Pay Review Bodies
Jeremy Hunt Excerpts(12 years, 4 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I am responding on behalf of my right hon. Friend the Prime Minister to the 28th report of the NHS Pay Review Body (NHSPRB) and to the 42nd report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The reports have been laid before Parliament today (Cm 8831 and Cm 8832). Copies of the reports are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
NHS Pay Review Body
We thank the NHS Pay Review Body for its 28th report and note its recommendations and observations.
We are clear that in the wake of the public inquiry into Mid Staffordshire NHS Foundation Trust, our first priority must be to ensure that the NHS can afford to employ the right number of frontline staff needed to ensure the safe, effective and compassionate care that patients have a right to expect.
The NHSPRB’s recommendations for a 1% consolidated rise for all staff, on top of automatic increments, are unaffordable and would risk the quality of patient care. Without a pay rise, incremental pay increases already commit nearly £1 billion every year for all NHS employees and add 2% each year to the NHS pay bill for Agenda for Change staff. The PRB proposals suggest a pay rise that would risk reductions in front-line staff that could lead to unsafe patient care. It is not possible to maintain appropriate numbers of front-line staff, give a general pay rise of 1 % and pay for incremental progression.
The Government are therefore adopting an approach by which all staff will receive at least an additional 1% of their basic pay next year. All staff who are not eligible to receive incremental pay will be given a 1% non-consolidated payment in 2014-15. Other staff will receive an increase of at least 1% through incremental progression.
It is our intention that in 2015-16 the same approach will apply and staff who are not eligible to receive incremental pay will receive a non-consolidated payment of 2% of pay, while other staff receive incremental progression. As this will be a two-year pay award, the NHSPRB will not be asked to make recommendations on a pay award for Agenda for Change staff in the 2015 pay round.
NHS staff are dedicated and hard working and the Government would prefer all NHS staff to receive a consolidated 1% increase. This would be affordable if incremental progression was frozen for one year in 2015-16. If the NHS trade unions were prepared to agree to this then the Government would be prepared to reconsider the position and make a consolidated award as other public sector work forces are receiving.
The Government agree with NHSPRB’s observation that a thorough review is required of the Agenda for Change pay structure, including the operation of incremental scales, so that it might better support the challenges facing the NHS in terms of both patient care and affordability.
We note its offer to look into this, given an appropriate remit and evidence and we will consider whether to ask them to look at contract reform issues in next year’s report.
Review Body on Doctors’ and Dentists’ Remuneration
We thank the Review Body on Doctors’ and Dentists’ Remuneration for its 42nd report, note its recommendations and observations, and:
in respect of general medical practitioners (GMPs), we accept its recommendation for an increase of 1% to general medical practitioners’ income after allowing for movement in their expenses, equating to an uplift of 0.28% to the overall value of general medical services contract payments for 2014-15; and
in respect of general dental practitioners (GDPs), we accept its recommendation for an increase of 1% to general dental practitioners’ income after allowing for movement in their expenses, but abate the increase in the general dental service contract for GDP staff costs from the recommended 2.5% to 1%. This results in an overall uplift of 1.6% to be applied to gross earnings for independent dental contractors for 2014-15.
In respect of employed doctors and dentists, we are clear that in the wake of the public inquiry into Mid Staffordshire NHS Foundation Trust, our first priority must be to ensure that the NHS can afford to employ the right number of front-line staff needed to ensure the safe, effective and compassionate care that patients have a right to expect.
The DDRB’s recommendations for a 1% consolidated rise for all staff, on top of automatic increments, are unaffordable and would risk the quality of patient care. Without a pay rise, incremental pay increases already commit nearly £1 billion every year for all NHS employees and add 2% each year to the NHS pay bill for employed doctors and dentists. The DDRB proposals suggest a pay rise that would risk reductions in front-line staff that could lead to unsafe patient care. It is not possible to maintain appropriate numbers of front-line staff, give a general pay rise of 1% and pay for incremental progression.
The Government are therefore adopting an approach by which all staff will receive at least an additional 1% of their basic pay next year. All staff who are not eligible to receive incremental pay will be given a 1% non-consolidated payment in 2014-15. Other staff will receive an increase of at least 1% through incremental progression.
It is our intention that in 2015-16 the same approach will apply and staff who are not eligible to receive incremental pay will receive a non-consolidated payment of 2% of pay, while other staff receive incremental progression. As this will be a two-year pay award, the DDRB will not be asked to make recommendations on a pay award for employed doctors and dentists in the 2015 pay round.
NHS staff are dedicated and hard working and the Government would prefer all NHS staff to receive a consolidated 1% increase. This would be affordable if incremental progression was frozen for one year in 2015-16. If the NHS trade unions were prepared to agree to this then the Government would be prepared to reconsider the position and make a consolidated award as other public sector work forces are receiving.
We note that the DDRB would welcome a proactive and systematic approach to considering contractual issues at an appropriate stage of the consultant and doctors in training negotiations and we will consider whether to make this part of their remit for the 2015 pay round.
Care Bill [Lords]
Jeremy Hunt Excerpts(12 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move, That the Bill be now read the Third time.
The Bill will bring about the most profound change in the care system for a generation. It provides certainty on care costs that has never been available before; independent and transparent inspections to drive up the quality of care; integration of the health and social care in a way that has been talked about for years but never delivered; and real patient empowerment to put people firmly in the driving seat for their care planning.
The Bill will also implement or help to implement many key recommendations made in the Francis report following the shocking failings at Mid Staffordshire NHS foundation trust. We are also establishing vital new principles for dealing with failure where it occurs, most notably the requirement and ability to deal with unsafe care quickly before lives are lost unnecessarily.
I thank all those who have been involved in considering and scrutinising the Bill, including my predecessor, who was responsible for originating it, together with my right hon. Friend the Member for Sutton and Cheam (Paul Burstow). I particularly wish to thank the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), and the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) for their herculean efforts in Committee and today to ensure that the Bill returns to the other place in the best possible state. There was a well-informed and rich debate on this landmark piece of legislation, for which I thank Members on both sides of the House.
We know that in the next 20 years, 1.4 million more people are likely to need care and support. The Bill prepares our country for that change with the most comprehensive reform of social care legislation in more than 60 years, creating for the first time a single, modern statute for adult care and support that is focused around the person, not the service. Meanwhile the new £3.8 billion merger of health and care services will allow the delivery of seamless, co-ordinated, whole-person care for those in need. In doing so, we will be realising a vision that was talked of for 13 years by the previous Government and actioned in three by this one.
Crucially, these reforms make a reality of the proposals of the Commission on the Funding of Care and Support, chaired by Andrew Dilnot. Many older people and people with disabilities face catastrophic and potentially ruinous bills for their care and support. The Dilnot commission judged quite simply that the current funding system is not fit for purpose. The Government have listened to the commission’s advice, have acted, and are implementing its recommendations. For the first time, a cap on care costs at £72,000 in today’s prices will provide protection to every single person in England. People who have worked hard all their lives need no longer fear that they will lose everything just because they are unlucky enough to develop care needs beyond any reasonable budget.
The difficult decisions the Government have taken on public spending have enabled us to pledge £2 billion per year to fund this cap, from which more than 100,000 people will directly benefit financially. What is more, we are raising the threshold for the means test for help with residential care, so that in 2016-17 alone, up to 35,000 more people will receive support with their care costs. Our universal deferred payment scheme will put an end to people being forced to sell their homes in their lifetime to pay for their care.
People often enter care at a point of crisis, and at a time of great distress. These reforms will create a better, fairer system, enabling people to grow old, safe in the knowledge that they will receive the care they need without facing unlimited costs. Combined with the Government’s wider moves to protect pensions and improve care standards, we are determined to fulfil our vision to make Britain the best country in the world to grow old in.
Sarah Newton
I had the great privilege to serve in Committee, during which the Minister of State, Department of Health, my hon. Friend the hon. Member for North Norfolk (Norman Lamb) expressed support for my view that if the pilots prove successful, we should be able to provide free social care at the end of life to allow more people to die with dignity at home. Would my right hon. Friend commit to that this evening?
Mr Hunt
I thank my hon. Friend for her work in Committee. That is an aspiration that we all share, and some of the results from the pilots are extremely encouraging in terms of the extra care and support we are able to give people. End-of-life care is a priority for everyone, so I share her enthusiasm that we can make progress on that very important area.
Financial security must be combined with confidence in the standard of care received. A year on from the Francis report, we are debating a Bill that will help us to deliver 61 commitments that we made in response to it. We are restoring and strengthening a culture of compassionate care in our health and care system.
Robert Francis’s report said that the public should always be confident that health care assistants have had the training they need to provide safe care. The Bill will allow us to appoint bodies to set the standards for the training of health care assistants and social care support workers. These will be the foundation of the new care certificate, which will provide clear evidence to patients that the person in front of them has the skills, knowledge and behaviours to provide compassionate high-quality care and support.
New fundamental standards will ensure that all patients get the care experience for which the NHS, at its best, is known. In his report, Robert Francis identified a lack of openness extending from the wards of Mid Staffs to the corridors of Whitehall. We want to ensure that patients are given the truth when things go wrong, so the Bill introduces a requirement for a statutory duty of candour which applies to all providers of care registered with the CQC. The Francis inquiry also found that providing false or misleading information allows poor and dangerous care to continue. We want to ensure that organisations are honest in the information they supply under legal obligation, so the Bill introduces a new criminal offence for care providers that supply or publish certain types of false or misleading information.
The care.data programme will alert the NHS to where standards drop and enable it to take prompt action. To succeed, it is vital that the programme gives patients confidence in the way their data are used. For that reason we have today amended the Bill to provide rock-solid assurance that confidential patient information will not be sold for commercial insurance purposes.
Patients also need to have confidence that where there are failings in care they will be dealt with swiftly. At Mid Staffs that took far too long. That is why the Care Bill requires the CQC to appoint three chief inspectors to act as the nation’s whistleblowers-in-chief. Their existence has started to drive up standards even in the short time they have been in their jobs.
Perhaps most fundamentally, the Bill re-establishes the CQC as an independent inspectorate, free from political interference. The Bill will remove nine powers of the Secretary of State to intervene in the CQC to ensure that it can operate without fear or favour. The Bill will also give the CQC the power to instigate a new failure regime and will give Monitor greater powers to intervene in those hospitals that are found to be failing to deliver safe and compassionate care to their patients. For the most seriously challenged NHS providers, there needs to be a clear end point when such interventions have not worked. The Bill makes vital changes to the trust special administration regime, established by the Labour party in 2009, to ensure that an administrator is able to look beyond the boundaries of the trust in administration to find a solution that delivers the best overall outcome for the local population.
Jim Dowd
I realise that the Secretary of State was not in office when the TSA process was started in the South London Healthcare NHS Trust, but he did accept the report of the administrator and, of course, appealed against the High Court decision that found against him. Will he clarify and put on the record that it is the coalition Government’s view, and the view of their constituent parties, that the people of Lewisham should not have an accident and emergency unit; should not have a maternity unit; should not have a paediatric specialty; and that two thirds of the hospital site should be sold off? Those were the recommendations of the TSA, which he wanted to accept.
Mr Hunt
Let me first tell the hon. Gentleman that the TSA did not recommend the closure of the A and E unit at Lewisham hospital, and he knows that perfectly well.
I will say what this Government are determined to ensure does not happen again. Mid Staffs went on for four years before a stop was put to it. Patients’ lives were put at risk and patients died because the problem was not tackled quickly. The point of these changes today is to ensure that, when all NHS resources are devoted to trying to solve a problem and they fail, after a limited period of time it will be possible to take the measures necessary to ensure that patients are safe. I put it to the hon. Gentleman and to all Opposition Members that if they were in power now they would not be making the arguments that they have been making this afternoon, because it is patently ridiculous to say that we will always be able to solve a problem without reference to the wider health economy. They know that: it was in the guidance that they produced for Parliament when they introduced the original TSA recommendations. What Government Members stand for is sorting out these problems quickly and not letting them drag on in a way that is dangerous for patients.
Andrew George
Following the concessions announced by the Under-Secretary in the previous debate, do I understand correctly that if the TSA makes recommendations to a non-failing trust to its detriment and the trust objects to those proposals, NHS England can, through its arbitration process, impose those changes?
Mr Hunt
Let me clarify, but first let me add that we want to listen to the consultation that will be led by my right hon. Friend the Member for Sutton and Cheam and the new Committee that he chairs. We are requiring local clinical commissioning groups and GP groups to come to an agreement on the right way forward in these difficult situations. We need an arbitration system for when agreement is not possible, which this clause allows for. We would like there to be agreement but we cannot allow a situation where, when there is not an agreement, we end up with paralysis and being unable to sort out the problem of a trust that is failing, particularly when it is unsafe and patients’ lives are being put at risk. That is exactly what was happening in the South London Healthcare NHS Trust.
As the Bill leaves the House to return to the other place for the final stages of its passage, we can be justly proud. This is a landmark piece of legislation that will transform the experience of those who rely on the NHS and care systems by giving patients and their carers both legal rights and a much better joined-up service. It will reduce the money wasted on duplication and allow more resources to be directed at the front line. It will remove the uncertainty and worry of unpredictable care costs in later life and will put individuals at the heart of a system built around their needs and not its own priorities.
Most of all it will send a signal loud and clear that when it comes to the challenge of treating an ageing population with dignity, compassion and respect, this House has not shirked its responsibilities but has risen confidently to the challenge.
Andy Burnham
My hon. Friend’s intervention brings me to my second reason for thinking that the Bill is not what it seems. The changes in eligibility for social care expose more people to social care charges than was the case before the present Government came to office, and, as has been demonstrated by my hon. Friend the Member for Leicester West, those charges are increasing above inflation. More people are paying care charges, and paying them at a higher level. The care cap is not what it seems. In fact, as my hon. Friend has consistently argued, it is a care con. The Secretary of State said today that the Bill would give people certainty about what they would pay—
Andy Burnham
The Secretary of State says yes, but I am afraid that it will not. The £72,000 cap is based on a local authority average, not on the actual amount that people will pay for care. So no, the Bill will not give them that certainty. The Secretary of State also said that people would not lose everything to pay for care. Let us take him at his word, and assume that £72,000 is the maximum that a person can pay, and £144,000 is the maximum for a couple. In my constituency, that would indeed mean people losing everything that they had worked for, although it might not mean that in the Secretary of State’s constituency or in other parts of the country. The Secretary of State needs to be honest with people. That is why we are saying that the Bill is not what it seems.
Andy Burnham
No I will not, as the hon. Gentleman has not been here all afternoon.
The third area is the claims that the Bill will improve regulation. Let me ask a direct question: if this is about improving the quality of services, why remove from the CQC the responsibility to provide oversight of local authority commissioning? Why do that if this Bill is about improving regulation? Why leave local government free to do what they like at a local level—to commission for 15-minute visits or for staff on zero-hours contracts—when we have seen the failures at Winterbourne View and other places? Why remove that important role from the CQC?
Andy Burnham
We have never had a proper answer to that. I hope we are about to get one.
Andy Burnham
The right hon. Gentleman has not answered the question. There was a responsibility on the CQC to provide oversight of local authority commissioning. This Bill removes it. Why does it do that? It is a backward step in my view.
The fourth area is that, in respect of the care data scheme, the Bill fails to provide the assurances the Government tried to herald in the press a few days ago—to borrow the Secretary of State’s words today, a “rock-solid assurance” that data could never be passed to commercial insurance companies. I do not believe it is possible to claim that new clause 34, which has now been added to the Bill, does that. It just has general aims around the promotion of health. That does not stop data being passed to private health insurance companies. Again, I do not think the Bill does what the Secretary of State claims it does.
The fifth area I want to challenge the Government on is the whole question we have just been debating. This goes to the heart of where the coalition began, which was that local people would be in the driving seat and local GPs would be in control. The coalition agreement said the Government would end centrally dictated closures. Well, they have ripped all that up this afternoon by passing clause 119 and keeping it in the Bill. They claimed they were just doing what we left behind. That is not the case, because the High Court told them otherwise. The High Court told them they had gone beyond the powers I had created in 2009. The Secretary of State was unable to answer that. He said everything was our fault—it is never their fault or his fault. Well, how about him listening to the Court? How about him reading the clause that we passed before he tried to close or downgrade Lewisham’s A and E? Would that not have been a good thing to do? He did not do that, however. He tried to plough on and downgrade a successful A and E in the teeth of opposition and he got found out. Yet he comes back here today and just thinks arrogantly he can ram the same powers back through this Parliament.
What we have seen today from the right hon. Member for Sutton and Cheam (Paul Burstow), who positioned himself as though he was going to make a stand for local involvement in the NHS, is the worst kind of collusion and sell-out of our national health service. Just as the Liberal Democrats voted for the Health and Social Care Act, again they have backed tonight the break-up of the NHS. In the last few days the right hon. Gentleman has been asking for all these signatures from all over the country—148,000 people to sign his petition—just so, it seems, that he could get a new job working within the coalition. I am not sure they are going to feel well represented this evening.
Mr Hunt
The shadow Secretary of State is bandying around some big words like “arrogant” so will he now show some humility and recognise that every single one of the 14 hospitals in special measures had warning signs when Labour was in office and Labour failed to sort out those problems?
Andy Burnham
We took action to address care standards in the NHS. The right hon. Gentleman is trying to politicise care failure. The Labour Government inherited the Bristol Royal infirmary scandal from the previous Conservative Government, along with the scandal at Alder Hey and the Shipman murders, but we did not try to politicise those failings. The Secretary of State is trying to politicise such failings today, however.
The Lib Dems have shown again tonight that they simply cannot be trusted to stand up for the national health service. There is only one party in this House that will do that, and that is the Labour party represented on these Benches. The next Labour Government will repeal the Health and Social Care Act and restore the right values to the heart of the NHS. In so doing, we will also repeal clause 119 of this Bill. We will take the powers that the Secretary of State has taken for himself today and hand them back to local people.
We will not get the care that we want until we are able to face up to the care crisis that this country now has. Our argument is that the full integration of health and care is the only way to reshape services around the person. That is the only way to go, and we will give a full green light to NHS organisations to collaborate and integrate, instead of working with the market regime that this Government have introduced. We have had the ludicrous spectacle of the Competition Commission telling two hospitals that wanted to collaborate that they could not do so because it would be anti-competitive. That is the reality of the NHS that this Government have created. That is the nonsense that people are facing on the ground. Only when we repeal the Health and Social Care Act and get rid of the powers that the Secretary of State has taken for himself today will we put the NHS back on the right path, away from the path towards fragmentation and privatisation, and begin to build a 21st-century NHS.
Francis Report
Jeremy Hunt Excerpts(12 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move,
That this House has considered the matter of the Francis Report: One year on.
A year on from the Francis report, let us remember that we stand here today thanks to the courage of a few lonely voices who fought against the odds to be heard as they campaigned against appalling neglect and abuse at the heart of our national health service. They had a truth to be told, they refused to be ignored, they stood up to a mighty system, and when they were turned away by regulators, NHS leaders and Ministers, they just came back speaking even louder—people such as Julie Bailey and Helene Donnelly, both of whom received honours this year, and thousands more who wrote and campaigned for loved ones, not because they wanted a penny of compensation but because they wanted to prevent this tragedy from ever happening again.
The last Government repeatedly refused to set up a public inquiry into what happened at Mid Staffordshire NHS Foundation Trust, but to his enormous credit, my predecessor overturned that decision, with the honourable support of a number of Staffordshire Members. As a result, the voices of their constituents were finally heard, and hard truths were told.
Today, the whole House will want to thank Robert Francis QC and his inquiry team for the thorough and thoughtful job that they carried out. Their remarkable report demanded a monumental response, and I sincerely hope that that is what the coalition Government have delivered. The Care Quality Commission, once ridiculed, is now trusted, with a record number of calls to its whistleblowing helpline. Failing hospitals are being turned around, with stronger leadership and improved staffing levels: there are 3,500 more nurses on our hospital wards since the Francis report, more than 80% of hospitals have taken new action in response to the report, and confidence among NHS staff that their organisation has the right priorities has risen. Of course, there are many more things to do, but it is clear that something profound has changed in the culture of the NHS.
Mr John Redwood (Wokingham) (Con)
I admire what my right hon. Friend is doing to get a new culture of honesty in the NHS. Does he think that all the major hospitals in the country now automatically report problems and mistakes, so that they can be investigated and remedied?
Mr Hunt
The truth is that the process takes time, and there are still examples of where candour is lacking. Allegations have recently surfaced in the press, the substance of which makes it appear that that reporting has not happened. There is much work to do, but the signal has gone out loud and clear that if people are open, transparent and honest from the start when something goes wrong, that should not be punished but should be recognised as a way of improving how we look after patients, in the same way as profound changes in the airline industry have made our aeroplanes much safer. We need that change in the NHS.
We also now recognise that however important ministerial objectives and national targets may be, NHS organisations should never prioritise them at the expense of dignity and respect for patients. We now know that the best way to deal with poor care is for people to speak out about it, whether they are a health care assistant, doctor, nurse or even Secretary of State, and that that should never be confused with “running down the NHS”. We also know that failing to speak out about poor care, or to support those who do, is a betrayal not just of patients but of the kindness and humanity of more than 1 million dedicated NHS staff, thousands of whom pledged themselves to compassionate care just two days ago on NHS change day.
What has happened in the past year? Robert Francis asked why the system effectively failed to detect or deal with the problems at Mid Staffs for a shocking total of four years. We have re-established the CQC as a rigorous and independent inspectorate, with three powerful new chief inspectors appointed to speak truth to power. The Keogh review inspected 14 hospitals last summer, and the new chief inspector of hospitals, Professor Sir Mike Richards, has already completed inspections of a further 18 trusts, with 19 more inspections taking place now. As a direct result, 14 trusts are now in special measures—a record in NHS history—and, thankfully, long-standing problems are finally being tackled.
On staffing, the inquiry found
“an unacceptable delay in addressing the issue of shortage of skilled nursing staff.”
The latest figures show that not only are there 3,500 more nurses on our hospital wards since the Francis report, in just a year, but we now have more nurses, midwives and health visitors in the NHS than ever in its history. From this summer, all hospitals will publish their staffing levels monthly, on a ward by ward basis, so that shortfalls are speedily identified.
Robert Francis identified a closed, defensive and secretive culture at Mid Staffs. In response, we have ended gagging clauses and we are making it a criminal offence for trusts to publish or provide specified information that is false or misleading. We are also placing a statutory duty of candour on organisations so that they are required to be honest with patients about poor care, and professional regulators are consulting on a new professional duty of candour that provides protection for staff against being struck off if they are open about the problems they see. I believe that will create one of the most transparent and open health care systems in the world.
Andrew George (St Ives) (LD)
I welcome the important steps in the right direction that have been taken with regard to recording and safe staffing on acute hospital wards. The Secretary of State also announced last year that he intended to introduce a system whereby nurse trainees would shadow or work alongside care assistants for up to a year. Is that idea being developed at the moment?
George Freeman (Mid Norfolk) (Con)
Does the Secretary of State agree that it is important to remember that part of what allowed the Francis report was the release of data on outcomes, and that such data transparency is crucial to understanding where best and worst practice exists, which may not otherwise be picked up?
Mr Hunt
My hon. Friend is, as ever, absolutely right on this issue, which he has spoken about a great deal. The use of data allows inspections to be meaningful in a way that has not been possible before. We have to ensure that the public are happy that protections are in place on how their data are used, but at the same time we must be bold in using those data, because that saves a lot of lives.
The inquiry condemned the way in which complaints were handled in Mid Staffs. Following the excellent work carried out by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart, all hospitals will now have to demonstrate to inspectors that they treat complaints as more than just a process and are actively using them to learn and improve.
Doctors have responded to the new climate of transparency by agreeing to a world first: to make England the first country anywhere that publishes surgery outcomes by consultant for 10 major specialties. More specialties will follow.
Chris Bryant (Rhondda) (Lab)
This point does not quite follow on from what the Secretary of State is saying, but I spent all day yesterday with rugby players and neuropathologists talking about chronic traumatic encephalopathy, which often follows rugby injuries. One big difficulty is that concussion is regularly misdiagnosed, or completely and utterly missed, throughout the whole NHS, and that sports bodies are not taking the matter seriously. Will he seriously consider changing the whole way in which the NHS engages with sports and with that issue?
Mr Hunt
As the hon. Gentleman knows, I used to be responsible for sport in this country, so I take a great deal of interest in the issue. I will certainly consider his point. We all remember what happened to Fabrice Muamba, and sport has a role to play in raising awareness of conditions that people might not otherwise be aware of.
Mr Mark Harper (Forest of Dean) (Con)
From listening carefully to my right hon. Friend’s remarks, I noticed that he referred to England. I am not sure that all the lessons from the Francis report have necessarily gone across the border to Wales. That concerns me, because thousands of my constituents are forced to use the NHS in Wales—although their GP is in England, they are registered with the NHS in Wales. Can my right hon. Friend say anything to reassure my constituents that they will soon be entitled to treatment in England, as is their legal right?
Mr Hunt
I am concerned about that on a number of levels, but I can reassure my hon. Friend that I have taken on board that point, which he has raised with me privately, and I will look into it. I have asked for a solution to be found soon, and certainly before the end of the year, so that his constituents can have that long-standing problem addressed.
Nurses, who were mentioned by the hon. Member for St Ives (Andrew George), have also embraced reform. The inquiry was clear that
“practical hands-on training and experience should be a pre-requisite to entry into the nursing profession”.
We now have 165 nurse trainees spending up to a year as health care assistants before starting a degree—a pilot that will inform how we roll out the programme nationally. The inquiry said the public should always be confident that health care assistants have had the training they need to provide safe care, and on the advice of Camilla Cavendish our new care certificate will provide assurance that health care assistants and social care support workers receive the high-quality, consistent training they need to do their jobs and deliver compassionate care.
Robert Francis also identified particular problems with the leadership of Mid Staffordshire Trust. We have many outstanding leaders in the NHS, but not enough, so we have set up a 50-place fast-track executive programme to attract clinicians and talented outsiders into NHS management, and we have already had more than 1,600 applicants. We are also introducing a new fit and proper persons test for board-level appointments, to help ensure that people with poor track records cannot resurface elsewhere.
The inquiry also heavily criticised my Department for being
“too remote from the reality of the service they oversee”.
We have introduced a new programme, “Connecting”, under which civil servants will spend four weeks every year on the front line. In the past year, Ministers, including me, and senior officials have spent more than 1,300 days working on the front line, leading to what I believe is a real and profound change in the way we approach our work and ensure good advice is provided to Ministers. Those changes have seen a welcome increase in the number of staff who feel that care of patients is the main priority for their organisation, according to the latest NHS staff survey.
If the NHS has listened, so too must we in this House. As constituency MPs, many of us, including me, have championed our local hospitals, sometimes unquestioningly, and sometimes without sufficient regard for the quality of care provided. Too often we have accepted the convenient explanation that individual cases of poor care were the exception, when in our hearts we knew the problem was more widespread. We must be champions for change in our communities, just as the Mid Staffs campaigners were champions for change in theirs.
Nowhere is that more true than in Wales. Although health is a devolved issue, unfortunately failures in care in Wales are now having a direct impact on NHS services in England, with a 10% rise since 2010 in the number of Welsh patients using English A and E departments, leading to very real additional pressure on border town hospitals. What is causing that pressure? Dr Dai Samuel of the Welsh BMA describes standards of care in Wales as follows:
“It’s pretty horrific...the level of care being given to patients is compromised...substandard we are seeing a miniature Mid Staffs every day.”
NHS England medical director professor, Sir Bruce Keogh, and president of the Royal College of Surgeons, Professor Norman Williams, have written to the Welsh authorities calling for action, only to be completely ignored. Professor Williams said that
“an analysis of NHS data in the region has highlighted the fact that the waiting lists for elective cardiac surgery in South Wales are higher than is clinically appropriate... Expert reports suggest that 152 patients have died in the past 5 years while on the waiting lists”.
If that creates pressure in England, it is a tragedy for Wales, yet still the authorities there continue to act as if the lessons of Mid Staffs stop at the border. If the Labour party, which runs the NHS in Wales, will not listen to the Government about this, it should please listen to its own Back-Bencher, the remarkable right hon. Member for Cynon Valley, who, following her own terrible family experience, has campaigned tirelessly to improve standards of care in Wales, particularly with respect to mortality rates at six Welsh hospitals. If there is one outcome from today’s debate, let it be not simply an examination of data methodology in Wales, but a proper, independent examination of mortality rates, allowing UK-wide comparisons. Given the implications for the English NHS, we need leadership from Labour Front Benchers in this place to encourage their Welsh colleagues to do what is right to save lives in Wales, as well as to reduce pressure on the NHS in England.
That highlights a broader, more uncomfortable issue for the House. Clear policy mistakes lay at the heart of why Mid Staffs was ever allowed to happen, but while no one is questioning the integrity or good intentions of Ministers in that period, those mistakes have never been acknowledged by the Labour party, even though the entire tragedy happened on its watch. Labour continues to make a political issue of which party can be “trusted” with the NHS, but cannot see that the refusal—[Interruption.] This is uncomfortable for Labour Members to hear, but lives were lost and I suggest they listen. Refusing to learn the lessons of Mid Staffs is the surest way to persuade the public that Labour does not merit that trust.
Do Labour Members now accept that the Government were right to hold a public inquiry into Mid Staffs, contrary to their wishes, given the many important changes that have come about as a result? Do they accept that Mid Staffs was not just about bad individuals, but about a corporate obsession with system targets that led to poor and unsafe care, and that we must not allow that to happen again? Do they accept that the Government were right to restore expert-led inspections that Labour got rid of 2008, and will they now undertake to support the new chief inspectors in their much more rigorous inspections? Do Labour Members accept that Ministers should never—as was alleged to have happened before—put pressure on regulators to tone down news about poor care? Do they support the statutory independence that we have now granted the CQC? Do they accept that we should never push hospitals to foundation trust status so quickly that they neglect patient care? Finally, and most important, do they accept that exposing and being honest about poor care is not about running down the NHS but is about protecting it and standing up for patients? I hope that when the right hon. Member for Leigh (Andy Burnham) responds he will be able to answer those questions and put to rest the concerns of relatives and survivors of Mid Staffs about his approach to date.
Mr William Cash (Stone) (Con)
May I reiterate what my right hon. Friend has said about the absolute point-blank refusal, repeatedly and whenever I raised the question of an inquiry under the Inquiries Act 2005, to hold such an inquiry? The previous Government would not hold an inquiry; they totally refused to do so, which was an absolute disgrace. To his credit, the present Prime Minister listened to my arguments, and one of the first things he did when he came to government was set up an inquiry, which now has the capacity to transform the national health service.
Mr Hunt
We are about to hear from the shadow Health Secretary who will have the chance to put things right on that account. My hon. Friend the Member for Stone (Mr Cash) was extremely courageous, determined and persistent in campaigning for a public inquiry, and with the support of my predecessor and the Prime Minister, that is leading to the profound changes we are seeing today. We would all welcome the Labour party’s support for that.
I opened this debate by paying tribute to a few brave individuals who started a movement in England for safe, effective and compassionate care.
Mr Hunt
No, I am about to conclude. This afternoon it falls to this House of Commons to stand four-square behind that movement, so that one year of the Francis report becomes a lifetime of change for the NHS. We all want to say two words, “Never again,” but those words derive their conviction from what we do as well as what we say. However contrite we feel now, we should always remember that good people with good intentions stood at this Dispatch Box, and still an unspeakable tragedy was allowed to happen. We cannot rewrite history but we can, and must, learn from it.
Andy Burnham (Leigh) (Lab)
This debate is a welcome opportunity to review progress on the Francis report one year after its publication. That publication completed a long process of independent inquiry into the terrible failings at Stafford hospital, and it began in July 2009 with my appointment of Robert Francis, QC. Ever since, the onus has been on us all to learn the important lessons and implement all the recommendations of the Francis report.
First, however, I will say a word about the previous Government’s record. It was the previous Labour Government who introduced for the first time independent regulation to the national health service, following the scandals of the 1990s at Bristol Royal infirmary, Alder Hey and, of course, the Shipman murders. It was that independent regulator which uncovered the problems at Mid Staffs. To listen to the Secretary of State, one would not believe that those were the facts—
Andy Burnham
I want to make some points at the beginning and then I will give way to the Secretary of State.
Those were the actions of the last Government in dealing with the issues that we inherited. It was the last Government who left the national health service with the lowest ever waiting lists and the highest ever public satisfaction, and no attempt by the Conservatives to rewrite history can take away that fundamental strength in the NHS which the last Government left behind.
Mr Hunt
I agree with the right hon. Gentleman that his predecessors deserve credit for introducing an inspection regime into the NHS, but would he now agree that it was a big mistake to allow expert-led inspections—the kind of really thorough inspections that could have uncovered what happened at Mid Staffs—to be abolished in favour of generalist inspections, which meant that the same people inspected dental clinics, GP practices and big London teaching hospitals? That was a profoundly important mistake that this Government are right to correct.
Andy Burnham
It is no good coming all holier than thou and claiming a counsel of perfection from the Government and that all the problems arose under Labour. There was no independent regulation in the NHS under the previous Conservative Government. There were no data of the kind that the hon. Member for Mid Norfolk (George Freeman) mentioned, so that comparisons could be made. Those things were introduced by the previous Labour Government, learning the mistakes of previous failings. This has been a continuous journey in the NHS—when things go wrong, the Government of the time act to make things better. The Secretary of State would do well to remember that before he makes the kind of statements he has made today.
We welcome some of the steps that have been taken, and I want to focus on two in particular on which we have seen an important change of emphasis. First, severe cuts to front-line staffing numbers were a primary cause of what went wrong in Stafford. In the last year, there has been a temporary halt to the cuts to nursing numbers that we saw in the early years of the coalition Government. However, Monitor has warned that this is just short term, and points to further large planned job cuts of close to 7,000 nursing posts in 2014-15 and 2015-16, made worse by severe cuts to nurse training places since 2010, which have forced many trusts in England to recruit from overseas. While we welcome the change of emphasis, we will watch carefully to ensure that recent progress on staffing is not lost.
Secondly, the Secretary of State has been right to focus on the care of older people. Moves to appoint named consultants and GPs for over-75s will clearly help to improve continuity of care. Those are the first steps in the right direction, but we would argue that something much more radical is needed. I believe that the time has come for a fundamental rethink, from first principles, of the way we care for older people, and that is what our commission on whole person care, published yesterday, has begun to set out.
Today, there are quite simply too many older people in our hospitals. Many do not need to be there, but hospital is fast becoming the last resort for people who have lost support in the home—be it support by social care or by the NHS. If we continue as a country on the current path—with further severe planned cuts to social care throughout the rest of this decade—it is a plan for the ever-increasing hospitalisation of frail older people. It is no answer to the ageing society and indeed will make it much harder to address the issues that Robert Francis identifies in his report. Instead, we need a completely new approach, where we start in the home and build a truly personalised service around each individual, their family and their carers. We need an NHS for the whole person, able to see all of an individual’s needs. We need a service where the home not the hospital becomes the default setting for care and, as I will come on to explain, that is what our policy of full integration of health and care is designed to deliver.
To listen to the Secretary of State today, people would be forgiven for thinking that everything in the NHS right now is just fine, everything is being put right and there are no problems. I have to say to him that the complacency he showed in his speech is simply not justified and, in fact, very worrying. May I remind him that hospital A and Es in England have now missed his Government’s target for 32 weeks running? The last 12 months since the Francis Report was published have—taken together—been the worst year in A and E for at least a decade, with almost 1 million people waiting more than four hours. That shows that NHS services have got worse, not better, since the publication of the Francis report.
Andy Burnham
In a moment.
On all measures, this winter has been just as bad as the last, with some patients waiting hours on trolleys, or held at the door of A and E or in the back of ambulances. A and E is the barometer of the whole health and care system, and that barometer is warning of severe storms ahead.
Mr Jeremy Hunt
As it happens, waiting times for A and E departments are now half what they were when the right hon. Gentleman was Health Secretary, but may I gently suggest that rather than trying to turn this debate into a discussion about who had the better A and E performance, he should return to the Francis report, which is what the debate is about and which deals with something that happened on his watch? The country wants to know what his party, and he personally, have learned from the mistakes that were made that allowed Mid Staffs to happen.
Andy Burnham
Pressure on hospitals, and how we relieve it so that they can care for people properly, is the core of this debate. What we have seen under this Government is an ever-increasing number of frail, elderly people coming into hospital via A and E. The Secretary of State shakes his head, but Francis made specific recommendations on the care of older people in hospital. The point I am making is that under him the number of older people admitted to hospitals as emergency admissions has gone up significantly, and that goes to the heart of the issues raised by the Francis report.
Mr William Cash (Stone) (Con)
It is quite difficult at this stage in the saga—the tragedy—of Stafford hospital to recall how it all came about and the difficulties that those of us who experienced it had to endure, the patients and the victims in particular. There was complete and total resistance—indeed, worse than that, a granite-like refusal—to having a proper look at what was going on. It would take much longer than I have available this afternoon to explain exactly the tooth and nail battle that I had to engage in to get the inquiry in the first place under the Inquiries Act 2005.
In a previous incarnation as the Member for Stafford, I had already had Stafford hospital in my constituency for 14 years, from the date of a by-election some 30 years ago in May 1984. I experienced a tragedy in Stafford hospital during that time with legionnaire’s disease, and I came to this House and asked the then Prime Minister, the late Margaret Thatcher, whether she would give us a full public inquiry—equivalent to one under the provisions of the 2005 Act. I did that because I knew it was impossible to get to the root of what was going on unless we had such forensic evidence, with cross-examination on oath and all the other—not paraphernalia, but necessary ingredients as part of the process, to ensure that we could bring to light what was required.
I was absolutely astonished that successive Secretaries of State completely refused, point-blank, to have such an inquiry in the case of Mid Staffordshire. I have to put it on record that the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who is not even in the House this afternoon—perhaps he has some excuse or justification—was the Secretary of State during a lot of the time in question. Patricia Hewitt was also Secretary of State for part of the time when serious problems were going on. The right hon. Member for Kingston upon Hull West and Hessle refused to have a public inquiry. The right hon. Member for Leigh (Andy Burnham) also refused to have an inquiry of the 2005 Act type. Although it is certainly true that he agreed to a Francis inquiry, and that there was also the Alberti report, the Colin-Thomé report and one or two other investigative exercises, none of them had the right ingredients to give them the capacity to get to the root of what was going on.
I am delighted with what my right hon. Friend the Secretary of State has done since then. I was extremely glad that, when we were in opposition, I was able to overcome some resistance to a 2005 Act inquiry from shadow Ministers. The current Prime Minister, then the Leader of the Opposition, listened to the arguments that I and others made and agreed to have a full 2005 Act inquiry, because he understood how important it was, as the Secretary of State does. The consequence has been to enable us to make changes throughout the entire health service that, as Opposition Members have acknowledged today, have enabled us in Staffordshire to be a pathfinder for solving some, if not all, of the problems presented in the health service.
The work of Cure the NHS has included that of my constituent Deborah Hazeldine. She does not get a great deal of publicity, but she was the one who came to me in my office in December 2008, with Julie Bailey, and explained that they were getting nowhere with the complaints and concerns that they were expressing. They asked what could be done about it, and I explained to them that if they did certain things, I thought we would be able to get a campaign moving of the kind that would be needed to get a 2005 Act inquiry. I pay tribute to them, and to Ken Lownds, who has been a tower of strength. He is a man of enormous integrity, knowledge, skill and commitment. I pay tribute to him for what he did to ensure that we got the inquiry, for the evidence that he gave to it and for his continual determined input into improving the health service since the Francis report was produced.
I am delighted that the Francis report came out as it did. It had, I believe, 299 recommendations, and it has been immensely important to the future of the health service. I do not need to go into all the details, but I pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), my next-door neighbour, with whom I worked closely from the beginning. He committed himself to a 2005 Act inquiry when he was in what could be described as the delicate situation of being about to become the Member of Parliament for Stafford but not entirely certain that it would happen. He did it, and he was right, and I pay tribute to him for everything that he has done since.
Mr Jeremy Hunt
I am grateful to my hon. Friend for his generous comments. While he is paying tribute to people who have played an important role in getting us to where we are, may I add my thanks to Deborah Hazeldine, and also to Ken Lownds, who was the first person who really talked to me about the important concept of zero-harm health care? I know my hon. Friend will not mind if I also mention campaigners from other hospitals, such as James Titcombe in the case of Morecambe Bay, who have also played an extremely important role in the debate.
Mr Cash
I am extremely glad that my right hon. Friend has made that point. The zero-harm policy is so important, and I am grateful for that specific intervention. It will make Ken Lownds’s day. I also pay tribute to people all over the country who have taken up the message and sought to improve the health service in their areas. This has turned into a national campaign, and the Secretary of State deserves great credit for the way he has helped to co-ordinate it.
I was, and remain, completely amazed that the right hon. Member for Kingston upon Hull West and Hessle, and Patricia Hewitt, were not even asked to give evidence to the inquiry. I still find that completely staggering to my way of thinking. I know that the right hon. Member for Leigh was asked to give evidence, and did, but I place the point on the record because I found it extraordinarily difficult to understand then, and I still do now.
I have constantly and repeatedly called for the resignation of Sir David Nicholson. I know he is retiring soon and that that resignation will not happen, but I repeat my concern, as I did in evidence to the inquiry, because the whole target-based policy was very much tied up with his approach to these matters. Indeed, in the last of, I think, about 600 paragraphs of his evidence to the inquiry, he referred in the last two lines to the fact that the Member of Parliament for Stone, Mr Bill Cash, had raised the question of his involvement in target-based policies. He said that there were arguments on both sides of the equation regarding target-based policies, but I do not agree with that. I do not think target-based policies were the right way to go, and I am glad that the hon. Member for Stoke-on-Trent North (Joan Walley) agreed with me. As I pointed out in my evidence to the inquiry, such policies had a terrible effect on the attitude of Monitor regarding the financing issues that provided 39 of the 45 or so questions put by William Moyes to the foundation trust when it received its approbation—something it should never, ever, have got. I say to the right hon. Member for Leigh that through the mechanism of the Department—I cannot point precisely to chapter and verse—the fact that the foundation trust got such status was also the product of a misjudgment by the Government at the time.
I have already referred to correspondence in an intervention, but in the prime ministerial guidelines of 2005, under the previous Government, it was clearly stated that when Members of Parliament write to Secretaries of State and other senior Ministers, they are entitled to receive a full, comprehensive response—personally—from that Minister. I found that wanting during this process. I was glad to note, however, that in the course of evidence to the inquiry, the situation moved from what appeared to be resistance to going down that route, to an acceptance that—to paraphrase from the evidence given by the chief executive of the Department of Health—from now on, when a Member of Parliament writes with a letter from a constituent, and explains that things have not gone properly regarding that constituent’s health problems, there is a mechanism to ensure that the issue is dealt with properly. I will not have to go into all that today, because it has been rectified.
In my evidence, I also raised the issue of whistleblowing. I also tabled amendments to the then health legislation, calling for the repudiation of gagging clauses and providing that any chief executive who endorsed them and got his legal advisers to agree to them should be dismissed. That is another area that has been dealt with, so we are making progress. I very much endorse the views expressed on both sides of the House about having unity across the Floor of the House, as far as we can achieve it, on the central principles.
I agree with what my hon. Friend the Member for Stafford said about the issue, although I have a difference, not of opinion but of emphasis, because my constituency is very rural, and access to the artery of the M6 is not easy. It can be difficult to reach, especially at night, because it can be a long way through small rural lanes, to access the M6 and the University hospital of North Staffordshire or hospitals in Wolverhampton. That is my caveat on that.
We have made enormous progress. I am glad that the Mid Staffs foundation trust is being dissolved, and that—as my hon. Friend the Member for Stafford said—the Prime Minister, at a recent Prime Minister’s questions, backed plans, in as many words, for consultant-led maternity to continue at Stafford hospitals. That service, plus paediatric services, critical care and a 24-hour emergency service, is necessary for constituents in Stone and the rest of Staffordshire. I will work with my hon. Friend to ensure that that is delivered.
Mid Staffordshire NHS Foundation Trust
Jeremy Hunt Excerpts(12 years, 5 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I wish to inform the House that I have made a decision regarding the action recommended by the trust special administrators (TSAs) of Mid Staffordshire NHS Foundation Trust (Mid Staffs, or the trust), as I am required to do by section 65KB of the National Health Service Act 2006 (the 2006 Act).
A document setting out in more detail the reasons for my decision has been placed in the in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Local people suffered too much for too long under a system which ignored appalling failures of care in their local hospital. They now deserve to know that same system has learned the lessons and is guaranteeing high quality, safe services for local people. The proposals I am accepting today will provide just this.
The strength of public interest in the TSAs’ work, and the huge response to their consultation exercise, is a testimony to the great commitment local people have to the future of their hospitals.
I must also commend the trust’s staff, who have helped turn around the quality of care provided at Mid Staffs, and who in recent months have continued to provide quality services in the face of great uncertainty about the trust’s future. The interest, support and contributions of hon. Members have also been extremely valuable. In particular, the way in which the hon. Member for Stafford (Jeremy Lefroy) has championed the interests of local people at every stage of the process has been remarkable. I believe the proposals I am accepting today will bring about improvements for local people that reflect his continued concern for patient welfare and the future of Stafford hospital.
Today’s announcement secures a first-rate offer for local patients—something they were denied for too long. Great strides have been made towards improvement in recent years but the challenges remain stark. Without over £20 million in subsidy funding from the Department of Health in 2012 and 2013, the trust would have been unable to pay its staff and suppliers. At the same time, a number of services are being operated with consultant numbers below Royal College guidelines, and the trust has experienced ongoing challenges in recruiting and retaining staff. Patients deserve high-quality services, which are clinically sustainable.
Today’s announcement provides an assurance that the solution to the trust’s financial and clinical problems will deliver safe and high-quality services, now and into the future. I know that the TSAs and local stakeholders have worked hard to develop a set of recommendations which will achieve this.
Having considered the TSAs’ proposals in detail, I confirm I am satisfied on each of the points set out in section 65KB of the legislation, and therefore support the action recommended by the TSAs. I am also satisfied that, in accordance with my request, the TSAs have undertaken a thorough analysis and taken account appropriately of the issues regarding the four tests for reconfiguration. I am pleased that, after a long period of instability, we are able to offer the local population of Mid Staffordshire the certainty it so desperately needs.
Before turning to the detail of the proposals, I would like to remind the House of the background to the administration process at Mid Staffs. Monitor appointed an independent contingency planning team (CPT) to the trust in October 2012. In January 2013, the CPT concluded in a report for Monitor that Mid Staffs was neither clinically nor financially sustainable in its current form. In a subsequent report the CPT advised that neither the trust nor local commissioners would be able to deliver the changes required, and consequently recommended the appointment of administrators. On the basis of the CPT’s conclusions. Monitor appointed TSAs to Mid Staffs with effect from 16 April 2013. Since taking up their role, the TSAs have found no reason to dispute the CPT’s conclusions regarding the trust’s sustainability, and their analysis has only strengthened the case for change.
Since April the TSAs have been working with the trust, local commissioners and providers, and a wide range of other stakeholders, in order to develop a solution for the services at Mid Staffs. The TSAs’ final report, which has been approved by Monitor, was submitted to me on 16 January.
The TSAs’ report recommends that Mid Staffordshire NHS Foundation Trust is dissolved, and that Stafford and Cannock Chase hospitals are operated by other local providers. It is vital that this structural change is made as soon as possible to stabilise local health services. The TSAs have also proposed a clinical model for the services currently provided by the trust, which their independent clinical advisory group (made up of leading clinicians from the Royal Colleges) has confirmed will be clinically safe. I am pleased that under this model the majority of patient visits, approximately 90%, will continue to take place at Stafford and Cannock hospitals. I also welcome the enhancements proposed for a number of current services, for example, the inclusion of specialist frail and elderly support within the Medical Assessment Unit at Stafford. All of this will contribute to a much improved offer for local people.
However, to ensure this improved offer, it is clearly not possible for all of Mid Staffs’ services to go on as they are, and therefore the TSAs’ recommendations will mean moving a small minority of services away from Stafford hospital. Local people can be reassured that local commissioners would need to be satisfied that there is sufficient capacity available elsewhere before moving services. In parallel, I am asking NHS England to identify whether consultant-led obstetrics could be sustained at Mid Staffs in a safe way in the future. In doing this, NHS England will work with local commissioners as part of their wider review of the local health economy.
The TSAs’ report also identifies the funding required to support this model and I am satisfied that, in the light of intervention from the NHS Commissioning Board (also known as NHS England) in the form of time limited funding, and a commitment from commissioners to deliver further savings during and following implementation, the recommended clinical model is affordable in the medium term and, subject to the actions of local commissioners, can be a financially sustainable one. My right hon. Friend the Chief Secretary to the Treasury has expressed his support for my acceptance of the proposals.
On this basis, I am content for the proposals to proceed to implementation. I would like to emphasise the critical role commissioners have in this process, and in particular their commissioning freedom to build upon the TSAs’ recommendations, such as in maternity, where they consider this is to be sustainable and in the interests of patients. Local commissioners will also oversee and monitor local service changes as part of their ongoing commissioning responsibilities, including, where going beyond the recommendations, undertaking further public engagement where appropriate.
I therefore ask that local commissioners, local providers and all other local organisations work together during the coming months and years to implement the proposed changes, with appropriate involvement from NHS England and other national bodies, in order to secure the high-quality services that the people of Mid Staffordshire deserve.
Oral Answers to Questions
Jeremy Hunt Excerpts(12 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
David Rutley (Macclesfield) (Con)
1. What progress he has made on improving out-of-hospital care for the frail and elderly.
The Secretary of State for Health (Mr Jeremy Hunt)
We will ensure that everyone over the age of 75 has a named GP, responsible for delivering proactive care for our most vulnerable older people in the best traditions of family doctors. Through our £3.8 billion better care fund, we are also merging the health and social care systems to provide more joined-up health and social care.
David Rutley
I welcome the steps that my right hon. Friend is taking to improve and enhance the quality of care for the elderly. Given that east Cheshire has one of the fastest-growing ageing populations in the UK, will he tell the House what specific steps he is taking to improve out-of-hospital care in and around Macclesfield? Furthermore, does he agree that it is vital that appropriate funding is in place to take care of the elderly and most vulnerable patients?
Mr Hunt
May I congratulate my hon. Friend on the campaigning work he does in his constituency on health matters? I commend the Eastern Cheshire clinical commissioning group for its “Caring Together” programme and for the fact that Cheshire was selected as one of the 14 integrated care pioneers. I hope that it will blaze a trail in joining up the barriers that have bedevilled our health and social care system for too long, so that his constituents are not pushed from pillar to post because of arguments about budgets and people can be discharged on time. I think his area is blazing a trail.
Hazel Blears (Salford and Eccles) (Lab)
The national dementia strategy has been fundamental in improving care for many frail and elderly people with dementia living in the community. The strategy is due to expire in April—in two months’ time. Will the Secretary of State give a commitment to the House now that the national dementia strategy will be renewed? I understand that we have the Prime Minister’s dementia challenge, but, like many of us, Prime Ministers come and go. We need a strategy and not simply the Prime Minister’s challenge.
Mr Hunt
I can assure the right hon. Lady that this Prime Minister is here to stay. Indeed, I can also reassure her that the national dementia strategy is here to stay. As she has announced that she is stepping down at the end of this Parliament, may I thank her for her campaigning on dementia, which, I think, came from a family connection with the issue? She has attended many of my dementia meetings and the G8 dementia summit. She has made a really important contribution, and I thank her for that.
Paul Burstow (Sutton and Cheam) (LD)
May I follow up on the question that the right hon. Lady has just asked? The Secretary of State has said that the national strategy is here to stay and that is very welcome, but the national strategy was drafted with the intention that it would expire this year. It would be useful if he now indicated the intention to refresh and update it so that we have a clear road map for at least the next decade.
Mr Hunt
I know that my right hon. Friend showed great interest in this issue when he was in my Department. When I say that the strategy is here to stay, I mean that it is here to be refreshed and updated. We are subscribing to some big new ambitions, including that by the time of the next election two thirds of people with dementia will be diagnosed and have a proper care plan and support for them and their families. That is a big improvement on the 39% of people who were diagnosed when we came to office. There is much work to do, but I assure him that we are absolutely committed to delivering.
Lyn Brown (West Ham) (Lab)
Some hospitals are making a virtue out of quick discharge for their stroke victims. Is the Secretary of State convinced that elderly stroke victims, perhaps those without people to advocate on their behalf, are getting appropriate care and that their care and rehabilitation are not being scrimped on or rationed?
Mr Hunt
No, I am not convinced. We need to do much better when it comes to the discharge of vulnerable older people, especially when they leave hospital not cured and still with a long-term condition. They may be recovering from a stroke or dementia or any other condition. We need to have much better links between hospitals and GPs and to have named accountable GPs in the communities looking after those very people.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
I was disappointed with the allocation of funding by NHS England for care around the country because it did not reflect the demands of the elderly population. People in my constituency have to do a 200-mile round trip to receive support such as cardiac care. Will the Secretary of State ask it to think again for future years?
Mr Hunt
My hon. Friend is right to campaign hard on that issue. I agree that the funding formula does not always do justice to people, especially those in sparsely populated rural areas. I know that NHS England is trying to do what it can to move to a more equitable funding formula, but it is not something that can be done overnight. I encourage her to keep pressing on that issue.
Mr Jamie Reed (Copeland) (Lab)
Welcome back, Mr Speaker. Easy access to GPs is a key part of out-of-hospital care for elderly and frail people. Days after the election, the Prime Minister scrapped Labour’s guarantee that gave patients a GP appointment within two working days, and took away funding that kept thousands of surgeries open in the evenings and at weekends. Now the Royal College of General Practitioners is warning that 34 million patients will fail to get an appointment. Will the Secretary of State listen to the Patients Association, bring back the 48-hour appointment guarantee and help older people to see their doctor when needed?
Mr Hunt
The reason that we got rid of that guarantee was that the number of people who were able to see a GP within 48 hours was falling in the last year in which the target was in place. It was not working, and that is why the British Medical Association and the Royal College of General Practitioners were against it. In the same survey that the hon. Gentleman quoted, the RCGP said it estimated that there had been a 10% increase in the number of GP appointments compared with when his Government were in office.
Steve Brine (Winchester) (Con)
2. What recent steps he has taken to improve maternity care.
The Secretary of State for Health (Mr Jeremy Hunt)
People can opt out of the care.data programme through their GP surgery. Depending on the surgery, that may well be done online or by telephone.
Mr Robinson
Is the Secretary of State aware that the Government’s handling of the scheme has been shambolic from the very start and that their failure to communicate is nowhere better illustrated than in Pulse, the GP’s magazine, in which an article states that only 15% of members of the public surveyed knew that they had the right to opt out? What will he do to restore public confidence in a scheme that could be very beneficial?
Mr Hunt
It is a pleasure—I think for the first time—to take a question from someone who might be one of my constituents in Godalming. However, I do not agree with the hon. Gentleman that the process has been shambolic. The programme has been in place for 25 years, so it is important to understand that this big public debate is happening because this Government did something that the previous Government did not do: we said that if we are going to use anonymised data for the benefit of scientific discovery in the NHS, people should have the right to opt out. We introduced that right and sent a leaflet to every house in the country, and it is important that we have the debate—[Interruption.] The right hon. Member for Leigh (Andy Burnham) complains, but he did not want to give people the right to opt out when he was Health Secretary.
Dr Sarah Wollaston (Totnes) (Con)
The Secretary of State will be aware of the report in The Daily Telegraph setting out how hospital episode statistics data were sold to insurance companies, which were able to match that information with credit ratings data. Nothing will undermine this valuable project more than a belief that data will be sold to insurance companies, so will he set out the way in which he will investigate how that sale was allowed to happen and categorically reassure the House that there will be no sale of care data to insurance companies?
Mr Hunt
My hon. Friend is absolutely right to raise that issue and I am happy to give that assurance. That incident is one of the reasons why we set up the Health and Social Care Information Centre through the Health and Social Care Act 2012, in the teeth of opposition from the Labour party. Following the establishment of the centre, the guidelines in place mean that such a thing could not happen. She is also right that it is important that we reassure the public because, let us not forget, it was this important programme that identified the link between thalidomide and birth defects, that identified that there was no link between MMR and autism, and that helped to identify the link between smoking and cancer, so it is vital that we get this right.
Mr David Crausby (Bolton North East) (Lab)
20. Virtually everyone wants to improve patient care in the NHS, so why not scrap the underhand way in which the care.data programme has progressed so far, and instead provide a diverse choice of ways to opt in, limit the use of medical data to the NHS and keep the public’s personal information out of the hands of the private sector?
Mr Hunt
May I gently tell the hon. Gentleman that the reason why we are having the debate is that this Government decided that people should be able to opt out from having their anonymised data used for the purposes of scientific research, which the previous Labour Government refused to do? When they extended the programme to out-patient data in 2003 and to A and E data in 2008, at no point did they give people the right to opt out. We have introduced that right, which is why we are having the debate.
Dr Julian Huppert (Cambridge) (LD)
There are of course huge benefits from using properly anonymised data for research, but it is difficult to anonymise the data properly and, given how the scheme has progressed so far, there is a huge risk to public confidence. Will the Secretary of State use the current pause to work with the Information Commissioner to ensure that the data are properly anonymised and that people can have confidence in how their data will be used and how they can opt out?
Mr Hunt
I will do that, and NHS England was absolutely right to have a pause so that we ensure that we give people such reassurance—[Interruption.] When we had a pause before, the result was the very good Health and Social Care Act, which is doing good things for patients throughout the NHS. This programme is too important to get wrong, and while I think that there is understanding on both sides of the House about the benefits of using anonymised data properly, the process must be carried out in a way that reassures the public.
Andy Burnham (Leigh) (Lab)
When he was appointed, the Health Secretary declared it his personal mission to have a “data revolution” in the NHS, but what he has presided over is a spectacular collapse in public confidence in the use of patient data. The only revolution he has created is a growing public revolt against his care.data scheme. Coming after his NHS 111 shambles and the court humiliation over Lewisham hospital, it cements a reputation for incompetence. When was he first warned about problems with care.data and what action did he take?
Mr Hunt
The shadow Secretary of State searches for NHS crises with about as much success as George Bush searching for weapons of mass destruction. My first contact with that programme, when I was told about it, was to decide to do something that he never did as Health Secretary: to say that every single NHS patient should have a right to opt out of having their data used in anonymised scientific research. I think that was the right thing to do. Of course we are having a difficult debate, but its purpose is to carry the public with us so that we can go on to make important scientific discoveries.
Andy Burnham
Again, the right hon. Gentleman never takes responsibility—it is always somebody else’s fault. Even by this Government’s standards, this is a master-class in incompetence. First, we have this useless glossy leaflet. He said that it has gone to every home, but that is not true, because homes that have opted out of junk mail have not received it. Many people report that they still have not had it through their letterbox. Secondly, when people cannot even get through to their GP practice on the phone, as we heard earlier, or get an appointment, he has made it almost impossible to opt out of the scheme. Has this cavalier approach not built an impression that the Government are taking patient confidentiality for granted in trying to force through the scheme, increasing public mistrust and putting the important scheme at risk?
Mr Hunt
It is intriguing that the shadow Secretary of State has chosen not to talk about a winter crisis, because it has not happened, despite the fact that he predicted it time after time. Let me tell him what was cavalier: the previous Labour Government’s refusal to give patients a right to opt out of giving their data to this programme, even though it was going on for their whole time in office. We believe that we should have a data revolution, but to do that we need to carry the public with us, which is why we need to have this important debate and give people the reassurance they deserve.
Rushanara Ali (Bethnal Green and Bow) (Lab)
6. What recent assessment he has made of the number of available mental health crisis beds for young people in England.
Ian Lavery (Wansbeck) (Lab)
12. What recent meetings he has had with representatives of the private health care sector.
The Secretary of State for Health (Mr Jeremy Hunt)
In the past three months, I have had two meetings with private sector health care providers, both in China, helping them to win export orders. In the same period, I have had 20 meetings with traditional NHS providers.
Ian Lavery
Private health companies with strong links to the Conservative party have been awarded contracts to run NHS services worth about £1.5 billion, which surely raises serious questions about the level of influence of Conservative donors on health policy. In the interests of transparency, will the Secretary of State commit to publishing a list of private health care companies that have made donations to the Conservative party?
Mr Hunt
The difference between donors to the Conservative party and donors to the Labour party is that our donors do not write our policies. While we are talking about private sector health care providers, I remind the hon. Gentleman of what an unnamed shadow Cabinet Minister told The Independent last week:
“We all remember when Andy was Health Secretary and happily contracting out bits of the NHS to the private sector… You have to ask yourself what’s changed.”
Steve Baker (Wycombe) (Con)
The NHS diagnostic centre in Wycombe, which is operated by the private sector, does a fantastic job. Will the Secretary of State join me in congratulating and thanking Opposition Members for all that they did to extend private and independent provision in the NHS?
Mr Hunt
I am happy to do that. My hon. Friend may be interested to know that in the last four years of the last Government, private sector contracts in the NHS doubled—something that this Government have not been able to match. It is important to look at the facts before we start any hares running with respect to privatisation.
Julian Sturdy (York Outer) (Con)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
I would like to thank Public Health England and the NHS emergency services for their extraordinary work during the recent floods, and say that this House is proud of their dedication and commitment to help those in great need. Since the previous Health questions, we have also had the first anniversary of the Francis report on Mid Staffs. As a result, I am proud that the Government have taken significant steps to restore compassionate care to all parts of our NHS, with a regulator now free from political interference, failing hospitals being turned round, and more nurses, midwives and health visitors in our NHS than at any time since 1948.
Julian Sturdy
The family of my eight-year-old constituent Ben Foy have been fighting for more than two years for the funding of sodium oxybate—a drug that his doctors feel could help him cope with narcolepsy and cataplexy. This is a particularly distressing condition for Ben and his family, but sadly, after all this time there is still complete confusion as to who has responsibility for Ben’s commissioning request. Will the Secretary of State look into the matter and clear up that confusion?
Mr Hunt
I reassure my hon. Friend that I have looked into Ben Foy’s case, and NHS England has confirmed that it is responsible for commissioning his care. The particular drug that my hon. Friend mentioned is not recommended by the manufacturer for use by children and adolescents, but I am happy to arrange for him to meet NHS England and get to the bottom of the issue.
Andy Burnham (Leigh) (Lab)
I want to return to care.data—an important scheme that needs to be saved from the incompetence of this clownish coalition. The Secretary of State said earlier that I was in search of a crisis, but now I will offer him a solution. If the Government work with us to introduce a series of tough new safeguards to protect patients, we will work with the Secretary of State to help rescue this failing plan. Those safeguards include tougher penalties for the misuse of data, Secretary of State sign-off on any application to access data, full transparency on organisations granted access, and new opt-out arrangements by phone or online. Will he meet me to discuss changes to the Care Bill to put that important scheme back on track?
Mr Hunt
The right hon. Gentleman has still not addressed the fundamental question of why he did not introduce an opt-out for the use of personal data, which this Government are doing. We have taken more steps than his Government ever did, and we will continue to work hard to ensure that this important scheme goes ahead. The right hon. Gentleman should know better.
Penny Mordaunt (Portsmouth North) (Con)
T2. There is great unmet need among older people in our communities, particularly for dementia care and support. In Portsmouth we are holding a community summit to join up local agencies to meet that unmet need. Will the Minister meet me to discuss what central Government can do to ensure that advice on additional funding streams is clearly and readily available?
Barbara Keeley (Worsley and Eccles South) (Lab)
T4. Further to the answer given earlier to my hon. Friend the Member for Wansbeck (Ian Lavery), the lobbyist John Murray and an organisation funded by large pharmaceutical companies led a consultation and co-wrote a report for NHS England on the future of commissioning for £12 billion of NHS services. Will the Secretary of State tell the House whether it is now Government policy to have lobbyists and big drug companies drafting reports that directly influence the commissioning of NHS services?
Mr Jeremy Hunt
Let me say this to the hon. Lady: we have very clear rules, and for people who are involved in industry and have a self-interest we have important protections to ensure there is no conflict of interest. Let us be clear: the private sector has an important role to play in the NHS, but it grew far faster under the previous Government than it has done under this one. We are not going to take any lessons about being in hock to the private sector.
Lorraine Fullbrook (South Ribble) (Con)
T3. As the NHS comes through another winter, when it has delivered an outstanding service to more patients than ever before, how does my right hon. Friend assess the damage done by the unfounded scaremongering talk of crisis by the Opposition and some parts of the media?
Mr Hunt
My hon. Friend is absolutely right. I encourage those on the Opposition Front Bench in particular to talk to a few people in A and E and ask whether they think they have been supportive, in a very difficult winter, by whipping up all these scare stories when, in fact, because of their hard work, we are seeing 2,000 more people every single day in less than four hours than when the shadow Secretary of State was Health Secretary. A and E is performing better than ever.
Ms Margaret Ritchie (South Down) (SDLP)
T5. There are nearly 500 UK-trained medical practitioners now working in Australia, of whom 6% never return owing to the better conditions available there. What steps will the Secretary of State and his ministerial team take to ensure that we retain those qualifying in emergency medicine this year, to keep local A and E departments open in Britain and Northern Ireland?
Bill Esterson (Sefton Central) (Lab)
T10. The village of Melling has grown in recent years, yet its surgery hours have been cut drastically. Elderly and disabled residents now face a four-hour round trip by public transport to see their doctor. How can cuts in surgery hours, like those in my constituency, be justified if the Government are serious about having a first-class NHS?
Mr Jeremy Hunt
We absolutely want to make primary care more accessible and that is why we are introducing named GPs for everyone aged 75 or more from April. This is a significant and important reversal of, I think, a mistake that everyone now agrees was made in 2004 when named GPs were abolished. Its purpose is to make GPs more accessible to the people who need them the most.
Jason McCartney (Colne Valley) (Con)
T9. The father of one of my constituents passed away at the weekend, one of 8,700 people who are diagnosed with pancreatic cancer each year in the UK, of whom only 3% will survive beyond five years. That survival rate has not changed in over 40 years. Will my right hon. Friend update the House as to what the Government are doing to improve patient outcomes for those with pancreatic cancer?
Mike Kane (Wythenshawe and Sale East) (Lab)
The Manchester Evening News recently highlighted the enormous pressures faced by Wythenshawe accident and emergency after the downgrading of Trafford accident and emergency. Will the Secretary of State meet me to discuss this and to tell me when Wythenshawe will receive the extra funds that it has been promised?
Mr Jeremy Hunt
I welcome the hon. Gentleman to the House and congratulate him on representing in his constituency a fantastic hospital; I have been to Wythenshawe hospital and it is superb. Some big changes are happening in the Greater Manchester area that will lead to that part of the country having some of the best NHS care in the country. Obviously there is a difficult transition in A and E services between Trafford and Wythenshawe, and I am happy to meet him to discuss it further.
Nicholas Soames (Mid Sussex) (Con)
Does my right hon. Friend agree that it is unacceptable that investigations into failures in hospital services take so very long? There has recently been one in my constituency: a very sad and badly handled case connected with mental health. Does my right hon. Friend agree that the authorities need to provide answers very promptly to families who are left completely beleaguered by such behaviour?
Mr Hunt
I absolutely agree with my right hon. Friend. One of the tragedies that the Francis report helped us to uncover was that so many failings had been allowed to persist for so long: in the case of Mid Staffs, between 2005 and 2009. We owe it to families to be much quicker, which is why there is now a time limit on the failure regime: hospitals must be turned around within a fixed period of time or go into administration. Otherwise, we will not have safe hospitals in our areas.
Barry Gardiner (Brent North) (Lab)
The Minister earlier told the House that 1,500 new midwives had come on stream since the Government started, but, of course, the Government promised that there would be 3,000 delivered by 2015. Midwives are very good at delivery; how good is the Department?
Andrew Bridgen (North West Leicestershire) (Con)
Last year I spent a busy and informative day with the East Midlands ambulance service on the road. It was clear speaking to those professionals that a large proportion of individuals taken to A and E would be better served by going to their GP or by accessing other services. However, the ambulance service felt completely disempowered to advise or even to refuse to take anyone to A and E who requested it.
Mr Jeremy Hunt
That is one of the things we need to be much better at—linking up the services offered by ambulance services. I would add that pharmacies have a big role to play in this, as one in 11 or 12 A and E appointments could be dealt with at a pharmacy. My hon. Friend is absolutely right that this is something we need to do better.
David Wright (Telford) (Lab)
A hugely expensive review of A and E services is going on in Telford, the Wrekin and Shropshire. The Secretary of State was in Telford a couple of weeks ago but did not have the courtesy to let me know. Will he say whether we will retain full 24-hour, seven-day-a-week services at Telford and whether there will be downgrade of our A and E?
Mr Hunt
First, I apologise to the hon. Gentleman if my office did not let him know that I was visiting, an oversight for which I take responsibility. I had a good visit to the Redwoods, a superb mental health in-patient unit where I learned a great deal. I am not aware of any plans to change or downgrade his A and E.
NHS
Jeremy Hunt Excerpts(12 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Andy Burnham
My hon. Friend is right. For the very first time in the history of the NHS, competition intervenes to block sensible collaboration between two hospitals seeking to improve care and make savings. Since when have we allowed competition lawyers to call the shots instead of clinicians? The Government said that they were going to put GPs in charge. Instead, they have put the market in charge of these decisions and that is completely unjustifiable. The chief executive of Poole hospital said that it cost it more than £6 million in lawyers and paperwork and that without the merger the trust will now have an £8 million deficit. That is what has happened. That is not just what I say; listen to what the chief executive of NHS England told the Health Committee about the market madness that we now have in the NHS:
“I think we’ve got a problem, we may need legislative change…What is happening at the moment…we are getting bogged down in a morass of competition law…causing significant cost and frustration for people in the service in making change happen. If that is the case, to make integration happen we will need to change it”—
that is, the law. That is from the chief executive of NHS England.
Andy Burnham
No, it was your law, your Government’s law, the Health and Social Care Act 2012—the same law against which his own care Minister, the hon. Member for North Norfolk (Norman Lamb), has recently been speaking out. He recently told the King’s Fund:
“I have a problem with the OFT being involved in all of these procurement issues… I think that’s got to change… In my view I think it should be scrapped in the future… That might happen at some future date… we’ve got to look at the barriers and address them and sort them out.”
Is that just his view, or the view of the whole Government? [Interruption.] He voted to let the OFT into the NHS. Why is he now changing his tune?
The former care Minister, the right hon. Member for Sutton and Cheam (Paul Burstow), said the same:
“The one area I have my concerns about is the way”—
the 2012 Act—
“opened up the role of the OFT.”
Yes, but did we not tell him that two years ago when he voted for the Act and when his hon. Friend the Member for St Ives (Andrew George), who is sitting next to him, joined us in the Lobby to oppose it? This is exactly what we warned them about. We warned them that it would let the market run riot through the NHS, but they would not listen, and that is why we are where we are today.
It is not just Ministers who are saying it; the comments by the chair of the Care Quality Commission at the weekend show the utter confusion in Government policy on competition in the NHS:
“We need more competition…more entrants into the market from private-sector companies”.
Will the Secretary of State clarify? Is that a statement of official Government policy? Is it his policy to get more private sector companies and more competition into the NHS? Is that what he wants? If that happens, it will mean more enforced competition leading to the fragmentation of care, and it will load extra costs on to the NHS at the worst possible time.
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“notes the strong performance of NHS accident and emergency departments this winter; further notes that the average waiting time to be seen in A&E has more than halved since 2010; commends the hard work of NHS staff who are seeing more people and carrying out more operations every year since May 2010; notes that this has been supported by the Government’s decision to protect the NHS budget and to shift resources to frontline patient care, delivering 12,000 more clinical staff and 23,000 fewer administrators; welcomes changes to the GP contract which restore the personal link between doctors and their most vulnerable patients; welcomes the announcement of the Better Care Fund which designates £3.8 billion to join up health and care provision and the Integration Pioneers to provide better care closer to home; believes that clinicians are in the best position to make judgements about the most appropriate care for their patients; notes that rules on tendering are no different to the rules that applied to primary care trusts; and, a year on from the publication of the Francis Report, notes that the NHS is placing an increased emphasis on compassionate care, integration, transparency, safe staffing and patient safety.”.
The right hon. Member for Leigh (Andy Burnham) today made some strong accusations. He talked about the worst winter in A and E for a decade. For months now, he has been predicting a winter crisis in A and E, but as ever, when we look at the facts, they simply do not stack up. Let us look at the last week available for A and E statistics, which is the week ending 26 January. Over 96% of patients were seen within four hours. At this stage in the winter, we have missed the target four times; at the same stage when he was Health Secretary, he had missed it 12 times. That is three times more. [Interruption.] He says the target is different. It is true: on the basis of advice from clinicians, the target was reduced from 98% to 95%, so let us strip out the targets altogether and just ask a simple question. How many people every day are being treated within four hours? Under him, it was fewer than 52,000; under this Government it is nearly 55,000. That is 3,000 more people every day.
The right hon. Gentleman did not just say that; he also said that people were waiting longer and longer to be seen, but that is simply not true. When he was Health Secretary, shockingly, people had to wait on average over an hour to be seen in emergency departments. With 350 more A and E consultants—as my hon. Friend the Member for Mid Norfolk (George Freeman) rightly mentioned—under this Government we have cut that to just 30 minutes. The right hon. Gentleman has the gall to stand up and criticise a record that is better than his.
Julie Hilling
In relation to those targets, the Secretary of State ignores the number of people who have not registered because they are in ambulances or because there is a huge queue to be registered. I wonder how that is factored into his claim that people are always seen within half an hour, when patently they are not.
Mr Hunt
With great respect to the hon. Lady, it was under her Government that we had the horrific tragedy of ambulances circling round hospitals because hospitals did not want to admit them in case they missed their four-hour A and E target. There is a lot of pressure in the system, but the fact is that 3,000 more people every day are being seen within four hours than when her Government were in power. That is something that A and E departments up and down the country can be rightly proud of.
Graham Evans (Weaver Vale) (Con)
I have had reason to visit my accident and emergency four times with my young son, who is 10 years old and an enthusiastic rugby and football player. On those four occasions—for a broken nose, a damaged knee, damaged ankles and damaged elbows—we were seen within minutes for pain relief and were out of A and E within two hours.
Mr Hunt
That is exactly what is happening in so much of the country. Despite a lot of pressure, our A and E departments are holding up extremely well. I wonder how the staff in that hospital would feel about the constant running down of the NHS that we get from the Opposition.
Let us look at the figures that the right hon. Member for Leigh quoted in more detail. How does he get the number he quoted for the worst winter for a decade?
Andy Burnham
Let us have a proper debate. I did not say the worst winter for a decade; I said the worst year in A and E for a decade. Let us get it straight. The Secretary of State should not redefine the question at the beginning of his speech. I am talking about the last 12 months, from this day today back to February 2013. Let us get that absolutely clear and let him answer for the last year, during which he has missed the A and E target 44 times out of 52.
Mr Hunt
Let us be absolutely clear. Why has Labour decided to remove the word “crisis” from the motion it submitted to the House this afternoon? It does not mention the word “crisis” at all, because the winter crisis that the right hon. Gentleman has been predicting for over six months now has simply not materialised.
Let us look—this is important—at how the right hon. Gentleman has been manipulating the statistics. He knows perfectly well that there is no A and E target for single categories of A and E; rather, the target applies to all A and Es. He gets his numbers by singling out the biggest A and E departments, type 1s, which are extremely important. How did type 1s—the most important and biggest A and Es—perform during the winter when he was Health Secretary? Let me tell the House: they missed their target every single week up until this point in the year. There are indeed pressures on A and E departments, but why does he think the country will listen to him, when by his own yardstick he failed to deliver every single week up until this point in the year?
The right hon. Gentleman has been predicting a winter crisis for months, and we are still waiting. For him, these debates are not about the reality on the ground; they are about hyperbole and spin. As someone who has been Health Secretary, he must know—this is a serious point—the effect that lurid headlines based on dubious statistics have on morale for staff and those using the NHS, but still we get the same cracked record, because for him, politics always matters more than patients.
It is not just A and E performance; under this Government—[Interruption.] It might not be comfortable for the Opposition, but let us look at the figures. Under this Government, MRSA rates have virtually halved, mixed-sex wards have nearly been eliminated and when it comes to elective care, more than 35,000 fewer people are waiting more than 18 weeks. That is thanks to the efforts of hard-working front-line staff. Our NHS is doing 800,000 more operations year in, year out than it did under Labour—something we can be immensely proud of.
Ms Margaret Ritchie (South Down) (SDLP)
My right hon. Friend the Member for Leigh (Andy Burnham), the shadow Secretary of State, has referred to comments by Dr Cliff Mann about the shortage of A and E doctors and the fact that the issue was flagged up some two years ago. What will the Government do to address the 50% shortage in A and E doctors, not only in England but throughout the UK?
Mr Hunt
The hon. Lady is right to highlight the fact that there has been a long-standing issue with recruitment into A and E. We have made some good progress. We have 350 more consultants in post than at the time of the election, but we need to do even better, so we are looking at the training process for A and E consultants. We are also looking at the contractual terms for A and E consultants, particularly as they relate to things such as shift work, to try to make it a more attractive profession. I am confident that these issues are now being addressed—in fact, I have had some encouraging feedback from the College of Emergency Medicine saying that it, too, is confident about that.
Mr Hunt
I will give way in a minute, but this is an Opposition day debate, so I want to return to the central motion. Let me remind the right hon. Member for Leigh that he told this House—in fact, he had an Opposition day debate to do it—that the NHS budget had been cut in real terms. It had not: it rose. He also claimed that the number of nurses was being cut, when actually it went up. His attempts to talk up a winter crisis have been disproved time and again. That is important, because we have not had a proper apology to this House in relation to the letter he received from the chief executive of the south-western ambulance trust complaining about his spinning, which stated:
“information provided to your office in response to a Freedom of Information request…has been misinterpreted and misreported in order to present a grossly inaccurate picture for the purposes of apparent political gain.”
The right hon. Gentleman should not be playing politics with the pressures in A and E; he should be getting behind front-line staff, who are working extremely hard and who find that kind of tactic extremely demoralising.
Andy Burnham
For the record, I am afraid that the letter the Secretary of State quotes had its facts wrong. The information provided by the south-western ambulance service that I quoted was accurate. I wrote to the service the day it wrote to me to put it straight, and I am afraid it has not come back since and said that I was wrong; so again, let us get the facts straight. We have had enough spin from the Secretary of State; he needs to start dealing in a bit of fact.
Mr Hunt
I will tell the right hon. Gentleman exactly what the facts are. The other word I heard him use several times in his speech was “complacency”. I will tell him what complacency is: it is complaining about an English NHS that is hitting its A and E targets and completely ignoring Labour-controlled Wales, where the NHS has been missing its A and E targets since 2009. Something else that is complacent is this idea Labour has that, almost a year after the Francis report, the lessons of Mid Staffs stop at the border of England and Wales—that Wales has nothing to learn and does not need to do a Keogh report into excess mortality rates, which the Welsh Labour Government have consistently refused to do. People in Welsh hospitals are suffering because the Welsh NHS has refused to bite the bullet on excess mortality rates.
Mr Slaughter
Tonight, at a “Save Our Hospitals” meeting in west London, I shall be speaking to A and E doctors and GPs about the largest-ever closure programme: four NHS emergency departments are to close in west London. Eight west London MPs, including me, have asked the Secretary of State to meet us and discuss the issue. Shall I tell those who attend tonight’s meeting that the Secretary of State is still refusing to meet eight MPs who collectively represent nearly a million people in west London?
Mr Hunt
As the hon. Gentleman knows, I must follow a strict legal process in relation to such decisions, and we have had an extensive consultation. However, let me say this to him. When he talks to those MPs, he should tell them the facts about the proposals for north-west London which I approved—proposals for three brand-new hospitals in which seven-day working is to be introduced, 24/7 obstetrics, 16/7 paediatrics, seven-day opening of GP’s surgeries, and a range of other services which will help to address precisely the issues raised by the right hon. Member for Leigh in connection with transforming out-of-hospital care, which I support. As a result of those proposals, the services that I have listed will be available in north-west London before they will be available in many other parts of the country. I hope that the hon. Gentleman will inform the MPs whom he is meeting of those important facts.
Gordon Birtwistle (Burnley) (LD)
My right hon. Friend may remember that in 2009 the Labour Government transferred an A and E unit from Burnley to Blackburn, some 15 miles away. Last week, we opened the doors of a new emergency facility in Burnley to replace the one that Labour had shipped out. Does my right hon. Friend agree that it is right to invest capital in A and E, and to stop listening to the rubbish that is being spoken by Labour Members?
Mr Hunt
I understand my hon. Friend’s frustration. This is the shadow Secretary of State who said that it was irresponsible to maintain the NHS budget at its current levels and who actually believes that it should be cut, and he has stuck to that position. It is not possible to make such investments by following the right hon. Gentleman’s advice.
The right hon. Gentleman talked a great deal about competition, and I am afraid that his comments about that also showed a wilful disregard for the facts. He raised two distinct issues, and he was right to do so, because they are important. The first relates to mergers. NHS hospitals often need to concentrate services for clinical and safety reasons, but the involvement of the Office of Fair Trading and the Competition Commission is not a result of the Health and Social Care Act 2012, as the right hon. Gentleman alleged. As he well knows, it is as a result of powers that they have under Labour’s Enterprise Act 2002. All my Front-Bench colleagues agree with me that we must ensure that when those powers are exercised, they are exercised in a way that is in the best interests of patients. For that reason, I have had useful discussions with both the Competition and Markets Authority—which is replacing the OFT and the Competition Commission—and Monitor about how their respective roles can be clarified.
Kevin Barron (Rother Valley) (Lab)
If the Secretary of State believes that, can he explain why the Health and Social Care Act contains a section stating that any mergers of NHS trusts must be referred to the Office of Fair Trading and the Competition Commission?
Mr Hunt
Yes, I can explain that. When drafting the Act, my predecessor wanted to ensure that investigations would not be carried out by both Monitor and the Competition Commission. [Interruption.] If Members wish me to answer the question, I will happily do so.
If we repealed the Health and Social Care Act—as the right hon. Gentleman has often argued should happen—the Competition Commission and the OFT, or the Competition and Markets Authority, would still have the power to stop mergers, under the Enterprise Act. The right hon. Gentleman should get his facts right before presenting his arguments.
Secondly, the Health and Social Care Act did not introduce new rules in relation to procurement. For all the efforts of the right hon. Member for Leigh to convince people otherwise, clinical commissioning groups observe the same procurement requirements as applied to primary care trusts. Labour may have made many mistakes in office, and the right hon. Gentleman may have shifted his own views dramatically to the left, but it will not do for him to try to seek cover for that by attaching blame to the Health and Social Care Act.
Andy Burnham
If everything is exactly the same, why did the Government legislate? Why did they need a 300-page Bill if they were doing everything that the previous Government had done? Let the Secretary of State answer this question directly. There was a huge debate in the House about section 75 of the Health and Social Care Act, and his Minister had to withdraw the regulations and rewrite them, but the view of the entire NHS is that section 75 requires services to be put out to open tender, and does not leave discretion with GPs. GPs cannot decide, as the Secretary of State has claimed. Services are being forced out to open tender. Is that the correct position, or is it not?
Mr Hunt
I am about to answer, if the right hon. Gentleman will be a little bit patient. The Act does not change the procurement requirements under which PCTs operated. It does not change the locus of the Competition Commission or the OFT under the Enterprise Act.
While we are correcting some facts, the right hon. Gentleman may be interested to know—as would my hon. Friend the Member for Taunton Deane (Mr Browne), but he is no longer in the Chamber—that we have the figures for the number of people admitted to the NHS with scurvy in 2011-12 and in 2012-13. In 2011-12, the number of admissions not just to A and E departments but in total—[Interruption.] Yes, including A and E departments. In 2011-12, eight people were admitted—[Interruption.] This was the right hon. Gentleman’s big argument about why A and E departments are under so much pressure. In 2012-13, 18 people were admitted. With the greatest respect, I think that the right hon. Gentleman is building his house on sand.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
We have figures for 2010-11, because they were included in the answer to a parliamentary question that I asked just before Christmas. The Minister of State, who is present, replied that they were not the total figures, because the Department had the hospital admission figures but did not have the figures for primary care admissions.
Mr Hunt
With the greatest respect, what we heard earlier from the right hon. Member for Leigh was a big argument about a massive growth of pressure on A and E departments that had been caused by, among other things, scurvy, and we found that the total number of admissions was 18. I think that that says a great deal.
Mr Stewart Jackson (Peterborough) (Con)
On the subject of disastrous mistakes made by the Labour Government, may I point out that one of the omissions in their motion is the lack of any apology for the £63 billion ticking time bomb generated by off-balance-sheet dodgy deals under the private finance initiative? The worst in the whole country, which was signed off by the right hon. Member for Leigh (Andy Burnham) at Peterborough and Stamford Hospitals Trust, has produced an indicative structural debt of £40 million a year. [Interruption.]
Mr Hunt
I am afraid that my hon. Friend is absolutely right. Perhaps the situation is put into perspective when we know that those PFI deals are costing the NHS more than £1 billion a year: £1 billion that could have been spent on providing compassionate care and looking after patients with dignity and respect, but instead is having to finance Labour’s appalling mismanaged PFI contracts.
Let me return to the issues raised by the right hon. Member for Leigh. I think that a much more substantive argument relates to the things that he chose not to say. This is the day before the anniversary of the Mid Staffs report, and this is the day on which hospitals are finally putting behind them Labour’s appalling legacy of poor care. We have 14 hospitals in special measures—all of them, incidentally, with A and E departments—making encouraging progress after a very difficult year, with 650 additional nursing staff and 50 board-level replacements between them. Every single one of those hospitals had warning signs under Labour, but rather than sorting out the problems, Labour chose to sweep them under the carpet, sometimes because they had arisen during the run-up to an election. There are 5,900 more clinical staff in the NHS than there were a year ago, and there are 3,300 more hospital nurses than there were at the time of the last election. All those people are vital to the functioning of our A and E departments.
Bullying, harassment and intimidation were perhaps the ugliest features of Labour’s management of the NHS. Now we have seen courageous A and E whistleblower Helene Donnelly being given a new year honour, alongside brave campaigner Julie Bailey, who was literally left out in the cold when she came to lobby the right hon. Member for Leigh about poor care at Mid Staffs.
There is much to do—poor care persists in too many places—but with a new Ofsted-style inspection regime, in England but not in Labour-run Wales, we can at least be confident that poor care in A and E departments and throughout hospitals will be highlighted quickly, and not hidden away. We will keep people out of A and E departments in the first place—that is something to which the right hon. Gentleman referred—with the return of named GPs for the over-75s and integrated health and social care through the better care fund: precisely the joined-up, personal and compassionate care that was envisaged when the NHS was founded 65 years ago.
Barbara Keeley (Worsley and Eccles South) (Lab)
Was not one of the key points that Francis made about transparency? The Secretary of State is making claims about staffing numbers which are not recognised. Ministers have had the opportunity to go along with a better scheme of transparency in hospitals, whereby they display every day on the ward their staffing ratios—as Salford Royal does. The Secretary of State will not accept that, however. If he thinks that putting out the totals of staff once a month is an adequate way of dealing with the Francis recommendations, he is fooling himself.
Mr Hunt
We on the Government Benches will take absolutely no lessons about transparency in the NHS from Labour after what it did for so many years. I think what we are introducing is a huge step forward, because for the first time every hospital in the country will, as a minimum, have to publish their ward-by-ward staffing ratios every single month. They can publish more—they can do what Salford does—but for every hospital in the country to do that every month is a huge step forward.
James Morris (Halesowen and Rowley Regis) (Con)
The Secretary of State talks about finding alternatives to people presenting at A and E. May I commend Rowley Regis hospital in my constituency, which has just opened a GP-led primary care assessment centre in order to deal with people in the community—in a community setting—rather than having to refer to A and E? That hospital used to have five in-patient wards, but they were closed by the Labour party and the right hon. Member for Leigh (Andy Burnham) when he was Secretary of State. However, three of them have been reopened in the past three years, which is a substantial new investment in a very important community hospital.
Mr Hunt
I commend what is happening; it is very important that locally driven solutions are providing good alternatives to going to A and E. One of the most important things we can do for my hon. Friend’s constituents is make sure we have proper continuity of care so that for our most vulnerable patients there is a doctor who knows what is up with them at any time, whether they are in or out of hospital, and who can give them joined-up care and make sure they have a proper care plan wrapped around them. That is the kind of care we need to see.
Mrs Anne Main (St Albans) (Con)
My right hon. Friend is making a very pertinent point about transparency, because again what the Opposition refuse to acknowledge is how many patients were left off the books. It has been discovered in my hospital trust that a significant number of patients who were not discharged because there was not a link-up with social care were left off the books and so did not show in the statistics.
Mr Hunt
I think my hon. Friend is talking about the issues in West Hertfordshire trust, which I am extremely concerned about. The whole House will want to get behind the efforts of the outstanding chief executive there, who is sorting out those problems.
It is of course challenging when we read about these things in the media, but we have to remember that it is essential that poor care or cover-ups such as the ones that may have happened in that case are brought to the surface very quickly. That is the big change we want to make.
Guy Opperman
Does my right hon. Friend agree that it is the right policy to highlight trusts such as Northumbria, which is leading the way on integration between hospice care and local authorities, and which is also assisting another trust, in this case North Cumbria, which is presently in special measures and which we hope will come out of them very soon?
Mr Hunt
Absolutely. One of the most encouraging developments in the last year was the setting up of buddying systems so that hospitals in difficulty such as North Cumbria—where I think there was a pay-out of £3.6 million to just one person under the last Government because of some utterly appalling care—are given help by a hospital that is being run well.
Mr Marcus Jones
Will my right hon. Friend join me in welcoming the progress being made under the Keogh review at the George Eliot hospital, where changes to working practices and more innovation are meaning that the A and E department is turning into one of the best performing in the country?
Mr Hunt
I will make some progress, because I need to make one final point.
All of these changes cost money, at a time when we are still living with the economic mess we inherited from Labour. None of these changes would be possible without the tough decisions we took on public spending in 2010, all opposed by Labour, which allowed the NHS budget to be protected and, as growth returns to the economy, secured for the long term.
Mr Hunt
Our amendment talks about the Francis report, which I know is desperately uncomfortable territory for the Labour Opposition—the 81 times they refused to have a public inquiry; the 50 warning signs missed by Labour Ministers and the officials working for them; the warning signs ignored at countless other hospitals now in special measures.
Madam Deputy Speaker (Dawn Primarolo)
Order. Mr Reed, the Secretary of State has repeatedly made it clear that he is not prepared to give way to you, so perhaps we could move on with the debate. Perhaps you will find another way to make your point.
Madam Deputy Speaker
Order. I say to the Secretary of State that actually it does not indicate anything except that you do not wish to give way to the hon. Gentleman. So, return to your speech.
Mr Hunt
Thank you, Madam Deputy Speaker. We will all draw our own conclusions about why the Opposition are using these tactics, but I want to offer the Opposition today, a year after the Francis report, a chance to draw a line under this whole tragedy. I as Secretary of State am happy to move on from Mid Staffs in terms of the debates in this House if the Opposition pass three tests: to tell Labour in Wales to do a Keogh-style mortality review so that we deal with the poor safety in Welsh hospitals, just as we are doing in England; to apologise to the relatives and survivors of Mid Staffs not just for what happened, but for the policy mistakes that led to what happened; and to commit Labour to more compassionate, safer care in the NHS by promising never to accuse those who highlight problems of “running down the NHS”, and instead to support every whistleblower and concerned member of the public when they raise concerns. Do that, and the world will know that Labour has changed; but fail to do it, and the country will know for sure that the NHS is simply not safe in Labour’s hands.
Oral Answers to Questions
Jeremy Hunt Excerpts(12 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mark Menzies (Fylde) (Con)
12. What steps his Department has taken to ease the short and long-term effects of winter pressures on the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
In the short term, a record £400 million has been assigned to help the NHS through this winter, with £250 million announced in August, much earlier than before. For the long term, we are restoring the link between GPs and vulnerable older patients by bringing back named GPs for all over-75s—something that was broken in 2004.
Chloe Smith
I thank the Secretary of State for that answer. My constituents, including a family who came to my surgery on Saturday, are frustrated by the brick walls that sometimes seen to exist between different bits of the health service, and which are all the worse in urgent and traumatic winter cases. Different health services in Norwich have come together in Operation Domino to improve services in the face of demand, and they have used winter funding money to run a new style of urgent care unit at Norfolk and Norwich hospital. Does my right hon. Friend agree that Norfolk is leading the way?
Mr Hunt
I congratulate the health services in Norfolk—and indeed in Norwich—on what they are doing to break down those barriers. That is the key issue, and this year I am working closely with the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), to merge the health and social care systems—a £4 billion merger—to ensure that medical records can be shared across all the different systems, and that there is a named accountable doctor for the entirety of people’s time outside hospital. I hope that will make a difference in Norwich as elsewhere.
Mark Menzies
My constituency has a high proportion of elderly people. What steps is the Secretary of State taking to reduce admissions of elderly people to hospital this winter?
Mr Hunt
We are doing a very great deal and the £400 million announced to help the NHS through the winter is a record amount. My hon. Friend will be pleased to know that a lot of that money is being spent not inside A and E departments but in the community to help GP practices, and to try to recognise properly that for many older people—particularly vulnerable people with dementia —a busy A and E department is not the best place to go when something goes wrong, and if we possibly can we should avoid it.
John Healey (Wentworth and Dearne) (Lab)
Is it the case that worries about winter pressures are greatest in A and E, and that the crisis in A and E is entirely of the coalition’s own making? Ministers have been warned about cuts to elderly care and letting GPs off the hook on office hours and opening in the evenings and at weekends, and about the increasing costs of locum staff. They have been warned but they have not acted. What will the Secretary of State do now, late as it is, to ensure that A and E has enough doctors to see patients safely through the winter?
Mr Hunt
The Opposition try to talk up a crisis in A and E, but unfortunately, such talk does not withstand the facts. Let us look at the facts on how A and E is doing and perhaps the right hon. Gentleman will understand. We are seeing 2,000 more people every single day within the four-hour target than were seen when Labour was in power; we have 20% more A and E consultants; and the waiting time to be seen in A and E is half what it was under the Labour Government. However, we are doing more: we are addressing the long-term pressures in A and E, including the barriers to the social care system, which were mentioned in an earlier question, and the lack of good primary care alternatives. That is why we are restoring named GPs for the over-75s.
David Wright (Telford) (Lab)
A and E is in crisis across the country, but getting people out of hospital in a suitable time frame is also important. What is the Secretary of State doing to better connect the health service with other social care providers? Does he acknowledge that, in places such as Telford and Wrekin, there has been a substantial cut in continuing health care funding, which means the system is in danger?
Mr Hunt
Thank you for that guidance, Mr Speaker. Let me assure you that this winter, a lot is happening in Telford to break down the barriers between the health and social care systems. One big change we are championing—it is starting to happen for the first time—is a seven-day social care system, so that hospitals can get people assessed and discharge them at weekends. With respect to the hon. Gentleman, if he looks at the facts, he will see that that is beginning to happen in a way that it did not when Labour was in power. He should welcome it.
Margot James (Stourbridge) (Con)
I congratulate my right hon. Friend on the planning for, and the extra resources he has committed to, relieving winter pressures in A and E departments. What effect does he expect the additional combined budget for health and social care to have on admissions to A and E, particularly of older people?
Mr Hunt
We know that every year, 1.2 million of 5.2 million admissions to hospitals are avoidable if we have better alternatives in the community. The Government believe that restoring that personal link between doctors and the people on their lists—the people in their communities—who could often be much better looked after outside hospitals is the way to deal with that. That is why we are making that major change to the GP contract—it is the biggest change since named GPs were removed in 2004. That will benefit my hon. Friend’s constituents and those of all hon. Members.
Andrew Gwynne (Denton and Reddish) (Lab)
Before Christmas, the Secretary of State said that the A and E crisis is behind us. However, NHS data released last Friday show that patients have just experienced the worst week in A and E so far this winter. The A and E target was missed; 103 trusts failed to meet their individual target; and, shockingly, more than 5,000 patients were left waiting on trolleys for more than four hours—more than double the number in the previous week. The Secretary of State asks us to look at the facts, but those are the facts. They are apparent to all except, seemingly, him. Is he really still of the view that the crisis is behind us?
Mr Hunt
Let us look at those facts for last week and compare them with the facts in the identical week when the right hon. Member for Leigh (Andy Burnham), the shadow Health Secretary, was Secretary of State. When he was Secretary of State, 362,462 people were seen within four hours. Last week, we saw 365,354 people—3,000 more people—within the target. A and E is doing better under this Government than it ever did under Labour.
Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)
3. How many mesothelioma cases are being treated by the NHS; what strategies have been adopted for treatment and prevention of mesothelioma; and if he will make a statement.
Jesse Norman (Hereford and South Herefordshire) (Con)
5. What steps he is taking to promote the health and well-being of older people.
The Secretary of State for Health (Mr Jeremy Hunt)
We will ensure that everyone over the age of 75 has a named GP responsible for delivering proactive care for our most vulnerable older citizens in the best tradition of family doctors. Through our £3.8 billion better care fund, we are also merging the health and social care systems to provide more joined-up health and social care.
Jesse Norman
Dementia is a terrible blight for an increasing number of older people. Last week, I had the great privilege of opening Henffordd Gardens in Hereford, a supported living scheme that will allow dementia sufferers in my constituency to enjoy a better quality of life for longer and is a model of good practice for the country. Will the Secretary of State join me in congratulating Herefordshire Housing and all those who have worked so hard to bring this plan to fruition?
Mr Hunt
I absolutely join my hon. Friend in congratulating Herefordshire Housing. One of the key things about people with dementia is that relatively small adjustments to their homes can make it possible for them to live at home healthily and happily for much longer under the care of a husband, wife or partner without having to go into residential care. Those are precious years that we should treasure and do everything we can to facilitate, so I am delighted that that is happening, and he will be pleased to know that, thanks to the Government’s initiative, it is happening all over the country.
John Cryer (Leyton and Wanstead) (Lab)
Figures from the House of Commons Library show that £1.8 billion has been cut from social care budgets since 2010. Does not that imply that delayed discharge among older people will be driven upwards because the finances are just not there to look after them?
Mr Hunt
I think the figures the hon. Gentleman is talking about are efficiencies and not actual cuts. [Laughter.] Well, Members should look at the figures carefully. If they are the figures from the Association of Directors of Adult Social Services, that is what they will find. If the hon. Gentleman looks more specifically at the figures related to delayed discharges, he will find that, year on year, the number attributable to the social care system went down by 50,000 bed days in the last year.
John Howell (Henley) (Con)
One of the principal ways of promoting the health and well-being of older people in my constituency would be a rapid sign-off for the rebuild of the Townsland hospital complex. I recognise that the decision lies with NHS Property Services, but will the Secretary of State join me in using whatever influence we have to put pressure on it to get a move on?
Mr Hunt
I have spoken to my hon. Friend about the scheme, which sounds excellent. Obviously we want to encourage it, while working within the correct processes. The Under-Secretary of State for Health, my hon. Friend for Central Suffolk and North Ipswich (Dr Poulter), has agreed to meet him to do all we can to speed it along.
Sheila Gilmore (Edinburgh East) (Lab)
One of the things that some older people would like is to move closer to their families. Will the Secretary of State update me on what discussions he is having with the Scottish Government on the portability of home care packages across the border?
Mr Hunt
We are very keen to make home care packages much more portable. There are problems with home care packages across the board, particularly the 15-minute slots that, frankly, are completely unacceptable. We are definitely looking at that issue and I encourage the hon. Lady to talk to the Minister responsible for care services, my hon. Friend the Member for North Norfolk (Norman Lamb), to get more details on the progress we are making.
Mr Stephen Dorrell (Charnwood) (Con)
Does my right hon. Friend agree that the question asked by my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) is the most important single question facing the health and care system? Do not too many elderly people—the greatest single source of growing demand on the health and care system—experience our system not as a national health service but as a national illness service? Is not the challenge facing the system to ensure that, as people live longer, we enable them to get greater quality out of those extended life years?
Mr Hunt
As so often, my right hon. Friend encourages us to raise our heads above the horizon and to look forward. He is absolutely right. There will be 1 million people with dementia by 2020 and, as he knows, most of those will have other long-term conditions alongside dementia. The name of the game will be looking after people so they can live healthily at home, which will be the focus of health policy.
Huw Irranca-Davies (Ogmore) (Lab)
Regular social interaction and a comfortable home environment are critical to the health and physical and mental well-being of older people. Has the Secretary of State carried out any assessment across Government or within his own Department of the effect of cost of living pressures and cuts in local services on the home environment, and on older people?
Paul Burstow (Sutton and Cheam) (LD)
Dementia is the disease that people over the age of 50 say they fear the most and it is one of the biggest challenges for our society and for our health and social care systems. One of the ways to meet that challenge is through research, and the coalition Government is to be commended for the doubling of spending on research into dementia by 2015. However, it will take another decade, until 2025, for this Government or a future one to double it again. Will he reconsider that? Surely there needs to be greater ambition and greater pace to deliver the cures, the solutions and the prevention we need.
Mr Hunt
I commend my right hon. Friend for his work on dementia when he was working at the Department of Health. We are doing our bit as a country but we will not be able to do it on our own. Dementia is an incredibly difficult disease to crack, which is why, in December, the Prime Minister hosted a G8 summit to encourage other leading countries to increase their investment in dementia. We secured a commitment that they would significantly increase that investment and we want to encourage the private sector to do the same.
Andrea Leadsom (South Northamptonshire) (Con)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
I know that the whole House will wish to join me in remembering Paul Goggins at our first Health questions since his tragic death. He campaigned with great distinction on a number of health issues, including contaminated blood, mesothelioma and services at Wythenshawe hospital. I had the privilege of visiting a GP surgery in his constituency with him, and I know how much this utterly decent and selfless man cared about the health of his constituents. He has so sadly passed away, and the whole House will want to honour his memory and pass on our condolences to his family.
Andrea Leadsom
I certainly associate myself with the Secretary of State’s remarks. Will he undertake to look carefully at The 1001 Critical Days manifesto, which was recently launched by the right hon. Member for Birkenhead (Mr Field), the right hon. Member for Sutton and Cheam (Paul Burstow), who is in his place, the hon. Member for Brighton, Pavilion and me? Will he look at what more can be done to provide a comprehensive care pathway for the perinatal period?
Mr Jeremy Hunt
Yes, we are looking at that closely, with the Minister responsible for paediatric services doing so particularly closely. In principle, we support what my hon. Friend is trying to achieve with that document and we welcome its contribution to the debate.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Last week, we heard shocking revelations about the reasons behind the Government’s U-turn on minimum unit alcohol pricing. In particular, researchers at Sheffield university have confirmed that they were asked by government not to publish a report that would have undermined the Government’s decision to shelve minimum unit pricing. Why were Ministers so keen to suppress the report? Will the Secretary of State please tell us why some of our country’s leading public health experts are accusing Ministers of deplorable practices and of dancing to the tune of the drinks industry?
Joan Walley (Stoke-on-Trent North) (Lab)
T4. Given that tomorrow Staffordshire county council intends to confirm devastating cuts to services for those with special needs, including the closure of the purpose-built Kidsgrove day centre in my constituency, does the Secretary of State agree that it is time now for the council to wait and at the very least share its detailed needs assessment and future action plan before forcing these cuts through?
Mr Jeremy Hunt
I am very happy to look into the issue that the hon. Lady raises. Obviously, some very big changes are happening in the Staffordshire health economy, and the purpose of those is to improve services for everyone, so if she gives me the details of her concerns, I will happily look at them.
Stephen Mosley (City of Chester) (Con)
T3. At the end of last year, the Prime Minister hosted the very successful G8 summit on dementia. What plans does the Secretary of State have to continue, and indeed enhance, the UK’s global leadership on tackling dementia in 2014?
Mr Hunt
My hon. Friend is absolutely right. That is a critical job that we must do this year. The purpose of the G8 summit was to wake up the world to the huge threat posed by dementia, as the world woke up to the threat of HIV/AIDS in the 1980s and the threat of cancer in the 1960s. We need to continue that work. Summits will be going on in America, Canada and Japan over the course of the next couple of years, and we need to keep up the momentum, because everyone agrees on the need to do such work.
Hugh Bayley (York Central) (Lab)
T5. On 1 January, the York Teaching Hospital NHS Foundation Trust ceased providing antenatal advice classes for pregnant women and refers them instead to online advice on its website. Is that an approach the Government support, and will they urgently invite the National Institute for Health and Clinical Excellence to review the change in policy and look at its effectiveness?
Mr Gary Streeter (South West Devon) (Con)
T6. On any given day in the Derriford hospital in Plymouth, 75% of patients are over 65 years of age and rising. Does that not demonstrate the demographic pressures that face our acute hospitals, and what more can this Government do to ensure that people, especially elderly people, are treated in the community?
Mr Jeremy Hunt
We are doing a huge amount, but the first thing is to ensure that there is someone in the NHS who is accountable and responsible for all vulnerable older people outside hospital, because out-of-hospital care is where we need to have the big revolution. There will be a big change in April with named GPs for the over-75s. The integration of the health and social care systems is the next step. I hope that my hon. Friend will see real progress for his constituents.
Steve McCabe (Birmingham, Selly Oak) (Lab)
T7. The Secretary of State has had a letter from 118 specialists about the MenB—meningococcal B— vaccine. It is available to parents who pay privately, but denied to most of our children by the Joint Committee on Vaccine and Immunisation. Will the Secretary of State agree to meet the families of children who have had meningitis B and consider all the points raised by the clinicians before letting the JCVI rule out access to the vaccine?
Mr Hunt
I recognise the real concern over the previous advice given by the JCVI. I hope that the hon. Gentleman agrees that, on something as important as this, it is helpful to have an independent body coming to these decisions and making a ruling. When a ruling is made, we are legally bound to accept the advice, which means that there is a measure of independence. I have met families campaigning for the MenB vaccine. We are waiting to hear what the JCVI says in February. We should let it come to its conclusion after re-reviewing all the advice and the literature.
Richard Graham (Gloucester) (Con)
T8. The Government’s decision to increase our dementia research budget was welcome news, and the G8 conference agreement to share research among all G8 members was an important development too. Does my right hon. Friend agree that there is a role for MPs in helping to keep constituents informed about scientific developments that may lead to significant progress?
Mr Hunt
I do agree, and I congratulate my hon. Friend on his work. I know that he is meeting Alzheimer’s Research UK next month in his own constituency. This matter is something in which we can all be involved in our own constituencies. There is a lack of willingness to talk about dementia. Many people are frightened of it, and the more we can do to raise the profile of this condition, the more we can give people hope that something can be done about it.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
Although I support the principles of the Better Care Fund, does the Minister recognise that, in the context of severe cuts to local authorities and cuts in the NHS, the top-slicing of existing budgets is not sufficient? To encourage the kind of innovation that we need to get better integration, we must have additional funding.
Mr Robert Buckland (South Swindon) (Con)
T10. I warmly welcome initiatives such as the introduction of personalised GP care for the over-75s, but what more can be done to ensure that personalised care treats the individual’s well-being as opposed to merely a collection of symptoms?
Mr Jeremy Hunt
We want people to be treated as individuals, not a bundle of illnesses. That personalised care must happen not only out of hospitals but in hospitals, too. We want doctors to take responsibility for the whole stay and to avoid that sense of people being passed from pillar to post. That is an area in which we hope to announce some important changes shortly.
Alison Seabeck (Plymouth, Moor View) (Lab)
In an earlier response, the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), expressed his dislike for the working time directive. Would the Secretary of State be happy to revert to a situation in which patient safety, already compromised at weekends, is further compromised by over-tired doctors?
Mr Hunt
No one wants to go back to the bad old days of junior doctors working all the hours God gives, but the working time directive has had a negative impact on patient safety. It has made training rosters more difficult and it has meant that there is less continuity of care as people do not see the same doctor when they go back to hospital. We need to look at whether we can do that better, because it is not helping patients.
Mr Philip Hollobone (Kettering) (Con)
By Christmas, almost 2,000 staff at Kettering general hospital had received their flu jab—that is about 60% of front-line staff. Would the Secretary of State like to congratulate the hospital and its members for its bid to become the acute trust in the east midlands with the best flu jab record for three years in a row?
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
At the excellent James Cook University hospital between 19 December and 1 January, 49 ambulances were delayed for more than 30 minutes, 168 beds were blocked and 82% of admitted patients had been treated within 18 weeks, rather than the Government target of 90%. Why does the Secretary of State think that that is the case?
Mr Simon Burns (Chelmsford) (Con)
Is the Secretary of State aware that every fast food outlet in the United States displays the number of calories for each portion of food that it sells? Given that some fast food restaurants in this country, such as McDonald’s, already do that, does he believe that more should be done to make all fast food outlets in this country display the number of calories so that people are educated before they make a choice about what they are going to purchase?
Migrant Access to the NHS
Jeremy Hunt Excerpts(12 years, 6 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
On 30 December 2013, I published a response to the recent consultation on proposed changes to the way temporary migrants and visitors access the NHS in England. The response sets out initial decisions and next steps, taking account of feedback received during the consultation as well as the results of independent research on visitor and migrant use of the NHS that we commissioned in parallel with the consultation and which we published on 22 October1.
The independent research was commissioned to provide, for the first time, a reliable estimate of visitor and migrant health care costs, in particular the costs of provision for those who should be charged, and for “health tourism” where visitors have an explicit intention of obtaining extensive health care without due payment. This research provides a compelling case for new and more robust and consistent administrative processes and systems to be introduced.
The consultation was launched on 3 July at the same time as a linked consultation, “Migrant Access to Health Services in the UK” from the Home Office. Both consultations put forward the proposal that non-EEA temporary migrants should in future contribute to the costs of their health care. The Immigration Bill includes a provision to introduce the immigration health surcharge on a UK-wide basis to allow people to make this contribution with minimal operational impact or burden on the NHS.
The consultation also sought views on whether any changes should be made to the categories of non-residents who should be exempted from charges. A proposal to provide more generous exemptions to ex-pats, many of whom should be charged for treatment provided when returning on visits, received broad support. The response proposes to confirm the principle that exemptions should be consistent with criteria applied to UK pensions and other state benefits, but further work is required to confirm specific qualifying criteria and financial impact.
The open review of current exemptions generated requests for a number of new or extended exemptions for maternity, victims of domestic and other violence as well as victims of human trafficking and children. The response commits my Department to give further thought to the exemptions for victims of domestic and other violence and of human trafficking, seeking the views of relevant agencies and advisers as appropriate.
We do not intend to establish an exemption for children or for pregnant women. In both cases we believe there is significant risk of abuse by visitors either seeking maternity care for themselves or care for their children with existing serious illnesses, and may act as a draw to illegal migrant families. We will listen to arguments about how best to cover other vulnerable children who might otherwise be unable to access treatment. All of these potential changes will be subject to further final cabinet approval following further evaluation.
The consultation also proposed extending the scope of NHS services for which charges should apply for non-exempt visitors. Charges currently can only be made for most secondary care in hospitals. In primary care, we will retain free access to GP consultations. We expect GP practices to participate actively in the administration of the new system for identifying and recording chargeable patients.
The response signals our commitment to charge visitors for treatment in hospital A&Es, but this will not be introduced until improved systems can support its effective administration, including the safe and efficient delivery of A&E services, avoiding unintended charging of legitimate residents and ensuring immediately necessary treatment is not refused. It also confirms the intention to extend charging to other services and treatment that are part of primary care, including community-based health care, prescriptions and dental services (that are already subject to charges for many residents). Officials will work with the NHS to determine how appropriate and cost-effective non-resident charging should be defined and administered.
Finally, the response reinforces the need to make significant improvements in how the NHS manages and administers the charging and recovery process. Sir Keith Pearson, the independent NHS advisor to the visitor and migrant NHS cost recovery programme, and the director of cost recovery are working in partnership with external NHS experts and stakeholders to design and roll out proportionate, cost-effective and operationally successful implementation.
All of these proposals apply to the NHS in England only, although my officials will continue to engage with devolved Administrations who may wish to replicate some or all of the proposed changes.
“Sustaining services, ensuring fairness; Government response to the consultation on migrant access and financial contribution to NHS provision in England” and the supporting equality analysis has been placed in the Library. Copies of the response are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper office.
It is also available at: www.gov.uk/government/consultations/migrants-and-overseas-visitors-use-of-the-nhs.
Note:
1https://www.gov.uk/government/publications/overseas-visitors-and-migrant-use-of-the-nhs-extent-and-costs
Accident and Emergency
Jeremy Hunt Excerpts(12 years, 7 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(12 years, 7 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.