Accident and Emergency
Jeremy Hunt Excerpts(11 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
What we have heard today is a deeply unconvincing attempt by the Opposition to turn A and E into a political football. As a former Health Secretary who missed his own target for 14 of the 26 weeks that covered winter, the shadow Secretary of State should know better than to run down the phenomenal achievements of hard-working NHS staff at this busy time of year.
The right hon. Gentleman threw out numerous statistics—[Interruption.] He asked me to give him some answers, so he should just listen. He threw out numerous statistics, but let us look at the facts he chose not to mention. First, given that A and E departments across the United Kingdom face similar demographic challenges and have similar structures and targets, a comparison with Wales is instructive, not least because, with a Labour-run Government, it is following policies that are closer to those that he favours. The most recent full-month data available for both countries show that England hit the target, with 95.7%, but Wales missed it, with 90.4 %. Last year, England hit the target, with 95.9%, but Wales missed it, with 87.7%. In fact, Wales has missed it every single year since 2009. He also talked about ambulance times. In October, the figure for England was 74.6%, and for Wales 65.2%.
The right hon. Gentleman used some strong language. He talked about complacency and crisis. Will he now demonstrate that those comments were not shallow point scoring by making the same criticisms of Labour in Wales? If not, the House will see those comments for what they are: a hollow attempt to turn an operational challenge—one that he faced, that I face, and indeed that all Health Secretaries face—into a political argument regardless of the impact on patients or staff. Vulnerable people are relying on our emergency services this winter, so to whip up fear and run down performance, as he has done, is frankly shameful. It is putting politics before patients, and not for the first time from the Opposition Benches.
If the right hon. Gentleman does not want to talk about Wales—[Interruption.] I will move on to that later. If he does not want to talk about Wales, let us look more closely at England. Again, the statistics he did not want to share with the House show that NHS A and E departments are actually performing much better than when he was Health Secretary.
Guy Opperman (Hexham) (Con)
Does the Secretary of State welcome the example being shown by the award-winning Northumbria NHS Trust, which is building a brand-new specialist emergency care hospital in these difficult times, offering 24-hour cover seven days a week with consultants? That idea preceded the Keogh review and shows the way forward that A and E should be taking.
Grahame M. Morris
If the Government are doing so well in relation to targets, why have they downgraded the four-hour waiting target from 98% to 95%?
Mr Hunt
I will tell the hon. Gentleman why. It was done on clinical advice, for the good reason that there are some patients whom it is better to see, even if it takes longer than four hours, so that they can be discharged and sent home, rather than admitting them to the hospital, which is what was happening under the 98% target. Labour agrees with that, because it is following the same procedure in Wales.
Mr Hunt
I am going to make some progress.
I want to talk about what is happening in England, because the right hon. Gentleman wanted to know the truth. These are the statistics he did not want to tell the House about the comparison with his time in power, which he said was so good: 1.2 million more people are going through A and E every year, and more than 2,000 are being seen within four hours every single day, compared with when he was Health Secretary. The average wait to be seen is now 33 minutes compared with 77 minutes when he was Health Secretary—that is 44 more minutes longer, on average, to be seen under Labour than under this Government. For treatment, the average wait is now 75 minutes compared with 102 minutes when he was in office.
Andy Burnham
Will the Secretary of State give a straight answer to this simple question: is there or is there not a crisis in A and E?
Mr Hunt
I refer the right hon. Gentleman to the people who know about this at the College of Emergency Medicine, which says today on its website:
“There is now cause for optimism that the crisis is behind us.”
He should listen to that before whipping up fears of a crisis that the College of Emergency Medicine says is not happening.
Mr Hunt
I am going to make some progress and then I will give way.
There are 216 more consultants and 111 more registrars than during Labour’s time. On ambulance performance, frankly the right hon. Gentleman should be ashamed, because his whipping up of the problem so appalled the ambulance service that he received a letter from the chief executive of the south-western ambulance service, who said about his comments in the House of Commons:
“It is both disappointing and concerning that the information provided to your office has been misinterpreted and misreported in order to present a grossly inaccurate picture for the purposes of apparent political gain...I am astonished that anyone would present such misleading information to the House of Commons.”
Something else that the right hon. Gentleman did not want to tell the House regarding delays is that there has been a 28% fall in the number of 30-minute handover delays compared with the same period last year—that magically did not make it into his speech. Yes, ambulance services are under pressure; yes, there are issues with the performance of some trusts; and yes, this is a busy winter, but the one thing they and the patients they serve can do without is Opposition politicians demotivating crews by misrepresenting the reality on the ground.
Kate Green (Stretford and Urmston) (Lab)
Patients in Trafford will not recognise the Secretary of State’s characterisation of this as a crisis that is in the past. They are reporting long delays at Wythenshawe hospital’s and Manchester Royal infirmary’s A and E departments, particularly, as he will know, because Trafford general hospital’s A and E was downgraded to an urgent care centre and now closes overnight, as of three weeks ago. Does he agree that during transition periods for such reconfigurations it would make sense to ensure that there were adequate resources for neighbouring A and Es to take on the new patients? Those resources have not been provided to these hospitals; will he guarantee to provide them now?
Mr Hunt
I recognise the hon. Lady’s concern for her constituents. I have looked into the issues in the Manchester and Trafford areas very carefully, and I am assured by people on the ground that the problems and challenges they face do not relate to the changes that have been announced in Trafford.
Lorely Burt
We have had a very successful campaign in Solihull to restore two-member-crew ambulances being based in the constituency. However, they still face a big problem with admittance to Heartlands hospital to discharge their patients so that they can get out on the road and back to Solihull again. Can the Secretary of State suggest how the ambulance service could work in a joined-up way with hospitals in order to improve flow-through?
Mr Hunt
My hon. Friend raises an important point. Again, we would not hear this from the Opposition spokesman, but ambulance services across the country are making great strides. For example, in the past year there has been a 10% increase in the number of patients that ambulance services do not take to A and Es, and an 8% increase in the number of patients that ambulance services and paramedics are able to treat and discharge on the spot. Those kinds of things can make a huge difference.
Mr Hunt
I am going to make some progress.
I want to move on to what we have been doing. As I said, every Health Secretary deals with difficult winters in the NHS. However, this year is different because we have taken unprecedented steps to relieve the pressure in the short and the long term. For this winter, we have distributed more financial help—£400 million in total—than ever before. So far, that money has paid for 2,900 additional staff, 1,100 more hospital beds, and 1,200 more community beds. It has also paid for additional support for ambulance services and 111 centres. We distributed that money earlier than ever before. [Interruption.] The hon. Member for Copeland (Mr Reed) says that we should not have cut the money in the first place. We did not—we protected and increased the NHS budget, which the shadow Health Secretary still wants to cut, as he reaffirmed today and on Monday. We distributed the money in August, earlier than ever before. We extended the winter flu campaign to two and three-year-olds. Patients who require emergency treatment this winter can be assured that they are getting high-quality and speedy care despite the pressure that we all recognise A and E departments are under.
We have gone further. This year, we have started to tackle the root causes of the long-term pressures in A and E, which are the result of the ageing population, yes, but also, sadly, the disastrous mistakes made by the previous Government, including the 2004 GP contract changes and the 48-hour GP appointment target that did not work.
Mr Hunt
I want to make some progress on this because it was the central point of the shadow Health Secretary’s speech. The reason the 48-hour target was scrapped is very simple: access was getting worse, not better, under that target. On the right hon. Gentleman’s watch, the proportion of people getting an appointment within two days fell, while 25% of people who wanted an appointment more than two days ahead could not get one. They would call wanting an appointment for the following week and be told, “You can only get an appointment by calling less than 48 hours in advance.” But do not take it from me. This morning—
Mr Hunt
Well, the hon. Gentleman should listen to the Royal College of General Practitioners if he does not want to take it from me. This morning, its chair, Dr Maureen Baker, said that Labour’s
“proposal to bring back the 48-hour target for GPs is an ill-thought out, knee-jerk response to a long-term problem.”
Unlike Labour, we listen and act when doctors tell us that Government targets are harming patient care.
Siobhain McDonagh (Mitcham and Morden) (Lab)
If the right hon. Gentleman feels that scrapping the 48-hour rule for GP appointments was wrong, what would he say to my constituent Mr C, who has e-mailed me today imploring me to get an appointment with his GP because his wife needs a new prescription for her blood pressure drugs and he has spent the past 48 hours on the phone attempting to gain one? How could he help my constituent?
Mr Hunt
I would urge him to urge his own MP to back this Government’s initiative to introduce seven-day GP surgery opening in pilots in every single region of the country, and to back plans like those in north-west London, where seven-day GP opening has been introduced—for which we have not had support from Labour.
Guy Opperman
Does the Secretary of State agree that prevention is the most important thing to alleviate A and E pressure, and that the simplest thing we can do is to encourage the populations in all our constituencies to take up the flu jab, which will prevent a large number of people going to A and E?
Mr Hunt
My hon. Friend is absolutely right. This year we have extended flu jabs to two and three-year-olds because we think that prevention is better than cure.
We have been looking at other causes of the long-term pressure on A and E, such as Labour’s 2004 GP contract. The right hon. Gentleman spent the past year telling this House that that contract, which scrapped named GPs, has nothing to do with the problems in A and E. This is despite what nearly every A and E department in the country is talking about—namely, the pressure being caused by poor primary care alternatives, particularly for the frail elderly. What did he tell Sarah Montague on the “Today” programme when we reversed that GP contract and brought back named GPs for the over-75s? He conceded to her, as he never has in this House, that our changes which reversed that contract would help A and E, so he is finally accepting on the radio what he does not accept in this House and what A and E staff have been saying for months—that having someone in the community responsible for frail elderly will help.
Mr Hunt
I am going to make some progress.
Our plans go much further than simply reversing the 2004 contract. GPs will offer the most vulnerable guaranteed same-day telephone consultations, which never happened under Labour. There will be a dedicated telephone line so that A and E doctors, ambulance paramedics and others can get advice from GPs about treatment in urgent situations. GPs will co-ordinate care for elderly patients discharged from A and E to try to ensure they get proper wrap-around care to minimise the chance of needing to go back.
We have done something else that the right hon. Member for Leigh never did to tackle long-term pressure on A and E. One of the biggest problems has been not being able to discharge people from hospital because of poor links between the health and social care systems. Through our £3.8 billion better care fund, this Government are doing something that Labour talked about a lot but never actually delivered: we are merging the health and social care systems. Gone will be people being pushed from pillar to post, because in order to access this fund, clinical commissioning groups and local authorities will have to commit to joint commissioning and joint provision.
Finally, we have looked at the long-term structure of A and E. The previous Government were battered by a succession of failed reconfigurations. We, too, have had challenges over decisions, such as those with regard to Lewisham. Sir Bruce Keogh’s recent review of urgent and emergency care has changed the terms of this debate by setting out a 21st-centruy vision of emergency care. Sir Bruce rightly said there should be more extensive services outside hospital, and this, too, will help to reduce A and E queues. He rightly said that while the number of A and Es is not expected to change, the services offered by all of them should not be identical if we are to maximise the number of lives saved. Our duty to patients is to make that a reality and we will not hesitate to drive that vision forward.
A and E and the ambulance services are performing well under unprecedented pressure. I cannot speak highly enough of the hard-working staff who are working around the clock to deliver vital services. They share our overriding commitment to putting patients first this winter. Unlike Labour Members, we do not seek to turn a tough winter into a political football. If they want to make the comparison between our record and theirs, we are happy to do so: more people being seen within four hours, shorter waiting times, and long-term problems being tackled—not posturing from the Opposition, but action from the Government, and a commitment to do what it takes to support hard-working front-line staff over Christmas. We should get behind them and not undermine their efforts.
Mike Gapes
On a point of order, Madam Deputy Speaker. This information was embargoed until two o’clock today, but following an investigation the Care Quality Commission has put King George hospital Ilford and Queen’s hospital Romford into special measures. I tried several times to intervene on the Secretary of State in order to raise the matter, but he refused to take an intervention from me. I therefore seek your advice: how can I draw attention to the matter and the fact that the previous Secretary of State said that King George’s A and E department would close within two years? That is clearly not happening. There is chaos in my local A and Es, yet the Secretary of State did not let me intervene.
NHS Commissioning
Jeremy Hunt Excerpts(11 years, 6 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
NHS England’s board has today agreed its clinical commissioning group planning guidance and allocations. Final documents will be published on the NHS England website by Friday 20 December and copies will be placed in the Library.
As we set out in the mandate to NHS England, the NHS needs to change to meet the needs of an ageing population. This guidance will help commissioners develop plans for services that more closely address the needs of local populations and deliver better integration of health and social care services.
The planning guidance sets out the priorities for commissioners. Commissioners are asked to plan for the next two years, with a specific emphasis on improving health, reducing health inequalities and moving towards a parity of esteem for mental and physical health.
In order that such an important decision is considered objectively, free from party political considerations, the Health and Social Care Act 2012 made how health funding is allocated between different areas of the country a responsibility of NHS England.
The NHS England board has today made decisions on how to distribute its budget so patients benefit. This includes allocating funding for individual clinical commissioning groups.
The Government have protected the overall health budget and NHS England has today decided that every CCG in England will continue to benefit from at least stable real-terms funding for the next two years. Those areas with fastest growing populations will benefit from more rapid growth in funding.
By reflecting changes in population around the country and better targeting where the pockets of deprivation are located, the NHS can offer the best services where patients need them most.
Care Bill [Lords]
Jeremy Hunt Excerpts(11 years, 6 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 a Second time.
Our health and care system stands for compassionate care, or it stands for nothing. That was the vision when the NHS was founded 65 years ago: that anyone and everyone, regardless of background or income, should receive the best quality health care and be treated with dignity, compassion and respect. Because we have made much progress in delivering that vision, the NHS rightly remains the single biggest reason people are proud to be British. This Government want to keep it that way, which is why we are determined to root out poor care whenever and wherever it exists. Tragically, it does exist, both in the NHS and in private provision. In recent years, we have heard of patients being left in their own excrement at Mid Staffs, of patients left unchecked on trolleys for hours on end at Tameside, and of blood on the curtains and catheters on the floor at Basildon. All are issues that could and should have been dealt with by the last Government. Tragically, those problems were swept under the carpet, with devastating consequences for families across the country.
Today it gets worse, because the same people who failed to face up to those problems as Ministers will troop into the Lobby to try to vote down the very measures that will stop them ever happening again. People watching this debate will be asking one simple question: what more will it take for Labour to learn the terrible lessons of these tragedies? How many more people will need to suffer before the Labour party, the party that is rightly proud to have founded the NHS, comes to its senses and recognises that, on its watch, targets mattered more than patients and good news mattered more than good care?
Ian Lucas (Wrexham) (Lab)
The right hon. Gentleman casts those allegations around widely. Will he name the Ministers against whom he is making them?
Mr Hunt
I will absolutely go on to name the problems and the Ministers involved, if the hon. Gentleman will just be patient.
Hon. Members should not simply take my word for this. This is what Mid Staffs campaigner Ken Lownds, a former Labour party member, says about Labour’s decision today:
“It’s shocking and deeply depressing that Labour have learnt nothing from Mid Staffs. Their decision to oppose the Care Bill is a slap in the face for the campaigners and relatives who have fought for years for these measures that deliver a safer, more transparent and more compassionate NHS. Once again they have let patients and whistleblowers down by putting their political interests ahead of patient safety.”
Heidi Alexander (Lewisham East) (Lab)
The Secretary of State has come here to introduce the Second Reading of a very important Bill, yet it has taken him only two minutes to start casting aspersions on the previous Labour Government. When is he going to start acting like a Secretary of State?
Mr Hunt
I will make some progress, then I will give way.
Labour will today vote against measures that will help to implement 61 of the most important recommendations made by Robert Francis. Many of these will be policed by the new chief inspector of hospitals, appointed to be the nation’s whistleblower in chief, whose duties will be enshrined in today’s legislation, which Labour are voting against.
Andy Burnham
How can it be appropriate to introduce a debate on such fundamentally important issues as the way we care for older people with such narrow, petty, partisan, point scoring efforts? May I just say to the Secretary of State that he should not stand there and misrepresent the position of the Opposition? We will not oppose the Second Reading—we have tabled a reasoned amendment, because we do not believe his proposals for a cap are what they seem, but we will not oppose the Second Reading of this Bill. He should get his facts straight before he comes to that Dispatch Box.
Mr Hunt
The right hon. Gentleman needs to read his own amendment, because it says that he “declines to give” the Bill “a Second Reading”. If he is changing his position now, that is the fastest U-turn in history.
Let me go on to say why it is so important that the Labour party supports today’s Bill and does not, as the amendment says, decline to give the Bill a Second Reading.
Mr Hunt
I am going to make some progress. The new chief inspector of hospitals will act as Ofsted does with schools and, as with Ofsted, will inspect and rate hospitals using simple language that the public can understand: “Is my local hospital safe? Is it caring? Is it responsive? Is it clinically effective? Is it well led?” We will also make sure that the same scrutiny is directed at services outside hospitals, so the Bill makes provision for a chief inspector of social care and a chief inspector of general practice.
Ministers in the previous Government were repeatedly asked to strengthen the regulatory system and repeatedly ignored those requests. [Interruption.] The right hon. Gentleman says, from a sedentary position, that that is rubbish, but this is what Barbara Young, the chair of the Care Quality Commission at the time and now a Labour peer, told the Francis inquiry about the inspection system that the right hon. Gentleman introduced:
“The annual health check was so flawed in so many ways that I went and saw the Secretary of State. It was nonsense. And having argued that with the Secretary of State, I was told firmly that we weren’t permitted to change it. I was very unhappy about that.”
Well, today—
Andy Burnham
On a point of order, Mr Speaker. Is it in order for the Secretary of State to misrepresent the views of the previous Government and previous Ministers, and refuse to take interventions? He has just said that I refused to change and strengthen the regulation system of hospitals in England—that is factually incorrect. I brought forward a new system for the registration of all hospitals in England in autumn 2009, on the back of recommendations from the CQC. Again, he should get his facts straight at that Dispatch Box.
Mr Speaker
I am grateful to the right hon. Gentleman for his point of order, and I make two points in response. First, every Member and every Minister must be responsible for his or her comments in the Chamber—the accuracy and appropriateness thereof. I am afraid that, however angry people feel, on either side of the argument, these are matters of debate. Secondly, the situation would be greatly helped if the Secretary of State now, immediately, turned his mind to the presentation of the argument in support of the introduction of the Bill, which is, ordinarily, the matter upon which one anticipates a Secretary of State will focus his remarks. This is not an occasion for a historical legerdemain; it is an occasion for the presentation of the case for a Bill, to which I know that, without delay, the Secretary of State will turn his mind.
Mr Hunt
I am delighted to do so, Mr Speaker, and I know that you would think it was legitimate of me to hold the Labour party to account for its decision if it is voting against today’s Bill or declining to support it, as its amendment clearly states.
However, today is a day to rise above party political considerations, as Mr Speaker has just said, and recognise that putting these things right is overwhelmingly in the interests of patients. If the Labour party continues its stubborn refusal to support legislative underpinning for a new chief inspector of hospitals, which is in today’s Bill, how will it ever be able to look patients in the eye again? Perhaps the most shocking thing about Mid Staffs, which is one of the reasons we have so many provisions in the Bill, was not just the individual lapses in care but the fact that they went on for four long years without anything being done about them.
Barbara Keeley (Worsley and Eccles South) (Lab)
Will the Secretary of State give way?
Mr Hunt
I am going to make some progress.
When problems are uncovered, action must be swift. Robert Francis cited confusion over which part of the regulatory system is responsible for dealing with failing hospitals, so this Bill makes it clear where the buck stops. It is the CQC’s job to identify problems and instigate a new failure regime when it does so. Monitor and the Trust Development Authority will then be able to use powers to intervene in those hospitals, suspending foundation trusts’ freedoms where necessary to ensure that appropriate action is taken. If, after a limited period, a trust has failed significantly to improve, the Bill requires a decision to be taken on whether the trust needs to be put into special administration on quality grounds—and, yes, where necessary, a trust special administrator will be able to look beyond the boundaries of the trust and consider the wider health economy. As we know from Lewisham, that is not easy, but we will betray patients if we do not address failure wherever it happens.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
Why, when the Secretary of State and the Prime Minister have clearly set out the four tests that have to be met for any downgrading of hospital services, is he now introducing this clause? Those greater powers will totally undermine the clinical commissioning groups that his Government set up to meet local clinical and health needs, and not to balance the books for people outside their area.
Mr Hunt
I recognise that the right hon. Lady campaigns hard for her constituents. The four tests set out by the Prime Minister were never designed to require unanimous support from local CCGs for necessary changes. If we had to secure that, it would be virtually impossible to make any major reconfigurations. Where there is a failing hospital, it is important to resolve and address situations. There are exceptional occasions when that cannot be done in an individual trust’s area. The change in the law will not apply retrospectively to Lewisham, but it is right to ensure that, if we are to learn one lesson from what has happened in recent years, we deal much more quickly with failing hospitals, and that applies to South London Healthcare NHS Trust as well. Governments and the NHS must never again sit on coasting or failing hospitals for year after year without doing what it takes to sort them out. That is why this year, for the first time, we have put 13 hospitals into special measures. How utterly inexplicable but sadly predictable it is that the Labour party, which failed to sort out those problems, is today refusing to back the changes that mean those mistakes can never be repeated.
Another lesson from the Francis inquiry is that we need to create a culture of openness in health and social care so that, rather than being bullied and intimidated, doctors and nurses feel they can speak out about problems. The Care Bill will introduce a duty of candour as a requirement for registering with a CQC. That means that honesty and openness must come as standard for every organisation. We are also introducing a new criminal offence that will apply to care providers that supply or publish false or misleading information. Directors and other senior staff involved in committing the offence will be held to account. In addition to the Bill, the professional regulators have agreed to place a new strengthened professional duty of candour on all doctors and nurses. The Government are on the side of openness and transparency in our health care system.
Grahame M. Morris (Easington) (Lab)
I am sorry that the Secretary of State has not made any reference to part 1 of the Bill, which is about care and support. I hope he will come on to it, because it is so important. Perhaps he will also explain why Francis’s recommendations on a duty of care are being applied to organisations but not to individuals?
Mr Hunt
As the hon. Gentleman knows, we considered that matter carefully. We decided that the best way forward is to strengthen the professional duty of candour on individual doctors and nurses through their professional codes. After extensive consultation, which was supported by the medical profession, including the British Medical Association, we decided that that was a better way of ensuring that we had the right outcomes and did not create a legalistic culture that could lead to defensive medicine, which would not be in patients’ interests.
If supporting the Francis measures in the Bill is too awkward or embarrassing for Labour Members, can they not see the merits in the parts of the Bill that deal with out-of-hospital care? I am talking about not just vulnerable older people, but carers, for whom we need to do more. We need to do much more to remove the worry that people have about being forced to sell their own home to pay for their care.
Mr Hunt
I will give way in a moment, but let me make some progress first.
I commend the right hon. Member for Leigh (Andy Burnham) for championing integration, although he chose not to do anything about it when he was in office. How, then, when a Government take steps to do that for the first time, can he possibly justify not supporting it?
Hazel Blears
At a time of austerity, when there is very little public money around, the need for innovation and creativity is much greater. On reflection, does the Secretary of State regret not being more ambitious in the Bill about the full integration of health and social care in order to maximise the impact for those who need care and support—unlike my right hon. Friend the shadow Secretary of State for Health, who has talked about whole person care and full integration?
Mr Hunt
With the greatest of respect to the right hon. Lady, who, I know, played a good role in the G8 dementia summit last week, the Bill is extraordinarily ambitious. Nearly £4 billion is going into a merger of the health and social care systems. The previous Government had 13 years to do something about this and they did nothing. We are delivering. I hope, if she believes in this, that she might at least support the Bill in the Lobby tonight and not decline to support it, as her party’s amendment suggests.
The fund will ensure joint commissioning and the seamless provision of services, preventing the nightmare of people being pushed from pillar to post with no one taking responsibility. It has led to the unprecedented step of the NHS and local authorities working together in all 152 local authority areas to plan joined-up services.
Mr Hunt
I am going to make some progress.
Thanks to our reversal of Labour’s 2004 GP contract, vulnerable people over 75 will have an accountable, named GP responsible for making sure they get the wraparound care they require.
The collapse of Southern Cross showed the risks to people’s care when providers fail, so through the Bill we are introducing provisions to help ensure that people do not go without care if their provider fails, even if they pay for their own care. The CQC will monitor the financial position of the most difficult-to-replace providers in England to help local authorities provide continuity of care in a way that minimises anxiety for people receiving care.
We also need to improve the training of health care assistants and social care support workers. For the first time, health care assistants will have a new care certificate to ensure they get training in compassionate care and the Bill allows us to appoint a body to set the standards for that training. That means that the public can be assured that no one will be assigned to give personal care to their loved ones without appropriate training or skills. My hon. Friend the Minister of State, who is responsible for care and support, will have more to say on those elements of the Bill when he closes the debate and I thank him for his outstanding work on raising standards in that area.
We also need to address the funding of care. At the moment, people fear being saddled with catastrophic costs and even having to sell their home at the worst possible time to pay for their care. The Care Bill significantly reforms the funding of care and support, introducing a duty on local authorities to offer a deferred payments scheme so that people will not be forced to sell their homes in their lifetime to pay for residential care.
We will also introduce a cap on people’s social care costs, raising the means test at which support from the state is made possible and delivering on the recommendation of the independent Dilnot commission.
Andrew George
I am very grateful to my right hon. Friend for giving way. He says that everyone will be protected, but of course the cap on care costs is not a cap on “daily living costs”, as the Bill puts it. Will he therefore confirm that the £70,000—or whatever figure the cost ends up at—will not be the end of the costs for many people going into residential care?
Mr Hunt
My hon. Friend is right. We followed the recommendations of Andrew Dilnot, who did not think that the cap should apply to hotel costs, and, indeed, the policy that the Opposition followed in their national care service White Paper. We think that it is reasonable to cap the care costs. There is a cost issue—we would like to be more generous, but by the end of the next Parliament this proposal will cost nearly £2 billion. People who would like a more generous system must be obliged to tell us where they will get the extra funding.
Mr Hunt
The right hon. Gentleman will have a chance to speak later.
We want to be one of the first countries in the world where it is as normal to save for one’s social care costs as it is for one’s pension, and this Bill’s provisions make that possible. The deferred payments scheme, with a threshold of £23,250, on which we openly consulted, excludes only the wealthiest 15% of people entering residential care. How extraordinary it is that Labour should play politics by feigning concern for the richest in society, when they failed to do anything for the poorest over 13 years when they had the chance to do so.
Mr Hunt
The Government’s response to the tragedy of Mid Staffs has been widely welcomed, which is why the Opposition’s stance today is so disappointing. Robert Francis welcomed our measures as a
“carefully considered and thorough response”
to his recommendations that will
“contribute greatly towards a new culture of caring and making our hospitals safer places for their patients.”
The BMA said that it supports
“the Government’s commitment to put patient care first and foremost”.
The Patients Association said that it believes that this
“is a move towards restoring the faith patients have in the NHS.”
This Government would prefer to proceed on vital matters such as this with cross-party support, but I must warn the Opposition that we will do what is right for patients, whether or not we have their support. If they are today refusing to learn those lessons by not supporting this Bill, the country will draw its own conclusions about their fitness to run the NHS. They will know that for Labour it is all about politics, and it is politics before patients every time. We, on the other hand, profoundly believe that if we focus on patients, our NHS can be the safest, highest quality, most compassionate and fairest health care system in the world, and we will stop at nothing to make that happen. I commend this Bill to the House.
Andy Burnham
Those are the facts. The councils that are still trying to provide support to people with moderate needs are not all, but by and large, Labour councils. They are still trying to do that, but they have lost significantly more per head under this Government than councils elsewhere. The situation is about to get a lot worse, because NHS England will meet tomorrow to consider a major change to the NHS resource allocation formula, which will reduce the weighting given to health inequality and increase the weighting given to age. That will have the effect of taking more money out of Salford and Wigan and giving more money to areas where healthy life expectancy is already the longest. The Government are making it impossible for people who want to do the right thing.
Mr Jeremy Hunt
Local authority budgets were indeed cut to deal with the deficit, so will the right hon. Gentleman tell the House whether he would reverse those cuts—yes or no?
Andy Burnham
I am not sure that I agree with the hon. Lady. Some older people in my constituency probably do not have as good a quality of life in later life as some in her area, because there are ex-miners with chronic obstructive pulmonary disease and other things, who have very extensive needs caused by the dangers they were exposed to during their working life, and that places a burden on our health service. Of course, people are more likely to be living with chronic disease in more deprived areas, and both those things have to be recognised in the funding formula. If the change goes ahead, it will cause great volatility and move a lot of money around the system, but it will not allow areas such as the one I represent to invest in the home-based, high-quality, integrated services that the Secretary of State said he wanted.
To return to the costs of care charged by councils, let us call the hikes in charges what they are—stealthy dementia taxes that seek out the most vulnerable people in our society. The more vulnerable someone is and the greater their need, the more they pay. People who are paying more for care under the current Government and often receiving a worse service will not be convinced by the Secretary of State’s claims for his Bill today. It will feel like a con, and that feeling will only intensify when people understand more about the proposed cap.
Although we welcome the principle of a cap, this one is not what it seems. It is set at £72,000, despite Dilnot warning that a cap above £50,000 would not provide adequate protection for people with low incomes and low wealth. The Health Secretary has repeatedly said that people will not have to pay more than £72,000 for care.
Andy Burnham
The Secretary of State is nodding, but I hope he will be honest enough to admit today that that is simply not the case. In reality, the average pensioner could pay more than £150,000 for their actual residential care home bill—£300,000 for a couple—before they hit the so-called cap. I will explain why. It is because the cap will be based on the standard rate that local authorities pay for a care home place, not the actual amount that self-funders are charged, which is often much higher than the council rate. It is estimated that in 2016-17, when the cap is due to start, the average council rate for residential care will be £522 a week, and the average price of a care home place will be £610 a week. That is because self-funders pay more than councils. However, that will not be taken into account when the cap is calculated.
Andy Burnham
They are offering a similar scheme but at the moment they are not allowed to charge interest on it. That brings me to the next part of what is wrong with these proposals. What the Health Secretary has not said today is that interest will be charged on his proposed deferred payment scheme, which is not universal because it is not available to everybody. A loan to cover the average length of stay in a care home—two and a half years—would clock up extra costs of £3,500 in interest alone. That interest would not be included in the cap but would be outside it. Again, people will not feel that what they are paying is related to a cap.
Andy Burnham
I noticed that the Secretary of State was not very good at giving way, and I hope in future he will bear that in mind.
Andy Burnham
I was proposing a fundamentally different policy in a national care service. I ask the Secretary of State politely whether it is about time he stopped trying to say that everything is about the past? Why did he not stand there, explain and justify his own policy? Would that have been a good thing for him to have done today, instead of leaving it to me to explain what he is proposing?
Andy Burnham
That illustrates the confusion that is currently at the heart of the NHS. No one knows who is in charge of anything. What if CCGs and the boards of foundation trusts disagree with the conclusions of the TSA? How will that be resolved? Were we not told that doctors were sovereign? Were they not supposed to decide everything? Was that not the big call when the Government introduced their Bill? It seems that that is no longer the case: everything can be done “top down” by the Secretary of State. It takes power away from every Member and could be used as a back-door way to railroad through unpopular changes.
The real danger of the proposal comes when it is seen in the context of the competition regime created by the Health and Social Care Act 2012. Of course, it is sometimes necessary to make changes to local health services beyond just a failing trust. That is best done through partnership and collaboration, but such sensible changes are now being blocked by the market madness imposed by the Act. We recently saw the ludicrous spectacle of the Competition Commission intervening in the NHS for the first time to stop the sensible collaboration between Bournemouth and Poole. Since when did competition lawyers decide what was best for patients?
Andy Burnham
One reason the Lewisham clause is so worrying is that simple collaboration between hospitals to solve financial problems is no longer an option to ease financial pressures. That is what it has got to do with the Care Bill. The Government are making a case for all hospitals standing or falling on their own, and in that context, the weakest can be picked off by the Secretary of State and closed without consultation. Given the financial pressures on many organisations, this special administration process is likely to be used on an increasing basis, putting more hospitals at risk. That should send a shiver though every community represented in the House today.
G8 Dementia Summit
Jeremy Hunt Excerpts(11 years, 6 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
A Health Ministers summit of the Group of Eight was held in London today. The summit identified and agreed a new international approach to dementia research, to help break down barriers within and between companies, researchers and clinicians and secure a new level of co-operation needed to reach shared goals faster than nations acting alone. The following items were on the agenda for discussion:
Pre-summit briefing on the UK Prime Minister’s Dementia Challenge
The UK presented to the meeting on the UK Prime Minister’s dementia challenge which includes dementia friendly communities, health and care and research.
Ministers’ and European Commission’s Prepared Statements
Statements were made by Canada, France, Germany and Italy. These were followed by statements from Japan, Russia, UK, United States and the EU.
Improving Life and Care for People Affected by Dementia and their Carers
The meeting held an exchange of views on the action that can be taken to provide better and more concrete measures for improving services and support for people with dementia and their carers.
Preventing and Delaying Dementia
The meeting held an exchange of views on the action that can be taken to stimulate greater investment and innovation in dementia prevention, diagnosis, treatment and care.
Social Adaptation to Global Ageing and Dementia
The meeting held an exchange of views on the action necessary to adapt to ageing society and to reduce the impact of dementia.
As part of the agreement reached, countries have agreed to:
set an ambition to identify a cure or a disease-modifying therapy for dementia by 2025—backed by a commitment to together significantly increase the amount spent on dementia research and increase the number of people involved in clinical trials and studies on dementia;
a new global envoy for dementia innovation, following in the footsteps of global envoys on HIV and Aids and on climate change—the global envoy will bring together international expertise to stimulate innovation and co-ordinate international efforts to attract new sources of finance, including exploring the possibility of a new private and philanthropic fund to support global dementia innovation;
develop an international action plan for research—in particular to identify current gaps and how to fill them;
share information and data from dementia research studies across the G8 countries to work together and get the best return on investment in research; and
encourage open access to all publicly-funded dementia research to make data and results available for further research as quickly as possible
A copy of the declaration and communiqué 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.
Savile Investigations
Jeremy Hunt Excerpts(11 years, 7 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I promised to update the House about the investigations into Jimmy Savile and the NHS in my written statement on 14 October 2013, Official Report, column 39WS.
The Metropolitan Police Service has completed its document review and transferred various material concerning Jimmy Savile and the NHS to the Department of Health. The information has been passed on to the relevant hospital trust for further investigation as appropriate. Names of the hospitals are taken from the information received. These include hospitals that may have closed in which case the information has been passed on to the legacy organisation.
Kate Lampard, who was asked to provide independent assurance of the NHS investigations on behalf of the Department of Health, will provide general assurance of the quality of all reports in her final assurance report. We expect the final reports of all the investigations to be completed by June 2014, with publication sooner if that is possible.
Information has been passed on by the Department to the 19 trusts who have responsibility for the relevant hospitals as set out in the table below:
Hospital | Relevant Trust | |
|---|---|---|
1. | Barnet General Hospital | Barnet and Chase Farm NHS Hospitals NHS Trust |
2. | Booth Hall Children’s Hospital | Central Manchester University Hospitals NHS Foundation Trust |
3. | De La Pole Hospital | Hull and East Yorkshire Hospitals Trust |
4. | Dryburn Hospital | County Durham and Darlington NHS Foundation Trust |
5. | Hammersmith Hospital | Imperial College Healthcare NHS Trust |
6. | Leavesden Secure Mental Hospital | Hertfordshire Partnership University NHS Foundation Trust |
7. | Marsden Hospital | The Royal Marsden NHS Foundation Trust |
8. | Maudsley Hospital | South London and Maudsley NHS Foundation Trust |
9. | North Manchester General Hospital | The Pennine Acute Hospitals NHS Trust |
10. | Odstock Hospital | Salisbury NHS Foundation Trust |
11. | Pinderfields Hospital | Mid Yorkshire Hospitals NHS Trust |
12. | Prestwich Psychiatric Hospital | Greater Manchester West Mental Health NHS Foundation Trust |
13. | Queen Victoria Hospital, East Grinstead | Queen Victoria Hospital NHS Foundation Trust |
14. | Royal Free Hospital, London | Royal Free London NHS Foundation Trust |
15. | Royal Victoria Infirmary, Newcastle | The Newcastle upon Tyne Hospitals NHS Foundation Trust |
16. | Seacroft Hospital, Leeds | The Leeds Teaching Hospital NHS Trust |
17. | St Mary’s Hospital, Carshalton | Epsom and St Helier University Hospitals NHS Trust |
18. | Whitby Memorial Hospital | York Teaching Hospital NHS Foundation Trust |
19. | Wythenshawe Hospital | University Hospital of South Manchester NHS Foundation Trust |
Oral Answers to Questions
Jeremy Hunt Excerpts(11 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Alec Shelbrooke (Elmet and Rothwell) (Con)
2. What steps he is taking to ensure that compassionate care is at the heart of the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
Last week, we published a full response to the Mid-Staffs public inquiry and set out our ambition to transform the quality of compassionate care in the NHS. We have already put in place a robust new inspection regime and measures to make it easier for doctors and nurses to speak out when they are concerned about standards of care or safety.
Alec Shelbrooke
Compassionate care goes right through from surgeons to GPs. Will my right hon. Friend comment on evidence that epileptic women of child-bearing age are not being shown the compassion necessary during pregnancy from their GPs or neurologists and are not having the risks of taking their epilepsy medication outlined to them? To date, such medication has caused more than 20,000 birth defects.
Mr Hunt
I thank my hon. Friend for highlighting this important issue. The Medicines and Healthcare products Regulatory Agency regularly reviews the evidence relating to anti-epileptic drug use, particularly sodium valproate products, and we check what information is available to doctors so that it can be passed on to patients. I am concerned about the issue my hon. Friend raises, so I have asked NHS England’s national director of patient safety, Dr Mike Durkin, to look into it carefully and get back to me.
Nick Smith (Blaenau Gwent) (Lab)
New York has raised the age for buying tobacco products to 21. As a public health care policy, has the Department considered that matter?
Jonathan Lord (Woking) (Con)
23. Does the Secretary of State agree that transparency is critical in improving hospital standards and that, following the Government’s latest measures in response to the Francis report, the health cover-ups by the previous Government will never be allowed to happen again?
Mr Hunt
The Labour party does not like to hear this, but the reality is that micro-managing the NHS through top-down targets failed to deal with the problems of compassionate care. My hon. Friend is absolutely right that the best way to deal with this is through total transparency, so that when we are sure there is a problem, the public find out about it quickly and it is dealt with quickly.
Jim Shannon (Strangford) (DUP)
Compassionate care must be central to the NHS. The Health Minister in Northern Ireland has launched “Quality 2020”, a strategy that is intended to improve care in Northern Ireland. What discussions has the Secretary of State had with the Northern Ireland Assembly and the Health Minister about this issue?
Mr Hunt
We are in close touch with all the devolved Administrations about the changes that we are making in the NHS in England, and, interestingly, we are experiencing different levels of engagement. We have had very good discussions with the Northern Ireland Health Minister about some of the changes, but those in Wales are still refusing to commission a Keogh report on excess deaths, which I think shows that Labour in Wales has not learnt the lessons of transparency.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
3. What steps he is taking to train and retain more accident and emergency health specialists in the UK.
The Secretary of State for Health (Mr Jeremy Hunt)
I have asked Health Education England to consider how we can improve the structure and skill mix of the emergency medicine work force to deal with long-standing shortages in staff at both consultant and trainee levels. Along with the Emergency Medicine Taskforce, we are considering a number of options, such as increasing the non-doctor work force and the number of emergency nurse practitioners.
Mr Sheerman
Just what is going on in medical education in this country? We train doctors, but some never work as doctors, and others move abroad. Calderdale and Huddersfield NHS Foundation Trust has advertised and advertised again, but it cannot recruit accident and emergency staff. It certainly cannot recruit any who have been trained in this country, or who have been trained in paediatrics. What is going wrong with medical education here?
Mr Hunt
The hon. Gentleman has raised some important issues. We do face big challenges. We have increased the number of doctors in the NHS by 6,600 over the last three years, but it is still very difficult to attract as many people as we need to disciplines such as A and E.
I know that Calderdale and Huddersfield NHS Foundation Trust is especially concerned about A and E staffing. I had a very good meeting with representatives of the College of Emergency Medicine last week to discuss A and E consultants’ terms and conditions and, in particular, their antisocial working hours. We are giving the matter close consideration, but I agree with the hon. Gentleman that we need to do better in this regard.
Mr Philip Hollobone (Kettering) (Con)
While it is important to recruit and retain more A and E specialists, part of the problem is that a third of the patients who are dealt with in A and E departments could receive better treatment closer to their homes. What can the Secretary of State do to encourage that?
Mr Hunt
My hon. Friend is absolutely right. One of the biggest mistakes made in health care over the past decade was the introduction of the disastrous changes in the GP contract in 2004, which broke the personal link between GPs and their patients. Hard-pressed A and E departments, including the one at Kettering hospital, say that one of the things that will make the biggest difference to them is the provision of a named GP for the over-75s, so that they know that someone is responsible for those people when they are not in hospital.
Fiona Mactaggart (Slough) (Lab)
Is it not the chaotic and overstretched nature of many A and E departments that makes A and E an unattractive discipline for people to work in? Ever since the closure of the A and E department at Wycombe general hospital in my constituency, Wexham Park hospital has been unable to cope. What will the Secretary of State do about that?
Mr Hunt
We have gained more than 600 additional A and E doctors over the last three years, so the numbers are rising. However, the best thing that we can do for A and E staff is to give them a sense that we are addressing the long-term challenges that they face. The issues of integration with social care and delayed discharges are being addressed through the health and social care integration transformation fund, but we must also ensure that there are better primary care alternatives. The named GP for the over-75s will make a big difference in that regard.
Margot James (Stourbridge) (Con)
My local hospital, Russells Hall, is experiencing considerable difficulty in recruiting A and E consultants. Would not a good alternative approach be to train more paramedics to serve on ambulances and provide more effective and robust triage at emergency centres, so that patients can be redirected when necessary?
Mr Hunt
As ever, my hon. Friend speaks very wisely about this subject. In his review of A and E services, which was published a couple of weeks ago, Professor Keogh said that paramedics could deal with 50% of 999 calls on the spot, without taking people to hospital. I think that there is a big role for ambulance services that are prepared to upskill. It is also important for us to ensure that they have the necessary information. One of the main changes that we intend to make next year will ensure that they have access to the GP records of the people whom they pick up, so that they can give those people the care that they need in their own homes.
Mr Jamie Reed (Copeland) (Lab)
The president of the College of Emergency Medicine has said that the Government’s reorganisation has made A and E recruitment worse; the chief executive of the NHS Confederation has said that A and E pressures have been compounded by three years of structural reforms; yesterday, we learnt that the number of nurses choosing to leave their profession had jumped by more than one quarter under this Government; and the Health Secretary himself admits he is worried by the fall in nurse numbers on this Prime Minister’s watch. I hope he listens carefully so that he can answer precisely: will he today give the House a guarantee that every A and E in the country will have enough nurses this winter?
Mr Hunt
Will the hon. Gentleman think about what he has said? He said he was against a reorganisation that got rid of 8,000 managers and put 6,600 doctors on to the front line. That is why we are doing nearly a million more operations every year and why waiting times for longer waits are shorter than they were under Labour. We are recruiting more doctors because we are putting money into the front line.
Miss Anne McIntosh (Thirsk and Malton) (Con)
It takes seven years to train a doctor, but, for whatever reason, the new GP contract is looking to end seniority pay in six years. Is my right hon. Friend not concerned that that will lead to a mass retirement of doctors at the end of that six-year period in 2020?
Mr Hunt
We have to make the GP profession attractive to younger GPs as well. The money we save from getting rid of seniority pay will go back into practices, but it should not be given to people just for length of service; it should be related to quality of service too, which will make the GP profession much more attractive.
Rosie Cooper (West Lancashire) (Lab)
5. What recent assessment he has made of ambulance handover times at accident and emergency departments.
Nick de Bois (Enfield North) (Con)
17. What progress his Department has made on improving out-of-hospital care for frail elderly people.
The Secretary of State for Health (Mr Jeremy Hunt)
Improving the quality of out-of-hospital care is the biggest strategic long-term change that we need to make in the NHS. It will help to make the NHS sustainable. Reforming the GP contract is the first step, but we also need to make major progress on integrating the health and social care systems.
Mark Menzies
I welcome the Government’s announcement of named GPs for older people. What does the Secretary of State envisage that will mean for my older constituents?
Mr Hunt
My hon. Friend is not the only person to welcome that change. After months of telling the House that this was nothing to do with the A and E problems, the shadow Health Secretary said on the “Today” programme that he welcomed the change and that it would make a difference to A and E. So I welcome the return of the prodigal son with great pride and pleasure. For my hon. Friend’s constituents, this will mean that there will be someone in the NHS who is responsible for ensuring that they get the care package that they need. That is incredibly important, because when people are discharged from hospitals, the hospitals worry about whose care they will be under. This change will provide that crucial link and make a real difference.
Sir Tony Baldry
Does my right hon. Friend agree that the 2004 GP contract did enormous damage to the relationship between GPs and their patients, and that the recent changes agreed with GPs should ensure much more proactive care of our most vulnerable constituents and ease pressure on A and E departments?
Mr Hunt
I agree with my hon. Friend, and I am pleased that the shadow Health Secretary also agrees with him in welcoming the reversal of that disastrous contract. The personal relationship between doctor and patient is at the heart of what the NHS stands for, and at the heart of that is a responsibility to ensure that people get the care they need. That is what we need to get back, and I think that the change will make a big difference to my hon. Friend’s constituents.
Nick de Bois
Enfield CCG is working closely with Enfield council to try to deliver integrated health and social care, particularly for the elderly and the frail. Noting our higher-than-average elderly age demographic in the borough, will the Secretary of State take steps to ensure that those efforts are supported with extra funding?
Mr Hunt
My hon. Friend knows that the funding arrangements are decided independently of the Government, by NHS England, which will make its decision at a board meeting before Christmas. He is absolutely right to suggest that the funding formula should reflect not only social deprivation but the age profile of constituents, because the oldest people are of course the heaviest users of the NHS.
Liz Kendall (Leicester West) (Lab)
The Health Secretary claims that he wants the NHS to be the best in the world at looking after the elderly. Nice rhetoric, but the reality is that we now have the highest-ever number of elderly people trapped in hospitals because they cannot get the health and social care they need at home. We now have the equivalent of five hospitals full of elderly people who do not want to be there, and that is costing the taxpayer £20 million a month. Is not the truth that care of the elderly is getting worse, not better, on his watch?
Mr Hunt
The truth is that the previous Government had 13 years to integrate the health and social care systems, but they failed. We are doing that, and we are also providing named GPs to the most vulnerable people, so that, hopefully, they do not have to go to hospital in the first place. That is doing a lot more for older people than the hon. Lady’s Government ever did.
Mr Stephen Dorrell (Charnwood) (Con)
Does my right hon. Friend agree that successive Governments over 30 years have talked about the importance of joining up the different bits of the health care system and joining that up with social care? Is not the difference between this Government and their predecessors that, through health and wellbeing boards, the integrated care fund, named GPs and the pioneers programme that he has announced, this Government are actually doing it, rather than just talking about it?
Mr Hunt
I have to pay tribute to my right hon. Friend, because he has been talking about the integration of health and social care for a lot longer than I have, and he is absolutely right. I would add to his list one other really important thing we are doing: we are making sure that whatever part of the system someone is in, doctors can access their GP medical record—with their permission—because that information is vital in showing their allergies, medical history and previous admissions. Breaking down the barriers that prevent that from happening is one of the things that has not been picked up but is in the GP contract.
Graham Evans (Weaver Vale) (Con)
7. What steps his Department has taken to ease the short and long-term impact of winter pressures on NHS services.
The Secretary of State for Health (Mr Jeremy Hunt)
In the short term, a record £400 million has been assigned to help the NHS cope with winter pressures this winter, with £250 million announced in August—much earlier than before. For the long term, we will provide better out-of-hospital care for the frail elderly, by restoring the link between GPs and older patients, and looking to integrate the health and social care systems.
Graham Evans
Will my right hon. Friend join me in praising the outstanding work of Age UK and, in particular, Age UK Cheshire, which serves my constituency? It is raising older people’s awareness of seasonal impacts on health and offering support to prevent unnecessary pressures on the health service.
Mr Hunt
I am delighted to do that. As these are the last Health questions before Christmas, all of us would want to pay tribute to the voluntary organisations that do an extraordinary job of making sure that vulnerable older people do not get lonely over the Christmas period. It is heroic what they do—when we are with our families, they are looking after other people—and we should salute them all.
Valerie Vaz (Walsall South) (Lab)
22. One way to ease the pressure on the NHS is by not handing the £2.2 billion underspend back to the Treasury. Will the Secretary of State consider using it for the NHS?
Steve Baker (Wycombe) (Con)
Along with county colleagues, I wrote to the Secretary of State on this subject, because Buckinghamshire Healthcare NHS Trust is relatively underfunded compared with the rest of the country and it is in special measures following the Keogh review. Further to the answer that he gave to the earlier question, when can we expect the NHS England funding settlement to reflect more equitably the age of the public?
Mr Hunt
I commend my hon. Friend for the campaigning he does for high standards in his local trust. That has not been easy because, as he says, there have been a lot of problems there, although I hope he thinks that we are beginning to turn a corner. The decision on the funding allocations will be made by NHS England before Christmas, and the things that he says will, of course, be taken into account.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Yesterday we learned that the number of people suffering from hypothermia has soared by almost 40% on this Government’s watch. This morning the Office for National Statistics revealed that the number of older and vulnerable people who died unnecessarily last winter jumped by 29%. For every person who tragically loses their life over the winter months, eight more are admitted to hospital, putting huge strains on our crisis-ridden accident and emergency services. Will the Secretary of State please tell us what he is going to do about it?
Mr Hunt
I do not think I have yet answered a question across the Dispatch Box from the hon. Lady, so I welcome her to her post. I just say that she should be careful what she chooses to turn into a political football, because hypothermia admissions, as Public Health England said in August, are very closely linked to the number of cold days over a winter and the length of that winter. We had a particularly difficult winter last year, but the number of winter deaths was nearly 20% higher under the previous Government, when the right hon. Member for Leigh (Andy Burnham) was Health Secretary.
Mrs Mary Glindon (North Tyneside) (Lab)
8. What assessment he has made of the effects of social care budget changes on attendances at accident and emergency departments.
Simon Danczuk (Rochdale) (Lab)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
I need to correct the record. In the House on 30 October, I said that it took 21 minutes longer for the average person to be seen in A and E under the previous Government—a figure that was repeated by the Prime Minister in Prime Minister’s questions. My Department made a statistical mistake: it turns out that under Labour, the average person took not 21 but 44 minutes longer to be seen. I apologise for underestimating the improvements made under this Government.
Simon Danczuk
When people have mental health problems, waiting too long for talking therapies can lead to poor recovery, relationships falling apart, and job loss. What progress has the Minister made in establishing and delivering maximum waiting times for talking therapies?
Mr Hunt
The hon. Gentleman is absolutely right: this is a big priority for the Government. We are a big fan of talking therapies. We have taken huge strides in improving take-up, but there is still a long way to go, and we are looking at introducing access standards, so that there is a maximum time beyond which no one has to wait.
John Pugh (Southport) (LD)
T3. What measurable progress is being made in improving data sharing, not just between hospitals and general practitioners, but between the NHS and social services, to avoid bureaucracy and additional cost?
Mr Hunt
My hon. Friend has taken a great interest in this topic, and he is absolutely right to do so, because if we are to give integrated, joined-up care, in which people deal with NHS professionals who know about them, their medical history, their allergies and all the other important things, it is vital that, if they give their consent, their medical record can be accessed. That needs to be from GP surgery to hospital to social care system. Under the named GP policy that we have announced, there is a big opportunity for care homes to access GP records and keep them updated daily, so that GPs are kept in daily contact with how some of the most vulnerable people are doing.
Andy Burnham (Leigh) (Lab)
Today I want to put to the Secretary of State new evidence that the A and E crisis is deepening, and having a serious knock-on effect on ambulance services. Information from police forces reveals that cases in which police cars have to ferry patients to A and E are far more widespread than people realise; in some areas, it happens on a daily basis. One ambulance service is now using retained firefighters to attend calls, and—this is how bad things have got—another ambulance service has seen a 350% increase in the number of 999 calls attended by taxis. Does the Secretary of State think that it is ever acceptable that when a patient dials 999, a taxi turns up?
Mr Hunt
I am afraid that that is utterly irresponsible. We are hitting our A and E target, and we are hitting our ambulance standard. When the right hon. Gentleman was Health Secretary he missed the ambulance standard for October, November, December and January. He is trying to talk up a crisis that is not happening. He should think about people on the front line and, just for once, put patients before politics.
Andy Burnham
The country will have heard the complacency from the Secretary of State. He needs to explain why he spent Friday afternoon making panicked phone calls to hospitals up and down the country that were missing their A and E target. He did not condemn the use of taxis, which is unacceptable but is happening on his watch because ambulances are trapped at A and E, unable to hand over patients. That means that 999 response times have got worse and large swathes of the country, right now, are without adequate ambulance cover. Is it not time that the Secretary of State was honest with the public and admitted the scale of the crisis facing the NHS this winter, and took action now to prevent it from engulfing other emergency services?
Mr Hunt
We will take no lessons in complacency from the party that did so little to sort out excess deaths in hospitals such as Mid Staffordshire, Morecambe bay, Basildon and Colchester, and many other hospitals. The truth is that, compared with when he was Health Secretary, we see nearly 2,000 more people every single day within the four-hour standard. We are doing much, much better: we have more A and E doctors, and the NHS is doing extremely well. I know that for him it is always politics first and patients second but, for once, he should be responsible and think about the people on the front line.
Neil Carmichael (Stroud) (Con)
T4. In contrast to the previous Government’s lack of focus, what have this Government done about hospital infection control, with particular reference to data management systems?
Rosie Cooper (West Lancashire) (Lab)
T2. Following Francis and Keogh, and in creating a more open and accountable NHS, will the Secretary of State, in the spirit of total transparency that he favours, order foundation trusts to publish all their board papers, have exactly the same publishing requirements as non-FTs, and hold all their board meetings in public?
Mr Jeremy Hunt
I absolutely encourage that transparency. In fairness, the hon. Lady will accept that this Government have done more to improve transparency in the NHS than any Government have ever done. I would encourage all FTs to be transparent about their board meetings, but they are independent organisations, and we have learned—[Interruption.] Well, this was legislation that her Government introduced, and we have learned that it is important to give people autonomy and independence, because they deliver a better service for patients.
Dr Julian Huppert (Cambridge) (LD)
T6. Cambridgeshire and Peterborough clinical commissioning group receives one of the lowest amounts of funding per head in the country. The Government’s own fair shares formula, which takes account of factors such as population, age and deprivation, says that we should have £46.5 million more each year. I know that it is not his decision, but does the Minister think that the new formula should be implemented?
Caroline Lucas (Brighton, Pavilion) (Green)
T5. The last time I asked the Secretary of State about the £30 million-worth of cuts forced on hospitals in Brighton and Sussex, he said that it was all down to local discretion. Does he admit that behind his rhetoric about protecting the NHS budget there still lies a real 4% cut to the centrally dictated national tariff? Does he acknowledge, therefore, that hard-working nurses and doctors have to do more with less money while patients suffer? Will he reverse those cuts?
Mr Jeremy Hunt
Can I explain to the hon. Lady that the reason for the 4% efficiency savings is that, although we protected the budget in real terms, demand for NHS services has gone up by 4% year in, year out, so we need to find those efficiencies? Within that, it is incredibly important that we do not make false economies in relation to the number of nursing staff, which is why last week’s announcement on our response to the Francis report will make a big difference, and we have already begun to see more nurses.
Jonathan Evans (Cardiff North) (Con)
T7. Given the more than 30% increase in the past five years in the cost to the NHS of prescribing stoma appliances, what action is the Minister taking to promote training for stoma patients in alternative management techniques, such as colostomy irrigation?
John Healey (Wentworth and Dearne) (Lab)
The European Union has just agreed a trade deal with Canada that excludes health care, so will the Secretary of State ensure that the proposed EU trade and investment agreement with the US also excludes health care?
Mr Jeremy Hunt
We are looking at that very closely. We are big supporters of having a free trade deal between the EU and the US, but we do not want to do anything that would affect the fundamental principles, values and practices of the NHS.
Stuart Andrew (Pudsey) (Con)
The new review into children’s heart units feels very different, and I am pleased that everything is on the table. However, I was concerned to learn that the task and finish group has decided to meet in private. Given the group’s importance in decision making, and remembering the experience of the Safe and Sustainable review, does my hon. Friend agree that, in the interests of openness and confidence, the group should meet in public?
Karen Lumley (Redditch) (Con)
In the past two weeks I have had to visit accident and emergency units in Redditch and in north Wales, unfortunately with members of my family. Although health is a devolved matter in Wales, will my right hon. Friend the Secretary of State invite his counterpart in Wales to spend some time at the great A and E unit in Redditch to see for himself the stark differences between the two services?
Mr Jeremy Hunt
I would be delighted to do so. He will see the impact of not cutting the NHS by 8%, which is what Labour has done in Wales, which means that in this country we are hitting our A and E targets and in Wales they have not hit them since 2009.
Mr Speaker
I am sorry to disappoint colleagues, but we must move on. Demand usually outstrips supply.
Medical Innovation (No. 2) Bill
Jeremy Hunt Excerpts(11 years, 7 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
Medical innovation has been vital to the dramatic rise in life expectancy of the last century. This country has a proud heritage of medical innovation from Alexander Fleming and the discovery of penicillin to Sir Peter Mansfield’s enabling of magnetic resonance imaging.
The Government should do whatever is needed to remove barriers that prevent innovation which can save and improve lives. We must create a climate where clinical pioneers have the freedom to make breakthroughs in treatment.
The Medical Innovation (No. 2) Bill, sponsored by my hon. Friend the Member for Northampton North (Michael Ellis), and the comparable Bill introduced by my noble Friend Lord Saatchi in the other place, correctly identify the threat of litigation as one such barrier. Their hope is that legislation to clarify when medical innovation is responsible will reduce the risks of clinical negligence claims. Their argument is that with this threat diminished, doctors will be confident to innovate appropriately and responsibly. This innovation could lead to major breakthroughs, such as a cure for cancer.
Their cause is a noble one, which has my wholehearted support. My noble Friend Lord Saatchi, in particular, is a great example of a parliamentarian motivated by conscience.
It is precisely because this issue is so important, because it affects us all, that we need a full and open consultation. A consultation that gets the views of patients on the right balance between innovation and safeguards. A consultation that hears from clinicians on the problems they face in innovating and how to overcome them. We are grateful to my hon. Friend the Member for Northampton North and my noble Friend Lord Saatchi for their own work to understand and address these issues.
So the Government commit today to carrying out a full consultation, working with my noble Friend Lord Saatchi and my hon. Friend the Member for Northampton North. This will draw on the wide engagement and discussions that they have already carried out with the public, patients and the legal and medical professions. Such a consultation will enable an open debate on medical innovation, as well as highlighting its vital importance. The Government expect to launch this consultation in January 2014 and to respond by May 2014.
My second commitment is that the Government will seek to legislate at the earliest opportunity, subject to the results of the consultation.
We all owe a debt to my hon. Friend the Member for Northampton North and my noble Friend Lord Saatchi for the great effort they have already expended on this issue. The Government will work closely with them to bring this to a satisfactory conclusion.
Health
Jeremy Hunt Excerpts(11 years, 7 months ago)
Ministerial CorrectionsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
It is impossible to deliver safe care without safe staffing levels. All hospitals will be required to monitor their staffing levels on a ward-by-ward basis, analysing precisely how many shifts meet safe staffing guidelines. By the end of this year, this will be done using models independently approved by the National Institute for Health and Care Excellence. No hospital will be able to conceal unsafe staffing from the public because from next June all that data, both at ward and hospital level, will be published alongside other safety data on a new NHS safety website, triggering CQC action if there is cause for concern.
[Official Report, 19 November 2013, Vol. 570, c. 1096.]
Letter of correction from Jeremy Hunt:
An error has been identified in the oral statement given on 19 November 2013.
The correct statement should have been:
The Secretary of State for Health (Mr Jeremy Hunt)
It is impossible to deliver safe care without safe staffing levels. All hospitals will be required to monitor their staffing levels on a ward-by-ward basis, analysing precisely how many shifts meet safe staffing guidelines. By the end of next year, this will be done using models independently approved by the National Institute for Health and Care Excellence. No hospital will be able to conceal unsafe staffing from the public because from next June all that data, both at ward and hospital level, will be published alongside other safety data on a new NHS safety website, triggering CQC action if there is cause for concern.
Mid Staffordshire NHS Foundation Trust
Jeremy Hunt Excerpts(11 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I would like to make a statement about the Government’s response to the Mid Staffordshire NHS Foundation Trust public inquiry.
Let me start by paying tribute to the men and women of courage, without whom this darkest episode in the history of the NHS would never have come to light. I am talking about people such as Julie Bailey and members of Cure the NHS, who stood outside the Department of Health in all weathers because no one would meet them to hear about the inhumane care given to their loved ones; brave whistleblowers such as Mid Staffs nurse Helene Donnelly; and campaigners who suffered tragedies elsewhere such as James Titcombe, who never gave up the fight after losing his son Joshua at Morecambe Bay. They suffered greatly for their selfless determination to ensure that their personal losses were not in vain. All of us in the House are humbled today to stand in the giant shadow of their bravery.
Robert Francis and his team also deserve huge credit. Their diligence and thoughtfulness led to an outstanding reform, which will transform our NHS for the better. Finally, let me pay tribute to all NHS front-line staff for whom reading about these events in the media has been immensely distressing. We owe it to them to make sure that poor care is never again allowed to take root and survive unchallenged in our NHS.
Since our initial response to the inquiry in March, much has happened. Thirteen hospitals have been put into special measures as part of a tough new failure regime. Those hospitals, where poor care had been allowed to persist, are now being turned around, and I thank the Keogh inquiry team for its painstaking work in that area. Independent Ofsted-style ratings of hospitals are under way, led by Professor Sir Mike Richards, the new chief inspector of hospitals. The first 18 trusts are currently being inspected, with quality of care and safety paramount. We have appointed new chief inspectors of adult social care and general practice, whose robust inspections of care homes, domiciliary care and surgeries start next year, and surgical survival rates for 10 major specialties have been published by individual surgeons, making the NHS a world-leader in transparency.
Today the Government are publishing our further response to the inquiry, as well as our response to the Select Committee on Health’s report on the inquiry. Both responses have been laid before Parliament.
The NHS is a moral being or it is nothing. It was set up 65 years ago with the noble ideal that no one should ever be prevented by background or finance from accessing the best care. That is why it remains the most loved British institution, and rightly so. But each and every case of poor care betrays those worthy aims. I do not simply want to prevent another Mid Staffs. I want our NHS to be a beacon across the world for not just its equity but its excellence. I want it to offer the safest, most compassionate and most effective care available anywhere. I believe that it can, but only if there is a profound transformation of the culture in the NHS.
The inquiry shows the devastating effects of overly defensive responses: hurting families, suppressing the truth and preventing lessons from being learned. Failure cannot be addressed when it is covered up, so today I am announcing new measures to promote a culture of openness and transparency. From 2014, every organisation registered with the Care Quality Commission will have a statutory duty of candour. Patients must be told promptly about any avoidable harm, but there will be a statutory requirement to notify any harm that has led to avoidable death or serious injury.
We will consult on whether hospitals that are found not to have been open and transparent with patients or families at the earliest reasonable opportunity should risk having their indemnity from litigation awards reduced or removed by the NHS Litigation Authority. The signal must go out loud and clear from hospital boards and chief executives to all clinicians: if in doubt, report an incident and tell the patient. The professional regulators have agreed to place a new, strengthened professional duty of candour on all doctors and nurses. Failing to inform a patient, not reporting avoidable harm or obstructing someone else seeking to do so will be subject to sanctions, including being struck off.
Inspired by the airline industry, the duty will cover “near misses”—occasions when mistakes were made that could have led to harm and from which we need to learn. Conversely, prompt reporting may be considered as a mitigating factor in a professional conduct hearing. That is not about penalising staff for making mistakes; it is about enabling them to learn from them. The NHS will adopt a culture of learning, as recommended by Don Berwick and his expert committee, and I thank them for their seminal report.
A culture of openness also means learning from complaints. In line with the recommendations of the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart’s excellent review, all patients will be able to access independent help in making their complaint, with clear signs in every ward explaining how to do so. The chief inspector of hospitals will inspect complaints handling to establish whether trusts are genuinely seeking to understand and learn from them; every quarter, trusts will publish the number of complaints received and lessons learned; and the health service ombudsman will dramatically increase the number of cases she looks at in detail.
[Official Report, 22 November 2013, Vol. 570, c. 12-14MC.]It is impossible to deliver safe care without safe staffing levels. All hospitals will be required to monitor their staffing levels on a ward-by-ward basis, analysing precisely how many shifts meet safe staffing guidelines. By the end of this year, this will be done using models independently approved by the National Institute for Health and Care Excellence. No hospital will be able to conceal unsafe staffing from the public because from next June all that data, both at ward and hospital level, will be published alongside other safety data on a new NHS safety website, triggering CQC action if there is cause for concern.
Things are already changing for the better and I am pleased to report that trusts are planning to recruit an additional 3,700 nurses compared with a year ago, but we need to go further to train and motivate staff, particularly the health care assistants and social care support workers who perform so much vital care. Health care assistants and social care support workers will be required to have a new care certificate to ensure that no one is ever asked to perform personal care without adequate training, whether in hospitals or care homes. The title “nursing assistants” will be used widely in hospitals, and paths to nursing careers will be improved. I thank Camilla Cavendish for her excellent work in this area.
We also need to broaden the talent pool going into NHS management positions, in particular by attracting more clinicians and those with good external experience. We have introduced a fast-track leadership programme, sending 50 people a year to a world-leading business school followed by time shadowing top NHS chief executives.
Robert Francis correctly highlighted the failure of regulatory systems to identify quickly what happened at Mid Staffs. Subsequently it has become clear that Ministers put pressure on regulators that may have led them to tone down news about poor care. That is totally unacceptable, so we will strengthen the statutory independence surrounding reports into care quality. The chief inspector will be the nation’s whistleblower-in-chief and nothing must ever be allowed to stand in his way.
The CQC can prosecute when fundamental standards are breached and trusts put into special measures will have a strictly limited time to get their house in order before administration is considered. Foundation trusts in special measures will have their autonomy suspended and action will be taken to ensure that they quickly improve. No trust will be able to progress to foundation status unless it is rated good or outstanding.
Proper accountability must be at the heart of the NHS. I have therefore accepted Professor Berwick’s recommendation of legal sanctions for those found guilty of wilful neglect or ill treatment. There will be a new criminal offence for care providers that supply or publish false or misleading information and a new fit and proper persons test will enable the CQC to bar unfit directors from boards.
Finally, every hospital patient should have the names of a responsible consultant and nurse above their bed. Starting with over-75s from next April, there will be a named accountable clinician for out-of-hospital care for vulnerable older people.
One of the most chilling accounts in the Francis report came from Mid Staffs employees who considered the care they saw to be “normal”. Cruelty became normal in our NHS and no one noticed. The Francis report made 290 recommendations. I accept the principles behind all of them, and wherever possible have adopted the practical solutions suggested by the inquiry. Robert Francis has welcomed today’s announcement as a carefully considered and thorough response to his recommendations, which he says will contribute greatly towards a new culture of caring and making our hospitals safer places for their patients.
Today’s measures are a blueprint for restoring trust in the NHS, reinforcing professional pride in NHS front-line staff and above all giving confidence to patients that after Mid Staffs the NHS has listened, the NHS has learned and the NHS will not rest until it is delivering the safest, most effective and most compassionate care anywhere in the world. I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
What happened at Mid Staffs was a betrayal of the NHS and its values. The previous Government rightly apologised, but now is the time to back our words with action. That is why, although I welcome much of what the Secretary of State has just said, it is my job to press him on where we feel he could have gone further and to question why, of the 290 Francis recommendations, 86 are not being implemented in full.
First, let me, too, pay tribute to my right hon. Friend the Member for Cynon Valley (Ann Clwyd), Professor Tricia Hart, Professor Sir Bruce Keogh, Camilla Cavendish, Professor Don Berwick and, of course, Robert Francis. Between them, they have given us proposals that will help to prevent a repeat but, more importantly, as the Secretary of State said, change the whole of the NHS for the better.
Both Francis reports found three primary and fundamental causes of what went wrong: a failure to listen to patients; a lack of properly trained staff; and a dysfunctional culture. I shall take each of those issues in turn.
First, I am sure the Secretary of State agrees with me that patients and their families must always, as Francis recommends, be the first priority for the NHS. That principle unites this House and it must also unite the NHS. Is not Robert Francis right to recommend that the NHS constitution, and the ethos it sets out, should be required reading for all NHS staff? I congratulate the right hon. Gentleman on agreeing to implement the Clywd review in full and change the way the NHS handles complaints.
Secondly, on the issue of staffing numbers and training, the first Francis report found that Mid Staffs made dangerous cuts to front-line staffing over a short period. I welcome the Government’s new focus on this issue, but is it not the case that nurse-patient ratios across the NHS have got significantly worse in the past three years, with 5,890 fewer nurses, more older patients in hospital and bed occupancy running at record levels? It is encouraging that the NHS has plans to recruit more nurses this year, and is introducing more monitoring. The Secretary of State says “things are already changing for the better”, but is he aware that Monitor has warned that trusts are planning major nurse redundancies in the 2014-16 period, far outweighing any increases this year? Will he intervene now to stop that? Further, can he explain why he stopped short of requiring safe staffing levels? Is he further aware that nurse training places have been severely cut in recent years and trusts are being forced to recruit overseas?
Alongside nursing, more action is needed to raise standards across the caring work force. As Robert Francis has said, it is unacceptable that the security guard at the door of the hospital is more regulated, and subject to professional sanctions, than the health care assistant attending to an elderly patient. The development of the care certificate as proposed by Camilla Cavendish is a step forward, but will it not work only alongside a register of those who hold it and an ability to remove it if they fall short? Was not Robert Francis right to recommend a system of regulation for health care assistants and, going forward, will the Government reconsider their decision to rule this out? Overall, although there is progress on staffing today, it does not go far enough and we will continue to challenge the Government on it.
Thirdly, on culture change, Francis’s central proposal is a new duty of candour on organisations and individuals. Extending the duty to organisations is a step forward, but patient groups are disappointed today that it will cover only the most serious incidents. Can the right hon. Gentleman say why it has not been extended to all incidents of harm? Further, it is not clear how an organisational duty alone will help individuals challenge an organisation where there is a dysfunctional culture. Is it not the case that an individual duty as proposed by Francis is essential? This point comes over clearly from the evidence given to Francis from a senior, soon to be retired consultant. He said:
“I took the path of least resistance . . . here were also veiled threats at the time, that I should not rock the boat at my stage in life.”
It is only when an individual is both required to speak out, and protected in doing so, that this House can say it has done enough to safeguard patients.
The duty of openness and transparency should apply equally to all organisations providing NHS services including, as Francis rightly recommends, contractors providing outsourced services. Given that this Government are bringing into the NHS more outside providers, patients will need reassurance that we do not have an uneven playing field where private providers face less scrutiny. So will the Secretary of State extend the duty of candour to all health care organisations, as Francis proposed? His amendments to the Care Bill do not make that clear. And should not he now commit to extending freedom of information law to any provider of NHS services?
On openness, Francis made a direct call on the Government to set an example to the rest of the NHS. He said that
“risk assessments should be made public, and debated publicly, before a proposal for any major structural change to the healthcare system is accepted.”
Given that the Government claim today to be accepting this, should they not show now that they mean what they say by finally publishing the risk register on the current reorganisation of the NHS?
Finally, on openness, the NHS would be more accountable to families with a proper system of death certification. The House will remember that this was a recommendation of the Dame Janet Smith inquiry into the Shipman murders. The report today says that the Francis recommendations on this are not accepted in full. If we fail to act now, might people be justified in thinking that this House has not learned the lessons of tragedies that have gone before? If the Secretary of State brings forward proposals, we will work with him on a cross-party basis to implement them.
In conclusion, I do not believe that cruelty has become normal in the NHS, but there is a much deeper question for us all and that is how, in the century of the ageing society, we do a better job of caring for older people. We should not accept the situation where, as Cavendish says, people are paid less than the national minimum wage. Should we not all set much higher ambitions for the care of older people and, in so doing, learn the most fundamental lesson of all from what happened at Mid Staffs?
Mr Hunt
Let me take the right hon. Gentleman’s points in turn. First, he will know, because this is what happened after the Bristol inquiry and the Shipman inquiry under the previous Government, that Governments do not always accept every single recommendation. What I have said today is that we accept all the principles behind every single one of Robert Francis’s recommendations. We are implementing 204 in full, and in respect of the 86 that we are not implementing exactly as he said, we are doing everything we can to make sure that we implement the spirit behind them, but we need to make sure that everything we do is workable in practice. Francis himself has said that it is a “carefully considered” response that is a “comprehensive collection of measures”.
On staffing numbers, which is an essential part of what we have to consider, if the right hon. Gentleman looks at the nursing hours per bed, he will find that they have gone up since 2010, not down. We recognise the crucial importance of front-line staff, which is why I gently say to him that we made some reforms to the NHS that meant that there are 5,500 more doctors on the front line and 8,000 fewer managers. What we also need is more nurses. That is why it is so encouraging that in response to what Robert Francis has said and the recognition throughout the NHS of the importance of compassionate care, we are getting a reaction from NHS trusts—not as a result of a direct ministerial decision, but because trusts themselves are recognising the importance of compassionate care. We think that is a very encouraging sign.
With respect to whether staffing levels should be mandatory, we agree that there are minimum recommended staffing levels, but they are not the same for every ward in every hospital. The minimum level might be one in six for an acute medical unit, one in four for a general medical unit, and one on one for intensive care. We took extensive advice on whether it would be appropriate to set a national minimum mandatory number. Not only is the chief nurse and leading nurses from across the country against this; the King’s Fund and the British Medical Association are against it. The BMA said something today in a statement which I never thought I would read in my lifetime—it said that the “Government is right” on this issue.
The right hon. Gentleman also opposed mandatory staffing levels back in 2011, although it is fair to say that in the House his position on this has changed. The important thing is that we allow local discretion to make sure that nursing levels are adequate, and that where they are not, that is exposed quickly so that there is no repetition of what happened at Mid Staffs.
On the regulation of health care assistants, every health care assistant will have to have a care certificate. Effectively, there will be a database which allows employers to check whether someone has such a certificate. That is a kind of register. The other reason for people talking about the regulation of health care assistants is that they want to make sure that if someone fails in their duty of care, they are not able to appear somewhere else in the country. That is why we have a vetting and barring scheme to make sure that that does not happen.
On the individual duty of candour, let us be clear: we want total candour about all avoidable harm, at every stage that it happens, anywhere in the NHS. We decided after much discussion that extending the statutory duty of candour to individual front-line clinicians would be likely to create a huge amount of bureaucracy and damage the culture of openness that we are trying to create, because everyone would constantly be worried about whether or not they were breaking the law. We decided that the right way to achieve the objective is through a professional duty of candour, which is much stronger than the current professional duty states. Critically—this is a key change—we decided to make sure that, just as airline pilots have protection if they speak out, if front-line NHS employees speak out, they too will get protection if there is a professional conduct case, and that openness at an early stage will be treated as a mitigating factor. That is really important in terms of changing the culture.
Finally, we absolutely do need to resolve the issue of death certificates. It is important that we have an independent view to certify deaths. It is a question of finding a practical way to make sure that we do that, but we very much accept the spirit of what Robert Francis said.
Today I hope that we will find a way forward on all the problems that Robert Francis addressed in his response and that we have been thinking hard about. I urge the shadow Secretary of State to join Government Members in saying that this is a moment when the NHS can once again reach forward and aim to be the very best in the world, because the kind of measures that we are talking about are not happening anywhere else, and that is something of which we can all be very proud.
Jeremy Lefroy (Stafford) (Con)
I thank my right hon. Friend the Secretary of State for his statement and commitment. A culture of compassionate and safe care for all in the NHS must be the legacy of the Francis inquiry. It is the least that those who suffered from dreadful neglect, and their loved ones who campaigned for justice, deserve. Staff throughout Mid Staffordshire trust have made firm strides since then in improving that culture with clear results in patient care, but will my right hon. Friend be the patients champion and ensure that the NHS puts patients first and foremost?
Mr Hunt
That is the central change in culture that we need throughout the NHS. I pay tribute to my hon. Friend in particular, because he has had a more difficult challenge with respect to his local hospital than any hon. Member. He has campaigned for the people who use that hospital and for the staff there with great integrity and courage, which I commend.
I have never believed that there is a conflict or a choice between putting NHS staff first and putting the patient first. I have never met a doctor or nurse who does not want to put the patient first. The trouble is that we have created structures and incentives that make it difficult for front-line staff to do what they joined the NHS to do, which is to care for patients with dignity, compassion and respect. That is what we are trying to do in the changes today.
Ann Clwyd (Cynon Valley) (Lab)
I am grateful for the kind words about the report from the Secretary of State and from my right hon. Friend the shadow Secretary of State. If I may plug our report for a moment, “A Review of the NHS Hospitals Complaints System: Putting Patients Back in the Picture” is available. I have not yet gone through the tick-list of all the things that we asked for, but I shall be doing that. The Secretary of State has agreed that we can monitor the progress that Sir Mike Richards makes in putting complaints and the treatment of complaints at the top of his list when he visits hospitals around in the country.
May I press the Secretary of State on one point? He said in his statement that “all patients will be able to access independent help in making their complaint”. How exactly will that be done and how will it be resourced? I am grateful to the many thousands of people who wrote to me during the course of the review who complained about similar experiences to mine on the lack of care and compassion. That applies not just to nurses, but throughout the NHS from top to bottom. I hope that this will address some of the many complaints from Stafford and elsewhere.
Mr Hunt
I congratulate the right hon. Lady on the extremely good report that she produced. I hope she will not find herself in a position of wanting to complain to me about the way in which I have implemented her report on complaints, because we intend to take it extremely seriously. She knows that I basically accept everything she said in it, although we will have to work carefully on the implementation of some things to make sure we get them right. She highlights one of the most fundamental problems. Probably the biggest problem is that some hospitals treat their complaints procedure as a process rather than something that they can learn from. Every NHS patient whom I have met who has had problems only ever says the same thing. They just want to know that the NHS will learn from what has gone wrong. That is all that they are interested in.
The point that the right hon. Lady makes is a very important one. People do sometimes feel that it is them against the system, and taking on a big establishment that might be well funded and is not really interested in hearing what they have to say is a very lonely process. It is vital that everyone who wants it can get independent support. One thing that we will be requiring is a sign, prominently displayed in every ward of every hospital, telling people, first, how they can make a complaint, and secondly, how if they want it they can get independent help and support. That could be a very good role for the new healthwatch organisations, but it may not be them in all cases, so most importantly, we will insist that people everywhere can access that independent help.
Mr William Cash (Stone) (Con)
Did my right hon. Friend hear my constituent, Debra Hazeldine, this morning on the “Today” programme, with a harrowing description of the way in which her mother was let down and died in Stafford hospital? I agreed with everything she said. Does he acknowledge that, although my right hon. Friend the Prime Minister listened, after correspondence and meetings with him, to my repeated calls and motions for the setting up of an inquiry under the Inquiries Act 2005, which the Prime Minister set up and which has led to a complete shake-up, not only of Mid Staffs but the entire health service, successive Labour Secretaries of State in the last Government disgracefully and repeatedly refused to agree to such an inquiry, and that but for our determined campaign with Cure the NHS, and in particular Julie Bailey, Debra Hazeldine and Ken Lownds and his campaign for zero harm, the 2005 Act inquiry would never have taken place and the Francis report would never have been produced, with all its beneficial consequences, in the Secretary of State’s hands, for the NHS in the national interest? When will the debate take place on this report on the Floor of the House in Government time?
Mr Hunt
I did not hear Deb Hazeldine this morning, but I have met her on a number of occasions, and she is an extraordinary, powerful advocate for the changes that we need to make in the NHS. I have had discussions with my right hon. Friend the Leader of the House about the possibility of debating this on the Floor of the House, and I would very much welcome the opportunity to do so. My right hon. Friend deserves great credit for the fact that he was one of the earliest people to push for a full inquiry. I hope that the shadow Secretary of State will now accept that it was wrong not to have a public inquiry—it was blocked so many times by the Labour party—because we have learned so much from what Robert Francis has been able to say, and the NHS will be the better for it. Great credit should go to my predecessor, who is sitting here now, who took the decision to have that public inquiry.
Frank Dobson (Holborn and St Pancras) (Lab)
Does the Secretary of State not agree that the horrors of Mid Staffs were taking place at the same time that wonderful first-class care, from both a clinical and compassionate point of view, was available in many hospitals throughout the country? Is he confident that the measures that he is putting forward now will ensure that the worst performing hospitals will raise their standards to those of the best?
Mr Hunt
We have to wait and see, but we have put in place a radical, tough new Ofsted-style inspection regime. The point of that regime is not just to identify hospitals where care is unsafe, but to identify outstanding hospitals, so that hospitals in difficulty have hospitals from which they can learn, and we create a culture, just as we have in schools, where failing schools learn from outstanding schools and have a pathway to improvement. That will make a big difference. As the right hon. Gentleman knows, we now have 13 hospitals in special measures, and I am sure there will be more as the inspection process gets under way. But we will also have the great hospitals that we can learn from, which will mean that this can be a positive process for the NHS.
Mr Stephen Dorrell (Charnwood) (Con)
I commend my right hon. Friend for the thoughtful and thorough way in which he has conducted the reaction to the publication of the Francis inquiry. Does he agree that the most chilling finding of Francis was that professional people whose focus should have been on the needs of their patients found themselves, in Francis’s words, “doing the system’s business”? Is not the central driver of my right hon. Friend’s recommendations to ensure that never again shall we have closed institutions in a closed system where that is possible, and that the key way forward is to throw sunlight into institutions that have too often been unchallenged?
Mr Hunt
My right hon. Friend, as so often, speaks wisely. This is probably the boldest step towards transparency taken by any health care system anywhere in the world. We will see if he is right, but I think that he is, because sunlight is the best disinfectant. It means that problems are sorted out much more quickly, but it is sometimes an uncomfortable process. It is really important that we as a country understand that exposing poor care in one place does not mean that there is poor care everywhere and that, in fact, exposing it is the quickest way to sort it out.
Alan Johnson (Kingston upon Hull West and Hessle) (Lab)
We need total candour with regard to avoidable deaths. The only way to determine that is through an independent review of medical case notes by neutral clinicians. That exercise took place at Stafford. Will the Secretary of State remind us of the result?
Mr Hunt
I do not have the results in front of me, but I am happy to supply them. I want to take up the right hon. Gentleman’s point about avoidable deaths, because one of the changes we want to make today is to avoid the temptation, when there is an avoidable death, for people on the front line to say that it was unavoidable. We are trying to create the structures that make it easy for people to speak out if they think that a death was avoidable and to ensure that they are encouraged to do so.
Paul Burstow (Sutton and Cheam) (LD)
I very much welcome the introduction of a statutory duty of candour, which the Minister of State, my hon. Friend the Member for North Norfolk (Norman Lamb), wrote into our 2010 manifesto. May I ask the Secretary of State about his plans to prosecute if the fundamental standards are breached, which is an important step with regard to corporate criminal accountability? In drafting those standards, will he ensure that advice is sought from the Director of Public Prosecutions, the Health and Safety Executive and others to ensure that the wording is clear and fit for purpose so that when a prosecution takes place there is no hiding behind the language in those fundamental standards?
Mr Hunt
We will absolutely do that. We are in the process of a very big consultation to ensure that we get the definitions of the fundamental standards absolutely right, but we also want to try to create a culture that means we do not get to that point in the first place. One of the problems we had with the current system is that the definition of success for a hospital tended to be about meeting waiting time targets and financial balance, rather than caring for patients properly. We want to re-engineer the system through the new inspection regime so that a hospital cannot be good or outstanding unless it is delivering good or outstanding care.
Joan Walley (Stoke-on-Trent North) (Lab)
What happened at Mid Staffordshire must never be allowed to happen again, but given that safe staffing levels will depend on adequate resources, can the Secretary of State give an assurance that there will be a debate in the House in Government time on the successor arrangements for Mid Staffordshire and for the University Hospital of North Staffordshire?
Mr Hunt
As the hon. Lady knows, we are going through a process at the moment and the trust special administrator is drawing up detailed plans, so it is premature to say what will happen, but we will of course keep the House well informed and there will be plenty of opportunities for her to question me, or anyone else she wants to question, about any decisions that are eventually made.
Dr Sarah Wollaston (Totnes) (Con)
I warmly welcome the Secretary of State’s statement, which will help health professionals to get on with their jobs and improve openness and transparency across the NHS. I particularly welcome his recognition of the important role played by the 1.3 million health care assistants across health and social care. In implementing the vetting and barring scheme, will he ensure that individuals looking after people at home or in outside institutions can access that list to ensure that they have health care assistants who comply with the fundamental standards?
Mr Hunt
That is a very good point. I will take it away and look at whether that will be possible, because there is a powerful logic behind making that happen. As my hon. Friend has mentioned health care assistants, I would like to highlight the brilliant work they do, along with so many NHS staff. It has been a very challenging year for them to read about these examples of poor care, which are as shocking to them as they are to us. I agree that now is the time to get behind the people on the front line, who really want to change the culture for the better.
Robert Flello (Stoke-on-Trent South) (Lab)
I, too, welcome the Secretary of State’s statement and the observations made by my right hon. Friend the shadow Secretary of State, but my constituents will be concerned about the impact of whatever the trust special administrator decides is right for Mid Staffordshire on the university hospital and the care they will receive there. Whether as a result of pressures from Cannock Chase or other areas, there is the risk that work will go to the university hospital but that it will not be fully recompensed for what is needed and that—this is a terrible thing to talk about in these terms—the profitable work that would otherwise cross-subsidise that might well go to other areas. Will the Secretary of State look carefully at ensuring that the university hospital is not penalised as a result?
Mr Hunt
We want to ensure that no hospitals are penalised and that we end up with a solution for the whole local health economy that is sustainable for the long term. The comfort that I think the hon. Gentleman can draw from today’s announcement is that, as a result of the openness and transparency and the rigorous independent inspections that will be happening at all the hospitals his constituents use, poor care, where it exists, will come to the surface and be dealt with much more quickly.
David Tredinnick (Bosworth) (Con)
The improved transparency and increased accountability will do much to right the wrongs of the past. When will the health care certificates for nursing assistants be introduced, and has my right hon. Friend considered giving hospital managers discretion to appoint individual nurses to the under-75s?
Mr Hunt
We are looking at improving care for people in all age groups, but we started the focus on the over-75s because they are the most vulnerable older people. Implementation of the care certificate is a very big change that will apply to several hundred thousand people, so it will not be an immediate process, but we want to get on with it. I think that it will give them a big boost and more professional confidence. We also want to improve the pathway into nursing, which is why we will be encouraging use of the phrase “nursing assistants”, rather than “health care assistants.”
Valerie Vaz (Walsall South) (Lab)
The College of Emergency Medicine has consistently called for an increase in emergency doctors, because there has been a 50% shortfall over the past three years. What plans has the Secretary of State to address that concern?
Mr Hunt
I met the College of Emergency Medicine yesterday to discuss those issues, among others. We have 300 more doctors working in our A and E departments than we did three years ago, but the hon. Lady is absolutely right that we need more, because 1 million more people a year are going through A and E than there were in 2010. Part of the challenge is to make A and E a more attractive profession for doctors. They might work long shifts and antisocial hours, which can make it unattractive. We need to find a way of dealing with that.
Andrew Bridgen (North West Leicestershire) (Con)
Frank and Janet Robinson’s son John died in 2006 as a result of failings at Stafford hospital. They are my constituents. The inquest into his death lasted only 90 minutes and called only two witnesses. After much campaigning and lobbying by his parents, a second inquest has been granted. It will call 12 witnesses, many of whom were available to the original coroner, and is scheduled to last four days. Does my right hon. Friend agree that had the original coroner’s report into John’s death been more thorough, many avoidable deaths at Stafford and across the NHS could have been prevented?
Mr Hunt
I agree with my hon. Friend. I hope that he will be encouraged by today’s announcement, because if in such a situation, which was an appalling tragedy, a trust is found not to have been open and transparent about something serious that has gone wrong, the fact that it risks becoming financially liable for any award made will be a major disincentive to trying to cover things up. That is a profound change, so I hope that it will comfort John’s parents to know that the kind of culture they had to fight so hard against will not be allowed to continue.
Hazel Blears (Salford and Eccles) (Lab)
The Secretary of State is right to highlight the need for fundamental culture change, but it is still the case that some of the most vulnerable people in our hospitals today—those with dementia—stay longer and are more likely to be readmitted and more of them die. My local hospital, Salford Royal, has recently implemented the Royal College of Nursing’s system called the triangle of care, which fully involves patients, carers and their families in the care of those with dementia. Will the Secretary of State take steps to ensure that that kind of system is implemented across the NHS?
Mr Hunt
I absolutely want to encourage that. I know that the right hon. Lady has campaigned a great deal on the needs of people with dementia, and I share her desire to do much better for them. Salford Royal is one of the best hospitals in the country and we should always learn from what it does, but 25% of people in hospitals now have dementia. The tragedy of what happened at Mid Staffs and of many of the stories of poor care in other hospitals that we read about is that very often they involve people with dementia, because they are the kinds of people who have been deprioritised when hospital managements have decided, for example, that they want to cut nursing inappropriately. We absolutely have to change that culture. There is now a very good system at several hospitals. People with dementia, in particular, must be helped to eat and drink at meal times. Many of us have been shocked by the stories of full trays of food being taken away because someone is unable to eat unaided. That, in particular, we need to stamp right out.
Margot James (Stourbridge) (Con)
The Cavendish review found too many instances of health care assistants being badly treated and managed by nurses. Health care assistants, now to be called nursing assistants, are on the front line of very many patient experiences. Will my right hon. Friend assure the House that other measures, in addition to the very welcome new certificate for nursing assistants, will provide the extra support to those staff that is obviously needed?
Mr Hunt
It is really important that we value the work of some of the lowest-paid people in hospitals who are carrying out some of the most important personal care for patients. They need to be managed properly, fairly and decently, given how important that work is. We need to ensure that nurses have the right attitude to the health care assistants who are working for them—as, most of the time, they absolutely do. That is why earlier in the year we proposed changes that we are piloting, so that before getting funding for a nursing degree, people had to spend time, potentially up to a year, on the front line as health care assistants. That will allow them to experience just how important that work is and then perhaps appreciate it a bit more.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
The Secretary of State has spoken about staffing levels, which will be of the greatest interest to patients and their families. He said that the situation will vary across wards and that there would be local discretion, with failings being exposed. When those failings are exposed, how will corrective treatment occur? Who will be responsible for ensuring that the corrections and changes are actually made?
Mr Hunt
We have set up a new inspection regime with a new chief inspector of hospitals under the Care Quality Commission. The CQC will look at the figures that are published every month on a trust-by-trust basis, alongside other safety data such as MRSA rates, bedsore rates, numbers of complaints, and other information that is crucial to its decisions. It is then its absolute duty and responsibility to swoop quickly if it thinks there is any cause for concern.
Mr Aidan Burley (Cannock Chase) (Con)
We now know that poor care was allowed to continue at Mid Staffs because staff were simply too afraid to speak out and, if they did, they were ignored or, worse, their careers were threatened. The high death rates at Stafford hospital were not taken seriously enough at the time and were merely explained away rather than used as an alarm signal that should have triggered further investigations. There was clearly a culture of fear among NHS staff, many of whom witnessed the appalling care of my constituents. Will my right hon. Friend make it his legacy to instil a culture of candour and openness in the NHS whereby concerns are acted on and high standardised mortality ratios are no longer brushed under the carpet to protect the NHS’s reputation but are instead properly investigated so that patient safety finally comes first?
Mr Hunt
My hon. Friend is absolutely right. These problems of high mortality rates date back very many years, and nothing, or too little, was done to sort them out. We must therefore make sure that we have a system where that cannot happen. Concealing poor care does not protect the reputation of the NHS, because in the end it gets out and destroys public confidence. I hope his constituents will feel that today’s announcements will create a new culture of openness and transparency that gives them confidence, so that if these awful things were ever to happen again—we hope they do not—we would find out quickly and action would be taken.
Mr Kevin Barron (Rother Valley) (Lab)
Having spent nine years as a lay member of the General Medical Council and five years chairing the Health Committee, I have heard little this afternoon that is likely to change the culture inside the national health service. May I refer the Secretary of State to the report on patient safety that the Committee produced in the previous Parliament? We considered the idea of having a statutory ombudsman to whom people could complain and who would have the power to investigate, even anonymously, instead of this situation in which doctors, particularly young doctors working in hospitals, dare not complain about what senior doctors are doing because of the attack on their career structure. We really must get some independence into this. We can have good words, we can talk about candour, and we can wish a lot of things, but changing the culture of the NHS is not done by statements or by legislation in this House; it is done by working inside the NHS. I am afraid that at the moment the system works against changing the culture owing to career structures and everything else. We need some independence in all this so that people can really learn how to change. New Zealand would be a good example to look at.
Mr Hunt
All I can say to the right hon. Gentleman is that Robert Francis himself stated this morning that we have announced a comprehensive collection of measures that
“will contribute greatly towards a new culture”
in the NHS. He is persuaded that this will make a very big difference.
Independence is a vital part of this change, so what are we doing to create it? For the first time, we will have an independent chief inspector of hospitals who goes anywhere he likes in the system to try to root out poor care. That person will be the nation’s whistleblower-in-chief, and their job will be to find out about these things inside hospitals. We are creating a culture in which it is in the interests of hospitals and doctors to be open and transparent, and that is another significant change. I do not want to underestimate the scale of the challenge we face, but I think most people would say that in the past 12 months we have seen one of the most fundamental attempts to change the culture of the NHS in its 65-year history.
Fiona Bruce (Congleton) (Con)
An essential part of being a medical professional is to exhibit a compassionate and caring approach whatever one’s circumstances, as indeed most NHS staff do. What new measures will offer patients assurances that this will be a priority in future?
Mr Hunt
The biggest assurance that patients will have is that the definition of success as regards how the system views a hospital will be the same as patients’ definition of success. They want to go somewhere that treats them promptly and safely and with decent, compassionate care. That has not been how the system has judged the success of a hospital or its chief executive or board. That is why it is such a profound change to have a new chief inspector and Ofsted-style ratings. I think this will make a big difference, but I do not want to underestimate how big a challenge it is and how long a process it will be fully to make the transformation we need.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The Secretary of State will be aware of people’s disappointment that there is still no proper system of regulation for health care assistants. Does he understand that many members of the public feel that one of the problems with general standards of care in the health service may have been the push—under a Labour Government—for an all-graduate nursing profession? There is a strongly held view among members of the public that that has led to elevating taking exams and inputting data on a computer over providing basic levels of care, which is what they really value in a nurse.
Mr Hunt
Never has the hon. Lady spoken with so much support from this side of the House—I do not wish to destroy her credibility with her own party! She points to something that the public feel very strongly about and that is an issue in some parts of the nursing profession. We looked carefully at whether we should remove the requirement for graduate qualifications and decided that nurses are now asked to do a great deal more than they were 20, 30 or 40 years ago in, for example, giving people medication and the clinical procedures they are asked to be involved in. We need to make sure that there is the right culture in nursing. That is why I proposed—it was very controversial at the time, although I think it has been quite broadly accepted now—that before becoming a nurse people should spend some time, potentially up to a year, on the front line as a health care assistant to make sure that those going into nursing had the right values and recognised that giving this personal care is a fundamental part of what being a nurse should always be about.
Dr Julian Lewis (New Forest East) (Con)
Will the package of reforms and the greater accountability put into effect as a result of the Mid Staffs tragedy have any bearing on other areas such as the all-too-prevalent cases of people being injured or even dying as a result of hospital-acquired infections?
Mr Hunt
Absolutely, because this is a package designed to deal with all avoidable harm, and hospital-acquired infections are an avoidable harm. It is designed not only to have much more transparency on the levels of harm in our hospitals, but to make sure that there is a culture of openness so that when people spot things that are going wrong, it is in their interests and in those of their hospital that they speak out. The changes are likely to result in—my hon. Friend will be the first to notice this—an increase in the amount of reported harm over the next few months. That will not be a bad thing, because it will mean that hospitals will be reporting harm that up until now they have not reported. We should welcome the fact that that will then mean that this harm will be addressed.
Sammy Wilson (East Antrim) (DUP)
Although health is devolved to the Northern Ireland Assembly, the culture and its consequences identified by the Francis report can nevertheless occur in the health service anywhere in the United Kingdom. What plans does the Secretary of State have to share the lessons learned and actions taken with the Health Minister in Northern Ireland and, indeed, with all the other devolved Administrations?
Mr Hunt
I am very happy to share any of the lessons we have learned, but I do so from a position of humility, because we still have to address very serious challenges in our NHS in England. It will take us time to sort them out. I am happy to work with any devolved Administrations. Indeed, I would like to work with other countries across the world, because the challenge of how to deliver high-quality, compassionate health care when resources are tight and with an ageing population is one that all countries face.
Andrew George (St Ives) (LD)
The Government’s position on the publication at ward level of safe registered nurse staffing levels is a welcome step in the right direction. My right hon. Friend will be aware that I have consistently argued for safe registered nurse-to-patient ratios at ward level, and no manner of enhancements of culture and leadership can ever be used to mask the risk to patients if there are not enough nurses on the ward. Is he aware that some trusts are conflating trained care assistants with registered nurses, and will he reassure me that, in enumerating the number of registered nurses on wards, trusts cannot conflate trained care assistants, welcome though they are, with registered nurses?
Mr Hunt
My hon. Friend makes a very important point, because in an era of transparency we depend on honesty from the people supplying the information being used. It is not always possible independently to audit every single piece of information. What we have said today is that deliberately supplying false or misleading information will be a criminal offence, which is a much tougher sanction than anything else we are saying today. We think that the most important thing is to establish a culture in which people tell the truth and speak out if there is a problem, because then something can be done about it.
Jenny Chapman (Darlington) (Lab)
There is a great deal to welcome in the Secretary of State’s statement, not least with regard to transparency and complaints. I welcome in particular the comments on staffing, although, obviously, we used to have more nurses than we have now. Will the Secretary of State look at the vetting and barring service, because my understanding is that use of the service and referrals to it have been declining over the past couple of years?
Mr Hunt
I have concerns about how much that service is used. My particular concern is not so much whether employers are checking before they employ someone, but whether they are informing the service that an employee should be referred to it for delivering inappropriate care. That is something that we will look at.
Mr Bernard Jenkin (Harwich and North Essex) (Con)
I remind my right hon. Friend that the Public Administration Committee is conducting an inquiry into complaint-handling across the public service and that Essex recently had an instance of failure at our local hospital, where complaints were not properly handled. How does my right hon. Friend intend to deliver on his statement that “all patients will be able to access independent help in making their complaint”? May I suggest to him that, rather than setting up a new structure or body, perhaps the ombudsman is the right body to help facilitate those complaints, because it would create a one-stop shop for them?
Mr Hunt
We have avoided setting up a new structure or body in our response to the recommendations made by the right hon. Member for Cynon Valley. As for how we will make sure that this happens, I agree with my hon. Friend that the ombudsman is the final port of call if someone is not satisfied with the way in which their complaint has been treated. That is incredibly important, and the ombudsman has herself agreed that she will handle vastly more complaints and go into detail a lot more than she does at present, which is welcome. Prior to that stage, however, lots of people feel that complaining directly to the trust, which has to be the first step, is a very daunting and difficult process and that they want independent help. That is why we have said that it will be an absolute requirement for trusts to show people how they can access that independent help and, indeed, to be prepared to make the finance available so that they get that help. There will also have to be signs on every ward telling people exactly how to do that.
Mr George Mudie (Leeds East) (Lab)
The Secretary of State will agree that the ethos and culture of any organisation start at the top. Over the past three decades, the boards have moved towards being composed more of practitioners and businesses than of consumers and patients. Will he consider putting an independent voice, or independent voices, on the boards so that the complaints go to a board that will listen to and debate them? Will he also consider advising trust boards to set up a formal structure up to board level so that complaints can arrive there, be seen and discussed?
Mr Hunt
The hon. Gentleman is right that reporting back about complaints to board level is a fundamental thing that should happen at every trust. We also need to make sure that all trusts are putting patients first; they will not be able to get a good inspection result from the chief inspector of hospitals unless they do so. The hon. Gentleman will know that the new structure of foundation trusts is designed to make sure that FTs are run for the benefit of their patients by the large number of members who are effectively the governing body of FTs. The hon. Gentleman is also right to say that this is not happening everywhere, and that is why today’s changes will, I hope, make a big difference.
Mr Brian Binley (Northampton South) (Con)
My A and E department has seen a massive 30% increase in patient throughput in recent years and a concerning 16% in recent months. Furthermore, 100 people who do not need medical care are taking up beds. I have recently organised meetings between local government leaders and the chief executive officers of our hospitals to explore other ways of dealing with these problems. Will the Secretary of State accept that more can be done in this respect, and will he tell us what he can do to further that approach?
Mr Hunt
My hon. Friend is absolutely right to focus on those pressures. We have been thinking about this very hard. Over the summer we announced £250 million to be distributed to the 53 A and E economies where the most difficulty is being experienced in meeting high standards for the public, and we are doing more. We are talking to the College of Emergency Medicine. Anything that my hon. Friend can do at a local level will be greatly appreciated. This is going to be a difficult winter and we need to stand full square behind our front-line staff.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Secretary of State just said that Salford Royal hospital is one of the best hospitals in the country and we should learn from what it does. What it does is support minimum safe staffing levels for patients and then publish the actual-versus-planned staffing levels on the wards every day. Staffing levels published on websites is a little step forward, but it is not enough. Why do we not learn from what Salford Royal does? I do not think that patients and their families are interested in what the staffing levels were a month ago; they are interested in what they are today.
Mr Hunt
We have based our recommendation today precisely on what Salford Royal does. It uses the kind of model to ensure minimum recommended staffing levels on every ward that we want every hospital to use. We say that we want those data published monthly, but that is a minimum. Salford Royal publishes them every day, which is very impressive. Given that most hospitals are not using tools anything like as sophisticated as that, it will be a big step up for most hospitals to do that. We want to do it. What is significant about our announcement is that we want to assemble those data for every trust in the country so that they can be compared on a monthly basis and so that people can know how many wards and how many shifts are being safely staffed at their local hospital compared with neighbouring hospitals.
Rehman Chishti (Gillingham and Rainham) (Con)
The Secretary of State will know that Medway Maritime hospital in my constituency had the seventh worst mortality rate in 2005 and 2006, yet nothing was done until he put the hospital into special measures. It is now linked with the outstanding Frimley Park hospital, sharing good practice and turning things around, so that my constituents can get good care, while inspections are also on their way. He said that if hospitals do not turn things around in the short term, they will be put into administration, but what does “short term” mean—is it a year or six months?
Mr Hunt
Our intention is that the maximum period when a hospital is put into special measures should never be longer than a year. After that, if it is not making significant progress, there is the possibility of it being put into administration. The reason for that, precisely as my hon. Friend said, is that we cannot let poor standards and poor care persist over a long period. I am pleased about the progress made at Medway Maritime in recent months; Frimley Park, which is my local hospital, delivers truly outstanding care. He is absolutely right to say that it should never have taken so long to get to the heart of the problem.
Diana Johnson (Kingston upon Hull North) (Lab)
The Secretary of State said that it is impossible to deliver safe care without a safe staffing level, which of course depends on resources. Under the coalition’s new funding formula, Hull NHS is due to lose £28 million, and it will not get any money for the A and E winter pressures that are bound to happen. How does he think that that will help safe staffing levels in Hull?
Mr Hunt
The funding formula is decided independently, and no final decision has been made. The decision will be made by NHS England, which I know is looking at that at the moment. It has to decide equitably across the whole country, based on need, population, social deprivation and other factors. Like the hon. Lady, I am waiting to see what it decides.
David Mowat (Warrington South) (Con)
Some 14% of the entire NHS budget goes on complaints relating to injury compensation. Of that, a third or £4 billion per year goes to lawyers. That diversion of cash away from the front line to lawyers makes it much harder to get the staffing levels that Francis envisaged. Will the Secretary of State address that as part of the wider issue?
Mr Hunt
My hon. Friend is right that it is absolutely shocking that we spend more than £1 billion a year on litigation claims in the NHS. The only long-term way of reducing that bill is to improve the safety record of the NHS, so that we do not have the terrible incidents that lead to high claims. The only way to do that is through openness and transparency, which is why today’s measures will make a big difference.
Nick Smith (Blaenau Gwent) (Lab)
I welcome the proposal on legal sanctions for those found guilty of wilful neglect. In south Wales, police Operation Jasmine has looked at the alleged abuse of elders in care homes. I understand the difficulties, but will today’s announcement help us to hold to account those responsible for corporate neglect in private sector care homes?
Mr Hunt
Absolutely. The Minister of State, Department of Health, who has responsibility for care services, has been very focused on making sure that there is proper corporate accountability. Today, we have announced the new fit and proper persons test that will apply to all organisations delivering care to make sure that directors of companies responsible for care homes and domiciliary services in which poor care happens are properly held to account. That is vital, because there should be no hiding place for people who send signals to their staff that lead to our reading the horror stories that, sadly, we have read.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
To my mind, the issue is about patients having confidence in their local hospital. What can we do to ensure that patients in my constituency have a better understanding of how Derriford hospital is performing and whether it is improving?
Mr Hunt
This is the heart of the change that we are making this year. My hon. Friend and I know exactly how well all the schools in our constituencies are doing, because there are transparent, independent Ofsted ratings, but we do not know how well our local hospitals are doing. We need an expert to go in and look at hospitals and then tell us, in language that non-clinicians can understand, just how well they are doing, as well as what needs to change when they are not doing well. We will get that with the new chief inspector of hospitals.
Emily Thornberry (Islington South and Finsbury) (Lab)
I was struck by the Secretary of State saying that cruelty became normal in the NHS. I do not agree with him and I do not think that the public believe that cruelty has become the norm in the NHS. Most people join the NHS as a calling or a public duty: they believe in kindness and the importance of care.
It seems to me that one of the reasons for cruelty—and it does happen—is the stress of under-staffing. I understand that, as a result of the report, the Secretary of State will publish safe staffing levels ward by ward, but that he will not enforce them. The question that the public want answered is why. How can he, as Secretary of State, be happy to know that wards up and down the country are under-staffed and unsafe, and that he is not doing anything about it?
Mr Hunt
We have had a very bipartisan discussion this afternoon, so I am slightly disappointed that the hon. Lady is twisting my words. I did not say that cruelty became the norm everywhere in the NHS; I said that in places such as Mid Staffs cruelty became normal. If she reads the Francis report, she will find that that is the case.
Trying to duck or run away from that fact is what got us into a great deal of trouble, because we did not deal with the issues in Mid Staffs nearly as quickly as we should have done. On staffing levels, we are doing something that did not happen before. When her Government were in power, we did not know where staffing was unsafe, but now we will know and can do something about it.
Stephen Metcalfe (South Basildon and East Thurrock) (Con)
Will my right hon. Friend confirm that never again will Ministers duck their responsibility to be open and transparent in the reporting of failures, as they perhaps were in relation to Mid Staffs and potentially were in relation to Basildon hospital before 2010?
Mr Hunt
My hon. Friend is absolutely right. It is incredibly important that Ministers never, whether deliberately or inadvertently, give a signal to the system that they do not want poor care to be highlighted as quickly as possible. I am afraid that there is evidence that, whether or not former Ministers intended this, it was interpreted that the emergence of bad news stories would be met with a great deal of ministerial disapproval, and that did enormous damage.
Mr Marcus Jones (Nuneaton) (Con)
Out of Francis has come Keogh, which is leading to seven-day working and more doctors and nurses on the wards at George Eliot hospital. Increasing staffing numbers is important in our NHS, but does my right hon. Friend agree that having the right ratio of staff to suit the needs of individual patients is equally if not more important?
Mr Hunt
That is absolutely vital. I have been to the A and E department in George Eliot hospital, and reports I have heard say that morale is really turning a corner. I want to back the staff: it is incredibly difficult to work in a hospital that has been put into special measures, knowing that everything is not as it should be. They now have a sense that a corner is being turned and that the problems that they have long worried about are finally being addressed, particularly because of the link with University Hospitals Birmingham, which is one of the best in the country.
I agree with my hon. Friend that safe staffing is one of the measures that matters. George Eliot hospital has some pretty antiquated IT systems that mean staff spend much longer than they should filling out forms, rather than spending time with patients.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
Will my right hon. Friend give more details about how we can stop bad leaders and bad providers from working in the NHS? Will he confirm that that change will extend to ambulance trusts as well as to hospitals?
Mr Hunt
The change will absolutely extend to ambulance trusts. I know that my hon. Friend has had experience of poor leadership of ambulance trusts in her area. It will apply to all organisations registered with the Care Quality Commission. There will be a fit and proper persons test, because where people are responsible for poor care, we do not want them to pop up somewhere else in the system.
Guy Opperman (Hexham) (Con)
There has always been a professional duty on medical professionals to advise patients when errors occur; yet we know that that has not always happened. Although all hon. Members welcome the greater candour, transparency and protection in relation to whistleblowers that this Government are proposing through the fit and proper persons test, does the Secretary of State agree that true culture change will not happen unless the views of junior doctors, the staff generally in all hospitals and everyone in the NHS are made as important as the views of those at the very top?
Mr Hunt
My hon. Friend is absolutely right. True culture change is incredibly difficult to achieve unless we get behind the people on the front line and get them to want to change the culture. That is the insight in the report that Professor Berwick delivered in August. That is why today’s response is about backing front-line staff to deliver the care that they want to deliver and to be open when they are worried, and about supporting them in what is a very challenging period for the NHS. If we do not back them to do the right thing, then no matter what happens at the top, we will not see change on the front line.
Mr Philip Hollobone (Kettering) (Con)
I am sure that my constituents will welcome what the Secretary of State has said about transparency and openness, especially with respect to Kettering general hospital. When somebody goes into hospital, they want to have confidence that they will be treated efficiently and with a great deal of care. They get that confidence not just from statistics on the number of nurses or clinicians on a ward, but from the experiences that they hear about from friends and relatives who have been treated at the same hospital. They also get confidence from hearing examples of where things have gone wrong—some things will always go wrong—and that the complaints have been handled quickly and efficiently, and have not been dragged out. Does my right hon. Friend agree that hospitals should provide examples of good care that has gone right to give local people the confidence that their local hospital is doing the very best for them and that, when things do go wrong, people will put their hands up, admit it and deal with it quickly and efficiently?
Mr Hunt
Absolutely. It is a sign of great confidence when a hospital is open about things that have gone wrong. When I meet the top chief executives who are running the best hospitals in the country, I am always struck by how willing they are to be open about the problems that they have had. It is often in the less well-performing hospitals that the management feel less confident and willing to talk about the problems. That culture is really important. I hope that today is a step in the right direction.
Mr Peter Bone (Wellingborough) (Con)
I thank the Secretary of State for coming to the House and making such a detailed statement. I served under the previous Chairman of the Select Committee on Health, the right hon. Member for Rother Valley (Mr Barron), during the inquiry into patient safety. The Secretary of State has a point. The problem at the moment is that people make a complaint after something goes terribly wrong, but the complaints system is deliberately long, drawn-out and delayed. One never actually reaches the ombudsman. If we are to have a change in culture, we have to stop the managements of hospitals delaying the complaints system deliberately.
Mr Hunt
I totally agree with my hon. Friend. That is why I hope that what we have announced today will bring about a transformation in the way in which hospitals manage complaints. Some excellent work has been done to help us do that. The heart of the matter is that hospitals should be really interested in the complaints that they receive, because that will enable them to understand where they are not delivering good care and what they can do to put it right. That does not happen everywhere. Too often, the complaints system is treated as a process, in effect, to fob people off, rather than to get to the heart of what people are talking about. We absolutely need to change that.
Urgent and Emergency Care Review
Jeremy Hunt Excerpts(11 years, 7 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 update the House on Professor Sir Bruce Keogh’s urgent and emergency care review following this morning’s briefing to the media.
The Secretary of State for Health (Mr Jeremy Hunt)
In January this year, the board of NHS England launched a review of urgent and emergency care in England. Urgent and emergency care covers a range of areas, including accident and emergency departments, NHS 111 centres and other emergency telephone services, ambulances, minor injury units, and urgent care centres. The review is being led by Professor Sir Bruce Keogh, NHS England’s medical director. A report on phase 1 of the review is being published tomorrow, and it is embargoed until then. [Interruption.] This is an NHS England report, and NHS England is an independent body, accountable to me through the mandate. The report that will be published tomorrow is a preliminary one, setting out initial thinking. [Interruption.]
Mr Speaker
Order. There are highly charged feelings on this matter, but the Secretary of State has been asked a question, and his reply must be heard.
Mr Hunt
I should underline the fact that this morning’s briefing was under embargo, an embargo which, to my knowledge, has been respected. The final version will be published in the new year.
Sir Bruce has said that he will outline initial proposals and recommendations for the future of urgent and emergency care services in England, which have been informed by an engagement exercise that took place between June and August this year. There will be further consultation on the proposals through a number of channels, including commissioning guidance and demonstrator sites. Another progress report will be produced in the spring of 2014.
Decisions on changing services are made at a local level by commissioners and providers, in consultation with all interested parties. That is exactly as it should be, as only then can the system be responsive to local needs. It is vital to ensure that both urgent and emergency care and the wider health and care system remain sustainable and readily understandable to patients. A and E performance levels have largely been maintained, thanks to the expertise and dedication of NHS staff. A and E departments see 95% of patients within four hours, and the figure has not dropped below the 95% target since the end of April. However, urgent and emergency care is falling behind the public’s needs and expectations.
The number of people going to A and E departments has risen historically, not least because of an ageing population. A million more people are coming through the doors than in 2010. Winter inevitably challenges the system further, which is why we are supporting the most under-pressure A and Es with an additional £250 million. Planning has started earlier than ever this year, and the NHS has been extremely focused on preparing for additional pressure.
We will look at Sir Bruce’s report extremely carefully. Reform of the urgent and emergency care system may take years to complete, but that does not mean that it is not achievable. We are exceptionally fortunate in this country to have in the NHS one of the world’s great institutions. NHS staff are working tirelessly to ensure that the care that people need will continue to be available to them, wherever and whenever they need it.
Andy Burnham
Rarely has this House been treated to a more disrespectful and complacent reply. There are new reports today of 12,000 patients spending 12 hours or more on trolleys in A and E. A and E is in crisis according to the College of Emergency Medicine, and this is before the winter has even started. People are increasingly asking, “Where are the Government and what are they doing about it?” So far all they have heard is, “Crisis? What crisis?” But behind the scenes it is a different story. Such is the panic in Whitehall, the Prime Minister has apparently taken personal charge and this morning the media were given a private briefing on a major review of emergency care. What is going on and why is the Secretary of State running scared, blaming NHS England and trying to keep this House in the dark? It should not be for us to drag the Secretary of State here to give Members information already passed to journalists.
Let me remind the House what the Secretary of State said at Health questions in July. He said that Bruce Keogh’s review
“will report this autumn, precisely so that we can make sure we learn any lessons we need to learn for this winter”.—[Official Report, 13 July 2013; Vol. 566, c. 902.]
To hear him now, it was all about the long term. Let me ask him: what are those lessons, and what immediate action is he now taking ahead of winter?
Weekend briefings suggested Sir Bruce emphasises alternatives to A and E, such as walk-in centres and 111, but Monitor reported yesterday that one in four walk-in centres have been closed and others are today under threat of closure. We need a clear answer. Will the Secretary of State stop further closures of walk-in centres? Does he now accept that his 111 helpline is flawed, and will he put nurses back on the end of the phone, rather than call handlers? And what of the recruitment crisis in A and E? There is a shortage of senior A and E doctors and, according to the Royal College of Nursing, 20,000 too few nurses. Will the Secretary of State give a clear commitment to bring all A and Es back up to safe staffing levels?
Last week, a complacent Prime Minister stood there, told us everything was fine, and even claimed that the average waiting time in A and E had gone down to 50 minutes, but that is not true. I have here a written reply from the public health Minister telling us it has gone up to over two and half hours. When are the Government going to show this House and the country some respect, cut the spin, and give us the real picture about a crisis that is happening right now?
Mr Hunt
Mr Speaker, I will tell the right hon. Gentleman what complacency is: it is refusing to have a public inquiry into Mid Staffs, where staff in A and E departments were bullied and harassed when they tried to speak out. He did not think it was worth having a public inquiry into the poor care that his Government swept under the carpet and which we are doing something about. There is one figure that he refused to mention: the A and E performance figures published last week of 96.4%—hitting the target, higher than the previous week, higher than this time last year. That sums it up: in a good week he wants to run down the performance of hard-working staff whereas this Government are backing them.
Why are we having an A and E review? It is to clear up the mess and confusion caused by 13 years of Labour mismanagement of our emergency services. The right hon. Gentleman talks about walk-in centres. Why were they introduced? Because of the disastrous mistake over the GP contract. The brave thing for his Government to have done would have been to admit they got that wrong and reverse it, but they did not. They introduced a whole new raft of services, which confused the public: A and E, walk-in centres, GP surgeries, telephone helplines. Tomorrow we will sort out those problems. Yes there are difficult decisions, but they are decisions his Government ducked and left the public exposed as a result.
Before the right hon. Gentleman runs down our A and E services, let me just gently remind him that he talked about a recruitment crisis, but we have 300 more A and E consultants than when he was Health Secretary, we have nearly 2,000 more people—[Interruption.] I am sorry that this is difficult for those on the Opposition Front Bench to listen to. We have nearly 2,000 more people being seen within four hours every single day than when the right hon. Gentleman was Health Secretary —that is some 700,000 more people every year. We have more hospital doctors, more hospital nurses, more treatments and fewer long waits than when he was Health Secretary, and he should celebrate that improvement in our NHS’s performance, instead of trying to run down the people on the front line.
I will tell the right hon. Gentleman something else we are doing. We are tackling the long-term causes of pressure in A and E that his Government absolutely failed to do: not just the GP contract but also the integration of the health and social care system, the lack of which means that hospitals are not able to discharge people from their beds on time, causing huge pressure. Today, the shadow Health Secretary has shown his true colours. The man whose Government made so many wrong decisions about A and E is exposed as trying to make political capital while this Government sort out his mess.
David Tredinnick (Bosworth) (Con)
How many extra lives does my right hon. Friend expect to save through consolidating the A and E facilities in London, by having a smaller number of hospitals with more doctors? Does he expect to replicate that across England?
Mr Hunt
My hon. Friend is absolutely right. The changes we announced in north-west London will save hundreds of lives, by using principles that we will hear more of from Sir Bruce tomorrow. In particular, we are putting 800 extra people into out-of-hospital care, which will help the frail elderly, many of whom should never go to A and E—it is the most confusing place that someone with advanced dementia can go. If we can treat them at home, it is better for them and for our hard-working A and E departments.
Mr Ben Bradshaw (Exeter) (Lab)
May I assure the Secretary of State that the people of Exeter are not confused about their walk-in centres, but appreciate them and have been using them in ever-increasing numbers? These centres are now under threat, so will he at least admit that closing NHS walk-in centres and scrapping Labour’s GP access targets has been a dreadful mistake?
Mr Hunt
Perhaps the right hon. Gentleman might like to hear what the British Medical Association said yesterday about walk-in centres. The BMA is not known for its support of Government policies, but it said that urgent care centres
“were often opened in places with little patient demand…The result has been a lot of money being spent on these facilities with some now closing because commissioners have found there is not sufficient demand”.
That is the problem we are sorting out.
Paul Burstow (Sutton and Cheam) (LD)
One long-term cause of pressures in our A and E departments is the lack of parity of esteem between physical and mental health. Does the Secretary of State agree that it is unacceptable that two thirds of people experiencing a mental health crisis do not get access within four hours to a psychiatric assessment? Was it not a failure of the previous Government not to set access standards for people with mental health problems? Is it not time, as the mandate does today, to deliver just that?
Mr Hunt
My right hon. Friend is absolutely right about that. We do need parity of esteem between mental and physical health. The situation puts particular pressure on A and E departments, including the one closest to this House, at St Thomas’s hospital, where people said that the biggest single worry they have and the biggest single thing that makes it difficult for them to meet their targets is the lack of quick access to psychiatric services. We are looking at this matter and he is right to highlight it.
Mr Kevin Barron (Rother Valley) (Lab)
The Minister said that changes taking place in urgent and emergency care are done locally for local need. What does he think of the following statement made by Sir David Nicholson last week before the Select Committee on Health? He said:
“We are bogged down in a morass of competition law…we have competition lawyers all over the place telling us what to do, which is causing enormous difficulty.”
Does the Secretary of State not agree that the Government were warned about that when they brought in the Health and Social Care Act 2012? They were told that competition law was going to create chaos in the NHS, and it is doing exactly that.
Mr Henry Bellingham (North West Norfolk) (Con)
Is the Secretary of State aware that hospitals in Norfolk have recently made it clear to MPs that one of the key drivers of a big increase in people going to A and E is the fact that many people are not going to their doctor? Does he agree that it is essential that the GP contract of 2004 is rewritten so that doctors provide that 24/7 cover? When will he be able to sit down with the BMA and make real progress to right a serious mistake that the Opposition made?
Mr Hunt
My hon. Friend speaks wisely. The most senior A and E doctor in the country, Professor Keith Willett, said that he thought that between 15% and 30% of the people attending A and E could be looked after in the community. This is a root cause of pressure. I am afraid that the Labour party needs to show some humility before it starts whipping up public concern about problems that it had a very big part in making. I am in the process of discussions with the BMA, and I hope my hon. Friend will not have to wait too long for some good news.
Glenda Jackson (Hampstead and Kilburn) (Lab)
Will the Keogh review genuinely examine the lack of parity in respect of those who are physically ill and those who are mentally ill? We are already suffering from a crisis in emergency mental health beds in London and we are seeing an increasing use of A and E departments for those who are mentally ill. Surely we should be looking at an increase in walk-in centres for the mentally ill, which have proven to be remarkably effective in helping those on the brink of a serious fall.
Mr Hunt
The hon. Lady is absolutely right that the urgent emergency care we offer to people with mental health problems is not up to scratch and needs to be a great deal better. Different solutions will be appropriate in different parts of the country, but often going to a normal A and E is not the right approach. We need to consider whether, when people have such conditions, there can be better access to people who know them, their medical history and their condition and who are in a position to advise them in a way that means they do not end up doing what I have seen happening time and again in A and Es, where people end up as frequent fliers, going again and again to an A and E just because there is nowhere else to go. That is one thing that we are trying to sort out tomorrow.
David Rutley (Macclesfield) (Con)
We have heard a lot today about NHS A and E services in England. Will my right hon. Friend tell the House whether there are any lessons to be learned from A and E services in Labour-run Wales?
Mr Dennis Skinner (Bolsover) (Lab)
This Government have been in power for three and a half years. They could have chosen to remedy some of the continuing problems in the health service, but what did they do? They decided to reorganise it from top to bottom. Is there any wonder there is a crisis this winter? Instead of closing A and Es and walk-in centres, why does the Secretary of State not walk away? It would give him more time to count his money.
Mr Hunt
Let me tell the hon. Gentleman that thanks to the reorganisation that he is so bitterly against, we have 5,500 more doctors on the front line and 8,000 fewer managers. We would not be managing to hit our A and E target today if we had not taken the difficult decisions that the Leader of the House took when he was doing my job.
Glyn Davies (Montgomeryshire) (Con)
Geography dictates that my Montgomeryshire constituents depend on A and E services in hospitals in England. Will my right hon. Friend reassure us that devolution will not be allowed to create a health care iron curtain between England and Wales, and will he ensure that decisions on A and E services in Shropshire take account of the interests of my constituents?
Heidi Alexander (Lewisham East) (Lab)
On repeated occasions in this place, the Health Secretary has claimed to be saving A and Es when his proposals would remove intensive care units in many hospitals and allow blue-light ambulances to go sailing past their doors. Will the Health Secretary tell me what his definition of an A and E is?
Mr Speaker
Order. I can scarcely hear the Secretary of State’s answers, and I want to hear them. Let us hear the response.
Mr Hunt
Thank you, Mr Speaker.
The hon. Member for Lewisham East (Heidi Alexander) will know that her constituents have some of the best stroke survival rates in England because we reduced the number of hospitals in London offering stroke services from 32 to eight. I am not going to stand in the way of those changes if they save lives.
Jeremy Lefroy (Stafford) (Con)
I very much look forward to the review, which is urgent. Given that accident and emergency departments do not operate in isolation, will the Secretary of State assure me that the review will consider the whole system, including support services, critical care units and the availability of specialist consultants—particularly those in paediatrics—who need to be available for an A and E to function effectively?
Mr Hunt
No one has campaigned more assiduously than my hon. Friend for his local hospital, despite the incredible tragedies and difficulties that it has been through and the pressures that has created for the people of Stafford. He is absolutely right: if we are going to solve the problem, we must consider the system holistically and consider how different A and E departments can specialise services. We need much more of a hub-and-spoke system, rather than one where every A and E has to offer exactly the same menu of services. If we do that, we will save more lives and that has to be the right thing to do.
Mr Pat McFadden (Wolverhampton South East) (Lab)
Following Monitor’s report yesterday on the closure of walk-in centres, is it not the case that at the heart of the Government’s NHS reforms is a massive shift in power from the consumers—the patients—to the producers of services? When the Government’s slogan is, in effect, “All power to the producers”, it is not surprising that services have been reorganised in a way that does not benefit patients. May I suggest that instead of sticking up for the BMA, the Secretary of State starts to stick up for patients?
Mr Hunt
After what happened at Mid Staffs, we will not take any lessons on sticking up for patients—none whatsoever. We are taking the power out of the hands of the managers in PCTs and SHAs and putting it into the hands of doctors on the front line who are seeing patients every day. That is the best thing we can possibly do.
Bob Stewart (Beckenham) (Con)
My constituents tell me that they much prefer to go to their doctor than to any other centre. Will the Secretary of State try to get more doctors involved in out-of-hours care?
Mr Hunt
That is the tragedy of what happened in 2004, when the personal link between doctor and patient was broken because the previous Government abolished named GPs for every patient. My hon. Friend speaks very wisely, as that is exactly what most members of the public want—they want to be able to get in and see their own GP quickly and easily. That is at the heart of the problem that tomorrow’s review of A and E will seek to address.
Caroline Lucas (Brighton, Pavilion) (Green)
Notwithstanding the brilliant local work of nurses and doctors, hospitals like those in the Brighton and Sussex University Hospitals NHS Trust face real challenges, including bed shortages and people having to wait for many hours for tests such as X-rays and so on. Sometimes, people wait in A and E for 12 hours for a bed. Does that not demonstrate how reckless and dangerous it is for the Secretary of State’s Department to impose cuts of £30 million on that hospital trust this year and next year, and will he reconsider?
Mr Hunt
Let me gently remind the hon. Lady that we have protected the NHS budget—we took a very difficult decision—but how the NHS budget is spent in local areas is a matter for local discretion. It is challenging for all hospitals, because if we are to address the long-term stability of the NHS we need to spend more money out of hospitals, which means finding efficiency savings in hospitals. We do not want to duck those challenges, which is why we are having the review that will be published tomorrow.
Angie Bray (Ealing Central and Acton) (Con)
My right hon. Friend will be aware that there are concerns about whether blue-light ambulance services will continue to define what an A and E is. Does he agree that for some years now victims of stroke, trauma and other serious problems have not necessarily gone to their local A and E but to specialist hospitals, and that that has been the reason behind the excellent improvement in outcomes?
Mr Hunt
My hon. Friend speaks extremely wisely. We have talked about stroke, so let me give another example, which is trauma. We have cut mortality rates by 20% as the result of a strategy to specialise trauma care. Those are the difficult decisions that the Government believe that we should not duck and that we need to face up to. If I may say so, when the Opposition were in power, they took a slightly wiser approach to the issue than the party political posturing we are getting today.
Graham Jones (Hyndburn) (Lab)
The Secretary of State earlier quoted the suggestion that GP walk-in centres were in the wrong places, where there was little demand. Last year, 33,000 people used the under-threat Accrington Victoria hospital walk-in centre, and now there is deep anger with the Conservative party. Will he explain how 36,000 people going to overstretched Royal Blackburn hospital A and E will help the situation there?
Mr Hunt
The hon. Gentleman makes my point for me extremely eloquently. Under the previous Government, we had a top-down, ham-fisted policy of opening walk-in centres everywhere as a sticking plaster solution to the disasters with their GP contract. Sometimes they were valuable services, sometimes they were not. We are clearing up the mess, but sometimes, when those centres are useful and important for the public, we will keep them.
Martin Horwood (Cheltenham) (LD)
The origins of the recruitment crisis in A and E obviously predate this Government. Will Sir Bruce Keogh’s review highlight the local trusts, like that in Gloucestershire, which appear to have significantly worse recruitment and retention records than neighbouring trusts and have used it as a rationale for downgrading services—such as, in this case, those at Cheltenham general hospital?
Mr Hunt
I hope that it will. I hope that it will give clarity about the long-term future for A and E departments, which has been a difficult issue for this Government and for the previous Government. What people want is stability, and they want to know that there is a Government who are prepared to face up to difficult decisions. They want to know that they have a future, and I hope that tomorrow’s review is the first step towards providing that security.
Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)
Is the Secretary of State aware that the A and E crisis is creating a huge backlog in specialist procedures, and will Sir Bruce Keogh’s review take that into account?
Mr Hunt
The number of people waiting more than a year for an operation has gone down from 18,000, when the hon. Gentleman’s Government were in power, to fewer than 1,000 now. We have reduced long waits at a time of great pressure on the NHS, so I do not recognise the hon. Gentleman’s figures at all, I am afraid.
Mr Lee Scott (Ilford North) (Con)
My right hon. Friend will have seen the disastrous reports that have come in about Barking, Havering and Redbridge University Hospitals NHS Trust, with some of the most alarming things including a report of a baby being put in a stationery cupboard. I am sure that, as he said in a recent debate, he will conduct a full review of King George hospital. Can that be done urgently, as we are now in a very serious situation?
Mr Hunt
I pay tribute to my hon. Friend for raising both publicly and privately his concerns about the hospital provision that his constituents face. We shall of course make sure that there is a proper review before any service changes are made. I hope that he will be reassured by the big change that happened this year with the introduction of an independent chief inspector of hospitals, who is going round the country rooting out poor care, not sweeping it under the carpet, as happened so often under the Labour Government.
Derek Twigg (Halton) (Lab)
Does the Secretary of State regret the loss of 6,000 nursing jobs since the last election?
Mr Philip Hollobone (Kettering) (Con)
The three Members for north Northamptonshire— the hon. Member for Corby (Andy Sawford), my hon. Friend the Member for Wellingborough (Mr Bone) and I—have come together on a cross-party basis, and are working with local clinical commissioning groups and Kettering general hospital to try to attract more investment to our local A and E because of the increase in the local population. May I share with the Secretary of State the fact that all agree that up to a third of attendees at A and E could be better treated closer to home, particularly in excellent urgent care centres such as that in Corby?
Mr Hunt
My hon. Friend speaks extremely wisely. He invited me to visit Kettering hospital, and I saw for myself that it was a very, very busy hospital. In the end, if we just stick with the current model we will reach bursting point, which is why we need to look at new models. That is why tomorrow’s review is important, and part of that—in fact, the bulk of the work in tomorrow’s review—is about how we transform out-of-hospital care, which is the big strategic change that we need to make in our NHS, and on which I am afraid the previous Government made so little progress.
Nic Dakin (Scunthorpe) (Lab)
Tomorrow’s review is supposed to deal with issues to do with this winter. Will the Secretary of State give the House an assurance that there will be no crisis of A and E on his watch this winter?
Mr Hunt
A and E departments are under huge pressure. We are seeing about 1 million more people every year than three years ago, and we have done more this year than has ever been done in NHS history to help to prepare the NHS for winter, including giving £250 million to 53 local health economies where the pressures are greatest. We continue to monitor the situation very, very closely to give more support where we can.
Alex Cunningham (Stockton North) (Lab)
The crisis in nurse vacancies and recruitment highlighted today by the Royal College of Nursing affects the North Tees and Hartlepool NHS Foundation Trust, which tells me that it has been forced to recruit trained nurses from the Philippines, as there are insufficient UK nurses available. What is the Secretary of State doing to address that particular part of his failure?
Mr Hunt
I have to gently say to the hon. Gentleman that recruiting nurses from the Philippines did not happen for the first time under this Government. One reason why those nurse vacancies have gone up is that the Government decided to conduct a public inquiry into what happened at Mid Staffs. The system reacts to that by wanting to hire more nurses, and I think that he should welcome that, not criticise it.
Barbara Keeley (Worsley and Eccles South) (Lab)
The report by the Health Select Committee on the A and E crisis found that only 16% of hospitals had the right level of consultant cover in A and E. Yesterday, we learned that half the vacancies for senior A and E doctors are unfilled, as doctors move to work overseas. The issue of staffing in A and E has been understood for the past three and half years, and there have been repeated warnings and reports. What has the Secretary of State done to address it and make sure that A and E wards have sufficient staff cover?
Jenny Chapman (Darlington) (Lab)
What has the Secretary of State got to say about the fact that in my area, compared with four years ago, it is harder to get a GP appointment. We no longer have NHS Direct, and cuts in adult social care mean that patients are not making room for other patients to go to A and E. The person raising that with me is the chief superintendant of Darlington police, who is fed up with his officers being held up by taking patients to A and E, as those patients would otherwise wait more than an hour for an ambulance?
Mr Hunt
The hon. Lady makes some important points, and I congratulate her on being the first Opposition Member to raise the fact that it has become harder and harder to get an appointment with a GP. [Interruption.] I know that it is hard to accept, but it is a fundamental problem, and a challenge facing our A and E departments that the Government are determined to sort out.
Jim Shannon (Strangford) (DUP)
Before tomorrow’s report on the urgent and emergency care review, may I tell the House that in Northern Ireland, we treat urgent referrals by direction to the doctor on call and linking up with the chemist. Emergency referrals are done through hospitals, showing good practice and delivery. Is the Secretary of State prepared to contact the Northern Ireland Assembly and the Minister responsible to see how best practice works?
Mr Hunt
I am in regular contact with the Northern Ireland Minister for Health, Social Services and Public Safety about good practice in Northern Ireland, and I am delighted to hear that they are doing some good things in urgent and emergency care. We should be open to all good practice, not just in our country but all over the world.
Mr Andy Slaughter (Hammersmith) (Lab)
The Secretary of State may have seen the report in The Sunday Times at the weekend about the dispute between the medical director for London, who said that 20% to 30% of blue-light A and Es should close, and Sir Bruce Keogh, who said that less than that should close. Disgracefully, the Secretary of State has not told us what is in Sir Bruce Keogh’s report, but we know that it is below that figure, so why did he announce to the House two weeks ago that four out of nine—45%—of blue-light A and Es in west London would close, pre-empting the Keogh review?
Mr Hunt
Because it is going to save the lives of the hon. Gentleman’s constituents; it will mean that 800 more people are employed in out-of-hospital care; it will mean three brand-new hospitals for the benefit of his constituents; it will mean seven-day working; and it will mean seven-day opening of GP surgeries. That is why.
Kevin Brennan (Cardiff West) (Lab)
On reflection, does the Secretary of State regret the fact that he described people who felt ill enough to have to go to A and E on a number of occasions as “frequent flyers”? And would he like to apologise?
Mr Hunt
I am sorry, that is a completely ridiculous thing to say. I was using the phrase to talk about people who have to go back to the NHS time and again. The whole purpose of the reforms is to make sure that we give a better service to people who regularly use the NHS, and he should understand perfectly well what I was talking about.
Paul Goggins (Wythenshawe and Sale East) (Lab)
What discussions has the Secretary of State had with his colleagues across government about the need for urgent additional investment in social care? Surely he appreciates that the savage cuts to local authority social care budgets have only added to the pressure on accident and emergency units.
Mr Hunt
I find it a little difficult to take a lesson from the right hon. Gentleman, as his Government cut social care funding per head when they were in power and when the economy was in much better shape than it has been since the financial collapse that they caused. If he looks at what we announced this summer, he will know that the Chancellor announced an extra £2 billion of support for the NHS budget going into social care to deal with precisely the problems that he raised.
Mr Virendra Sharma (Ealing, Southall) (Lab)
Last week, the Secretary of State assured—[Interruption.]
Mr Sharma
Last week the Secretary of State assured me that A and E at Ealing hospital is safe, but since then we have heard very confusing and contradictory statements in the local area. First, will the Secretary of State reassure us today that the A and E department at Ealing hospital is safe in the future? Secondly, will he meet me and my colleagues from the west London area—I have written to him—to discuss our concerns and so that we can express our feelings?
Mr Hunt
I am always happy to meet colleagues if they have concerns about what is happening in their constituency, but I absolutely stand by what I said. There will remain an A and E at Ealing. That was the decision that I made because I wanted to give clarity, but I also said that the shape and size of that A and E may change in accordance with the announcement that is being made tomorrow by Sir Bruce Keogh. I hope that will give the hon. Gentleman further clarity and further certainty to reassure his constituents.
Bill Esterson (Sefton Central) (Lab)
The Secretary of State has already acknowledged that keeping people in their own home is one important way to relieve the pressure on A and E. I do not understand why, if he wants to make a real difference, he will not reinvest the NHS underspend to make up for the cuts in local government and put it into social care.
Mr Hunt
We have put in an additional £2 billion—that makes a total of £3.8 billion being invested to support the social care budget. That is significant because it is recurring expenditure. We have shown our commitment by continuing to support the social care system through this Parliament. The trouble with underspends is that they depend on how many resources we have in any particular year. It is therefore much harder to invest off the back of them.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
The Secretary of State has spoken about the importance of continuing care from one’s own GP to limit admissions to A and E, yet in Hackney, when GPs tried to take over and run the out-of-hours service, the commissioners were paralysed by the fear of legal challenge and, rather than putting patients’ interests first, put the rich lawyers’ interests first.
Steve Rotheram (Liverpool, Walton) (Lab)
This Secretary of State has been forced to answer more urgent questions in the House than even the Prime Minister about Mrs Bone. When will he stop blaming others about the mess he has made of our NHS, take some responsibility for the top-down reorganisation and get on with the job that he has been over-promoted to do?
Mr Hunt
Let me tell the hon. Gentleman how well the NHS is doing. If one listens to the rhetoric from the Opposition Benches, one could completely underestimate the hard work of people on the front line. There are 800,000 more operations being carried out every year in the NHS than ever happened under Labour. At the same time, long waits for operations have gone down. I think that is something to be proud of.
John Woodcock (Barrow and Furness) (Lab/Co-op)
The response that the public health Minister gave to my written question showed that ambulance response times have increased over the past two years in 11 out of 12 trusts in England. Why is this happening?
Mr Hunt
Just as there is more pressure on A and E departments, there is also more pressure on ambulance services. We are treating that as very much part of how we support accident and emergency services over the coming period. There are particular pressures in the London area, the east of England and the east midlands, and we are doing everything we can to put those problems right.
Helen Jones (Warrington North) (Lab)
The Secretary of State referred to the Chancellor’s recent announcement about money for social care, yet this is only a tiny fraction of what the Government have already taken out of the social care budget through their 30% cuts to councils. Did he not realise the impact that that would have on A and E, or did he just not care about it?
Mr Hunt
I am very conscious of the pressure that having to sort out Labour’s deficit is creating on all Government Departments, but the Opposition cannot have it both ways. They cannot say that they are in favour of fiscal responsibility and then complain about every single cut. The difficult decision that this Government took was to protect the NHS budget. That is something that the Opposition did not agree with. They wanted to cut the budget from its current levels.