Patient Safety
Jeremy Hunt Excerpts(9 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Andy Burnham (Leigh) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on his announcement on patient safety.
The Secretary of State for Health (Mr Jeremy Hunt)
Mr Speaker, I would like to make a statement to the House about a package of measures that I have announced today to boost safety, transparency and openness in our NHS. It follows my earlier written ministerial statement.
Just last week, the independent Commonwealth Fund said that under this Government the NHS has risen to be the top-rated health care system in the world. Despite many challenges in our NHS, it is therefore clear that we have much to be proud of. However, it is also clear that there is more to do. It is estimated that for 12,000 deaths a year in hospitals there was a 50% or greater chance of their being prevented. Figures released by NHS England today tell us that there were 32 never events in the past two months, including cases of a throat pack and a hypodermic needle being left inside patients post-surgery. These are shocking statistics.
In the Government’s response to Sir Robert Francis’s landmark public inquiry on the poor standards of care at Mid Staffordshire NHS Foundation Trust, I made clear our determination to make the NHS the safest and most open health care system in the world. Today, all hospital trusts around the country will therefore receive an invitation to the Sign up to Safety campaign, which is led by Sir David Dalton, the inspirational chief executive of Salford Royal. The campaign will help us to achieve our ambition of halving avoidable harm, thereby potentially saving 6,000 lives. Trusts will be asked to devise and deliver a safety plan, and may receive a financial incentive from the NHS Litigation Authority to support implementation.
We are fulfilling the pledge that we made in our response to Francis to create a hospital safety website for patients. As of today, the NHS Choices website will tell us how all hospital trusts are performing across a range of seven key safety indicators, including one for open and honest reporting. For the first time, the website will let patients and the public see whether a hospital has achieved its planned levels for nursing hours. Indeed, I am pleased to inform the House that the latest work force statistics, published today, show us that we have 5,900 more nurses in our hospital wards since our response to Francis just over a year ago.
Finally, I am pleased to announce today that Sir Robert Francis QC will chair an independent review on creating an open and honest reporting culture in the NHS. The review will provide advice and recommendations to ensure that NHS workers can speak up without fear of retribution. It will also look at how we can ensure that where NHS whistleblowers have been mistreated, there are appropriate remedies for staff and there is accountability for those who have mistreated them.
I am confident that the package of measures announced today will shine a light on poor care so that lessons can be learned, action can be taken and harm to patients can be prevented. In the process, we will support front-line staff to help the best health care system in the world blaze a trail on issues of safety, transparency and compassionate care.
Andy Burnham
The Health Secretary rightly calls for openness, transparency and accountability. It is a pity that that does not extend to his dealings with this House. He spent the morning touring TV studios, but could not find the time to come to the Chamber. Is that because he has signed away day-to-day control of the NHS, as his public health Minister—the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison)—let slip, or is it because he did not want to face questions on the damning criticism of him from the outgoing president of the Royal College of Psychiatrists, who says that he is ignoring the “car crash” in mental health? Either way, it should not be left to us to drag the Secretary of State to the House.
An open, learning culture in all parts of the NHS is an ambition shared across this House and it builds on the work of the last Government following care scandals in the 1990s. More information is welcome, but how will the Secretary of State guard against the risk, as expressed this morning by Martin Bromiley, of creating a “naming, shaming and blaming” culture? He has just told the House that a fifth of hospitals are failing to report properly. Why is that and how will he correct it?
The Secretary of State mentions the Commonwealth Fund and I join him in celebrating the standing of the NHS. He implies that it has all been achieved in the past four years. That is pure spin. I remind him that the NHS first came top in 2007 and that this year’s report specifically traces the NHS’s recent success to reforms implemented by the last Labour Government and to the Darzi report, which it says led to
“an increased emphasis on improving the quality of care provided by the NHS.”
Perhaps the Secretary of State will reflect that analysis in any future statement on the previous Government’s record.
The Secretary of State promises new data on infection—one area where the Commonwealth Fund found cause for concern compared with 2010, with the NHS now ranked worst in the world for patients reporting infection in hospital or shortly after. What is he doing to turn that worrying trend around? On staffing, will he commit to publishing figures on how many of the nurses he mentioned are agency nurses? Is the NHS not now spending a fortune on agency staff—£1.4 billion, 162% higher than planned—because, in the first four years of this Parliament, the Government and the then Secretary of State, who is now the Leader of the House and sitting on the Front Bench, cut nurse training places by 10,000?
The Secretary of State talks about his new target to save 6,000 lives over three years. Can he explain how that will be achieved when people are now waiting longer to start treatment for cancer, when NHS waiting lists have hit a six-year high and when ambulance response times are getting longer? Is not that the real reason he was afraid to come here today? The NHS is getting worse on his watch and the Government have surrendered their power to do anything about it.
Mr Hunt
We talk about many things and there will always be political differences between Opposition and Government Members, but I would have thought that on patient safety, on saving patients’ lives, on dealing with the issue that once a week in the NHS we operate on the wrong part of someone’s body and on other terrible issues, there might be a degree of consensus. It is incredibly disappointing that, again, the right hon. Gentleman has chosen to make a political football out of something that should be above party politics.
Let me go through the right hon. Gentleman’s points. This morning in the radio studios, I talked about fulfilling a pledge that I made to the House in my response to Francis—that we would publish staffing data, something that he never did when he was in power. We have done that for 6,700 wards throughout the country, because we want to end the scandal of short staffing that happened on his watch and directly led to Mid Staffs.
I am delighted to come to the House. I have made a written ministerial statement. I often come to the House and I am delighted that the right hon. Gentleman has raised this issue. As he has raised some specific points, I need to address them. He quoted what the outgoing president of the Royal College of Psychiatrists said, but he failed to mention what the incoming president said this morning, which was to praise the remarkable work done by this Secretary of State and his Ministers to raise the issue of mental health.
The right hon. Gentleman talked about the Commonwealth Fund. Let us look at that. When he was Secretary of State, we fell from being top-rated in the world to being second. We are now back on top. He has spent the past four years saying that under the coalition Government the NHS is going to rack and ruin. Someone who is independent has now looked at it and said that we are the best in the world. The right hon. Gentleman should reflect on that before he starts to criticise and run down the NHS.
Let us talk about agency nurses. I am very proud of the fact that, in just over a year, we have 5,900 more nurses on our wards. That is an increase of 4,000 nurses across the system compared with when Labour was in power. Why is that? It is because we are doing something about the issue of safety and compassionate care—issues that the right hon. Gentleman repeatedly swept under the carpet when he was Health Secretary.
Finally, let me make this point. We are doing something that is a world first today: we are publishing staffing data on a hospital-by-hospital, ward-by-ward basis. Yes, we are also publishing which hospitals do not have an open and transparent reporting culture. Creating transparency about failures has, I am afraid, become one of the biggest dividing lines in this House. I think it is a very great shame that every time I raise the issue of poor care in the NHS, the right hon. Gentleman accuses me of running down the NHS and softening it up for privatisation, when what I am actually doing is standing up for patients, which is what he should have done when he was Health Secretary.
Dr Sarah Wollaston (Totnes) (Con)
I welcome today’s announcements. Unsafe care in the NHS carries not only a terrible personal cost, but a terrible financial cost—£1.3 billion a year in litigation alone—and I welcome the announcement of Sir Robert Francis’s review. Will the Secretary of State use this opportunity to reassure NHS staff that they do not need to wait for the outcome of that review, and that if they raise concerns about unsafe practice, not only will they be protected, but they would be failing their patients if they failed to do so?
Mr Hunt
I start by welcoming my hon. Friend to her new position as Chair of the Health Select Committee, which I think she will do brilliantly well. I also thank her for the fact that she had been talking about this issue long before she took up that post, and as someone who has worked in the NHS, she has always recognised its importance.
My hon. Friend is absolutely right to say that NHS staff should not wait until the outcome of the new Francis review before speaking out. My view is that the atmosphere is beginning to change inside the NHS. We are getting trust boards that are now spending much more time talking with safety, but the reason I wanted to have this review is that there are problems and issues across the world with people in health care speaking out, and nowhere has really embraced the culture of safety that we have in the airline, nuclear and oil industries, where concerns about safety are on a completely different level. I know that I have the wholehearted support of NHS staff in this mission; I think it is a shame that we do not have the support of the Labour party.
Kevin Barron (Rother Valley) (Lab)
In response to the Francis report in relation to the duty of candour, the Government said that it should be on institutions and not on individuals. Given that the Government appear not to want to bring in new regulatory bodies in relation to individual action inside the national health service, does the Secretary of State have any faith in the regulatory bodies currently looking after health professionals, given the state that Mid Staffs hospital ended up in?
Mr Hunt
We looked carefully at whether the duty of candour should apply to individuals, and we decided against that because we were worried about creating a legalistic culture in trusts. However, we are working with the regulatory bodies. The right hon. Gentleman is absolutely right to raise concerns, as they were indeed raised in the Francis report. Following on from my earlier response, one of the lessons that we learned from the airline industry is that pilots are professionally protected if they speak out, so on balance it is to their advantage to speak out rather than to shut up. As a result of that reporting of safety incidents, near misses and so on, the industry has achieved a remarkable reduction in accidents. I would like to see whether we can do the same thing in the NHS.
Angie Bray (Ealing Central and Acton) (Con)
One of my constituents spoke out against malpractice at the hospital where she worked and was subsequently vindicated at a tribunal, but she lost her job and has been unable to find work in the national health service ever since. Is it not time that we put an end to some kind of blacklist that stops people being re-employed when they have done the right thing?
Mr Hunt
I would like to thank my hon. Friend for the support that she has given to her constituent, whom I think I have also met. My hon. Friend is absolutely right: we have to stop this system of consequences for people who do the right thing and speak out. It is not right for me to comment on an individual case, because legal proceedings are often involved, but one hears of situations where people have spoken out and then been victimised by a trust, and that is wrong. We need to be better at looking after whistleblowers, but we need to go further and eliminate the need for whistleblowing by creating a culture where trusts are hungry to hear from their own staff about safety concerns because they want to put them right.
Mr Ben Bradshaw (Exeter) (Lab)
An Exeter psychiatric nurse of more than 20 years’ standing wrote to me in despair this week saying that
“mental health services are in collapse”,
and that patients are regularly placed in “life threatening” situations or sent as far away as Bradford because there are no beds locally. Vulnerable people are waiting a shocking three months for the co-ordination of their care. How dare the Secretary of State come to the House today and claim that our mental health services are not in crisis?
Mr Hunt
There are real pressures in our mental health services, but the right hon. Gentleman should recognise the progress that the Government have made. That includes doubling the money going into talking therapies, having global summits on dementia and putting a massive amount of money towards raising the profile of dementia in this country and across the globe, and legislating for parity of esteem as between mental and physical health—something that never happened under the previous Government. There is a lot of work to do, but I think he should give credit where it is due.
David Morris (Morecambe and Lunesdale) (Con)
On transparency of staffing levels, does my right hon. Friend know that the University Hospitals of Morecambe Bay NHS Health Trust vacancy level for nurses is now 4%, against a regional average of 10%? That is obviously an increase in nurses in my area, and I thank him for that.
Mr Hunt
I welcome the increase in nursing across the country, and I am surprised that Labour Members do not welcome it. When I started in this job they spoke constantly about nursing numbers, but I notice they have now stopped doing that. Although those numbers are an important first step, it is not possible to compare trust with trust at this stage because they are all self-reported numbers. Over the next months—certainly by next spring—we will go through all the figures ensuring that NICE-approved tools are used to fulfil them. We will then see how trusts are doing compared with each other, which will be useful to them.
Barbara Keeley (Worsley and Eccles South) (Lab)
As a member of the Health Committee, I am disappointed that the Secretary of State does not understand that being dragged to the House to answer an urgent question is not the same as coming here to make a statement. I would prefer to hear first in this House what the Government are doing.
The Secretary of State mentions the leadership of David Dalton and Salford Royal NHS Foundation Trust, but that leadership led to safe staffing levels, which he has not supported. A recent Nursing Times survey found that the majority of nurses said that their wards were dangerously understaffed. I hear from nurses who are working with ratios of 2:22, 2:24 or 2:28—that is the reality. Does he think it is time he apologised for cutting the number of nurses?
Mr Hunt
Again, I am surprised that we do not have more agreement. If the hon. Lady looks at the figures, she will see that in the past year there have been 5,900 more nurses on our wards. Why does she not welcome that? We are using Salford Royal—a brilliant hospital that she knows well—to lead a safety campaign across the whole country to learn from the brilliant things that it is doing. I put a written statement before Parliament, and nothing I said this morning is not in the public domain. I would be delighted to come to the House any time to make an oral statement, and I notice that far more coalition MPs want to ask questions about safety and compassionate care than do Labour MPs.
Steve Baker (Wycombe) (Con)
My right hon. Friend will remember some of the issues that I raised in the House about patient safety, and the Francis report, the Keogh review, and the new Care Quality Commission regime have made a material improvement. On Friday last week, Buckingham Healthcare NHS Trust was the second trust to emerge—at last—from special measures. Will the Secretary of State join me in congratulating that trust, and express the hope that that marks a new beginning about which we can be optimistic?
Mr Hunt
I would be delighted to do that. Incredible hard work by doctors, nurses and health care assistants on the front line of my hon. Friend’s local hospital has meant that the trust has come out of special measures, which the whole House should celebrate. Indeed, it was helped in that by Salford Royal, and one of the most encouraging things about the new special measures regime is that we are pairing up hospitals in difficulty with other hospitals that have a better record, and we are getting tremendous results.
Derek Twigg (Halton) (Lab)
Clinical commissioning groups commission services in hospitals. What discussions has the Secretary of State had with CCGs to ensure that when they commission services they particularly look to ensure transparency and that patient safety is the highest priority in their discussions?
Mr Hunt
We have a lot of discussions, and the hon. Gentleman is right: the commissioning of care is vital and we need CCGs to play their part. We have many discussions with NHS England about how to do that, and we will be considering how we can make CCGs more publicly accountable for their record in those areas.
Sir Tony Baldry (Banbury) (Con)
Oxford University Hospitals NHS Trust has managed to make multi-million pound recurring savings over the past couple of years and is now in the black. At the same time it has managed to create 400 new jobs in the trust, almost all of which are new doctors and nurses. Does that not demonstrate that it is possible for the NHS both to meet the Nicholson challenge, and to recruit more doctors and nurses to improve and enhance patient safety?
Mr Hunt
It certainly does, and that is another area where it would be refreshing to have a bit more openness from the Labour party. We can afford 8,000 more doctors and 4,000 more nurses in our NHS than when Labour was in power because we got rid of primary care trusts and strategic health authorities, and 20,000 administrative jobs that were not on the front line—a change that Labour opposed bitterly every step of the way. Labour Members must say what would happen to those doctors and nurses if we repealed the Health and Social Care Act 2012, as they have publicly committed to do.
Jenny Chapman (Darlington) (Lab)
If the Secretary of States wants some kind of TripAdvisor-style scheme for the NHS that is fine; it may improve safety and it may help patient choice. However, a woman who has fallen to the bottom of her stairs and is waiting hours for an ambulance does not have a choice. That is happening now and it was not happening five or six years ago. What is he going to do about that?
Mr Hunt
First, I will ensure that throughout the system when we have failures in care we are completely transparent about them and do not seek to brush them under the carpet. That is a very important change. Secondly, yes there is pressure on ambulance services, just as there is pressure in most parts of the NHS now, but under this Government our ambulance service is taking 1,000 more people every day on emergency journeys. We should credit it with doing a very good job in difficult circumstances.
Mr Bernard Jenkin (Harwich and North Essex) (Con)
I commend my right hon. Friend for being determined to create a different and more effective safety culture in the NHS, just as in the airline or oil and gas industries. Does he accept that publishing more data is only part of the equation and will not necessarily change attitudes and behaviours, particularly if those data are then gamed at another target? We must tackle attitudes and behaviours at source—in the operating theatre, the GP’s surgery and throughout the whole service—to get that better safety culture.
Mr Hunt
As ever, my hon. Friend speaks wisely. The first step is to be open and transparent about where the problems are, and I hope today will be a step in that direction. In the end, however, if we are to change things we must create a learning culture in all our hospitals so that the word goes out from the top down that the management is interested in hearing from staff if they have concerns about safety, because it wants to learn from those concerns and put them right. One of the messages I have been trying to get across is that that does not cost money; it saves money. We spend £1.3 billion a year on litigation and £800 million on adverse events. If we are feeling, as everyone is, a tough climate financially, this is a positive thing to do for that reason as well.
Mr Geoffrey Robinson (Coventry North West) (Lab)
The House will be aware that the Health Secretary has refused to comply with the Information Commissioner’s ruling to publish the risk register for NHS reorganisation. Will he at least say whether that risk register warned the Government specifically that such reorganisation would hit A and E services?
Mr Hunt
That risk register is in the public domain, but I defend the right of my officials to give confidential advice to Ministers as that is an important part of government. I want my officials to be open and transparent with me if they think I am about to do the wrong thing, and all Ministers need a protected area where they can get frank advice. The hon. Gentleman is one of my constituents, so he will be pleased to know that the Royal Surrey county hospital in Guilford is embracing the safety campaign with vigour and completely renewing the way its wards are organised to improve patient care and safety.
Mr David Ruffley (Bury St Edmunds) (Con)
I commend the Secretary of State for these practical and sensible reforms on patient safety, and I look forward to discussing them with staff at West Suffolk hospital—the biggest district general hospital in my area. Does he agree that the sensible and deliverable transparency reforms will ensure that the conspiracy of silence that we saw tragically in Mid Staffs is not repeated on his watch?
Mr Hunt
I am absolutely determined to make that the case. The biggest example—a number of them have been raised today—is the issue of hospitals put in special measures. Over the last year, we have put more than 10% of NHS acute trusts into special measures. That was a very difficult decision and was not welcomed at the time. The result, I am pleased to say, is that we are seeing real and significant change in all those hospitals. I hope as many of them as possible will get out of special measures quickly, but we can achieve that change only if we are honest about the problem in the first place.
Julie Hilling (Bolton West) (Lab)
Bolton hospital is having to go abroad to recruit qualified nurses this summer because there are no British-trained nurses available. Will the Secretary of State now take responsibility for cutting nurse training places by 10,000 since the last election and accept that the lack of qualified nurses is just making the problem of safety worse?
Mr Hunt
What I will take responsibility for is agreeing to a public inquiry into what happened at Mid Staffs—something rejected by the Labour party—that has woken up the whole NHS to the need for safe staffing in all our wards. We are implementing the report and that will indeed be reflected in the nurse training numbers going forward.
Jackie Doyle-Price (Thurrock) (Con)
Basildon and Thurrock hospital was the first to exit the special measures regime after a number of years of failure. It did so because the leadership embraced what happened, was willing to learn the lessons from what went wrong and went out of its way to fix them. Far from being a naming, shaming and blaming culture, is it not the truth that my right hon. Friend is strengthening the culture of accountability in the NHS, which is as it should be?
Mr Hunt
Yes, and I would like to thank my hon. Friend for her superb work in supporting Basildon and Thurrock hospital through a very difficult period. I think that the chief executive there, Clare Panniker, is an exemplary one. She wrote an article in The Guardian pointing out that it is incredibly painful for trusts when they go into special measures, that it causes a lot of pressure in the local media, but that it also means that change can be made much more quickly when an urgency to solve these problems, many of which have been around for years and years, is created. I commend the staff of that hospital not just for coming out of special measures but for being rated “good” by the chief inspector of hospitals—a fantastic achievement.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
Never mind the fact that this Government will not publish the risk register for a £3 billion top-down reorganisation; the Secretary of State and his Ministers will not meet me. If he wants to talk about accountability, why will he and his Ministers not meet me to talk about a minor injury unit in Guisborough being closed, a minor injuries unit in Brotton hospital being closed, a GP centre in Park End being closed and a walk-in and GP centre in Skelton being closed? All those units are in my constituency and they are all being closed, yet the Secretary of State and his Ministers will not meet me, which would represent genuine accountability.
Mr Hunt
Let me say to the hon. Gentleman that the accountability he talks about is precisely demonstrated by his ability to ask me questions right now as he has just done. He needs to be accountable and come clean with the House by saying that he has actually met my Ministers on a number of occasions on precisely the issues that he raised.
George Freeman (Mid Norfolk) (Con)
After the shocking events at Mid Staffs under the last Government, I would like to congratulate the Secretary of State on his crusade for accountability and transparency as the best disinfectant, as shown by his support for whistleblowers and for 4,000 additional nurses. Does he agree that the collection, monitoring and day-to-day use of data on health outcomes is absolutely key? I welcome his Minister’s support for measures in my ten-minute rule Bill, now adopted and sponsored by me and my hon. Friend the Member for Stafford (Jeremy Lefroy).
Mr Hunt
I am happy to do that, and I would particularly like to congratulate my hon. Friend on the insight he has brought with regard to the power of data. In one example of why this is so important, the latest figures showed 43 or 44 people dying in the NHS because of medication errors, but if the person giving the medication had been able to see the patient’s entire prescription history, those horrific tragedies might have been avoided. That is why proper sharing of data is so important.
Mr Andy Slaughter (Hammersmith) (Lab)
I want to ask about the safety of the 22,000 patients who use Hammersmith hospital A and E every year. There is no increased capacity in the acute primary or community care services locally, which the Secretary of State set as a prerequisite for any A and E closures in west London. Will he ask Imperial Healthcare Trust to review plans to close the A and E at Hammersmith on 10 September? Will he answer that question, as my constituents in Shepherd’s Bush and White City deserve an answer to it, not the spin and the game playing that I always get from the Secretary of State?
Mr Hunt
I am afraid I will take no lessons in spin and game playing after what the hon. Gentleman wrote in local election leaflets in Hammersmith and Fulham, failing to tell his own constituents about the brand new hospitals, the opening of a seven-day GP surgery and the 800 out-of-hospital professionals. I think he behaved absolutely disgracefully.
Charlotte Leslie (Bristol North West) (Con)
I very much welcome the Francis review into whistleblowing, which does indeed focus on transparency, and I am bemused and depressed that we cannot get universal welcome for it across the House. In addressing the name, shame and blame argument, does my right hon. Friend recognise that many front-line staff will be relieved at what he has announced because it will force management priorities to be the same as their priorities, which are overwhelmingly about patient safety?
Mr Hunt
My hon. Friend speaks wisely, and I commend her for her work in championing whistleblowers. In her relatively brief time here, she has made a big difference on that issue. Personally, I do not like to use the term “naming and shaming” because I think identifying problems should always be the first step to sorting them out. What we are doing today by identifying trusts that do not have a proper open and honest reporting culture is also helping them to change that reporting culture while at the same time identifying trusts that have a good culture. It is all about changing the culture, so this is a positive move, and I think that NHS staff will really welcome it.
Nic Dakin (Scunthorpe) (Lab)
Does the Secretary of State agree that the best way to deal with concerns about patient safety, such as those raised last week about Scunthorpe general hospital, is to have a proper independent investigation that respects patient confidentiality and reports objectively, clearly and transparently so that appropriate action can be taken when all the facts are known?
Mr Hunt
There are definitely times when an independent investigation is needed, and a number of them are going on in the NHS at the moment. The first thing, however, is to talk to the trust and get it to deal with the particular issues being raised and to create a culture in which trusts are willing, enthusiastic and keen to do that. Today is an attempt to deal not only with what happens when things go wrong with whistleblowers, but with how to create the right culture in the first place.
John Stevenson (Carlisle) (Con)
I commend the Secretary of State for his desire to put patients at the centre of the NHS. Does he agree that patient safety in places such as North Cumbria can be ensured not just by quality medical care, but by good-quality leadership and management? Would he therefore agree that we need quality management throughout the NHS that is confident about being open and transparent?
Mr Hunt
I would agree with that, and I am grateful to my hon. Friend for talking to me on many occasions about the issues at North Cumbria hospital and for sharing his determination to turn things around— [Interruption.] I find it extraordinary that Labour Members are making all this noise. My hon. Friend will know that that hospital had to give £3.6 million in compensation to just one person because of an appalling mistake when Labour was in power. They should be welcoming these changes, not criticising them.
Diana Johnson (Kingston upon Hull North) (Lab)
On 1 May I asked the care Minister why there had been a 60% drop in the number of people barred from working with vulnerable adults in the health and social care sector, and an even bigger drop of 75% in those barred from working with children. The Minister said that he was going to investigate, but I have heard nothing since. Does the Secretary of State share my concern that fewer unsuitable people are being barred from working in the social and health care sectors on his watch?
Andrew Percy (Brigg and Goole) (Con)
As the hon. Member for Scunthorpe (Nic Dakin) mentioned, local GPs raised concerns last week about a cluster of cases at Scunthorpe and Grimsby hospitals—not at Goole hospital, which was also revealed last week never to have breached its four-hour waiting target. There is still a lot more to be done, so does the Secretary of State share my concern at the evidence received by the Health Select Committee last week from the Care Quality Commission, which stated that all too often, members of staff who raise concerns are dealt with by the human resources department rather than in a proper way that allows their complaints to be properly aired?
Mr Hunt
That is a very good point, and I thank my hon. Friend for welcoming me to Goole hospital; I had a very good visit. That hospital is in special measures but it is making real progress. It was interesting to talk to staff at the front line. I do not know when the hospital will be ready to leave special measures, but the staff on the front line felt that things were changing, and they welcomed that. My hon. Friend is absolutely right that if someone raises a safety concern, it should not be viewed as an HR issue; it is a patient safety issue, and trusts need to treat it as such.
Jim Shannon (Strangford) (DUP)
In his reply to the right hon. Member for Leigh (Andy Burnham), the Secretary of State referred to avoiding avoidable harm. Given that Combat Stress has reported the referral of some 358 additional troops for urgent treatment—a rise of some 57%—will he give us some idea of the discussions in which he has engaged with service charities to ensure that that harm can be avoided?
Henry Smith (Crawley) (Con)
I welcome the action taken by my right hon. Friend to extend transparency for the purpose of safety in the NHS, but could it be extended to the social care sector, especially in the light of the January 2010 Care Quality Commission report on Orchid View care home in Copthorne, near my constituency? The report rated the home as good, but 19 patients subsequently died.
Mr Hunt
I thank my hon. Friend for raising that very harrowing issue. I hope I can reassure him by saying that we are progressively extending the changes we introduced to hospital inspections to inspections of general practice and adult social care settings. The new inspection regime is designed to be much tougher when it comes to identifying problems. It is never possible to identify all abuse in an inspection, which is why what I have announced today is so important: it is about the creation of a culture that tries to prevent such problems from arising in the first place.
Rehman Chishti (Gillingham and Rainham) (Con)
I welcome the statement and the work that the Secretary of State is doing. Mr Mufti, who was the medical director of Medway hospital under the last Government, raised serious concerns about the bullying of staff, which he feared was affecting the quality of care and patient safety. Will the new provisions address that problem?
Mr Hunt
That is exactly the intention. Following my conversation last week with Nigel Beverley, the chief executive of Medway, I think that the hospital is making good progress after going into special measures. However, it is important to recognise that while it is possible to change things externally, real culture change must come from inside. This is not a day on which we are announcing new targets or top-down initiatives. The Sign up to Safety campaign to be led by Sir David Dalton will be voluntary: hospitals must choose whether to sign up to it. I think that that will enable us to make more progress than we would make if we tried to do things in the old way.
Mr Rob Wilson (Reading East) (Con)
I was saving my energy, Mr Speaker.
I welcome my right hon. Friend the Secretary of State’s changes, which have made improving patient care and raising standards such a central part of the NHS mission. It is important to shine a light on poor performance, which is why I also welcome today’s CQC report on Royal Berkshire hospital, which highlights a number of important challenges that confront my local hospital. Does he agree that only by being open and transparent about problems can we tackle them and fix them for the long term?
Mr Hunt
I absolutely agree with my hon. Friend. I have had many discussions with him as he has campaigned in the House for his local hospital. The creation of a culture of openness and transparency should have support in all parts of the House, but that will not happen if every time we are honest about a problem, we are told that we are somehow running down the NHS. I urge Labour Members to think carefully about the way in which they approach this issue.
Margot James (Stourbridge) (Con)
I applaud the cultural change that my right hon. Friend is leading in the NHS and the social care sector. As he may know, three former members of staff at Granary care home, owned by Shaw Healthcare, were last week found guilty of appalling violence and abuse of frail elderly patients. The sentences handed down to those three individuals were utterly derisory, the longest being four months in prison. Will my right hon. Friend meet the Secretary of State for Justice to review sentencing in this crucial area?
Mr Hunt
I shall be happy to raise that issue with the Justice Secretary, and I thank my hon. Friend for raising it. I think it reminds us that whatever changes we may make in the House, it will take time for them to filter through. I am afraid that, even now, some terrible things are happening. One of the things that worries me most is that abuse of this kind often involves people who have dementia and cannot speak up for themselves. That is why it is so important for us to raise the profile of dementia, and to improve the training of those who care for people with the condition.
Martin Vickers (Cleethorpes) (Con)
May I take up what was said by my hon. Friend the Member for Brigg and Goole (Andrew Percy)? My right hon. Friend the Secretary of State will appreciate the concern felt by my constituents at a time when the local media are full of a dispute between the clinical commissioning group and the hospital trust about an ongoing investigation of patient safety. Can he assure patients that every support will be given to the CCG and the trust when the recommendations following the inquiry become known?
Mr Hunt
Yes, I can. My hon. Friend’s local trust is in special measures, and the decision on whether a trust should come out of special measures is no longer one for the Secretary of State; it is made independently by the chief inspector of hospitals. I hope that we have created incentives for system leaders to solve these problems, because if they do not, the chief inspector will simply not decide that the trust can be taken out of special measures.
John Howell (Henley) (Con)
I join my hon. Friend the Member for Wycombe (Steve Baker) in praising the improvements that have taken place in Buckinghamshire Healthcare NHS Trust, which has come out of special measures, and which affects part of my constituency. Are not those improvements a very good example of the way in which we are summoning up the political courage to tackle such trusts, particularly when they have experienced high death rates in the past?
Mr Hunt
I hope that they are. I think that in the end we shall be judged on how successful we are in turning around hospitals in special measures. Last week I met Anne Eden, the chief executive of Buckinghamshire Healthcare. I think she has done an excellent job in extremely difficult circumstances, but I know she would agree that there is still much work to be done. Taking hospitals out of special measures is the first step, but ultimately we must reassure the public that when there are problems, we shall be on their side and try to sort those problems out.
John Glen (Salisbury) (Con)
I welcome today’s announcement, and I assure the Secretary of State that Salisbury district hospital, which is in Odstock in my constituency, will be keen to sign up to the campaign. However, will he acknowledge that it and several other hospitals have been alive to issues of patient safety for a long time, and have recently been involved in a new patient safety initiative launched by Wessex academic health science network? Is it not important for existing arrangements to be acknowledged, so that there is no duplication of effort?
Mr Hunt
That is absolutely true. A number of initiatives are taking place, and I welcome them. The involvement of universities can help us to understand some of these very difficult issues. This is uncharted territory for the NHS, because nowhere else in the world are we seeing the rigour with which we are going about our task. I think that we should be open about anyone who can contribute to the debate.
James Morris (Halesowen and Rowley Regis) (Con)
I welcome the Secretary of State’s focus on transparency and accountability. He is right to draw attention to the positive steps that the Government have taken in regard to mental health services in the last four years, but given our aspiration to secure parity of esteem between mental and physical health in the NHS, and our need to drive up mental health care standards throughout the country, should we not extend the transparency and accountability measures that he has announced to those services?
Mr Hunt
I pay tribute to my hon. Friend’s campaigning on mental health issues, which has done a huge amount to raise the profile of the subject. Let me reassure him that the information that we are publishing on the website today includes staffing data for all the mental health trusts. We completely recognise the parity issue, at least in what we are doing today.
Guy Opperman (Hexham) (Con)
In my previous job, before I entered the House, I conducted dozens of clinical negligence cases. Almost every defending trust was obstructive, defensive and reluctant to admit blame, even when patently culpable. I strongly welcome the changes that are being brought about. Does my right hon. Friend agree that greater transparency and whistleblowing will bring about the safety changes that we all want to see?
Mr Hunt
I very much agree with my hon. Friend, and he will know that one of the things we have introduced this year is the duty of candour, which makes it a legal requirement for trusts to be honest with patients and their families when harm or avoidable death has occurred. He is absolutely right that we have to tackle this, and he will also know that when trusts are open and transparent, relatives are less likely to sue, because they recognise the good will and spirit involved.
Andrew Selous (South West Bedfordshire) (Con)
Will the Secretary of State join me in commending the initiative of Bedfordshire clinical commissioning group, under the excellent leadership of Dunstable GP Dr Paul Hassan, which has instituted unannounced checks on the wards of local hospitals by local GPs?
Jeremy Lefroy (Stafford) (Con)
May I commend my right hon. Friend on the work he has done on patient safety, while gently suggesting that perhaps the long-term, or even medium-term, aim should be to eliminate avoidable harm, rather than just halve it? In my case, in Stafford, we have seen huge improvements in patient safety since the very difficult times a few years ago, but I ask my right hon. Friend to bear in mind the hospital’s current situation, which is fragile, and to ensure that it is not left to its own devices, but that all the support necessary to maintain patient services during this difficult transition is given.
Mr Hunt
No Member of this House has done more for their local hospital than my hon. Friend, and I commend him on what he has done. We certainly will not leave that hospital to its own devices; we are following very closely what is happening. I want to pay tribute to him, too, on the issue of safety, because when the Francis report came out, he was one of the earliest voices saying, “Yes, this is about compassionate care, but it is also about safety.” I do not at all rule out the aspiration of zero harm and zero avoidable deaths, but that is a point we will have to get to step by step, and I am very proud that we are taking the steps that we are today.
Mr Philip Hollobone (Kettering) (Con)
A few years ago, Kettering general hospital had some of the very worst hospital infection rates in the whole country; now it has some of the very best. Last year, it had some of the very worst rates for attendance at A and E within the four-hour target; now it has some of the very best. Does this not demonstrate that determined local hospital leadership, plus dedicated and committed nursing staff, can transform the patient experience in our hospitals?
Mr Hunt
It absolutely does, and I think that is very important. There are huge pressures on NHS hospitals. I have been to Kettering hospital at my hon. Friend’s invitation, and it is a very busy hospital. There is a lot of pressure in the system, but with the right leadership it is absolutely possible to deal with these challenges, and I know that my hon. Friend has had a huge impact in Kettering, supporting the hospital through a difficult period.
Safety, Transparency and Openness in the NHS
Jeremy Hunt Excerpts(9 years, 10 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
Today I am announcing a package of measures to boost safety, transparency and openness in the NHS.
In March, I announced a new ambition to reduce avoidable harm in health care by half, thereby saving 6,000 lives. A new campaign—“Sign Up to Safety”—will be launched today to help achieve this ambition. The campaign will call for everyone working in the NHS to listen to patients, carers and staff, learn from what they say when things go wrong and take action to improve patient safety. Every health care organisation will be formally invited to sign up to the campaign and commit to delivering a safety plan that will contribute to the new ambition. The safety plans will be reviewed by the NHS Litigation Authority, and if the plans are robust and will reduce claims, trusts will receive a financial incentive from the NHS Litigation Authority to support implementation of their plans. This is just one way that we can tackle some of the financial costs of poor care.
In the Government’s response to Sir Robert Francis QC’s “Public Inquiry into Mid Staffordshire NHS Foundation Trust”, we pledged to create a hospital safety website for the public. As of today, NHS Choices will provide key hospital-level patient safety data in one place which means the public can see how hospitals compare in terms of safety across seven key indicators—including reporting culture, hospital infections and cleanliness, response to patient safety alerts and health care staff recommendations to their friends and families about the organisation they work in. In our response, the Government also said that hospitals needed to be more transparent about staffing levels, and for the first time the new hospital safety website will tell the public whether a hospital has achieved its planned levels for nursing hours.
Finally, I am announcing an independent review into creating an open and honest reporting culture in the NHS chaired by Sir Robert Francis QC, who chaired the landmark inquiry into the poor standards of care in Mid Staffordshire NHS Foundation Trust. The review is being established to provide independent advice and recommendations on measures to ensure that NHS workers can raise concerns with confidence that they will be acted upon, that they will not suffer detriment as a result and to ensure that where NHS whistleblowers are mistreated there are appropriate remedies for staff and accountability for those mistreating them. The review will consider the merits and practicalities of independent mediation and appeal mechanisms to resolve disputes on whistleblowing fairly. It will do this by listening to and learning the lessons from historic cases where NHS whistleblowers say they have been mistreated after raising their concerns and by seeking out best practice.
The safety campaign that we are launching today, together with what is now an unprecedented and world-leading level of transparency and openness, will help to create the right conditions needed to harness the commitment of everyone in the NHS to deliver the best and safest possible care.
Oral Answers to Questions
Jeremy Hunt Excerpts(9 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Robin Walker (Worcester) (Con)
1. What recent assessment he has made of the role of the Prime Minister’s challenge fund in improving access to GP services.
The Secretary of State for Health (Mr Jeremy Hunt)
Mr Speaker, it is a pleasure to see you again so soon.
The Prime Minister’s challenge fund will be rolled out over 1,100 of the 8,300 GP surgeries in the country. It will improve access out of hours, at weekends and electronically, and it will benefit up to 7.5 million people.
Mr Walker
I am glad that this Government, unlike the previous one, whose disastrous contract negotiations led to a decline in GP access, is making sure that out-of-hours care is as widely available as possible. Will the Secretary of State assure me that he will do whatever he can to ensure that places, such as Worcester, that have not yet been reached by the challenge fund will also see the benefits of this approach?
Mr Hunt
My hon. Friend is right to say that some bad changes were made. What will most benefit his constituents, whether or not they are part of the initial tranche of the Prime Minister’s challenge fund, is the reintroduction of named GPs for the over-75s. For people with complex long-term conditions, continuity of care is extremely important, and every single one of his constituents aged 75 or over will now get a named GP.
Kate Green (Stretford and Urmston) (Lab)
We are very pleased in Old Trafford to have secured funding for 80 extra care beds for one of the most deprived parts of my community. We also hope to be able to bring health care services, including GP surgeries, on to the same sites, but we are experiencing difficulty in unblocking funding via the NHS area team. Will the Secretary of State meet me to discuss this issue and how we might be able to move forward?
Jessica Lee (Erewash) (Con)
I thank my right hon. Friend the Secretary of State for his recent visit to Erewash. He has kindly offered to come back another time. We welcome the Prime Minister’s challenge fund being allocated to Erewash. May I reassure my right hon. Friend that our excellent GPs are working very hard to make sure that services and support are appropriately allocated in our community?
Mr Hunt
I thank my hon. Friend for her work to promote good health care in her area. I very much enjoyed meeting her local GPs. I was disappointed that it was only for about five minutes. I very much hope to go back and have a proper discussion. They were very enthusiastic about the Prime Minister’s challenge fund, and are making some very innovative changes.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
May I push the Secretary of State on this matter? What my constituents want is to be able to get to see a GP when they really need one; they do not want to turn up in A and E just because they cannot get an appointment for a week. Is not poor management of GP surgeries—poor management from top to bottom—at the heart of this problem?
Mr Hunt
Actually, I agree with the hon. Gentleman. I think that we do have a problem. We have some fantastically good GP surgeries and some brilliant GPs, but we have not in the past had structures in place to make sure that we deal quickly with underperforming GP surgeries and, indeed, underperforming GPs. We need to have much more transparency of data so that we can see where the problems are. We have introduced a rigorous new inspection regime, with a new chief inspector of general practice, and I hope that that will go some way to addressing the issues he raises.
Andy Burnham (Leigh) (Lab)
People ringing their surgery this morning only to be told that no appointments are available for days will be listening to the Secretary of State’s answers today and thinking that he is living in a different world. People’s real experience is that it is getting harder and harder to get a GP appointment under this Government, but for some it could get much worse. I recently visited a practice in east London that faces closure in October because of this Health Secretary’s changes to GP funding. NHS England says that 97 other practices are in the same position, affecting thousands of patients. Will he today give a guarantee that no practice will have to close?
Mr Hunt
Let us address this issue head on. The right hon. Gentleman knows perfectly well that it is totally wrong to have a system in which two neighbouring GP practices can be paid different sums of money for doing the same amount of work. We must have an equitable funding formula for GP practices, which is why we are phasing out the minimum practice income guarantee. That is a sensible decision. We are also taking measures to ensure that we do not affect patient care in the process. Of course we are looking at the individual cases carefully, but I am sure that he would agree that we have to fund GP practices equitably.
Graeme Morrice (Livingston) (Lab)
2. If he will commission a review of the safety of polypropylene transvaginal mesh implants.
Ms Margaret Ritchie (South Down) (SDLP)
5. If he will meet the chair of the College of Emergency Medicine to discuss A and E units.
The Secretary of State for Health (Mr Jeremy Hunt)
I met the chair of the College of Emergency Medicine four times in the last six months and I will meet him again next week.
Ms Ritchie
I thank the Secretary of State for his answer. Will he tell the House what progress has been made by Health Education England, along with the College of Emergency Medicine, to recruit trainee doctors from India in an attempt to address the serious staffing shortages in emergency medicines departments? Will he work with Ministers from other devolved regions to address the serious shortage in A and E doctors, which is having an impact on waiting lists in hospitals the length and breadth of the UK?
Mr Hunt
The hon. Lady is right that operational pressures on A and E are happening throughout the United Kingdom. We have made good progress in recruiting 50 A and E doctors to help relieve pressure this year in A and E departments, but that is a short-term measure. The long-term issue is to get more doctors going into A and E from training, and we are looking at contract structures and at what we can do with training schedules to make that more attractive. We will certainly work with colleagues in devolved Administrations and tell them what we have learned.
Chloe Smith (Norwich North) (Con)
I welcome the fact that waiting times have halved under this Government, but the Norwich walk-in centre should stay in its city centre location to continue to move people away from A and E when they do not need to go there. Will the Secretary of State meet me to discuss urgent and primary care provision in Norwich?
Mr Hunt
I would be delighted to meet my hon. Friend, and she is right to say that the long-term solution to pressures in A and E is to find alternatives in out-of-hospital care that are easy for people to find. That means improving GP access and any other alternatives, and I am sure we can find a good solution in Norwich.
Mrs Linda Riordan (Halifax) (Lab/Co-op)
There is not one person in my constituency who does not want to see the accident and emergency unit stay open. If this is made clear in any consultation, will the Secretary of State commit today to scrapping the callous closure proposals?
Mr Hunt
As the hon. Lady knows, local service changes are the responsibility of the local NHS, but when they get referred to me, through local authorities, I will never take a decision that is against the interests of patients, including her constituents. Were such a proposal to come to me, I would indeed listen to any representations that she makes.
David Tredinnick (Bosworth) (Con)
Does my right hon. Friend agree that a critical problem that A and E units will face in the future is antibiotic resistance? Is he aware that the Science and Technology Committee, of which I am a member, has been looking at this issue, and it also interests the Health Committee, of which I am also a member? Can he assure me that he is talking to the Prime Minister about how to stimulate new antibiotic research, and will he also remember that nature has its own remedies, such as tea tree oil?
Mr Hunt
My hon. Friend is right about the seriousness of the issue of antimicrobial resistance. Some 25,000 people die in Europe every year as a result of the failure of antibiotics—more than die in road traffic accidents. I raised the issue at the World Health Assembly and I have discussed it closely with the Prime Minister.
John Woodcock (Barrow and Furness) (Lab/Co-op)
The Health Secretary will be aware that the chair of Morecambe Bay trust has stood down today, ahead of what is expected to be another critical report from the Care Quality Commission about services. What guarantees can the Health Secretary give the worried people who are served by the Furness general hospital that its A and E department will be protected and the vital national industries that depend on its services will continue to be able to rely on them?
Mr Hunt
First, I thank the hon. Gentleman for the work that he does locally, in particular with people such as James Titcombe, who has campaigned extensively to improve the quality of care at Morecambe Bay. I assure the hon. Gentleman that whatever the problems are at Morecambe Bay, we will be transparent and open, and we will make sure that we deal with them promptly. That is why we have had these independent inquiries. We will look closely at what the report says and make sure that we act quickly.
Liz Kendall (Leicester West) (Lab)
The College of Emergency Medicine says that the use of agency doctors has become endemic in the NHS, and that hospitals are increasingly relying on more expensive agency nurses, just as Labour warned when jobs and training places were cut. It is clear that NHS finances are going backwards under this Government. Will the Minister now confirm Monitor’s latest figures, which show that annual spending on agency staff in foundation trusts has soared to £1.4 billion, a staggering 150% higher than trusts planned at the beginning of the year, and will he explain how that makes any financial sense?
Mr Hunt
Let us look at why the number of agency nurses has increased. It is because trusts have responded to the Francis report, published just over a year ago, and are seeking to end the shocking under-staffing of wards that was endemic under the last Labour Government. Of course we want people to recruit full-time nurses on proper contracts, and that is happening. That is why we have 3,000 more nurses—not agency nurses, but proper full-time nurses on proper NHS contracts—than when the hon. Lady’s Government were in power, and we will continue to make progress.
Mr Philip Hollobone (Kettering) (Con)
6. What recent assessment he has made of the performance of the A and E department at Kettering general hospital.
Mr Speaker
If the Secretary of State needs encouragement I am happy to give it to him.
Mr Hunt
I am most grateful for any encouragement I can get.
The NHS needs to change its culture to be much more open to whistleblowers. That is why we have banned gagging orders in contracts and funded a whistleblowing helpline and website, and why we are working with brave whistleblowers, such as Helene Donnelly from Mid Staffs, to reform the training of NHS clinicians to make it easier.
Michael Fabricant
I am grateful for that answer. About 10 years ago, two people, a nurse and a consultant surgeon from the same hospital, came to my surgery and showed me evidence of filth—mouse droppings—in even consulting rooms and the operating theatre. They were frightened to leave the documentation with me, because they thought they would be sacked if it was found that they were the whistleblowers. Will they now have the assurance that they could give me or others evidence without fear of retribution?
Mr Hunt
I hope so, but I want to be honest with the House. It takes time to change a culture, and that is the big change we have to make. Whistleblowers are now coming forward from Coventry, Cambridge, Ealing and all over the country. That is why I am afraid that I profoundly disagree with the shadow Health Secretary, who said that the lessons of the Francis report were about a local failure. This is about a systemic problem and we have to change it across the NHS.
Charlotte Leslie (Bristol North West) (Con)
Given there are so many emerging cases of whistleblowers—both current and historic—being treated with injustice, a precedent will not be set for accountability until these injustices are actually faced. Will the Secretary of State set up a truth and reconciliation committee to look at historic and current cases so that accountability becomes a reality?
Mr Hunt
First, I commend my hon. Friend for her campaigning on this issue in the House and on the Health Committee. We have not done everything we need to do to change the culture within the NHS, and we are looking at what more needs to be done to get a culture change profound enough to make it easier for people to speak out. This is not just about whistleblowing. If it is whistleblowing, we have failed because it means that someone has had to go to the press or outside their organisation when they were worried. We need an NHS where people within their own organisation are listened to when they have concerns, and we are looking at what we need to do to take that forward.
Mr John Baron (Basildon and Billericay) (Con)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
Almost a year ago, following the Keogh report, we put 11 NHS trusts into special measures, the first time such a large number of trusts have been put into special measures. Yesterday I was pleased to report to the House that the first trust, Basildon, has come out of special measures. I am pleased to tell the House today that across all the trusts in special measures, an additional 1,202 nurses and an additional 118 doctors have been recruited. The programme is making good progress, and the whole House will want to commend the efforts of all the staff in those hospitals on the tremendous efforts they are making.
Mr Baron
I join the Secretary of State in commending the management and all the staff of Basildon hospital for their excellent work and a great team effort. The hospital is now no doubt on an upward trajectory. I should like to raise with him the matter of the human papilloma virus vaccination programme for young women. It has been a success, and there is mounting evidence that is should be extended to young men. Will the Government now look into the feasibility of doing that?
Mr Hunt
My hon. Friend is right, and I am grateful to him for mentioning how proud we are of the HPV vaccination programme for girls and women. It is one of the best in the world, and we are getting an 86% take-up rate among eligible 12 to 13-year-old girls. He is also right to say that we now need to look at whether the programme should be extended to men and boys. A decision was taken at the time that it did not need to be, but we are now reviewing that decision. We will shortly be getting advice from the Joint Committee on Vaccination and Immunisation—which, as he will know, gives us independent advice on these matters—and we will take its advice seriously.
Andy Burnham (Leigh) (Lab)
I am sure that, like me, the Secretary of State will have been shocked to the core by the serious case review into the Orchid View care home. It spoke of institutionalised abuse and of residents dying of sheer neglect. This is just the latest case of appalling abuse in care homes, following that of Winterbourne View and the recent “Panorama” programme on Oban House. People are asking how many more times we must see abuse of this kind in our care homes before we take decisive action to stop it. Will the Secretary of State give serious consideration to the central finding of yesterday’s review, which was that the same principles of patient safety that apply in the NHS should now be applied to the care home sector?
Mr Hunt
I thank the right hon. Gentleman for that question. He is absolutely right to suggest that the lessons of Francis need to be applied to the care home sector, to general practice and to all out-of-hospital care every bit as much as they are applied to NHS hospitals. That is why we have legislated in the Care Act 2014 not only for a chief inspector of general practice but for a chief inspector of adult social care, Andrea Sutcliffe, who has made an excellent start. She is going around all the care homes, and she is bringing back the rigorous Ofsted-style analysis that was unfortunately taken away by the last Government. That will mean that we have proper transparency in standards. Going back to an earlier question from my hon. Friend the Member for Lichfield (Michael Fabricant), we also need to do more to help whistleblowers working in care homes. Because there are so many care homes, we cannot depend solely on the inspectors to get this right. We have also introduced the ability to prosecute offenders, which did not exist before.
Mr Nigel Evans (Ribble Valley) (Con)
T3. The fears of the people of the Ribble valley that the old Clitheroe hospital would be closed and not replaced were allayed when the new hospital was built. It recently opened with 32 in-patient beds, radiology, diagnostics and other facilities. Will the Secretary of State come to Clitheroe to have a look at this brand-spanking-new hospital, which is being welcomed by the local community, and to say thank you to the staff there for all they do? If he does so, I promise to take him for a pint of healthy real ale afterwards in the Campaign for Real Ale pub of the year in Pendleton in the Ribble valley, to celebrate the opening of the new hospital.
Mr Hunt
Well, I must say that that sounds like a pretty irresistible offer, and I will give it careful consideration. Local community hospitals have an important role to play in our NHS because of the high standard of compassionate care that they deliver, and because they are easy for relatives to get to. I am delighted to see my hon. Friend campaigning for his local hospital, and delighted that it is doing so well.
Steve McCabe (Birmingham, Selly Oak) (Lab)
T2. A Birmingham trust has recently announced that it will be possible to cut 1,000 beds across the city by setting a maximum stay of seven days for most patients. Not surprisingly, this has caused some alarm. Are Ministers aware of that proposal? What guidance, if any, can they offer in regard to such proposals?
Jesse Norman (Hereford and South Herefordshire) (Con)
T5. Like other rural communities, Herefordshire has long suffered from chronic underfunding in health care. Does the Secretary of State share my view that setting clinical commissioning group allocations should be an evidence-based process that takes into account factors including sparsity and old age? Also, will he ignore the calls from the shadow Health Secretary, who was seeking to cut the previous NHS allocations in areas such as Herefordshire?
Mr Jeremy Hunt
I agree with my hon. Friend that it has to be done on the basis of evidence. Part of that is an important change that the Government have made, which the Labour party criticised a great deal. We have depoliticised the process by giving it to NHS England, where it is decided at arm’s length from Ministers on the basis of need. It is challenging to do it fairly. There are some historical imbalances, and we have to do what we can to address them, but we have to do it in a way that is fair and is not tarnished by party politics.
Alex Cunningham (Stockton North) (Lab)
T4. Health inequality on Teesside is a major issue, but the Government axed plans for our new hospital four years ago. I am told that Ministers now accept that a new hospital to replace the two hospitals at North Tees and Hartlepool is the right way forward. When will they remove the barriers to the project and give the support that is needed?
Mr Andy Slaughter (Hammersmith) (Lab)
T10. Last October the Secretary of State said that Hammersmith accident and emergency would be closed when it was safe to do so. Imperial proposes to close it on 10 September, when on its own admission there is insufficient capacity at St Mary’s and it is not safe to do so. Will he keep his promise and ensure that Hammersmith A and E does not close, especially when there is not sufficient capacity in the system?
Mr Jeremy Hunt
I keep my promises, but may I point out to the hon. Gentleman that the way in which he has campaigned on those issues has been totally irresponsible? He put out leaflets in the local election campaign saying that Charing Cross hospital would be demolished. He failed to mention that it was going to be rebuilt as a brand-new hospital with an A and E department. I hope that he will not be invited to it when it is reopened unless he apologises to his constituents for the way he has presented this issue.
David Rutley (Macclesfield) (Con)
T8. Following the recent speech by the new NHS England chief executive Simon Stevens about the important role of local hospitals, can my right hon. Friend confirm that district general hospitals such as Macclesfield will continue to play a vital role in delivering local health services in the years to come?
Mr Jeremy Hunt
I can confirm that. What my hon. Friend said was profoundly important. There is not an automatic link between size and quality. We know that for certain types of treatment, there is huge benefit in centralising services, as has happened for stroke services in London, but other services can be delivered extremely well at smaller units, and we will continue to support those.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Minister has just talked rather piously about spending NHS money on front-line services, but the NHS is spending £300,000 on a university secondment for a staff member who has left. How does he justify that sort of abuse?
Ian Swales (Redcar) (LD)
T9. My constituent, Beth Charlton, recently lost her father to pancreatic cancer and notes that patients have only a 3% chance of surviving five years. That is much lower than the survival rates for other cancers and has not improved in 40 years. Will the Minister invest more in early detection and diagnosis of this silent killer?
Mr Dennis Skinner (Bolsover) (Lab)
In the last hour I have heard the Secretary of State and his Ministers complain about the problems with A and Es; I have heard them talk about the problems with GPs; now we hear that they have lost control of care of the elderly. Instead of continuing to blame the last Labour Government of four years ago, why does the right hon. Gentleman not admit that the NHS is not safe in his hands? Let us have an election and get a Labour Government.
Mr Jeremy Hunt
Because we are making the NHS safe. We are taking action to deal with the issues that the hon. Gentleman’s Government swept under the carpet. The NHS is getting safer and more compassionate. It is delivering more care to more people than ever happened under the Labour Government. We are proud of our record on the NHS, and we will not make the NHS better by pretending that problems do not exist when they do.
Sir Andrew Stunell (Hazel Grove) (LD)
Stockport Mind reports that it takes on average 12 months to receive the first appointment for cognitive behavioural therapy after diagnosis. What action can be taken to improve that standard in Greater Manchester?
Charlotte Leslie (Bristol North West) (Con)
As he heralds an era of transparency, can the Secretary of State update us on what steps he has taken to ensure that private providers in the NHS are every bit as transparent and accountable as public ones?
Mr Jeremy Hunt
I think they absolutely should be, and the changes that we introduced in the Care Act 2014 relating to the transparency of the inspection regimes apply to private providers supplying services to the NHS just as they do to NHS providers. Let us be absolutely clear: poor care is poor, whether it happens in the public sector or the private sector, and we must clamp down on it wherever it happens.
Bill Esterson (Sefton Central) (Lab)
The Minister said that he was dealing with the chronic shortage of staff who help vulnerable children and young people, who cannot get access to mental health services. Will he tell us when there will be enough staff delivering those services to that important group?
Health
Jeremy Hunt Excerpts(9 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
The legislative programme presented to Parliament last week by Her Majesty the Queen builds on four years in which we have not shirked our duty to the British people to restore confidence in disastrous public finances; to lead the country from the deepest recession since the second world war to the strongest growth in the G7; and to implement a plan that secures our long-term economic future. As part of that programme, we have been following a long-term plan to transform our NHS and help it to meet the challenges of an ageing population. However, we must remember that without the difficult decisions made to restore faith in our public finances, the NHS would have been in a very different position.
In Ireland, the health pay bill was slashed by 16% because it ran out of money. In Greece, health spending was cut by 20%. In Portugal, the public were asked to double their personal contribution to the cost of health care, but in England difficult decisions meant that we were able to protect the NHS budget, unlike the Labour party, which plans to cut it in England, and did indeed cut it by 8% in Wales, with disastrous consequences. Labour made the wrong call on the economy and the wrong call on NHS finances. Because we made the right call, the NHS is now doing extremely well in very challenging circumstances.
Later, Members will hear the right hon. Member for Leigh (Andy Burnham) talk about operational pressures facing the NHS. He is right: it is tough out there. This week, we will announce new measures to help the service to meet the challenges that it faces. We will no doubt also hear attempts to politicise what are essentially operational pressures, but what we will not hear is how much better the NHS is doing than it ever did when he was Health Secretary. The facts speak for themselves. Every single day—[Interruption.] This is difficult for Labour Members to listen to, but they would do well to listen. Compared with when he was Health Secretary, every single day we are referring 1,000 more people with suspected cancers to specialists. We are transporting 1,000 more patients—
Mr Hunt
I am going to make some progress and then give way. The right hon. Gentleman needs to listen. We are doing much more now compared with what was done when he was Health Secretary. If he listens, he might learn something.
This is what is happening every single day: 1,000 people with suspected cancers are being referred, and 1,000 more patients are being transported in ambulances in emergencies. Every day we are performing 2,000 more badly needed operations, we are seeing 3,000 more vulnerable people in A and E departments, and every day we are providing around 6,000 more GP consultations for members of the public and 10,000 more vital diagnostic tests. At the same time, MRSA rates have almost halved, mixed-sex wards have been virtually eliminated, and fewer people are waiting for 18 or more weeks for their operation.
Andy Burnham
The Health Secretary is standing there claiming everything is fine and giving a litany of successes. Let us just consider cancer care. He said the NHS was worse when we were in government. So that we are absolutely clear, will he confirm that the last set of figures show that the NHS is now for the first time missing its standard of treating cancer patients within 62 days?
Mr Hunt
The right hon. Gentleman should have listened to what I said: I said he was right to say it is tough out there, and I also said that this week we will be announcing measures to help the NHS deal with operational pressures. He talks about how long people are waiting for operations, so let us look at one particular statistic that sums up what I am saying: the number of people waiting not 18 weeks but a whole year for a vital operation. Shockingly, when the right hon. Gentleman was Health Secretary, nearly 18,500 people were waiting over a year, and I am proud that we have reduced that to just 500 people. Those results would not be possible without the hard work and dedication of front-line NHS staff, and whatever the political disagreements today, the whole House will want to pay tribute to their magnificent efforts.
Mr Andy Slaughter (Hammersmith) (Lab)
Will the Health Secretary comment on the shambles he has reduced the NHS to in west London, where he is closing A and E departments, like that at Hammersmith on 10 September, while there are inadequate numbers of beds at the only hospital people have been directed to? It means that there is no acute care, and primary care is in such a state that there is an emergency in-year redistribution of money across north-west London. How is he going to sort that out?
Mr Hunt
What is happening in north-west London is going to make patient care better. It involves the seven-day opening of GP surgeries, over 800 more professionals being employed in out-of-hospital care, and brand new hospitals. That is a huge step forward, and the hon. Gentleman is fighting a lone battle in trying to persuade his constituents that it is a step backwards.
This Government recognise the pressure that the NHS is under, as I was telling the shadow Health Secretary. The fact that the population is ageing means that the NHS now needs to perform 850,000 more operations every year than when he was in office, which we are doing. That means that some patients are not receiving their treatment as quickly as we would like, so NHS England is this week announcing programmes to address that, ensuring that we maintain performance while supporting the patients waiting longest for their treatment, something that did not happen when he was in office. We will not allow a return to the bad old days when patients lingered for years on waiting lists because once they had missed their 18-week target, there was no incentive for trusts to treat them.
A and Es, too, are facing pressure and are seeing over 40,000 more patients on average every week than in 2009-10. NHS staff are working incredibly hard to see and treat these patients within four hours, and it is a tribute to them that the median wait for an initial assessment is only 30 minutes under this Government, down from 77 minutes under the last Government. However, as we did last year, we will continue to support trusts to do even better both by improving their internal processes and working with local health economies to reduce the need for emergency admissions. This will be led by NHS England, Monitor and the NHS Trust Development Authority.
David T. C. Davies (Monmouth) (Con)
We have heard some comments from Opposition Members about waiting times. My right hon. Friend will be aware that fewer than 2% of patients in England wait for more than six weeks for diagnostic treatment, but is he aware that the figure is 42% of patients in the Labour-run NHS in Wales?
Mr Hunt
I am aware of those shocking figures, and I am also aware that the Royal College of Surgeons says that 152 people died on waiting lists in Wales at just two hospitals because they did not get their treatment in time. I gently suggest to the shadow Health Secretary that the Labour party might want to fix what is going on in Wales if it is really serious about patient care, because how Labour is running the NHS in Wales is an absolute disgrace.
Mr Hunt
I am going to make some progress, and then I will give way.
The NHS is about more than just getting through difficult winters. Looking to the future, this Government will continue to take the bold steps necessary to prepare our NHS for the long-term challenges it faces. There are two key areas for action if we are to rise to this enormous challenge. First, we must never turn the clock back on Francis. The NHS will never live up to its founding ideals if it tolerates poor or unsafe care. The last Government presided over an NHS in which doctors or nurses who spoke out were bullied, in which problems at failing hospitals were brushed under the carpet and in which vulnerable older people were ignored and, tragically, on occasions, treated with contempt and cruelty. This Government have stood up for the patient, championing high standards with a new culture of compassionate care which is now transforming our health and care system.
Alex Cunningham (Stockton North) (Lab)
The Secretary of State has already admitted some of his own failures this afternoon. Does he not think that some of the money he invested in his £3 billion reorganisation of the national health service could have been used to ensure that the NHS was hitting its targets today?
Mr Hunt
Perhaps the hon. Gentleman would like to look at the facts relating to the actual cost of the reorganisation. The net saving as a result of it has been more than £1 billion a year, and we are now employing 7,000 more doctors and 3,000 more nurses than when his party was in office. Last year, as a result of this programme—
Mr Hunt
This might not be something the Opposition agree with, but they should listen. I need to tell the House that we have put 10% of all acute trusts into special measures, and that in each and every one of them the warning signs were there under the last Government. The George Eliot hospital, for example, had one of the worst mortality rates in the country back in 2005. Tameside had to pay £9 million compensation for mistakes in just two years, and at the Queen’s hospital in Romford in 2006, a lady gave birth in a toilet, leading to the tragic death of her child.
Mr Brian H. Donohoe (Central Ayrshire) (Lab)
The Secretary of State will be aware of a problem that is affecting thousands of women. It relates to medical implant devices that a court in America has banned. What is he prepared to do to deal with the situation in this country that is affecting thousands of women, both north and south of the border?
Mr Hunt
The hon. Gentleman mentioned to me earlier that he was going to raise that point. I will look closely at the issue, as it sounds like an extremely important one.
I want to look at what has changed under this Government. One of the trusts that has been in special measures is the Basildon and Thurrock University Hospitals NHS Foundation Trust. When the right hon. Member for Leigh was in office, inspectors at the hospital found blood stains on floors and curtains, blood spattered on trays used to carry equipment, and badly soiled mattresses. When the Care Quality Commission published those findings, it was allegedly leant on to tone down its press release. This Government put Basildon into special measures, and it now has 183 more nursing staff. I asked one of those nurses what the difference was. She said:
“It’s very simple. When we raised a concern before, they weren’t interested. Now, they listen to us.”
It gives me great pleasure to inform the House that the chief inspector of hospitals has today recommended that Basildon should be the first trust to exit special measures, and that Monitor has ratified that decision. The hospital has received an overall rating of “good” and has been praised for its excellent leadership. The chief inspector found that the trust had made significant improvements in a number of areas, including maternity services, which were rated as “outstanding”—[Interruption.] The Opposition might not care about what is happening at a trust in special measures, but we on this side of the House do.
Mike Gapes
On a point of order, Mr Speaker. The Secretary of State knows very well the issue I am trying to raise, because I raised it during the business statement last week. I want him to respond to an important fact. A leaflet was circulated in my borough on 20 May, two days before polling day. It was quoted in the local papers, and it related to the A and E department at King George hospital in my constituency. I simply want to ask him to confirm whether the announcement from the Secretary of State for Health referred to in the leaflet was made with his authority, or by him, during the week before polling day.
Mr Speaker
The hon. Gentleman is an ingenious and indefatigable Member. He probably knows that I can best describe that as an attempted point of order, because it is not a matter for the Chair. That said—[Interruption.] Order. That said, the hon. Gentleman has made his point forcefully, and it would certainly not be in any way disorderly for the Secretary of State to respond to it if he wished to do so.
Mr Hunt
I am most happy to respond to what—I agree with you, Mr Speaker—is a thinly disguised point of order. I will happily say this: what I said was completely in order because I was simply restating information publicly available on the trust’s website.
I want to go back to talk about Basildon hospital, because of the remarkable turnaround there. Chief executive, Clare Panniker, and her team deserve huge credit for the changes that they have made, which will truly turn a corner for patients who depend on their services.
Mr Speaker
As I said, they are coming up very soon, and I am grateful to the hon. Member for Weston-super-Mare (John Penrose) for concurring with my suggestion that “very soon” does indeed include tomorrow. There will also be opportunities at all times for the hon. Member for Ilford South (Mike Gapes) to table questions with the advice of the Table Office. I have known him for 20 years and more, and he is not very readily put off his stride. I have no doubt that he will continue to gnaw at the bone until he achieves an outcome that he regards as satisfactory. Meanwhile, we must continue with the debate and the oration of the Secretary of State.
Mr Hunt
The decision to place 11 trusts into special measures last summer was not taken lightly, but we can see today that it was the right decision. Across the whole NHS, the number of people who think they would be safe in an NHS hospital is as high as it has ever been, the number of people who think that people are treated with dignity and respect has risen by six percentage points over the year and the number of people who think that people are treated with compassion has gone up by eight percentage points. This Government have introduced new chief inspectors of hospitals, general practice and adult social care to oversee the toughest, most transparent and most independent rating system of any country anywhere. We have improved accountability with a statutory duty of candour, and we are supporting staff by publishing ward-level nurse staffing levels for every trust.
Jackie Doyle-Price
I thank my right hon. Friend for giving way. I am sorry that his congratulations to Basildon hospital were so dreadfully interrupted earlier, because its journey since 2009, when real deficiencies were highlighted, to where we are now with the special measures being lifted is, as he has said, real testament to the leadership of the hospital’s new management and the commitment of the staff. I thank him for the impetus that he has given that process, because it is only by admitting when things go wrong that we can put them right; that is the difference between the Government and the Opposition.
Mr Hunt
I congratulate my hon. Friend for her work campaigning for higher standards at her local hospital, and I agree with her. Why is it that interventions to do with improving safety and compassionate care are coming only from Government Members and that the Opposition are not interested? I just challenge Labour Members on whether they are really on the right side of the big changes that need to happen in our NHS.
Mr Speaker
Order. There is now a kind of institutionalised rowdiness about this debate, epitomised by the hon. Member for Swansea West (Geraint Davies) on the third row. It would be seemly if he would calm himself. I do not refer to people outside this place, but this debate is being keenly attended by a large number of citizens, who would expect Members to behave in as seemly a fashion as I feel sure they do on a day-to-day basis.
Mr Hunt
Despite the amount of work that has been done in the past year, there is still much to do to improve safety and care. According to a study based on case note reviews, around 5% of hospital deaths are avoidable. That equates to 12,000 avoidable deaths in our NHS every year, or a jumbo jet crashing out of the sky every fortnight. On top of that, every two weeks, the wrong prosthesis is put on to a patient somewhere in the NHS. Every week, there is an operation on the wrong part of someone’s body. Twice a week, a foreign object is left in someone’s body. Last spring, at one hospital, a woman’s fallopian tube was removed instead of her appendix. Last summer, the wrong toes were amputated from a patient. This spring, a vasectomy was given to the wrong man. To tackle such issues, we need to make it much easier for NHS staff to speak out when they have concerns. We need to back staff who want to do the right thing, and we are currently looking at what further measures may be necessary to achieve that.
Today, this Government vow never to turn back the clock on the Francis reforms, and I urge the shadow Health Secretary to do likewise when he stands up. Another vital set of reforms that we need to make if we are to prepare the NHS for the future involves the total transformation of out-of-hospital care. We know that prevention is better than cure and that growing numbers of older people, especially those with challenging conditions such as dementia, could be better supported and looked after at home in a way that would reduce their need for much avoidable and expensive care. This year, three important steps have been taken towards that vital goal. First, the new GP contract brought back named GPs for the over-75s—something that was so shamefully abolished by Labour in 2004. Older people often have chronic conditions that make continuity of care particularly important. However, Labour scrapped named doctors, and we are bringing them back.
We are also acting to break down the silos between the health and social care systems with an ambitious £3.8 billion merger between the two systems. The better care programme is, for the first time, seeing joint commissioning of health and social care by the NHS and local authorities, seven-day working across both systems and electronic record sharing, so that patients do not have to repeat their story time after time and medication errors are avoided.
Barbara Keeley
The Secretary of State touches on a couple of issues, including safety, but ignores one of the most important ones, which is nurse-to-patient ratios. A safe patient-to-nurse ratio has been adopted at Salford Royal, and it could be adopted elsewhere. He is now talking about the better care fund. There is no new money in that fund, and if he is worried about pressure on the NHS, surely he should think about the £2.68 billion that is being taken out of adult social care. In my local authority of Salford this year, 1,000 people will lose their care packages. How is that good for alleviating pressures on the NHS?
Mr Hunt
Perhaps I can reassure the hon. Lady on those matters. First, the better care fund is the first serious attempt by any Government to integrate the health and social care systems and eliminate the waste caused by the duplication of people operating in different silos. The Government require all trusts to publish nurse-staffing ratios on a website that will go live this month. It is an important, radical change, and we are encouraging trusts to do exactly what she says is happening in Salford. It is important to say that, where other Governments have talked about integration, we are delivering it. We are doing one more important reform: we are taking the first steps to turn the 211 clinical commissioning groups into accountable care organisations with responsibility for building care around individual patients and not just buying care by volume.
From next year, CCGs will have the ability to co-commission primary care alongside the secondary and community care they already commission. When combined with the joint commissioning of social care through the better care fund, we will have, for the first time in this country, one local organisation responsible for commissioning nearly all care, following best practice seen in other parts of the world, whether Ribera Salud Grupo in Spain, or Kaiser Permanente and Group Health in the US—[Interruption.]
Mr Speaker
Order. I say to the hon. Member for Rhondda (Chris Bryant), who has just published an extremely cerebral tome on the history of Parliament, that he should not be yelling and exhorting from a sedentary position as though he is trying to encourage a horse to gallop faster. It is not an appropriate way to behave.
Mr Speaker
Interventions should be brief—the hon. Gentleman is experienced enough to know that.
Mr Hunt
I agree with the new chief executive of NHS England. There is an incredibly important role for community hospitals and, indeed, for smaller hospitals. He was making the point that it is not always the largest hospitals that have the highest standards. One reason why the public like smaller hospitals is that they are more personal, and very often the doctors and nurses know people’s names, which makes a difference. They are also closer to people’s homes and easier to get to for relatives wishing to visit people in hospital.
Mr Hunt
I am drawing to a close, so I shall continue by saying that a long-term plan for our NHS that recognises immediate challenges and the need to reform going forward is what the Government have put into practice. It is not easy to implement, but it is the right thing to secure its future, and the right thing for our country. When the right hon. Member for Leigh rises to speak in a moment, he will say—he told The Independent that he would—that the NHS should have been included in the Queen’s Speech, ignoring the Bill to introduce additional child-care subsidies that will benefit thousands of NHS employees and ignoring the impact on NHS finances of the Bill to curb excessive redundancy payments—something for which his Government were largely responsible. He will not mention the straightforward security that the Government offer the NHS by sticking to a long-term economic plan that is working, so that we have the best possible chance to ensure that the NHS can be properly funded going forward.
If the right hon. Gentleman does not address those points, I hope that he will use his speech to show that he has learned from some of the big challenges facing the NHS over recent years. Does he accept that, without the reorganisation of about 20,000 administrators, the NHS would not be able to afford 7,000 more doctors and 3,000 more nurses? Does he accept that, without restoring named GPs, we will not be able to offer the joined-up care to vulnerable older people that he claims to champion? Most importantly, will he say publicly that, without honesty about poor care—honesty that he has repeatedly criticised as running down the NHS—we would not now be turning round 15 failing hospitals such as Basildon? In that spirit, will he categorically retract his statement, as reported in the Health Service Journal last week, that Mid Staffs was a local failure whose significance for the NHS has been exaggerated by this Government? If he does not do so, I have to say that we disagree profoundly on the biggest change that our NHS needs. We can state that change in just three words: put patients first. It is what NHS staff want to do, and they all want support to do it, but it is simply not possible unless they have the administrative and political leadership that puts patients first in every policy, target and announcement. The Government are proud of our record on the NHS: proud of record levels of high-quality care given to record numbers of patients, proud of tough economic choices that enabled us to protect the NHS budget and, most of all, proud of 1.3 million NHS staff who work hard day in, day out, to make our NHS so remarkable. We will not let them or the country down.
Andy Burnham (Leigh) (Lab)
Last week, the Secretary of State told the NHS Confederation that patient safety was crucial to the future sustainability of the NHS. Let me begin on a note of agreement. The Health Secretary is right to continue to send the clearest message to the NHS that patient safety must be its top priority. He knows that he has our support in introducing measures to implement the Francis report and, indeed, learning all the lessons from the terrible failings at Stafford hospital. A question arises that is perhaps more for the Government to answer than the right hon. Gentleman: why is the Secretary of State’s important priority not reflected in the Gracious Speech? It is approaching 18 months since the publication of the Francis report, yet many of its recommendations are still to be implemented. The failure to make progress in this legislative programme undermines the Secretary of State’s message today.
The Francis report recommended new legislation to modernise the regulation of doctors and nurses and speed up the handling of complaints. The regulatory bodies said that progress is urgently needed, and they were expecting a Bill in the Gracious Speech to implement those reforms. Not surprisingly, both reacted negatively to the decision to drop it. Niall Dickson, chief executive and registrar of the General Medical Council, said:
“We are disappointed that the government has not taken this opportunity to improve patient safety”,
and Jackie Smith, chief executive and registrar of the Nursing and Midwifery Council, said:
“Both the NMC and the public it protects now continue to be left, indefinitely, with a framework that does not best serve to protect the public.”
I hope the Secretary of State will explain why that Bill was dropped and answer the concerns of Jackie Smith and Niall Dickson.
Mr Hunt
The right hon. Gentleman said he would start on a note of consensus on the Francis report, so does he now retract his comments last week that what happened at Mid Staffs was “a local failure” and that the Government were exaggerating its significance for the rest of the NHS? That was a very damaging thing to have said.
Andy Burnham
The Francis report found that the failing at Stafford hospital was principally a failure of the local board. I served in the previous Government, who inherited problems from the preceding one—care failings at Bristol royal infirmary and Alder Hey, and the Shipman murders. Contrary to what the Secretary of State said today, we acted on those failures to bring more transparency to the NHS. We introduced independent regulation to the NHS. He needs to look at the statements that he has made over the past year and consider whether his response has always been appropriate. He has used language such as
“Cruelty became normal in our NHS”—[Official Report, 19 November 2013; Vol. 570, c. 1097.]
Does he stand by such statements and does he think that is fair to the thousands of NHS staff who give their all every day, doing their best to serve patients?
Andy Burnham
I will give way to the right hon. Gentleman once more, but he needs to answer those concerns of staff, who feel that he has been running down the NHS.
Mr Hunt
Let me be absolutely clear. I have never blamed NHS staff for what happened at Mid Staffs. I blame the policy failures of the right hon. Gentleman’s Government. It is not just I who say so. Robert Francis said in his report:
“Stafford was not an event of such rarity or improbability that it would be safe to assume that it has not been and will not be repeated”
in the rest of the NHS. He continued:
“The consequences for patients are such that it would be quite wrong to use a belief that it was unique or very rare to justify inaction.”
Will the right hon. Gentleman now retract his comment that this was “a local failure” whose impact has been exaggerated?
Andy Burnham
I am quite clear in what I said. I said that the finding of the Francis report was that it was a local failure, but of course there were lessons to be learned. That is why I brought in Robert Francis in the first place to begin inquiries at Stafford. The claim that we just brushed everything under the carpet could not be more wrong. The Secretary of State needs to drop it and start dealing responsibly with these issues.
The right hon. Gentleman wanted to distract the House from what I was saying—that a Bill should have been brought forward in this Gracious Speech to modernise professional regulation in the NHS. I quoted strong sentiments from Niall Dickson and Jackie Smith. There was no room for such a Bill, but it is hard to find measures in the rest of the Gracious Speech that may be considered more important than that Bill. The Speech found space, for instance, for measures on pubs and plastic bags, but not on patient safety. There was a time when the Prime Minister used to say that his priorities could be summed up in three letters—NHS. Not any more. Those letters did not appear in the Gracious Speech and received only a cursory mention when the Prime Minister addressed this House.
So what explains the relegation of health down the Government’s list of priorities? One commentator writing last Thursday offered an explanation. He said that
“there was no mention of the health service in the Queen’s Speech. Indeed, the Tories have had little to say on the subject at all recently.
I’m told that there is a precise reason for this: Lynton Crosby has ordered them not to.”
I do not know whether that is true, but it does not look good, does it? It creates the clear impression that the shape of the Gracious Speech had more to do with the political interests of the Conservative party than the public interest of the country.
Oral Answers to Questions
Jeremy Hunt Excerpts(10 years, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Andrew Selous (South West Bedfordshire) (Con)
1. What steps he is taking to improve compassionate care in the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
The Government have made it a key priority to restore a culture of compassionate care throughout our NHS. Ten thousand nurses and midwives will have taken part in a new leadership programme that champions patient-focused compassionate care. Pilots are testing whether all nurses should spend time on the wards prior to a nursing degree.
Andrew Selous
Will the Secretary of State join me in congratulating NHS staff, who are shifting the priorities of the NHS culture towards compassionate care and away from a tick-box culture? Does he agree with Robert Francis, who says that compassionate care very often saves money?
Mr Hunt
My hon. Friend is absolutely right. Last week I was in one of the safest hospitals in the world, Virginia Mason hospital in Seattle, which has cut litigation claims by three quarters since it introduced safer care. We have fantastic hospitals in this country too, such as Salford Royal. The truth is that safer care is better value for money: it means that more money can be spent on the front line, not on litigation.
Grahame M. Morris (Easington) (Lab)
The Secretary of State is not showing much compassion towards hard-working NHS staff, who have a 1% pay rise. One year on from the top-down reforms, what does he think of the survey showing that 69% of front-line staff think his reforms are damaging patient care?
Mr Hunt
The most damaging thing for patient care would be a pay award, which the hon. Gentleman sounds like his is supporting, that would mean the potential loss of 6,000 nursing jobs from our front line. That would be incredibly bad for patients and incredibly bad for nurses. All nurses are getting a minimum 1% rise. That is the right thing to do. That is supported by the shadow Chancellor but not, apparently, by the shadow Health Secretary.
Nadhim Zahawi (Stratford-on-Avon) (Con)
20. In a report published by the King’s Fund last month, South Warwickshire NHS Foundation Trust was highlighted as a leading example of compassionate care for the frail elderly. Will the Secretary of State join me in congratulating the trust’s staff on the move away from tick-box targets, and visit the trust to see this new emergency care model in practice?
Mr Hunt
I much enjoyed a recent dinner where I had the chance to meet a consultant from South Warwickshire NHS Foundation Trust. One of the discussions I remember having with him was how inside the NHS the definition of success for a hospital was in the past too narrowly focused on targets and financial balance, and not enough on patient safety, compassionate care and clinical outcomes. He, and many other people in the NHS, welcome the change that this Government have made in the past year to change that balance.
Helen Jones (Warrington North) (Lab)
Does the Secretary of State agree that compassionate care begins with being able to see a GP? In areas such as mine, GP appointments are increasingly hard to get. In fact, one practice has had its contract rescinded because of its failures. Does he now regret scrapping the target allowing patients to see a GP within 48 hours?
Mr Hunt
I am interested and rather astonished that the hon. Lady dares to mention the words “GP” and “contract” in the same sentence. It was Labour’s GP contract changes in 2004 that made it disastrously more difficult for people to see their GP and destroyed the link between patients and doctors by getting rid of named GPs. She will be pleased to know that from today we are reintroducing named GPs for the over-75s, which is big step forward in making it easier for people to see their GP.
Andrew George (St Ives) (LD)
Although the Secretary of State says that he is getting rid of tick-box targets, new targets are being introduced, including hourly ward rounding for nurses and the introduction of a requirement for nurses to undertake a year as a care assistant. Would it not be better to depend on the professionalism of the nursing profession?
Mr Hunt
That is exactly what we are doing. There is no target to introduce hourly rounding, but there is very good evidence from the hospitals that have it, such as Salford Royal, that it results in the buzzer going off less often, calmer wards and problems being nipped in the bud. People are given food and water before they feel the need to ask for it and we end up with much better and safer care. That is something the hon. Gentleman should welcome. We certainly want to work with the nursing profession to ensure we deliver that.
Mr David Crausby (Bolton North East) (Lab)
2. What his most recent estimate is of the cost to the public purse of reorganisation in the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
According to official figures, the new structure set up by the Health and Social Care Act 2012 will save £5.5 billion in this Parliament and £1.5 billion every year after that, all of which will be reinvested in front-line care.
Mr Crausby
Given that he promised in 2010 that there would be no top-down reorganisation of the NHS, how can the Secretary of State justify spending billions of pounds on top-down reorganisation on the day on which Simon Stevens, the new chief executive of NHS England, has warned that the NHS is facing the biggest
“budget crunch in its 66-year history”?
Mr Hunt
As Simon Stevens is starting today, I think that this is a good moment to welcome him to his post. He is an outstanding individual, and I know that we all wish him well in what will be a challenging but incredibly important job.
As for the reorganisation, the official figures make it clear that it is saving more than £1 billion every year during the present Parliament—money that is being reinvested in the provision of 1,600 more nurses, 1,700 more midwives, 1,800 more health visitors and nearly 8,000 more doctors than we had under Labour. I am afraid that that shows that Labour has not learned the lessons of Mid Staffs. Labour Members still want to turn the clock back and spend all that money on administration.
Mr Simon Burns (Chelmsford) (Con)
Does my right hon. Friend agree that savings that have been made through greater effectiveness and efficiency, and that can be ploughed back into patient care, should be warmly welcomed? Does he not think that such action is far preferable to the bizarre suggestion by a former Labour Health Minister that people should be charged £10 a month to visit their GPs, which would compromise Nye Bevan’s founding principle of a free health service?
Mr Hunt
I do think that that is a bizarre suggestion. Given our ageing population, we need to make it easier rather than harder for people to see their GPs. I also think it bizarre of the Opposition to set their face against the reforms that my right hon. Friend helped to pilot through the House. Because money has gone to the front line, 800,000 more operations are being performed in the NHS year in, year out than were performed under Labour. We are putting money where it is needed, with doctors and nurses.
David Wright (Telford) (Lab)
Will the Secretary of State give us more details about the amount of money that was spent on consultants during the top-down reorganisation? Would that money not have been better spent on nursing?
Mr Hunt
I will happily give the hon. Gentleman the figures, but if he is shocked by the amount that was spent on consultancy, he will be even more horrified to learn that it was vastly greater under the last Labour Government. We are paring that down precisely because we want money to be spent on the front line.
Caroline Dinenage (Gosport) (Con)
Does the Secretary of State share my hope that the Government’s joint commitment to increasing NHS spending and dealing with the legacy of private finance initiative debt will help areas such as Gosport, which is living under the umbrella of a huge PFI hospital that was approved under the last Government and is sucking up most of the NHS budget?
Mr Hunt
PFI debt is costing the NHS more than £1 billion every year. In some cases that money was well spent, but it was often very poorly spent. My hon. Friend is absolutely right: we want the money to be spent on front-line care, which is why we have drawn a line under the appalling deals negotiated by the last Government. We are spending money where it should be spent, in order to help patients.
Andy Burnham (Leigh) (Lab)
It is a year to the day since the Government’s reorganisation took effect, and now that the dust has settled, we can see the full scale of its folly. There are 163 more NHS organisations than there were before, four times more managers are being paid the very highest salaries than the Government planned for, and 4,000 staff received redundancy payments only to be rehired by the new organisations that the Government had created. Is not the reason why the NHS is the only public service that cannot honour a 1% pay increase for its hard-working staff the fact that these Ministers lost control of their own reorganisation, and it has now wasted billions of pounds?
Mr Hunt
I think that the right hon. Gentleman needs to look at the figures. The reorganisation, which he opposed through thick and thin, means that the NHS is spending less on administration and bureaucracy. If he questions that, may I ask how he thinks we found the money to pay for 8,000 more doctors and 15,000 more clinicians, if it was not by getting rid of primary care trusts and strategic health authorities? That is why there are now 2.5 million more diagnostic tests and 4 million more out-patient appointments every year. We are doing more for patients than was ever done when the right hon. Gentleman was Secretary of State.
Andy Burnham
I know that it is April fool’s day, and the Secretary of State certainly seems to be getting into the spirit of it with that answer, but his fantasy figures will be laughed at by anyone who works in the NHS. It is not just in relation to bureaucracy that the Government have broken promises. They said that the reorganisation would improve patient care, but 70% of NHS staff say that it has got worse. The first full year of the reorganised NHS has been the worst year for a decade in A and E. It is harder to get a GP appointment than it was before, and cancer patients are waiting longer to start treatment. Is it not now clear that the Government’s reorganisation has been a disaster on every level for patients and taxpayers who never voted for it, and who were promised that it would never happen?
Mr Hunt
I will tell the right hon. Gentleman what is not an April fool—the appalling care at Mid Staffs on his watch. If he is talking about how the NHS is doing, perhaps, for once, Labour Members should look at what patients are saying. I know that it is difficult, but if we look at what patients say, we see that since the election, there has been a 5% increase in those who think that their NHS care is safe, and a 10% increase in those who think that they will be treated with dignity and respect in the NHS under the coalition. We are proud of that, because we are putting patients before politics, which the right hon. Gentleman never does.
Mr John Spellar (Warley) (Lab)
3. How many staff have been made redundant and subsequently re-employed by NHS organisations since May 2010.
Karen Lumley (Redditch) (Con)
5. What progress he has made on improving out-of-hospital care for frail elderly people.
The Secretary of State for Health (Mr Jeremy Hunt)
Under the new GP contract, which starts today, we will ensure progressively that everyone over the age of 75 has a named GP responsible for delivering proactive care for our most vulnerable older citizens. The new contract will help to restore the personal relationship between doctor and patient that was destroyed in 2004 when named GPs were abolished.
Karen Lumley
Will my right hon. Friend congratulate Worcestershire Acute Hospitals NHS Trust, which has used some of its winter pressure money this year to buy beds in a nursing home in order to free up much-needed hospital beds? Does he agree that that model enables elderly people to be cared for in their community when they no longer need urgent treatment?
Mr Hunt
I am happy to congratulate the trust on its excellent work. It is worth reflecting on how well the NHS did this winter. Despite constant attempts by the Opposition to talk up a crisis, we hit the target for A and E in more weeks than was the case when the right hon. Member for Leigh (Andy Burnham) was in office, and 2,000 additional people were seen within four hours every single day.
Derek Twigg (Halton) (Lab)
Part of the problem with people being admitted and readmitted to hospitals involves access to their GPs. What is the Secretary of State doing to ensure that elderly people across the board have access to their GP, so as to prevent their admission or readmission to hospital?
Mr Hunt
The hon. Gentleman is absolutely right. If we are going to deal with the pressures in A and E, we need to have a massive improvement in primary care access. There has been historical under-investment in primary care, going back over many years, and we need to change that. One of the ways in which we want to do that is to reintroduce GPs taking personal responsibility for the most vulnerable older people, and today’s changes will help us to move towards that.
Lorely Burt (Solihull) (LD)
In my constituency the success of virtual wards has decreased the need for hospital beds. That is welcome, but dementia sufferers, who sometimes need hospital treatment and specialist care to mitigate the additional confusion and anxiety that they experience, do need specialist care within a hospital. Our local dementia unit is under threat of closure. Does the Secretary of State agree that it should not be closed and that that is a wrong decision?
Mr Hunt
I do not know the details of that particular case, but I am happy to look into it. I would say that a quarter of our hospital in-patients have dementia, and it is incredibly important that hospitals continue with a revolution in the way they look after people with dementia. There are some fantastic examples of that around the country, and I want to give them every support and encouragement.
Mr Jamie Reed (Copeland) (Lab)
GP access is a crucial element of out-of-hospital care, and the British Medical Association today said that the damage caused by this Government to the NHS has been “profound and intense”. Last week, the Royal College of General Practitioners said that more than a quarter of us now wait more than a week for an appointment with our family doctor. Within days of taking office, Ministers axed Labour’s guarantee of an appointment within 48 hours and took away the funding for evening and weekend opening. Under this Government, has it not got harder and harder to get an appointment with a GP? Let us have an honest, grown-up answer.
Mr Hunt
The honest factual answer is that we got rid of that target because when it was in place the number of people actually being able to see their GP within 48 hours was falling, so it was not working. I am afraid that this is the same old Labour problem: thinking that the solution to every problem in the NHS is another target. That is exactly what led to Mid Staffs and exactly what we will not allow to happen.
Mr Dominic Raab (Esher and Walton) (Con)
6. What steps he is taking to reduce the time taken to diagnose brain tumours in children.
The Secretary of State for Health (Mr Jeremy Hunt)
Last week, I launched a campaign to save up to 6,000 lives by halving avoidable harm and avoidable death in the NHS. I am inviting all NHS trusts to sign up to safety, by putting together their own plans, with support provided by NHS England, Monitor, the NHS Trust Development Authority and the NHS Litigation Authority. Learning from hospitals with the best safety records anywhere in the world, such as Virginia Mason in Seattle and Salford Royal here in England, we have a once-in-a-generation opportunity to put behind us the tragedy of Mid Staffs and make the NHS the safest health care system in the world.
Mr Bradshaw
People in Exeter and Devon with mental illness are now waiting more than two years for treatment. This is totally unacceptable and will, if it has not already, lead to the loss of lives. The Minister has repeated today his criticism of NHS England’s decision to cut funding for mental health, but as the shadow Minister reminded him, he is not a passive observer; he is the Minister responsible. What will he do about it?
Mr Hunt
The reason we are not passive observers is that we have made some substantial improvements in mental health provision since coming to office, including legislating for parity of esteem, which is precisely why the right hon. Gentleman feels able to ask that question. There are 55,000 more people every year getting a dementia diagnosis and nearly 80,000 people going on to psychological therapies. Lots has been done, but there is lots more to do, and we will continue to do everything we need to until we get that parity of esteem.
Mr David Heath (Somerton and Frome) (LD)
T3. The whole House will have been appalled by evidence from the Winterbourne View case and others of inappropriate methods of controlling patients. Will the Minister now take action to ensure that restraint is only ever used as a last resort, whether in care homes, hospitals or mental health units?
Liz Kendall (Leicester West) (Lab)
The Government’s damaging reorganisation has weakened the grip on NHS finances. Figures slipped out the day after the Budget show that NHS hospitals are in deficit for the first time in eight years, hospital trust deficits are three times higher than they were a year ago and twice as many foundation trusts are in the red. Will the Secretary of State now commit to publishing the final year-end figures for all hospitals in one annual account so that the House can hold him to account for his mismanagement of public money?
Mr Jeremy Hunt
It is financially challenging for the NHS, but we will not lose control of NHS finances, as happened under Patricia Hewitt. I remind the hon. Lady that for nine of Labour’s 13 years in office the NHS trusts sector as a whole was in deficit. We are getting a grip of those problems. We will publish the figures she wants, but the reason it has been particularly challenging this year is that hospitals have responded to the Francis report and hired 3,500 additional nurses to ensure that we have proper care on our wards.
Chris Heaton-Harris (Daventry) (Con)
T5. What progress is being made on ensuring that selective dorsal rhizotomy is available to children with cerebral palsy who need that life-changing operation?
Grahame M. Morris (Easington) (Lab)
T2. How does the Minister respond to a warning from the UK’s top cancer doctors that the planned closure of 18 specialist centres for treating the victims of brain cancer is putting patients’ lives at risk by delaying treatment? It is clearly at odds with the Prime Minister’s assurance about improving access. Those top brain surgeons say that it is appalling. Will the Secretary of State stop it and engage in a proper and meaningful review?
Mr Jeremy Hunt
The review the hon. Gentleman refers to is a consultation by NHS England to ensure that we commission specialist services better. There has been a 23% increase in the number of cancer sufferers getting treatment under this Government. We want to improve on that record even more, which means having sensible discussions on how to improve specialised commissioning, and that is what is going on.
Bob Blackman (Harrow East) (Con)
T6. In 2010 the Chancellor specifically set aside funding for the rebuilding of the Royal National Orthopaedic hospital in my constituency. The site has planning permission. Will my hon. Friend update the House on progress so that we see work on the ground before 2015?
David Tredinnick (Bosworth) (Con)
In his travels to the People’s Republic of China, what has my right hon. Friend the Secretary of State learned about the integration of western medicine with traditional Chinese medicine?
Mr Jeremy Hunt
What I have learned is that the most important thing is to follow the scientific evidence. Where there is good evidence for the impact of Chinese medicine, we should look at that, but where there is not, we should not spend NHS money on it.
Mr Dave Watts (St Helens North) (Lab)
T7. How is the Government’s pledge to get hospitals operating on a seven-day basis going? Many GP commissioners are refusing to provide the funding for hospitals to provide that service.
Andy McDonald (Middlesbrough) (Lab)
T8. The Health Secretary talks about Welsh patients flocking to the English NHS, but is he aware that the number of English patients going to Welsh hospitals has increased by more than 10% since 2010? Does that mean that the English NHS is in crisis?
Mr Jeremy Hunt
Unfortunately, a third of Welsh patients do not get things such as urgent scans within six weeks, compared with just 1% of patients in England. The Welsh NHS is struggling badly. I urge Labour, if it is to be consistent, to work closely with its colleagues in Cardiff to give a better standard of care to people in Wales, because they deserve a good NHS as well.
Mr Douglas Carswell (Clacton) (Con)
There is due to be a consultation on the future of maternity units at Clacton and Harwich hospitals. Last week, however, the management team at the already troubled Colchester trust decided to shut the units anyway. That has caused great anger and concern locally. Will my hon. Friend write to the board to ensure that it does not prejudice the outcome of the consultation and that decisions are made on the basis of fact, not muddled management?
Jenny Chapman (Darlington) (Lab)
Who is responsible for the disgraceful increase in the numbers of people across the country waiting hours in pain and indignity for an ambulance?
Mr Jeremy Hunt
We have 1.2 million more people going to A and Es every year. The ambulance service has, on the whole, been doing a good job, but there have been areas where there are problems. We need to change our attitude towards the capabilities of ambulance services, particularly the ability of paramedics to treat people on the spot, and we are driving through that change.
Mr Stewart Jackson (Peterborough) (Con)
In the absence of a definitive policy decision on the fortification of basic foodstuffs with folic acid, what steps are Ministers taking to encourage women of child-bearing age to take folic acid to reduce the incidence of neural tube defects such as spina bifida and hydrocephalus?
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
The Francis report highlighted the importance of ward sisters in properly managing wards, so why has the number of band 8 nurses in the north-east fallen by 87 since the general election?
Mr Jeremy Hunt
The number of nurses overall is up by 1,600 since the general election. Let me be absolutely clear that I do not believe in a system where the Secretary of State is micro-managing precisely how many nurses there are in every ward in every hospital in the country. Because we have protected funding that Labour wanted to cut, there are more doctors and more nurses than there were when it was in government.
Mr Philip Hollobone (Kettering) (Con)
Ten babies a day are born at Kettering general hospital. May I welcome the recent award of £400,000 of NHS modernisation funds to the hospital’s 33-bed maternity unit and urge the Minister to encourage NHS England to prioritise areas of high population growth such as Kettering for future funding?
Bill Esterson (Sefton Central) (Lab)
I cannot speak highly enough of the staff at Southport hospital who cared for me when I spent three days there as a patient last month. They told me that GPs now routinely send older patients straight to A and E because their funding has been cut and that community services are no longer in place to support people in their own homes, which is all leading to a crisis at A and E. Is not the sad reality that what is happening at Southport is being repeated up and down the country as a result of the Government’s disastrous reorganisation and cuts to front-line services?
Mr Jeremy Hunt
I am very pleased about the excellent treatment that the hon. Gentleman received. The problems that the nurses talked about are exactly why, from today, we are reintroducing named GPs for everyone aged 75 or over to bring back the kind of personal care and personal responsibility for patients that I am afraid was so sadly abolished previously.
Mental Health Act 1983 (Sections 135 and 136)
Jeremy Hunt Excerpts(10 years, 1 month ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I am announcing the details of the joint review between the Department of Health and the Home Office of the operation of sections 135 and 136 of the Mental Health Act 1983. These provisions are aimed at giving support to a person experiencing a mental health crisis, by giving the police powers to temporarily remove people who appear to be suffering from a mental disorder, who need urgent care, to a “place of safety”, so that a mental health assessment can be carried out and appropriate arrangements made.
The review will consider whether the primary legislation supports our overarching objective for all public services to respond to the needs of people experiencing mental health crises at the right time, and improving the outcomes for people experiencing mental health crises when they come into contact with the police. The review formally starts today and a briefing paper setting out the aims and time scales has been placed in the Library. Copies are available to hon. Members from the Vote Office, and to noble Lords from the Printed Paper Office.
Work on this issue was initiated by the Home Office, since when the Home Secretary and I; the Minister with responsibility for care and support, my hon. Friend the Member for North Norfolk (Norman Lamb) and the Minister for Policing, Criminal Justice and Victims have been working together to find the right way forward. We know there is a lot of interest about the way that sections 135 and 136 of the Act operate in practice, and the impacts both on the person detained, and on the use of police and health services’ time and resources. In particular, police officers can be called upon to make decisions on how to help someone experiencing a mental health crisis, when they may not be the best people to do so. We want to look at the evidence and to make sure that this part of the legislation is fit for purpose, clear, and workable.
The review will bring together evidence and cover a range of options, which may include leaving the legislation as it is and making changes to the associated codes of practice, or proposing amendments to the legislation. We will be engaging widely on developing the options with practitioners as well as those affected by the legislation. We will also seek the views of interested hon. Members, including the all-party parliamentary group who recently led a debate on the matter. I welcome the current Home Affairs Select Committee inquiry into policing and mental health, which will explore the relevant evidence.
Pay Review Bodies
Jeremy Hunt Excerpts(10 years, 1 month ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I am responding on behalf of my right hon. Friend the Prime Minister to the 28th report of the NHS Pay Review Body (NHSPRB) and to the 42nd report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The reports have been laid before Parliament today (Cm 8831 and Cm 8832). Copies of the reports are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
NHS Pay Review Body
We thank the NHS Pay Review Body for its 28th report and note its recommendations and observations.
We are clear that in the wake of the public inquiry into Mid Staffordshire NHS Foundation Trust, our first priority must be to ensure that the NHS can afford to employ the right number of frontline staff needed to ensure the safe, effective and compassionate care that patients have a right to expect.
The NHSPRB’s recommendations for a 1% consolidated rise for all staff, on top of automatic increments, are unaffordable and would risk the quality of patient care. Without a pay rise, incremental pay increases already commit nearly £1 billion every year for all NHS employees and add 2% each year to the NHS pay bill for Agenda for Change staff. The PRB proposals suggest a pay rise that would risk reductions in front-line staff that could lead to unsafe patient care. It is not possible to maintain appropriate numbers of front-line staff, give a general pay rise of 1 % and pay for incremental progression.
The Government are therefore adopting an approach by which all staff will receive at least an additional 1% of their basic pay next year. All staff who are not eligible to receive incremental pay will be given a 1% non-consolidated payment in 2014-15. Other staff will receive an increase of at least 1% through incremental progression.
It is our intention that in 2015-16 the same approach will apply and staff who are not eligible to receive incremental pay will receive a non-consolidated payment of 2% of pay, while other staff receive incremental progression. As this will be a two-year pay award, the NHSPRB will not be asked to make recommendations on a pay award for Agenda for Change staff in the 2015 pay round.
NHS staff are dedicated and hard working and the Government would prefer all NHS staff to receive a consolidated 1% increase. This would be affordable if incremental progression was frozen for one year in 2015-16. If the NHS trade unions were prepared to agree to this then the Government would be prepared to reconsider the position and make a consolidated award as other public sector work forces are receiving.
The Government agree with NHSPRB’s observation that a thorough review is required of the Agenda for Change pay structure, including the operation of incremental scales, so that it might better support the challenges facing the NHS in terms of both patient care and affordability.
We note its offer to look into this, given an appropriate remit and evidence and we will consider whether to ask them to look at contract reform issues in next year’s report.
Review Body on Doctors’ and Dentists’ Remuneration
We thank the Review Body on Doctors’ and Dentists’ Remuneration for its 42nd report, note its recommendations and observations, and:
in respect of general medical practitioners (GMPs), we accept its recommendation for an increase of 1% to general medical practitioners’ income after allowing for movement in their expenses, equating to an uplift of 0.28% to the overall value of general medical services contract payments for 2014-15; and
in respect of general dental practitioners (GDPs), we accept its recommendation for an increase of 1% to general dental practitioners’ income after allowing for movement in their expenses, but abate the increase in the general dental service contract for GDP staff costs from the recommended 2.5% to 1%. This results in an overall uplift of 1.6% to be applied to gross earnings for independent dental contractors for 2014-15.
In respect of employed doctors and dentists, we are clear that in the wake of the public inquiry into Mid Staffordshire NHS Foundation Trust, our first priority must be to ensure that the NHS can afford to employ the right number of front-line staff needed to ensure the safe, effective and compassionate care that patients have a right to expect.
The DDRB’s recommendations for a 1% consolidated rise for all staff, on top of automatic increments, are unaffordable and would risk the quality of patient care. Without a pay rise, incremental pay increases already commit nearly £1 billion every year for all NHS employees and add 2% each year to the NHS pay bill for employed doctors and dentists. The DDRB proposals suggest a pay rise that would risk reductions in front-line staff that could lead to unsafe patient care. It is not possible to maintain appropriate numbers of front-line staff, give a general pay rise of 1% and pay for incremental progression.
The Government are therefore adopting an approach by which all staff will receive at least an additional 1% of their basic pay next year. All staff who are not eligible to receive incremental pay will be given a 1% non-consolidated payment in 2014-15. Other staff will receive an increase of at least 1% through incremental progression.
It is our intention that in 2015-16 the same approach will apply and staff who are not eligible to receive incremental pay will receive a non-consolidated payment of 2% of pay, while other staff receive incremental progression. As this will be a two-year pay award, the DDRB will not be asked to make recommendations on a pay award for employed doctors and dentists in the 2015 pay round.
NHS staff are dedicated and hard working and the Government would prefer all NHS staff to receive a consolidated 1% increase. This would be affordable if incremental progression was frozen for one year in 2015-16. If the NHS trade unions were prepared to agree to this then the Government would be prepared to reconsider the position and make a consolidated award as other public sector work forces are receiving.
We note that the DDRB would welcome a proactive and systematic approach to considering contractual issues at an appropriate stage of the consultant and doctors in training negotiations and we will consider whether to make this part of their remit for the 2015 pay round.
Care Bill [Lords]
Jeremy Hunt Excerpts(10 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move, That the Bill be now read the Third time.
The Bill will bring about the most profound change in the care system for a generation. It provides certainty on care costs that has never been available before; independent and transparent inspections to drive up the quality of care; integration of the health and social care in a way that has been talked about for years but never delivered; and real patient empowerment to put people firmly in the driving seat for their care planning.
The Bill will also implement or help to implement many key recommendations made in the Francis report following the shocking failings at Mid Staffordshire NHS foundation trust. We are also establishing vital new principles for dealing with failure where it occurs, most notably the requirement and ability to deal with unsafe care quickly before lives are lost unnecessarily.
I thank all those who have been involved in considering and scrutinising the Bill, including my predecessor, who was responsible for originating it, together with my right hon. Friend the Member for Sutton and Cheam (Paul Burstow). I particularly wish to thank the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), and the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) for their herculean efforts in Committee and today to ensure that the Bill returns to the other place in the best possible state. There was a well-informed and rich debate on this landmark piece of legislation, for which I thank Members on both sides of the House.
We know that in the next 20 years, 1.4 million more people are likely to need care and support. The Bill prepares our country for that change with the most comprehensive reform of social care legislation in more than 60 years, creating for the first time a single, modern statute for adult care and support that is focused around the person, not the service. Meanwhile the new £3.8 billion merger of health and care services will allow the delivery of seamless, co-ordinated, whole-person care for those in need. In doing so, we will be realising a vision that was talked of for 13 years by the previous Government and actioned in three by this one.
Crucially, these reforms make a reality of the proposals of the Commission on the Funding of Care and Support, chaired by Andrew Dilnot. Many older people and people with disabilities face catastrophic and potentially ruinous bills for their care and support. The Dilnot commission judged quite simply that the current funding system is not fit for purpose. The Government have listened to the commission’s advice, have acted, and are implementing its recommendations. For the first time, a cap on care costs at £72,000 in today’s prices will provide protection to every single person in England. People who have worked hard all their lives need no longer fear that they will lose everything just because they are unlucky enough to develop care needs beyond any reasonable budget.
The difficult decisions the Government have taken on public spending have enabled us to pledge £2 billion per year to fund this cap, from which more than 100,000 people will directly benefit financially. What is more, we are raising the threshold for the means test for help with residential care, so that in 2016-17 alone, up to 35,000 more people will receive support with their care costs. Our universal deferred payment scheme will put an end to people being forced to sell their homes in their lifetime to pay for their care.
People often enter care at a point of crisis, and at a time of great distress. These reforms will create a better, fairer system, enabling people to grow old, safe in the knowledge that they will receive the care they need without facing unlimited costs. Combined with the Government’s wider moves to protect pensions and improve care standards, we are determined to fulfil our vision to make Britain the best country in the world to grow old in.
Sarah Newton
I had the great privilege to serve in Committee, during which the Minister of State, Department of Health, my hon. Friend the hon. Member for North Norfolk (Norman Lamb) expressed support for my view that if the pilots prove successful, we should be able to provide free social care at the end of life to allow more people to die with dignity at home. Would my right hon. Friend commit to that this evening?
Mr Hunt
I thank my hon. Friend for her work in Committee. That is an aspiration that we all share, and some of the results from the pilots are extremely encouraging in terms of the extra care and support we are able to give people. End-of-life care is a priority for everyone, so I share her enthusiasm that we can make progress on that very important area.
Financial security must be combined with confidence in the standard of care received. A year on from the Francis report, we are debating a Bill that will help us to deliver 61 commitments that we made in response to it. We are restoring and strengthening a culture of compassionate care in our health and care system.
Robert Francis’s report said that the public should always be confident that health care assistants have had the training they need to provide safe care. The Bill will allow us to appoint bodies to set the standards for the training of health care assistants and social care support workers. These will be the foundation of the new care certificate, which will provide clear evidence to patients that the person in front of them has the skills, knowledge and behaviours to provide compassionate high-quality care and support.
New fundamental standards will ensure that all patients get the care experience for which the NHS, at its best, is known. In his report, Robert Francis identified a lack of openness extending from the wards of Mid Staffs to the corridors of Whitehall. We want to ensure that patients are given the truth when things go wrong, so the Bill introduces a requirement for a statutory duty of candour which applies to all providers of care registered with the CQC. The Francis inquiry also found that providing false or misleading information allows poor and dangerous care to continue. We want to ensure that organisations are honest in the information they supply under legal obligation, so the Bill introduces a new criminal offence for care providers that supply or publish certain types of false or misleading information.
The care.data programme will alert the NHS to where standards drop and enable it to take prompt action. To succeed, it is vital that the programme gives patients confidence in the way their data are used. For that reason we have today amended the Bill to provide rock-solid assurance that confidential patient information will not be sold for commercial insurance purposes.
Patients also need to have confidence that where there are failings in care they will be dealt with swiftly. At Mid Staffs that took far too long. That is why the Care Bill requires the CQC to appoint three chief inspectors to act as the nation’s whistleblowers-in-chief. Their existence has started to drive up standards even in the short time they have been in their jobs.
Perhaps most fundamentally, the Bill re-establishes the CQC as an independent inspectorate, free from political interference. The Bill will remove nine powers of the Secretary of State to intervene in the CQC to ensure that it can operate without fear or favour. The Bill will also give the CQC the power to instigate a new failure regime and will give Monitor greater powers to intervene in those hospitals that are found to be failing to deliver safe and compassionate care to their patients. For the most seriously challenged NHS providers, there needs to be a clear end point when such interventions have not worked. The Bill makes vital changes to the trust special administration regime, established by the Labour party in 2009, to ensure that an administrator is able to look beyond the boundaries of the trust in administration to find a solution that delivers the best overall outcome for the local population.
Jim Dowd
I realise that the Secretary of State was not in office when the TSA process was started in the South London Healthcare NHS Trust, but he did accept the report of the administrator and, of course, appealed against the High Court decision that found against him. Will he clarify and put on the record that it is the coalition Government’s view, and the view of their constituent parties, that the people of Lewisham should not have an accident and emergency unit; should not have a maternity unit; should not have a paediatric specialty; and that two thirds of the hospital site should be sold off? Those were the recommendations of the TSA, which he wanted to accept.
Mr Hunt
Let me first tell the hon. Gentleman that the TSA did not recommend the closure of the A and E unit at Lewisham hospital, and he knows that perfectly well.
I will say what this Government are determined to ensure does not happen again. Mid Staffs went on for four years before a stop was put to it. Patients’ lives were put at risk and patients died because the problem was not tackled quickly. The point of these changes today is to ensure that, when all NHS resources are devoted to trying to solve a problem and they fail, after a limited period of time it will be possible to take the measures necessary to ensure that patients are safe. I put it to the hon. Gentleman and to all Opposition Members that if they were in power now they would not be making the arguments that they have been making this afternoon, because it is patently ridiculous to say that we will always be able to solve a problem without reference to the wider health economy. They know that: it was in the guidance that they produced for Parliament when they introduced the original TSA recommendations. What Government Members stand for is sorting out these problems quickly and not letting them drag on in a way that is dangerous for patients.
Andrew George
Following the concessions announced by the Under-Secretary in the previous debate, do I understand correctly that if the TSA makes recommendations to a non-failing trust to its detriment and the trust objects to those proposals, NHS England can, through its arbitration process, impose those changes?
Mr Hunt
Let me clarify, but first let me add that we want to listen to the consultation that will be led by my right hon. Friend the Member for Sutton and Cheam and the new Committee that he chairs. We are requiring local clinical commissioning groups and GP groups to come to an agreement on the right way forward in these difficult situations. We need an arbitration system for when agreement is not possible, which this clause allows for. We would like there to be agreement but we cannot allow a situation where, when there is not an agreement, we end up with paralysis and being unable to sort out the problem of a trust that is failing, particularly when it is unsafe and patients’ lives are being put at risk. That is exactly what was happening in the South London Healthcare NHS Trust.
As the Bill leaves the House to return to the other place for the final stages of its passage, we can be justly proud. This is a landmark piece of legislation that will transform the experience of those who rely on the NHS and care systems by giving patients and their carers both legal rights and a much better joined-up service. It will reduce the money wasted on duplication and allow more resources to be directed at the front line. It will remove the uncertainty and worry of unpredictable care costs in later life and will put individuals at the heart of a system built around their needs and not its own priorities.
Most of all it will send a signal loud and clear that when it comes to the challenge of treating an ageing population with dignity, compassion and respect, this House has not shirked its responsibilities but has risen confidently to the challenge.
Andy Burnham
My hon. Friend’s intervention brings me to my second reason for thinking that the Bill is not what it seems. The changes in eligibility for social care expose more people to social care charges than was the case before the present Government came to office, and, as has been demonstrated by my hon. Friend the Member for Leicester West, those charges are increasing above inflation. More people are paying care charges, and paying them at a higher level. The care cap is not what it seems. In fact, as my hon. Friend has consistently argued, it is a care con. The Secretary of State said today that the Bill would give people certainty about what they would pay—
Andy Burnham
The Secretary of State says yes, but I am afraid that it will not. The £72,000 cap is based on a local authority average, not on the actual amount that people will pay for care. So no, the Bill will not give them that certainty. The Secretary of State also said that people would not lose everything to pay for care. Let us take him at his word, and assume that £72,000 is the maximum that a person can pay, and £144,000 is the maximum for a couple. In my constituency, that would indeed mean people losing everything that they had worked for, although it might not mean that in the Secretary of State’s constituency or in other parts of the country. The Secretary of State needs to be honest with people. That is why we are saying that the Bill is not what it seems.
Andy Burnham
No I will not, as the hon. Gentleman has not been here all afternoon.
The third area is the claims that the Bill will improve regulation. Let me ask a direct question: if this is about improving the quality of services, why remove from the CQC the responsibility to provide oversight of local authority commissioning? Why do that if this Bill is about improving regulation? Why leave local government free to do what they like at a local level—to commission for 15-minute visits or for staff on zero-hours contracts—when we have seen the failures at Winterbourne View and other places? Why remove that important role from the CQC?
Andy Burnham
We have never had a proper answer to that. I hope we are about to get one.
Andy Burnham
The right hon. Gentleman has not answered the question. There was a responsibility on the CQC to provide oversight of local authority commissioning. This Bill removes it. Why does it do that? It is a backward step in my view.
The fourth area is that, in respect of the care data scheme, the Bill fails to provide the assurances the Government tried to herald in the press a few days ago—to borrow the Secretary of State’s words today, a “rock-solid assurance” that data could never be passed to commercial insurance companies. I do not believe it is possible to claim that new clause 34, which has now been added to the Bill, does that. It just has general aims around the promotion of health. That does not stop data being passed to private health insurance companies. Again, I do not think the Bill does what the Secretary of State claims it does.
The fifth area I want to challenge the Government on is the whole question we have just been debating. This goes to the heart of where the coalition began, which was that local people would be in the driving seat and local GPs would be in control. The coalition agreement said the Government would end centrally dictated closures. Well, they have ripped all that up this afternoon by passing clause 119 and keeping it in the Bill. They claimed they were just doing what we left behind. That is not the case, because the High Court told them otherwise. The High Court told them they had gone beyond the powers I had created in 2009. The Secretary of State was unable to answer that. He said everything was our fault—it is never their fault or his fault. Well, how about him listening to the Court? How about him reading the clause that we passed before he tried to close or downgrade Lewisham’s A and E? Would that not have been a good thing to do? He did not do that, however. He tried to plough on and downgrade a successful A and E in the teeth of opposition and he got found out. Yet he comes back here today and just thinks arrogantly he can ram the same powers back through this Parliament.
What we have seen today from the right hon. Member for Sutton and Cheam (Paul Burstow), who positioned himself as though he was going to make a stand for local involvement in the NHS, is the worst kind of collusion and sell-out of our national health service. Just as the Liberal Democrats voted for the Health and Social Care Act, again they have backed tonight the break-up of the NHS. In the last few days the right hon. Gentleman has been asking for all these signatures from all over the country—148,000 people to sign his petition—just so, it seems, that he could get a new job working within the coalition. I am not sure they are going to feel well represented this evening.
Mr Hunt
The shadow Secretary of State is bandying around some big words like “arrogant” so will he now show some humility and recognise that every single one of the 14 hospitals in special measures had warning signs when Labour was in office and Labour failed to sort out those problems?
Andy Burnham
We took action to address care standards in the NHS. The right hon. Gentleman is trying to politicise care failure. The Labour Government inherited the Bristol Royal infirmary scandal from the previous Conservative Government, along with the scandal at Alder Hey and the Shipman murders, but we did not try to politicise those failings. The Secretary of State is trying to politicise such failings today, however.
The Lib Dems have shown again tonight that they simply cannot be trusted to stand up for the national health service. There is only one party in this House that will do that, and that is the Labour party represented on these Benches. The next Labour Government will repeal the Health and Social Care Act and restore the right values to the heart of the NHS. In so doing, we will also repeal clause 119 of this Bill. We will take the powers that the Secretary of State has taken for himself today and hand them back to local people.
We will not get the care that we want until we are able to face up to the care crisis that this country now has. Our argument is that the full integration of health and care is the only way to reshape services around the person. That is the only way to go, and we will give a full green light to NHS organisations to collaborate and integrate, instead of working with the market regime that this Government have introduced. We have had the ludicrous spectacle of the Competition Commission telling two hospitals that wanted to collaborate that they could not do so because it would be anti-competitive. That is the reality of the NHS that this Government have created. That is the nonsense that people are facing on the ground. Only when we repeal the Health and Social Care Act and get rid of the powers that the Secretary of State has taken for himself today will we put the NHS back on the right path, away from the path towards fragmentation and privatisation, and begin to build a 21st-century NHS.
Francis Report
Jeremy Hunt Excerpts(10 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move,
That this House has considered the matter of the Francis Report: One year on.
A year on from the Francis report, let us remember that we stand here today thanks to the courage of a few lonely voices who fought against the odds to be heard as they campaigned against appalling neglect and abuse at the heart of our national health service. They had a truth to be told, they refused to be ignored, they stood up to a mighty system, and when they were turned away by regulators, NHS leaders and Ministers, they just came back speaking even louder—people such as Julie Bailey and Helene Donnelly, both of whom received honours this year, and thousands more who wrote and campaigned for loved ones, not because they wanted a penny of compensation but because they wanted to prevent this tragedy from ever happening again.
The last Government repeatedly refused to set up a public inquiry into what happened at Mid Staffordshire NHS Foundation Trust, but to his enormous credit, my predecessor overturned that decision, with the honourable support of a number of Staffordshire Members. As a result, the voices of their constituents were finally heard, and hard truths were told.
Today, the whole House will want to thank Robert Francis QC and his inquiry team for the thorough and thoughtful job that they carried out. Their remarkable report demanded a monumental response, and I sincerely hope that that is what the coalition Government have delivered. The Care Quality Commission, once ridiculed, is now trusted, with a record number of calls to its whistleblowing helpline. Failing hospitals are being turned around, with stronger leadership and improved staffing levels: there are 3,500 more nurses on our hospital wards since the Francis report, more than 80% of hospitals have taken new action in response to the report, and confidence among NHS staff that their organisation has the right priorities has risen. Of course, there are many more things to do, but it is clear that something profound has changed in the culture of the NHS.
Mr John Redwood (Wokingham) (Con)
I admire what my right hon. Friend is doing to get a new culture of honesty in the NHS. Does he think that all the major hospitals in the country now automatically report problems and mistakes, so that they can be investigated and remedied?
Mr Hunt
The truth is that the process takes time, and there are still examples of where candour is lacking. Allegations have recently surfaced in the press, the substance of which makes it appear that that reporting has not happened. There is much work to do, but the signal has gone out loud and clear that if people are open, transparent and honest from the start when something goes wrong, that should not be punished but should be recognised as a way of improving how we look after patients, in the same way as profound changes in the airline industry have made our aeroplanes much safer. We need that change in the NHS.
We also now recognise that however important ministerial objectives and national targets may be, NHS organisations should never prioritise them at the expense of dignity and respect for patients. We now know that the best way to deal with poor care is for people to speak out about it, whether they are a health care assistant, doctor, nurse or even Secretary of State, and that that should never be confused with “running down the NHS”. We also know that failing to speak out about poor care, or to support those who do, is a betrayal not just of patients but of the kindness and humanity of more than 1 million dedicated NHS staff, thousands of whom pledged themselves to compassionate care just two days ago on NHS change day.
What has happened in the past year? Robert Francis asked why the system effectively failed to detect or deal with the problems at Mid Staffs for a shocking total of four years. We have re-established the CQC as a rigorous and independent inspectorate, with three powerful new chief inspectors appointed to speak truth to power. The Keogh review inspected 14 hospitals last summer, and the new chief inspector of hospitals, Professor Sir Mike Richards, has already completed inspections of a further 18 trusts, with 19 more inspections taking place now. As a direct result, 14 trusts are now in special measures—a record in NHS history—and, thankfully, long-standing problems are finally being tackled.
On staffing, the inquiry found
“an unacceptable delay in addressing the issue of shortage of skilled nursing staff.”
The latest figures show that not only are there 3,500 more nurses on our hospital wards since the Francis report, in just a year, but we now have more nurses, midwives and health visitors in the NHS than ever in its history. From this summer, all hospitals will publish their staffing levels monthly, on a ward by ward basis, so that shortfalls are speedily identified.
Robert Francis identified a closed, defensive and secretive culture at Mid Staffs. In response, we have ended gagging clauses and we are making it a criminal offence for trusts to publish or provide specified information that is false or misleading. We are also placing a statutory duty of candour on organisations so that they are required to be honest with patients about poor care, and professional regulators are consulting on a new professional duty of candour that provides protection for staff against being struck off if they are open about the problems they see. I believe that will create one of the most transparent and open health care systems in the world.
Andrew George (St Ives) (LD)
I welcome the important steps in the right direction that have been taken with regard to recording and safe staffing on acute hospital wards. The Secretary of State also announced last year that he intended to introduce a system whereby nurse trainees would shadow or work alongside care assistants for up to a year. Is that idea being developed at the moment?
George Freeman (Mid Norfolk) (Con)
Does the Secretary of State agree that it is important to remember that part of what allowed the Francis report was the release of data on outcomes, and that such data transparency is crucial to understanding where best and worst practice exists, which may not otherwise be picked up?
Mr Hunt
My hon. Friend is, as ever, absolutely right on this issue, which he has spoken about a great deal. The use of data allows inspections to be meaningful in a way that has not been possible before. We have to ensure that the public are happy that protections are in place on how their data are used, but at the same time we must be bold in using those data, because that saves a lot of lives.
The inquiry condemned the way in which complaints were handled in Mid Staffs. Following the excellent work carried out by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart, all hospitals will now have to demonstrate to inspectors that they treat complaints as more than just a process and are actively using them to learn and improve.
Doctors have responded to the new climate of transparency by agreeing to a world first: to make England the first country anywhere that publishes surgery outcomes by consultant for 10 major specialties. More specialties will follow.
Chris Bryant (Rhondda) (Lab)
This point does not quite follow on from what the Secretary of State is saying, but I spent all day yesterday with rugby players and neuropathologists talking about chronic traumatic encephalopathy, which often follows rugby injuries. One big difficulty is that concussion is regularly misdiagnosed, or completely and utterly missed, throughout the whole NHS, and that sports bodies are not taking the matter seriously. Will he seriously consider changing the whole way in which the NHS engages with sports and with that issue?
Mr Hunt
As the hon. Gentleman knows, I used to be responsible for sport in this country, so I take a great deal of interest in the issue. I will certainly consider his point. We all remember what happened to Fabrice Muamba, and sport has a role to play in raising awareness of conditions that people might not otherwise be aware of.
Mr Mark Harper (Forest of Dean) (Con)
From listening carefully to my right hon. Friend’s remarks, I noticed that he referred to England. I am not sure that all the lessons from the Francis report have necessarily gone across the border to Wales. That concerns me, because thousands of my constituents are forced to use the NHS in Wales—although their GP is in England, they are registered with the NHS in Wales. Can my right hon. Friend say anything to reassure my constituents that they will soon be entitled to treatment in England, as is their legal right?
Mr Hunt
I am concerned about that on a number of levels, but I can reassure my hon. Friend that I have taken on board that point, which he has raised with me privately, and I will look into it. I have asked for a solution to be found soon, and certainly before the end of the year, so that his constituents can have that long-standing problem addressed.
Nurses, who were mentioned by the hon. Member for St Ives (Andrew George), have also embraced reform. The inquiry was clear that
“practical hands-on training and experience should be a pre-requisite to entry into the nursing profession”.
We now have 165 nurse trainees spending up to a year as health care assistants before starting a degree—a pilot that will inform how we roll out the programme nationally. The inquiry said the public should always be confident that health care assistants have had the training they need to provide safe care, and on the advice of Camilla Cavendish our new care certificate will provide assurance that health care assistants and social care support workers receive the high-quality, consistent training they need to do their jobs and deliver compassionate care.
Robert Francis also identified particular problems with the leadership of Mid Staffordshire Trust. We have many outstanding leaders in the NHS, but not enough, so we have set up a 50-place fast-track executive programme to attract clinicians and talented outsiders into NHS management, and we have already had more than 1,600 applicants. We are also introducing a new fit and proper persons test for board-level appointments, to help ensure that people with poor track records cannot resurface elsewhere.
The inquiry also heavily criticised my Department for being
“too remote from the reality of the service they oversee”.
We have introduced a new programme, “Connecting”, under which civil servants will spend four weeks every year on the front line. In the past year, Ministers, including me, and senior officials have spent more than 1,300 days working on the front line, leading to what I believe is a real and profound change in the way we approach our work and ensure good advice is provided to Ministers. Those changes have seen a welcome increase in the number of staff who feel that care of patients is the main priority for their organisation, according to the latest NHS staff survey.
If the NHS has listened, so too must we in this House. As constituency MPs, many of us, including me, have championed our local hospitals, sometimes unquestioningly, and sometimes without sufficient regard for the quality of care provided. Too often we have accepted the convenient explanation that individual cases of poor care were the exception, when in our hearts we knew the problem was more widespread. We must be champions for change in our communities, just as the Mid Staffs campaigners were champions for change in theirs.
Nowhere is that more true than in Wales. Although health is a devolved issue, unfortunately failures in care in Wales are now having a direct impact on NHS services in England, with a 10% rise since 2010 in the number of Welsh patients using English A and E departments, leading to very real additional pressure on border town hospitals. What is causing that pressure? Dr Dai Samuel of the Welsh BMA describes standards of care in Wales as follows:
“It’s pretty horrific...the level of care being given to patients is compromised...substandard we are seeing a miniature Mid Staffs every day.”
NHS England medical director professor, Sir Bruce Keogh, and president of the Royal College of Surgeons, Professor Norman Williams, have written to the Welsh authorities calling for action, only to be completely ignored. Professor Williams said that
“an analysis of NHS data in the region has highlighted the fact that the waiting lists for elective cardiac surgery in South Wales are higher than is clinically appropriate... Expert reports suggest that 152 patients have died in the past 5 years while on the waiting lists”.
If that creates pressure in England, it is a tragedy for Wales, yet still the authorities there continue to act as if the lessons of Mid Staffs stop at the border. If the Labour party, which runs the NHS in Wales, will not listen to the Government about this, it should please listen to its own Back-Bencher, the remarkable right hon. Member for Cynon Valley, who, following her own terrible family experience, has campaigned tirelessly to improve standards of care in Wales, particularly with respect to mortality rates at six Welsh hospitals. If there is one outcome from today’s debate, let it be not simply an examination of data methodology in Wales, but a proper, independent examination of mortality rates, allowing UK-wide comparisons. Given the implications for the English NHS, we need leadership from Labour Front Benchers in this place to encourage their Welsh colleagues to do what is right to save lives in Wales, as well as to reduce pressure on the NHS in England.
That highlights a broader, more uncomfortable issue for the House. Clear policy mistakes lay at the heart of why Mid Staffs was ever allowed to happen, but while no one is questioning the integrity or good intentions of Ministers in that period, those mistakes have never been acknowledged by the Labour party, even though the entire tragedy happened on its watch. Labour continues to make a political issue of which party can be “trusted” with the NHS, but cannot see that the refusal—[Interruption.] This is uncomfortable for Labour Members to hear, but lives were lost and I suggest they listen. Refusing to learn the lessons of Mid Staffs is the surest way to persuade the public that Labour does not merit that trust.
Do Labour Members now accept that the Government were right to hold a public inquiry into Mid Staffs, contrary to their wishes, given the many important changes that have come about as a result? Do they accept that Mid Staffs was not just about bad individuals, but about a corporate obsession with system targets that led to poor and unsafe care, and that we must not allow that to happen again? Do they accept that the Government were right to restore expert-led inspections that Labour got rid of 2008, and will they now undertake to support the new chief inspectors in their much more rigorous inspections? Do Labour Members accept that Ministers should never—as was alleged to have happened before—put pressure on regulators to tone down news about poor care? Do they support the statutory independence that we have now granted the CQC? Do they accept that we should never push hospitals to foundation trust status so quickly that they neglect patient care? Finally, and most important, do they accept that exposing and being honest about poor care is not about running down the NHS but is about protecting it and standing up for patients? I hope that when the right hon. Member for Leigh (Andy Burnham) responds he will be able to answer those questions and put to rest the concerns of relatives and survivors of Mid Staffs about his approach to date.
Mr William Cash (Stone) (Con)
May I reiterate what my right hon. Friend has said about the absolute point-blank refusal, repeatedly and whenever I raised the question of an inquiry under the Inquiries Act 2005, to hold such an inquiry? The previous Government would not hold an inquiry; they totally refused to do so, which was an absolute disgrace. To his credit, the present Prime Minister listened to my arguments, and one of the first things he did when he came to government was set up an inquiry, which now has the capacity to transform the national health service.
Mr Hunt
We are about to hear from the shadow Health Secretary who will have the chance to put things right on that account. My hon. Friend the Member for Stone (Mr Cash) was extremely courageous, determined and persistent in campaigning for a public inquiry, and with the support of my predecessor and the Prime Minister, that is leading to the profound changes we are seeing today. We would all welcome the Labour party’s support for that.
I opened this debate by paying tribute to a few brave individuals who started a movement in England for safe, effective and compassionate care.
Mr Hunt
No, I am about to conclude. This afternoon it falls to this House of Commons to stand four-square behind that movement, so that one year of the Francis report becomes a lifetime of change for the NHS. We all want to say two words, “Never again,” but those words derive their conviction from what we do as well as what we say. However contrite we feel now, we should always remember that good people with good intentions stood at this Dispatch Box, and still an unspeakable tragedy was allowed to happen. We cannot rewrite history but we can, and must, learn from it.
Andy Burnham (Leigh) (Lab)
This debate is a welcome opportunity to review progress on the Francis report one year after its publication. That publication completed a long process of independent inquiry into the terrible failings at Stafford hospital, and it began in July 2009 with my appointment of Robert Francis, QC. Ever since, the onus has been on us all to learn the important lessons and implement all the recommendations of the Francis report.
First, however, I will say a word about the previous Government’s record. It was the previous Labour Government who introduced for the first time independent regulation to the national health service, following the scandals of the 1990s at Bristol Royal infirmary, Alder Hey and, of course, the Shipman murders. It was that independent regulator which uncovered the problems at Mid Staffs. To listen to the Secretary of State, one would not believe that those were the facts—
Andy Burnham
I want to make some points at the beginning and then I will give way to the Secretary of State.
Those were the actions of the last Government in dealing with the issues that we inherited. It was the last Government who left the national health service with the lowest ever waiting lists and the highest ever public satisfaction, and no attempt by the Conservatives to rewrite history can take away that fundamental strength in the NHS which the last Government left behind.
Mr Hunt
I agree with the right hon. Gentleman that his predecessors deserve credit for introducing an inspection regime into the NHS, but would he now agree that it was a big mistake to allow expert-led inspections—the kind of really thorough inspections that could have uncovered what happened at Mid Staffs—to be abolished in favour of generalist inspections, which meant that the same people inspected dental clinics, GP practices and big London teaching hospitals? That was a profoundly important mistake that this Government are right to correct.
Andy Burnham
It is no good coming all holier than thou and claiming a counsel of perfection from the Government and that all the problems arose under Labour. There was no independent regulation in the NHS under the previous Conservative Government. There were no data of the kind that the hon. Member for Mid Norfolk (George Freeman) mentioned, so that comparisons could be made. Those things were introduced by the previous Labour Government, learning the mistakes of previous failings. This has been a continuous journey in the NHS—when things go wrong, the Government of the time act to make things better. The Secretary of State would do well to remember that before he makes the kind of statements he has made today.
We welcome some of the steps that have been taken, and I want to focus on two in particular on which we have seen an important change of emphasis. First, severe cuts to front-line staffing numbers were a primary cause of what went wrong in Stafford. In the last year, there has been a temporary halt to the cuts to nursing numbers that we saw in the early years of the coalition Government. However, Monitor has warned that this is just short term, and points to further large planned job cuts of close to 7,000 nursing posts in 2014-15 and 2015-16, made worse by severe cuts to nurse training places since 2010, which have forced many trusts in England to recruit from overseas. While we welcome the change of emphasis, we will watch carefully to ensure that recent progress on staffing is not lost.
Secondly, the Secretary of State has been right to focus on the care of older people. Moves to appoint named consultants and GPs for over-75s will clearly help to improve continuity of care. Those are the first steps in the right direction, but we would argue that something much more radical is needed. I believe that the time has come for a fundamental rethink, from first principles, of the way we care for older people, and that is what our commission on whole person care, published yesterday, has begun to set out.
Today, there are quite simply too many older people in our hospitals. Many do not need to be there, but hospital is fast becoming the last resort for people who have lost support in the home—be it support by social care or by the NHS. If we continue as a country on the current path—with further severe planned cuts to social care throughout the rest of this decade—it is a plan for the ever-increasing hospitalisation of frail older people. It is no answer to the ageing society and indeed will make it much harder to address the issues that Robert Francis identifies in his report. Instead, we need a completely new approach, where we start in the home and build a truly personalised service around each individual, their family and their carers. We need an NHS for the whole person, able to see all of an individual’s needs. We need a service where the home not the hospital becomes the default setting for care and, as I will come on to explain, that is what our policy of full integration of health and care is designed to deliver.
To listen to the Secretary of State today, people would be forgiven for thinking that everything in the NHS right now is just fine, everything is being put right and there are no problems. I have to say to him that the complacency he showed in his speech is simply not justified and, in fact, very worrying. May I remind him that hospital A and Es in England have now missed his Government’s target for 32 weeks running? The last 12 months since the Francis Report was published have—taken together—been the worst year in A and E for at least a decade, with almost 1 million people waiting more than four hours. That shows that NHS services have got worse, not better, since the publication of the Francis report.
Andy Burnham
In a moment.
On all measures, this winter has been just as bad as the last, with some patients waiting hours on trolleys, or held at the door of A and E or in the back of ambulances. A and E is the barometer of the whole health and care system, and that barometer is warning of severe storms ahead.
Mr Jeremy Hunt
As it happens, waiting times for A and E departments are now half what they were when the right hon. Gentleman was Health Secretary, but may I gently suggest that rather than trying to turn this debate into a discussion about who had the better A and E performance, he should return to the Francis report, which is what the debate is about and which deals with something that happened on his watch? The country wants to know what his party, and he personally, have learned from the mistakes that were made that allowed Mid Staffs to happen.
Andy Burnham
Pressure on hospitals, and how we relieve it so that they can care for people properly, is the core of this debate. What we have seen under this Government is an ever-increasing number of frail, elderly people coming into hospital via A and E. The Secretary of State shakes his head, but Francis made specific recommendations on the care of older people in hospital. The point I am making is that under him the number of older people admitted to hospitals as emergency admissions has gone up significantly, and that goes to the heart of the issues raised by the Francis report.
Mr William Cash (Stone) (Con)
It is quite difficult at this stage in the saga—the tragedy—of Stafford hospital to recall how it all came about and the difficulties that those of us who experienced it had to endure, the patients and the victims in particular. There was complete and total resistance—indeed, worse than that, a granite-like refusal—to having a proper look at what was going on. It would take much longer than I have available this afternoon to explain exactly the tooth and nail battle that I had to engage in to get the inquiry in the first place under the Inquiries Act 2005.
In a previous incarnation as the Member for Stafford, I had already had Stafford hospital in my constituency for 14 years, from the date of a by-election some 30 years ago in May 1984. I experienced a tragedy in Stafford hospital during that time with legionnaire’s disease, and I came to this House and asked the then Prime Minister, the late Margaret Thatcher, whether she would give us a full public inquiry—equivalent to one under the provisions of the 2005 Act. I did that because I knew it was impossible to get to the root of what was going on unless we had such forensic evidence, with cross-examination on oath and all the other—not paraphernalia, but necessary ingredients as part of the process, to ensure that we could bring to light what was required.
I was absolutely astonished that successive Secretaries of State completely refused, point-blank, to have such an inquiry in the case of Mid Staffordshire. I have to put it on record that the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who is not even in the House this afternoon—perhaps he has some excuse or justification—was the Secretary of State during a lot of the time in question. Patricia Hewitt was also Secretary of State for part of the time when serious problems were going on. The right hon. Member for Kingston upon Hull West and Hessle refused to have a public inquiry. The right hon. Member for Leigh (Andy Burnham) also refused to have an inquiry of the 2005 Act type. Although it is certainly true that he agreed to a Francis inquiry, and that there was also the Alberti report, the Colin-Thomé report and one or two other investigative exercises, none of them had the right ingredients to give them the capacity to get to the root of what was going on.
I am delighted with what my right hon. Friend the Secretary of State has done since then. I was extremely glad that, when we were in opposition, I was able to overcome some resistance to a 2005 Act inquiry from shadow Ministers. The current Prime Minister, then the Leader of the Opposition, listened to the arguments that I and others made and agreed to have a full 2005 Act inquiry, because he understood how important it was, as the Secretary of State does. The consequence has been to enable us to make changes throughout the entire health service that, as Opposition Members have acknowledged today, have enabled us in Staffordshire to be a pathfinder for solving some, if not all, of the problems presented in the health service.
The work of Cure the NHS has included that of my constituent Deborah Hazeldine. She does not get a great deal of publicity, but she was the one who came to me in my office in December 2008, with Julie Bailey, and explained that they were getting nowhere with the complaints and concerns that they were expressing. They asked what could be done about it, and I explained to them that if they did certain things, I thought we would be able to get a campaign moving of the kind that would be needed to get a 2005 Act inquiry. I pay tribute to them, and to Ken Lownds, who has been a tower of strength. He is a man of enormous integrity, knowledge, skill and commitment. I pay tribute to him for what he did to ensure that we got the inquiry, for the evidence that he gave to it and for his continual determined input into improving the health service since the Francis report was produced.
I am delighted that the Francis report came out as it did. It had, I believe, 299 recommendations, and it has been immensely important to the future of the health service. I do not need to go into all the details, but I pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), my next-door neighbour, with whom I worked closely from the beginning. He committed himself to a 2005 Act inquiry when he was in what could be described as the delicate situation of being about to become the Member of Parliament for Stafford but not entirely certain that it would happen. He did it, and he was right, and I pay tribute to him for everything that he has done since.
Mr Jeremy Hunt
I am grateful to my hon. Friend for his generous comments. While he is paying tribute to people who have played an important role in getting us to where we are, may I add my thanks to Deborah Hazeldine, and also to Ken Lownds, who was the first person who really talked to me about the important concept of zero-harm health care? I know my hon. Friend will not mind if I also mention campaigners from other hospitals, such as James Titcombe in the case of Morecambe Bay, who have also played an extremely important role in the debate.
Mr Cash
I am extremely glad that my right hon. Friend has made that point. The zero-harm policy is so important, and I am grateful for that specific intervention. It will make Ken Lownds’s day. I also pay tribute to people all over the country who have taken up the message and sought to improve the health service in their areas. This has turned into a national campaign, and the Secretary of State deserves great credit for the way he has helped to co-ordinate it.
I was, and remain, completely amazed that the right hon. Member for Kingston upon Hull West and Hessle, and Patricia Hewitt, were not even asked to give evidence to the inquiry. I still find that completely staggering to my way of thinking. I know that the right hon. Member for Leigh was asked to give evidence, and did, but I place the point on the record because I found it extraordinarily difficult to understand then, and I still do now.
I have constantly and repeatedly called for the resignation of Sir David Nicholson. I know he is retiring soon and that that resignation will not happen, but I repeat my concern, as I did in evidence to the inquiry, because the whole target-based policy was very much tied up with his approach to these matters. Indeed, in the last of, I think, about 600 paragraphs of his evidence to the inquiry, he referred in the last two lines to the fact that the Member of Parliament for Stone, Mr Bill Cash, had raised the question of his involvement in target-based policies. He said that there were arguments on both sides of the equation regarding target-based policies, but I do not agree with that. I do not think target-based policies were the right way to go, and I am glad that the hon. Member for Stoke-on-Trent North (Joan Walley) agreed with me. As I pointed out in my evidence to the inquiry, such policies had a terrible effect on the attitude of Monitor regarding the financing issues that provided 39 of the 45 or so questions put by William Moyes to the foundation trust when it received its approbation—something it should never, ever, have got. I say to the right hon. Member for Leigh that through the mechanism of the Department—I cannot point precisely to chapter and verse—the fact that the foundation trust got such status was also the product of a misjudgment by the Government at the time.
I have already referred to correspondence in an intervention, but in the prime ministerial guidelines of 2005, under the previous Government, it was clearly stated that when Members of Parliament write to Secretaries of State and other senior Ministers, they are entitled to receive a full, comprehensive response—personally—from that Minister. I found that wanting during this process. I was glad to note, however, that in the course of evidence to the inquiry, the situation moved from what appeared to be resistance to going down that route, to an acceptance that—to paraphrase from the evidence given by the chief executive of the Department of Health—from now on, when a Member of Parliament writes with a letter from a constituent, and explains that things have not gone properly regarding that constituent’s health problems, there is a mechanism to ensure that the issue is dealt with properly. I will not have to go into all that today, because it has been rectified.
In my evidence, I also raised the issue of whistleblowing. I also tabled amendments to the then health legislation, calling for the repudiation of gagging clauses and providing that any chief executive who endorsed them and got his legal advisers to agree to them should be dismissed. That is another area that has been dealt with, so we are making progress. I very much endorse the views expressed on both sides of the House about having unity across the Floor of the House, as far as we can achieve it, on the central principles.
I agree with what my hon. Friend the Member for Stafford said about the issue, although I have a difference, not of opinion but of emphasis, because my constituency is very rural, and access to the artery of the M6 is not easy. It can be difficult to reach, especially at night, because it can be a long way through small rural lanes, to access the M6 and the University hospital of North Staffordshire or hospitals in Wolverhampton. That is my caveat on that.
We have made enormous progress. I am glad that the Mid Staffs foundation trust is being dissolved, and that—as my hon. Friend the Member for Stafford said—the Prime Minister, at a recent Prime Minister’s questions, backed plans, in as many words, for consultant-led maternity to continue at Stafford hospitals. That service, plus paediatric services, critical care and a 24-hour emergency service, is necessary for constituents in Stone and the rest of Staffordshire. I will work with my hon. Friend to ensure that that is delivered.
Mid Staffordshire NHS Foundation Trust
Jeremy Hunt Excerpts(10 years, 2 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I wish to inform the House that I have made a decision regarding the action recommended by the trust special administrators (TSAs) of Mid Staffordshire NHS Foundation Trust (Mid Staffs, or the trust), as I am required to do by section 65KB of the National Health Service Act 2006 (the 2006 Act).
A document setting out in more detail the reasons for my decision has been placed in the in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Local people suffered too much for too long under a system which ignored appalling failures of care in their local hospital. They now deserve to know that same system has learned the lessons and is guaranteeing high quality, safe services for local people. The proposals I am accepting today will provide just this.
The strength of public interest in the TSAs’ work, and the huge response to their consultation exercise, is a testimony to the great commitment local people have to the future of their hospitals.
I must also commend the trust’s staff, who have helped turn around the quality of care provided at Mid Staffs, and who in recent months have continued to provide quality services in the face of great uncertainty about the trust’s future. The interest, support and contributions of hon. Members have also been extremely valuable. In particular, the way in which the hon. Member for Stafford (Jeremy Lefroy) has championed the interests of local people at every stage of the process has been remarkable. I believe the proposals I am accepting today will bring about improvements for local people that reflect his continued concern for patient welfare and the future of Stafford hospital.
Today’s announcement secures a first-rate offer for local patients—something they were denied for too long. Great strides have been made towards improvement in recent years but the challenges remain stark. Without over £20 million in subsidy funding from the Department of Health in 2012 and 2013, the trust would have been unable to pay its staff and suppliers. At the same time, a number of services are being operated with consultant numbers below Royal College guidelines, and the trust has experienced ongoing challenges in recruiting and retaining staff. Patients deserve high-quality services, which are clinically sustainable.
Today’s announcement provides an assurance that the solution to the trust’s financial and clinical problems will deliver safe and high-quality services, now and into the future. I know that the TSAs and local stakeholders have worked hard to develop a set of recommendations which will achieve this.
Having considered the TSAs’ proposals in detail, I confirm I am satisfied on each of the points set out in section 65KB of the legislation, and therefore support the action recommended by the TSAs. I am also satisfied that, in accordance with my request, the TSAs have undertaken a thorough analysis and taken account appropriately of the issues regarding the four tests for reconfiguration. I am pleased that, after a long period of instability, we are able to offer the local population of Mid Staffordshire the certainty it so desperately needs.
Before turning to the detail of the proposals, I would like to remind the House of the background to the administration process at Mid Staffs. Monitor appointed an independent contingency planning team (CPT) to the trust in October 2012. In January 2013, the CPT concluded in a report for Monitor that Mid Staffs was neither clinically nor financially sustainable in its current form. In a subsequent report the CPT advised that neither the trust nor local commissioners would be able to deliver the changes required, and consequently recommended the appointment of administrators. On the basis of the CPT’s conclusions. Monitor appointed TSAs to Mid Staffs with effect from 16 April 2013. Since taking up their role, the TSAs have found no reason to dispute the CPT’s conclusions regarding the trust’s sustainability, and their analysis has only strengthened the case for change.
Since April the TSAs have been working with the trust, local commissioners and providers, and a wide range of other stakeholders, in order to develop a solution for the services at Mid Staffs. The TSAs’ final report, which has been approved by Monitor, was submitted to me on 16 January.
The TSAs’ report recommends that Mid Staffordshire NHS Foundation Trust is dissolved, and that Stafford and Cannock Chase hospitals are operated by other local providers. It is vital that this structural change is made as soon as possible to stabilise local health services. The TSAs have also proposed a clinical model for the services currently provided by the trust, which their independent clinical advisory group (made up of leading clinicians from the Royal Colleges) has confirmed will be clinically safe. I am pleased that under this model the majority of patient visits, approximately 90%, will continue to take place at Stafford and Cannock hospitals. I also welcome the enhancements proposed for a number of current services, for example, the inclusion of specialist frail and elderly support within the Medical Assessment Unit at Stafford. All of this will contribute to a much improved offer for local people.
However, to ensure this improved offer, it is clearly not possible for all of Mid Staffs’ services to go on as they are, and therefore the TSAs’ recommendations will mean moving a small minority of services away from Stafford hospital. Local people can be reassured that local commissioners would need to be satisfied that there is sufficient capacity available elsewhere before moving services. In parallel, I am asking NHS England to identify whether consultant-led obstetrics could be sustained at Mid Staffs in a safe way in the future. In doing this, NHS England will work with local commissioners as part of their wider review of the local health economy.
The TSAs’ report also identifies the funding required to support this model and I am satisfied that, in the light of intervention from the NHS Commissioning Board (also known as NHS England) in the form of time limited funding, and a commitment from commissioners to deliver further savings during and following implementation, the recommended clinical model is affordable in the medium term and, subject to the actions of local commissioners, can be a financially sustainable one. My right hon. Friend the Chief Secretary to the Treasury has expressed his support for my acceptance of the proposals.
On this basis, I am content for the proposals to proceed to implementation. I would like to emphasise the critical role commissioners have in this process, and in particular their commissioning freedom to build upon the TSAs’ recommendations, such as in maternity, where they consider this is to be sustainable and in the interests of patients. Local commissioners will also oversee and monitor local service changes as part of their ongoing commissioning responsibilities, including, where going beyond the recommendations, undertaking further public engagement where appropriate.
I therefore ask that local commissioners, local providers and all other local organisations work together during the coming months and years to implement the proposed changes, with appropriate involvement from NHS England and other national bodies, in order to secure the high-quality services that the people of Mid Staffordshire deserve.