Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 17th November 2015 Commons Chamber

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

By 2020, all patients admitted to hospital in an emergency will have access to the same level of consultant assessment and diagnostic tests, whichever day of the week they are admitted.

[Michael Tomlinson]

With mortality rates at weekends suggesting that there is an increased risk of dying, does the Secretary of State recognise the importance for Dorset of getting right the proposal for a new emergency hospital in the Poole and Bournemouth area and ensuring that there are specialist consultants 24/7?

[Mr Hunt]

I thank my hon. Friend for raising that issue, which is incredibly important for his constituents and for Dorset as a whole. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who has responsibility for hospitals, will be going there very soon. The clinical standard says that anyone admitted to hospital in an emergency should be assessed by a consultant within 14 hours. Across every day of the week and all specialties, that happens in only one in eight of our hospitals. That is why it is so important to get this right.

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

Bootham Park mental health hospital and York’s place of safety shut with four working days’ notice, so York no longer has a seven-day service, nor even a one-day service in our hospital. That would have been totally avoidable if one NHS body had overarching responsibility for patient safety. Will the Secretary of State agree to meet me and to have an independent inquiry so that mental health patients are not put at serious risk again and we can have a full seven-day service before 2020?

[Mr Hunt]

Obviously, I am very concerned to hear what the hon. Lady says. I know that my right hon. Friend the Minister of State has been looking at this issue and is very willing to talk to her about it. Alternative provision has been made, but she is right to make sure that her constituents have access to urgent and emergency care seven days a week.

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

Does my right hon. Friend agree that full hospital services does not mean full services in every hospital, and that if we are to achieve our ambition of driving down excess weekend deaths, we will have to look again at concentrating services in regional and sub-regional centres, and, in addition, make sure that we network properly among smaller hospitals, where they exist?

[Mr Hunt]

My hon. Friend speaks very wisely on this issue. Yes, this is not about making sure that every hospital is providing every service seven days a week. It is about making sure that in an urgent or emergency situation, people can access the care they need and that, for example, high dependency patients are reviewed twice a day, even at the weekends, by consultants. That happens across all specialties in one in 20 of our hospitals, which is why it is so important to get this right.

[Ms Margaret Ritchie (South Down) (SDLP)]

What assessment has the Department made of the impact of reduced accident and emergency hours, and what effect will that have on the implementation of a seven-day work plan?

[Mr Hunt]

I am not quite sure I understand what the hon. Lady is referring to. We are not reducing A and E hours; we are investing. We have nearly 2,000 more consultants in our A and E departments than five years ago and we need to support strong A and E departments as much as possible.

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

Over the weekend we learned of the close links between the leadership of the British Medical Association and the Labour party. It seems that the BMA is more interested in pushing its own political agenda than in securing the best deal for its members. Can my right hon. Friend assure me that he will hold his nerve and deliver the seven-day NHS that will make the NHS safer for our patients?

[Mr Hunt]

I can absolutely give my hon. Friend that assurance. This is essential for the constituents of all hon. Members, whichever side of the House they sit on, and this Government will always stand on the side of patients. The weekend mortality rates are not acceptable. That is why we are doing something about them.

[Daniel Zeichner (Cambridge) (Lab)]

Given the acute pressures on the national health service, we are a long way from the vision that the Secretary of State wants to achieve. I met the Indian Workers Association this morning. Thousands and thousands of care workers of Indian origin are trained nurses and could be in our NHS, but the bar for the language test has been set so high that they are excluded. Will the Secretary of State look again at the test?

[Mr Hunt]

I commend the extraordinary contribution made by NHS front-line workers of Indian origin. I have met the Indian doctors association, the British Association of Physicians of Indian Origin, and have had many discussions on that front. It is very important, however, that people speak good English if they are providing care in the NHS. There are real issues for clinical safety when the standard of English is not high enough. We have a lot of fantastic support from immigrants who do a great job on the NHS frontline, but good English is an absolute pre-requisite.

[Maggie Throup (Erewash) (Con)]

3. What steps the Government are taking to improve diagnostic testing in primary care.

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[Caroline Lucas (Brighton, Pavilion) (Green)]

9. What plans he has to introduce a new contract for junior doctors.

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

Junior doctors are the backbone of the NHS. It is highly regrettable that their union has let them down by refusing to negotiate a new contract that will be fairer for doctors and safer for patients, and deliver the truly seven-day services we all want.

[Oliver Colvile]

I thank my right hon. Friend for that answer, but has he had an opportunity to speak to medical schools about the new contract for junior doctors, especially the Peninsula medical school in my Plymouth, Sutton and Devonport constituency?

[Mr Hunt]

NHS Employers has regular discussions with the Medical Schools Council, which represents the Peninsula medical school. Although the training of doctors is not the specific contractual dispute that is in the headlines, it is something on which we could make significant improvements. We want to use this opportunity to work with medical schools and the royal colleges to see whether we can bring back some of the continuity of training that used to be such an important feature of junior doctors’ training.

[Caroline Lucas]

The person who has let down junior doctors is none other than the Secretary of State. Does he recognise how insulting it is to those doctors to imply that they are not already working seven days? Crucially, will he listen to the professionals—junior doctors and their senior counterparts who support them—and drop his threat to impose the contract so that meaningful talks can take place?

[Mr Hunt]

What exactly would the hon. Lady say to her constituents who are not receiving the standard of care that they need seven days a week, and will she stand side-by-side with them, or with a union that has misrepresented the Government’s position? We have been clear that there are no preconditions to any talks, except that if we fail to make progress on the crucial issue of seven-day reform, we of course reserve the right to implement a manifesto commitment. That must be the way forward, and I urge the British Medical Association to come and negotiate rather than grandstand, so that we get the right answer for everyone.

[Dr Sarah Wollaston (Totnes) (Con)]

I am deeply concerned about the impact on patient care caused by the proposed three days of industrial action, including two days of a full walk-out. Will the Secretary of State say what advance preparations are taking place to ensure patient safety? Will he reassure the House that there are no preconditions that will act as barriers and to which the BMA has to agree before negotiations can take place?

[Mr Hunt]

I absolutely give my hon. Friend that reassurance. There are no preconditions, and this morning I wrote again to the BMA to reiterate that point. Of course, if we fail to make progress we have to implement our manifesto commitments, but we are willing to talk about absolutely everything. I agree strongly with my hon. Friend that it will be difficult to avoid harm to patients during those three days of industrial action. Delaying a cancer clinic might mean that someone gets a later diagnosis than they should get, and a hip operation might be delayed when someone is in a great deal of pain. It will be hard to avoid such things impacting on patients, and I urge the BMA to listen to the royal colleges—and many others—and call off the strike.

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

It is 40 years since the last junior doctor strike—before I even started medical school. Given the ballot tomorrow, does the Secretary of State regret the antagonistic approach that he took before the summer towards senior and junior doctors? Should he instead have worked with them and not threatened to impose a contract so as to reach a stronger emergency seven-day service?

[Mr Hunt]

I do not know what the hon. Lady thinks is antagonistic about holding reasonable discussions with doctors for three years to try to solve the problem of seven-day care. Those discussions ended with the BMA, after two and a half years, walking away from negotiations last October. We made a manifesto commitment to have a seven-day NHS and to do the right thing for patients, and we simply asked the BMA to sit round the table and talk to us about it. I am confident that we can find a solution.

[Dr Whitford]

Claiming in July that senior doctors do not work outside 9 to 5 was perhaps felt to be antagonistic. Contrary to the figures quoted by the hon. Member for Dudley North (Ian Austin) last Monday, A&E figures for NHS England are 5% below those in Scotland. With such disappointing figures before we even get into winter or face a work-to-rule, and in the presence of eye-watering deficits, how does the Secretary of State plan to support hospital trusts through the winter?

[Mr Hunt]

I urge the hon. Lady to correct for the record her wholly untrue statement that I ever said that doctors do not work outside 9 to 5. That is exactly the kind of inflammatory comment that makes the current situation a whole lot worse than it needs to be. I have always recognised the work that doctors do at weekends, but I also recognise that we have three times less medical cover at weekends, which means that mortality rates are higher than they should be. On A&E performance, we are taking extensive measures to ensure that the NHS is prepared for winter. It will be a tough winter, but unnecessary and wholly avoidable industrial action by the BMA will make it worse.

[Sir Simon Burns (Chelmsford) (Con)]

17. Does my right hon. Friend agree that the failed attempt by the BMA to get an injunction against the General Medical Council to stop it issuing guidance on how doctors should behave responsibly towards patients if there were to be a strike undermines the BMA’s claim that it is putting patient safety first? Will he assure the House that the BMA will have no veto on a seven-day NHS? That was a Conservative party manifesto commitment and it is what the vast majority of people in this country want.

[Mr Hunt]

My right hon. Friend championed the cause of patients when he was a Health Minister, and we must continue to do the right thing for patients, which is also the right thing for doctors. It is wholly inexplicable that the BMA should try to gag the GMC and stop it issuing guidance to doctors about their professional responsibilities. Whatever the disagreements over the contract, the most important thing is to keep patients safe.

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

I am sure that both sides of the House genuinely appreciate the excellent work done by all staff in our NHS, which at a time of unprecedented strain relies more than ever on the goodwill of its employees to keep going. We have to support and value our staff, not criticise them and provoke them when there is disagreement. Calling junior doctors militant is not the way to end a dispute, and we have heard more of the same rhetoric this morning. Industrial action is always a last resort when negotiations have failed. Does the Secretary of State accept any responsibility for that failure?

[Mr Hunt]

I accept total responsibility for doing the right thing to save patients’ lives. I have to say that I think that any holder of this office would be doing wholly the wrong thing if they were to try to brush under the carpet six academic studies that we have had in the last five years that say we have higher mortality rates at weekends than we should expect. This Government are on the side of patients and we will do something about that.

[Philip Davies (Shipley) (Con)]

10. If he will take steps to reduce the number of children born with genetic problems due to marriages between first cousins.

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[Kate Hollern (Blackburn) (Lab)]

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

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

On Friday, I announced an ambitious plan to halve the rates of maternal deaths, neonatal harm and injury and still births by 2030 by learning from best practice in this and other countries. Following the tragic events in Paris, I know the House would also like my reassurance that we regularly review and stress test the NHS’s preparedness for responding rapidly to terrorist attacks. I have written to Madame Marisol Touraine, my French counterpart, to offer our solidarity and support. Vive la France!

[Kate Hollern]

Just after the election, the Health Secretary called childhood obesity a national scandal and made tackling health inequalities one of his key priorities. How will a flat-rate cut in the public health grant across all authorities, regardless of specific health challenges, as well as a further projected cut, under the reformulation, of £3 million in my constituency, help him to achieve his mission?

[Mr Hunt]

I gently say to the hon. Lady that we have to find efficiencies in every part of the NHS, and we are asking the public health world to find the same efficiencies as hospitals, GP surgeries and other parts of the NHS, but that should not be at the expense of services. I completely agree with her about childhood obesity, on which we will announce some important plans shortly.

[Mr Speaker]

Forgive me colleagues, but what we need at Topical Questions is short inquiries, without preamble, if we are to make progress. Let us be led in this exercise by Fiona Bruce.

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[Heidi Alexander (Lewisham East) (Lab)]

On Sunday, independent experts, the King’s Fund, the Nuffield Trust and the Health Foundation, had this to say about the coming winter:

“Expect the inevitable: more people dying on lengthening waiting lists; more older people living unwell, unsupported and in misery; and a crisis in Accident and Emergency.”

Are they all wrong?

[Mr Hunt]

They are right about the pressures on the NHS, which is why we are investing £5.5 billion more into it than Labour promised. Those pressures will be made a lot worse by the forthcoming strike, so will the hon. Lady clear something up once and for all: does she condemn the strike—yes or no?

[Heidi Alexander]

Let us be clear: if junior doctors vote for industrial action, one person will be to blame, and that person is the Health Secretary.

The Health Secretary does not want to admit that NHS funding is not keeping pace with demand and that over the last five years, his Government’s deep cuts to social care have left the NHS bleeding. Will he guarantee that every penny of the money his Department had set aside for implementing the now-postponed cap on care costs will go directly into funding social care?

[Mr Hunt]

That is the difference: the hon. Lady follows the unions; I lead the NHS. When Labour had a big choice whether to support vulnerable patients who desperately need better weekend care, they chose political expediency—and the whole country noticed.

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[Ruth Cadbury (Brentford and Isleworth) (Lab)]

T2. I strongly associate myself and my colleagues with the remarks of the Secretary of State about the atrocities in France this weekend. What assessment has the right hon. Gentleman made of the impact of housing problems on the difficult task of recruiting and retaining clinical staff, particularly nurses in London and London’s NHS?

[Mr Hunt]

I do think it is a serious problem. People find it hard to live near to the hospital at which they work, particularly where housing is very expensive. This is an issue that we are looking at closely.

[Julian Sturdy (York Outer) (Con)]

T8. Can the Secretary of State assure me that the NHS funding review that is currently under way will deliver a fairer formula for my constituents and many others across York and North Yorkshire by putting age and rurality—some of the biggest drivers of health costs—at the heart of this long overdue review?

[Margaret Greenwood (Wirral West) (Lab)]

T4. Can the Health Secretary explain how cutting £200 million from public health budgets is consistent with the emphasis on prevention and public health as set out in the five-year forward view?

[Mr Hunt]

I have already explained that, but I hope the hon. Lady will understand that we also need the Labour party to explain why it is committed to £5.5 billion less for the NHS over this Parliament than this Conservative Government, on the back of a strong economy that her party has never been able to deliver.

[Mrs Flick Drummond (Portsmouth South) (Con)]

T9. Some of our GP surgeries are finding it difficult to attract new GPs. What plans do the Government have to train new GPs and encourage them to work in areas where it is difficult to recruit?

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[Heidi Allen (South Cambridgeshire) (Con)]

For the avoidance of doubt, will the Secretary of State please repeat again that he will enter into completely open-minded, non-preconditional negotiations with the British Medical Association? The public need to see that we are approaching this matter with an open mind.

[Mr Hunt]

I am happy to confirm that we are willing to talk about absolutely anything with the BMA to avoid a dispute that would be very damaging to patients. We do, of course, reserve the right to implement our manifesto commitment to seven-day reforms if we fail to make progress in the negotiations, but at this time, in the interests of patients, the right thing to do is sit round the table and talk rather than refusing to negotiate and going ahead with the strikes.

[Simon Danczuk (Rochdale) (Lab)]

T7. Rochdale infirmary now has fantastic dementia provision which really meets the needs of local people. Will the Secretary of State observe the good practice there, and look into how it could be shared more widely?

[Mr Hunt]

I shall be happy to do that. We have made great progress in tackling dementia, and there are some very good examples all over the country, but we can still do a lot better. We now need to concentrate not just on dementia diagnosis, but on the quality of the care that we give people when they have been given such a diagnosis.

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[Norman Lamb (North Norfolk) (LD)]

Is the Secretary of State doing everything he can to ensure that we secure extra dedicated investment in mental health in the spending review? He will know that introducing the access rights that everyone else already enjoys requires hard cash. I am sure he will agree that we must end the outrageous discrimination against those who suffer from mental ill health.

[Mr Hunt]

I congratulate the right hon. Gentleman on his timing, given that the Prime Minister is now present. I assure him that we are committed to putting extra resources into the NHS, and to ensuring that we increase the proportion of those resources that go into mental health. I also congratulate the right hon. Gentleman on the mental health award that he received last week, which was extremely well deserved.

Junior Doctors Contract

Jeremy Hunt Excerpts

Wednesday 4th November 2015 Written Statements

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

This Government are completely committed to the values of the NHS—the same values that encourage aspiring doctors to take up a career in medicine.

Junior doctors are the backbone of the NHS, but the current contract has failed to prevent some working unsafe hours, and does not reward them fairly. We know also that they feel unsupported because consultants and diagnostic services are not always available in the evenings and at weekends.

Today a firm offer for a new contract has been published by NHS Employers. The new contract will be fairer for doctors, safer for patients and juniors alike, better for training, and will better support a seven day NHS.

This offer builds on the cast-iron guarantees that I have previously offered the British Medical Association (BMA) including that we would not remove a single penny from the junior doctors’ pay bill, and we would maintain average earnings for junior doctors. The proposals offer an 11% increase to basic pay, with further increases linked to progressing through training and taking on roles with greater responsibility—instead of being based on time served.

Our ambition for the NHS to be the safest healthcare system in the world is underpinned by reducing, not increasing, the number of hours junior doctors work each week. Juniors will be supported by improved contractual safeguards—the best protection junior doctors have ever had against working long, intense and unsafe hours. For example, no junior will be required to work more than a weekly average of 48 hours without consent and those who opt out of that legal limit in the European working time directive will not be able to work more than a weekly average of 56 hours. The number of hours that can be worked in any single week by any junior will be limited to 72, down from 91; there will be a 13 hour limit on shifts; and there will be no more than five consecutive long days or four consecutive nights, compared to the current contract which permits seven consecutive night shifts or up to 12 consecutive day shifts.

Putting patients first is the responsibility of employers and staff. Where doctors are asked to work in conditions that they believe are unsafe, including being asked to work patterns that put patient safety at risk, they will be asked to use reporting mechanisms available to them to raise the issue with the board of their trust, and reporting data will now be available for the Care Quality Commission (CQC) to use during inspections. We would expect trust boards to look at any such report and decide how to respond to it; and we would expect the CQC, when it carries out an inspection, to look at how the board has responded to this and other data reporting safety incidents and concerns—a tough new measure to ensure safe working.

In order to better support a seven day NHS, basic pay will increase by 11 % to compensate for an extension in plain time working on Saturdays during the day and on weekday evenings, and there will be enhanced rates for hours worked at nights, on Saturday evenings and Sunday. The Government have also decided that plain time will be extended only to 7pm on Saturdays, instead of 10pm on Saturdays, and want to improve training and ensure better clinical supervision from consultants as well.

We will offer new flexible pay premia for those training in hard-to-fill training programmes where there is the most need, such as general practice, emergency medicine and psychiatry, and we will protect the salaries of those who return or switch to training in these programmes. Junior doctors who take time off for academic research that is part of their NHS training, or which contributes to the wider NHS and improvements in patient care, will get additional pay premia to make sure they do not lose out.

Today, I have also written to all junior doctors in England confirming that no junior doctor working legal hours will receive a pay cut compared to their current contract during transition. Around three quarters will see an increase in pay and the rest will be protected. The exception to this is those who currently receive up to a 100% salary boost as compensation for working unsafe hours. Instead, new contractual safeguards will ensure they are not required to work unsafe hours at all. To see how the offer affects them, junior doctors can now log on to a pay calculator published by NHS Employers where they can calculate projected take home pay.

Our preference throughout has been, and continues to be, to reach agreement through negotiations. We have maintained that, in reforming the contract, we must put patients right at the heart of everything the NHS does every day of the week. A fair, sustainable contract with stronger safeguards, together with the greater availability of consultants at the weekends and evenings, is good for patients and good for junior doctors.

The details published today represent the Government’s offer in England, which will be for doctors and dentists in postgraduate training programmes overseen by health education England.

Since they withdrew from negotiations in October 2014—despite agreeing the need for change as far back as 2008—the BMA have refused to return to the table. In light of today’s announcement we hope that the BMA will now agree to return to negotiations.

[HCWS288]

NHS England: Mandate

Jeremy Hunt Excerpts

Thursday 29th October 2015 Written Statements

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

Today I am launching a consultation on the mandate to NHS England to 2020. The consultation will close on Monday 23 November, in preparation for the publication of a new mandate to NHS England following the Government’s spending review, to take effect from April 2016.

The mandate to NHS England sets the Government’s objectives for NHS England, as well as its budget. In doing so, the mandate sets direction for the NHS, and helps ensure the NHS is accountable to Parliament and the public. In accordance with the Health and Social Care Act 2012, the Secretary of State must publish a mandate each year, to ensure that NHS England’s objectives remain up to date.

This consultation document sets out, at a high level, how the Government propose to set the mandate to NHS England for the course of this Parliament. The mandate will be finalised in light of consultation responses and subject to the outcome of the Government’s spending review.

The new mandate will be based on the priorities this Government believe are central to delivering the changes needed to ensure that free healthcare is always there whenever people need it most. Our priorities for the health and care system as a whole are:

creating the safest, high quality health and care service in the world by securing high quality health and care services and seven day care to improve clinical outcomes;

maintaining and improving performance against core standards of access while achieving financial balance;

transforming out-of-hospital care to ensure services outside hospital settings are more integrated and accessible, and that every patient has routine access to a GP in the evenings and at weekends, as well as effective 24/7 access to urgent care. We will also strive to reduce the health gap between people with mental health problems and the population as a whole;

driving improvements in efficiency and productivity by reducing waste and inefficiency to ensure every penny delivers the maximum possible benefit to patient care;

improving and reducing variation in outcomes and quality of care at a national and local level;

preventing ill health and supporting people to live healthier lives by tackling obesity and improving quality of life for people with long term conditions such as diabetes and those with dementia; and

supporting research, innovation and growth, and influencing global health priorities.

The Government welcome views on the proposals and invite comments through the consultation process. The consultation document can be accessed online at:

http://www.gov.uk/government/consultations/setting-the-mandate-to-nhs-england-for-2016-to-2017.

[HCWS274]

Junior Doctors’ Contracts

Jeremy Hunt Excerpts

Wednesday 28th October 2015 Commons Chamber

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

I beg to move an amendment, to leave out from “House” to the end of the Question and add:

“welcomes the Government’s commitment to delivering seven-day hospital services and saving lives by combating the weekend effect; notes the British Medical Association’s (BMA) decision to walk away from negotiations to reform a contract which all sides acknowledge is not fit for purpose; further notes the Government’s proposed introduction of new contractual limits which protect staff from working unsafe hours and the commitment that average junior doctors’ pay will not fall; and calls on the BMA to put patient care first, to choose talks over strikes, and to return to negotiations.”.

I warmly welcome the hon. Member for Lewisham East (Heidi Alexander) to her post at her first Opposition day debate.

One Saturday in April 2006 a 20-year-old man called John Moore-Robinson was out mountain biking with his friends in Cannock Chase when he fell off his bike and the handlebars hit his stomach. His friends dialled 999 and he was rushed to hospital. Although the paramedic who took him to hospital thought he had life-threatening internal bleeding, instead of being treated he was left for 50 minutes, apart from a brief examination. Then he was told he had bruised ribs and sent home. In fact, he had a ruptured spleen and tragically died later that Saturday night.

Tragedies happen in any healthcare system, and despite such stories I am fiercely proud of our NHS and the brilliant care given by our doctors and nurses seven days a week. The hon. Lady was right to thank each and every one of them. Anyone who uses such stories to denigrate the NHS should remember that last year the Commonwealth fund rated us the best healthcare system of 11 major countries—better than France, Germany, Australia or the US—and rated our A and E departments —[Interruption.] It was the Opposition who called this debate, so they might want to listen to some of the arguments. This is a very important issue about the lives of NHS patients, and I am saying that the tragedies and the problems we have should not be used to denigrate the NHS or our A and E departments.

Part of being the best in the world is being honest about where we need to improve, and the fact remains that in our hospitals today we have around three times less medical cover at weekends. In our manifesto in May this Government committed to a truly seven-day NHS so that we prevent a repeat of the tragedy that happened to John Moore-Robinson.

[Ms Gisela Stuart]

The Secretary of State is absolutely right that we need to address the fact that there seems to be less cover at the weekends. He is trying to circle that square without expanding the number of doctors and the services. He is thinning the service on Monday to Friday to bring more cover to the weekends. That does not solve the problem.

[Mr Hunt]

I am happy to deal with that. We went into the election in May saying that on the back of a strong economy we were prepared to commit £10 billion extra to the NHS in real terms over the course of this Parliament. That was £5.5 billion more than the hon. Lady’s party was prepared to commit. In the last Parliament, when the increase in NHS spend was half that amount, we increased the number of doctors by 9,000, so we are increasing the number of doctors, but as we do so we need to ensure that we give the right care to patients.

I want to give a word of caution to the shadow Secretary of State. The tragedy of John Moore-Robinson, the gentleman I have mentioned, happened not only on a Saturday, but at Mid Staffs. The last time the House discussed the difference between excess and avoidable deaths was under a Labour Government, when they tried to brush the problems at Mid Staffs under the carpet, saying that we should not take the figures on excess deaths too seriously because they were a statistical construct and different from avoidable deaths. I would have hoped that the Labour party learned the lessons of Mid Staffs and would not make the same mistakes again. [Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. The hon. Member for Islington South and Finsbury (Emily Thornberry) may shake her head, but I expect voices in the Chamber to be a little quieter. I want to hear the Secretary of State, and I think all our constituents do. I understand that you might not agree.

[Mr Hunt]

Let us look at some of the facts. What is the most important thing for people admitted to hospital at the weekend? It is that they are seen quickly by a consultant. Currently, across all key specialties, in only 10% of our hospitals are patients seen by a consultant within 14 hours of being admitted at the weekend. Only 10% of hospitals provide vital diagnostic services seven days a week. Clinical standards provide that patients should be reviewed twice a day by consultants in high-dependency areas but, at weekends, that happens in only one in 20 of our hospitals across all key services.

[Helen Whately (Faversham and Mid Kent) (Con)]

Is the Secretary of State shocked, as I am, that the shadow Health Secretary seemed to say that the NHS should continue as it is, and that she appears to deny the weekend effect, which means that people are dying unnecessarily?

[Mr Hunt]

Yes, I am shocked. I am really shocked about the suggestion that there is a difference between what is right for patients and what is right for doctors. The shadow Secretary of State spent a lot of time talking about morale. The worst possible thing for doctors’ morale is their being unable to give their patients the care they want to give.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

Does the Secretary of State not see anything perverse in making the case for a seven-day NHS—he has repeatedly done so—while drawing up a junior doctor contract that financially penalises doctors who already work evenings and weekends? How can that make any sense?

[Mr Hunt]

The contract will not do that. The contract we are proposing will give more reward to people who work the most antisocial hours. I will explain the details of that later.

The shadow Secretary of State talked about academic studies, so let us look at what the academic studies on the weekend effect say. The Freemantle study, published in the British Medical Journal, which is owned, incidentally, by the British Medical Association, said in September that the mortality rate for those admitted to hospital on a Sunday is 15% higher than for those admitted on a Wednesday. It said the weekend effect equated to 11,000 excess deaths. Let us be clear about what that means. It does not mean that every one of those 11,000 deaths is avoidable or preventable—it would be wrong to suggest that. It means that there are 11,000 more deaths than we would expect if mortality rates were the same as they are on a Tuesday, Wednesday or Thursday. Professor Sir Bruce Keogh, the NHS England medical director, called it

“an avoidable ‘weekend effect’ which if addressed could save lives.”

It is not just one study. In the past five years, we have had six independent reviews. Another study in the British Medical Journal, by Ruiz et al, states:

“Emergency patients in the English, US and Dutch hospitals showed significant higher adjusted odds of deaths…on Saturdays and Sundays compared with a Monday admission.”

The Academy of Medical Royal Colleges—the body that represents all the royal colleges—said in 2012 that deficiencies in weekend care were most likely linked to the absence of skilled and empowered senior staff and the lack of seven-day diagnostic services.

[Norman Lamb (North Norfolk) (LD)]

rose—

[Mr Hunt]

I am happy to give way to my former colleague.

[Norman Lamb]

During my travels across the country, I recently spoke with the chief executive and the chair of an acute trust. They said that they have no difficulty at all with junior doctors and ensuring that there is cover at weekends; their problem is with consultants—and the Secretary of State has just made that point. Has he not chosen the wrong target?

[Mr Hunt]

Chief executives of trusts and NHS employers have been very clear that this is about reform of contracts for both consultants and junior doctors, because the reduction in medical cover at weekends happens with both the consultant and the junior doctor workforces. Also, as I will go on to say, it puts huge pressure on junior doctors at the time when they do not have senior support and the ability to learn from it, and that is exactly what we want to sort out.

Junior doctors are not to blame for the weekend effect. The situation would actually be far worse without them, because they perform the lion’s share of medical evening, night and weekend work. In many ways, they are the backbone of our hospitals. However, the BMJ study this year showed that there is evidence that junior doctors felt clinically exposed at weekends, and nothing could be more demotivating for a doctor than not being able to give the standard of care they want for a patient.

[Mary Creagh (Wakefield) (Lab)]

The right hon. Gentleman has prayed in aid the weekend effect and quoted Sir Bruce Keogh, his own NHS medical director. Is he aware that Professor Keogh has also said that

“it is not possible to ascertain the extent to which these excess deaths may be preventable; to assume they are avoidable would be rash and misleading”?

[Mr Hunt]

Yes, and I agree with that, but it would be equally rash and misleading to say there are no avoidable deaths. Professor Keogh was saying that lives could be saved if we tackled this. All these studies are saying that 15% more people die than we would expect if we had the same level of cover at weekends as we have during the week. Therefore, as he says, the moral case for action is unanswerable.

[Jeremy Lefroy (Stafford) (Con)]

The hospital to which my right hon. Friend referred earlier is in my constituency. The accident and emergency department has improved hugely over the past few years—well over 95% of patients are seen within four hours—and one reason for that is that it has consultant cover all the time. It is not open 24/7—we want it to be—but for the 14 hours a day that it is open, it has consultant cover all the time.

[Mr Hunt]

My hon. Friend is absolutely right. The fact is that this is a package designed to ensure that we eliminate the weekend effect, and it involves both junior doctors and consultants, because they both have their part to play.

[Emily Thornberry]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress before taking any further interventions.

The question for a Government and for a Health Secretary is this: when we are faced with this overwhelming evidence—six studies in five years—should we take action or ignore it? We are taking action. That is why in July I announced that we will be changing the contracts for both consultants and junior doctors as part of a package of measures to eliminate the weekend effect. If we believe in the NHS, and if we want it to be there for everyone, whatever their background or circumstances, we must be able to offer every NHS patient the promise of the same high-quality care, whichever day of the week they need it.

Let me set out for the House what I have proposed. We announced ambitious plans to roll out seven-day services across the country, with better weekend staffing across medical, diagnostic and support services in hospitals, as well as better integration with social care and seven-day GP access. That will reach a quarter of the population by March 2017, and the whole country by 2020. For consultants, we proposed an end to the right to opt out of weekend working, replacing it with a maximum obligation to work one weekend in four. To its credit, the BMA’s consultants committee has agreed to negotiate on that.

For junior doctors, we proposed to reduce the high overtime and weekend rates, which prevent hospitals from rostering enough staff at weekend, and increase basic pay to compensate. We have made a commitment that the pay bill as a whole would not be reduced, and today I can confirm that not a single junior doctor working within the legal limits for hours will have their pay cut, because this is about patient care, not saving money. Incidentally, I made it clear to the BMA at the beginning of September that that was a possible outcome of negotiations, in an attempt to encourage it to return to the negotiating table. Rather than negotiating, it chose to wind up its own members and create a huge amount of unnecessary anger.

[Mark Spencer (Sherwood) (Con)]

Given the Secretary of State’s assurance, is there any reason why the BMA should not come back to the table and negotiate with him to solve this problem so that patients are safer at weekends?

--- Later in debate ---

[Mr Hunt]

There is no reason whatsoever. What was strikingly absent from the shadow Health Secretary’s comments was an entreaty to the BMA asking it to come and negotiate. Labour Members can play a constructive role in this, but so far they have declined to do so.

[Emily Thornberry]

Is the right hon. Gentleman going to continue with his plan to change the rules so that trusts that insist on doctors working unsafe hours can no longer be fined for doing so? It will help if he can assure us that those rules will continue and trusts will be fined if they break them.

[Mr Hunt]

They are not fines; they are perverse incentives to doctors to work unsafe hours. We want to go one better than that. We propose to stop hospitals requiring doctors to work five nights in a row or six long days in a row, and to bring down the maximum number of hours that hospitals can ask a doctor to work in any one week. On top of that, we have imposed the toughest hospital regime of any country anywhere in the world that comes down very hard on hospitals that are not providing safe care.

[Lady Hermon (North Down) (Ind)]

rose—

[Norman Lamb]

rose—

[Mr Hunt]

I am going to make some progress before I give way again.

[Norman Lamb]

rose—

[Mr Hunt]

As the right hon. Gentleman is my former colleague, I will give way once more.

[Norman Lamb]

I want to ensure that I fully understand the commitment that the Secretary of State gave about not a single doctor losing out. I think he said that that is “provided they are working within maximum legal hours”. Does that mean people working up to 48 hours, which is the maximum working week under the working time directive? What about doctors who have opted out of that and are working 60 or 70 hours? Could they lose out?

[Mr Hunt]

It applies to all doctors working within the legal limit. If they opted out of the working time directive, it would apply up to 56 hours. For people who are working more than the legal limits, even after opting out, the right answer is to stop them working those extra hours because it is not safe for patients. But yes, that is the commitment to people even if they have opted out.

[Lady Hermon]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress, if I may.

As well as reducing the maximum hours a doctor can be asked to work from 91 to 72 in any week—a significant reduction—and banning hospitals from requiring doctors to work five nights in a row or six long days in a row, as hospitals can currently make them do, we propose to ban the routine use of fixed leave arrangements that mean that some doctors have to give up to three months’ notice before taking leave, meaning that they miss out on vital family or personal occasions.

We did not, and do not, seek to impose a new contract; rather, we invited the BMA to negotiate a new contract so that we could end up with a solution that was right for doctors and right for patients. However, because we had recently won an election in which a seven-day NHS was a manifesto commitment, we said that having tried to negotiate this unsuccessfully for two and a half years, we would ask trusts to introduce new contracts if we were unable to succeed in negotiations.

[Lady Hermon]

I have a specific point about Northern Ireland. Of course, health is devolved to the Northern Ireland Assembly, but I can assure the Health Secretary that junior doctors in Northern Ireland are absolutely furious about the proposed changes to their contracts. It would help if he could confirm that he is in regular direct dialogue with the Health Minister in the Stormont Assembly, Simon Hamilton MLA. I ask him not to reply that officials talk to each other regularly, because “Minister to Minister” is what I would like to hear.

[Mr Hunt]

We do have regular dialogue. I suggest that the reason doctors in Northern Ireland might be angry is that they have been listening to misinformation about what the Government in England are proposing, which has, very disappointingly, made doctors all over the UK very angry. I hope that the assurances I am giving, which I gave to the BMA last month and the month before, face to face and in letters, will encourage the hon. Lady to report to the doctors she mentions that the right thing for the BMA to do is to come and talk to the Government. Regrettably, the BMA’s junior doctors committee has refused to negotiate since last June. Instead, it put up a pay calculator on its website that scared many doctors by falsely suggesting that their pay could be cut by between 30% and 50%. It has now taken that pay calculator down, but the damage to morale as a result of it continues.

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

Will the Secretary of State give way?

[Mr Hunt]

I will make some progress. Some people say that this is a battle between the interests of patients and those of doctors, but that is profoundly wrong. Doctors who are happy and supported in their jobs provide better care to patients, and the link between a motivated workforce and high-quality care is proven in many studies, as well as in hospitals such as that in Northumbria, where staff have become the greatest advocates for seven-day services since their introduction. Our proposed new system is intended to provide better support to doctors who work weekends, and make seven-day diagnostics more widely available across the NHS.

[Simon Hoare]

Given the clarity with which my right hon. Friend has addressed the principal concerns of junior doctors, does he expect the BMA’s junior doctors Committee to change its stance, come to the Department and restart negotiations, or will it continue to stall?

[Mr Hunt]

If the BMA is serious about wanting to do the right thing for doctors and patients, there is no reason for it not to negotiate with the Government to get the right solution. This is a test of how serious it is—my hon. Friend’s point is well made.

[Rachael Maskell]

This debate is reminiscent of 12 months ago and the “Agenda for Change”, when the Government refusal to negotiate with 1 million NHS staff caused industrial action and a strike. The same thing seems to be happening again. Will the Secretary of State take the shackles off the negotiations and enable the professionals to put their case on the table? Will he listen to them and let them lead negotiations?

[Mr Hunt]

That is exactly what I would like to happen, but it can happen only if members of the BMA walk through my office door—it is open—and sit down and start negotiating, which they have refused to do since last June. Just as it is wrong to pit doctors against patients, it is also wrong for the Labour party to pit the Government against doctors. In the previous Parliament, Labour wanted to cut the NHS budget, but we protected it. In May’s election we promised £5.5 billion more for the NHS than Labour did, and in the last Parliament a Conservative-led Government delivered 9,000 more doctors to the NHS, 1 million more operations a year, and 600,000 more people were referred for urgent suspected cancer every year.

Because we are not stopping at that, and because we are passionate that the NHS should offer the highest standards of care available anywhere in the world, the Government have also been honest about the problems facing the NHS. Two hundred avoidable deaths every week is too many—it is the equivalent of a plane crash every week. Nor is it acceptable that twice a week we operate on the wrong part of someone’s body, or allow other “never events” to happen. In many of those areas the NHS is performing at or better than international norms, but that does not make such things any more acceptable. We want the NHS to be the first healthcare system in the world to adopt standards of safety that are considered normal in the airline, nuclear or oil industries.

[Rehman Chishti]

The Secretary of State said that we are open to problems being highlighted. May I thank him for what he did by putting hospitals into special measures? Medway Maritime hospital had the seventh highest mortality rate in 2005, yet nothing was done. Support is now being given to that hospital to turn it around. We are highlighting problems, but we are also introducing measures to fix those problems.

[Mr Hunt]

I thank my hon. Friend for his consistent support for his local hospital. It has had many troubles, but it is beginning to show signs of turning a corner. If we want to turn things around, we must first be honest about the problem.

I welcome the shadow Health Secretary to her place. Her predecessor tried to minimise the care problems that took place under a previous Labour Government, and he described our attempts to put them right as trying to “run down the NHS”. I hope that she does not do the same. Labour used to be the party that stood up for ordinary men and women; it cared enough about them to set up the NHS, so that no one had to worry about getting good medical care, whatever their circumstances. People need to know that they can depend on our NHS seven days a week. Instead of making mischief about a flawed doctors contract that was introduced by a Labour Government in 2000, the hon. Lady should stand with us as we sort out this problem. Be the party not of the unions but of the patients who depend on high quality care, day in, day out. Professor Bruce Keogh talked about the moral and professional case for concerted action. Surely in that context, she might reconsider this rather ill-judged attempt to make party political capital out of a very real problem.

Everyone who cares about the NHS should want the same thing. The hon. Lady should tell the BMA to get around the negotiating table, something she conspicuously failed to do. In doing so she would stand alongside the many independent voices calling on the BMA to return to the table and discuss a solution with the Government—the Royal College of Surgeons, the Royal College of Physicians, NHS providers and the Academy of Medical Royal Colleges. If she does not do that, the British people will draw their own conclusion about which party is backing the NHS with the resources it needs, which party is supporting hospitals to become safer at the weekends, and which party is standing four-square behind doctors and nurses in their ambition to deliver high quality standards of care for patients. There is only one party that can be trusted, one true party of the NHS, and that is the Conservative party.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

There will be a four-minute limit on Back Bench speeches.

--- Later in debate ---

[Dr Whitford]

I totally agree. I also agree with the Secretary of State about patient safety. There is no one in the profession who does not want a seven-day emergency service that is strong and responsive to the needs of unwell patients, but we keep moving from people who are ill to routine services. He has said we must not call them avoidable, yet he just referred to 200 avoidable deaths a week, which is exactly what Bruce Keogh described as “rash and misleading”, and people object to that. There are no excess deaths at the weekend; the issue is with people admitted at the weekend, usually for radiology or investigation. Scotland has been moving on this for the last decade, by working with the profession, not pulling out the pin and throwing a grenade.

[Mr Jeremy Hunt]

For the sake of clarity, the 200 avoidable deaths are not about the weekend effect specifically, but come from the Hogan and Black analysis, which found that 3.6% of hospital deaths in England had at least a 50% greater chance of having been avoidable, which is separate from the weekend effect—the higher mortality rate among people admitted at weekends. None the less, where there are avoidable deaths—where death rates look higher than they should be—we have an obligation to do something.

[Dr Whitford]

I agree that it is important to investigate, but it is also important to understand the cause of the problem. A lot of the problem at Mid Staffs was the ratio of registered nurses to patients. That was echoed by Bray in his review of 103 stroke units, which showed that additional consultant ward rounds at weekends had no impact on death rates, while a better ratio of registered nurses reduced them by a third. We need to know the problem before spending billions trying to solve the wrong thing.

--- Later in debate ---

[Andrew Gwynne]

I do not have time to give way, I am afraid.

I echo those sentiments of sincere thanks, but we have heard of junior doctors who already work weekends, already work nights, already work holidays and give their all for their patients. Despite all this, the junior doctors now face a situation that has left them feeling deflated, demoralised and devalued.

Patient safety has been a key theme of today’s debate. Some Members have valiantly leapt to the Health Secretary’s defence, but those voices have been far outnumbered by Members who are deeply concerned that this contract is unsafe for doctors and unsafe for patients.

Members have argued that the removal of the financial penalties that apply to hospitals that force junior doctors to work unsafe hours risks taking us back to the bad old days of overworked doctors, too exhausted to deliver safe care. The BMA says this safeguard, which is built into the current contract, has played an important role in bringing dangerous working hours down. Removing this financial disincentive to overworked junior doctors is extremely alarming, especially at a time when junior doctors are already coming under an enormous amount of pressure and strain. If the Health Secretary would just listen, he would hear junior doctors shouting loudly and clearly that they cannot give any more.

Many Members highlighted the protests and marches that have taken place throughout the country in recent weeks. We had only to catch a glimpse of the placards that were waved as thousands of junior doctors marched against the contract to understand that those doctors now fear for their own health and well-being. I was struck by one banner which read, “I could be your doctor tomorrow, or I could be the patient”, and those doctors’ concerns have been echoed by many Members today. How can the Secretary of State possibly say that he is acting in the interests of patient safety if the very people who work in the NHS say he is putting safety at risk?

Another argument that has been advanced today is that the contract is necessary to ensure that our NHS works seven days a week. Not only does that argument do a huge disservice to our NHS staff who already provide care seven days a week and 24 hours a day, and reveal just how out of touch some Conservative Members are with the realities of working on the frontline in our NHS, but it is wholly inaccurate. If this junior doctor contract were imposed in its current form, it would have the opposite effect, as many independent clinical voices have warned.

It is a bitter irony that the problems that the new junior doctor contract was supposed to be trying to address when it was originally proposed back in 2012—the need to introduce better pay and work-life balance—are the very problems that will be made worse should the contract go ahead in its current form. In letters to the Secretary of State, the presidents of a number of royal colleges and faculties have made it very clear that they share those concerns, but he presumably thinks that they too have been misled.

The Secretary of State said that he did not intend to cut the pay of any junior doctor, but his sums simply do not add up, and everyone can see through the spin. No one with a GCSE in maths can believe that no doctor will be worse off as a result of the new contract. Let the right hon. Gentleman come to the Dispatch Box in the minute that I have left, and answer this question. To what percentage of junior doctors currently working within the legal limits will what the Secretary of State has said today apply? Is it 50%? Less than a quarter? What is it?

[Mr Jeremy Hunt]

All of them.

[Andrew Gwynne]

In that case, I ask the Secretary of State to explain this. If the pay envelope is not increasing, and if the pay is not being reduced, how can these sums add up? They just do not add up, and I suggest that he go back to night school and learn some basic arithmetic.

We know that the BMA has been conciliatory today: it has offered to speak to the Secretary of State again. I ask him, please, let us take this down a notch. Let us get him talking to junior doctors again. The simple fact is that these are the junior doctors who work in our A & E; these are the junior doctors who work in every department of every hospital on the frontline. They come in early and leave late, they already provide care for seven days a week, 24 hours a day, and they deserve a lot better than this Government.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 13th October 2015 Commons Chamber

[Mike Wood (Dudley South) (Con)]

6. What plans his Department has to increase capacity in general practice and primary care.

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

It is a pleasure to be back, Mr Speaker. By 2020, we will increase the primary and community care workforce by at least 10,000, including an estimated 5,000 doctors working in general practice, as well as more practice nurses, district nurses and pharmacists.

[Suella Fernandes]

Fareham community hospital is an example of Labour’s expensive PFI gone wrong. At a cost of £28 million, it remains underused, half-built and subject to complex governance structures. What will my right hon. Friend do to enable better use of this facility to allow provision for minor injuries, a GP practice and more primary care?

[Mr Hunt]

My hon. Friend is right, regrettably, that the PFI projects under the previous Labour Government created a lot of unsustainable debt. I know her local clinical commissioning group is meeting GP practices and working with community health partnerships to see if they can progress the idea she is campaigning for. I hope to visit her in the near future to discuss it myself.

[Mike Wood]

Will my right hon. Friend join me in welcoming the £2.7 million in vanguard funding given to Dudley to provide primary care services out in the community? This will not only improve the level of clinical and social services provided to people in Dudley South, but relieve pressures on Russells Hall hospital.

[Mr Hunt]

I welcome my hon. Friend to his post. I am not sure I have had a question from him before. I know quite a bit about the Dudley vanguard programme, because I shared a taxi to Manchester station with the entire Dudley team. They told me, at close quarters, about their exciting plans. What really struck me was how they are talking to different bits of the health and social care system in a way that has never happened before. It is really exciting and I think it really will be in the vanguard of what can happen in the NHS.

[Helen Jones (Warrington North) (Lab)]

Many people in my constituency are struggling to see a GP from Monday to Friday. Warrington has fewer GPs than it had in 2010, despite a rise in population. The number of unfilled GP vacancies quadrupled under the previous Government. How does the Secretary of State expect to produce a seven-day service when he cannot properly staff the service from Monday to Friday?

[Mr Hunt]

I shall tell the hon. Lady how I expect to do it. We are, in fact, making very good progress. By March next year, a third of the country will be able to access routine GP appointments at evenings and weekends. We do need more GPs. I agree with her that it takes too long to get a GP appointment, but we are doing something about it. That is why we have announced plans to recruit an estimated 5,000 more GPs. That will be a 15% increase in the number of GPs, the biggest increase in the history of the NHS.

[John Cryer (Leyton and Wanstead) (Lab)]

It is widely known that there is a serious lack of doctors who want to go into general practice. At the same time, the Secretary of State is guilty of an abject failure to engage with the British Medical Association in negotiations on junior doctors’ practices. On that basis, how the hell can he promise to increase general practice?

[Mr Hunt]

Just look at our track record in the previous Parliament: we increased the number of GPs by 1,700—a 5% increase. We are, on the back of a strong economy, putting in funding that will make it possible to increase that number even more. The hon. Gentleman talks about the BMA. I simply say that the people refusing to negotiate are not the Government, but the BMA.

[Several hon. Members rose—]

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

Unfortunately, every time I open a page of my local newspaper these days I am met with the beaming face of yet another general practitioner in his mid-50s who has decided to throw in his hand after many, many years of serving his community. These doctors are best placed to manage patients in primary care and ensure that they do not have to go to secondary care or A&E. What analysis has my right hon. Friend made of the reasons these experienced professionals are leaving the profession prematurely, and what will his reforms do to stem the tide?

[Mr Hunt]

My hon. Friend makes a very important point. We have done extensive analysis, because of our commitment to transform the role of general practice, of the issues. They include too much bureaucracy and form-filling, which means that doctors do not spend enough time with patients, and a sense that successive Governments have not invested in general practice and primary care. That is exactly what we seek to turn around with the “Five Year Forward View”.

[Ms Margaret Ritchie (South Down) (SDLP)]

What discussions have taken place with the devolved Administrations regarding the introduction of the new GP contract, particularly the junior doctor contract, given the exodus of junior doctors to Australia?

[Mr Hunt]

We also have Australian paramedics working in the UK, particularly London, so that traffic goes both ways, but, as the hon. Lady will know, health is a devolved matter, and people follow their own paths. For England, we are determined to eliminate the weekend effect. Every year, there are 11,000 excess deaths as a result of inadequate cover at weekends, and we do not want that to continue.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

2. How much additional investment there will be in children and young people’s mental health services in 2015-16.

--- Later in debate ---

[Chris Philp (Croydon South) (Con)]

3. What progress his Department has made in delivering seven-day-a-week NHS services.

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

Eighteen million patients will benefit from seven-day GP appointments by March next year, and seven-day hospital services will reach a quarter of the country by then.

[Chris Philp]

In my borough of Croydon, the clinical commissioning group is currently consulting on the possibility of having three seven-day-a-week, 12-hour-a-day combined minor injury and GP centres, with one at Purley hospital in my constituency. Can the Secretary of State confirm whether any additional funding is available from central Government to facilitate this seven-day-a-week service?

[Mr Hunt]

Yes, I can. I should have said that seven-day hospital services will be available to a quarter of the country by March 2017. We are putting an extra £10 billion into the NHS in the course of this Parliament, which will help in the roll-out of seven-day services—I hope in Croydon, as well. I commend my hon. Friend for his efforts in that respect.

[Alison McGovern (Wirral South) (Lab)]

I met a large group of junior doctors in my constituency on Friday, and we talked a lot about seven-day working. They asked me to put two things straight with the Health Secretary: first, the vast majority of junior doctors are already working seven days a week; and, secondly, on their contract, it was not terms and conditions that they were worried about, as I thought they were, but safety. In respect of those new contracts for junior doctors, what assessment has the Secretary of State’s Government made about patient safety?

[Mr Hunt]

I am very happy to do that, and to correct some of the misleading impressions given by the BMA about what the changes are. The changes are about patient safety. They are about the fact that someone is 15% more likely to die if admitted on a Sunday than on a Wednesday because we do not have as many doctors in our hospitals at the weekends as we have mid-week. I want to give better support to the doctors who work weekends by making sure that they have more of their colleagues and more consultants there, as well as proper safeguards, which I do not believe we have at the moment. I will be getting that message out, and I hope that the hon. Lady will, too, when she next meets her junior doctors.

[Sir Simon Burns (Chelmsford) (Con)]

I urge my right hon. Friend to continue on his drive to improve patient safety and to reduce avoidable harm in our NHS because that is crucial for patients and the professions.

[Mr Hunt]

I thank my right hon. Friend for his question, and for the interest that he showed in these issues when he was a Minister.

The reality is that about we have about 200 avoidable deaths every week in our hospitals. It is the same in other countries—this is not just an NHS issue—but it is a global scandal in healthcare, and I want England and our NHS to be the first to put it right. I think that that is consistent with NHS values, and consistent with what doctors and nurses all want.

[Heidi Alexander (Lewisham East) (Lab)]

It is good of the Secretary of State to join us today. If he had been here yesterday to discuss the small issue of the £2 billion NHS deficit, he would have heard me say that I hoped we could have a mature and constructive relationship.

As has already been said, junior doctors are key to the delivery of a seven-day NHS. The Secretary of State said recently:

“I don’t want to see any junior doctor have their pay cut.”

Can he now guarantee that no junior doctor will be paid less as a result of his proposed new contract? Yes or no?

[Mr Hunt]

I welcome the hon. Lady to her post. I hope that, just occasionally, we might agree on some things, although I suspect that today may not be one of those occasions.

Let me be absolutely clear about the commitment that we have made to junior doctors. We will not cut the junior doctor pay bill, but what we do need to change are the excessive overtime rates that are paid at weekends. They give hospitals a disincentive to roster as many doctors as they need at weekends, and that leads to those 11,000 excessive deaths. Let me gently say that that was a change to the doctors’ contracts made in 2003, so for members of the Labour party to say that this is nothing to do with them is not accurate, and they should help us to sort out the problem.

[Heidi Alexander]

I think it is fair to say that junior doctors will make up their own minds about that response.

Last week I received an e-mail about a seriously ill woman who had needed to be admitted to hospital over the weekend, but had stayed at home for two days because of recent interviews given by the Department of Health that had made her think

“that the NHS was not staffed at weekends.”

Her doctor went on to say:

“This delayed her operation, put her life in danger and ultimately will have cost the NHS more”.

Does the Secretary of State feel any responsibility for that?

[Mr Hunt]

Let me give the hon. Lady the facts. According to an independent study conducted by The BMJ, there are 11,000 excess deaths because we do not staff our hospitals properly at weekends. I think it is my job, and the Government’s job, to deal with that, and to stand up for patients.

The hon. Lady talked about being constructive. There is something constructive that she can do, which is to join the Royal College of Surgeons, the Royal College of Physicians and the Royal College of Nursing, and urge members of the British Medical Association not to strike but to negotiate, which is the sensible, constructive thing to do. Will the hon. Lady tell them to do that?

[Mr Peter Bone (Wellingborough) (Con)]

The question is about the seven-day NHS, but there is no point in our having a seven-day NHS if it is not an NHS across the country. I have a constituent with advanced prostate cancer who, as his oncologist says, needs docetaxel chemotherapy. In fact, all east midlands oncologists say that it is needed, but it is not provided by the NHS in my constituency, although it is provided in Birmingham. If we are to have a seven-day NHS, we need treatment across the board. Will the Secretary of State step in and do something about this?

[Mr Hunt]

I will look into the individual case that my hon. Friend has raised, but I think patients recognise that sometimes they need to travel further for the most specialist care, and can receive better care if they do so. However, the way in which what we are doing will help my hon. Friend’s constituents, and other people with cancer, is not just about consultants and junior doctors working at the weekends; it is about seven-day diagnostic tests, which will enable us to get the answers back much more quickly and catch cancers earlier.

[Catherine West (Hornsey and Wood Green) (Lab)]

4. What progress his Department has made in introducing a cap on care costs.

--- Later in debate ---

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

17. What additional financial support he is making available to the NHS to help it deal with winter pressures.

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

Some £400 million in resilience money has been invested in the NHS for this winter. Learning from previous years, we have put this money into the NHS baseline for 2015-16 so that the NHS can plan effectively at an earlier stage.

[Liz McInnes]

I thank the Secretary of State for his response. In my constituency we have an excellent and much-used facility—a walk-in centre in Middleton town centre—which is now threatened with closure. Will he support our campaign to keep it open? Does he agree that its closure would create more A&E attendances and increase winter pressures on our acute services?

[Mr Hunt]

I welcome the question and understand the hon. Lady’s concerns about the changes. She will understand that we do not direct these changes centrally and they are decided locally. One of the things we have to try to do is deal with the confusion a lot of people have at a local level as to what they should do when they have, for instance, a child with fever at the weekends and whether they require a GP, an urgent care centre or an A&E department. I would ask all CCGs to be very careful to make sure they sort out that confusion so NHS patients know exactly what they should do.

[Tulip Siddiq]

The Royal Free hospital in my constituency is at the cutting edge of medical research and is currently treating Ebola patient Pauline Cafferkey. I am sure the Secretary of State will join me in wishing her a speedy recovery, yet the hospital faced considerable winter pressures last year. Will the Secretary of State work with the fantastic nurses and doctors at the Royal Free to ensure these winter pressures do not happen again this year?

[Mr Hunt]

I thank the hon. Lady for her excellent question. I know that the whole House is thinking of Pauline Cafferkey and her family and that it is proud that, under Dr Mike Jacobs and his team, she is getting the most outstanding care that it is possible to get anywhere in the world. We all wish her a speedy recovery. With respect to winter pressures, I know that the Royal Free had a difficult winter but I also know that it has a very good management team and made heroic efforts. I know that the whole team of doctors and nurses will do an excellent job, and we will want to support them in any way we can.

[David Tredinnick (Bosworth) (Con)]

As part of my right hon. Friend’s plans for dealing with winter pressures, will he look at making greater use of the 63,000 practitioners on the Professional Standards Authority’s 17 accredited registers covering 25 occupations? Has he found time yet to read the authority’s report, “Accredited Registers—Ensuring that health and care practitioners are competent and safe”?

[Mr Hunt]

I must confess that I have not yet read that report, but my hon. Friend has reminded me of how important it is that I should do so. I will read it carefully while thinking about whether it could help us to get through the winter pressures this year.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering general hospital, the local clinical commissioning group and the Government are all agreed that the best way to help the NHS in north Northamptonshire to cope with pressures all year round, including in the winter, would be to develop a £30 million urgent care hub at Kettering general hospital. That project is with Monitor. What can the Secretary of State do to encourage Monitor to speed up its deliberations?

[Mr Hunt]

Once again, I thank my hon. Friend for his persistent campaigning on behalf of Kettering general hospital. It is a very busy hospital under a great deal of pressure, and I know that people work very hard there. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who has responsibility for hospitals, met campaigners from Kettering recently to discuss this issue, and I will bring the matter up with Monitor as well.

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

The Department of Health’s own figures show a dramatic change, from a £500 million surplus to a £100 million deficit in 2013, following the introduction of the Health and Social Care Act 2012. That deficit moved to £800 million last year and we have heard in the past week that it stood at more than £900 million from the first quarter of this year. Does the Secretary of State recognise that this situation has been exacerbated by the outsourcing and fragmentation of the NHS, which involves spending money on shareholder profits and tendering bureaucracy, rather than on patients?

[Mr Hunt]

I do not. That Act meant that we reduced the number of managers and administrators in the NHS in England by 19,000, saving the NHS £1.5 billion a year. The reason for the deficits that the hon. Lady talks about is that, around the same time, we had the Francis report on Mid Staffs, and hospitals in England were absolutely determined to end the scandal of short-staffing. However, agency staffing is not a sustainable way of doing that, which is why we are taking measures today to change that.

[Dr Whitford]

The Francis report recognised the problems of nursing levels. As hospitals will not be able to use agency staff or immigrant staff, how does the Secretary of State suggest they tackle the nursing ratios in hospitals?

[Mr Hunt]

If the hon. Lady looks at what has happened with permanent full-time nursing staff, she will see that the numbers have gone up in our hospitals by 8,000 over the past two years, so there are alternatives. We need to do more to help the NHS in this respect, and I will be announcing something about that shortly.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

10. What plans he has to review renewal arrangements for the issuing of NHS medical exemption certificates.

--- Later in debate ---

[Chris Skidmore (Kingswood) (Con)]

16. What steps his Department has taken to improve transparency in the NHS.

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

Last year I launched My NHS, where patients can see how safe their local hospital is and many other things. From next May, there will be overall information on the quality of mental health and cancer care.

[Chris Skidmore]

Does the Secretary of State share my view that driving up standards in the NHS is better achieved through a culture whereby providers can learn from their peers? For example the excellent maternity department at my local Cossham hospital recently received an outstanding rating from the Care Quality Commission. That is better than the old ways of doing things through targets driven by Whitehall.

[Mr Hunt]

I agree, and I congratulate the doctors and nurses working in the Cossham maternity unit. Southmead hospital in Bristol has some of the best maternity survival rates in Europe, so there is a lot of very good practice. The way to get the word out is through transparency of outcomes, not endless new targets, so my hon. Friend is absolutely right.

[Paula Sherriff (Dewsbury) (Lab)]

T2. If he will make a statement on his departmental responsibilities.

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

I would like to make a statement on measures the Government are taking to help NHS organisations tackle the deficits by reducing the cost of agency staff. Building on previously announced controls, from the end of November we will introduce maximum shift rates for all clinical staff employed through agencies, which will gradually decrease over time as the measures take effect and demand for agency staff reduces. In addition, we will work with each trust to limit or reduce the overall agency spend. Exceptional breaches of the limits will require advance agreement. Taken together, these measures are expected to improve patient care and reduce NHS agency staff spend by £1 billion over three years. The chief inspector of hospitals has confirmed that he believes this is the right thing to do.

[Paula Sherriff]

Like many Members across this House, I have been inundated with letters and emails from junior doctors who feel completely undervalued and undermined by the actions of this Government, so much so that thousands of them are leaving the UK. This weekend over 2,000 medics and students wrote to the Secretary of State, condemning him for his proposed unfair and unsafe changes to the junior doctors contract. What further evidence does he need to see that he has lost the confidence of the future leaders of the NHS, and does he think he can win it back?

[Mr Hunt]

Yes, I do. Let us be clear: this is about patient safety, about which every single doctor and nurse in the NHS is passionate. The problem is that the doctors whom the hon. Lady has met have been misled by their own union. This is not about cutting the pay bill for junior doctors, as the BMA has suggested. This is about safer care at weekends, reducing unsafe hours and doing the right thing for patients, and that is the right thing for doctors as well.

[Martin Vickers (Cleethorpes) (Con)]

T4. It emerged earlier this month that North East Lincolnshire CCG was operating a primary care incentive scheme intended to reduce outpatient referrals. Understandably, this has met with a hostile reception from my constituents, who fear it may affect decisions on their care. Will Ministers look into this scheme and either offer some reassurance or instruct the CCG to reconsider?

[Andrew Gwynne (Denton and Reddish) (Lab)]

Last week senior officials at Monitor reported being leaned on by the Department of Health to suppress the publication of financial figures ahead of the Conservative party conference. This week the Health Secretary has been accused of vetoing the release of impartial independent reports on measures that could reduce our consumption of sugar. Does he not understand that leadership on transparency must come from the very top? Will he now commit to practising what he preaches on NHS transparency and release this report immediately?

[Mr Jeremy Hunt]

I will take no lessons on transparency from the Opposition. Professor Sir Brian Jarman said that the Department of Health under Labour was a “denial machine” when it came to the problems of Mid Staffs. We have made the NHS more transparent than ever before, and we will continue to practise transparency.

[Mr Steve Baker (Wycombe) (Con)]

T6. What progress has been made towards the implementation of the Keogh review of urgent and emergency care?

[Mr Hunt]

We are making good progress and we expect to make a substantive announcement on that before the end of the year. That will be about improving the standard and the quality of care in A and E departments, which I know my hon. Friend has a great interest in, and removing the confusion that people feel about what precisely the NHS offer is in their area. It is looking good and I hope to have something to announce to the House before too long.

[Teresa Pearce (Erith and Thamesmead) (Lab)]

T3. A recent whistleblower revealed that the 111 helpline is in meltdown and at least two babies have died after staff failed to recommend treatment that may have saved them. Two weeks ago my own three-week-old premature granddaughter was very ill. Her parents called 111 and were promised that the duty doctor would call. He did not. They waited the whole long night and the next morning took her to A and E, and she was diagnosed with meningitis. What exactly is the Minister doing to fix the crisis in the 111 service?

[Mr Hunt]

This is a very serious issue and I will happily look into it personally to make sure that a full investigation is taking place into the incident the hon. Lady mentions, which clearly should not have happened. The 111 service has been an improvement on what we had before. It has taken nearly three times as many calls as the service it replaced, and around a quarter of those are referred to a clinician, but it is clearly not perfect, given the hon. Lady’s story, so I will look into the case that she raised.

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

T9. Patients in England wait 18 weeks for an operation, but in Wales, where Labour has run the NHS for the past 16 years, they wait 26 weeks. Does that not prove that only the Conservative party can be trusted to run the national health service?

--- Later in debate ---

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

To continue on the same theme—hopefully I am coming in at the right time, Mr Speaker—I chair the all-party group on patient safety, in collaboration with the Patients Association. We are about to look into hospital infections, and in Parliament in November I will launch a hand washing campaign. What is the Department of Health doing to promote infection control outside hospital settings?

[Mr Jeremy Hunt]

I thank my hon. Friend for her great interest in this issue and for the campaigning she did before entering Parliament, which I know stemmed from personal tragedy. This is an incredibly important issue. We face a crisis in global healthcare as a result of anti-microbial resistance, which means the current generation of antibiotics is no longer as effective as it needs to be. Proper hygiene in hospitals is therefore vital, and we have a lot of plans that I will be happy to share with her.

[Owen Thompson (Midlothian) (SNP)]

T7. What measures is the Secretary of State putting in place to recruit and retain GPs? Given that he has indicated recruiting 5,000, where does he plan to find them?

[Dr Sarah Wollaston (Totnes) (Con)]

Delayed publication of evidence is as damaging as non-publication, which is why we rightly expect clinicians, researchers and managers to publish their evidence and data in a timely and transparent manner. It is a matter of great regret to the Health Committee that we started our inquiry today without access to the detailed and impartial review of the evidence that we need to make a contribution to this inquiry. Will the Secretary of State please set out when he will publish it?

[Mr Jeremy Hunt]

I agree with my hon. Friend about the importance of transparency and publishing in a timely manner. I will look again at the planned publication date for the report she wants to see, which will be published so that Parliament can debate it properly. The normal practice is for advice to Ministers to be published at the same time as policy decisions are made, as happened with the Chantler review and the Francis report.

[Caroline Flint (Don Valley) (Lab)]

T8. The Royal College of Nursing reports that it is becoming clear that for the first time since the early 2000s there is a critical shortage of registered nurses in the UK. Both the UK and global nursing labour markets are changing, and our increasing reliance on alternative sources is not sustainable. In 2014, 37,645 students across the UK were turned away from nursing courses. Is it not time the Minister admitted that the situation is not good enough and that the Government need drastically to scale up those places to reduce dependency on overseas nursing staff?

[David Mowat (Warrington South) (Con)]

Last year the NHS paid £300 million to claimants’ lawyers. Indeed, for small and medium claims, the lawyers made two to three times as much as the claimants themselves. Is there more we can do to stop this abusive behaviour?

[Mr Jeremy Hunt]

There certainly is. We spend £1.3 billion every year on litigation claims—money that could be used to look after patients on the front line. The way to avoid spending that money is to have safer care, and that is why it is so important that we have a seven-day service.

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

T10. As the Secretary of State will know, the Scottish Government are once again in the vanguard in introducing crucial legislation—the Smoking Prohibition (Children in Motor Vehicles) (Scotland) Bill, which will eradicate more than 60,000 journeys per week where children are exposed to dangerous second-hand smoke. Will he advise on what plans are in place for the rest of the UK to follow Scotland’s example?

--- Later in debate ---

[Mr Jeremy Hunt]

The hon. Lady is absolutely right; we need more midwives. We recruited more midwives in the previous Parliament, and we do need to expand maternity provision as we have a growing birth rate. I am happy to look at the problems in her area. However, we also have a maternity review coming up early next year, led by Baroness Cumberlege, that will help us to address this problem sustainably.

[Philip Davies (Shipley) (Con)]

What health problems are caused by first-cousin marriages, and how much does dealing with those problems cost the NHS each year?

NHS Modernisation

Jeremy Hunt Excerpts

Tuesday 21st July 2015 Written Statements

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

The health and care reforms came into operation on 1 April 2013. They reshaped the NHS to give patients a stronger voice and give doctors, nurses and elected councillors more power to decide how best to use local resources to significantly improve services and patients’ health.

The National Audit Office subsequently reported that the transition to the reformed health system was successfully implemented and the savings in administration costs would far outweigh the implementation costs.

The Department of Health originally forecast the total cost of transition to be £1.5 billion. On publication of the Department’s annual report and accounts for 2014-15, I can today announce that the actual costs to 31 March 2015 are £1.38 billion, and total costs are forecast to be under £1.43 billion. The costs to 31 March 2015 comprises:

£473 million on staff redundancies;

£75 million on IT for the new organisations;

£88 million on estates costs of closing bodies and setting up new organisations;

£29 million on internal Departmental costs (e.g. programme management);

£323 million on setting up clinical commissioning groups (excluding items above); and

£395 million on other costs of closing bodies (e.g. PCTs) and setting up new organisations.

The Department of Health also originally forecast that between 2010-11 and 2014-15 the reforms would save the NHS £4.5 billion in lower administration costs, as well as a further £1.5 billion a year thereafter. I can today also announce that actual savings were far greater, in cash terms at £6.9 billion over this period, including £2 billion in 2014-15—and in 2010-11 prices comparable to the impact assessment £6.5 billion, including £1.8 billion in 2014-15. This means the Government have successfully achieved their aim to reduce NHS bureaucracy costs by a third.

By removing excessive layers of bureaucracy, the NHS has significantly reduced the number of managers it employs. For example, the reduction of central administrative staff by 18,000 since 2010 has helped the NHS to increase the number of professionally qualified clinical staff by over 23,500, including over 8,500 more nurses and over 9,000 more doctors. These extra clinicians are treating record numbers of patients. For example, compared to 2012-2013, in 2014-2015 the NHS admitted 600,000 more patients to hospital, saw 3.4 million more outpatients, and did 2.2 million more diagnostic tests.

[HCWS161]

NHS England

Jeremy Hunt Excerpts

Tuesday 21st July 2015 Written Statements

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

Today, I am laying before Parliament my annual assessment of the NHS Commissioning Board (known as NHS England) for 2014-15. The NHS Commissioning Board Annual Report & Accounts 2014-15 were also laid (HC109). Together these documents show an improving picture of performance, both in terms of delivering the Government’s mandate and more widely as an organisation. Copies of both documents will be available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

NHS England’s annual report sets out the progress that has been made in the last year in delivering the Government’s mandate as well as acting to reduce health inequalities, improve quality and encourage greater public and patient involvement in the health service. I am encouraged by its focus on improving efficiency and delivery across the health service and its plans to tackle those areas where improvement is required.

My annual assessment recognises the progress that NHS England has made, I have been impressed by the way in which NHS England has worked with organisations across the health system to develop the NHS Five Year Forward View. We are committed to this vision for a better NHS, which has generated consensus across the health system about how care needs to change to meet patients’ needs.

The assessment also sets out my expectations of NHS England for the year ahead. In particular we want to see the NHS make further progress on achieving parity of esteem for mental health and to address winter pressures including restoring and sustaining performance all year round against access standards. We also want to see NHS England strengthen commissioning assurance as well as working with the health system to deliver the productivity and efficiency savings identified within the NHS Five Year Forward View.

Overall NHS England has made good progress during 2014-15. We will continue to work closely with NHS England to address the significant challenges ahead that will require NHS England to work with organisations across the health system to deliver the new care models, along with the productivity and efficiency savings articulated in the NHS Five Year Forward View.

[HCWS165]

NHS Reform

Jeremy Hunt Excerpts

Thursday 16th July 2015 Commons Chamber

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

With permission, Mr Speaker, I would like to make a statement on measures to improve the safety culture in the NHS and further strengthen its transition to a modern, patient-centric healthcare system. The failings at Mid Staffs, detailed in the Francis report, were not isolated local failures. Facing up to widespread problems with the safety and quality of NHS care and learning the appropriate lessons has been a mission that the Government and the NHS have shared, with a common belief that the best way to deal with problems is to face up to them rather than wish that they did not exist.

Measures taken in the last Parliament include: introducing the toughest independent inspection regime in the world; more transparency on performance and outcomes than any other major healthcare system; new fundamental standards; a duty of candour; and the excellent recommendations by Sir Robert Francis QC. But because the change we need is essentially cultural, a long journey remains ahead. The Department of Health was described during the Mid Staffs era as a “denial machine”. We therefore have much work to do if we are to complete the transformation of the NHS from a closed system to an open one, from one where staff are bullied to one where they are supported, and from one where patients are not ignored but listened to.

Today I am announcing some important new steps, including: our official response to Sir Robert Francis’s second report, “Freedom to Speak Up”; our response to the Public Administration Select Committee report “Investigating clinical incidents in the NHS”; and our response to the Morecambe Bay investigation. I am also publishing Lord Rose’s report into leadership in the NHS—a key part of the way in which we will prevent tragedies such as these from happening again. I would like to thank everyone involved in writing those reports for their excellent work.

In his report “Freedom to Speak Up”, Sir Robert Francis QC made a number of recommendations to support this cultural change. All NHS trusts will appoint someone whose job is to be there when front-line doctors and nurses need someone to turn to with concerns about patient care that they do not feel able to raise with their immediate line manager. We will also appoint an independent national officer, located at the Care Quality Commission, to make sure that all trusts have proper processes in place to listen to the concerns of staff before they feel the need to become whistleblowers. Other changes will include providing information about raising concerns as part of the training for healthcare professionals and part of the curriculum for medical students, and placing a greater focus on learning from reflective practice in staff development.

Dr Bill Kirkup’s report into Morecambe Bay brought home to the House that there can be no greater pain than when a parent loses a child and then finds that pain compounded when medical mistakes are covered up. We will accept all the recommendations in this report, including removing the Nursing and Midwifery Council’s current responsibility and accountability for statutory supervision of midwives in the United Kingdom, and bringing the regulation of midwives into line with the arrangements for other regulated professions.

Likewise, we agree with the vast majority of the recommendations of the excellent PASC report into clinical incident investigations. In particular, we will set up a new independent patient safety investigation service by April 2016, based on the success of the “no blame” approach used by the air accidents investigation branch in the airline industry. It will be housed at Monitor/Trust Development Authority, which have the important responsibility of promulgating a learning culture throughout the NHS. Monitor/TDA will operate under the name “NHS Improvement”, and Ed Smith, currently a non-executive board member of NHS England, will become the new chair, with a brief to appoint a new chief executive by the end of September.

For NHS managers, Lord Rose’s report, “Better leadership for tomorrow”, makes vital recommendations to join up the support offered to NHS managers, to improve training and performance management, and reduce bureaucracy. He extended his remit to cover the work of clinical commissioning groups, which play a key role in the NHS, and today I am accepting all 19 of his recommendations in principle, including moving responsibility for the NHS leadership academy from NHS England to Health Education England.

These are important recommendations, which, in the end, all share one common thread: that the most powerful people in our NHS should not be politicians, managers or even doctors and nurses, but the patients who use it. Using the power of intelligent transparency and new technology, we now have the opportunity to put behind us a service where you get what you are given and move to a modern NHS where what is right for the service is always what is right for the patient.

A litmus test of that is our approach to weekend services. About 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals. Someone is 15% more likely to die if they are admitted on a Sunday than if they are admitted on a Wednesday. That is unacceptable to doctors as well as patients. In 2003-04, the then Government gave GPs and consultants the right to opt out of out-of-hours and weekend work, at the same time as offering significant pay increases. The result was a Monday-to-Friday culture in many parts of the NHS, with catastrophic consequences for patient safety.

In our manifesto this year, the Conservative party pledged to put that right as a clinical and moral priority. I am today publishing the observations on seven-day contract reform for directly employed NHS staff in England by the Review Body on Doctors and Dentists Remuneration—the DDRB—and the NHS Pay Review Body. They observe that some trusts are already delivering services across seven days, but this is far from universal. According to the DDRB, a major barrier to wider implementation is the contractual right of consultants to opt out of non-emergency work in the evenings and at weekends, which reduces weekend cover by senior clinical decision makers and puts the sickest patients at unacceptable risk. The DDRB recommends the early removal of the consultant weekend opt-out, so today I am announcing that we intend to negotiate the removal of the consultant opt-out and early implementation of revised terms for new consultants from April 2016. There will now be six weeks to work with British Medical Association union negotiators before a September decision point. We hope to find a negotiated solution but are prepared to impose a new contract if necessary. To further ensure a patient-focused pay system, we will also introduce a new performance pay scheme, replacing the outdated local clinical excellence awards, to reward those doctors making the greatest contribution to patient care.

I am also announcing other measures today to make the NHS more responsive to patients. Those include making sure patients are told about Care Quality Commission quality ratings as well as waiting times before they are referred to hospitals, so that they can make an informed decision about the best place to receive their care. NHS England will also develop plans to expand control to patients over decisions made in maternity, end-of-life care and long-term condition management, which I will report in more detail subsequently to the House. Finally, because the role of technology is so important in strengthening patient power, we must ensure that no NHS patient is left behind in the digital health revolution. I have therefore asked Martha Lane Fox, the former Government digital champion, to develop practical proposals for the NHS National Information Board on how we can ensure increased take-up of new digital innovations in health by those who will benefit from them the most.

When we first introduced transparency into the system to strengthen the voice of patients, some called it “running down the NHS”. Since then, public confidence in the NHS in England has risen 5 percentage points. By contrast, in Wales, which resisted this transparency, a survey has seen public satisfaction fall by 3 percentage points. Over the previous Parliament, the proportion of people who think that the NHS in England is among the best healthcare systems in the world increased by 7 percentage points, the proportion of those who think NHS care is safe increased by 7 percentage points and the proportion of those who think that they are treated with dignity and respect increased by 13 percentage points. That demonstrates beyond doubt the benefits of an open and confident NHS, which is truly focused on learning and continuous improvement.

As we make progress in this journey, we must never forget the people and the families who have suffered when things have gone wrong. In particular, there are the families and patients at Morecambe Bay and Mid Staffs, the whistleblowers who contributed to Sir Robert Francis’s work, and everyone who has had the courage to come forward in recent years to help reshape the culture of the NHS. Without their bravery and determination, we would not have faced up to the failures of the past or been able to construct a shared vision for the future. We are all massively in their debt. This statement remains their legacy, and I commend it to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement and for advance sight of it. Let me say at the beginning that I support much of what he said. I will focus my remarks on his plan for seven-day working, and then touch on some of the other issues he raised.

Ensuring that our health services are there for everyone whenever they are needed—be that a weekday or a weekend—should be our shared goal across this House for a 21st-century national health service. Illnesses do not stop at the weekend and nor should our NHS. Although we support the principle of what the Secretary of State is trying to achieve with seven-day working, and will work with him where possible, I urge some caution in the manner in which he is attempting to drive through these changes. His remarks contain no acknowledgment that the NHS right now is in a very fragile condition. It has gone backwards, not forwards, in recent times. A&E is in crisis, and primary care services are overwhelmed. There is a shortage of staff and an over-reliance on agency workers. Staff are demoralised and worn out. If he does this in the wrong way, many may walk away and that would make matters even worse. Given all that, it is not immediately clear how seven-day services can be delivered in the timeframe he has set out without significantly impacting on the rest of the NHS.

The Secretary of State said that around 6,000 people lose their lives every year because we do not have a proper seven-day service. Of course that is an appalling statistic, but is there not a risk of implementing seven-day services by simply spreading existing resources more thinly? A recent study published in “Health Economics” concluded:

“There is as yet no clear evidence that 7-day services will reduce weekend deaths or can be achieved without increasing weekday deaths.”

Will the Secretary of State tell us on what evidence he has based his announcement and, crucially, what steps he is taking to guard against what the study warns could be an increase in weekday deaths?

If the Secretary of State wants to make changes on this scale, it is vital that he works in partnership with NHS staff. I gently say to him that briefing headlines such as “Declaring war on doctors” have not got us off on the right foot, as doctors are already feeling worn out and put upon. The British Medical Association said:

“Today’s announcement is nothing more than a wholesale attack on doctors to mask the fact that for two years the Government has failed to outline any concrete proposals for introducing more seven-day hospital services.”

Will the Secretary of State take care to avoid provocative statements such as “Declaring war” and will he rethink the manner in which he is pursuing these negotiations? Talk of imposing deals at this stage is not helpful; it is premature and it would be better to proceed in a more constructive manner.

Staff across the entire hospital system—not just doctors —will be needed to run these services, but the Government confirmed only last week that many of them will face another five years of pay cuts. In total, that will amount to a decade of pay cuts. Has the Secretary of State looked at the detail of the Chancellor’s announcement on pay for NHS staff? Will he tell the House what effect he believes this deal could have on staff numbers and retention?

The Secretary of State said very little about how he will fund seven-day services, but given that the NHS is struggling to fund weekday services, it is likely to need significant investment over the next five years, over and above funding attached to the five-year forward view. Can he confirm that the money allocated to fund the five-year forward view does not include seven-day working? That is not specifically mentioned in the “Five Year Forward View”. If so, what extra funding will be made available specifically to deliver seven-day working, and when will this funding be available? The announcement today appears to be unfunded and it will not escape the House’s attention that the 2010 Conservative manifesto also promised to deliver seven-day services. The Secretary of State has a lot of convincing to do if he expects people to believe him this time.

In a statement last week in another place, Lord Prior, the Under-Secretary of State with responsibility for NHS productivity, said he was establishing an independent inquiry into extending charges in the NHS. This has sounded alarm bells among many patient groups. Will the Secretary of State say more about the terms of reference for this independent inquiry and when it will proceed with its work?

The Francis “Freedom to speak up” report contained a number of important recommendations to foster a more open culture and we support his work to implement them. The right hon. Gentleman will know that there have been a number of appalling examples of poor care in recent times at Orchid View, Oban Court and Winterbourne View, and these scandals were exposed only when undercover reporters infiltrated the care home. Will he look seriously at the idea of an independent body to receive complaints from NHS staff and social care staff so that they are not faced with the problem of always going to their employer if they are to blow the whistle?

I welcome what the Secretary of State had to say about the Kirkup report and his acceptance in full of its recommendations. We, too, think of the families affected by the failures at Morecambe Bay. I supported steps to improve the regulation of midwives, but the big question mark over the right hon. Gentleman’s commitment is the failure to bring in a Bill on professional regulation. This was an important recommendation of the Francis report and the continued delay in implementing this proposal is putting patients at risk and preventing regulators from doing their job. Will the Secretary of State now commit to legislating at the earliest opportunity for the Law Commission’s reforms?

These are extremely serious matters and I do not believe that some of the Secretary of State’s more political comments today were appropriate, nor do I believe they will build the consensus that will be needed across this House to deliver these important changes. Labour introduced more transparency into the NHS with the establishment of independent regulation and the inspection of hospitals. I appointed Robert Francis to begin the work of looking at what went wrong at Mid Staffs. Where the Secretary of State seeks to build on these constructive changes, we will support him, but he will not achieve his goals by provoking confrontation with doctors or playing politics with patient safety.

[Mr Hunt]

I thank the right hon. Gentleman for his support on many of the measures that we are announcing today. Where we can work together, we should. I thank him for his support for the principle of seven-day working, although I gently point out that this was in our manifesto in May and it was not in his. I shall deal in turn with the points that he raised.

On funding for seven-day services, the right hon. Gentleman has just fought an election on plans that would have meant that the NHS would get £5 billion less than this Government are prepared to commit. We are committing £10 billion to the NHS to implement the five-year forward view, which we can do on the back of a strong economy. That includes plans for a seven-day service.

The right hon. Gentleman talked about comments by Lord Prior in another place. There is no independent review on charging for NHS services. After the election, he should be very careful of such scaremongering. That is what he was doing for the whole election. When he makes such comments, he frightens NHS staff. He should think about the effect on morale when he does that.

The right hon. Gentleman said that the NHS has gone backwards, not forwards, but I have just presented figures showing that public confidence in the NHS is going up; the number of people who think that the NHS is one of the best systems in the world has increased. I gently point out that the reports we are publishing today are a response to problems that happened on his watch and that we are facing up to, so he should have a little modesty in this situation.

The right hon. Gentleman asked an important question about spreading services currently offered on five days over seven days. A lot of work has been done on this. The truth is that having services only on five days is not only dangerous for patients but incredibly inefficient for hospitals. For example, someone admitted to hospital on a Friday in need of a diagnostic test might not get the result until the following Monday or Tuesday so will have to stay in hospital for the weekend even though they could possibly have been discharged. That is bad for the patient and expensive for the NHS, so these measures will result in huge cost savings.

Most importantly, the right hon. Gentleman talked about carrying staff with us. Doctors go into work every weekend throughout the NHS and do a fantastic job, but often it is not recognised and they are not thanked. We want a more professional contract that recognises that contribution. That is why these measures are supported by the Royal College of Surgeons, the Royal College of Physicians and the Royal College of Emergency Medicine.

When the previous Labour Government changed the consultants’ contract in 2003, senior doctors did not like it. They said that it led to

“a loss of a sense of vocation and what it means to be professional”.

That quote is from a King’s Fund report. It undermined the basic relationship between doctor and patient. We are not blaming doctors, and actually we are not blaming unions, because unions will always ask to see what they can get—the right hon. Gentleman spends more time with unions than I do, so he knows that better than I do. The people responsible for that decision in 2003 were the Ministers who signed off changes to the consultants’ contract and the GPs’ contract. It was Labour politicians who were responsible for those changes, and they must take responsibility for the fact that it was the wrong thing to do.

Finally, this is the most important question of all, and we have not heard an answer today: does the right hon. Gentleman support the measures that the Government are putting forward to make our hospitals safer with seven-day working or not? Leadership is about making choices, and today’s choice is this: is he on the side of the patient or on the side of the union? We know whose side we are on. For Labour, once again, the politics matters more than the patients.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the Secretary of State’s vision of an NHS that is empowered to focus more fully on the people and communities it serves and that is more transparent, less bureaucratic and as safe on a Sunday as it is on a Wednesday, and I welcome his comments about culture change. Does he agree that meeting that challenge will also depend on financing? As welcome as the extra £8 billion announced in the Budget is, will he join me in urging colleagues to ensure that as much of that as possible is front-loaded, because it is so necessary for the transformational changes he has talked about? In encouraging leadership across the NHS, will he ensure that the changes that are needed at a local level, and the systems we can integrate for the benefit of patients, can be introduced more quickly and effectively?

[Mr Hunt]

I thank my hon. Friend for her important comments, and for sitting through a very long speech I gave this morning. We are trying to achieve many things. At their heart, as she rightly says, is a recognition that culture change does not happen overnight. She is right that the profiling of the extra money that the Government are investing in the NHS is important, because we need to spend money soon on some things, such as additional capacity in primary care, as in two to three years’ time that will significantly reduce the need for expensive hospital care. We are going through those numbers carefully. She is also right that local leadership really matters. I know that she will agree, especially as she comes from Devon, that leadership needs to be good at a CCG level as well as a trust level, because CCGs have a really important role in commissioning healthcare in local communities. That is an area where we need to make a lot of improvements.

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

I have to declare an interest: like most doctors, I am a member of the British Medical Association.

I commend the Secretary of State for his announcement about a national officer for whistleblowers. Shona Robertson, Scotland’s Cabinet Secretary for Health, announced this in June, and we are taking action on the Francis report in the same direction. It is vital that members of staff feel they have someone to speak to if things are not going well, and that if they are not being responded to locally there is an independent voice that they can go to.

With regard to seven-day services, the excess deaths of people who are admitted at weekends is recognised and abhorred by the vast majority of doctors. I do not know anybody who gets up and works the hours we do and does not care that someone did not do well. However, I think we are blurring the lines between the elective and emergency systems. The sickest people the Secretary of State mentions—those who run the risk of dying if admitted on a Friday or a Sunday—are not part of the elective system but of the out-of-hours emergency system. It is suggested that hospitals are like the Mary Celeste and there are no doctors. In fact, any service with an emergency component runs 24/7, but there is a multi-disciplinary team. Sometimes patients will be stuck on a ward because they cannot get access to a scan or there is no physiotherapist to help them recover from their stroke.

We are already working towards solving this in Scotland. We are doing so in a more collaborative way, and that is important. There is no resistance to that, because it is recognised that we need all parts of the service. This is different from people coming in for a routine check-up on a Sunday when that does not result in a detriment to them if it is not available. The biggest shortage we have is in human resources—doctors, nurses, physios, occupational therapists and radiographers. I recommend that the Secretary of State separate these two aspects. The first is that hospital consultants did not get the option to opt out of 24/7 care for emergency patients in the contract, whereas GPs did. It is a matter of providing, funding and setting up a full service with all that is behind it to deal with ill patients seven days a week, no matter when they come in.

The other aspect is trying to get value for money. If we have invested in expensive machines and theatres, we want them to work as many days a week as possible so that we get value for money, but that must be secondary to the first priority, which is looking after sick people. I suggest that the Secretary of State starts talking about the two aspects on separate tracks and not crossing backwards and forwards, and that this should be collaborative. I echo the hon. Member for Totnes (Dr Wollaston) in saying that we require the money to be front-loaded so that we get it to start changing the service now.

[Mr Speaker]

Order. May I gently say that from now on we are going to have to enforce the time limits on Opposition responses to ministerial statements much more strictly? Otherwise they eat into the time available for other colleagues. The shadow Secretary of State has five minutes in response to a 10-minute statement and the third party spokesperson has two minutes. That really does have to be adhered to as a matter of course from now on.

[Mr Hunt]

The hon. Lady speaks with the authority of someone who works in hospitals, and I always listen to her very carefully. I do not think it is easy to make a rigid distinction between elective and emergency care. The opt-out in emergency care does apply, for example, to accident and emergency doctors. Sometimes when people are admitted to hospital because they are ill—they would not be admitted if they were not—their condition may not appear to be life-threatening on a Friday afternoon but then, over the course of the weekend, they deteriorate, and by the time they are seen by a senior consultant on a Monday or a Tuesday, it is too late. The trouble is that we have a culture in which a lot of major services are available only from Monday to Friday, and that is what is causing these avoidable deaths. The hon. Lady is right to say that this is not just about senior consultant cover; it is also about diagnostic care, handovers and many other things, and we are working at those. The Royal Edinburgh Infirmary has done a very good job of eliminating the difference between weekday and weekend mortality rates, as have Salford Royal and Northumbria hospitals in England. We need other hospitals to follow those examples.

[Mr Graham Brady (Altrincham and Sale West) (Con)]

Senior clinicians in my constituency are warning of a major threat to patient safety as a result of a proposed downgrade of one of Britain’s best hospitals, Wythenshawe. The regional transplant unit is a world-class centre for heart and lung and there is a major trauma centre adjacent to Manchester airport, where it should be. That must all be protected. The Secretary of State knows my view that the consultation has been opaque, and that the decision-making process has been flawed. Will he review the decision as urgently as possible, and meet me and other Members for local constituencies as a matter of urgency before the summer recess to discuss what can be done?

[Mr Hunt]

I am more than happy to meet my hon. Friend to discuss those matters. Wythenshawe is an excellent hospital—I have been there—and it has provided a number of staff who have helped to turn round the standard of care at Tameside hospital, which has seen dramatic improvements. I recognise that Wythenshawe is an excellent hospital, and I am very happy to meet him to listen to his concerns.

[Mr Ben Bradshaw (Exeter) (Lab)]

How will the Secretary of State pay for his very laudable objective of seven-day working when he has lost control of NHS finances? Contrary to what he claimed about the situation in Devon, as things now stand our patient care is suffering, waiting times are rocketing and we are facing a £434 million deficit.

[Mr Hunt]

Let me tell the right hon. Gentleman why so many places are going into deficit. They have looked at the lessons of Mid Staffs and said, “We don’t want that to happen here.” That is why, in the past two and a half years, hospitals have employed 8,000 more nurses on hospital wards to deal with the scandal of short staffing that they faced and wanted to do something about. In the end, if it is not sustainable, it is not quality care, so we have to find smart ways to control deficits—not by reducing the staff and making care unsafe, but by making changes to process and through efficiencies, such as making sure that nurses do not spend too long filling out forms and can spend more time with patients. In terms of funding, I would just say that the only way to fund a strong NHS is to have a strong economy, and that is why the country voted in a Conservative Government in May.

[Dr Tania Mathias (Twickenham) (Con)]

I declare an interest as a member of the BMA.

I absolutely agree with all the points made by my hon. Friend the Member for Totnes (Dr Wollaston). I like the reforms of leadership, but will the Secretary of State recognise the existing great leadership in the NHS? A safe NHS is one in which staff morale is at its best. If every leader in the NHS was at the level of Professor Sir Peter Morris, we would already have the best and safest health service in the world.

[Mr Hunt]

My hon. Friend obviously speaks with huge knowledge—I am wondering whether she is the first Conservative MP who is also a member of the BMA —and is extremely welcome for the insights she brings to the House.

Leadership and morale are absolutely crucial. One of the ways in which we can improve morale is by giving patients and doctors alike the sense that we are honest about the problems and have good plans in place to tackle them. Nothing eats away more at morale than people going in day in, day out and not giving patients the care that they want to give and feeling that nothing is being done about it. That is why the move towards transparency, which I know my hon. Friend supports, is so important.

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

I echo the comments of the hon. Member for Altrincham and Sale West (Mr Brady). Despite a public consultation wanting five major trauma receiving sites in Greater Manchester and Wythenshawe hospital being the public choice, it did not receive specialist status at the end of the Healthier Together process yesterday. What assurances can the Secretary of State give the people of Trafford and south Manchester, particularly in relation to the 18 specialisms that are underpinned by Wythenshawe being a major trauma receiving site?

[Mr Hunt]

As I said to my hon. Friend the Member for Altrincham and Sale West (Mr Brady), I will look into the decision made by Healthier Together. The assurance that I can give to the constituents of the hon. Member for Wythenshawe and Sale East (Mike Kane), and indeed to all people in the Greater Manchester area, is that with some of the most exciting changes, such as the integration of health and social care and the transformation of out-of-hospital care—it has just been announced that there will be seven-day GP services across Greater Manchester—they are blazing a trail. It will be exciting for his constituents; none the less, I understand their concerns about their local hospital and I am happy to look into that.

[Christopher Pincher (Tamworth) (Con)]

We in Staffordshire know better than most what the denial machine that the Secretary of State referred to meant to local people, so I congratulate him on his commitment to transparency and consistency. Will he encourage the Heart of England NHS Foundation Trust and the Burton Hospitals NHS Foundation Trust to work much more collaboratively, so that that commitment to transparency and better service is delivered to my constituents in Tamworth and Fazeley?

[Mr Hunt]

I will absolutely encourage that. The Heart of England NHS Foundation Trust is one of the biggest in the country and has had significant challenges. The Burton foundation trust has been through the special measures process, and patient care has improved as a result. Collaborative working will be the way forward. We need to break down the silos that have cursed so much of the NHS, and I will happily pass on that message.

[Norman Lamb (North Norfolk) (LD)]

I advised food manufacturers in the ’90s about bringing in seven-day working to keep supermarket shelves stacked. Twenty years on we are still talking about seven-day working in the NHS, and it seems to me that good care and saving lives are rather more important. Will the Secretary of State ensure that exactly the same principle applies to mental health? Does he recognise that it is just as important to ensure that people can leave hospital and go home on a timely basis, seven days a week, but that with cuts to local government funding there will be more pressure and it will be more difficult to achieve that? Together with the extraordinary pressure that the system is under, does that not make the case even more strongly for a new settlement for the NHS and social care?

[Mr Hunt]

I thank the right hon. Gentleman for finding time to come to the Chamber on what I know is an important day. I am not sure whether I am allowed to wish him luck, but I greatly value the time that I spent working with him as a ministerial colleague, and I know he will make an important contribution to the House. He is right, as ever, to speak about mental health. The programme towards seven-day working is as important for mental health as it is for other services, and we must also ensure that the revolution happens for things such as suicide rates and crisis care. He is right about the importance of the social care system; and in my mind when I speak about seven-day care I am thinking about social care and health as one entity.

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

Our doctors no doubt work incredibly hard in our hospitals. The people of Brigg and Goole and the Isle of Axholme work at weekends, whether in factories, at the docks or in the fields, and they want an NHS that does the same. The Secretary of State will know about my passion for ambulance services, which at weekends are often the last line of support for patients. What will his plans mean for ambulance services and the incredible job that paramedics do across the country?

[Mr Hunt]

I thank my hon. Friend because he leads by example as a first responder and does a fantastic job in his constituency—indeed, that role takes place at weekends. Paramedics and ambulance services operate a seven-day service. Nurses, paramedics and others who work in hospitals currently do not have an opt-out; consultants are the only ones who do. These measures will give ambulance services confidence that if they take someone to hospital at the weekend, there will be a proper senior consultant present and their patient will get in front of the right person. That will make their job all the more rewarding.

[Valerie Vaz (Walsall South) (Lab)]

The Secretary of State has not outlined what steps should be taken to recruit, train and retain front-line staff who are key to patient safety.

[Mr Hunt]

We have big plans to recruit and retain staff, and those are being worked up by Health Education England. We think that we will need extra doctors to deliver seven-day care, just as we will need more GPs. We think we can afford that within the extra £10 billion that we are putting into the NHS, and we are ensuring that all the numbers add up. I am sure that I will inform the House once we have come to a conclusion.

[Maria Caulfield (Lewes) (Con)]

I declare an interest as an NHS nurse. Does the Secretary of State agree that the UK has one of the worst one-year cancer survival rates compared with the rest of Europe, with one in five cases being diagnosed as an emergency admission? Having a prompt diagnosis is very important. A seven-day-a-week service would be a major step forward, because patients should be seen when clinically indicated, not when indicated by the calendar. With a seven-day service they will be seen more quickly and be less poorly. Not only will that save money but—more importantly—it will save lives.

[Mr Hunt]

Absolutely. May I say how pleased I am to welcome my hon. Friend’s experience to the Conservative Benches? It makes a big difference. She is absolutely right. NHS England will be saying more about how we intend to deal with the problem of late diagnosis of cancer, which is critical if we are to improve our cancer survival rates. One point that links to the announcements I have made today is better collaboration between senior cancer consultants and GPs. If GPs are to be able to spot cancers earlier, they will need to link into the learning they can receive through closer contact with consultants and hospitals. That is something we need to think about.

[Mr Dennis Skinner (Bolsover) (Lab)]

As someone who has spent quite a bit of time going to hospitals over the past 16 years, I have learned a little about it. I suspect that some people, like the doctors who the Secretary of State wants to collaborate with, just might have reflected on why this Tory Government are more concerned with getting in agency nurses and doctors than giving nurses a decent pay increase. Has it not crossed his mind that by telling nurses they are worth only 1% more, he will finish up with more agency nurses? The truth is that doctors see this happening every day. The main reason is that the Government have tried to reform and privatise the NHS for the past five years. The doctors and the nurses do not trust him—it is time he got out.

[Mr Hunt]

Let me tell the hon. Gentleman what the doctors and nurses working in our NHS hospitals see. They see 8,000 more hospital nurses on full-time contracts than when his party was in power, because we are doing something about the scandal of short-staffed wards that was left behind by his Government.

[Mr Steve Baker (Wycombe) (Con)]

Will my right hon. Friend ensure that neither the revalidation regime nor the NHS’s status as a near monopsony employer is allowed to promote anxiety among NHS staff who would otherwise wish to speak up? It is essential that they know they have that freedom and security.

[Mr Hunt]

As ever, my hon. Friend is spot on. At the heart of what I am saying today is creating a new learning culture inside the NHS where people are able to be open. In the airline industry, it is much easier for a junior pilot to talk to a senior pilot about a mistake they think the senior pilot has made without feeling it will impact on their career. We need to break down the barriers, so that when people talk about their concerns—even about what their boss has done, which is never easy—they are listened to and treated seriously, and there are no consequences as a result. We absolutely have to make that change.

[Catherine West (Hornsey and Wood Green) (Lab)]

Are the Government considering the introduction of charging in the NHS, as a member of the Secretary of State’s ministerial team, Lord Prior, suggested in the other place in response to Lord Patel?

[Mr Hunt]

No, that is not the case, and the hon. Lady should avoid scaremongering.

[Mr Christopher Chope (Christchurch) (Con)]

Given the political priority which my right hon. Friend attaches to 24/7 consultant cover for accident and emergency hospitals, why was his Department unable to answer the question I put about which hospitals in England currently provide such cover? Will he collect that data and make sure that it is published?

--- Later in debate ---

[Mr Hunt]

The truth is that all hospitals have been moving in this direction in the past five years in different ways. My hon. Friend is absolutely right to say that, to make sure we deliver on our manifesto commitment, we will be doing a full and comprehensive audit of which people are delivering which types of services. It is partly about senior consultant cover, which we are talking about today, partly about seven-day diagnostic services, partly about handover, and partly about mental health and many other standards, but, yes, that work is being done.

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

The Secretary of State was unclear before. May I say that, as far as I am concerned, Labour Members are absolutely in favour of measures that will increase safety at the weekend, and that my party will never prosper as a mouthpiece for the British Medical Association? Is he not concerned that the porters and nurses, who are being asked to swallow a decade-long real-terms pay cut, will not be able to deliver such change given the level at which they are being demoralised?

If you will permit me, Mr Speaker, may I also say that I very much welcome the full acceptance of the recommendations of the Morecambe Bay inquiry? Will the Secretary of State ensure that the families will remain fully involved in ensuring that these measures are implemented, as well as accepted, by Government?

[Mr Hunt]

Of course. The hon. Gentleman has liaised very closely with the Morecambe Bay families over the period of the inquiry. I am happy to give him the assurance that they will remain closely involved.

I am very pleased that the hon. Gentleman says he does not want his party to be the mouthpiece of the BMA, but if that is the case, it needs to get behind the proposals that the Government are making today and say it supports them. We have not heard that from his party and that is what the public want to hear.

[Jeremy Lefroy (Stafford) (Con)]

The trust or place that has probably learned the most from Mid Staffordshire is Mid Staffordshire, or, as it now is, County Hospital, Stafford. Quality of care and performance has increased dramatically, with 98% and more patients seen within four hours at A&E. That is why we need a 24/7 A&E. May I urge the Secretary of State to ensure that the new independent patient safety investigation service is truly independent, despite being housed in the Monitor-Trust Development Authority building?

[Mr Hunt]

I thank my hon. Friend for the amazing work he has done in supporting County Hospital through the most unimaginably difficult circumstances. I put on record my thanks to the doctors and nurses working in that hospital who are doing a fantastic job. They have improved care. Many of them were working at the old Mid Staffs hospital and, even during the period of those problems, they were working incredibly hard and doing a very good job for patients. They did not want to be associated with any of the bad things that happened. They are a shining example to all of us. Yes, the independent patient safety investigation service needs to be independent, but I think trusts will welcome this measure. It will mean that a trust has a body, which is completely independent of anyone working in the trust, that it can call in. In a no-blame way, it can find out exactly what happened—a bit like a French juge d’instruction; that kind of principle. I think that will be really welcomed in the NHS, but independence is vital.

[Karin Smyth (Bristol South) (Lab)]

I declare my interest as a former NHS manager, latterly for a clinical commissioning group. I very much welcome the focus on patients, transparency and the use of digital, which will be very helpful for the challenges we will face. As a former NHS manager, I would make the plea that management needs support in facing the challenges ahead. I am afraid that confrontation with local doctors as the first step over the summer period is not helpful. Will the Secretary of State please support NHS managers in this difficult task ahead, across clinical and non-clinical standards? I very much welcome the Rose review, but can we please give managers the support they need?

[Mr Hunt]

I am really grateful to the hon. Lady for making that point. NHS managers have one of the most difficult challenges in the country. Not only do they have to balance revenue and expenditure; they have patients’ lives at risk and public accountability. It is really difficult to run a hospital or a clinical commissioning group. These are some of the most difficult jobs one can imagine. We need to support them. I hope they will agree and welcome a move away from targets as the main way of driving change in the NHS to intelligent transparency and peer review. This is not a confrontation with doctors. Doctors overwhelmingly support a seven-day service. It is, I am afraid, a battle with the BMA, with which we have been trying to negotiate on the matter for nearly three years. It has refused to move. It needs to get in touch with what its members want and what the public want, and then I hope we can make much faster progress.

[David Mowat (Warrington South) (Con)]

A characteristic of the health system in our country is that we have something like 20% to 25% fewer doctors per head of population than comparable countries such as France, Germany and Spain. Is it part of the Secretary of State’s vision to correct this over time, and will that make reforms such as these easier to push through?

[Mr Hunt]

We do need more doctors and more nurses. We saw an increase of about 8,000 nurses and 10,000 doctors in the previous Parliament. We will need more for the simple reason that we will have 1 million more over-70s by the end of this Parliament. That said, the NHS is admired in the other countries my hon. Friend talks about for our models of care, which are sometimes less hospital-centric and therefore inherently more efficient than what happens in some other systems. The learning should go both ways.

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

My question is about whistleblowers. I want to know whether the Secretary of State is really satisfied that the fit and proper person test for managers is working, when it allows a chief executive who bullies and mismanaged, as happened in Hull, as the Secretary of State knows, to move with the help of the Trust Development Authority to another job as a chief executive, paying £170,000, and yet the whistleblower has to fight for her rights. When the fit and proper person test was invoked, the TDA investigated and the new trust, unsurprisingly, said that that chief executive was okay. I do not think that that is independent, transparent or in the spirit of Francis.

[Mr Hunt]

I recognise that the hon. Lady has legitimate concerns about the way that the whistleblower, who I think is one of her constituents or is near to her constituency, was treated. I have, as she requested, looked into that very carefully. She will understand that it would not be right or proper for me to comment on an individual case. She knows that, as a result of requests by her and fellow MPs, I looked into whether due process was followed in the case that she mentioned. All I will say is that bullying behaviour should not happen anywhere in the NHS. That is a very important part of the culture change that I want to see.

[Kevin Foster (Torbay) (Con)]

In Torbay, there are a number of concerns about access to primary care, due to issues of recruitment and retention of GPs. Recognising the comment that the Secretary of State made earlier in response to my hon. Friend the Member for Totnes (Dr Wollaston), how does the Secretary of State see his statement today helping to improve this situation?

[Mr Hunt]

We have some fantastic primary care in Torbay. I remember visiting my hon. Friend during the election campaign and going to a hospice run by an absolutely inspirational lady. We need to build on those traditions, and modern technology offers us an opportunity to go even further. In the end, this is about having a less hospital-centric system and prevention rather than cure, and our great tradition of general practice will be our strongest asset in that change.

[Sue Hayman (Workington) (Lab)]

The idea of seven-day working sounds absolutely fantastic for supplying services, but in west Cumbria, where we struggle to deliver services five days a week, it sounds like nothing more than a fantastic pipe dream. I am aware that the Secretary of State understands the specific problems we have in west Cumbria, but I want to ask him about a letter that I recently wrote to him to do with Cockermouth hospital—a beautiful new hospital which sits half empty. Will he meet me and clinicians from that hospital to see how we can deliver and solve the problems in Cockermouth?

[Mr Hunt]

I would be very happy to meet the hon. Lady and clinicians. I am aware of the problems in that health economy and I am aware that they are long-standing. They are a concern to me and I would be delighted to do anything I can to support her in helping to solve them.

[Pauline Latham (Mid Derbyshire) (Con)]

I was shocked to hear the right hon. Member for Leigh (Andy Burnham) running down the NHS yet again. He obviously has not been watching the series on television about the Royal Derby hospital, or looked at its website, where most of the comments are incredibly positive. Also in Mid Derbyshire we have surgeries that wish to take some of the burden away from hospitals. Does the Secretary of State agree that we should be encouraging that, where they can offer services to save people from going to hospital?

--- Later in debate ---

[Mr Hunt]

I absolutely agree. I commend the Royal Derby, which is an excellent hospital, and thank my hon. Friend for mentioning it. It is really interesting: around the country the number of people per thousand who use A&E varies from 166 to 355—a dramatic variation—and a lot of that relates to the availability of good primary care services, which is why our plans for seven-day GP appointments are also a very important part of the programme.

[Wes Streeting (Ilford North) (Lab)]

I welcome the partnership on patient safety that is being announced today between Queen’s hospital in Romford and King George hospital in Ilford and the Virginia Mason Institute, and echo some of the comments made by my hon. Friends about the Government taking staff with them and looking at issues around pay and workforce. May I gently point out to the Secretary of State that it is now two months since I wrote to him about pressures in our local health economy and the future of our A&E department. Can he offset my disappointment by agreeing to meet me and my hon. Friend the Member for Ilford South (Mike Gapes) and other local MPs to discuss those issues?

[Mr Hunt]

I know that the hon. Member for Ilford South (Mike Gapes) secured a Westminster Hall debate on this yesterday, during which I hope the hon. Member for Ilford North (Wes Streeting) covered most of the issues he wants to address, but I am happy to arrange to meet him or to get the Under-Secretary of State for Health with responsibility for hospitals, my hon. Friend the Member for Ipswich (Ben Gummer), to meet him to discuss those issues in more detail. The hospital trust that the hon. Gentleman talks about—Queen’s and King George are covered by the same trust—has been through a very challenging period. It is a big trust; it is going through special measures, but I think it has good new management. I think they have really turned things around, and that staff are to be absolutely commended. The link with Virginia Mason in Seattle will be as inspirational for them as it has been for me to see what is possible.

[Andrew Stephenson (Pendle) (Con)]

I welcome today’s statement about transformation of our NHS. Will the Secretary of State join me in welcoming the progress made by East Lancashire Hospitals NHS Trust, which came out of special measures about 12 months ago, and particularly the fact that a Health Service Journal and Nursing Times survey recently ranked the trust among the top 100 places to work, with improved staff engagement and morale, which is a huge transformation from where we were when the trust was put into special measures?

[Mr Hunt]

I thank my hon. Friend for his passionate support for that trust through a very difficult period. I also thank him for giving us perhaps the single biggest insight into how to transform a hospital in difficulty: according to all the measures, the most important single thing is to engage with staff. If staff feel supported and listened to, the result is safer care for patients and better outcomes. That is something they have done in East Lancashire, and it is something that many other hospitals could learn from.

[John Pugh (Southport) (LD)]

Many current failures in care are caused by poor integration of services, not the failure of a specific service. What, in the proposals announced, addresses that problem?

--- Later in debate ---

[Mr Hunt]

The integration of the health and social care systems, as talked about by the right hon. Member for Leigh (Andy Burnham), is a very big priority. It is a vision shared by all parties. That is part of delivering safe seven-day care. The consequences for the health and social care system if we do not have safe hospital care are people with much greater medical needs, creating much more pressure in the system, so it is part of the same picture.

[Mr Peter Bone (Wellingborough) (Con)]

I thank the Secretary of State for coming to the House and also, I think, for making two written statements. There are only 32 other written statements from Ministers. I remember that when I first got here, there would be 87 written statements on the last day of term, with no chance to scrutinise the Minister. Following what my hon. Friend the Member for Lewes (Maria Caulfield) said, has the Minister had a chance to look at my Ovarian Cancer (Information) Bill, which would help reduce the number of ovarian cancer deaths through earlier detection?

[Mr Hunt]

I thank my hon. Friend for his support for that Bill. I hope that plans that NHS England will announce shortly about how we can improve early cancer detection will give him much encouragement. He will see that some of the things that he is campaigning for are actually going to happen.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Everyone supports seven-day-a-week, 24-hour NHS care—who would not? But the bottom line is that there are insufficient resources and insufficient people at the moment for it to be possible to deliver those services. For the Secretary of State to try to blame the health unions for that is not fair, and there are people behind that. The tone of the statement that the Secretary of State made this morning at the King’s Fund has already caused alarm among GPs, and Maureen Baker, chair of the Royal College of General Practitioners, said that this announcement

“will sound…alarm bells for hardworking GPs who fear we will be next in line—even though we are already being pushed to our limits in trying to provide a safe five-day”

a week

“service for our patients.”

[Mr Hunt]

I do not blame doctors; I do not blame the unions. I blame Ministers from the hon. Lady’s Government who gave consultants an opt-out at weekends that has had a catastrophic impact on patient care. I am delighted that she supports seven-day care, but it was not in the Labour manifesto; it was in the Conservative manifesto, and we are putting in extra money—£5.5 billion more than Labour was promising—to ensure that we can pay for it.

[Graham Evans (Weaver Vale) (Con)]

I welcome the changes that my right hon. Friend has announced today in turning the NHS into a learning organisation rather than a denial machine. Does he agree that there should be a best practice industry standard for healthcare in this country, which learns and compares itself with other countries’ healthcare systems, such as Germany, France and Canada?

[Mr Hunt]

That is a very interesting idea, and I am happy to take it away. I am a strong believer in learning from best practice all over the world. Sometimes it is difficult to gather the data, but it is an interesting idea.

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

The Secretary of State might be in aware that in Huddersfield we are having great difficulty in attracting and recruiting A&E specialists, nurses and GPs. He will know that I am more an education specialist than a health specialist, but given that this is an NHS reform statement, is it not time that we had a serious, fundamental look at how we educate and train everyone in our health service—doctors, nurses, technicians, the whole lot? At the moment it seems more appropriate to sometime in the 20th century than to looking forward in the 21st.

[Mr Hunt]

The hon. Gentleman makes an important point. As part of what I said in my statement, we are looking at how we train doctors. My hon. Friend the Member for Weaver Vale (Graham Evans) talked about creating a learning culture, and the big change that we need to make is creating a culture in which people feel supported to speak out about any concerns or anything on which they think they can see a way of doing something better. They must not feel that that could threaten their career prospects. We do not have that culture in the NHS at the moment, but we need it if the NHS is to be the world’s largest learning organisation, as I argued in a speech this morning. I think staff are up for it, but it is a big change.

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

I thank my right hon. Friend very much for his extraordinarily embracing response to the Public Administration Select Committee report on clinical incident investigation. We started less than a year ago with the germ of an idea, and it has turned into what amounts to a radical reform of safety investigation in the health service. That is a tribute to him and to the Committee’s witnesses, but it is a tribute to the health service itself that it has embraced the idea, which is a big change that I believe will be transformative.

May I pick up on the Secretary of State’s reluctance to provide special legislation for the immunity of those giving evidence to the new patient investigation body? Will he keep an open mind on the subject? If he wants that body to be truly independent and to have a special status, he should remember that the marine accident investigation branch and the air accidents investigation branch have specific legislation to provide for such immunity. Public interest disclosure protection must not be challenged by freedom of information requests, given that freedom of information has been extended into areas where we never imagined it would go. We have to be specific in legislation that that cannot happen in this instance.

[Mr Speaker]

Too long—I hope the answer will be somewhat briefer.

[Mr Hunt]

It will, Mr Speaker.

My hon. Friend’s idea is really interesting, and I am happy to take it up and explore whether we need to replicate that immunity so that we can get to the truth more quickly in a no-blame context.

I thank my hon. Friend for the work of the Public Administration Select Committee. I think it is true to say that we would not have the new patient safety investigation service, modelled on the air accidents investigation branch, which has worked so well in the airline industry, if it had not been for the work of PASC. It brought the idea to my attention and it was a good idea, and I know that he will help me make sure that it is a success in practice as well.

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

I support the comments of my neighbours, the hon. Member for Altrincham and Sale West (Mr Brady) and my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane). Three years ago the new health deal for Trafford resulted in the reduction of overnight and weekend services at Trafford General hospital on the basis that patients would receive better specialist care at Wythenshawe hospital. Does the Secretary of State understand that local people feel that the process has been chaotic, opaque and unresponsive to their concerns, and will he undertake to review the decision as a matter of urgency?

[Mr Hunt]

I thank the hon. Lady for the responsible approach that she took to the changes at Trafford general. Of course, I will listen to her concerns carefully, alongside those of her colleagues, and take them up with the NHS. Perhaps if she comes to the meeting that I am organising for her colleagues, that will provide an opportunity for me to do that.

[Helen Whately (Faversham and Mid Kent) (Con)]

I welcome a huge amount of the statement, particularly about the balance between transparency and more autonomy and the combination of scrutiny and support. Does the Secretary of State agree that not only hospitals and GPs but community and social care services need to be 24/7?

[Mr Hunt]

My hon. Friend speaks with great knowledge about health matters, because of her previous job. [Hon. Members: “McKinsey.”] Yes, McKinsey, which does some important work for the NHS. She is absolutely right that we need to be able to discharge into the community on all seven days, and it is important that the primary care and social care systems are part of that change.

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

When does the Secretary of State intend to implement the recommendation of the Royal College of Pathologists and introduce the role of medical examiner, to provide independent scrutiny of deaths? That has been repeatedly delayed, despite the success of five pilot schemes and the fact that it was recommended in the Francis report.

[Mr Hunt]

That is an important recommendation, and the Government support it. We intend to implement it, but there are costs involved, which we are going through as part of the spending review process.

[Tom Pursglove (Corby) (Con)]

Local people in Corby and east Northamptonshire want to see a truly seven-day NHS. One way of achieving that in our area is to get moving on the new urgent care centre at Kettering, which has attracted cross-party support. Some Members could learn valuable lessons from that project and from what has been going on in Northamptonshire. I thank Ministers for all that they have done in the past to help get that project moving. Will the Secretary of State do everything he can to help it come to fruition in the months ahead?

--- Later in debate ---

[Mr Hunt]

It sounds a promising project, and I will keep myself closely informed of its progress. We need to better integrate urgent care centres into the work of GPs and hospitals so that, for example, somebody’s GP medical record can be accessed in those centres and any advice that people get there can be seen by their hospital consultant or GP at a later date.

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

I must first declare an interest as a state-registered health clinician who worked in acute medicine until the election.

I have witnessed pilots of seven-day working, on the ground and across the country, that have just taken five-days-a-week services and stretched the same complement of staff to seven days a week, therefore not making the service any more efficient or safe. With £22 billion of efficiency savings, or cuts, how will we fund seven-day working?

[Mr Hunt]

A lot of the efficiency will come from seven-day working, and I do not agree with the hon. Lady that there will be a simple cost increase. The cost to a hospital of cranking down all its services on a Friday afternoon and then having to crank them up on a Monday morning is huge, and it is not efficient. Part of the savings will come from having more streamlined services that operate to a consistently high standard across the week.

[Bob Blackman (Harrow East) (Con)]

Many of my constituents complain about the lack of availability of GP appointments at weekends and outside normal hours. The consequence of that is that people who are ill turn up at A&E, causing pressure on it. I know that my right hon. Friend is taking action on that, but what is he doing to ensure that we have proper seven-days-a-week working across the NHS in primary care as well as in hospitals?

[Mr Hunt]

My hon. Friend is absolutely right to draw attention to the fact that our manifesto commitment was to a true seven-day service across hospitals and general practice. That is why, a few weeks ago, we announced in our new deal for general practice plans to recruit 5,000 GPs so that we can increase capacity and make sure that people can get routine appointments in the evenings and at weekends.

[Jim Shannon (Strangford) (DUP)]

I welcome the NHS Pay Review Body’s report on seven-day services. There is a compelling case for such services, but contractual barriers to reform need to be addressed. Today’s statement refers to England and Wales, and the Northern Ireland Assembly has devolved responsibility for health. Will the Secretary of State consider having contact with the other UK regions, to assist them in engaging with national bodies based here on the mainland on how this important matter can be taken forward?

[Mr Hunt]

I am very happy to do that. We can learn a lot from each other across the UK about how things are implemented. I thank the hon. Gentleman for his interest in English health matters, because there is always a good read-across.

NHS Leadership

Jeremy Hunt Excerpts

Thursday 16th July 2015 Written Statements

[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

Thursday 16th July 2015 Written Statements

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

I am responding on behalf of my right hon. Friend the Prime Minister to the 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]