Ambulance Service: England
Jeremy Hunt Excerpts(9 years, 11 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today I am announcing that NHS England is to pilot a possible change to the way ambulance services respond to 999 calls, based on clinical advice that this will improve the chances of survival for patients, especially those with the most serious conditions.
In light of the unprecedented increase in demand for ambulance services in the last two months, I asked NHS England to consider whether there were any changes which could be brought forward quickly in order to help ambulance services maintain, and perhaps even improve, clinical outcomes for patients.
I have now received and considered NHS England’s advice. A copy of the letter from Professor Keith Willett, the National Director for Acute Care at NHS England, with his recommendations, is attached and has been placed in the Library of the House. I agree with his advice that there is significant evidence to suggest that giving call handlers extra assessment time to make the right decision for the patient could improve clinical outcomes and improve their chances of survival. At present, ambulance services are allowed only 60 seconds before the clock starts to decide what the right course of action is for that individual patient. This sometimes leads to ambulances being dispatched unnecessarily, so that fewer ambulances are available for patients who really do need emergency assistance.
In the interests of patient safety, I therefore agree that giving call handlers very limited extra assessment time would ensure that ambulances are better deployed to where they are most needed and would allow a faster response time for those patients who really need it.
I have agreed to two local pilots where call handlers will be allowed up to a maximum of an additional 120 seconds for assessment, before the clock starts, for all 999 calls. This will not include those calls which are immediately life threatening (categorised as Red 1 calls). The pilot will therefore allow for a maximum of 180 seconds to assess a call, in order to reach a more detailed diagnosis and send the most appropriate response.
In these pilot sites, a small number of potentially life threatening conditions, such as overdoses and certain types of gunshot wounds, will also be upgraded from the Red 2 category into the Red 1 category so they receive a faster response than is currently the case.
The two pilot sites will be South West Ambulance Service NHS Trust and the London Ambulance Service NHS Trust—one running the NHS Pathways triage system and one running the Advanced Medical Priority Dispatch System. The pilots will start in February and will jointly cover a patient population of around 13 million people.
During the pilot, ambulance targets for all other areas will not be changed. We will continue to publish national data as normal, and the pilot data will be published alongside this in the interests of transparency. Given the pilots will only be affecting two ambulance services for a very limited period of time at the end of the reporting year, we do not anticipate that this will have a significant impact on the overall national data.
The pilot will be subject to rigorous and independent external evaluation which will be published. I will not support any extension of this pilot more widely unless the following three tests are met:
There is clear clinical consensus that the proposed change will be beneficial to patient outcomes as a whole, and will act to reduce overall clinical risk in the system.
There is evidence from the analysis of existing data and piloting that the proposed change will have the intended benefits, and is safe for patients.
There is an associated increase in operational efficiency. The aim is to reduce the average number of vehicles allocated to each 999 call and the ambulance utilisation rate.
After the evaluation has been published, I will consider the outcomes of the three tests and the findings of this external evaluation before making any decisions to implement these changes throughout England.
The letter from Professor Keith Willet can be viewed online at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2015-01-16/HCWS201
[HCWS201]
Oral Answers to Questions
Jeremy Hunt Excerpts(9 years, 11 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
The Government have provided an extra £50 million of funding to ambulance services as part of our record package of support for the NHS this winter.
Bridget Phillipson
Notwithstanding what the Secretary of State has just said, the North East ambulance service has warned that it is under severe pressure caused by delayed ambulance turnaround times at hospitals such as Sunderland Royal. When Ministers embarked on their top-down reorganisation of the NHS, were they warned at any point that chaos would ensue in A and E departments?
Mr Hunt
The reforms the hon. Lady mentions mean that we have 9,000 more doctors, 3,000 more nurses and 2,000 more paramedics in the ambulance service. The point is that those reforms are putting money on to the front line, which means that the NHS is better equipped to deal with winter pressures than ever before.
David T. C. Davies (Monmouth) (Con)
In England around 75% of ambulances meet the target response time, as opposed to 60% in Wales. Will the Minister tell the House why ambulance response times are so much better in England than in the area of the United Kingdom run by the Labour party?
Mr Hunt
What is so disappointing about the health debate is that Labour Members tour TV studios trying to whip up a sense of crisis in the NHS in England, and then deny that things are even worse in Wales. Services are better in England because we have put more money on to the front line and less into management.
Helen Jones (Warrington North) (Lab)
Prior to Christmas, a motorcyclist in my constituency with serious leg injuries was left lying on the ground in the rain for an hour and 40 minutes waiting for an ambulance. Local people had to bring out blankets and hot water bottles to try to keep him warm, but because no ambulance arrived, the police had to commandeer a council minibus to take him to hospital. Is the Secretary of State ashamed to stand at the Dispatch Box and tell the House that the NHS is not in crisis, when that is what is happening on the ground?
Mr Hunt
Let me tell the hon. Lady what we are doing—[Interruption.] This is what I think is so shocking: Labour Members are not actually interested in what is happening to avoid precisely the kind of things that the hon. Lady mentioned. We are putting £4.6 million of extra support into the North West ambulance service this winter, and that money is being used to employ more paramedics, to train people so that they can see and treat patients on the spot, and to help more people on the phone so that they do not need an ambulance. The hon. Lady should perhaps have listened to the earlier question, because where Labour is running the ambulance services, results are even worse.
Tim Farron (Westmorland and Lonsdale) (LD)
Does the Secretary of State agree that the rules for commissioning ambulance services need to be looked at again to ensure that ambulances serving rural areas such as South Lakeland which do not have an acute centre of their own and therefore export their ambulances further afield need to be compensated with additional ambulances to take account of the fact that so many of our vehicles are out of county most of the time?
Mr Hunt
My hon. Friend makes an important point about the way targets are set up. It is possible for ambulance services to hit their targets while not delivering a satisfactory service to the most rural areas, and we have discussed that issue a number of times. Because we are in the middle of a challenging winter, we do not think that now is the right time to review the issue, but he should rest assured that we are keeping it under review.
Andy Burnham (Leigh) (Lab)
Although focus has been on A and E, it is becoming clear that the knock-on crisis in the ambulance service is more serious than people realise. Evidence is emerging of services unilaterally abandoning national standards and putting patients at risk. We know of one ambulance service that left patients at the door of A and E without handing them over to A and E staff, and last night East of England ambulance service was forced to release an internal report on the downgrading of thousands of 999 calls, including calls made by terminally ill patients. The report covered only a sample, but it showed that at least 57 of those patients died after a decision was taken not to send an ambulance. Withholding ambulances from terminally ill people is the most cruel form of rationing imaginable. Will the Secretary of State today order a full, independent investigation into how that happened, and into every death or adverse incident?
Mr Hunt
We investigate deaths and adverse incidents carefully, and the East of England ambulance service got £3.6 million of extra support to help it this winter. Let us look at what is happening in the ambulance service. Year on year, the number of the most serious category A calls—those that need to be answered within eight minutes—has increased by 26% over one year, and the number of ambulances dispatched within eight minutes has increased by 22%. That is 1,900 extra ambulance journeys arriving within eight minutes, which is a record of an ambulance service doing well under a lot of pressure. The right hon. Gentleman should be getting behind the paramedics and ambulance services, not trying to politicise the issue.
Andy Burnham
I raised a very serious issue, which came to light last night, regarding 57 terminally ill patients. As that was only a sample, it is not the whole story. I am surprised that the Secretary of State did not answer the very specific question about a serious failure in the East of England ambulance service. The truth is that this is not confined to the ambulance service in the east of England. Last year, we heard of a 77-year-old great-grandfather from Bolton who waited for more than four hours on a freezing pavement and a 92-year-old grandmother who tragically died after waiting for five hours in agony on the floor of her home in Muswell Hill.
Whatever the Secretary of State says, those are not isolated cases. New figures last week showed that in November a staggering 17,000 critically ill patients who were classified as needing an urgent category A 999 response waited longer than 19 minutes for an ambulance to arrive. Will the Secretary of State agree that this chaos is now putting lives at risk and cannot carry on? Will he tell the House what precise steps the Government are taking to bring responses to 999 calls back up to acceptable standards?
Mr Hunt
But we are taking measures. That is why we have 2,000 more doctors and 5,000 more nurses compared with a year ago. Frankly, the last thing those doctors and nurses on the front line want is scaremongering by the right hon. Gentleman—posters saying that the NHS might cease to exist under this Government; and leaflets like the one I have here from Lancaster saying that the local hospital might close. We are backing the NHS with more doctors, more nurses, more resources and a long-term plan. Will he now back the NHS by disowning this kind of scaremongering and stop trying to weaponise the NHS?
Bill Esterson (Sefton Central) (Lab)
3. What the average waiting time was for a GP appointment in the most recent period for which figures are available.
Henry Smith (Crawley) (Con)
16. What progress his Department has made on its long-term plans for easing pressures on A and E departments and preparing the NHS for the future.
The Secretary of State for Health (Mr Jeremy Hunt)
A strong NHS needs a strong economy, and because this Government have put Britain back on the road to recovery, we are able to invest an additional £2 billion in the NHS front line next year. This is a down payment on NHS England’s “Five Year Forward View”—the NHS’s own plan to transform care in the community and reduce pressure on hospitals.
Caroline Nokes
Does my right hon. Friend agree that the NHS 111 service has been unfairly criticised by the Opposition, despite their key role in establishing it, and that it has provided impressive support this winter to our A and E departments by suggesting to patients convenient and effective alternatives to the emergency department?
Mr Hunt
My hon. Friend is absolutely right. Part of the solution to the pressure in A and E is providing good alternatives, and in the last year for which we have figures, the 111 service took 12 million calls, which is three times more than the 4 million calls that NHS Direct took in its last year of operation, and 27% of people said that had they not called 111 they would have gone to A and E. That is a huge success.
Mr Spencer
The Secretary of State will be aware of the additional pressure on Sherwood Forest hospitals trust as a result of the £40 million a year disastrous private finance initiative deal signed by the last Government. Will he meet me, my hon. Friend the Member for Newark (Robert Jenrick) and representatives from the hospital to discuss how we might move forward and deal with this terrible PFI deal?
Mr Hunt
I am aware of the problems with that deal, signed back in 2005, which is now consuming 17% of the trust’s income. It would like to spend that income on more doctors and nurses, but it cannot because of the shockingly bad deal signed. I would be happy to meet my hon. Friend to discuss what is possible in the current circumstances.
Julian Sturdy
There are many causes of the pressure on A and E, and in more rural areas direct access to services can be difficult and costly. As such, will the Secretary of State consider investing further money in new technologies that could drive a revolution in health care facilities, and if such opportunities present themselves, may I promote York and north Yorkshire as an ideal testing ground for these technologies, given its ageing population and rurality?
Mr Hunt
I remember my hon. Friend’s campaigning on superfast broadband in north Yorkshire from my last portfolio. He is absolutely right that technology has a big role to play. That is why a year and a half ago the Prime Minister announced plans to expand weekend and evening GP appointments through the use of technology, which is already helping 5.5 million people and by March will be helping 7.5 million people. We must absolutely consider this as a solution.
Henry Smith
In 2005 under the previous Labour Government, Crawley hospital’s A and E department was closed, but I am pleased to say that in recent years health and other emergency services have been returning to the facility. Will my right hon. Friend consider centring more emergency centres in Crawley, as the natural sub-regional population centre?
Mr Hunt
I congratulate my hon. Friend on his campaigning for Crawley hospital and pay tribute to staff at the hospital, which was rated “good” by the Care Quality Commission last year as part of the new inspection regime. He will welcome the fact that since 2010 the number of doctors at the hospital has increased by 97 and the number of nurses by 107. Of course, we will always consider ways to improve services for his constituents.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
22. The Home Secretary talked about the £2 billion he has put aside for the NHS, some £1.5 billion of which is for clinical commissioning groups and specialised commissioning. Why are more than 50 CCGs in the south of England to receive a 3.6% increase in funding to the detriment of the north, where my own CCG is to receive only 0.24%, which is below inflation and a pittance compared with the south?
Mr Hunt
These things are decided independently by NHS England, which made the decision on the basis of which CCGs were most off their target allocation and on social deprivation and the number of older people. I remind the hon. Gentleman that there are many older and vulnerable people in the south, too, and they need a fair settlement from the NHS. That is why the decision was made.
Valerie Vaz (Walsall South) (Lab)
The College of Emergency Medicine says that the extra money the Secretary of State has given is not reaching A and E. What steps is he taking to ensure that the money does not stay with the CCGs, but actually goes into A and E?
Mr Hunt
I have had a number of discussions with the College of Emergency Medicine and what it actually says is that the system is working pretty well—[Interruption.] Well, that is what the College of Emergency Medicine says. The country’s A and E doctors welcome the fact that with the winter pressures money, there are now 800 more doctors and 4,700 more nurses, but we always want to make sure that the money is getting through as quickly as possible, so if the hon. Lady has any particular examples, I would be happy to look into them.
Dr William McCrea (South Antrim) (DUP)
Surely the Secretary of State will accept that quicker appointments with the patient’s local GP will certainly alleviate some of the blockages in A and E.
Barbara Keeley (Worsley and Eccles South) (Lab)
It is increasingly recognised that the causes of the A and E crisis include the closure of walk-in centres, such as the one in Little Hulton in my constituency and this Government’s savage cuts to council budgets, leading in Salford to 1,000 fewer people getting care packages funded this year. When will the Health Secretary start to take responsibility for his own Government’s policies and do something to ensure investment in social care to ease that pressure on A and E? The better care fund is not the answer.
Mr Hunt
I am sorry, but this says it all about the Labour party’s campaign. It talks about savage cuts to social care and then the shadow Chancellor says he is not going to do anything to reverse them. It really has to be consistent. On the walk-in centre, Labour Members were saying earlier today that they want GPs present in every A and E department and that is exactly what has happened at Salford Royal. The walk-in centre was closed so that GP services could be moved closer to the A and E at that hospital. Perhaps the hon. Lady should talk to Sir David Dalton, her local chief executive, who will tell her why this is doing a better job for her constituents.
Paul Burstow (Sutton and Cheam) (LD)
The Secretary of State is absolutely right to highlight the success of the coalition in delivering a better economy, which is allowing us to invest £2 billion from April this year. Will he address the point put to him about the importance of social care, and seriously consider investing some of that £2 billion in social care, not just in our health care system.
Mr Hunt
May I reassure my right hon. Friend by saying that I agree with him? I want to pay tribute to him for campaigning on this issue for some time, both in office and out of office. The truth is that there is a strong link between what happens in the social care system and what happens in the NHS. This year, we are putting £1.1 billion of support from the NHS into the social care budget. Next year, that increases by another £2 billion. We need to recognise that these two systems need to be brought together as one system—and with the better care fund, that is what is happening.
Mark Reckless (Rochester and Strood) (UKIP)
To attract more senior doctors into emergency medicine—an extraordinarily demanding specialty where doctors work solely for the NHS—should we consider paying them more than they get under the standard consultant pay scale?
Mr Hunt
I think we need to look at the emergency medicine contracts. One thing said by the College of Emergency Medicine—I have a lot of sympathy with this view—is that emergency doctors want not more money, but the right to the same holidays that other doctors get. It is the time off that is important to them. They have to work 24/7 and they get extremely tired; they want some compensation for that in being able to spend extra time with their families. We are getting more people into emergency medicine, but we should look at anything we can do to make it better.
Dr Sarah Wollaston (Totnes) (Con)
NHS staff are working extraordinarily hard to deal with not only the extra demands, but the increased complexity of patient cases in all parts of the urgent care system. Will the Secretary of State set out what more can be done to make sure that people access the right part of the system and that all parts of the system work together?
Mr Hunt
As a former GP, my hon. Friend understands this issue better than most. For me, the single most important thing for patients with the most complex needs, particularly for vulnerable older people, is having a system where the buck stops with a doctor. Someone must be accountable for ensuring that such people get the right care wrapped around them. We have brought back named GPs for all over-75s this year as a first step, but there is much more to do.
John Healey (Wentworth and Dearne) (Lab)
The Secretary of State did not answer the question put by my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson). Surely the unprecedented problems we are now seeing in A and E and the wider NHS can be traced back directly to the risks of the huge top-down reorganisation, which were set out for Ministers in November 2010, but ignored. One of the current Ministers and his predecessor said, as reported in the House:
“We have every intention of publishing the risk register in due course, when we think the time is right.”—[Official Report, 10 May 2012; Vol. 545, c. 156.]
Four years on, will the Secretary of State now publish this risk register and let people see for themselves what warnings he was given about current problems and how far he has been hiding the truth on the NHS?
Mr Hunt
It was published, because it was leaked. The fact is that there is one part of the United Kingdom that carried out those reforms and has the best A and E performance in the country, and another part of the United Kingdom—Wales—that set its face against those reforms and has one of the worst A and E performances in the country.
Robert Halfon (Harlow) (Con)
5. What steps have been taken to help Princess Alexandra hospital in Harlow to deal with extra pressure over the winter.
Charlie Elphicke (Dover) (Con)
6. What assessment he has made of the level of improvement made by East Kent Hospitals NHS Trust since it was put into special measures.
The Secretary of State for Health (Mr Jeremy Hunt)
I am pleased to report that East Kent Hospitals NHS Trust has started to make good progress since it was placed in special measures last August. That includes improved incident reporting rates, a revised policy enabling staff to raise concerns, and the creation of a cultural change programme.
Charlie Elphicke
Does not the Secretary of State’s answer highlight the fact that the best way of dealing with long-term and deep-set problems is to put patients first and ensure that there is a culture of transparency? Does that not contrast sharply with the denial and cover-ups that we have seen too often in the past?
Mr Hunt
Absolutely. I think that what shocks people is Labour trying to make political capital out of winter pressures in the NHS, and then sweeping the poor care that happened on its watch under the carpet. We are making great progress at East Kent Hospitals NHS Trust: there are 82 more nurses, and more than 100 more doctors. That is because we are facing up to the problems, not running away from them.
Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)
7. With reference to his Department’s publication “Transforming care: A national response to Winterbourne View Hospital”, published in December 2012, if he will take steps to ensure that the statutory guidance implementing the adult autism strategy uses clear language and is mandatory.
Chloe Smith (Norwich North) (Con)
9. What steps have been taken to support NHS hospitals in meeting increased demand in winter 2014-15.
The Secretary of State for Health (Mr Jeremy Hunt)
The Government have prepared for this winter earlier than ever before, with a record £700 million to help the NHS through winter, including £3.6 million to help my hon. Friend’s local area.
Chloe Smith
The Norfolk and Norwich university hospital has declared a major incident and is also being examined by Monitor for its waiting times. Its medical director stresses that services are safe, but we all know that there is a need to ensure that people can move on from hospitals into other parts of the health care system. Can my right hon. Friend reassure me that he would expect the use of the resources he has provided to be jointly planned out with social care?
Mr Hunt
Obviously this is very important, and that is what is happening now for the first time. We are seeing the true integration of health and social care through the better care fund and record working, and in my hon. Friend’s area, despite the pressures they have been feeling this winter, they have made some good progress. They have put an urgent care centre next to the A and E. They are seeing within four hours nearly 12,000 more people every year, and they are doing about 12,000 more operations every year as well.
Mr Kevan Jones (North Durham) (Lab)
In the Chancellor’s announcement last year of extra funding for the NHS, my clinical commissioning group got a 0.24% increase, whereas Windsor, Ascot and Maidenhead got 3.7%. The Secretary of State blamed the NHS for this when he responded to my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop), but is it not because this Government have taken need out of the formula—a similar thing to what they have done in local government—which means the movement of money from the north to the south?
Mr Hunt
No, we have not. The NHS funds were allocated on the basis of a formula and the extra money was given to the places that were most off-target on the basis of the number of older people, the level of social deprivation and a range of other important factors. All I would say to the hon. Gentleman is that we have increased the NHS budget in real terms in his area, whereas those on his own Front Bench wanted to cut it.
Sir Gerald Howarth (Aldershot) (Con)
May I take this opportunity to salute the efforts made by Frimley Park hospital, the first hospital in the land to have been awarded outstanding status by the Care Quality Commission? Is it not the case that it has responded well to the pressures and elicited praise from my constituents, which is down in large measure to the leadership of Sir Andrew Morris, who was rightly awarded a knighthood in the new year’s honours?
Mr Hunt
I think it is, and my hon. Friend is right that it is a brilliant hospital; it serves my constituents as well. One of the things it is doing is helping to turn around Heatherwood and Wexham Park hospitals trust, which was in special measures, including its A and E department, which is doing much better. Sir Andrew Morris has been running that hospital for 26 years, and that kind of stability in leadership makes a huge difference.
Ms Margaret Ritchie (South Down) (SDLP)
On easing winter pressures in NHS hospitals, could the Secretary of State indicate when he last met the chair of emergency medicine and what steps will be taken to ensure greater accessibility to GP practices?
Mark Pawsey (Rugby) (Con)
10. What steps his Department is taking to ensure support for smaller district hospitals.
Heidi Alexander (Lewisham East) (Lab)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
The Chancellor agreed in the autumn statement to support NHS England’s five-year forward view with the £1.7 billion of additional funding that the NHS requested. On top of that, the Chancellor allocated £1 billion of funding to transform primary care facilities, and I am pleased to announce today that a letter will shortly be sent to every single GP practice in the country, inviting them to bid for the first tranche of that funding with the aim of supporting more GP appointments and more proactive care for the most vulnerable.
Heidi Alexander
Last week, one of my constituents had a fall and fractured her pubic bone. She was taken to Queen Elizabeth hospital in Woolwich because 15 ambulances were stuck in a queue outside Lewisham. She then waited 12 hours on a trolley. If the Secretary of State had got his way and been successful in his attempt to axe services at Lewisham, exactly how much longer would he have expected my constituent to wait? Is it not true that if he had got his way the A and E in Woolwich would have been totally and utterly overwhelmed?
Mr Hunt
No, and I can tell the hon. Lady that her constituents would be receiving far worse care had we not tackled the long-standing issues with the South London Healthcare NHS Trust, which the last Government ducked but which we have confronted and dealt with. If she looks at the performance of A and E in her area, she will see that 48,000 more people are being seen within four hours than when Labour was in power.
Dame Angela Watkinson (Hornchurch and Upminster) (Con)
T2. The Secretary of State will be aware that the London borough of Havering has the highest proportion of elderly people of all the London boroughs, but he may not know that the average age of an in-patient at Queen’s hospital is 86. Will he agree to look at the balance of future funding between acute care and community health care, so that elderly people can be supported at home and beds freed up for people waiting for acute operations?
Mr Hunt
My hon. Friend makes an important point. It is one of the underlying causes of pressure in A and Es that for an over-75 attending an A and E in winter, there is an 80% chance that, rather than going home, they will be admitted to hospital and probably stay there a long time. That is why improving community care, as she says, is at the heart of this Government’s strategy to reduce pressure on hospitals.
Mr Jamie Reed (Copeland) (Lab)
If it is not too late, let me wish you, Mr Speaker, a happy new year.
The care failings uncovered by the Care Quality Commission at Hinchingbrooke hospital are appalling and unacceptable. The inspection
“found poor emotional and physical care which was not safe or caring.”
The response to call bells was so bad that some patients were told to soil themselves; drinks were left out of patients’ reach; and one member of staff was overheard telling a patient,
“don’t misbehave you know what happens when you misbehave.”
Will the Secretary of State tell us when he was first told about the problems at Hinchingbrooke? Given that the CQC inspection happened in September, why was the trust put into special measures only last Friday?
Mr Hunt
What I can tell the hon. Gentleman is that what happened at Hinchingbrooke completely destroys what Labour has been saying about privatisation, because it was this Government who introduced an independent inspection regime, which did not exist before, that roots out poor care without fear or favour. That is what we have done in 18 hospitals run by the NHS and it is what we are doing at Hinchingbrooke run by the private sector.
Duncan Hames (Chippenham) (LD)
T3. The three GP surgeries in Chippenham were turned down by the Prime Minister’s challenge fund, despite developing imaginative plans to bring together all the town’s acute GP care at a new urgent care centre at Chippenham community hospital. They received no feedback, even from NHS England. Will the Secretary of State be more flexible when receiving further proposals from the doctors, who are, after all, very busy looking after their patients?
Steve McCabe (Birmingham, Selly Oak) (Lab)
T4. The Bournbrook Varsity medical centre is about to face a double-whammy financial crisis, as NHS England scraps its minimum practice income guarantee and forces it to switch from a personal medical services contract to a general medical services contract. Why should that excellent practice, which has done all that could be asked of it, and its patients be victimised because a high proportion of the patients are young students? Will the Secretary of State agree to look at this disaster immediately?
Jeremy Lefroy (Stafford) (Con)
T5. The recent extraordinary pressures on A and E in the north midlands underlined for me and my constituents the importance of returning the A and E at Stafford County hospital from 14 to 24-hour opening. Given that consultant-led maternity is due to transfer from Stafford to Stoke this week and the remaining serious emergency surgery next month, will my right hon. Friend set out what steps have been taken to ensure that the safety of my constituents and other users of the services is the top priority, and advise me whether he is confident in them?
Angela Smith (Penistone and Stocksbridge) (Lab)
T8. My constituent Mr Offord waited 22 minutes after a 999 call for a double-crewed ambulance, and his death was referred by the South Yorkshire coroner to Ministers because of a concern that he might have survived if he had received medical help sooner. The Yorkshire ambulance service has just settled the case brought by Mr Offord’s family out of court. When will the Secretary of State recognise the growing crisis in ambulance services and support my right hon. Friend the shadow Secretary of State’s call for an investigation?
Mr Hunt
I do recognise the pressures on the ambulance service and the hon. Lady’s local area has had £1.6 million extra to help to deal with winter pressures. We have 1,700 more paramedics in the ambulance service and they are doing 2,000 more emergency journeys every day, but none of that is any consolation to the family whom she talks about, and that is why we must always ensure that every lesson is learned.
Andrew Percy (Brigg and Goole) (Con)
The Secretary of State, the Department of Health and my local hospital trust inform me that there are more doctors and nurses in the local NHS and the NHS nationally than there were in 2010. This weekend, residents in north Lincolnshire received a leaflet from the Labour party saying that there were fewer doctors and nurses and less care. Who is telling the truth?
Kevin Barron (Rother Valley) (Lab)
T9. Does the Under-Secretary of State remember the case that I raised in an Adjournment debate of Mrs Monica Barnes and the inadequate service she received from the health service ombudsman’s office? The ombudsman’s office has today announced a consultation on a new service charter. Does he welcome it and hope for a better service for our constituents?
Mr Hunt
There have been a number of problems with the service offered by the ombudsman. There has been a lack of expertise in the ombudsman’s office to investigate the most difficult cases. This is obviously a responsibility of Parliament not of mine, but I have had good discussions with my hon. Friend the Member for Harwich and North Essex (Mr Jenkin), who chairs the Public Administration Committee, about how the services can be improved.
Mr Jonathan Djanogly (Huntingdon) (Con)
The last week has been an extremely testing time for Hinchingbrooke hospital in my constituency, for its hard-working staff and for its loyal patients. Will my right hon. Friend please take this opportunity to confirm his Department’s full support for Hinchingbrooke hospital and to give some advice on the way management will be transitioned so as to minimise patient disruption?
Mr Hunt
I am happy to do that, and I reassure my hon. Friend that our top priority will be to ensure that there is a smooth transition to the new management of the hospital as Circle moves away. I thank him for the measured tone he has taken and I reassure him that his constituents’ safety and care is our top priority.
Kerry McCarthy (Bristol East) (Lab)
T10. At Southmead hospital in Bristol, just 81% of patients are seen within four hours and the number of blocked beds is three times the national average. At Bristol Royal infirmary it is double the national average. What is the Secretary of State doing specifically to help hospitals in the Bristol area?
Greg Mulholland (Leeds North West) (LD)
All the talk about appointments concentrates on GPs and A and E, but does not seem to focus on pharmacies, which have a hugely important role to play, considering how many years pharmacists train for. My constituent Mr. Dhand of the Headingley pharmacy is undertaking a pilot to see how many people could and should have gone to a pharmacy rather than to a GP. Would Ministers support that?
Mr David Anderson (Blaydon) (Lab)
Despite all the warm words we hear every week from the Government about their support for the staff of the NHS, which I welcome, the Government still refuse to pay the award recommended by the independent review body. At the same time the chief executive of the trust in my part of the world has had a 78% salary increase and the people who set the allowances, the board of governors, have had an 88% increase in their allowances. Is this what is meant by “we are all in this together”?
Michael Fabricant (Lichfield) (Con)
The Institute of Translational Medicine at Birmingham university medical school is probably the top place in Europe for genetic research into innovative cancer cures. I have visited it. Will the Secretary of State visit it, and will he ensure that funding continues for that department?
Mr Iain Wright (Hartlepool) (Lab)
The Secretary of State refuses to meet Hartlepool borough council and me on the issue of hospital services in Hartlepool. On Wednesday in this House he said:
“I take responsibility for everything that happens in the NHS.”—[Official Report, 7 January 2015; Vol. 590, c. 277.]
If so, will he respond to the 12,000 people who signed the petition organised by the Hartlepool Mail, the 1,000 people who marched on Saturday morning, Hartlepool borough council and me on this issue? Will he stop snubbing the people of Hartlepool, work with us and make sure that hospital services can return to Hartlepool?
Mr Hunt
I do take responsibility, but I hope the hon. Gentleman will be responsible in his campaigning in Hartlepool and welcome the extra doctors, extra nurses, extra operations and extra number of people seen within four hours in his constituency. It is a record of success, of which this Government are proud.
Steve Baker (Wycombe) (Con)
As it becomes increasingly obvious that the public insist on receiving urgent care in a hospital setting, will the Government move to incentivise the delivery of a new generation of urgent care centre, as specified in the end of the phase 1 report on the urgent and emergency care review?
Mr Hunt
I have visited my hon. Friend’s local hospital. I commend him for his interest and I commend the hospital for the remarkable turnaround. From being a hospital in special measures, it has done extremely well. We want to implement the proposals in that review and we want also to make sure that for the oldest and frailest people there are alternatives that mean that they do not have to visit hospital.
Cancer Drugs Fund
Jeremy Hunt Excerpts(9 years, 11 months ago)
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David T. C. Davies (Monmouth) (Con)
6. How many patients have received treatment through the cancer drugs fund since the inception of that fund.
The Secretary of State for Health (Mr Jeremy Hunt)
More than 60,000 patients in England have received treatment through the cancer drugs fund since its inception in October 2010. They and their relatives will be very concerned at the suggestion made by the shadow Health Secretary last month that a Labour Government could abolish the fund.
David T. C. Davies
I congratulate the Secretary of State on that very high figure. Is he aware that some of those people who are being treated have had to sell up their homes and move here from Wales, where they are routinely denied life-prolonging cancer drugs by the Labour-run Welsh Assembly Administration. What does that teach us about the respective differences between the health services in England and Wales?
Mr Hunt
I thank my hon. Friend for raising that point. The last Labour Government did leave us with one of the lowest cancer survival rates in western Europe, which is one of the reasons why we introduced the CDF. Unfortunately, the current Labour Government in Wales are continuing with those policies, which is why 6,500 Welsh cancer patients were admitted for treatment in English hospitals last year.
[Official Report, 25 November 2014, Vol. 588, c. 732.]
Letter of correction from Mr Hunt:
An error has been identified in the response I gave to my hon. Friend the Member for Monmouth (David T. C. Davies) during Questions to the Secretary of State for Health.
The correct response should have been:
Mr Hunt
I thank my hon. Friend for raising that point. The last Labour Government did leave us with one of the lowest cancer survival rates in western Europe, which is one of the reasons why we introduced the CDF. Unfortunately, the current Labour Government in Wales are continuing with those policies, which is why last year there were 6,500 admissions to English hospitals for cancer treatment where the patient was from Wales.
A and E (Major Incidents)
Jeremy Hunt Excerpts(9 years, 11 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
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Andy Burnham (Leigh) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the major incidents that have been declared at a number of hospitals and on A and E performance in England.
The Secretary of State for Health (Mr Jeremy Hunt)
Mr Speaker, I welcome this opportunity to come to the House and make a statement on accident and emergency services.
First, we must recognise the context. The NHS always faces significant pressures during the winter months, but, with an ageing population, we now have 350,000 more over-75s than just four years ago. As a result, we are seeing more people turning up at our A and Es, with 279,000 more attendances in quarter three of this year as compared with last, and a greater level of sickness among those who do arrive, leading to an increase in emergency admissions of nearly 6% on last year. This picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland all missing key performance standards as a result.
A number of hospitals have declared major incidents over the past few days, in what is traditionally a particularly busy time in A and E. A major incident is part of the established escalation process for the NHS, and has been since 2005. This enables trusts to deal with significant demands, putting in place a command and control structure to allow them to bring in additional staff and increase capacity. It is a temporary measure taken to ensure that the most urgent and serious cases get the safe, high-quality care they need.
The decision to declare a major incident is taken locally—there is no national definition—and we must trust the managers and clinicians in our local NHS to make these decisions, and support them in doing so by making sure there is sufficient financial support available to help deal with additional pressures.
I chaired my first meeting to discuss that support on 17 March last year. On 13 June, we gave the NHS an additional £400 million for winter pressures, topped up in the autumn by £300 million to a record total of £700 million, ensuring local services had the certainty of additional money and time to plan how best to use it.
The NHS started this winter with 1,900 more doctors and 4,800 more hospital nurses than a year ago. This planning and funding has been widely welcomed by experts in the system, including NHS England, NHS Providers, the College of Emergency Medicine and the NHS Confederation. The funding the Government have put in, which is on top of the year-on-year real-terms increases in funding, is made possible by a strong economy, and will pay for the equivalent of 1,000 more doctors, 2,000 more nurses and 2,000 other NHS and care staff including physiotherapists and social workers. It will fund up to 2,500 additional beds, both in the acute and community sectors, and also provide £50 million to support ambulance services.
But the NHS also needs longer-term solutions to these pressures. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million people, with over 4 million already benefiting. Our better care programme integrates, for the first time ever, health and social care services in 151 local authority areas, with plans starting in April to reduce, on average, emergency admissions to hospitals by 3%. And we have funded the NHS’s own plan to deal with these pressures, the five-year forward view, with an additional £1.7 billion for the NHS in 2015-16 and £1 billion of capital over the next four years to improve primary care facilities.
Mr Speaker, let me finish by thanking hard-working NHS staff across the country for the outstanding care they continue to deliver under a great deal of operational pressure.
Andy Burnham
All over England, the NHS is stretched to the limit—and in places is at breaking point. Staff are working flat-out and we thank each and every one of them for all they are doing, but the situation is now serious and getting worse. Right now, too many vulnerable people are exposed to too much risk, waiting hours for ambulances to arrive, and held in the back of them outside A and E or on trolleys in corridors. This cannot be allowed to carry on. Patients and staff deserve better answers than they have had to date about what is being done to address this issue, and that is why, faced with this complacency, we have again had to force the Secretary of State to come here today.
Fourteen hospitals have declared major incidents. Will the right hon. Gentleman explain clearly what this means for services in those areas? What is the official advice to people living in those areas? Is he providing any central support and advice to those hospitals? If a number of major incidents are declared in the same area at the same time, what contingency plans will be put into place to protect the public? More broadly, what new measures does he have under active consideration to ease pressure at all hospitals?
The Secretary of State mentioned resources. When he allocated additional resources for winter pressure, what assessment was used to determine how much was needed? Clearly, it is not working. Does he now plan to reassess the situation and perhaps allocate more? Ministers keep blaming unprecedented demand, but the question is this: why is there such unprecedented demand? Could it have anything to do with the difficulty in getting a GP appointment, the closure of walk-in centres or the cuts to social care?
Let me turn to ambulance services. There are alarming reports of people waiting hours for ambulances to arrive. This is because ambulances are trapped in queues outside A and E departments. We are hearing that at least one service has implemented a policy of leaving patients at the door of A and E without handing them over to A and E staff. Is the Secretary of State aware of this practice, and is he satisfied that it is not putting patient safety and care at risk?
The last time we had to drag the Secretary of State here, he failed to inform the House that he had approved a proposal to relax 999 response times. So will he today tell the House what the current status of those plans is and whether they are still going ahead this winter? I have real concerns, which I have relayed to ambulance leaders, about making any such change without proper consultation and evidence. There are also reports of police and fire vehicles being used to carry people to A and E. What discussions has he had with police and fire service leaders about this practice? What training or advice has been given to front-line police and fire staff? Is he fully satisfied that patient safety is not being compromised?
Finally, cuts to social care are a root cause of the pressure on hospitals. A record number of elderly people are trapped in hospital beds, and any solution to this crisis must involve councils and a solution for social care. So will the Secretary of State now act on our constructive proposal to hold an urgent summit of all the public services affected—councils, police and fire services—and to develop a co-ordinated plan to ease this crisis? NHS staff deserve it. Safe patient care demands it. When will he deliver it?
Mr Hunt
First, let me thank the right hon. Gentleman for this opportunity once again to go through the plans that we have in place to support the NHS and to reiterate the gratitude of the whole House to NHS staff for what they are doing under huge pressure at the moment. Let me start by telling him where I agree with him. I agree that what happens in the social care system is closely linked to what happens in the NHS. That is why, from June last year, meetings have been happening in 140 local authority areas between the local NHS and local authorities to work out how best to plan for winter. The result of that planning process, which is funded by £700 million of Government support, is extra doctors, extra nurses, extra beds and new plans in every area. I am absolutely satisfied that that money is making a difference. Every day in our A and E departments, 2,500 more people are being seen within four hours than was the case four years ago when the right hon. Gentleman was Health Secretary. The local structures worked last year, and they are working now. Now is the time to get behind them and to support the local NHS.
In a letter that the right hon. Gentleman wrote to me yesterday, he talked about Government failure. This is not the time to play politics—[Interruption.] Perhaps Opposition Members will listen to this. The head of NHS England, Simon Stevens, a former Labour special adviser, said yesterday
“the NHS, the Department of Health and local clinicians have done everything that could reasonably be expected”
to put in place plans over the last weeks. If the right hon. Gentleman will not listen to that, perhaps he will listen to Rob Webster, who runs the NHS Confederation, a representative body of all NHS organisations. He says that we should be grateful for the huge effort NHS staff have put in over the past few weeks and that it is not the time to play political football.
The right hon. Gentleman talked about ambulances, where we are putting in £50 million of support this winter, and some changes proposed by the Association of Ambulance Chief Executives, which he was informed about three months earlier than they came to public light. This is what the AACE said:
“We have been surprised by some of the reaction today given that over the last three months the principles of what we are proposing…have been shared with Labour…and we have received no negative feedback”.
What did the right hon. Gentleman say? He said it was a panic decision to relax 999 standards. There was no panic, no decision, no relaxation of 999 standards; I did what any Health Secretary should do: I simply asked for clinical advice on what would be best for patients. He chose to frighten the public, to scaremonger for party political purpose. Is it not time the Labour party, for once, thought about the impact on patients of the kind of things it is saying in the press?
The right hon. Gentleman then talked, and the Leader of the Opposition has talked, about the causes of these challenges being the reforms this Government introduced in this Parliament. Let me say to him that the one part of the UK that introduced these reforms, England, happens to have the best A and E performance and the one part of the UK that has most set its face against these forms, Labour-run Wales, has one of the worst performances. If he wants to do something about A and E pressures, instead of trying to make political capital in England, he should be getting Labour to turn things round in the one place it does run the health service—Wales. He should be backing this Government’s support for the NHS in a difficult period that has meant more doctors, more nurses, more people being seen quickly, more operations, long-term support and a plan for our NHS; it should not be politics and scaremongering ahead of an election.
Dr Sarah Wollaston (Totnes) (Con)
May I join the Secretary of State in warmly thanking NHS staff, who are stepping up to meet the extraordinary increase in demand for their care and expertise? Will he reassure the House that in meeting this extraordinary, complex challenge, they will not be made to chase targets, as we know that that was distorting clinical priorities in Mid Staffs, and that clinical staff should always feel absolutely confident that they have his support to place clinical priorities first and foremost?
Mr Hunt
My hon. Friend is absolutely right about that, and it is very important. Targets matter, but not targets at any cost. It is worth remembering that, over the four years we were seeing the tragedy unfold in Mid Staffs, it was meeting its A and E target the majority of the time. So it is very important that patient safety is the priority. That is why we have to support NHS trusts when they have major incidents and why we have to make it clear that, although targets matter, trusts need to be sensible and proportionate in their efforts to meet those standards.
Frank Dobson (Holborn and St Pancras) (Lab)
Does the Secretary of State accept the truth of the assertions by A and E doctors and nurses that the call handlers working for the 111 service are referring far more patients to A and E than happened when NHS Direct was staffed by nurses, who exercised professional discretion?
Mr Hunt
It is always important to keep the algorithms used by call handlers—111—under review. I say to the right hon. Gentleman that 111 is part of the way we have been able to relieve pressure on A and E departments. Calls to 111 doubled this Christmas, and 27% of the people who called it said that they had been planning to go to an A and E department but did not do so following the call. That is a very important way of relieving pressure on our A and E departments.
Mr Kenneth Clarke (Rushcliffe) (Con)
Does the Secretary of State share my recollection that five years ago no political pundit of any kind predicted that the welcome ageing of the population and the ending of the 24 hours a day, seven days a week commitment of general practice would produce the quite extraordinary surge in demand that we now have to cope with? Does he therefore agree that instead of wild criticisms of local crises he needs to persist in the short term by providing resources and improving co-operation between social services and health care, and in the long term by implementing the changes necessary in response to demand, as set out by Simon Stevens in his report, which our reforms have enabled NHS England to produce?
Mr Hunt
My right hon. and learned Friend speaks with a great deal of wisdom as someone who has occupied this post and he is absolutely right. All Health Secretaries face pressures of the kind we are going through now and face difficult winters. Winter is always a difficult time for the NHS and, as the Prime Minister said, we need a short-term plan to help—that is what our plan of creating about 5,000 extra front-line clinicians this winter alone is doing—but we must also consider the long-term plan. That involves finding a better way of looking after vulnerable older people other than through A and E departments—that means better care in the community, better support from GPs and better community services—and that is exactly what we are doing.
Barbara Keeley (Worsley and Eccles South) (Lab)
Bolton Royal hospital is one of the hospitals declaring a major incident. The context is as follows. The Little Hulton walk-in centre was closed, when it saw 2,000 patients a month. Salford city council had £100 million cut out of its budget, so 1,000 people this year are losing care packages. I have an elderly constituent who was admitted to Bolton Royal following poor care. It is obvious that those things are causing the problem. When will the Secretary of State take responsibility?
Mr Hunt
We take responsibility and I take responsibility for everything that happens in the NHS. Let me tell the hon. Lady what we are actually doing, because there have been some serious bed capacity issues in Bolton. Bolton has had £3 million this winter to help deal with those pressures, which has included £340,000 to spend on additional beds in the hospital supporting the A and E department and more than £100,000 to pay for additional staff in A and E. Overall, compared with in 2010, there are 114 extra doctors and 571 extra nurses. She should welcome that, rather than trying to make a political issue of it.
Jesse Norman (Hereford and South Herefordshire) (Con)
May I remind the House that the private finance initiative, which expanded hospitals to 100 from zero after 1997, created at least £2 billion to £10 billion, and possibly even £20 billion, of additional costs that could now be used? In Hereford, the hospital is too small because of PFI. I have estimated that £30 million could have been spent on the hospital if contracts had been properly implemented in the first place. That is why my hospital, which declared an incident this week, has been struggling and it is quite wrong to suggest otherwise.
Mr Hunt
My hon. Friend is absolutely right. I congratulate the doctors and nurses who are working very hard in his local hospital and point out that there are a number of historical problems. The £71 billion of PFI debt is one of those and it means that more than £1 billion every year is diverted from the front line. We have done something about the top-heavy management structures and, as a result, across the NHS we have 9,000 more doctors and 3,000 more nurses. It is very important in this debate that we focus not only on short-term pressures but on dealing with the long-term issues in the NHS. That is what we want to do in his area and in every area.
Kevin Barron (Rother Valley) (Lab)
On 9 December, a member of my family was admitted to Rotherham hospital through A and E after a fall at home. She was told two days later by a doctor that there was no medical reason she should be in hospital. She spent her 93rd birthday, on 24 December, in Rotherham hospital and was discharged on Monday of this week, having at last got a care package together. Does the Secretary of State think that the cuts to Rotherham borough council’s social services have helped or hindered the situation?
Mr Hunt
We need to have much better working between the health and social care systems. If the right hon. Gentleman supports that, he should support the better care programme, which from April of this year will see co-operation between the local NHS and local authorities in 150 local authority areas for the first time. Instead, Labour is calling for that plan to be halted.
Robert Halfon (Harlow) (Con)
Will my right hon. Friend thank the staff of the NHS at Harlow Princess Alexandra hospital for their passion and commitment? Although the Government have invested £5 million in our accident and emergency services, issues in nearby hospitals mean that the pressure on our A and E has been immense. Princess Alexandra hospital is one of the busiest by far for attends by bed and one in five ambulances arrives from out of the area. The PAH is now admitting four more patients a day than it was this time last year. Will my right hon. Friend meet me and the chief executive of the Princess Alexandra hospital, and will either he or the Minister responsible for hospitals visit the hospital to see what can be done to help the situation?
Mr Hunt
I am very happy to do that and I am aware of the significant pressures at the Princess Alexandra. I thank my hon. Friend for the way in which he is supporting staff in his local hospital, getting behind local plans. It is a mistake to say that there is always a new national initiative. Lots of people in the NHS have been saying over the past few days that they do not want new national initiatives. They want exactly what my hon. Friend is doing; they want people to support their local NHS and not to turn it into a political football.
Hazel Blears (Salford and Eccles) (Lab)
On Monday evening, the trust of Salford Royal hospital, which, as the Secretary of State knows, is an excellent hospital, declared a major incident. I am pleased to say that the pressure has been dealt with and it has now been lifted, but it is clear to me that many of the thousands of elderly and frail people in hospital have dementia, which means that they stay longer and are readmitted more often. I welcome the better care fund, but it will not be enough. There needs to be a whole systems change to prevent people from being admitted in the first place, with better support and more action by GPs. We need to get on with that urgently.
Mr Hunt
I agree entirely with the right hon. Lady. The better care fund is a first step, but it is only a first step. It is happening from this April, but we have the NHS England five-year forward view, which is the long-term plan to improve community care. I agree that Salford Royal is an excellent hospital. It had £3.5 million to help it deal with winter pressures this year, but it is also a good example of how integrated care between the acute trust and local community services can make a real difference, and it is delivering some of the safest care in the country.
Paul Burstow (Sutton and Cheam) (LD)
May I pay tribute to the accident and emergency staff at my local hospital, St Helier, whom I met on Monday? One thing they made clear to me is that although there is no single cause of the pressures on A and E at the moment and there is therefore no single solution, they want certainty about the long-term plans for NHS funding. Although the down payment of £2 billion announced in the autumn statement was very welcome, will the Secretary of State say whether the Government or any Government in whom he might participate in the future will deliver the additional £8 billion necessary to secure the closing of the funding gap that Simon Stevens identified?
Mr Hunt
When we did the autumn statement last year, we asked Simon Stevens and NHS England how much they needed for their plan next year and they told us it was about £2 billion, so we made that commitment. We also said that that was a down payment on delivering the entire plan, not a one-off payment. I agree about the importance of long-term certainty over funding, but the most important thing in that regard is to have a strong economy that can deliver the money that will support our NHS. It is only Government Members who have shown that they are capable of delivering that strong economy rather than the instability that would come from disastrous economic policies.
Grahame M. Morris (Easington) (Lab)
The Secretary of State and Prime Minister accuse the Labour party of using the NHS as a political football and as a weapon. May I advise the Secretary of State that the NHS is a weapon—a very powerful one—for the treatment of illness and the relief of disease and suffering, and that it is being blunted by this Government and his Department under his stewardship? I met the chief executive of City Hospitals Sunderland NHS Foundation Trust about the NHS crisis and the A and E crisis, and one of the problems he identified was the lack of sufficient staff and the need to recruit locums. What is the Secretary of State doing about recruiting more staff and how many vacancies are being carried?
Mr Hunt
I agree that we need more staff, but the hon. Gentleman should welcome the fact that under this Government there are 9,000 more doctors and 3,000 more nurses. Such an increase was made possible by a reorganisation that took money away from bureaucracy and management and put it on to the front line. What is wrong is for the Leader of the Opposition to say that he wants to weaponise the NHS—turn it into a political weapon. The NHS is not a political weapon; it is there for patients. Labour should be ashamed of trying to turn it into a political football.
Sir Alan Haselhurst (Saffron Walden) (Con)
Is my right hon. Friend aware that the declaration of a major incident by Addenbrooke’s hospital has caused concern among my constituents whose non-urgent admissions have had to be postponed? Is he also aware that the hospital is currently looking after more than 300 people aged over 85, which is in itself a remarkable tribute to the NHS? However, such a figure underlines the fact that we have to give more attention to the integration of health and care issues.
Mr Hunt
I am aware of the problems at Addenbrooke’s. Indeed, the main issue, as my hon. Friend rightly says, is delayed discharges relating to care. The chief executive is running the command and control system and working with the local authority to facilitate the discharges that are necessary and to de-escalate the situation. The hospital has £2.2 million for its winter pressures support and 185 more doctors than four years ago.
Derek Twigg (Halton) (Lab)
The national health service in my constituency is under immense pressure, as are the adult services. It has been known for some months now that the number of acutely ill people coming into hospital has been growing. Has the Secretary of State investigated the reasons for that significant increase, which I am hearing about from the chief executives of the hospitals? If he has, what are those reasons? Is it to do with access to primary care, or problems with adult social services? Will he tell the House now?
Mr Hunt
We have looked into that matter in huge detail. There are probably three broad factors that are behind the increase in demand. One is the ageing population. There are 350,000 more people over the age of 75 than four years ago. The point is that if someone of that age goes into A and E in the winter, there is an 80% chance they will be admitted to hospital and quite a large chance they will stay in hospital for some time. The second factor is changing consumer expectation among younger people who want faster health care—[Interruption.] That is what Professor Keith Willett, the director of emergency care at NHS England, said, and Opposition Members should listen to what our clinical leaders are saying. The third factor is a refusal by NHS trusts to do what they were pressurised to do in the past, which is to cut corners to hit targets.
Angie Bray (Ealing Central and Acton) (Con)
My right hon. Friend will be aware that there have been significant changes to hospital services across north-west London. There is considerable concern from some of my constituents that the closure of A and E departments at Central Middlesex and Hammersmith hospitals has led to some of the increasing pressure elsewhere. Will he tell me whether there is any evidence of that?
Mr Hunt
I am aware that there have been particular pressures at Northwick Park hospital, but I am also aware that a plan is in place in north-west London to have weekend opening of GP surgeries to improve out-of-hospital provision. The pressures that are faced there are like those in the rest of the country—very severe. We are doing everything we can to support the hospitals in that area with our winter pressures plans.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The Secretary of State spoke about the algorithms used by 111 call handlers. Does he appreciate that a frightened mother with a sick child is not really interested in algorithms? What she wants to know is that her child can get the medical help that they need promptly. He has told the House that he has been having meetings on this winter crisis since March. Is he not a little bit embarrassed that we now have people queuing to see their GPs first thing in the morning, ambulances queuing outside hospitals, people being treated in tents outside hospitals, and old people staying in hospital longer than they need to because there is a lack of funding and no proper co-ordination between health and social care?
Mr Hunt
Of course I regret any individual incidents where people do not get the care they need promptly. The hon. Lady will know that the solutions to such problems are not always things that can be done overnight. If she looks at the record of joined-up care over the past few years, she will see that this is the first Government to encourage 150 local authority areas to sit down with their local NHS and jointly plan care for the most vulnerable people in the social care system. That is a very big step forward. We are also doing nearly 1 million more operations every year across the NHS. In accident and emergency, the number of people being seen within four hours has gone up by nearly three quarters of a million since the start of this Parliament. That is real progress, but of course there are long-term issues, and we will focus on those as well.
Andrew Percy (Brigg and Goole) (Con)
I congratulate Goole hospital on hitting its target 99.7% of time, and the trust as a whole on hitting its target 93% of the time. I spent my Christmas volunteering in the NHS at A and E and with the ambulance service. Staff repeatedly told me that as first responders what they see are more old and frail people needing to be admitted to hospital. That situation was not helped by 50,000 hospital beds being cut by the previous Government. One way of dealing with the problems would be to move to a community paramedicine model and to use the skills of our ambulance services more. I encourage the Secretary of State to ensure that NHS England is seriously looking at that option.
Mr Hunt
May I congratulate my hon. Friend on the shining example he gives to everyone in this House by being a first responder? I do agree that one thing that we could do in the next year is to integrate better what happens in the ambulance services, out-of-hours GP services and 111. Individually, they are all doing a good job, but they could do a much better job if what they did was integrated.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)
Facts are important in this debate. There is now good evidence to show that overcrowding in emergency departments increases mortality and length of stay. Will the Secretary of State ensure that the figures for hospitals are available in the House of Commons on a monthly basis, so that we can correlate spikes following emergencies with what happens to mortality rates? If mortalities increase, the problem is even more serious than we think it is.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
I have just been visiting a much-loved elderly relative in hospital and I have seen what a wonderful job our nurses are doing and the pressure that they are under, but may I tell the Secretary of State that Huddersfield and Calderdale used to have an amazingly good partnership of people in the health service working together. The antagonism now between trusts and commissioning services has destroyed that partnership. All we have now is tension and stress. We no longer have a partnership delivering health care in our country.
Mr Hunt
I agree with the hon. Gentleman about the hard work of the doctors and nurses at his local trust, but the feedback I get from the front line is of closer partnership working than has ever happened before, with the local authorities and the local NHS sitting down together planning what they will do for the most vulnerable older people through the better care fund. I want to encourage that everywhere I can.
Sir Richard Ottaway (Croydon South) (Con)
I join the Secretary of State in praising Croydon University hospital staff who have been working their socks off in recent days, but is he aware that CUH has a recently modernised subsidiary in Purley with a minor injuries unit, which is open only in the afternoons, and an under-used X-ray department? Will he explore with Croydon commissioning group whether those facilities can be used full time, because that would take the load off the A and E department at Croydon University hospital?
Mr Hunt
I am happy to explore that. All these suggestions need to be considered very carefully. That trust has had 40 extra doctors and nearly 300 extra nurses and £4.5 million to help with its winter pressures this year. Perhaps some of that money could be used for that purpose. I am happy to look into it.
Mr David Lammy (Tottenham) (Lab)
As the Minister who introduced the precursor A and E target, may I say that the Secretary of State was right to continue with the target? Making the target work was dependent on NHS Direct, delayed discharges, the integration of social care, and targets in the rest of the hospital, particularly on cancer. He has demolished that whole system. Will he now apologise for the absence of those targets, the problems in delayed discharge and the scrapping of NHS Direct?
Mr Hunt
I am afraid that what the right hon. Gentleman says is simply not correct. We have continued with key operational targets. A number of them are under pressure, but when we look at each of them we see that the reason is that the NHS is treating more people than ever before but demand is outstripping supply. For example, nearly half a million more people visited A and E in the most recent quarter than in the last quarter of the previous Labour Government, and we have 1,000 more doctors in our A and E departments. That tells us that, along with short-term help with these pressures we need a long-term solution, which is what this Government are committed to.
Andrew George (St Ives) (LD)
This is a serious and complex issue, and one of the factors causing it is that many seriously ill patients cannot be admitted to acute hospital wards because there are insufficient beds. In the light of that, I draw the Secretary of State’s attention to an NHS Confederation report from May 2006, “Why we need fewer hospital beds”. I cautioned at the time that it would be unwise to pursue such a policy without first front-loading primary and social care. Will he look at enhancing acute hospital beds until primary and social care have the capacity to help out the acute sector?
Mr Hunt
The hon. Gentleman makes an important point. In fact, I was talking with someone senior at the Royal Cornwall hospital on Monday about the particular pressures there. Indeed, some of the funding that we allocated to the NHS in the autumn statement for next year is designed to do precisely that—to allow hospitals to maintain bed capacity while we ramp up facilities in community and primary care. It is very important to get the timing absolutely right.
Lilian Greenwood (Nottingham South) (Lab)
Yesterday the emergency department at Nottingham’s Queen’s Medical Centre faced such intense pressure that the trust was forced to enact its internal incident plan and cancel planned operations and out-patient clinics. Higher than expected admissions and delays in discharging patients who are well enough to leave hospital have been creating problems for many months. How can we resolve what is now a crisis if the Secretary of State will not even acknowledge that his Government’s deep cuts to social care are undermining the efforts of our dedicated NHS and social care staff?
Mr Hunt
We are doing an enormous amount to support social care. Some £3.9 billion of NHS funds has been given to the social care system over this Parliament, and we have strongly encouraged local authorities to ensure that any savings they have to make are done through efficiency savings, not cuts to front-line services. The hon. Lady’s local hospital has received £11 million in funding to help it through the winter. We are doing a huge amount to support the NHS through a difficult period, and she should support those efforts.
Sir Tony Baldry (Banbury) (Con)
It is obviously important that those who need to be treated in A and E are treated there and that those who do not go to those parts of the NHS where they can be treated best. Does my right hon. Friend agree, therefore, that the initiatives taken by clinical commissioners in Oxfordshire where, for example, they are trying to triage patients essentially at the door of A and E so that those who need to go in can do so and those who need primary care get it, will help reduce pressures on A and E and ensure that people are treated in the right part of the NHS?
Mr Hunt
Those are exactly the kinds of initiatives that can make a big difference—indeed, they are recommended by the College of Emergency Medicine. Of course, the long-term solution is to ensure that people are better looked after at home so that they do not need to end up at the door of a hospital. That is why more proactive care by GPs—we plan to recruit 5,000 more GPs over the next five years—should mean that that becomes less of a pressure point.
Yasmin Qureshi (Bolton South East) (Lab)
The Royal Bolton hospital in my constituency yesterday declared a major incident. As of 1 pm yesterday, there were 53 people in the A and E department, 15 waiting for a bed, some for more than 12 hours, and a number of non-urgent operations were cancelled. I thank the hospital for all its hard work, because there have been problems for the past few weeks. I would like the Secretary of State to deal with the crisis by immediately reopening walk-in centres, because their closure is the reason so many people are going to A and E, and have proper funding given to local authorities so that they can put in place a proper health and social care budget for the elderly and vulnerable.
Mr Hunt
There have indeed been pressures at the Royal Bolton hospital, particularly in relation to bed capacity and intensive care unit capacity. All patients on the wards have been reviewed and discharges have been created—the plan was to discharge between 30 and 50 patients before the end of yesterday. We are doing a lot to support the hospital. It has been given £3 million in winter money, £350,000 to create extra bed capacity and £100,000 for extra A and E staff.
Mr Philip Hollobone (Kettering) (Con)
Kettering general hospital is experiencing its busiest winter on record. The three hon. Members for north Northamptonshire, the hon. Member for Corby (Andy Sawford), my hon. Friend the Member for Wellingborough (Mr Bone) and myself for Kettering, are working together to attract extra investment into our A and E. When we go to see the Secretary of State’s colleague, the hospitals Minister, next week, will he encourage the Minister to receive us warmly and favourably?
Mr Hunt
I think that my hon. Friend should always be able to count on being received warmly and favourably. There are particular pressures in Northamptonshire. I am planning to have a conversation with the chief executive of Northamptonshire county council in the next week to see whether there is anything more that can be done to facilitate discharges and relieve the pressure at Kettering.
Mark Reckless (Rochester and Strood) (UKIP)
I greatly welcome the £13.4 million of investment recently signed off for Medway hospital’s A and E department. Does the Secretary of State also understand the hospital’s need for a further £20 million of capital for medical wards around the A and E department to support integrated care and improve the throughput of patients to assist in turning around Medway hospital?
Mr Hunt
I am aware of those proposals, which we will obviously look at carefully. I am also aware that there are big pressures in the A and E department at Medway, but there are also other, more profound issues to do with the leadership at the hospital. The hon. Gentleman should rest assured that we are taking every step possible to try to turn things around.
Sarah Newton (Truro and Falmouth) (Con)
I recently spent a shift at the Royal Cornwall hospital’s A and E department and saw at first hand the fantastic work it is doing. Does my right hon. Friend agree with the clinical team and with Mr Virr, who leads the department so well, that people need to remember that A and Es are for life and limb emergency treatment on the day and that they should consider the excellent alternatives, such as minor injuries departments and out-of-hours GP services, before automatically going to A and E?
Mr Hunt
I commend my hon. Friend for her tremendous interest in the Royal Cornwall hospital and for her campaigning to support its efforts. I spoke with the chief executive earlier this week about the particular challenges with discharging patients. I also spoke with the deputy chief executive of the South Western Ambulance Service NHS Foundation Trust about the dramatic increase in 999 calls this winter. My hon. Friend is absolutely right that the public can help us by ensuring that they use alternatives to A and E wherever possible.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
When I led an integrated health and social care team 20 years ago, we found that carers no longer being able to care was a key reason why people went into hospital and into care. Will the Secretary of State now look again at the eligibility criteria introduced under the Care Act 2014 and ensure that a much greater number of carers can get support, because at the moment the number is being reduced?
Mr Hunt
Under that Act we introduced national eligibility criteria to try to remove the postcode lottery that had existed previously. We have also introduced new rights for carers that require local authorities to take account of the pressures on them. I think that we are going in the right direction, but I accept that there is always more that can be done.
David T. C. Davies (Monmouth) (Con)
Some 92.6% of patients in England are seen within four hours, as opposed to just 83.8% of patients in Wales. If Labour wants to make this a political football, why does it not play an away game down in Cardiff, where it is in charge and responsible for the disgracefully lower standards that we receive there?
Mr Hunt
My hon. Friend makes his point powerfully, as ever. The rhetoric that we have heard from the Labour Benches today is interesting for its absence when we have debates on Wales. It seems to the public watching this that there is one rule for England and one rule for Wales, and that Labour is satisfied with lower standards in the parts of the country that it runs.
Geraint Davies (Swansea West) (Lab/Co-op)
The NHS is in financial crisis, with more money needed for A and E, yet we are spending £10 billion a year on diabetes because people are consuming twice the daily amount of sugar that they should be consuming—nine teaspoonfuls for men, which is equivalent to a can of Coke, or six for women, which is equivalent to a light yoghurt. Does the Secretary of State agree and will he support my Bill, which is published today, which requires manufacturers to express sugar content in teaspoonfuls on products to empower consumers to make rational choices in order to manage down overall obesity—
Mr Speaker
No. I am not debating with the hon. Gentleman; I am telling him. His inquiry suffered from one little disadvantage: it was too long.
Mrs Anne Main (St Albans) (Con)
My right hon. Friend will be aware that the Minister for Policing, Criminal Justice and Victims, my right hon. Friend the Member for Hemel Hempstead (Mike Penning), and I were very unhappy that the A and E was closed and moved to Watford. Since then Watford hospital has had a turbulent time. This morning the chief executive resigned, having got part-way through a process of consultation. May I ask for the consultation to be put on hold until the new chief executive is in place and has their feet under the table? We do not need more turbulence in our hospitals in west Hertfordshire.
Bill Esterson (Sefton Central) (Lab)
One of my constituents wrote to me about her elderly mother who faced a wait of many hours for an ambulance to A and E. My constituent told me that at A and E she saw patients on trolleys backed up through the corridor to ambulances waiting in the car park. Meanwhile, patients were waiting at home, unable to get those same ambulances. She described the scene as “a war zone”. Is it not the case that A and E is unable to cope, the ambulance service is unable to cope, and patients who need to go to A and E are suffering?
Mr Hunt
I agree that there are real pressures in A and E across the system, but it is important to remind the public that even under that pressure, nine out of 10 people continue to be seen, treated and sent home within four hours. That is an extremely impressive record for the people working very hard in our A and E departments.
Chloe Smith (Norwich North) (Con)
The Norfolk and Norwich hospital declared a major incident. Its medical staff say that care is safe. Will my right hon. Friend join me in supporting Norwich NHS staff and their innovative urgent care unit, will he urge Norwich GPs to apply to the access fund, and will he condemn some of Labour’s political leaflets in Norwich which carry fake NHS stories, as told to me by NHS workers?
Mr Hunt
It is important for all parties to behave responsibly when the NHS front line is under such pressure. My hon. Friend might want to remind her Labour opponents locally that in Norwich there are 97 more doctors than four years ago and 145 more nurses, all possible because of a strong economy.
Alison Seabeck (Plymouth, Moor View) (Lab)
Last week 1,631 people visited Plymouth A and E. One in 10 of them waited more than four hours. Staff are showing great dedication and doing extra shifts, but that is not sustainable. Will the Secretary of State please take his head out of the sand and, if he is serious about depoliticising the issue, will he take up the shadow Secretary of State’s offer of a cross-party summit to look at all the issues behind the crisis?
Mr Hunt
I was talking to a doctor at Plymouth last night and I recognise that there are real pressures there and staff are working very hard. The long-term solution is to back the non-party political plan that the NHS itself has put together under the leadership of Simon Stevens—the “Five Year Forward View”. We made the big call in our autumn statement to find £2 billion, which is what he said the NHS needed next year, and I hope Labour will support that. Then we can have the kind of consensus that the hon. Lady asked for.
Paul Uppal (Wolverhampton South West) (Con)
In 2003, a dozen years almost to the day, I accompanied my grandmother to A and E. We arrived at 8 o’clock in the morning. She was not allocated a bed until 9.30 that evening. May I impress upon my right hon. Friend that money alone is not the issue? It is important that we push ahead with the long-term plan and do not adopt a short-term opportunistic approach.
Mr Hunt
My hon. Friend is right. It is important to say that lots of people in the NHS have been asked in the past few days on the media what the issues are, and they have not been saying that it is about money. They have been saying that it is about reforming the structures. That is why, as well as the money that is available for this winter, we need to look at the plans that we can put in place to improve access to GPs, to improve the co-ordination between the health and the social care systems, to deal with issues that prevent people from going to hospital in the first place. That is what this Government want to do.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
Many of my constituents in Feltham and Heston have raised with me their concerns about being able to access GP services, some having to wait weeks and in the mean time having to seek emergency help. Does the Secretary of State now regret the Government’s decision to axe Labour’s guarantee of a GP appointment within 48 hours?
Mr Hunt
If the hon. Lady regrets that, she might want to ask her Labour colleagues in Wales why they also axed the 48-hour target. We do need better access to GPs. That is why we are funding the training of 5,000 more GPs over the next five years. With targets, we must be careful of unintended consequences. When we had that target in place, a quarter of people who asked for an appointment in more than two days were told that that would not be possible, because we found that people played the target. That is why we do not want to go back to that system.
Justin Tomlinson (North Swindon) (Con)
As set out in the College of Emergency Medicine’s 10-point plan to improve A and E, co-location of GP surgeries is key. Does my right hon. Friend agree?
Mr Hunt
I agree with pretty much all the College of Emergency Medicine’s 10-point plan. That has very much informed our approach to helping the NHS over this winter. Co-location of GP surgeries on hospital sites is very helpful, but we also need more proactive care for the most vulnerable older people before they feel the need to go to hospital. That will be at the heart of the changes that we want to see.
Mr Andy Slaughter (Hammersmith) (Lab)
The reason that west London now regularly has the worst waiting times for A and E, with up to 50% of patients waiting more than four hours, is a direct result of the Secretary of State’s decision to close the Hammersmith and Central Middlesex A and E four months ago. These are sick people who need A and E, not GP services. We have GP services at those hospitals. What we need is for him to cancel or at least review the downgrading of the A and E departments at Charing Cross and Ealing hospitals to GP-led emergency centres. Will he at least do that?
Mr Hunt
I say gently to the hon. Gentleman that if we are to solve the problems in his area and others, we should listen to the doctors about the structures that will work best. The structures that we put in place are the structures that doctors advised us to set up. That is why we are supporting them.
Mr Peter Bone (Wellingborough) (Con)
Mrs Bone would like to offer best wishes for the new year to the Secretary of State. The reason she can do this is the excellent health care provided by the NHS in both Kettering general hospital and Northampton general hospital. Locally, the commissioners and the acute hospitals are together working out a plan to deal with accident and emergency. Is not that the way forward?
Mr Hunt
Indeed. I pass on my best wishes for the new year to Mrs Bone. Like many people, she has benefited from superb NHS care. A million more people are having operations every year under this Government, and 700,000 more people are being seen within four hours at A and E under this Government.
Gavin Shuker (Luton South) (Lab/Co-op)
The NHS is a system, which is why cuts to social care and other parts of the system affect A and E. With that in mind, and with 14 hospitals in a state of emergency, will the Secretary of State review the plans that are in place should a winter crisis of cold weather come along at this very vulnerable point?
Mr Hunt
It is interesting that the hon. Gentleman did not want to talk to the House about his own local hospital, which is performing extremely well for A and E. It would be good if more of those on the Opposition Benches talked about the good things that are happening in the NHS, including nine out of 10 people who go to A and E being seen within four hours.
Rehman Chishti (Gillingham and Rainham) (Con)
I thank the Secretary of State for the £13.4 million given to Medway Maritime hospital’s A and E department. Will he assure me that everything that can be done is being done to turn around hospitals in special measures such as Medway, which had the seventh highest mortality rate in 2006 yet nothing was done? Will he also join me in paying tribute to all the front-line staff who do a fantastic job at Medway?
Mr Hunt
I am happy to do that. One of the things that this Government are most proud of is what we have done to turn around hospitals with entrenched low standards of care following the terrible tragedy at Mid Staffs, with 18 hospitals put into special measures and six of them turned around. Despite all the pressure on me and on this Government to hit targets, we are sending out signals to the system, loud and clear, that targets matter, but not at any cost, and that we do not want corners cut when it comes to patient safety.
Graham Jones (Hyndburn) (Lab)
Last weekend at Royal Blackburn hospital’s A and E, which I have been concerned about for quite a while, 18 ambulances were waiting outside. That was revealed not by the NHS but by a whistleblower, who described the situation as “chaos”. Is it happening because there are too many patients putting too much pressure on the NHS or because of mismanagement of the NHS by the Conservatives?
Mr Hunt
It is because of unprecedented demand caused by a range of factors. If the hon. Gentleman looks at the facts, he will see an NHS that is treating more people more quickly, with more doctors, more nurses and more operations than ever before. Sometimes, though, as I said yesterday, people on the front line feel that they are running just to stand still because there is so much pressure. That is why the £700 million in our winter plan and the money we are putting in to back the five-year forward view next year are so important.
Karen Lumley (Redditch) (Con)
Does my right hon. Friend agree that we should not be playing party politics with the NHS in the way that my opponent in Redditch is by putting out leaflets saying that I am systematically voting against the NHS, but that we should be working together with our trusts and partners in ensuring that we get through this problem, as we are trying to do in Worcestershire?
Jonathan Ashworth (Leicester South) (Lab)
The Secretary of State will know that major incident status was declared at Leicester hospitals this week for the seventh time in three months. In the week before Christmas, just 67% of patients at Leicester Royal Infirmary in my constituency were seen within the four-hour target, and clinicians, who are working flat out, expect pressures to increase over the next three months. What is he now going to do to support clinicians in Leicester and get a grip of this situation?
Mr Hunt
I am aware of the situation in Leicester. The hospital has had significant space pressures in its emergency department, and a couple of nights ago it had a high in-flow during one night, but it is absolutely on the case in trying to resolve this. What are we doing? We have put in £9.2 million of winter pressures money to make sure that whatever people decide the right solution is, it is not through lack of resources that they cannot do it.
Chris Skidmore (Kingswood) (Con)
Last Saturday night, while I was visiting my wife’s family in Leicestershire, my baby daughter suddenly became quite ill. Rather than going to A and E, we rang the 111 service and were quickly referred to Loughborough urgent care centre, where we had fantastic treatment; I pay tribute to the staff. Does this not go to show that we need to prioritise new models of urgent care, as set out in Simon Stevens’s review?
Mr Hunt
We absolutely do that. Telephones and the internet provide different ways to get the right advice to people quickly. The 111 service is taking a considerable amount of strain at the moment, and we have put in more money to support it. We are investing a lot more in tele-health and tele-medicine, and a lot more to help GPs who want to give people out-of-hours appointments. In the long run, that is the way we will reduce the kinds of pressures that my hon. Friend talks about.
Helen Goodman (Bishop Auckland) (Lab)
Over three years ago, I raised with Ministers problems about the North East ambulance service that had been pointed out to me by the paramedics, but unfortunately they were brushed aside. My constituent, Violet Alliston, had the terrible experience of her partner ringing for an ambulance three times in the course of an hour before the ambulance came. She then died. This is obviously completely unacceptable. Why will not the Secretary of State look again at the resources he is taking out of the North East ambulance service, the skills base of the call handlers, and the triage system?
Mr Hunt
I am extremely sorry to hear the story that the hon. Lady talks about, and I know that the NHS will investigate it fully. We are not cutting resources to ambulances, though. We have 2,000 more paramedics than four years ago, and £50 million is being put in this winter. Of course, we need to look very carefully into the particular case that she mentions and make sure that any lessons are learned.
Richard Graham (Gloucester) (Con)
Thank you, Mr Speaker—I will seize the moment.
Part of the long-term solution is attracting and retaining more nurses. Will my right hon. Friend encourage the National Health Executive to allow the university of Gloucestershire to run pre-registration training courses for nurses so that we can attract and retain more local nurses?
Andy Sawford (Corby) (Lab/Co-op)
The Secretary of State will be aware that there are particular issues at Kettering General hospital’s A and E unit. It has improved its performance, but it has been described, to the shock of all the MPs in the area, as the worst seen in the country. We have done an awful lot of work. On Tuesday we are bringing the local health organisations together to the Department. Will he encourage his ministerial colleagues to give the green light to our plan for our area?
Fiona Bruce (Congleton) (Con)
My constituent, Mr J. Hollinshead, rang Ashfields surgery, Alsager, for an appointment at 8.30 am on 2 January. He was given one for 10.30 am, when his doctor referred him for three tests to be done with the practice nurse at 11.30 am, then on to Leighton hospital for an X-ray, and he was home by 1.30 pm. His response: “How good is that?” Is not that a truer picture of the NHS under this Government than the negative messages coming out from Labour Members?
Mr Hunt
I agree that we need to recognise the successes of the NHS, and there are many of those successes. The reason we need to do that—I urge Labour Members to remember this—is that it is very important for the morale of people working in the NHS that we publicly recognise where they are being successful.
Clive Efford (Eltham) (Lab)
Is it not true that this Government set out with a plan to close nine out of 31 A and Es in London, including the one at Lewisham, as directed specifically from the Secretary of State’s office? Does he regret that? What state does he think the A and E services in south-east London would be in if he had been successful, in the face of public opposition, in closing that A and E?
Mr Hunt
First, as the hon. Gentleman knows perfectly well, there were never any plans to close that A and E, and he should desist from scaremongering about what was happening at Lewisham hospital. He should also remember that when this Government came into office—[Interruption.] The plans—
Mr Speaker
I am grateful to the hon. Gentleman for his withdrawal and I note what he says.
Mr Hunt
The plans were to continue to have an A and E at Lewisham but to take some of the higher-risk patients to another hospital. Those are the plans that we originally had that have now been changed. What I will say to the hon. Gentleman, though, is that there were problems with South London Healthcare Trust for years and years. This Government dealt with them and sorted them out, and that means that his constituents are getting better care than they otherwise would have done.
David Morris (Morecambe and Lunesdale) (Con)
Will my right hon. Friend join me in congratulating the staff at Royal Lancaster Infirmary on meeting their A and E targets in November? Will he also share my revulsion at the Opposition putting out a leaflet saying that there are all kinds of things wrong with the A and E and that it is going to close?
Kerry McCarthy (Bristol East) (Lab)
The South Western ambulance service came close to declaring a major incident on 27 December, and local hospitals warned of unprecedented demand last weekend. What is the Secretary of State doing specifically to help hospitals and the ambulance service in the Bristol and Avon area to survive the winter?
Mr Hunt
As I mentioned earlier, I have talked to the chief executive of South Western ambulance service about the particular pressures it has faced, such as the 25% increase in 999 calls. We are doing a lot of things, including helping to recruit more paramedics. We have 40 more paramedics starting for the London ambulance service this month, and we are doing what we can to help the South Western ambulance service as well.
Stephen Mosley (City of Chester) (Con)
About a third of the patients attending A and E at the Countess of Chester hospital are from the Welsh side of the border. They choose to go there because they know they will get treated a lot quicker in England than they will in Wales. Why is that the case?
Mr David Crausby (Bolton North East) (Lab)
Before a major incident was declared yesterday morning, 76 patients were awaiting transfer to social care in the Royal Bolton hospital—nearly four wards-full—so when is the Secretary of State going to do something effective about the crisis in social care that is causing mayhem in our accident and emergency department?
Mr Hunt
I recognise the pressures that the hon. Gentleman is talking about, but last year, for the first time, the local NHS and the local authority in Bolton sat down together to plan social care for the most vulnerable people—his constituents—who need such joined-up care and have wanted but not had it for so many years. With the better care programme from this April, we will start to see some real improvements.
Henry Smith (Crawley) (Con)
In 2005, the Labour Government closed the accident and emergency department at Crawley hospital, but services are now returning to the urgent treatment centre. Does my right hon. Friend believe that such centres play an important part in relieving pressure on emergency services?
Mr Hunt
They absolutely do. One thing we must do better is signpost people to the different parts of the NHS, such as walk-in centres, urgent treatment centres, GP surgeries or A and E departments. That is why the 111 service is so important in giving that advice at the earliest possible stage.
Dr Alan Whitehead (Southampton, Test) (Lab)
Does the Secretary of State now regret the cuts inflicted on Southampton social care provision—they were draconian, disproportionate and possibly motivated by political football—given that Southampton city council has been unable to support the Southampton general hospital by moving people into social care and away from accident and emergency? Will he have a word with Communities and Local Government Ministers to get that put right?
Ben Gummer (Ipswich) (Con)
I was at Ipswich hospital this morning to talk to the senior clinical team. They have exceeded their targets in A and E—it is the fifth best performing hospital in the country—and they have done so because of their work. Will the Secretary of State congratulate them, and does he regret the politicking that undermines their incredible efforts in the service of my constituents?
Diana Johnson (Kingston upon Hull North) (Lab)
The Secretary of State said that 14 major incidents have been declared. I am told by a senior front-line worker that many hospitals are declaring internal major incidents—they have done so for some time—because that is more politically expedient and does not get into the press. How many internal major incidents have been declared in the past month?
John Stevenson (Carlisle) (Con)
The Cumberland infirmary in Carlisle is coping and improving. However, to improve more quickly, it needs to conclude the acquisition by Northumbria Healthcare NHS Foundation Trust as soon as possible. Will the Secretary of State do everything he can to help to achieve that, as I believe it will lead to better health care, both in A and E and generally, in Carlisle?
Kate Green (Stretford and Urmston) (Lab)
What is being done to address staff well-being during this exceptionally pressured period? Repeated pressure on A and E—with staff being required, or volunteering, to do extra shifts—does in the end put pressure on staff, and may cause burn-out and risk to patients. What is being done to attend to that issue?
Mr Hunt
There are two things. First, as I am sure the hon. Lady does, I take every opportunity to praise the work being done by staff through a very difficult and challenging period. Secondly, the practical way in which we can most help them is to try to recruit more staff where we possibly can, and to make sure that resources are not a barrier to recruiting more staff. We have about 5,000 more nurses in hospitals compared with 12 months ago, and that has made a difference.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
The Secretary of State stood up and said that he takes personal responsibility for everything that happens in the NHS. Given that his Government undertook a costly and time-consuming reorganisation, does he now regret that people took their eye off the ball in relation to the highly predictable population shifts that have led to the pressure on A and E?
Mr Hunt
I am afraid that that is an example of the politicisation of the NHS that people find so distressing. Those reforms were not enacted in Wales, which is run by the hon. Lady’s party, and A and E performance there is significantly worse. It does not make any logical sense to blame A and E performance on those reforms.
Julie Hilling (Bolton West) (Lab)
Royal Bolton hospital says that it is in crisis because it cannot discharge patients. The Secretary of State says that the hospital and local authority in Bolton are talking to each other, but Bolton council has had £100 million-worth of cuts. What will he do to reverse the cuts in social care that have created the crisis in our hospital?
Mr Hunt
If the hon. Lady is making a criticism, I would ask her what she is going to do, because the shadow Chancellor confirmed this week that he will not find extra money for social care. I will tell her what we are doing. We are merging the social care and local NHS systems to try to stop people being pushed from pillar to post, and to give them the joined-up, compassionate, safe care that we think is an absolute priority. That is happening in Bolton—I have visited facilities in Bolton that are displaying excellent care—and we should support such efforts, not criticise them.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
In January 2013, I raised with the Health Secretary the incident in which an 84-year-old lady had to wait 11 hours for an ambulance. This Christmas, a 101-year-old lady had to wait six hours for an ambulance, and an 89-year-old pensioner also had to wait 11 hours for an ambulance. When do individual incidents of failure become a pattern, and is the Health Secretary himself an individual incident of failure?
Mr Hunt
I take huge interest in individual examples of where things have gone wrong, and that has informed a lot of my approach to the job. Just like A and E departments, when ambulance services get calls, they have to triage them and deal with the highest-priority calls quickest. The calls they get can sometimes be dealt with after a period of hours, but other calls are much more urgent. The important thing for ambulance services is to know that we are backing them with more paramedics, more investment and more ambulances, and that is what we are doing.
Mr Steve Reed (Croydon North) (Lab)
One of my constituents, an 80-year-old woman, collapsed at home over the weekend. She had to wait an hour for an ambulance to arrive, and she then waited 10 hours in A and E before being treated by medical staff. For most of that time she was on a trolley in a corridor. Will the Secretary of State apologise to my constituent? Does he not regret wasting billions of pounds on a top-down reorganisation of the health service, instead of using the money to fund the additional doctors and nurses who could have treated my constituent and thousands of others like her across the country more quickly?
Mr Hunt
Management costs in the NHS doubled under the hon. Gentleman’s Government; under this Government, they have been cut by £1 billion a year, which is paying for 9,000 more doctors and 3,000 more nurses. That is the reality of the NHS under this Government—1 million more people are getting operations every year—and if he really believed in the NHS, he would support and welcome that, rather than criticise it.
UK Ebola Preparedness
Jeremy Hunt Excerpts(9 years, 11 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I would like to make a statement about the UK’s Ebola preparedness and the care being given to Pauline Cafferkey, the NHS nurse being treated for Ebola at the Royal Free hospital in London.
I know the whole House will join me in wishing Pauline well and commending her and her NHS colleagues for the exceptional bravery and compassion they showed in joining the battle against Ebola in Sierra Leone. The work done by Pauline and her colleagues is not just helping to save thousands of lives in Africa; it is protecting the UK from potentially disastrous consequences if the disease spreads beyond the countries where it has currently taken hold. Alongside 69 other NHS volunteers from UK-Med, Pauline spent Christmas on the front line of this vital battle. This House and this country owe them and other colleagues from Public Health England, the Department for International Development, the Foreign Office and the Ministry of Defence an enormous debt of gratitude.
You will appreciate, Mr Speaker, that for reasons of patient confidentiality I cannot go into great detail about Pauline’s current medical condition. However, I have this morning spoken to Dr Mike Jacobs, an expert in infectious diseases who is leading the team of doctors and nurses caring for Pauline at the Royal Free. As has been reported, Pauline’s condition has deteriorated to a critical state, although she stabilised yesterday and continues to receive the best possible care. She said in Sierra Leone that she hoped her loved ones would be proud of her. Well, she should know today that the whole country is proud of her for her bravery and dedication to the service of others. She stands, quite simply, for the very best of NHS values.
I wish to turn to the issue of screening and why Pauline continued her journey from Heathrow to Glasgow. Having worked in Sierra Leone for six weeks caring for Ebola patients, she was screened and cleared to depart on her exit from Sierra Leone on Sunday 28 December. She arrived at Heathrow after a connection in Casablanca at 3.50 pm that day, where she was again screened in line with the protocols introduced into major airports and Eurostar terminals last October. As her temperature was within the acceptable range, she was cleared to fly home to Scotland. Clinical experts have always been clear that the process will pick up a few active infections, but it also provides the best opportunity to ensure that returning staff know whom to contact, and this system worked. While still at Heathrow, her reassessment was triggered because of concerns that she may have had an elevated temperature. She was reassessed and her temperature taken a further six times over 30 minutes. As her temperature was within the acceptable range, she was again cleared to travel.
Pauline arrived in Glasgow at around 11.30 pm on Sunday 28 December and was driven home. She became feverish overnight and, in line with the public health advice that she had been given at Heathrow, she contacted local services. She was admitted to an isolation facility at the Brownlee unit in Gartnavel hospital in Glasgow at 8 am on Monday 29 December. A blood sample tested positive for Ebola at the NHS Lothian testing facility that afternoon, so she was transferred overnight to the Royal Free in a military plane, arriving at 8 am on Tuesday 30 December.
Some have asked whether it was appropriate for Pauline to be allowed to travel on to Glasgow after she raised concerns about her health at Heathrow. The clinical advice on this is clear. Someone can contract Ebola only by coming into contact with the bodily fluids of an infected person—that means blood, vomit or diarrhoea—which becomes a risk when a patient is exhibiting feverish symptoms. Because she did not have a high temperature, the clinical judgment was made to allow her to continue her journey home.
However, we recognise that medical understanding of the disease is not complete, which is why we had already taken a number of precautionary steps that go further than strictly required by the clinical evidence. These include asking potential Ebola carriers to avoid crowded places and long journeys on public transport within the 21-day potential incubation period once they arrive back home. Existing guidance also bans any direct patient work for returning health care workers.
On that precautionary basis, we have, as of last Monday, strengthened our guidance to ensure that anyone from a higher risk group who feels unwell will be reassessed. Advice will immediately be sought from an infectious diseases specialist and the passenger will be referred for testing, if appropriate. The screening centres at Heathrow were viewed at first hand on 1 January by the chief medical officer and the Minister with responsibility for public health and all arrangements, including the revised protocols, were found to be working well.
We will continue to keep screening and logistical arrangements under review and look to improve or strengthen the process, as guided by expert clinical advice. It is important, however, to remember that the risk to the public of contracting Ebola from contact with someone carrying the virus remains very low indeed while they are not exhibiting any symptoms. The critical point—this is the main purpose of the screening—is to ensure that potential Ebola carriers are identified and know how to ask for medical assistance the moment they display any feverish symptoms, so that they can then be isolated, tested and given full medical support as quickly as possible.
For that reason, on a precautionary basis, Public Health England has been making contact with passengers on the flight that Pauline was on from Casablanca to Heathrow, and has been working with Moroccan colleagues to trace additional UK passengers on the flight from Freetown to Casablanca to make sure that they know what to do if they start exhibiting symptoms consistent with Ebola. I can inform the House that Health Protection Scotland has made contact with all the passengers on the London to Glasgow flight, and Public Health England has made contact with all UK-based passengers who travelled on the flight from Casablanca to London. I would like to thank British Airways and Royal Air Maroc for their assistance in this process.
The safety of our volunteers is our first priority. Before any NHS workers are deployed to treatment centres, staff from UK-Med, which runs the NHS humanitarian register, review the clinical protocols and procedures and confirm that they are content that the centre meets appropriate standards. All UK-Med volunteers receive thorough training in the UK and in Sierra Leone before they treat any Ebola patients so that they know how to use their personal protective equipment and understand the nature of the work. In the current case, as the House would expect, Save the Children is conducting a review of its procedures to ensure that any lessons are learned.
The House will want to be reassured about the overall state of UK preparedness for Ebola. This country was the first in Europe to screen arrivals from high-risk places in west Africa, and numerous countries have since asked for information on how we did this. We have committed more than £230 million to fight the disease in Sierra Leone. We have sent more than 800 military personnel, 150 Department for International Development staff, 70 NHS staff through UK-Med and 64 Public Health England staff to fight the outbreak on the ground—a bigger contribution than any country in the world except for the United States.
The chief medical officer, Professor Dame Sally Davies, has always been clear that we are likely to see up to a handful of cases in this country, of which, very sadly, this is the first to be diagnosed. NHS England has procured personal protective equipment for each of the hazardous area response teams in England and has additionally arranged for 75,000 PPE suits to be procured for the NHS.
We have been practising Ebola resilience since 30 July and have had 16 ministerial Cobra meetings in total, including five chaired by the Prime Minister. Both the chief medical officer and the NHS England medical director, Professor Sir Bruce Keogh, are satisfied that at this stage we have made sufficient preparations. However, they stress that, although the risk to the public remains low, we must remain vigilant and be constantly prepared to adjust and improve our processes and protocols as this rapidly changing situation evolves.
I would like to place on record my thanks to colleagues in the Scottish Government and the UK Government, to the authorities in Sierra Leone and Morocco, to NHS England and to the NHS doctors and nurses at both Gartnavel hospital and the Royal Free for their dedication and hard work over the past few days. I would also like to pay tribute to the dedicated PHE staff who set up the new screening process so rapidly, and thank Border Force staff for their assistance.
Our thoughts are with Pauline Cafferkey today, but I know all of us are also thinking about her friends and colleagues and the many UK NHS and other personnel working in Sierra Leone right now. They can be reassured that we have no greater priority than their safety, and I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
Over the break, there have been a number of reports suggesting that the Ebola outbreak is far from under control and we saw, as the Secretary of State has said, the first case diagnosed here in the UK. Concerns are rising and that is why the Secretary of State was right to give his informative update to the House at the very first opportunity.
May I echo the tribute he paid to all the NHS staff, members of the armed forces and aid workers who are showing immense courage in the most difficult of circumstances? In particular, we echo his moving words and good wishes for Pauline Cafferkey. Our thoughts are with her and her family right now, and we know she could not be in better hands than those of the team at the Royal Free.
On the substance of the Secretary of State’s statement, we welcome what he had to say and the action he is taking. As I said the last time he updated the House, we will play a constructive part in helping the Government to minimise the risk to the public. That remains the case and the questions I will put to him—some of which will cover areas he has not mentioned, particularly treatment and vaccine—will be asked in that constructive spirit.
Let me begin with the circumstances surrounding the case. The Secretary of State mentioned the Save the Children review of how Pauline caught the disease. Are the Government part of that review and/or are they carrying out their own, and when will the results be known? He did not mention when it would be published, but that is important as the next group of NHS volunteers will leave for west Africa in the coming weeks. They will want to know whether procedures and guidance for medical staff working out in west Africa will be reviewed in the light of this case.
I would also be grateful if the Secretary of State could tell us whether he is satisfied with current guidance to NHS staff here on handling Ebola patients. He will be aware that the US Centres for Disease Control and Prevention have recently strengthened their infection control guidance, and on the last occasion he updated the House he said he would follow their lead. What revisions, if any, have been made to those protocols following the CDC’s changes?
Let me turn to screening. We know that Pauline travelled to Glasgow via London Heathrow and despite informing screening staff at Heathrow that she felt unwell she was still allowed to fly home. I welcome what the Secretary of State has just said about reviewing procedures for future passengers in a similar position, but there are broader concerns. Martin Deahl, who was part of the same volunteer group as Pauline and sat next to her on the plane home, said:
“The precautions and checks at the airport were shambolic. There seemed to be too few staff and too few rooms or places to put us in. We were crowded into a small reception area where we waited for an hour or more. I had a higher temperature so they wanted to put me in a room by myself—but they could not find one because they were using every inch of space.”
I welcome the Secretary of State’s commitment to keep the arrangements under review, but may I ask him to look into the specific concerns raised by Mr Deahl and to rectify any problems as a matter of urgency, and certainly before the return of the next group of volunteers?
More broadly, is the Secretary of State satisfied that the screening procedure is adequate in terms of the medical checks that are carried out—are more checks needed than just temperature checks—and, indeed, is he satisfied that staff have had sufficient training? Were the Scottish NHS, the Scottish Government and, crucially, Glasgow airport informed that Miss Cafferkey had warned officials that she felt unwell? In the light of this case, should screening checks be expanded to cover more ports? I would be interested in the Secretary of State’s views on those points. I am sure he would agree that maintaining public confidence in the screening procedure is crucial, and I hope he will continue to keep all those questions under review, as he has said he would.
Let me turn to post-arrival monitoring. A number of states in America have introduced it for all travellers returning from an affected country, whereas only those showing symptoms on return are actively monitored here. Given that symptoms of Ebola can emerge up to 21 days after exposure, is there a case for strengthening post-arrival monitoring in line with other countries?
On treatment, we understand that Pauline is receiving an experimental drug, not ZMapp, owing to a worldwide shortage. When the Secretary of State last updated the House, I asked him whether plans were in hand to increase supplies of ZMapp, so the latest news is a matter of concern. Are any efforts under way to increase manufacturing capacity for ZMapp and/or any other potential treatments? Of course, what would give most confidence to people in the countries affected and further afield is the development of an effective vaccine. Will he say something about the timetable for that, and about the Government’s role in trying to expedite it?
More broadly, will the Secretary of State give the House his latest view on the adequacy of the international response to Ebola. We hear that the health system in Sierra Leone is in danger of collapse, immunisation programmes have come to a halt and people are not going to the hospitals or clinics because they are frightened of catching Ebola, and that might lead to the spread of other diseases. Over Christmas, William Pooley said:
“This is a global problem and it will take the world to fix it.”
Does the Secretary of State share that sentiment, and what are the Government doing to bring about a better global response than we have seen to date?
In conclusion, it is clear that Ebola will remain a threat for the foreseeable future, and it will not be easy to meet that challenge. We join the Secretary of State in sending our best wishes to Pauline and her family, and we will continue to work with him and the Government to minimise the risk to others.
Mr Hunt
May I first thank the right hon. Gentleman for the constructive tone of his comments and the official Opposition’s willingness to work closely with us on this very important issue? Let me cover some of the important points that he made.
The right hon. Gentleman is right that the disease is continuing to progress in those countries. We now have a total of 7,905 reported deaths, and there are 20,206 reported cases, which is likely to be an underestimate. There are some early—I stress, early—signs that the rate at which the disease is reproducing itself is beginning to fall to about the level where it is stabilising. However, those are early signs, and the truth is that we still need to do a huge amount of work to bring the disease under control.
We think that it is absolutely vital to proceed as quickly as possible with the vaccine that the right hon. Gentleman mentioned, and I can tell him that we currently have three vaccines in the first phase of clinical trials. We have made some changes to speed up the process by which they can be used in the field, and DFID has put in £1.34 million to establish a joint research fund with the Wellcome Trust, so we are making progress on that front.
It has been impossible to get supplies of ZMapp—the drug given to the other Ebola patient treated in the UK, Will Pooley—because it is grown using genetically modified tobacco plants, so there is a time constraint. Clinically, we do not yet know whether it was significant in Will Pooley’s recovery. We have tried other experimental treatments on Pauline Cafferkey, including using some of the plasma from Will Pooley, and we hope that will have an effect.
The review by Save the Children is being conducted in conjunction with Public Health England staff in Sierra Leone, and I hope that it will report in the next few days. We are obviously keen for them to report as quickly as possible, but we do not want to put them under pressure not to do a thorough report. I am satisfied with current protective arrangements on the basis of our clinical evidence, but as we saw with the screening arrangements, with a disease such as Ebola we must constantly keep an open mind about the best ways of dealing with things, and we will look carefully at what Save the Children recommends. I am satisfied with the protections in place for NHS workers in the UK on the basis of advice from the chief medical officer, and we will obviously also look at what happened in the US. At the moment we do not believe that the personal protective equipment suits have been breached, but we must keep an open mind and see what other evidence comes forward.
On the screening procedure, our clinical protocols were followed when Pauline Cafferkey arrived, but organisationally I do not think that it was as smooth as it needed to be. There were a lot of people to deal with, and because it was over the Christmas period we probably did not have as many people to do that as we needed, which meant that those coming for screening needed to wait longer than we would have liked. However, on the basis of revised protocols, and to ensure that we do not repeat this situation—nine more volunteers are coming back this Sunday and 60 more the following Sunday—the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), and the chief medical officer have been to inspect what is happening, to ensure that we learn the necessary lessons. Other volunteers have said that they think the screening procedure is working smoothly. This was a relatively isolated incident, but we must learn the lessons.
On expanding screening to other airports, I will look into whether Glasgow airport was informed and let the right hon. Gentleman know, but we have obviously learned from this event the importance of close working with the Scottish Government, and that has worked very well.
Finally, the right hon. Gentleman mentioned the active monitoring of people who come back, and I think that we have the best system. We are not only actively monitoring those who have been tested for having contracted the disease, but actively monitoring anyone in the high-risk groups. Of the 2,495 people who have been screened since we set up the process, 54 have been identified as having had direct contact with Ebola patients and as being in the high-risk group, and we have an enhanced monitoring process for them. Everyone else is informed exactly what to do if they develop feverish symptoms, which is what happened with Pauline Cafferkey.
I again thank the right hon. Gentleman for his constructive approach to this issue.
Dr Sarah Wollaston (Totnes) (Con)
I join the Secretary of State in paying tribute to Pauline Cafferkey and all NHS volunteers, aid workers, staff at DFID and Public Health England for the work they are doing to keep us safe in the UK by fighting Ebola on the front line in west Africa at great personal risk. I also thank him for updating the House so succinctly on the improvements to the screening protocols, so that everyone will be screened if they have symptoms, not just a temperature. Will he update the House on the vaccines and say whether there has been any progress on the provision of rapid screening for Ebola? Will he reassure us that he will not follow the knee-jerk response that we have heard calls for from some quarters, which is to quarantine all NHS staff, because of the unintended consequences of such an approach?
Mr Hunt
I thank my hon. Friend for her constructive comments and I agree with what she has said on this issue. Some 678 health care workers have contracted Ebola since the outbreak of the disease, and of those nearly 400 have died, the vast majority African. That shows how incredibly brave front-line workers are, and perhaps the fact that—tragically—we have someone in this country who has contracted Ebola is a good way of reminding ourselves that many hundreds of other people have already been in this situation. They are all incredibly brave. We are proceeding as quickly as we can with the possibility of having a much speedier Ebola test, which would obviously be helpful for the screening process.
I agree with my hon. Friend that we do not want a knee-jerk response on quarantining people who come back. The contribution of NHS volunteers and health care workers from western countries in fighting the disease in Sierra Leone, Guinea and Liberia is critical. Some 1,500 people from the NHS have volunteered, but they volunteer on the basis that we will follow proper clinical protocols, meaning quarantining people when it is clinically necessary to do so, but not doing so when it is not necessary. If we are to keep their confidence, we must be proportionate in our response.
Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)
Pauline Cafferkey is a constituent of mine and works at Blantyre health centre in my constituency. I have spoken to a number of those whom she has treated and her colleagues over the past few days. I am sure the House will appreciate that there is a huge amount of support and concern for her locally, but also a huge admiration for her work in Sierra Leone as an NHS volunteer. I am sure that that is shared by communities throughout the UK, with the exception of a small handful of people who should keep their opinions to themselves.
On the Secretary of State’s concerns about the screening process, when an experienced clinician describes a process as shambolic, it is not only about the protocol, but about the practicalities. As well as keeping the matter under review, will he ensure constant monitoring each weekend as people come back to ensure that the practicalities are properly kept in check, to ensure that the situation that seemed to happen last Sunday is not repeated?
Mr Hunt
I echo the hon. Gentleman’s comments about what a remarkable lady Pauline Cafferkey is. When she was asked why she was going, she said, “Why wouldn’t you go when so much suffering is happening in west Africa?” That is the measure of the woman.
On the screening process, I am satisfied that the right clinical processes were followed, but I am not satisfied that it was as well organised as it should have been. That is why we have revised not just the clinical protocols, but the organisation, to ensure that we have the right capacity in place, and that we do not make people wait for as long as they did when Pauline returned on her flight. It is also important to recognise that the Public Health England staff at Heathrow are working very hard doing a difficult job, and are doing their very best.
Mr David Heath (Somerton and Frome) (LD)
I commend the federal and state authorities in Nigeria for the work they did in containing the Ebola outbreak there last year. In the space of a four-day visit, I had my temperature taken 34 times—whenever one goes into a public building, one has one’s temperature taken. Everyone who visits a Nigerian airport has to fill out a form giving details of where they have been and where they are going, contact details, and details of where they sat on the plane. Is the Secretary of State confident that he has the same level of traceability in this country as the Nigerian authorities have achieved in their country?
Mr Hunt
Yes, I am. I join the hon. Gentleman in commending the actions of the Nigerian authorities. What has happened in Nigeria in respect of Ebola shows a great deal of hope for what is changing in Africa more generally. There was a perception that all African countries would find it as challenging to deal with Ebola as Sierra Leone, Liberia and Guinea have found it, but it is clear that a generation of African countries have developed substantially and are able to respond in a much more effective way. That is a very encouraging change from what might have been the case 10 or 20 years ago.
Frank Dobson (Holborn and St Pancras) (Lab)
I thank the Secretary of State for his statement. I am in no position whatever to comment on the effectiveness of the screening and suspect that no one else in the Chamber is. On long-term preparedness, it is several decades since Peter Piot, now director of the London School of Hygiene and Tropical Medicine, first identified Ebola. Worldwide, not enough has been done to address the problems. We should not be looking for a vaccine now; it should have been looked for years ago. I hope the Secretary of State gives full support to the rare disease consortium that has been established by the London School of Hygiene and Tropical Medicine, Imperial college and the Royal Veterinary College to look at infectious diseases that are capable of crossing from one species to another, and in particular this species.
Mr Hunt
The right hon. Gentleman is absolutely right. Peter Piot is a remarkable man who came to Downing street to advise the Prime Minister and me early in the development of the Ebola crisis. He is well worth listening to on this subject.
The right hon. Gentleman also makes a good point in that the global response to Ebola was far from adequate. The World Health Organisation has some important lessons to learn, and tomorrow my right hon. Friend the Secretary of State for International Development and I will meet Margaret Chan, when we will no doubt talk about those lessons. In an era of globalised travel, it is important that we have a much faster and more effective response when we have outbreaks of deadly viruses.
Sarah Newton (Truro and Falmouth) (Con)
Will my right hon. Friend join me in thanking the staff of the Royal Cornwall hospital who treated someone returning from Sierra Leone with great professionalism, caring and compassion? Will he reassure me and those staff that, as well as those arriving back from west Africa by plane or train, those arriving back into our ports by ship are effectively screened?
Mr Hunt
I am happy to pass on my thanks to the staff of the Royal Cornwall—in fact, I spoke to someone from that hospital this morning and I know that they are very focused on this issue, as are all NHS hospitals. We have introduced information at all ports and, where necessary, screening. My hon. Friend makes an important point—it is never actually possible to put every single person through a screening process. We are one of the most open economies in the world and people constantly come in and out of the UK. We depend on public knowledge, so that people who have been to the affected areas know to present themselves to get immediate assistance if they develop any feverish symptoms.
Mr Peter Hain (Neath) (Lab)
Has the Secretary of State had the chance to consult the British Medical Journal editorial of 13 October, which insisted—more than two months ago—that the Government’s airport screening policy for Ebola was illogical? I spoke to the author yesterday and he argues that we have missed the one case to have been imported while thousands, many at low risk, have been delayed, detained and made to fill in a form just because they have been to west Africa. Experts such as the author insist that what the Government should have been doing is ensuring that all those at risk, especially health workers such as Pauline, know exactly what to do if they start to feel unwell. Might it be sensible to keep health workers away from direct patient contact for 21 days after they return?
Mr Hunt
Perhaps I can reassure the right hon. Gentleman on that point. Health care workers are kept away from direct patient work for that incubation period, so that protocol has been put in place. The BMJ article to which he refers is based, I think, on the misunderstanding that screening is the same as testing. The reality is that the tests for Ebola show up only when the virus has reached a certain level, at which point the patient will have become feverish and started displaying symptoms, so testing before that point is a waste of time. The purpose of the screening process is to identify those at highest risk so that we can make sure that they are actively monitored when they go home and that they know exactly what to do if they do develop symptoms. That is exactly what happened with Pauline Cafferkey.
Andrew Bridgen (North West Leicestershire) (Con)
There is a saying that when it rains everyone’s roof gets wet. That is apt in the case of Ebola which, as we have heard, poses a global threat. Does my right hon. Friend agree that the best way to protect the British people from the Ebola outbreak is to continue to actively support international efforts to eradicate it in west Africa itself?
Mr Hunt
My hon. Friend is right. The most important thing we can do is to eliminate this disease at source, and that is why we can be extremely proud of the efforts of DFID and my right hon. Friend the Secretary of State. As I have said, we are the country that is doing the second most in the entire world to combat the disease in west Africa. There is no better example of the link between proper development policy abroad and security at home.
Glenda Jackson (Hampstead and Kilburn) (Lab)
May I thank the Secretary of State for his statement, affording as it does an opportunity for the House to pay tribute not only to Nurse Cafferkey and all the other NHS volunteers, but the staff of the Royal Free hospital in my constituency who day in, day out demonstrate all that is best in our NHS? When the Secretary of State meets the World Health Organisation tomorrow, will he highlight a most recent report that states that, although it is possible there has been a diminution in urban areas in west Africa, rural areas in west Africa are still giving great cause for concern? There seems to be no overarching co-ordinated work in those particularly difficult areas. Will he also, as the United Kingdom was the first off the blocks to offer services to sufferers of Ebola, act as some kind of needle to the other countries in the international community that are still failing to help in the fight against this potential catastrophe?
Mr Hunt
The hon. Lady is absolutely right that we need all countries to play their part. We have been very involved in international efforts to try to ensure that other countries, particularly in Europe, play their part as we in the UK have been doing. I commend her constituents who work at the Royal Free for their remarkable work, which really is world beating and incredibly impressive. It is also very challenging. The situation that Pauline is in is very difficult for them to cope with, but they are doing so with the highest levels of professionalism. On rural areas, DFID has been focused from the start on how to ramp up community care in rural areas. She is right to say that that is a very important priority.
Mr Philip Hollobone (Kettering) (Con)
I thank the Secretary of State for the tone and content of his statement. Nevertheless, I think my constituents in Kettering would have two concerns about the Pauline Cafferkey incident. First, what my constituents do not understand is why, when this health worker reported feeling unwell, caution was not prioritised and she was not tested before travelling, as we now know on a crowded underground train into the centre of London. Secondly, I understand that she travelled back to this country with quite a large number of other health workers. When an airport knows that a large number of health workers are about to descend on it, why are resources not in place to deal with quite a large number of people all in one go?
Mr Hunt
We have learned the lessons to speed up the process so that people, I trust, will not have to wait as long. One of the lessons we learned in the Christmas period is that we do not want people to have to wait as long. I want to stress to my hon. Friend—perhaps he could stress this to his constituents—that the clinical risk of contracting Ebola from sitting next to someone who is not exhibiting feverish symptoms is very low. That is why the clinical advice was, and remains, that it is perfectly safe for someone to travel on a train if they are not displaying the symptoms. We want to go further, however. We recognise that we do not know everything about this disease and therefore want to be precautionary. That is why we have said that if people in the high-risk categories—those who have had contact with Ebola patients—say they are unwell, we will have a different protocol going forward even if their temperature is within the normal range. I hope that will reassure his constituents.
Keith Vaz (Leicester East) (Lab)
The Government were absolutely right to start screening on 14 October. May I urge the Secretary of State to resist calls from those who say that screening is not effective and should stop? This was not a direct flight: it went through Casablanca. Although we have put a lot of resources into Sierra Leone and we have resources at Heathrow, there appears to be no international effort in the major hubs in Africa. What steps are going to be taken to help Governments such as that in Morocco, specifically in Casablanca, which receives so many flights from other countries in Africa that end up at Heathrow airport?
Mr Hunt
I thank the right hon. Gentleman for raising that point; he has done so on a number of occasions. It is very important that there is not a weak link in the chain. We have been relatively satisfied with the screening procedures at Casablanca, which we have obviously inquired into in great detail because of the fact that Pauline came through Casablanca, but I will ask Public Health England to reassure me that it is satisfied with those screening procedures, and, if not, if there is any assistance we can provide to the Moroccan authorities.
Jeremy Lefroy (Stafford) (Con)
I thank my right hon. Friend for paying tribute not only to the British defence, NHS, Public Health England and DFID workers, but to the immense courage of Sierra Leonean, Liberian, Guinean and Nigerian health workers, as well as many others. As he said, several hundred have paid the ultimate price for their devotion to their patients. The right hon. Member for Leigh (Andy Burnham) mentioned the health system in Sierra Leone. Will the Secretary of State, along with my right hon. Friend the Secretary of State for International Development, ensure that as much help as possible is given to the Sierra Leonean Government to strengthen their health system and avoid a collapse that could pose a great risk to the UK?
Mr Hunt
I can reassure my hon. Friend that my right hon. Friend the International Development Secretary has spoken to the President of Sierra Leone about that very issue. One of the big learning points from the relative success of Nigeria, which we discussed earlier, in combating Ebola compared with Sierra Leone has been about the strength of the local health system. One particular challenge is that the entire health system in Sierra Leone is now focused on Ebola, raising the risk of other diseases, such as malaria, tuberculosis and HIV, killing more people even than Ebola. Strong local health care systems are an important long-term insurance policy to ensure that countries can deal with infectious diseases.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)
We are still learning about Ebola and the efficacy of the screening processes. What discussions has the Secretary of State had with other European countries, particularly European Health Ministers, to share best practice, exchange what we have learned and ensure a comprehensive approach?
Mr Hunt
I have spoken to several European Health Ministers, and the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for public health, is in regular touch with them about the international effort. The hon. Lady is right that no one country can solve this on its own, and we collaborate well with others—perhaps most closely with the French, who have taken responsibility for the fight against Ebola in Guinea.
Martin Horwood (Cheltenham) (LD)
I declare an interest, as my wife worked for Public Health England. I am sure that all PHE staff will appreciate the Secretary of State’s calm and supportive words today.
Local directors of public health have traditionally formed part of the response to such incidents, not least in reassuring the general public—perhaps the hon. Member for Kettering (Mr Hollobone) as well—so is the Secretary of State confident that they still have the resources and organisational support to do this effectively now that they are part of local government, not the NHS?
Mr Hunt
To date, no issues have been raised about resourcing for those very important responsibilities, but we will keep an eye on that. Every local area has had a resilience exercise to ensure it is prepared for what happens if someone contracts Ebola in its area, and so far we have been satisfied with the response, but obviously we will keep it under review.
Mr Frank Roy (Motherwell and Wishaw) (Lab)
I understand the constraints on the availability of the ZMapp drug to fight Ebola, but is the Secretary of State really telling the House that there is nothing the Government can do to minimise those constraints?
Mr Hunt
If we could buy it, we would, but there is no availability internationally, and we are waiting for more supplies. We are using other experimental treatments on Pauline, and it is important to stress that we do not know whether ZMapp actually worked, but we want to do absolutely everything we can.
Margot James (Stourbridge) (Con)
I wholeheartedly support my right hon. Friend’s comments about the bravery of Pauline Cafferkey and the other health and military workers fighting Ebola in Sierra Leone. Their sacrifice and bravery humble us all. Will he confirm that the Government will continue to follow medical advice and keep a sense of perspective regarding the real threat of contagion when monitoring and setting screening policies here in the UK?
Mr Hunt
Yes, I can absolutely confirm that, and I thank my hon. Friend for raising the point. It is important to say that this is not an exact science, because we do not know everything about the disease, so a balance sometimes has to be struck, but I think my discussions with Professor Paul Cosford and the chief medical officer have brought us to the right place: we follow the clear clinical guidelines, but where there is a precautionary extra step we think would be sensible in the circumstances, we take that as well.
Stewart Hosie (Dundee East) (SNP)
I place on record my thanks for the work done by Pauline Cafferkey and her colleagues and express my sympathy for the predicament in which she finds herself. I would like to thank the Secretary of State, too, for what he said about continuing to keep screening arrangements under review and looking to improve them on the basis of expert clinical advice. If recommendations emerge quickly for improvements to, or an expansion of, screening, will he move equally quickly to put those recommendations into place?
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
Pauline Cafferkey is a heroine and the thoughts of the whole House are with her and her family at this difficult time. Many people will be glad that the Secretary of State mentioned the hundreds of African health workers who have died fighting Ebola, showing extraordinary heroism and devotion to duty. Our constituents, including those linked to families in that region, will want to know that we will continue to give the region all the support we can in fighting Ebola long after it has dropped from the headlines.
Mr Hunt
I could not agree more with the hon. Lady. Some 382 health care workers have died of Ebola, and it is worth saying that they include not just local people from Sierra Leone, Liberia and Guinea, but people from all over Africa as well as small numbers from other parts of the world. The very least we can do is to continue to support an aid budget, which will allow them to continue to improve their local health care systems.
Barry Gardiner (Brent North) (Lab)
The Prime Minister said over the weekend that those displaying symptoms at Heathrow would be referred straight to Northwick Park hospital in my constituency because the isolation units are based there. Those isolation units are, however, strictly limited—I think there were only six at the last count—so can the Secretary of State advise us whether back-up facilities will be put in place? Given the nature of this disease, six isolation may prove inadequate.
Mr Hunt
I would like to reassure the hon. Gentleman that isolation facilities are available at other London hospitals. The ones he mentioned happen to be the closest, so they are the ones we would use first. Let me briefly clarify that it has always been the case that if someone showed any symptoms, we would isolate them and put them into quarantine. The change in protocol I am announcing today—we enacted it last week, but I wanted to report it to the House at the earliest opportunity—will mean that even if someone is not displaying the symptoms but says that they are feeling a bit under the weather, they will be isolated if they are in the high-risk category.
Mr Russell Brown (Dumfries and Galloway) (Lab)
It is somewhat ironic that only a couple of days before Christmas, I wrote to the Prime Minister saying that we should fully recognise all the volunteers who leave this country to do this excellent, selfless work, putting themselves in danger—and here we are today discussing the case of Pauline Cafferkey. Everyone’s thoughts are with Pauline and her friends and family.
I am led to believe that any problem should be dealt with at source, and there is still great concern about the amount of contaminated material, medical waste and contaminated protective equipment that is perhaps not being dealt with properly at source—being buried rather than incinerated, for example. I contacted the office of Professor Dame Sally Davies, and was told to write to her. I did so last week, asking her to look at finding a means of disposing of waste in a far better manner. So far, I have not had word back from her, but I am sure the Secretary of State will want to take this matter on board and ensure that it is dealt with better at the source of the infection.
Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)
Will the Secretary of State tell us more about the support given across all Departments in finding treatments for Ebola, including support for the current trials being conducted by the Institute of Infection and Global Health at Liverpool university under Professor Tom Solomon?
Mr Hunt
We are giving strong support to that important work. Our support is being led in the Cabinet Office by my right hon. Friend the Minister for Government Policy and Chancellor of the Duchy of Lancaster, who is bringing together all the Departments that can provide it. The sooner we can obtain a vaccine or a treatment that works, the better, and this could prove to be a very important part of the process of turning the tide.
A and E and Ambulance Services
Jeremy Hunt Excerpts(10 years ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
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Andy Burnham (Leigh) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the performance of accident and emergency departments and ambulance services, and what plans are in place to help them cope with winter pressures.
The Secretary of State for Health (Mr Jeremy Hunt)
I welcome this opportunity to come to the House and confirm NHS plans to support A and E and ambulance services over the challenging winter period. First, we must recognise the context. The NHS always faces significant pressures during the winter months, and with an ageing population we have 350,000 more over-75s than four years ago. As a result, more people are turning up at our A and Es, with attendances up 5% on last year, and a greater level of sickness among those who turn up has led to an increase in emergency admissions of nearly 6% on last year. That picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland, as well as England, missing key performance standards as a result.
In England, where performance has been relatively better than in other home nations, we have been preparing for this winter for more than nine months—indeed, I chaired my first meeting to discuss the issue on 17 March. On 13 June we gave the NHS an additional £400 million for winter pressures. That was topped up in autumn by £300 million, making a total of £700 million to ensure that local services had the certainty of additional money and time to plan how it should best be used. That funding was provided earlier than ever before in NHS history, and was possible because a strong economy has allowed us to make year-on-year real-term increases in NHS spending. That funding will pay for the equivalent of 1,000 more doctors, 2,000 more nurses, and 2,000 other NHS and care staff, including physiotherapists and social workers. It will fund up to 2,500 additional beds in the acute and community sectors, and provide £50 million to support ambulance services.
We are also progressing with a long-term plan to reduce pressures on A and E. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million people, and more than 4 million people are already benefiting from that. Our better care programme integrates, for the first time ever, health and social care services in 151 local authority areas, with plans starting in April to reduce, on average, emergency admissions to hospitals by 3%. The Five Year Forward View is funded by an additional £2 billion of new money announced in the autumn statement—we have a long-term plan for our NHS, just as we do for the economy.
The winter will be tough, but a number of changes made over the last four years will put us in a much stronger position. Since 2010, the NHS has nearly 1,200 more A and E doctors, including 400 more consultants, almost 600 more registrars, 1,700 more paramedics and 17,200 more clinical staff overall. Our A and E departments are seeing and treating around 2,000 more people within four hours every day, and our ambulances are making nearly 2,000 additional emergency journeys every day. The Care Quality Commission has confirmed that compassionate care in A and Es has improved over the last two years, and according to patients the NHS is getting record scores for the safety of care, and for treating people with dignity and compassion.
I will conclude by thanking hard-working NHS staff across the country for the outstanding care that they continue to deliver under a great deal of operational pressure. On behalf of the whole House I also thank the 70 NHS front-line volunteers who will be making this country safer by spending their Christmas in Sierra Leone on the front line in the fight against Ebola. They are the bravest of the brave and make our entire country proud.
Andy Burnham
I thank the Secretary of State for his statement. I of course echo the sentiments he expressed about NHS staff and volunteers fighting Ebola.
I have to say, however, that I heard a good deal of misplaced complacency in what he had to say. Winter has not begun in earnest, but there are already signs of A and Es and ambulance services being stretched to the limit. Last week, a record number of people waited more than four hours in A and E and on trolleys. Ambulance response times are getting worse across England, with some 999 calls taking hours. Overnight, news has emerged of an 82-year-old man who waited more than three hours for an ambulance to arrive at his nursing home. He then waited a further 19 hours on a trolley in a corridor. That is appalling, and there are fears that things will get worse when the House is in recess.
Given that, it should not be for me to drag the Secretary of State here today to explain what he is doing to prevent a full winter crisis in the NHS. The question he did not answer, but must answer today, is this: does he have a winter plan? If he does, will he publish it? People working in the NHS need to know what is in it. [Interruption.] He seems to suggest that he has one, but let me quote Dr Mark Porter, chair of the British Medical Association. He criticises what he calls the
“total failure by government to come up with a meaningful plan”.
The Secretary of State will have to reassure Dr Porter.
The Secretary of State mentions money, but is it not the case that £300 million of it was allocated only in November? Does he really think that that gave the service enough time to plan? Dr Clifford Mann, chair of the College of Emergency Medicine, does not think so. He says:
“Had these funds been used back in summer and early autumn we might have more resilience in the system now.”
Dr Mann also questions where this money has gone, saying “very little” has been seen by front-line A and E staff, and instead
“a lot of it has gone to shoring up balance sheets in acute trusts”.
Is that true? Will the Secretary of State provide of full breakdown of how that money was allocated and has been spent to date? Were any conditions attached? I am sure he will claim the money has been used properly, but, if that is the case, why is the NHS already under so much pressure?
Over the break, hon. Members will want to monitor the situation in their local hospitals very closely. However, we have learnt that from tomorrow the publication of data on A and E will be suspended for three weeks over the crucial Christmas period. That is simply unacceptable. Given that we know the figures are still being collected, there is absolutely no reason why they should not be published. The Secretary of State rightly puts a premium on transparency. Will he today order an end to the news blackout and instruct NHS England to maintain weekly reports?
I have visited a number of acute trusts in recent days and they all say that the pressure on A and E is critically linked to the severe shortage of places in nursing and residential homes and cuts to social care. The sad truth is that today a record number of older people are trapped in hospital. They are well enough to go home, but do not have the support to do so. When are the Government going to wake up to the very real crisis in social care and the fact that it is dragging down the NHS?
Finally, no one can predict what this winter will hold, but the warning signs are there and the NHS needs to plan for all eventualities. What discussions has the Secretary of State held with other Departments, and do the Government have a wider contingency plan for the NHS?
This is a serious situation. If patients and staff are to have confidence, they need better answers than they have had so far. I hope the Secretary of State will start providing them now.
Mr Hunt
First, may I thank the shadow Health Secretary for bringing this matter to the attention of the House? As a former Health Secretary, he knows that operational pressures are one of the biggest challenges facing any Health Secretary. Indeed, he had many examples of very, very poor care on his own watch and he is absolutely right to give the House a chance to hear more about our plans for winter.
The shadow Secretary of State asks whether we have a plan. It seems to me that he prepared his comments before he listened to the statement. We have put in more money than ever before. Plans were announced in June. NHS England had a press conference in which it went through the plans relating not just to the £400 million, but the extra £300 million that was agreed in September and allocated through October. That is a record amount. Let us consider what is happening in his own constituency. In Wigan borough, since 2010, because of spending that he opposed, Wrightington, Wigan and Leigh NHS Foundation Trust has taken on 78 more doctors, 149 more nurses and 209 more clinical—[Interruption.] He says, “Does this help?” These are extra doctors and nurses on the front line, helping patients in his own constituency.
The right hon. Gentleman talked about care homes. The £3.3 million going to help his own constituents with winter pressures is to monitor the mental and physical health of patients in care homes and to help reduce the number of emergency admissions. We have a winter plan that is working in his own constituency to help improve the lot of his constituents. He needs to acknowledge that.
The right hon. Gentleman talked about the publication of figures over Christmas. We have never published figures over the Christmas period because it would mean forcing NHS staff to work over Christmas, whereas, where possible, we would like them to be able to go home for Christmas, just like Members of this House. When he was Health Secretary, did he publish performance or weekly A and E figures over Christmas? He did not. He did not publish them at Christmas or Easter; he did not publish any weekly A and E figures at all, so to come to the House and call it a news blackout says to me that he is more interested in political opportunism than in care for patients.
It is disappointing that the right hon. Gentleman did not take this opportunity to disown his own leader’s instructions to weaponise the NHS. The NHS is not, and never should be, a political weapon. This is what third parties say. Dr Mann, president of the College of Emergency Medicine, whom the shadow Secretary of State mentioned, said yesterday that
“the system is under pressure but it’s working pretty well”.
The Foundation Trust Network said:
“NHS providers prepared for this Winter earlier and more fully than ever before”
and that—he should listen to this bit—the
“NHS needs support not criticism”
please. The NHS Confederation said the NHS was pulling out all the stops on urgent care and A and E, and that earlier planning and extra money were helping.
The right hon. Gentleman wants to draw comparisons. Nine out of 10 people are being seen within four hours in this country, which is a higher proportion than in any country anywhere in the world that measures A and E performance—faster than Australia, New Zealand, Canada, Scotland, Northern Ireland and, yes, faster than Labour-run Wales. Eight people out of every 100 wait more than four hours in A and E in England; in Wales, that figure is 15 hours. He should concentrate on saving the NHS in Wales, rather than running it down in England, where it is doing so much better.
Finally, if the right hon. Gentleman is worried about poor care, why is he still saying it was wrong to have a public inquiry into Mid Staffs? This is what Julie Bailey, the Mid Staffs campaigner, said this week about his comments:
“It is very worrying, because if he becomes Health Secretary again at the election it is clear we would go straight back to the old days of covering up.”
The NHS is performing well under great pressure. He should commend the efforts being made by front-line staff, not undermine them by trying to turn the NHS into a political football.
Mr Simon Burns (Chelmsford) (Con)
Will my right hon. Friend join me in congratulating the staff of Broomfield hospital in Chelmsford and the GP surgeries in mid-Essex on the fantastic job they are doing to look after patients in difficult circumstances because of the significant increase in the number of patients needing and accessing care? Furthermore, does he agree that it is rather demoralising for staff and sad that Labour seeks to turn the NHS into a party political football simply—
Mr Speaker
Order. The Secretary of State does not need to concern himself with Opposition policy, as I think the right hon. Member for Chelmsford (Mr Burns), on his good days, knows. The Secretary of State should focus on a brief statement of the Government’s policy, for which we will be grateful.
Valerie Vaz (Walsall South) (Lab)
The College of Emergency Medicine gave the Secretary of State a 10-point plan in 2013. Will he say which of those 10 points he has enacted?
Mr Hunt
We have enacted, or started to enact, every single one of them. Some of them take a bit longer—the contracts for A and E consultants, for example, which we want to ensure are attractive enough to encourage people to want to become A and E consultants. I am pleased to say that we have made some progress on that and are now getting the recruits coming into A and E that we want to see. Other things are starting to happen this winter—more co-location of GP services at A and E front doors and better discharging procedures from hospitals. We have been working very closely with the College of Emergency Medicine, which has been a great help to us in devising these winter plans.
Mr Mark Hoban (Fareham) (Con)
Last Friday, my hon. Friends the Members for Portsmouth North (Penny Mordaunt) and for East Hampshire (Damian Hinds) and I met leaders of the health and social care system in south-east Hampshire to discuss how it is dealing with the operational challenges it faces. May I commend to my right hon. Friend the model it is using—of working together to prevent unnecessary admissions, ensuring a safe and speedy assessment of those who turn up at A and E and also issuing a prompt discharge of those who are medically fit to return to their own homes?
Mr Hunt
My hon. Friend is absolutely right, and I commend what is happening in his constituency. He will be pleased to know that this is beginning to happen all over the country. The heart of the long-term solution is to have people in the social care system, people in primary care and people in hospitals to see themselves as part of one system, in which people are properly flowing between different parts of the system in the way that is right for them, ignoring organisational or institutional barriers. Where that happens, we are making good progress and we are getting the right performance in A and Es.
Ms Karen Buck (Westminster North) (Lab)
Last week, the chief executive of Imperial College Healthcare NHS Trust told me that it had a ward of patients that it was unable to discharge into the community. This week the Care Quality Commission ranked the A and E unit at St Mary’s as being inadequate owing to a lack of bed capacity and physical capacity in the ward. Yesterday the London ambulance service had to call in emergency help because it is under such pressure. What is the Secretary of State doing to turn around the crisis in central London’s health service? Will he remind us again why it made sense to close two west London A and E units in the middle of an A and E crisis?
Mr Hunt
It is funny how the hon. Lady talks about the closing of A and E departments without talking about the opening of A and E departments and the improvement of facilities. The plans for north-west London involve significant improvements, including weekend opening of GP surgeries, which is one of the key things that the shadow Front-Bench team has talked about as something that will help A and E departments. As for what is happening specifically, I was disappointed with the CQC report about the A and E at St Mary’s, but I gently say to her that it was this Government who set up an independent inspection regime with a chief inspector who gives the public information in a way that they did not have before. I think that is the biggest spur to making sure that the right changes are made quickly.
Sir Bob Russell (Colchester) (LD)
The general public will not have been impressed with the political posturing from the shadow Secretary of State. Does my right hon. Friend agree that a significant number of people who go to A and E should not be there, and as part of his long-term NHS planning, does he agree that if first aid were taught as part of the national curriculum, fewer people would go to A and E?
Mr Hunt
I commend my hon. Friend for championing this cause. He is absolutely right that we need first aid. I think that my hon. Friend the Member for Brigg and Goole (Andrew Percy)—I am not sure he is here—is a first responder, and I want to commend him for the work he does in that respect, because it makes a big difference in emergency situations if we can people to patients more quickly.
Mr Andy Slaughter (Hammersmith) (Lab)
The CQC report into Imperial, to which my hon. Friend the Member for Westminster North (Ms Buck) referred, found poor standards of cleanliness, too few nurses and thousands of patients awaiting surgery. It is the third CQC report in west London in four months, and it has found five major hospitals as requiring improvement and three A and E departments inadequate. The only one that is not inadequate—Charing Cross, which is good—is the one the Secretary of State wants to close. Waiting times are down to some of the worst in the country, yet they used to be among the best. We in west London do not recognise what he is saying. After two years of refusing, will he now meet me and other west London MPs to talk about the crisis in west London health care?
Mr Hunt
On the contrary, it is the hon. Gentleman’s constituents who do not recognise what he says or all the scaremongering leaflets about what is happening to NHS services in north-west London. We have plans to open two brand-new hospitals; we have weekend opening of GP surgeries; and we have big improvements happening in A and E departments. Let me gently say to him that, along with his Front-Bench team, he voted not to have a chief inspector of hospitals who could provide independent information about the quality of services. Now that he is quoting that information, I hope he realises that that was a mistake.
Sir Tony Baldry (Banbury) (Con)
Clinical commissioning groups and hospital trusts throughout the country, including those in Oxfordshire, are working very hard to ensure that they can triage people at the entrance to accident and emergency departments, so that those who need primary care get primary care and those who need A and E services get A and E services. Was the urgent question not simply a new form of political ambulance-chasing?
Mr Hunt
What my right hon. Friend has said about what is happening in Oxfordshire is very important. I commend the efforts that are being made there, as well as those that are being made in so many other parts of the country. It is interesting to note that all the questions that are being asked by those on the Government Benches are about the details of how we can help the NHS to get through the winter, while on the Opposition Benches it is all about politics. I think we know which side cares about patients the most.
Douglas Carswell (Clacton) (UKIP)
There have been serious problems with ambulance response times in Clacton. I recognise that the ambulance trust is addressing some of them, and I recognise that the Secretary of State is taking genuine steps, not least in establishing proper inspection systems, which is fantastic. However, many of the problems have been connected with turnaround times at Colchester hospital’s A and E department. Would it not be helpful if patients could access primary care via GPs in the first place rather than being forced to go to A and E departments? Emergency care would be then accessible in emergencies.
Mr Hunt
The long-term solution is to provide more GPs and GP capacity, which is why we plan to train 5,000 more GPs over the course of the next Parliament, but that will take time, so we need to find shorter-term solutions. We are working with the Royal College of General Practitioners to establish what can be done in the short and medium term.
Mr David Nuttall (Bury North) (Con)
Does my right hon. Friend agree that hoax calls are one of the causes of the pressures on the ambulance service, and that those responsible should always be prosecuted and dealt with in the most severe manner possible?
Mr Hunt
It is totally unacceptable for people to create extra pressure on ambulance services when they should not be doing so. One of the encouraging aspects of the better care programme is the fact that we are starting to analyse the ambulance service, the local NHS and the social care system in order to establish where the highest volumes of ambulance calls are coming from and sort out the problem.
Mr Clive Betts (Sheffield South East) (Lab)
Two weeks ago, along with other Members of Parliament, I met executives of the Sheffield Teaching Hospitals NHS Foundation Trust, which, as I am sure the Secretary of State agrees, is an outstanding trust that invariably meets its care and financial targets. However, we were told that even that trust was not meeting its A and E targets. Would the Secretary of State care to reflect on the fact that if a trust as good as the Sheffield Teaching Hospitals trust is experiencing those problems now, there is a real prospect of crisis in the NHS this winter?
Mr Hunt
I agree that that is an excellent hospital, and I commend the leadership of Sir Andrew Cash, its chief executive. I have been to the hospital myself; it was absolutely spotless, and I was very impressed by what I saw.
The hon. Gentleman is right. What we cannot do, given the pressures faced by the NHS, is start pointing fingers at individual hospitals, because even well-run hospitals are experiencing a high level of pressure. Hospitals tell us that the solution is often not in their own hands. It is a question of the number of people who turn up at the front door and the number of people whom they are able to discharge at the back, and if neither of those problems is sorted out—which will require proper links with the rest of the local NHS—there will be further problems. The system resilience groups that are now working throughout the country are trying to deal with the issue.
Sir Peter Bottomley (Worthing West) (Con)
I praise the clinical and other staff at Worthing and Swandean hospitals, and at Rustington’s Zachary Merton hospital. Could hospitals and GPs in each region or locality get together with care homes and nursing homes and establish, with the help of paramedics and members of the ambulance service, which people should be taken to hospital and which people should remain at the nursing or care homes? Too often, people in old age are taken to hospital when that is inappropriate.
Mr Hunt
My hon. Friend is absolutely right. I commend the care at Worthing hospital. As he will know, I try to go out on the NHS front line and take part in a shift most weeks, and the very first hospital I went to was Worthing hospital, where I thought the care was excellent. He is right that it is about close working; people in care homes who end up going to A and Es when they could have been better looked after at their care home is probably top of the list of admissions to hospital that we could avoid, because we know the vast majority of those people will end up being admitted to hospital if they arrive at an A and E. That is often not the best thing for people with late-stage dementia, for example, so my hon. Friend is absolutely right and I want to reassure him that that is a big focus of our efforts this winter.
Kate Green (Stretford and Urmston) (Lab)
Mrs J, an elderly constituent of mine, waited two hours following a fall for an ambulance that should have reached her in 30 minutes. The Secretary of State will be aware that there have been similar cases, not least the one described to the Deputy Prime Minister by my hon. Friend the Member for Bolton West (Julie Hilling) at Prime Minister’s questions last week. Two calls were made to the North West ambulance service in respect of Mrs J, and one was received from NWAS one and a half hours after the first report, explaining there would be a delay in getting an ambulance to her because of pressures in the system. While it is welcome that the family and carers were kept informed about what was going on, is it not a symptom of terrible pressures in the system that routine operating procedures now have to include call-backs to explain delays?
Mr Hunt
The hon. Lady is right, and there is particular pressure in the ambulance service across the country. We are putting in £50 million of winter-pressures money to help address those issues. Where there are unavoidable delays because of other emergencies at the same time, it is important to get the communication right, and I do not think we do that as well as we should. There are times when we could give more specific information about the likely arrival times of ambulances, according to the algorithms used by 999 and 111 call-handlers. That would keep the public better informed. That is something we are looking at.
Jeremy Lefroy (Stafford) (Con)
West midlands ambulance paramedics and staff do a brilliant job under great pressure at the moment, but one thing that the head of the ambulance service has mentioned to me is the difficulty in planning ahead to provide more vehicles and staff because some of the funding—not particularly the winter-pressures funding, but funding around Stafford hospital—is on a short-term recurring, rather than a long-term, basis. Might the Secretary of State look into that and see how it could be made long term, so that instead of paying lots of overtime, we could recruit and train more paramedics?
Mr Hunt
My hon. Friend is absolutely right to draw attention to that issue. One issue that has been debated often in this House is the money we waste in the NHS on locum staff, who are much more expensive than full-time staff. One of the ways we can deal with that is through something I announced in my response to the extra money in the autumn statement on our long-term plan for the NHS, which is to give multi-year commissioning contracts and multi-year tariffs to trusts, so that they can have a longer-term horizon. Too often the planning horizon is just for the next year. Indeed, I think there is a discussion to be had about whether this winter pressures money we put in every year to help could be better integrated in NHS core budgets, as a way of making sure we get the best use of that money.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
North-East ambulance service is now the eighth out of 10 ambulance services to be moved to operational level 4 as a result of winter pressures—while temperatures are 12° C and above. In my area, the local hospital trust is £91 million in deficit and the Government have gone into a process of closing minor injuries units in Guisborough hospital and Brotton hospital and walk-in centres in Skelton and Park End. Does the Health Secretary believe any of those factors might be adding to winter pressures, or am I just scaremongering and being political?
Mr Hunt
If the hon. Gentleman looks at the facts, rather than being political, he will see that in his constituency there are more doctors and nurses and more front-line clinical staff than there were, and he will find that more people are getting operations and more people are being seen at A and E departments than when his party was in power. That is why, I am afraid, it is very political. I notice that on the day when the Labour party is saying that there is a big issue with winter pressures in the NHS, fewer than 10 Labour Back Benchers are present—fewer than 10; that is how seriously Labour is interested in this issue. Is it not really about the politics?
Dr Matthew Offord (Hendon) (Con)
Having accompanied the London ambulance service on a shift at the Mill Hill depot in my constituency, I have seen the unrealistic demands placed on the ambulance service. Fiona Moore, the medical director of the London ambulance service, has said that more than 6,000 calls were made in the capital over the Christmas period last year in connection with alcohol-related incidents. Does the Secretary of State agree that that is unacceptable and that it places an unfair burden on the service?
Mr Hunt
I do. I thank my hon. Friend for going out with his local ambulance service. Indeed, I want to thank the many Members on both sides of the House who go out and see what is happening on the NHS front line. The problem that my hon. Friend raises is exactly the kind of problem we are trying to address. I do not want to pretend that all these problems can be addressed this winter. Part of the issue is that the quickest way to see a doctor is to go to A and E, where the average waiting time to see a doctor is only half an hour across the country. That is the fastest time anywhere in the world. We need to find better out-of-hospital alternatives, and better alternatives to calling an ambulance, if we are to reduce the pressure on the emergency services.
Kerry McCarthy (Bristol East) (Lab)
It was reported recently that Bristol’s Southmead hospital was the third worst performing hospital in the country on emergency targets, with only 84% of cases seen within four hours. NHS England temporarily withheld £1.35 million to cope with extra winter demand while a believable improvement plan was produced. Clearly, 84% is nowhere near acceptable, particularly as we approach winter. What can the Department of Health do to ensure that Southmead hospital improves its performance?
Mr Hunt
We are doing a number of things. I have spoken to people in the Bristol area about what we need to do to improve the situation there and I assure the hon. Lady that we are focusing on it. It is partly why we are putting in £700 million this year to help hospitals to cope with those pressures. We have a brand-new hospital in Bristol as well, and it has had some teething problems, but I am confident that the staff there are working incredibly hard to turn the situation around.
Charlie Elphicke (Dover) (Con)
In Dover, we are looking at ways of reducing the pressure on A and E through the Prime Minister’s “8 till 8” challenge fund, and at upgrading the minor injuries unit to create a local emergency centre. Is that not a more fruitful thing to do than simply revelling in the winter problems in the NHS, as the Opposition have been doing?
Mr Hunt
My hon. Friend is right. The NHS wants to know that it has a Government who have a long-term plan for the NHS, who are prepared to fund that plan and who have thought about the long-term solutions. Better access to GPs is one of the key things, as is access to a GP who actually knows about the patient and their condition. Sadly, we lost named GPs following the changes to the GP contract in 2004, but I am proud to say that, from next April, we will be bringing them back.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
The Secretary of State has accused Opposition Members of political scaremongering. Perhaps I should refer him to the Public Accounts Committee’s report on out-of-hours services, which showed cost-shunting to the ambulance service by out-of-hours providers, and to our recent hearing on A and E, which revealed an incredible waste of public money and a lack of joined-up thinking. That is not scaremongering; those are facts from the National Audit Office being interpreted by Members from all parties.
Mr Hunt
Yes, and those are the facts that we are acting on with our winter plans. We are trying to reduce the amount of money spent on locum staff and to increase flow going into and out of A and E departments. There is a huge amount of practical things that can be done. I have absolutely no problem with dealing with constructive suggestions from both sides of the House on how we can help A and E departments to get through a difficult winter. It is unacceptable, however, constantly to turn this issue into a political football, when everyone knows that the pressures of an ageing population are making life very difficult for NHS staff and that those staff have a Government who are doing everything they can to support them.
Nigel Mills (Amber Valley) (Con)
I welcome the extra money for the NHS this winter, but what more can the Secretary of State do to improve awareness of and confidence in the 111 system, in order to stop people going to A and E when they do not really need to do so?
Mr Hunt
My hon. Friend asks an important question. The 111 service is one of the elements of the long-term solution that we have not touched on much this morning. There are definitely things that we can do to make the service better. For example, if someone is put through to a GP, that GP could, with the patient’s permission, access their medical records. That would give the GP access to information about the patient’s allergies, their medication history and other key information that would help the GP to give better advice. I am pleased to hear from NHS England that, by the end of this year, a third of 111 centres will be able to access GP records with the patient’s permission.
Robert Jenrick (Newark) (Con)
Will the Secretary of State join me in praising the Fosse Way first responders and the staff of the East Midlands ambulance service, whom I will be going out with over the Christmas period? The East Midlands ambulance service has its problems, with the last Care Quality Commission report finding it was failing on four of the six major measures, and any support he can give the service will be much appreciated by its new leadership. Does he agree that Nottinghamshire residents will be surprised to hear of the Opposition spokesman’s interest in ambulance services, given that we in Nottinghamshire trace the failings of our service directly back to the last Labour Government’s decision to regionalise the ambulances services, which took an excellent ambulance service down to a failing one within five years?
Mr Hunt
Interestingly, the Opposition, who are trying to make so much of this, have actually run out of questions in an urgent question on a matter that they said was very urgent. I commend my hon. Friend’s interest in the east of England and I reassure him that we discuss it most weeks in my Department, because two of my ministerial colleagues are covered by the east of England ambulance service and we are very conscious of the problems there. The situation is getting better but there is a long way to go.
Andrew George (St Ives) (LD)
My right hon. Friend is fully aware, because he attended the Health Committee last week, that accident and emergency services do not operate in isolation. So does he not agree that integrating not only in-hours and out-of-hours GPs, NHS 111, ambulances services and minor injuries units, but social services, mental health services and dental services is essential to ensure that we have fewer avoidable A and E admissions and that we therefore reduce the pressure we are debating today?
Mr Hunt
I do agree. The first thing we could do as a step towards that is properly integrate out-of-hours care, linking out-of-hours GP services, A and E departments and 111 departments. Obviously, that needs to be linked into the in-hours GP care that people will give. I wish to commend the efforts being made in Cornwall to improve A and E performance, which has been getting better in recent weeks. We are all very encouraged by that, because there have been a lot of challenges in that area.
Rehman Chishti (Gillingham and Rainham) (Con)
I thank the Secretary of State for the personal support he has given to Medway Maritime hospital, particularly the extra £5.5 million given to the hospital to improve its A and E services. Will he confirm that hospitals in special measures and in challenging circumstances will receive any additional resources they need over the coming winter months?
Mr Hunt
We absolutely will make sure that we give Medway what it needs. I wish to thank my hon. Friend for his tireless campaigning to improve the situation, as it is very challenging there at the moment and he has taken a responsible attitude towards it. It is really important to praise the staff at the hospital, who are working very hard, and to reassure his constituents that although there are many improvement to be made, there is a lot of excellent care in that hospital and we all want to get there as quickly as we can.
Mark Pawsey (Rugby) (Con)
When I visited the A and E department of the University Hospitals Coventry and Warwickshire NHS Trust in Coventry, I saw some hard-working, dedicated staff dealing with many patients who had chosen to be there, rather than making an appointment with their GP, because that was easier and more accessible. Does the Secretary of State agree that much of the challenge of getting to see a GP arises from the GP contract negotiated by the previous Government?
Mr Hunt
We know that there were some serious problems in that contract. Interestingly, the hon. Member for St Ives (Andrew George) was talking about integrated care, but we used to have named GPs who were responsible for the entirety of someone’s care—the GP’s name was on that person’s medical record. That was abolished in 2004, which was a very big mistake—we absolutely want to put it right.
Martin Vickers (Cleethorpes) (Con)
When the Opposition use the NHS for political point scoring it can undermine the efforts of staff and cause unnecessary anxiety to constituents. A previous example of that was on 26 November when at Prime Minister’s questions it was suggested that Scunthorpe general hospital was turning away emergency cases, which was not the case. That necessitated the shadow Secretary of State’s office ringing the chief executive to clarify the situation. Will my right hon. Friend take this opportunity to thank the staff at Scunthorpe’s hospital and reassure my constituents that it is open for business?
Mr Hunt
I am happy to do that. Staff will have been extremely disappointed at the efforts of the Labour party to try to turn into some sort of political football the services that they offer under a lot of pressure and with much hard work. Members of the public just need to look at the Chamber right now, and they will see which party believes in the NHS and which party does not.
Mr Robin Walker (Worcester) (Con)
Tomorrow I will be visiting the Worcestershire Royal hospital, part of the Worcestershire Acute Hospitals Trust, in which there are 144 more nurses, midwives and health visitors as a result of investment by this Government. Hospital staff tell me that winter pressures are added to by the number of long-term dementia patients who are staying on wards. Does my right hon. Friend agree that we need to keep increasing investment in that area to ensure that we get better dementia care?
Mr Hunt
My hon. Friend is absolutely right. One of the most heartbreaking things is to see someone with advanced dementia arriving in an A and E department. People do not know anything about their medical history and the best care that they need, and it becomes very difficult for the hospital to discharge them in that situation. Having proper personalised care wrapped around those individuals will normally mean that hospital is not the best place for them to go. Indeed, to echo the comments that have already been made, the key to that is knowing where they would like to die. Very often it is not hospital, so we need to be much better in that regard.
Geoffrey Clifton-Brown (The Cotswolds) (Con)
Will my right hon. Friend examine the discharge situation in Gloucestershire Royal hospital? We had an instance this week of which he may be aware of clinically fit patients not being able to be discharged. We have some excellent community hospitals in Gloucestershire. Will his Department examine that problem to ensure that all branches of the NHS—the acute trust, the care services trust and the commissioning group—work closely together to avoid that problem becoming a real issue in the new year?
Andrew Percy (Brigg and Goole) (Con)
I thank the Secretary of State for his kind words about first responders. I will be on duty tonight, as will thousands of first responders in Yorkshire ambulance service, Lincolnshire ambulance service and throughout the country, responding to cardiac arrest, respiratory disease and so on. On the matter of community service, what are the Government doing in the light of the Royal College of Nursing saying to us at a Health Committee a few weeks ago that a failure to invest properly in community services 10 to 15 years ago is having a major impact now on our hospitals?
Mr Hunt
My hon. Friend is right about that. Just as this Government have taken a very robust attitude towards poor care in hospitals—we now have 6,000 more nurses on our hospital wards following the Francis report—we need to take an equally robust attitude towards what is provided in people’s homes, to make sure that we have proper care. It is a false economy to cut back on out-of-hospital care to pay for hospital care, as we need both.
Martin Horwood
Mr Speaker, your festive generosity equals only that of Father Christmas.
Gloucestershire hospitals have been under severe pressure in recent days, but is not one complicating factor that, in Gloucestershire and elsewhere, every unplanned GP admission to hospital goes via the emergency department? Although such cases may be relatively urgent, they are not necessarily what most of us would understand as an accident or an emergency.
Mr Hunt
The hon. Gentleman is absolutely right to make that point. There has been a lot of support for the NHS today from Liberal Democrats. If they are ever considering which is the best partner to back the NHS at any hypothetical time in the future, they should know that there is only one party that can provide the strong economy to fund a strong NHS.
Paul Burstow
My compliments of the season to you, Mr Speaker.
May I draw attention to the fact that people with mental health problems have double the attendance rates in accident and emergency departments compared with the general population? Given that fact, is it not strange that successive Governments have not invested in the evidence? If we invest in liaison psychiatry, we can reduce the numbers needing to go to A and E and give them better results as well. Is it not time that this Government did that and did it even more than they are planning to do?
Mr Hunt
Yes, my right hon. Friend is absolutely right. I can reassure him that we are investing more in liaison psychiatry both this year and next year. The Minister of State, my right hon. Friend the Member for North Norfolk (Norman Lamb), has particularly championed that, as it is a very good way in which to reduce pressure on A and E departments.
Mandate to NHS England
Jeremy Hunt Excerpts(10 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today the Government have laid before Parliament the updated mandate to NHS England for 2014-15.
Our mandate reflects the Government’s focus on getting the best health outcomes for patients, by empowering clinical commissioning groups, health and wellbeing boards and local providers of services.
We are making a non-recurrent increase to the revenue budget for NHS England for 2014-15, and a slight reallocation of resource from capital to revenue. A revision to the current mandate has been laid before Parliament today reflecting these changes to the budget only.
This week’s autumn statement set out the Government’s plans to invest significant additional funding in the NHS. This funding recognises the rising pressures on the NHS and the investment required to support the plans set out in the “Five Year Forward View”.
The additional funding for NHS England for 2015-16 will be confirmed in the revised 2015-16 mandate to NHS England which will be published shortly.
The updated mandate for 2014-15 is attached. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Attachments:
1. The Mandate (The_Mandate.pdf)
Attachments can be viewed online at http://www.parliament. uk/business/publications/written-questions-answers-statements/written-statement/Commons/2014-12-05/HCWS65/ .
Dalton Review
Jeremy Hunt Excerpts(10 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today I am announcing the publication of Examining new options and opportunities for providers of NHS care —The Dalton Review. In February 2014, I commissioned Sir David Dalton, Chief Executive of Salford Royal Foundation Trust, to lead this independent review into how we enable the best leaders and organisations in the NHS to expand their reach and do more for patients.
Sir David, the expert panel and the review team sought evidence and engaged widely across the NHS, with patients and system leaders, international health systems and other sectors to inform the work of the Review. This open and consultative approach is reflected in the publication alongside the report of the evidence packs, case studies and engagement findings which informed the analysis and recommendations aimed at continuing to secure the clinical and financial sustainability of providers of NHS care through offering new options for organisational forms.
The Report notes that while the NHS has a number of world-leading providers and has achieved remarkable successes over the past 10 years, not all NHS providers have improved at the same rate, resulting in variation in quality of care across the country. This variation in standards of care across the country, alongside the wider challenges faced by all providers of NHS services, must be addressed.
Sir David’s Report examines a range of organisational forms that are relevant to all providers of NHS care, providing options for them to drive the spread of improvement methodologies, quality systems and operating models they have developed to other organisations. The Report also provides options for providers who may not currently be delivering services at the standards they and we all expect. The recently published NHS Five Year Forward View, accepted by all parties, provided new and innovative models of care to meet the demands and challenges of the future; the recommendations and organisational forms of the Dalton Review complement the NHS Five Year Forward View, providing a range of organisational forms to help deliver these new models of care.
Sir David has highlighted five key themes in his Report, which are that: one size does not fit all; quicker transformational and transactional change is required; ambitious organisations with a proven track record should be encouraged to expand their reach and have an impact across the sector; overall sustainability for the provider sector is a priority; and, change must happen through supported implementation. The Report suggests that addressing these five key themes will accelerate the transformational change that is required to help overcome the challenges facing the NHS. To do this, the Report makes recommendations to the national bodies and leaders across the NHS, the wider system and to the Government.
Sir David highlighted the importance of funding and support for implementation of new care models and organisational forms. That is why I am delighted that the Government have announced £200 million funding to support these new models and transform challenged health economies as part of the Governments two billion pounds additional investment in the NHS in 2015-16.
The Government welcomes the Review and its recommendations, encourages all those working in or with the NHS to consider the options and recommendations of the Review and will take a close interest in their adoption and implementation over the coming months.
I would like to thank Sir David Dalton, the expert panel members and the Dalton Review team for their hard work and commitment.
Examining new options and opportunities for providers of NHS care - The Dalton Review has been placed in the Library of the House. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Attachments:
1. The Dalton Review (Dalton-Review.pdf)
Attachments can be viewed online at http://www.parliament. uk/business/publications/written-questions-answers-statements/written-statement/Commons/2014-12-05/HCWS63/
NHS (Five Year Forward View)
Jeremy Hunt Excerpts(10 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I wish today to make a statement on the future of our NHS, one that I hope everyone in this House will welcome. In October, NHS England and its partner organisations published an ambitious “Five Year Forward View” that was welcomed across the political divide. Today, I will announce how the Government plan to implement that vision.
Our response has four pillars. The first pillar is to ensure that we have an economy that can pay for the growing costs of our NHS and social care system: a strong NHS needs a strong economy. Some have suggested that the way to fund extra cost pressures is through new taxes, including on people’s homes. However, through prudent economic policies the Government can today announce additional NHS funding in the autumn statement without the need for a tax on homes. The funding includes £1.7 billion to support and modernise the delivery of front-line care, and £1 billion of funding over four years for investment in new primary care infrastructure. That is all possible because under this Government we have become the fastest growing economy in the G7.
The NHS itself can contribute to that strong economy in a number of ways. It is helping people with mental health conditions to get back to work by offering talking therapies to 100,000 more people every year than four years ago. The NHS can also attract jobs to the UK by playing a pivotal role in our life sciences industry. We have already attracted £3.5 billion of investment and 11,000 jobs in the past three years, as well as announcing plans to be the first country in the world to decode 100,000 research-ready whole genomes. Today, I want to go further by announcing that we are establishing the Genomics England clinical interpretation partnership to bring together external researchers with NHS clinical teams to interpret genomic information so that we go further and faster in developing diagnostics, treatments and therapies for rarer diseases and cancers. Too often, people with such diseases have suffered horribly because it is not economic to invest in finding treatments. We want the UK to lead the world in using genetic sequencing to unlock cures that have previously been beyond our reach.
The second pillar of our plan is to change the models of care to be more suited to an ageing population, where growing numbers of vulnerable older people need support to live better at home with long-term conditions such as dementia, diabetes and arthritis. To do that, we need to focus on prevention as much as cure, helping people to stay healthy without allowing illnesses to deteriorate to the point where they need expensive hospital treatment. Some have argued that to do that we need to make clinical commissioning groups part of local government and force GPs to work for hospital groups, but because that would amount to a top-down reorganisation we reject that approach. We have listened to people in the NHS who say that more than anything the NHS wants structural stability going forward, and, even if others do not, we will heed that message.
We have already made good progress in improving out-of-hospital care. This year, all those aged 75 and over have been given a named GP responsible for their care, something that was abolished by the previous Government. From next year, not just over-75s but everyone will have named GPs. Some 3.5 million people already benefit from our introduction of evening and weekend GP appointments, which will progressively become available to the whole population by 2020. The better care fund is merging the health and social care systems to provide joined-up care for our most vulnerable patients. Alongside that, the Government have legislated, for the first time ever, on parity of esteem between physical and mental health. To deliver world class community care, we need much better physical infrastructure. Today, I can announce a £1 billion investment fund for primary and community care facilities over the next four years. This will pay for new surgeries and community care facilities in the places where people most want them: near their own homes and families. These new primary care facilities will also be encouraged to join up closely with local job centres, social services and other community services.
Additionally, from the £1.7 billion revenue funding we are also announcing, we will make £200 million available to pilot the new models of care set out in the “Forward View”. To deliver these new models, we will need to support the new clinical commissioning groups in taking responsibility, with partners, for the entire health and care needs of their local populations. So as well as commissioning secondary care, from next year they will be given the opportunity to co-commission primary care, specialist care, social care, through the better care fund, and for the first time, if local areas want to do it, public health. The NHS will therefore take the first steps towards true population health commissioning, with care provided by accountable care organisations.
A strong economy and a focus on prevention are the first two pillars of our plan. The third pillar is to be much better at embracing innovation and eliminating waste. We are making good progress in our ambition for the NHS to be paperless by 2018, and last month the number of A and E departments and ambulance services able to access summary GP records exceeded a third for the first time, while from next spring, everyone will be able to access their own GP record online. However, today, I want to go further: £1.5 billion of the extra £1.7 billion revenue funding will go on additional front-line activity. To access this funding, we will ask hospitals to provide assured plans showing how they will be more efficient and sustainable in the year ahead and deliver their commitment to a paperless NHS by 2018.
We also have to face the reality that the NHS has often been too slow to adopt and spread innovation. Sometimes this is because the people buying health care have not had the information to see how much smart purchasing can contain costs, so from next year CCGs will be asked to collect improved financial information, including per-patient costings.
The best way to encourage investment in innovation is a stable financial environment, so I can today announce that the Government, in collaboration with NHS England, will give local authorities and CCGs indicative, multi-year budgets as soon as possible after the next spending review. We expect NHS England and Monitor to follow this by modernising the tariff to set multi-year prices and make the development of year-of-care funding packages easier.
The NHS also needs to be better at controlling costs in areas such as procurement, agency staff, the collection of fees from international visitors and reducing litigation and other costs associated with poor care. I have announced plans in all these areas, and we will agree the precise level of savings to be achieved through consultation with NHS partner organisations over the next six months. This will lead to a compact signed up to by the Department, its arm’s length bodies and local NHS organisations, with agreed plans to eliminate waste and allow more resources to be directed to patient care.
The final pillar of our plan is the most important and difficult of all. We can find the money; we can support new models of care; we can embrace innovation, but if we get the culture wrong, if we fail to nurture dignity, respect and compassionate care for every single NHS patient, we are betraying the values that underpin the work done every day by doctors and nurses throughout the NHS. We have made good progress since the Francis report: a new Care Quality Commission regime, six hospitals turned around after being put into special measures, 5,000 more nurses on our wards, the My NHS website, and 4.2 million NHS patients asked for the first time if they would recommend to others the care they received.
In the next few months, however, we will go further, announcing new measures to improve training and safety for new doctors and nurses, launching a national campaign to reduce sepsis and responding to recommendations made in the follow-up Francis report, tackling issues of whistleblowing and the ability to speak out easily about poor care.
Under this Government, the NHS has, according to the independent Commonwealth Fund, become the top-ranked health care system in the world. In 2010, we were seventh for patient-centred care, and we have now moved to the top. Under this Government, we have also become the safest health care system in the world. But with an ageing population, we face huge challenges.
How we prepare the NHS and social care system to meet those challenges will be the litmus test of this Government’s ambition to make Britain the best country in the world in which to grow old. We are determined to pass that test, and today’s four-pillar plan will help us to do just that. Our plan will need proper funding, backed by a strong economy, so I welcome yesterday’s comment by Simon Stevens that when it comes to money, the Government have played their part.
However, we also need ambitious reforms of the way we deliver care, focusing on prevention, innovation and a patient-centred culture that treats every single person with dignity and respect—proper reforms not as a substitute for proper funding, but as a condition of it. A long-term plan for the economy; a long-term plan for the NHS—I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
This weekend a 16-year-old girl in need of a hospital bed was held for two days in a police cell because there was not a single bed available for her anywhere in the country. As we have warned before, this is by no means an isolated example: the BBC reported on Friday that seven other people had died recently waiting for mental health beds. But it is not just mental health: last week I told the House of a stroke patient ferried to hospital by police on a makeshift stretcher made from blinds in his house. That patient later died. This is one of a number of alarming reports of people waiting hours in pain and distress for ambulances to arrive.
Listening to the Secretary of State for over 10 minutes today, one would have no idea that any of that was happening in the NHS right now—and that is the problem: nothing he has said today will address those pressures ahead of this winter. On mental health, does he not accept that there is an undeniable need to open more beds urgently —right now, this week—to stop appalling cases like the one we heard about at the weekend? What assessment has he made of the ability of the ambulance service to cope this winter? Is there a case for emergency support, on top of what has already been announced?
This statement offers no help now to an NHS on the brink of its worst winter in years, but there is another major problem with it. The weekend headlines promised £2 billion extra for the NHS, but the small print revealed that it is nothing of the sort. I note that the Secretary of State did not use the figure of £2 billion once in his statement, but that is what the NHS was led to believe it was getting. False promises and cheques that bounce one day after they are written are of no use to doctors and nurses struggling to keep services going. We all remember the omnishambles Budget unravelling the day after it was given, but an autumn statement unravelling three days before it has been delivered is a first even for this Government.
Will the Secretary of State confirm that £700 million of the £1.7 billion he talked about is not new money, but already in his departmental budget? A few weeks ago his Department told the Public Accounts Committee that it expects to overspend this year by half a billion pounds. His Department is in deficit right now. If that is the case, would he care to tell us where this £700 million is coming from and what services he will be cutting to pay for it? He mentioned research. At the weekend we exposed NHS England’s plans to cut the funding for clinical trials, which would have affected thousands of very poorly patients. Was that one of his planned central cuts to pay for this funding? Will he now guarantee that funding for research and clinical trials will not be cut?
But it gets worse. Not only is £700 million recycled; we gather that the other £1 billion will be funded by cuts to other Departments. The Institute for Fiscal Studies has warned of “staggeringly big cuts” to local government in the next Parliament. The NHS Confederation has said:
“If additional NHS funding comes at the expense of tough cuts to local government budgets, this will be a false economy as costs in the NHS will rise.”
Have the Government not learnt the lessons of this Parliament: that the NHS cannot be seen in isolation from other services, particularly local government, and that cutting social care only leads to extra costs for the NHS? Figures released on Friday revealed record numbers of older people trapped in hospital because the care was not there for them at home. That is happening on the Secretary of State’s watch.
This is the human consequence of the severe cuts to social care in this Parliament, and it is clear that this Government are preparing to do the same again in the next Parliament if they are re-elected. This is why hospital A and Es have missed the right hon. Gentleman’s own target for 71 weeks running. We also have cancer patients waiting longer for treatment to start, and everyone is finding it harder and harder to see a GP.
Is it not the case that most of what the Secretary of State has announced will go to patching up the problems he has created, leaving less than a quarter for the new models of care outlined in the “Forward View”? Let me remind him that policies such as a year of care for vulnerable patients and having accountable care organisations were developed by the Opposition, and for him to stand there today and lecture us about reorganisations of the NHS—well, I did not think that even he would have the nerve to do that.
The truth is that what the Secretary of State has announced provides nothing for the NHS now and is not what it seems, and because of that it will not be enough to prevent the NHS from tipping into full-blown crisis if the Tories are re-elected next year. They will not be able to find any more money for the NHS than this, because they have prioritised tax cuts for higher earners and have not yet found the money to pay for them. That explains their desperate attempts to inflate these figures and make them sound more than they are. Is it not the case that to deliver the “Five Year Forward View”, the NHS needs truly additional money on the scale proposed by Labour—an extra £2.5 billion over and above everything the Secretary of State has promised today, and an ambitious plan for the full integration of health and social care.
They said they would be the Government who cut the deficit, not the NHS, but it is the Health Secretary who has created a deficit in the NHS. It is because of that deficit that cancer patients are waiting longer, A and E is in crisis and children are being held in police cells, not hospital beds. He had nothing to say to those people today. They deserve better than a Chancellor fiddling the figures and a Health Secretary spinning the facts.
Mr Hunt
This is the day on which Labour’s attacks on the NHS have been shown up for what they are—every bit as shallow as their attacks on the economy. The country knows that we are addressing the squeeze on NHS funding caused by Labour’s wrecking of the British economy.
The right hon. Gentleman called today’s announcement “patching up the problems”. If growing the economy so that we can put more money into the NHS is patching up problems, how would he describe shrinking the economy and then cutting the NHS budget, as he wanted to do? He said that £2 billion of new money was a false promise. It was not a false promise: it was the truth—£1 billion of additional funding from the Treasury and £1 billion from the forex fines. That is £2 billion of new money, which has been welcomed by the King’s Fund today as a big step forward, and by the NHS Confederation, the Foundation Trust Network and Simon Stevens, the head of NHS England and former Labour No. 10 health adviser. This is a very significant moment when, after years of taking painful decisions to get the economy back on track, we can at last put more money into the NHS. The right hon. Gentleman should welcome it, not scorn it.
The right hon. Gentleman talked about deficits in the NHS. We will take no lessons on deficits from the Labour party—the party that left the country its biggest level of unfunded spending commitments in peacetime history. The truth is that now, with a strong economy that Labour could never deliver, we are putting things right.
The right hon. Gentleman talked about problems with care in the NHS, and the one thing that no one ever says about me is that I am a Health Secretary who shies away from those problems. The trouble is that every time I talk about problems with care in the NHS, he says it is running down the NHS. It is not running down the NHS to confront the problems of poor care. He also talked about the issue of police cells, but we are on track to reduce the number of mental health patients using them by 50% over the next few months.
As for pressures on the NHS front line, it is not that all Health Secretaries do not have to confront them; it is whether or not we sort them out. When it comes to poor care in hospitals such as the Medway and hospitals in Colchester, Basildon and Burton, this Government are sorting out those problems, while the previous Government swept them under the carpet. The right hon. Gentleman used the word “spin”, but he might like to reflect on the massive harm done to patients when under a Labour Government poor care was covered up by Labour spin—surely it was Labour’s darkest period ever when it came to running the NHS.
Government Members have a long-term plan for the economy, and a long-term plan for the NHS. By contrast—[Interruption.] Opposition Members might listen to the truth about the NHS. By contrast, the Labour leader said recently that he wanted to “weaponise” the NHS. He wanted to turn the NHS into a weapon—a weapon to get Labour votes. No, Mr Speaker, the NHS is not a weapon for political parties. It is there to help patients and to save lives, not to save political spins. Under this Government, it will always be there for patients: that is what this Government will deliver.
Mr Speaker
Order. For the avoidance of doubt—because there was some consternation about this matter—let me say that I am sure the Secretary of State is not making an allegation of any personal dishonesty on the part of any Member. It would simply not be legitimate to do so.
Mr Speaker
The Secretary of State confirms that he is not making any allegation of personal dishonesty against any individual. Enough: we are grateful. We will leave it there for now.
Dr Sarah Wollaston (Totnes) (Con)
I warmly welcome the statement. The extra funds for the NHS constitute a clear endorsement of Simon Stevens’s excellent “Five Year Forward View”. I particularly welcome the announcement of multi-year budgets and investment in patients’ ability to control their own records. Will the Secretary of State confirm that the process of creating paperless NHS hospitals will move seamlessly from primary to secondary care, and will be controlled by patients themselves?
Mr Hunt
The commitment to a paperless NHS is not a commitment to the creation of paperless hospitals by 2018; it is a commitment to the creation of a paperless NHS so that, with patients’ consent, information can flow seamlessly between different parts of the system. The interface between primary care and secondary care, and social care, is a very important part of that process.
Frank Dobson (Holborn and St Pancras) (Lab)
Will the Secretary of State tell the House how much money is now being diverted from patient care to the negotiation of legally binding contracts between commissioners and suppliers of services, or will he confirm that he cannot do so because he does not bother to collect the information?
Mr Adrian Sanders (Torbay) (LD)
May I focus for a moment on a constituency case? Last Thursday, a 16-year-old was placed in the custody centre at Torquay police station. What is of concern is that there is nothing new about that. In Devon and Cornwall alone, there have been 700 cases of people with mental health problems being placed in police cells. The problem for this young woman was that, at that point, not a single facility could be found anywhere in England to meet her needs. It really is outrageous that that could happen to a 16-year-old girl in this day and age. Where does the statement mention the fourth-tier funding to provide facilities that are clearly needed, and have been needed for years?
Mr Hunt
The hon. Gentleman is absolutely right. It is totally unacceptable for someone with severe mental health problems to be placed in a police cell. We are making very good progress in reducing the use of police cells for that purpose, with the active support of the care services Minister, my right hon. Friend the Member for North Norfolk (Norman Lamb). In the specific case to which the hon. Gentleman has referred, a bed was available but there was poor communication on the ground, which is why we were not able to solve the problem as quickly as we would have liked. As soon as NHS England was informed of the problem, it was able to find a bed within, I think, about three hours. However, as he says, this is a problem that we must eliminate.
Glenda Jackson (Hampstead and Kilburn) (Lab)
If that amount of new money is indeed going into the NHS, will the Secretary of State tell us how much of it will be dedicated to—perhaps even exclusively used for—better delivery of mental health services, not least services for child and adolescent mental health patients?
Let me point out to the Secretary of State that this is not the first occasion on which the House has raised with the Government the total failure to provide adequate services for people with mental health issues. The matter was most recently highlighted at the weekend, but it has been highlighted in the Chamber more than once in the recent past. What the Secretary of State has said today certainly does not calm my fear that if my constituents need a mental health bed, they will not find one in London, and heaven only knows how many hundreds of miles they may have to travel before they do find that security.
Mr Hunt
I hope I can reassure the hon. Lady, because today’s announcement includes £1.5 billion extra for the NHS front line next year. That will include mental health services, and we would expect commissioners to observe parity of esteem as they decide how to allocate those additional resources. It also includes £1 billion to improve primary care facilities, which will be used by many mental health patients. There is a lot in today’s announcement that I hope will relieve pressure. She is right to say that we need to do better on child and adolescent mental health services. This has been a long-standing problem, but we have been taking forward some important work to make a reality of our commitment to parity of esteem, which is something we are very proud to have legislated for.
Sir Nicholas Soames (Mid Sussex) (Con)
May I report to my right hon. Friend that, despite the dismal rant he heard from the shadow Secretary of State, the Princess Royal hospital in Haywards Heath and the Royal Sussex county hospital in Brighton, and their doctors and nurses, are doing a magnificent job in treating local people? Will he also accept that the problem with mental health services in this country goes back a long way? It will not be fixed overnight. I have had the same problem in my constituency of someone being put in a police cell. The problem fell entirely on the staff of the local trust, who simply did not deal with the matter properly. This is going to take a long time to fix, and I greatly welcome my right hon. Friend’s statement.
Mr Hunt
I thank my right hon. Friend for his comment, because the use of police cells is not an issue with which we should be playing party political games. As it happens, their use was much higher under the last Labour Government. We are starting to address that issue, and he is right: even one person spending a night inappropriately in a police cell is one person too many. That is why we are making good progress, but in the end it will require people who purchase health care in local areas to look at people with mental health needs in a holistic way—not just trying to solve issues problem by problem, but looking at and addressing the whole problem and making sure they get the treatment they need.
Mr Ben Bradshaw (Exeter) (Lab)
The Secretary of State should not be at all surprised by this terrible case of the young girl kept in a police cell in Devon over the weekend, because I and other Members have been raising this personally with him for at least the last three years. What has he been doing over that period to address the scandal of young people’s mental health services in Devon and nationally?
Mr Hunt
I will tell the right hon. Gentleman what I have been doing: I have been putting in place a strategy that will see over the next few months a reduction of 51% in the number of mental health patients who use police cells. That is progress. It still means that there are too many people in police cells, but I would just gently urge him not to try to make party political capital out of this, because a higher number of them were used under the last Labour Government. We are addressing a long-standing problem in a responsible way, and are determined to go further.
Mr Bernard Jenkin (Harwich and North Essex) (Con)
I welcome every word of my right hon. Friend’s statement, not least because his fourth pillar on culture change echoes the work done by the Public Administration Committee on complaints handling and the need for openness. His statement addresses all the needs and challenges we face in north-east Essex: the problems of openness and transparency in the local hospital and the need to transfer more of what the hospital does back to the community providers—to the multidisciplinary providers that need to be in the community. I welcome the £1 billion fund for developing community facilities, but how is he going to persuade the CCGs to transfer some of their commissioning power to these units? A hospital in Harwich, which was built under the last Labour Government, has two operating theatres that have never been used because the CCG, and its predecessor the primary care trust, would not commission services through those facilities.
Mr Hunt
I thank my hon. Friend for his long-standing support for the importance of transparency in driving up standards in health care. He has championed that for his own hospital, which has had particular issues on that front, but also through his role in this House, and he is absolutely right to do so. On his substantive point, we will get CCGs to do what he suggests through the reforms that I have announced, which will encourage them to take a holistic view of the health care received by the patients for whom they are responsible. In particular, we have got to move away from commissioning care piecemeal—commissioning a certain number of hips or a certain number of mental health consultations—and start looking at patients and all their needs in the round. If we commission in that way, we can avoid a number of the human tragedies that have come to light.
Lady Hermon (North Down) (Ind)
Will the Secretary of State kindly confirm that the Chancellor will include in his autumn statement on Wednesday an obligation on the Northern Ireland Executive to ensure that if, as we expect, further funding for health is devolved to Northern Ireland, it is ring-fenced so that it is spent exclusively on health? In that way, GP beds in community hospitals such as mine in Bangor—in North Down, not north Wales—can be reopened. Those beds were closed today, 1 December, causing enormous trauma and distress to the patients and staff there.
Mr Hunt
The system involves Barnett consequentials. As a result of today’s announcement, extra money will go to the devolved Administrations and we hope that they will use it for health purposes, but they do have a choice. The hon. Lady has just made the case extremely elegantly for that money to be put into health. She mentioned north Wales, and I know that Members on this side of the House will be hoping that the Welsh Government will also use the extra money for the NHS, given the profound problems in the Welsh NHS.
Richard Fuller (Bedford) (Con)
Dementia care for our parents, grandparents and loved ones is a growing issue for my constituents, and I congratulate my right hon. Friend on putting dementia care at the centre of what he is trying to do. I also congratulate the Bedfordshire clinical commissioning group on its recent review. Will he tell us what today’s announcement will do to help to support those parts of the country that are trying to make progress on dementia care?
Mr Hunt
I am happy to do so. We have made good progress during this Parliament, increasing by 10% the proportion of people with dementia who receive a diagnosis. This is not just about getting a diagnosis, however; it is the care and support that people get when the diagnosis is made that really matter. That is the reason for giving the diagnosis. Let me characterise the change that we want to see for people with dementia over the next few years. When someone gets a diagnosis, we want to wrap around them all the care and support that they and their family need to help them to live healthily and happily at home for as long as possible, so that they do not get admitted to hospital in an emergency or need to go into residential care until the very last moment. Of course that will cost the NHS less, but it is also far better for the individual concerned.
Mr Kevan Jones (North Durham) (Lab)
The Secretary of State talks about party politics, but he cannot get away from the fact that the number of mental health beds in this country has dropped by 1,500 on his watch. We have heard about the scandal in Devon last week, and my hon. Friend the Member for Hampstead and Kilburn (Glenda Jackson) has told the House how some patients have to travel up to 200 miles to access an emergency bed. What is the Secretary of State going to do to deliver those beds where the mental health patients who are in crisis actually need them, which is close to their homes?
Mr Hunt
I agree with the hon. Gentleman that we need to address the issue of availability of mental health beds for crisis care, but we also need to recognise that the model of care for people with mental health needs is changing. We think that it is much better to avoid long-term institutionalisation if we possibly can, and that is why there has been a process of reduction in the number of beds. That happened under the Labour Government as well. If he wants to know what I am doing, I will tell him. I am part of the Government who are delivering a strong economy, which means we can put more money into the NHS.
Mr Mark Hoban (Fareham) (Con)
I commend my right hon. Friend for securing £1 billion from the Chancellor to modernise primary care services. I know that the GPs in my constituency will welcome that, because they often cannot provide additional services owing to capacity constraints. May I urge him to ensure that, when money is spent from the fund, it is linked to delivery in relation to the proposals set out by Simon Stevens for improving primary care, for better provision locally and for closer integration with hospitals?
Mr Hunt
My hon. Friend is absolutely right. This will help to improve primary care premises and facilities. I know that there is an urgent need to upgrade a number of GP surgeries and primary care facilities, but this is not essentially about buildings. It is about new models of care. The single big change that we need to see over the next five years is in the role of GPs, so that they have the capacity and the desire to take proactive responsibility, particularly for the most vulnerable people on their lists, including people with long-term conditions such as dementia, diabetes and asthma. To do that, they will need better facilities—bigger facilities—and the ability to carry out more diagnostic tests in their surgeries, and I think that this funding will make a big difference.
Mr Andy Slaughter (Hammersmith) (Lab)
Will the Secretary of State confirm a report in The Guardian today that he shelved the downgrading of the majority of accident and emergency departments in England under the Keogh review because that is “political suicide” and because of criticisms from the College of Emergency Medicine, the Care Quality Commission and chief executives of trusts? Will this mean that he can now suspend Shaping a Healthier Future and remove the threat to the Charing Cross and Ealing A and Es?
Mr Hunt
I am always happy to confirm that a Guardian story is wrong. Let me tell the hon. Gentleman that there was no plan to downgrade the majority of A and Es. The plan is to invest in A and Es—to continue with broadly the same number of A and Es as we currently have but to recognise that some of them will need to specialise in different things. We will stick to that plan—it is a good one.
Paul Burstow (Sutton and Cheam) (LD)
I very much welcome the statement and, in particular, the Secretary of State’s ambition that Britain should become the best place in the world to grow old in. Given that home care is an essential part of maintaining frail older people and enabling them to remain in their own homes, and given that well-paid, well-trained and well-motivated home care staff enable people to stay in their own homes and families to juggle work with caring responsibilities, will he direct some of the extra £2 billion to the better care fund, so that it goes directly into social care so that these services can actually be provided?
Mr Hunt
First, I agree with the point that my right hon. Friend is making: home care is going to become an increasingly important part of what the NHS and social care systems deliver. I want them to deliver it in an integrated, joined-up way, and £200 million of the £1.7 billion going to the NHS front line is to help develop new models of care. I think that improved home care could be a very real way we do that.
Keith Vaz (Leicester East) (Lab)
The “Five Year Forward View” recommended a five-year programme to prevent type 2 diabetes that is evidence-based. How much of the money that the Secretary of State has announced today will be specifically about preventing diabetes, so that in the long run we will save even more money? At the moment, health and wellbeing boards are under no obligation to spend any part of their budget in a specific way on diabetes.
Mr Hunt
First, I congratulate the right hon. Gentleman on his campaigning on diabetes. I have looked at this carefully as Health Secretary and I looked at the possibility of ring-fencing certain sums in the budget for conditions such as diabetes, but the advice I received was that the broader change we need to make is in the whole mentality across the NHS for dealing with all long-term conditions, not only diabetes, but arthritis, dementia and chronic obstructive pulmonary disease. That is because within a couple of years we will have 3 million people who have three or more long-term conditions, one of which is often diabetes. Will a real focus of the change we want to see in the NHS be on people with long-term conditions? Yes, I would say that that is the biggest focus of all in the change we want to see over the next five years.
Sarah Newton (Truro and Falmouth) (Con)
I welcome today’s announcement of the national sepsis prevention campaign, which will make a such a difference to people in Cornwall and all around the UK. Will my right hon. Friend continue to work with the all-party group and the UK Sepsis Trust to implement the sepsis six, which it is estimated will save 12,500 lives and £2 billion for the NHS every year?
Mr Hunt
Yes, I will. I have to say to the House that the importance of being better at tackling sepsis was brought home to me personally by two moving meetings with Scott Morrish, the father of Sam Morrish, who was from the west country—perhaps near my hon. Friend’s constituency. His son’s tragic death from sepsis was avoidable, so this is an absolute priority for me in the next couple of months.
Clive Efford (Eltham) (Lab)
Two weeks ago, the Secretary of State could not muster enough Conservative MPs in this House to defend the Health and Social Care Act 2012, particularly those elements of it that have allowed competition regulators into the NHS to second-guess decisions of local commissioners. If he wants to save money in the NHS, he can do away with that element of the 2012 Act and stop money being diverted from patients to pay for lawyers and accountants to oversee a tendering process that is wasting money.
Richard Drax (South Dorset) (Con)
I congratulate my right hon. Friend on his remarks and thank him for the extra £1 billion for primary care. In South Dorset, I hear many complaints about the agency fees for recruiting staff, which is one reason why trusts tend to recruit nurses from abroad—from places such as Spain. Will he look at that and see if there is some way we can save a bit of money and act a little more efficiently?
Mr Hunt
We are spending too much on agency staff. It is fair to acknowledge that one reason why NHS trusts are doing that is in reaction to the Francis report. They want to ensure that they have proper staffing on their wards and proper staffing quickly. We have introduced transparency to encourage them to do that. As things settle down, they need to transfer more of those staff on to proper permanent contracts, because it costs the NHS too much to pay those exorbitant agency fees.
Ann Coffey (Stockport) (Lab)
I welcome any extra funding for the NHS, but will the Secretary of State ensure that it is fairly distributed, as on the current funding formula, Stockport is 4.9% from target, and that is affecting the ability of the clinical commissioning team to develop health services in the community as an alternative to emergency admissions to Stepping Hill hospital?
Mr Hunt
I recognise the hon. Lady’s concern about the way funding is allocated, and it is a concern that is shared in all parts of the House. It has been very difficult to get that right in a period when NHS funding has not been going up by large amounts, but that matter is now decided at arm’s length from Ministers by NHS England. It will make its decisions at a board meeting on 17 December, and I will make sure that I relay to it her concerns.
Margot James (Stourbridge) (Con)
Does my right hon. Friend agree that all patients, especially older and vulnerable patients, deserve the security of an NHS funded out of general taxation rather than part-funded by an unpredictable and opportunistic tax on people’s homes as proposed by the Labour party?
Mr Hunt
The trouble with a mansion tax is that, in the end, it will apply not to mansions but to homes, flats and people on low incomes. That is why it is the wrong way to put more funding into the NHS. The right way to do it is to have a strong economy, and only this Government can deliver that.
Karl Turner (Kingston upon Hull East) (Lab)
Up until her retirement, my mother was a very proud and committed nurse in the NHS. The Secretary of State wears a lapel badge pretending his love for the NHS. Today, my mother asked why, if the Secretary of State had £700 million in his Department, could he not have afforded the measly 1% pay rise for our committed nurses in the NHS, which would have cost £200 million.
Mr Hunt
It really demeans debate in this House to go on about some phoney argument that one side of the House cares about the NHS while the other does not. We have shown our commitment to the NHS by announcing today £2 billion of additional funding. That is a big deal and it shows our commitment. We have also given all nurses a 1% pay rise.
Andrew George (St Ives) (LD)
I welcome the additional money. My right hon. Friend is right that health providers need a stable financial environment, but many of them have been left with a debilitating legacy of debt. The Royal Cornwall Hospitals Trust in my own area has a legacy of debt, which is just a fraction of the amount by which the Government have admitted that they have underfunded the local health economy over many years. Rather than having distorting activity going on in that trust, would it not be better for it to start with a clean sheet of paper and to build for the future rather than constantly having to work from a position of debt?
Mr Hunt
I sympathise, because the previous Labour Government left hospitals with more than £70 billion of PFI debts. Those debts must be paid off and that money cannot be spent on front-line patient care. We have done what we can on a case-by-case basis to help trusts deal with those debts. It is extremely difficult when resources are tight and of course I will consider the trust’s particular case.
Mr Angus Brendan MacNeil (Na h-Eileanan an Iar) (SNP)
Any new money for health is, of course, welcome, but it has only come because of acute need in the English NHS. If there had been acute need in the Scottish NHS or further acute need in the Welsh NHS, we could whistle for it. Surely this is one reason for us to have full fiscal autonomy in Scotland so that we can control the spending and raising of money in Scotland rather than relying on mismanagement in England or on electoral advantage. What will be the consequences of this announcement for the Scottish NHS, the Welsh NHS and the Northern Irish NHS per annum?
Mr Hunt
I am very happy we devolve responsibility for the NHS to the devolved Administrations, because it means that people can compare performance and that we can learn from each other. For example, patients wait a shorter time for operations in England compared with in Scotland and Wales.
Sir Tony Baldry (Banbury) (Con)
Giving clinical commissioning groups the opportunity to commission GP services as well as secondary care will provide an amazing opportunity for there to be whole-population commissioning. Does it not also provide an opportunity for health and wellbeing boards? It provides an opportunity for elected councillors to work with clinical commissioning groups to try to design health care services, both primary and secondary, for the whole of the local population.
Mr Hunt
It absolutely does. My right hon. Friend makes his point very powerfully. This year, the better care fund—a programme derided by the Labour party, which said that it would not work—has been a huge success, with a £5 billion integration of the health and social care systems. The enthusiasm that that unleashed encouraged me to propose today that we should go further, so that where both parties are willing, local authorities and the local NHS should consider jointly commissioning public health as well. There would be huge benefits if they chose to do that.
Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)
Is it still the Government’s case that the emerging deficits across the English hospital trusts can be dealt with by efficiency savings alone?
Mr Hunt
There are huge pressures in the NHS. By the time of the election, we will have nearly 1 million more over-65s than there were at the last election. That means that people have to redouble their efforts to live within their means. At the same time people are trying to deliver the higher standards of care that we have talked about following the Francis review of what happened in Mid Staffs. It is challenging, but we expect all trusts to live within their budget. In all cases, they have recovery plans that we expect them to stick to.
Sir Bob Russell (Colchester) (LD)
I pay tribute to the medical and support staff at Colchester hospital for their work to bring it out of special measures. Twice the Secretary of State referred to focusing on prevention. May I suggest that a contribution to that admirable aim would be for first aid to be included in the national curriculum for schools?
Mr Hunt
No one campaigns more for first aid than my hon. Friend. I would certainly encourage all schools to teach first aid, as I think it is a very important skill and we should consider that as part of the prevention agenda. There is also a broader point, which is that we can do a lot with the Department for Education on this agenda.
Derek Twigg (Halton) (Lab)
In my constituency, people are increasingly finding it difficult to access GPs and the local hospital, Warrington and Halton, is in deficit and is missing its A and E targets. I therefore have a simple question for the Secretary of State. How many additional GPs will this money find, over and above the number of GPs who are in post today?
Mr Hunt
It takes seven years to train a GP, so the long-term solution is to train an additional 5,000 GPs, which is what the Government have decided to do and have announced. While they come on stream, this additional money will fund up to 20,000 additional posts, a number of which will be in the community.
David Tredinnick (Bosworth) (Con)
I congratulate my right hon. Friend on his emphasis on prevention. Has he had a chance to read Public Health England’s report “From evidence into action”? It encourages him to place greater emphasis on risk factors that contribute to an early death, such as tobacco, blood pressure, diet, inactivity and alcohol, rather than the actual conditions that people die from. That would cut demand for services.
Mr Hunt
That document is very powerful and I have said before that I hope that in our lifetimes this will become a smoke-free country. It is shocking that we still have 85,000 deaths every year linked to smoking. However, we are a free country so this is about supplying the information, incentives and nudges and not about compelling people.
Fiona Mactaggart (Slough) (Lab)
The right hon. Gentleman knows that GPs in my constituency have, on average, 4,500 patients on their list, which is about twice the average for England. Earlier he told my hon. Friend the Member for Stockport (Ann Coffey) that in constituencies such as hers and mine, where funding is so far from the target, we have to depend on NHS England, not him, to remedy the gap. How can we influence NHS England? What pressure is he putting on it to get fair funding for every area?
Mr Hunt
The reason we decided to give that decision to NHS England—it is now decided at arm’s length from Ministers—was to remove the worry people had that politicians might make these decisions for political purposes, rather than for what is right for the NHS. I encourage the hon. Lady to make representations to NHS England before its board meeting on 17 December.
Charlotte Leslie (Bristol North West) (Con)
I very much welcome the “Five Year Forward View” and the new investment, but does the Secretary of State agree that it is not so much a five-year forward view we need as a 20 or 50-year forward one, if we are to begin to meet the tsunami of demand we face? We will have to work together across the House as we face the tough questions on how to fund and manage the NHS. Otherwise, we will be accused by future generations of bickering while our NHS burns.
Mr Hunt
I hear what my hon. Friend says, but it is also important to have a clear plan of action to take us in the right direction over the next six years, which is what the plan from NHS England and Simon Stevens provides and what the Government have said we support. She is right that the demographic trends will get worse. By 2030 the number of over-80s will have doubled to 5 million. That is the sobering reality that we all have to face up to.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Is the Secretary of State aware the some of us on the Opposition side feel a bit sorry for him? This is the third “pie in the sky” statement we have had recently—we have heard statements on rail, on roads and now on health—which basically say that things might get better in future, and of course the election is in five months. The fact of the matter is that when I go back to Huddersfield, I see a health service in which all the players, who used to work together in partnership for something they believed in, are now at each other’s throats, as a result of his reforms: not collaborating, but fighting, disagreeing and making bids against each other.
Mr Hunt
Let us take one example. The better care fund has meant that for the first time—this did not happen in 13 years under Labour—local authorities are sitting around a table with the local NHS, working out how to jointly commission care for the most vulnerable patients in the community. That is a huge step forward. The hon. Gentleman should talk with the people in his local authority, because he will hear about the incredible progress that is being made. This is not pie in the sky; it is £2 billion of new money for the NHS. That will make a big difference to doctors and nurses in Huddersfield, just as it will everywhere else.
John Stevenson (Carlisle) (Con)
I welcome the announcement of additional funds for the NHS and give my support to the Minister for putting patients first and driving up the quality of care. However, does he agree that it is not all about money and that quality, committed and motivated staff are central to a successful NHS, as is good leadership and management, particularly at the local level?
Mr Hunt
My hon. Friend is absolutely right. For every hospital in difficulty—he has had many discussions with me about his hospital, which is going through a very difficult period—there is another with the same funding settlement that is able to deliver good care with motivated staff. Leadership is extremely important for motivating staff, and the one thing that staff say matters most to them is having leaders who listen to what they say and, when they have concerns, take them seriously. That is a change that we are beginning to see throughout the NHS.
Mr David Anderson (Blaydon) (Lab)
On that subject, I can advise the Secretary of State that last week I spoke to nurses in the hospital near my constituency, and they told me that as a result of the cuts in their pay, which have been going on for many years, they are seriously considering setting up shoebox collections to help their members get through this Christmas. At the same time, the chief executive of that trust has had a 17% pay increase, and the governors have had an 88% increase in their allowances. Is that what he means by all being in this together?
Mr Hunt
I am afraid we will not take any lessons from the party that increased managers’ pay at double the rate of nurses’ pay when in office. I will tell the hon. Gentleman what this Government have done: because of our increases in the tax-free threshold, the lowest paid NHS workers have seen their take-home pay go up by £1,000 a year.
Mr David Nuttall (Bury North) (Con)
Despite all the claims and counter-claims, does the Secretary of State agree that in the long term, with a taxpayer-funded NHS, Government will only ever be able to increase resources and meet the public’s expectations if UK plc is thriving and we have a growing economy?
Mr Hunt
My hon. Friend is absolutely right. The Labour party thought it would win this argument by pledging extra money for the NHS at its party conference, but that will not actually happen until the second half of the next Parliament and it may not happen at all if it has got its sums wrong. The public reaction was simply not to believe it, because they know that what Labour does to the economy actually puts all NHS funding at risk, which is something we must never allow to happen.
Mark Reckless (Rochester and Strood) (UKIP)
Earlier this year, the Secretary of State announced a welcome £6.12 million grant for Medway, and on Tuesday he referred to the extra doctors and nurses being taken on in a special measures regime for Medway hospital. Could he assure us that extra and recurring funding will also be available to cover the costs in future?
Mr Mark Spencer (Sherwood) (Con)
What impact will the extra money have on hospitals in special measures, such as the Sherwood Forest Hospitals NHS Foundation Trust? Could he assure the House that any extra moneys will reach clinicians and patients and will not be swamped by the disastrous private finance initiative that the previous Government signed?
Mr Hunt
Of course, that has been a huge problem for Sherwood Forest Hospitals NHS Foundation Trust. I have met the chief executive, who is doing a very good job in turning around the trust, but there are huge challenges. What doctors and nurses in failing hospitals or hospitals in special measures want to know is that they have a Government with a long-term commitment to the NHS and who will deliver the economy that can fund the NHS. They also want to know that they have a Government who will tell the truth about problems so that they get sorted out, which never used to happen before.
Mrs Madeleine Moon (Bridgend) (Lab)
Last week, as chair of the all-party group on motor neurone disease, I took evidence from professionals and patients who had been promised that £14 million would be available for communication support from April this year. Not a penny has been spent yet on equipment or new staff. I took phone calls from people who are end-stage kidney diseased who are frightened by the announcement that kidney dialysis is to go from NHS England to clinical commissioning groups. Will the Secretary of State get a grip, make sure that the money that is there is spent, and stop the disastrous move of kidney dialysis to CCGs, which are not functioning?
Mr Hunt
With the greatest respect to the hon. Lady, I will very happily look into the concerns she raises, but what we are talking about today is more money going into the NHS because the Government got a grip of public finances and got the economy growing. That means more money for people with long-term conditions, including people with motor neurone disease. The hon. Lady should therefore welcome today’s announcement.
Andrew Bridgen (North West Leicestershire) (Con)
According to clinicians in charge of health care and budgets, this Government have done much to take the politics out of running the NHS. Will my right hon. Friend confirm that average productivity in the NHS has improved under this Government, and does he agree that, given the outrageous comments of the Labour leader, it is clear that Labour is happy to see the NHS used as a political football?
Mr Hunt
I think what the public find very perplexing about this is that the Labour party opposed reforms that mean we have 10,000 more doctors and nurses on the front line. Labour is now not welcoming additional financial investment in the NHS that means we will have even more doctors and nurses, and it does not recognise the fundamental point that affects the whole NHS, which is that, in employing those extra doctors and nurses, we have to back them with a culture of safety and compassionate care that we never saw under Labour.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
Our NHS is indeed reliant on a strong economy, but we should note that the UK’s state deficit is the worst in the European Union at the moment and our state debt has more than doubled since May 2010. Can I take it from the Secretary of State that I can go back to the constituents of Middlesbrough South and East Cleveland and tell them that their acute hospital trust will have its £91 million deficit removed; that its PFI, which was opened up in the Major years, will be dealt with properly; that Hemlington, Park End and Skelton medical centres will stay open: and that minor injuries units in Guisborough and Brotton will remain open?
Mr Hunt
I warmly congratulate the hon. Gentleman on being the first Labour Member to say in this House that a strong NHS needs a strong economy. May I encourage him to transmit that message to those on his Front Bench, and perhaps to the shadow Chancellor, who might then understand why people in the NHS are backing this Government because they know that we will deliver a strong economy? I do not know whether we can do all the things the hon. Gentleman talked about, but we will have a better chance with the fastest-growing economy in the G7.
Rehman Chishti (Gillingham and Rainham) (Con)
I thank the Secretary of State for his statement and for the support that he has personally given to Medway Maritime hospital in my constituency, including, at a meeting last week, a commitment of £5.5 million to increase its A and E capacity. Can he assure me that hospitals in special measures that have problems going back to 2006 with high death rates will be given extra resources from the funding announced today to ensure that they are turned around as quickly as possible?
Mr Hunt
I assure my hon. Friend, who has campaigned very hard to improve standards at Medway hospital, that, first, we want to support its doctors and nurses, who are more passionate than anyone about putting this difficult period behind them; and that secondly, I have no greater focus than on making sure that we do turn around these hospitals in difficulty. It is a challenging process, but the extra funds that I have announced today will benefit all hospitals, including Medway.
Mr Jim Cunningham (Coventry South) (Lab)
The Secretary of State has boasted about the numbers of doctors and nurses coming through on his watch, but that actually started on Labour’s watch because, as he has said, the process takes seven years. What proportion of this new investment in the national health service is to be invested in Coventry, particularly given the disparity regarding doctors’ surgeries and the loss of doctors?
Mr Hunt
The training may have started under Labour, but if we do not have enough money in the NHS budget, we cannot pay for these doctors and nurses. We can do that because we took a decision, bitterly opposed by Labour, to disband the primary care trusts and the strategic health authorities and to lose 21,000 administrators so that we could pay for 10,000 extra doctors and nurses, including in Coventry.
James Morris (Halesowen and Rowley Regis) (Con)
The achievement of parity of esteem between mental and physical health in the NHS is absolutely fundamental to its future. As the Secretary of State will know, the Government have a reasonably good record on moving towards parity of esteem. Does he agree that we need not only more investment in mental health services, but, more importantly, better commissioning and a change of culture towards viewing patients as a single whole?
Mr Hunt
My hon. Friend has campaigned incredibly hard on this issue. I totally agree that the key aspect is a change in the approach of commissioners. People with mental health needs often have physical health needs and different needs relating to gambling and alcohol addictions, for example, that are connected to their mental health problems. Unless all these issues are tackled together, we are unlikely to make progress. We are very proud to have enshrined in legislation parity of esteem as something that we must achieve in the NHS. Today’s announcement will help this to go further.
Mike Kane (Wythenshawe and Sale East) (Lab)
Given that delayed discharges have reached a record high, what guarantee can the Secretary of State give that this money will not be paid for by further cuts to local government social care budgets?
Mr Hunt
The hon. Gentleman will have to wait to see what the Chancellor says on Wednesday about the Department for Communities and Local Government settlement. This Government have recognised that the fate of the social care system and the fate of the NHS are closely entwined, and that we cannot support the NHS at the expense of the social care system because the two go together. That is why we see close working with the Better Care fund.
Robert Jenrick (Newark) (Con)
As my hon. Friend the Member for Sherwood (Mr Spencer) highlighted, Sherwood Forest Hospitals NHS Foundation Trust remains in special measures. I know that the Secretary of State has taken an interest in this. The trust has many failings, but it also has one hand tied behind its back in the form of a particularly egregious PFI deal that takes up 16% of its budget every year. Is there anything he can do to review trusts that are in special measures and have particularly difficult PFI settlements?
Mr Hunt
I remember visiting Newark hospital with my hon. Friend before he was elected, and I know that he campaigns very hard on the issues facing the trust. I will happily take that issue away and look at it. It is worth saying that the doctors and nurses at that hospital are working incredibly hard to turn things around, and they have already made great progress.
Andrew Stephenson
Thank you, Mr Speaker; I am honoured.
I very much welcome the £2 billion of additional funding announced today. This morning, I was at Airedale hospital for the preview of its new £6.3 million A and E department, which will open to the public this Wednesday. Will the Secretary of State join me in paying tribute to all the hospital’s NHS staff and management, and its patients, who have been involved from the start of the process in making sure that the new A and E department, which is more than double the size of the old one, is now a reality?
Mr Hunt
I am happy to do so. It is an absolutely brilliant hospital. I was really impressed when I saw that it has integrated its IT systems with those of local GPs better than anywhere else I have seen in the UK, and it is now looking at integrating those systems with local residential care homes. It has a fantastic Skype system for patients who are vulnerable and have mobility problems. It is an amazing place, and my hon. Friend is absolutely right to draw attention to it.
Mr Marcus Jones
The previous Labour Government left my constituents with one of the worst health funding allocations in England. Despite the extra investment that this Government have put in, the issue still has not been properly resolved. Having heard my right hon. Friend’s advice earlier, I will be making representations to NHS England. Will he join me in supporting my constituents in getting a fairer funding deal?
Mr Hunt
I want everyone to have a fairer funding deal, and today’s announcement is significant in that respect. One of the reasons it has been difficult to help people to move closer to their target funding allocations is that the increases in the NHS budget have been only 0.1% every year, so we have not had the margins necessary to make changes. Precisely by how much, and where, we make those changes is a matter for NHS England, but I will happily refer my hon. Friend’s concerns to it.
Oral Answers to Questions
Jeremy Hunt Excerpts(10 years, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Grahame M. Morris (Easington) (Lab)
3. What representations he has received on exemption of the NHS from the provisions of the transatlantic trade and investment partnership.
The Secretary of State for Health (Mr Jeremy Hunt)
The Government will not allow TTIP negotiations to harm the NHS. Any suggestion to the contrary is both irresponsible and false. I am grateful to the former Labour shadow Health Secretary for confirming that.
Grahame M. Morris
That is an interesting answer but, without specific exemption from TTIP, how can the Secretary of State give any reassurance that predatory organisations such as the Hospital Corporation of America, which was prosecuted for fraud in the US, will not use the TTIP provisions to seek contracts in our NHS?
Mr Hunt
The best assurance I can give the hon. Gentleman is not what I have said, but what the EU Trade Commissioner, Karel De Gucht—I challenge colleagues in Hansard to spell that correctly without looking at my notes—has said. In an interview in September, he said:
“Public services are always exempted—”
from TTIP—
“there is no problem about exemption. The argument is abused in your country for political reasons but it has no grounds.”
Mr Speaker
Colleagues in Hansard may not even rely on the Secretary of State’s notes; they may have their own source material. They are very special people those reporters.
David Morris (Morecambe and Lunesdale) (Con)
I thank my right hon. Friend for that concise answer. I reiterate the message to the unions, which are sticking up billboards in my constituency, that Cameron and Hunt are not selling off the NHS.
Mr Hunt
I thank my hon. Friend for his comments. I was quite amused to see that I have a future career as an estate agent, along with the Prime Minister, when our hopefully long careers in politics are over, but the point is that this is scaremongering and it is wrong to scaremonger about something as important as the NHS. To suggest that the NHS is being privatised is fiction. What is not fiction is Labour’s legacy of poor care.
Clive Efford (Eltham) (Lab)
The Secretary of State’s definition of “harm” is not the definition that Labour Members have. My Bill, which was passed overwhelmingly on Friday, would require the Secretary of State to bring the matter back to this House should TTIP apply to the NHS in any way whatsoever. Will he support my Bill going into Committee without delay, so that we can discuss the detail and answer the questions he has?
Ms Margaret Ritchie (South Down) (SDLP)
Given the uncertainty of the French and German Governments on the investor-state dispute settlement mechanism, as well as the indication by EU Commission President Juncker that he will not back it, why have this Government not done more to protect the health service from a practice that would leave it vulnerable to private sector intervention?
Mr Hunt
This is what the EU chief negotiator said to the former Labour shadow Health Secretary, who is chair of the all-party group on TTIP:
“the rights of EU Member States to manage their health systems according to their various needs can be fully safeguarded…There is no reason to fear either for the NHS as it stands today or for changes to the NHS in future as a result of TTIP.”
It could not be clearer than that.
Mr Philip Hollobone (Kettering) (Con)
4. How many patient episodes there were at Kettering General Hospital in (a) 2010 and (b) the last year for which figures are available; and what assessment he has made of the reasons for the change in the number of such episodes.
David T. C. Davies (Monmouth) (Con)
6. How many patients have received treatment through the cancer drugs fund since the inception of that fund.
The Secretary of State for Health (Mr Jeremy Hunt)
More than 60,000 patients in England have received treatment through the cancer drugs fund since its inception in October 2010. They and their relatives will be very concerned at the suggestion made by the shadow Health Secretary last month that a Labour Government could abolish the fund.
David T. C. Davies
I congratulate the Secretary of State on that very high figure. Is he aware that some of those people who are being treated have had to sell up their homes and move here from Wales, where they are routinely denied life-prolonging cancer drugs by the Labour-run Welsh Assembly Administration. What does that teach us about the respective differences between the health services in England and Wales?
Mr Hunt
I thank my hon. Friend for raising that point. The last Labour Government did leave us with one of the lowest cancer survival rates in western Europe, which is one of the reasons why we introduced the CDF. Unfortunately, the current Labour Government in Wales are continuing with those policies, which is why 6,500 Welsh cancer patients were admitted for treatment in English hospitals last year. [Official Report, 12 January 2015, Vol. 590, c. 5-6MC.]
Valerie Vaz (Walsall South) (Lab)
So will the Secretary of State then publish the assessment of the CDF by the chemotherapy intelligence unit before 7 May 2015?
Mr Hunt
We are, on the NHS, the most transparent Government in history, and I can see no reason why we would not publish that. We are very proud of what the CDF has achieved. We are very proud that the level of cancer diagnoses has increased by more than 50% compared with what it was under the previous Labour Government, and so we are finally starting to win the battle against cancer.
Andrew Percy (Brigg and Goole) (Con)
We all remember the horror stories before the CDF existed locally, and all Government Members certainly support its continued use. Before any drugs are delisted from the CDF, will the Secretary of State make available the scoring of those drugs? Will he also outline what the provisions will be for consultation with patients and their families?
Mr Hunt
We will absolutely go through a transparent process on that. My hon. Friend is right to talk about the CDF’s success, which is why we have put its budget up by 40%. As part of the fund’s success, we want to make sure that it is allowing access to the latest drugs and to drugs that really work. Obviously, science has moved on since the fund was set up four years ago, which is why we want to make room for new drugs and take off existing drugs where there is evidence that they are not working as well as possible. However, the process must be transparent.
Liz Kendall (Leicester West) (Lab)
Last Wednesday, the Prime Minister denied that there is a problem with cancer care, yet the target for cancer patients to start their treatment 62 days after a general practitioner referral has been missed for nine months in a row. Cancer Research UK says that this target is vital for ensuring swift diagnosis and treatment so that we have the best survival rates in the world. Some 15,000 patients have already waited too long. This is a serious problem requiring serious action, so what is the Secretary of State going to do?
Mr Hunt
I think cancer patients in the hon. Lady’s constituency will welcome the fact that under this Government Leicester hospital has 194 more nurses and 120 more doctors, many of them involved in cancer care.
Let me answer the hon. Lady’s question directly. There is pressure on one of the cancer standards, and that is because every year we are now diagnosing 460,000 more people than happened under the last Labour Government, who left us with such a disappointing survival rate. When that many people are being diagnosed, it of course puts pressure on the diagnostic labs and the people doing those processes. But Cancer Research UK is also saying that we are seeing record increases in survival from cancer, and that is happening because of this Government’s policies.
John Robertson (Glasgow North West) (Lab)
7. Whether the Government have made a final decision on whether to introduce standardised packaging of tobacco products.
Lorraine Fullbrook (South Ribble) (Con)
12. What progress has been made in improving access to GPs.
The Secretary of State for Health (Mr Jeremy Hunt)
The Prime Minister’s £50 million challenge fund is improving GP access for more than 3 million patients across England, helping them to get evening and weekend appointments.
Lorraine Fullbrook
Many people in South Ribble will be able to see their GPs in the evening and at weekends, thanks to a locally led initiative by Chorley and South Ribble clinical commissioning group and Greater Preston CCG to extend GP surgery opening hours this winter. Does my right hon. Friend agree that such initiatives, which will give greater flexibility to patients and alleviate pressures on other areas of the NHS, particularly A and E, are exactly what is needed in the busy winter months?
Mr Hunt
I do agree with my hon. Friend. I took my own children to an A and E department at the weekend precisely because I did not want to wait until later on to take them to see a GP. We have to recognise that society is changing and people do not always know whether the care that they need is urgent or whether it is an emergency, and making GPs available at weekends will relieve a lot of pressure in A and E departments.
Andrew Gwynne (Denton and Reddish) (Lab)
I am afraid it is yet more spin from the Government. Everybody knows that it is getting harder not easier to see a GP under this Health Secretary. He has as much as admitted today that emergency departments across England have failed to hit the Government’s A and E target for 70 consecutive weeks, and that is in part because people are struggling to get a GP appointment in the first place. Will he now get a grip on this problem, and call on his Chancellor of the Exchequer in next week’s autumn statement to use £1 billion from banking fines to help ease pressure on the NHS this winter, as the Labour party has pledged?
Mr Hunt
We will not take any lessons from the Labour party about general practice. It is not just the disastrous 2004 GP contract. The president of the Royal College of General Practitioners says that the shadow Health Secretary’s plans
“could destroy everything that is great and that our patients value about general practice and could lead to the demise of family doctoring as we know it.”
David Tredinnick (Bosworth) (Con)
13. What steps he is taking to increase patient choice.
The Secretary of State for Health (Mr Jeremy Hunt)
This Government are committed to patients having greater choice and control over their health care, and decisions as to which treatments are available on the NHS are taken by GPs on the basis of available scientific evidence.
David Tredinnick
Does my right hon. Friend have any plans to increase personal health budgets, and will he ensure that there is greater awareness of the health professions that are regulated by the Complementary and Natural Healthcare Council, the Health and Care Professions Council and the Professional Standards Authority, which has recently accredited the Society of Homeopaths and the British Acupuncture Council?
Barbara Keeley (Worsley and Eccles South) (Lab)
With regard to reducing patient choice, can the Secretary of State explain the sudden move to remove dialysis from being regarded as a specialised commissioning service, which is of great concern to a constituent of mine who is a renal patient and to the renal community? Will the Secretary of State now agree to a proper consultation—not over the Christmas holidays—and will he think again about that risky move?
Mr Hunt
We hope to have a public consultation on the matter. We are not seeking to restrict access to dialysis—far from it. We want to make it easier for people to access those vital services, and we have been putting more money into the NHS budget because we recognise just how important they are.
Yasmin Qureshi (Bolton South East) (Lab)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
As we look forward to world AIDS day next Monday, the whole House will want to pay tribute to the 30 NHS volunteers who left for Sierra Leone at the weekend to help in the fight against Ebola. They stand for the very best of the NHS and make us all proud. Last week I formally launched the MyNHS website. It contains 395,000 pieces of information and is the first website of its kind anywhere in the world. It will help people compare vital information about the performance of their local hospitals, GP surgeries, councils, mental health trusts and residential care homes. It will be a vital way to ensure that patients are not kept in the dark about the quality of their NHS services.
Yasmin Qureshi
Further to the Secretary of State’s answer to the hon. Member for Worsley and Eccles South (Barbara Keeley), he must know that treating renal failure requires complicated, integrated care and that no one part of it can be separated. He must also know that there are 23,000 dialysis patients in the UK, and transplant patients have overlapping clinical needs. Handing responsibility for commissioning dialysis to commissioning groups is unacceptable, especially as it has been done without any consultation. Can he explain the rationale for all this, and will he meet me and colleagues from the all-party kidney group to discuss the matter?
Mr Hunt
I am happy to arrange a meeting between either me or one of my Ministers and members of the APPG to discuss the matter. I stress that we recognise how important those specialised services are. We want to get the benefits of nationally co-ordinated commissioning with the local integrated care that CCGs are in the driving seat to deliver. That is why we are having this discussion.
Sarah Newton (Truro and Falmouth) (Con)
T2. Public Health in Cornwall has estimated that 300 people in Cornwall might die from the cold this winter because they are living in cold homes. Last week the Government introduced the first proper fuel poverty strategy to eradicate that totally unacceptable situation by 2030. Will my right hon. Friend join me in praising the work being done in Cornwall by a partnership of over 30 organisations in the Winter Wellness programme to ensure that people stay warm and well this winter?
Andy Burnham (Leigh) (Lab)
Two weeks ago, news emerged of serious problems at Colchester hospital. People there still do not know the precise details, as Ministers have not made a statement and the Care Quality Commission has not published its report. But Colchester is not the only hospital in difficulty; we have learnt that hospitals in Scunthorpe, Middlesbrough and King’s Lynn have been turning patients away and others are already on black alert, and that is before winter has even begun. We do not have an accurate picture of what is happening in the NHS right now, because NHS England was due to begin publishing weekly reports on 14 November but has failed to do so. Why has that information not been published, and will the Secretary of State today instruct NHS England to do so without delay?
Mr Hunt
That information is published at the decision of NHS England—[Interruption.] It has said that it will publish it in a fortnight’s time. Let me just say to the right hon. Gentleman that it was this Government who decided to publish that information on a weekly basis, something he never did when he was Health Secretary.
Andy Burnham
I am afraid that is just not good enough. Who is in charge here? It is not just A and Es that are under pressure; there is a knock-on effect on ambulance services. Reports are now surfacing of serious failures in patient care. Last month, a six-year-old girl from Sunderland was left for three hours with a suspected broken back despite five 999 calls. At the weekend, it was reported that a 56-year-old stroke patient from Huyton was taken to A and E by police on a makeshift stretcher made from window blinds from the man’s home, and he later died. Yesterday, it emerged that a 57-year-old cancer patient from Bishop Auckland died after three ambulances were diverted to other calls. Is it not clear that the situation in the NHS right now is far more serious than the Government have acknowledged, and should not the Secretary of State now make an urgent statement to Parliament setting out what he is doing to reduce the risk of harm to patients this winter?
Mr Hunt
There are huge pressures in the NHS. That is why we have put a record £700 million into the NHS to help it to get through this winter. May I gently suggest to the right hon. Gentleman that he should not try to politicise every single operational problem? When the NHS is all about politics, patients get forgotten—as he should know, because that is what happened when he was Health Secretary. Whether in Medway, Colchester, Burton or George Eliot, patients were forgotten because for Labour it was politics before patients every time.
Eric Ollerenshaw (Lancaster and Fleetwood) (Con)
T6. Will the Secretary of State look again at the funding formula for hospital trusts so that some adjustment can be included to recognise the issues in trusts such as University Hospitals of Morecambe Bay NHS Foundation Trust which cover large and difficult geographical areas?
Mr Hunt
I recognise those issues, and I am very happy to take that suggestion away. I particularly want to put on the record that the scare stories put out by Labour in Lancaster about the potential closure of Royal Lancashire Infirmary are false. It is totally irresponsible to scare people in Lancaster in that way.
Alex Cunningham (Stockton North) (Lab)
T3. My constituent Corron Sparrow was left lying in the road for two hours with a compound fracture of his leg despite a call from a policeman to the North East Ambulance Service pleading for help. Eventually the service responded by sending an ill-equipped St John Ambulance team who then had to call for professional assistance. There are many more failures. It is now three weeks since I wrote to the chief executive, Yvonne Ormston, asking for an inquiry into this, but she has not even acknowledged my letter. Will the Minister intervene and tell the North East Ambulance Service that it cannot just ignore these matters?
David Rutley (Macclesfield) (Con)
T7. Eighteen NHS trusts have been placed in special measures, while so far six have come out. What progress is being made with the other 12?
Mr Hunt
I am happy to answer that, because for the first time we have a proper independent inspection regime. Labour tried to vote that down so that we could not have it, but we pressed on. A third of these trusts have been turned round. We are making good progress across most of the other 12 hospitals in special measures, including 1,500 more nurses, 200 more doctors, and 53 changes at board level. Where there were problems before, we are sorting them out.
Hugh Bayley (York Central) (Lab)
T4. Patients with mental health problems who are referred for psychological therapies wait, on average, less than 40 days for treatment, but in York the wait is 125 days. My constituent, Laura Goodacre, has now waited nearly 350 days. Will the Minister look at this worrying case and the need for our mental health trusts in York to reduce waiting times?
Charlie Elphicke (Dover) (Con)
T8. After all the cover-ups of the past, what is being done to ensure that the culture of the NHS is always improving, particularly in that patients are treated with dignity and respect and always have the highest standards of safety?
Mr Hunt
I thank my hon. Friend for his question. After the Francis report, we now have 5,000 more nurses on our hospital wards. The scores that patients themselves are giving for whether they are treated with dignity and respect are up by 10%. We want to put poor care behind us and behind the NHS. It is time that Labour got on board with this agenda instead of constantly saying that we are running down the NHS by sorting out poor care.
Ann Coffey (Stockport) (Lab)
T5. Recent reports indicate that the extent of child sexual exploitation and abuse is more widespread than previously recognised. The trauma of sexual abuse can have massive, life-long consequences on the physical and mental health of victims. Will Ministers consider designating child abuse and child sexual exploitation as a public health priority in the same way as smoking, alcohol, drug use and obesity?
Mr Ben Bradshaw (Exeter) (Lab)
T10. When I asked the Prime Minister two weeks ago about the financial crisis facing Devon NHS, he seemed completely unaware of it, so could the Health Secretary please explain why Devon NHS faces an unprecedented £430 million deficit and what he is doing to stop the rationing, cuts and total withdrawal of some services that is now being proposed?
Mr Hunt
We are not rationing services. In fact, we are doing 1 million more operations every year than were done under the previous Government. I will tell the right hon. Gentleman why that financial pressure exists: we have an ageing population, with nearly 1 million more over-65s than four years ago, and huge pressure to deliver good care in the wake of the Francis report. The NHS will be supported if we have a strong economy that can fund real-terms increases in health spending—something that never happens if the deficit is forgotten.
Greg Mulholland (Leeds North West) (LD)
My constituent, six-year-old Sam Brown, is one of 100 people with the rare disease Morquio. His family live in a state of anxiety because they do not know whether the drug Vimizim will be approved for further use on 15 December. Will a Minister please meet me and Katy and Simon, Sam’s parents, to give Sam the Christmas present he needs and to keep Sam smiling?
Mark Reckless (Rochester and Strood) (UKIP)
Last month one patient waited 35 hours in Medway’s A and E, and in the past year 10 patients have waited more than 24 hours. I was grateful to the Secretary of State for taking up my invitation to visit the hospital. What progress has been made specifically on turning around the A and E department?
Mr Hunt
There are more doctors and more nurses operating at Medway hospital and I know that when the hon. Gentleman was sitting on this side of the House he was very pleased with the progress that was being made in turning it around from special measures, but, like UKIP’s policy on the NHS, everything changes.
Alec Shelbrooke (Elmet and Rothwell) (Con)
May I welcome the recent launch of MyNHS? Does my right hon. Friend agree that transparency of NHS performance, whether it be that of hospitals, GPs or surgeons, will be a major driver in improving patient care, as international evidence suggests, and help us avoid a scandal such as Mid Staffs, which happened under that lot over there?
Caroline Lucas (Brighton, Pavilion) (Green)
Do Ministers agree that it is a scandal that cold homes are costing the NHS in England more than £1.3 billion every year, with kids growing up in cold homes twice as likely to contract diseases such as asthma? Do they also agree that it is hugely disappointing that not one penny of Treasury infrastructure funding is devoted to energy efficiency? Will they speak to their Government colleagues about that?