospitals that did not have enough staff. We are doing something about that. That is not mismanagement; that is doing the right thing for patients.
Andy Burnham
I am grateful that the Secretary of State has intervened because yet again he has got his facts wrong. Am I not correct in saying that in the first two years of the last Parliament the Government cut staffing further from the levels I left by 6,000? [Interruption.] No, he and his predecessor cut nurse places by 6,000 in the first two years of the last Parliament. Separately, they cut nurse training places, leading to a shortfall in nurse recruitment of around 8,000 in the last Parliament. When the Francis report was published, the NHS had fewer staff than it had in 2010 and fewer nurses coming through training.
The Secretary of State likes to blame everybody else, but how about taking a bit of blame himself for once? He left the NHS in the grip of private staffing agencies, and since the Francis report a small fortune has had to be spent on private staffing agencies. The figures have gone through the roof on his watch and he has failed to do anything about it. That is why people will not believe that the NHS is safe in his hands.
Health Services: East of England
Jeremy Hunt Excerpts(10 years, 3 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
In November 2011, Hinchingbrooke Health Care National Health Service Trust entered into a franchise management contract with Circle Hinchingbrooke Ltd. Circle Hinchingbrooke Ltd has issued a termination notice to the contract, and arrangements have been put in place for the trust to revert to operating independently again with effect from 1 April 2015.
Hinchingbrooke Health Care National Health Service Trust has always remained an NHS trust with all of the buildings and equipment owned by the trust, and all full-time staff apart from some of the executive leadership employed by the NHS. Responsibility for running the trust will return to the NHS as of 1 April. A new board has been appointed to run the trust, led by Alan Burns as the chair.
To ensure minimal disruption to services at the trust, Circle will continue to provide certain procurement services for a limited period to allow for a long-term plan to be put in place.
As for every provider of NHS services, the priority at Hinchingbrooke Health Care NHS Trust will continue to be the provision of safe, high-quality services to patients. To address the concerns raised by the chief inspector of hospitals in the CQC report, the NHS Trust Development Authority has appointed an improvement director as part of the special measures regime now in place at Hinchingbrooke Health Care Trust.
The trust will be supported to ensure a smooth transition to the new arrangements and to ensure continuity of all services provided by the trust, protecting care for patients and providing security for trust staff.
[HCWS484]
Infected Blood
Jeremy Hunt Excerpts(10 years, 3 months ago)
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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(10 years, 3 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I am responding on behalf of my right hon. Friend the Prime Minister to the 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(10 years, 3 months ago)
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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?
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(10 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
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.
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.
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?
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.