Accident and Emergency Departments

Jeremy Hunt Excerpts

Tuesday 10th September 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on his plans to alleviate pressure on accident and emergency departments.

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

This morning I made a written ministerial statement outlining the Government’s plans for the winter and detailing how we are allocating £250 million of funding for NHS England. Working with Monitor and the NHS Trust Development Authority, NHS England will distribute this money in 2013-14 to the areas where it is needed most. This follows the announcement in August by my right hon. Friend the Prime Minister that A and E departments will be given an additional £500 million over the next two years to deal with seasonal pressures. Patients need to be able to rely on the NHS all year round, and especially when demand is at its greatest. Ensuring the NHS’s sustainability means identifying each of the challenges it faces and, where possible, alleviating the burden.

Flu is an avoidable pressure on the NHS. Every year, around 750,000 patients see their GP with flu symptoms and nearly 5,000 people die. While flu levels have been comparatively low in the last two years, it would be complacent to assume that they will not rise. Should this happen, it will increase pressure on A and Es, which have already seen a rise in admissions of 32% in the last decade.

The best way to protect oneself and other people from flu is to get the flu vaccine, so, for the first time, children aged two and three will be offered the innovative nasal spray vaccine. Young children’s close contact with others makes them more likely to transmit flu to vulnerable groups including infants and the elderly.

Around 27,000 people spend time in hospital with flu every year, so it is very important that NHS staff should do all they can to avoid getting, and passing on, flu. Less than half of front-line NHS staff get vaccinated against flu. In some hospitals, that drops to fewer than one in five. The Government want to boost significantly the number of health care workers getting the flu vaccine. Trusts will not be eligible to receive a portion of the money in future years if they do not achieve a staff vaccination rate of 75%, except in exceptional circumstances.

This funding will be targeted in the following way: £15 million will go towards securing a reliable NHS 111 service throughout the winter period; subject to completion of current scrutiny of plans, a total provisional amount of £221 million will go to the 53 highest-risk systems; and a small contingency of £14 million will be used for final settlements, for trusts to use in the winter. My written ministerial statement outlines the indicative amounts that have been allocated to specific trusts. The additional allocation will require an increase to the revenue budget for NHS England for 2013-14, as had been specified in the mandate, and the revision to the mandate will be laid before Parliament in due course.

I recognise, however, that we need more radical change to reduce pressures on A and E departments over the longer term. I am currently consulting on my plans to provide improved care for vulnerable older people, to keep them out of hospital through better, more proactive care in their community. This will include better joint-working between the health and care systems; personalised, proactive care overseen by a named, accountable GP; and the sharing of GP records across different organisations, including out-of-hours GP services and the ambulance service.

NHS staff are working harder than ever before, and the British public rely on the NHS just as much as they have always done, and on a year-round basis. The plans outlined in this announcement will improve patient safety levels and help to reduce avoidable pressure on the NHS in the winter months ahead.

[Andy Burnham]

This Secretary of State has been in office for one year—the worst year in A and E in a decade: close to 1 million people waiting more than four hours, and on his watch, the first summer A and E crisis in living memory. But with this Government it is always someone else’s fault: GPs, nurses, patients, the weather, immigration, bank holidays—nothing to do with him, Mr Speaker, he is just a member of the public, as he is fond of saying. Well, I have got news for him: he is the Secretary of State, and it is time he started acting like it. All year we have warned him about the growing A and E crisis. First, he ignored those warnings, leaving A and E ill-prepared on the brink of a dangerous winter, as the NHS Confederation has warned. Now, in panic, he briefs out half-baked plans, without coming to this House. This is too little, too late. It is not good enough that we have had to drag him here on an issue of huge importance to our constituents. With his spin about the GP contract, he neglects the real causes.

First, on staffing, we learn today of the shocking shortage of doctors covering A and Es overnight, and we heard at the weekend reports of A and Es up and down the land without enough staff. More than 5,000 nursing jobs have been lost on the Government’s watch—and counting. Enough is enough. When will the Secretary of State stop the job cuts and ensure that all A and Es have enough staff to provide safe care?

Secondly, on GP opening hours, the Secretary of State tries to blame the 2004 contract but conveniently ignores the fact that A and E performance improved between 2004 and 2010. The truth is that it is the Government who have let GP practices stop evening and weekend surgeries, and it is the Government who ended the guarantee of appointments within 48 hours. What is he doing to restore patient access to GPs?

Thirdly, on social care, in the first two years of this Government there was an appalling 66% increase in the number of people aged over 90 coming into A and E via a blue-light ambulance—that is more than 100,000 very frail and frightened people in the backs of ambulances speeding through our cities and towns. That is a scandal, and it is more to do with social care cuts than anything else. I do not know how many more times I am going to have to ask the Secretary of State this: when will he do something to stop the collapse of social care in England?

All the while the Secretary of State blames a contract signed 10 years ago for today’s pressure he neglects the real causes of his A and E crisis. That is dangerous and it cannot carry on. Patients and staff cannot go through another year in A and E like the one we have just had. He should cut the spin, get a grip or go.

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[Mr Hunt]

In the right hon. Gentleman’s endless quest to turn the NHS into a political football, he, disappointingly, paints a picture that is a long way from reality. He talks about A and E performance. Yes, since I have been Health Secretary we have missed our target in one quarter, but when he was Health Secretary he missed it in two of the three quarters, including 14 weeks over the crucial winter period. What he does not tell the House is that this Government actually hit their A and E target for the year as a whole, whereas in Labour-controlled Wales the NHS budget has been cut and the A and E target has not been hit since 2009—he repeatedly refuses to confront that.

The right hon. Gentleman talks about the number of nurses being down. He might want to check the figures and correct the record for the House when he uses the 5,000 figure, because the fact is that the number of hospital nurses—hospitals are where A and E departments are—has gone up under this Government, as has the number of doctors, health visitors and midwives. None of that would be possible if we had cut the NHS budget by £600 million from its current levels, which is his policy.

The right hon. Gentleman then talks about the social care budget. Under his Government the number of over-80s went up by more than a quarter, yet the Labour Government cut social care funding per head. We have introduced the innovative £3.8 billion merged health and social care fund, which will transform the joined-up nature of the services that people receive.

Finally, I am afraid that Labour Members are burying their heads in the sand about the enormous damage they did when they removed named GPs for members of the public under the GP contract. Professor Keith Willett, one of the most senior doctors in the NHS and responsible for all A and E services in NHS England, has said that between 15% and 30% of the people using A and E could be using primary care instead. That is why we are announcing really important changes to the way in which the GP contract operates, in order to address this problem. When the Government come before the House with a sensible package of short-term and long-term measures, any responsible Opposition would welcome it—instead, we have had political posturing and no attempt to address the real challenges facing the NHS.

[Mr Stephen Dorrell (Charnwood) (Con)]

May I welcome the £250 million that my right hon. Friend has announced as short-term relief of the pressures in A and E departments this winter, and in particular the £10 million he has announced for Leicester’s hospitals trust? Does he agree that the way to relieve pressure in A and E departments is by recognising that the health and care system is a single system that needs to be joined up and that the announcement by the Chancellor of £3.8 billion made available from health service spending to promote better integration of health and social care is the most effective single thing we can do to relieve pressure on A and E departments?

[Mr Hunt]

As so often on these matters, my right hon. Friend speaks extremely wisely. Since April, we have been working hard to deal with the underlying pressures on A and E departments while ensuring that we have cash available for short-term measures while those longer-term measures are put in place. He is absolutely right that joined-up integrated services are critical for A and E departments, because one of the biggest problems that they mention is the difficulty in discharging people from hospital, which makes it hard for them to admit patients who need to be admitted, often in very distressed circumstances. We also need to address the longer-term IT problems that mean that A and E departments cannot access people’s medical records and the question of alternatives to A and E, particularly in the community and through enhanced GP services.

[Mr Ben Bradshaw (Exeter) (Lab)]

If the Secretary of State is serious about people not attending A and E unnecessarily, why did he cut Labour’s extended GP opening hours and why is he allowing NHS walk-in centres to close up and down the country?

[Mr Hunt]

The fact is that one thing we need to do is to address why people go to A and E instead of the alternatives, such as walk-in centres. Communication about the alternatives to A and E is not as good as it needs to be. We are addressing those issues, but I must say to the right hon. Gentleman that the previous Government failed to address this problem when he was Health Minister and the difficult issue of the reconfiguration of services was never fully grasped. We are grasping it and that is why Professor Sir Bruce Keogh is undertaking his review right now.

[Dr Sarah Wollaston (Totnes) (Con)]

I congratulate the Secretary of State on his welcome stand on continuity of care and the role that that plays in reducing A and E admissions. Could he go further in stating how he will ensure that we have more doctors trained from medical school in both A and E and general practice?

[Mr Hunt]

My hon. Friend is right and staff recruitment is critical. We have already said that we want another 2,000 GPs and are considering whether that is enough. We recognise the fact that general practice is very stretched, that we need GPs to offer more services and that we need more people to do that. Professor Keogh’s review is considering A and E departments, and one thing we are asking is why we are one of the only countries in Europe to have an emergency medicine specialty. Other countries do not do that and ask all doctors to spend time in A and E. We are also considering what we need to do to make A and E a more attractive profession for people to go into, given the antisocial hours that come with the territory. That is not an easy problem to solve, but we recognise that it is incredibly important that we crack it.

[Grahame M. Morris (Easington) (Lab)]

Has the Health Secretary had a chance to pause and reflect on the Government’s decision not to publish the risk register? If so, did the register warn that the reorganisation might have had an adverse effect on A and E performance?

[Mr Hunt]

As I recall, the risk register for that period found its way into the public domain. As for our publishing the risk register, we are following exactly the same policies as the hon. Gentleman’s Government followed in office. They refused to publish that register for the simple reason that officials need to be able to give Ministers frank advice in private if Ministers are to do their job properly. That is why we have not changed the policy.

[Mr Christopher Chope (Christchurch) (Con)]

The Royal Bournemouth hospital accident and emergency department treats 70,000 patients a year. Will my right hon. Friend explain how it can possibly be in the interests of those patients for that department to be downgraded to a minor injuries unit?

[Mr Hunt]

The changes that my hon. Friend alludes to are locally driven and have not crossed my desk. I want to reassure him that if they do cross my desk, I would not approve them unless there was convincing evidence that that was in the interests of patients and there had been proper consultation.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

Having been defeated in the High Court by the Save Lewisham Hospital campaign, the Secretary of State has decided to appeal that decision. Given the crisis in A and E in London, has he any new ideas as to how A and E services should be provided in Lewisham, and if so, will he share them with the local MPs?

[Mr Hunt]

We are determined to do what is right for the people of Lewisham and of south London. Let me be clear: the problems of South London Healthcare NHS Trust were not addressed by the right hon. Lady’s Government when they were in office. We are addressing them, and sometimes those decisions are difficult, and sometimes they are not popular with local people. I took the decision that I did because it will save about 100 lives a year. I think it was the right decision, and I want to ensure that I do the right thing by her constituents.

[Sir Tony Baldry (Banbury) (Con)]

The extra £10 million for the Oxford University Hospitals NHS Trust to deal with winter pressures is very welcome. Sir Jonathan Michael and his team have already made it very clear that they will open a significant number of new beds this winter and take on a significant number of new members of staff. The Oxfordshire clinical commissioning group is already working hard on enhancing primary triage, so that fewer people have to go to A and E. Would it not be better if we just let NHS managers—the NHS—get on with this, rather than the Opposition continuously shroud-waving every winter, in the hope there might be some failing that could shore up their flagging opinion polls?

[Mr Hunt]

We have not heard any kind of policy from the Opposition today, or any suggestion as to what they would do differently. We have presented to the House a package of short-term and long-term measures, designed to address the immediate and the underlying challenges. It is a very comprehensive package, but it is going to be a very tough winter and I would urge all responsible politicians from all parties to row in behind the package, which I think will make a very big difference on the front line.

[Mr Kevin Barron (Rother Valley) (Lab)]

If the 2004 GP contract was to blame for the current crisis in A and E, could the Secretary of State explain why, in 2009-10, over 98% of patients were seen within four hours?

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[Mr Hunt]

That contract set in train a process whereby it became easier and easier to access an A and E department, and harder and harder to access a local GP. Since that period we have had, I think, 3 million more people going to A and E every year than was the case at the time of that contract change. That is one of the underlying problems. It will take time, but we shall put that problem right.

[Sir Bob Russell (Colchester) (LD)]

I recently spent the whole evening on the night shift of the A and E at Colchester general hospital, and I do not recognise what we have heard from the Labour Front Bench today. As the Secretary of State is keen on alternatives to A and E, may I urge him to work with the Secretary of State for Education and implement first aid training as part of the school curriculum? Within a generation, we would have 1 million qualified first-aiders. That is one way of reducing unnecessary visits to A and E.

[Mr Hunt]

My hon. Friend has campaigned regularly on this subject and there is a lot of merit in what he says. We do need more young people to know the basics of first aid, and that can be extremely important—even life-saving. But we also need to ensure that the NHS is there when we need it, 24/7, and that is why we need to make some important changes to the way in which A and E departments operate, in both the short term and the long term.

[Jim Shannon (Strangford) (DUP)]

Twenty-four thousand elderly people died last winter due to cold-related illnesses, and many of them had been referred to A and E departments. What specific assurances will the Minister make to vulnerable elderly people, who really dread the onset of winter?

[Mr Hunt]

That is what today’s announcement is all about. We are trying to reassure them that we are leaving no stone unturned, and where there are things that we can do in the short term, we are doing those things because we want every older person to feel confident that their NHS will be there for them—that their local A and E department will be able to cope with the additional pressures that develop every winter. But I would also say to them that where there are alternatives to A and E departments, people should consider those as well. That is why some of the measures that we are investing in are good alternatives to A and E, which can often give more appropriate treatment.

[Mark Reckless (Rochester and Strood) (Con)]

Hospital staff have acted with extraordinary enthusiasm to, as they put it, reboot Medway following the Keogh review. Can the Secretary of State confirm that the £6 million or so extra that he may provide to help our A and E should be in addition to anything that the clinical commissioning group might otherwise have agreed to provide?

[Mr Hunt]

Yes, I am happy to confirm that it is additional money. I thank my hon. Friend for the interest that he shows in his local hospital, which is going through a very challenging time. We are absolutely determined that where hospitals are failing or delivering inadequate care, we will not sit on those problems; we will expose them and deal with them. That is the best thing we can do for my hon. Friend’s constituents and people all over the country where there are, unfortunately, problems with local hospitals.

[Mr John Denham (Southampton, Itchen) (Lab)]

In the last year, the A and E target was missed at Southampton hospital in 38 of 52 weeks. Since I last raised that in the House, Monitor has gone in to investigate the governance of the hospital, yet no money has been made available by the Secretary of State in today’s announcement. Is that not a sign that the crisis is so big that he has only been able to give a limited amount of help to those places that have an even worse crisis than we have in Southampton?

[Mr Hunt]

The pressure exists throughout the NHS. The right hon. Gentleman is absolutely right: there is real pressure in all hospitals. I commend all A and E departments for their hard work. The ones that got additional resources today were the 53 local health economies where we thought the risks were highest, and I think it was right to target that money to help those areas, but that is not to say that there is not a lot of pressure in other areas. That is why the long-term changes that we are talking about—the transformation in IT systems, the increased availability of GPs to look after frail and vulnerable older people, the integration of health and social care services—will benefit the right hon. Gentleman’s constituents and his hospital profoundly, and I am sure he will notice the difference.

[Angie Bray (Ealing Central and Acton) (Con)]

I welcome the extra money for Ealing Hospital NHS Trust and North West London Hospitals NHS Trust. It will come in very useful indeed. However, my right hon. Friend will be aware that four hospitals in North West London are still under threat of losing their A and Es. The independent review into that decision is due to report to his Department very shortly. When are we likely to get a final decision from him?

[Mr Hunt]

Let me reassure my hon. Friend. First, I thank her for her assiduous campaigning for her local hospital, which is recognised on both sides of the House. I am expecting that report on Friday, and as the House knows, when it comes to issues of hospital reconfigurations, I want to make decisions as quickly as I can. I will want to consider it very carefully, but I think everyone would like the certainty of knowing what will happen, so I will report to the House as soon as I am able to make a decision.

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

Hospitals across the north-east, as in many parts of the country, are facing considerable pressure on their A and E departments. Will the Secretary of State set out in more detail the rationale used to allocate the funding? I notice that not a single NHS trust in the north-east appears on his list.

[Mr Hunt]

The decision on which 53 areas to concentrate the resources was not made by me; it was made by NHS England, talking to Monitor and the NHS Trust Development Authority, on the basis of where, in their professional assessment, the highest-risk areas are. That is a sign that hospitals in the north-east are performing extremely well. In the past few months I have visited Newcastle, and I thought the hospital was absolutely fantastic; I did a stint on the front line there. There are some outstanding hospitals across the country, and there is very good NHS provision in the north-east. That is probably the reason.

[Andrew George (St Ives) (LD)]

I wish my right hon. Friend well in his quest to reintegrate a fragmented service —a trend which was largely started under the previous Government—but given the fact that the ambulance service provides a very good bolster, and indeed support, and helps to remove pressure from many A and E departments, how much of the £500 million will be made available to support ambulance services in their support of A and E departments?

[Mr Hunt]

Quite a lot of the money will help ambulance services indirectly because it will be intended to reduce the number of blue light calls by, for example, providing primary care alternatives to A and E by better integrating health and social care economies, but the long-term change that we announced last week, which I think will make a real difference to ambulance trusts, involves IT. In this day and age it is crazy that an ambulance can answer a 999 call and go to someone’s home not knowing that they are a diabetic who has mild dementia and who had some falls last year. That information could be incredibly helpful to paramedics and we want to make sure that, with patients’ consent, they have it at their fingertips.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

The A and E at the Wolverhampton New Cross hospital is already under great pressure and earlier this year had its busiest day in history, but what really concerns local people are the possible implications of the closure of the A and E at Mid Staffs and the transfer of the work to New Cross. Can the Secretary of State confirm that if that goes ahead, New Cross hospital will have the resources in terms of capital and staff to make it work, because the alternative will be a second-class service for patients in both Wolverhampton and Staffordshire?

[Mr Hunt]

I thank the right hon. Gentleman for the interest and support that he shows for his local hospital. Of course, Mid Staffs has an extremely troubled history and it would be a derogation of my duties if I did not try to sort out the problems there once and for all, but we will not make any changes that have knock-on effects on neighbouring trusts without proper assessment and making sure that provisions are in place so that they can cope with any additional pressures. The final decision about what is going to be done has not been made, but I reassure the right hon. Gentleman on that point.

[Steve Baker (Wycombe) (Con)]

The A and E crisis in Wycombe results from the closure of the department under the previous Government. Although I would love to lay the blame squarely on Labour, is not the truth that, over the life of the NHS, clinical practice and management have changed substantially? Will my right hon. Friend consider producing a White Paper that takes a holistic view of emergency and out-of-hours care so that we can have an A and E service that is fit for the 21st century?

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[Mr Hunt]

My hon. Friend has campaigned as hard as anyone in the House for more personalised and humane care for his constituents, and he is right. We need a radical rethink about the way that A and E departments work. My only hesitation in leaping to accept his suggestion of a White Paper is that that process takes a very long time. Professor Sir Bruce Keogh is in the middle of a review and I want him to be able to report back. I hope that we can get support across the House for what he says so that we can implement his solutions much sooner than that White Paper process would allow.

[Heidi Alexander (Lewisham East) (Lab)]

The Secretary of State may be holding on to some sort of misplaced belief that he did the right thing with regard to Lewisham. However, the High Court judgment in the summer ruled and found him to have acted unlawfully in taking the decision to slash services at Lewisham in order to solve financial problems elsewhere. Rather than wasting more taxpayers’ money in appealing against this judgment further, why will he not allow local health care professionals to determine the future shape of acute services in south-east London to meet the needs of the community and not just the needs of NHS accountants?

[Mr Hunt]

I know that the hon. Lady has campaigned assiduously and determinedly for her constituents. Even though we have different views, I hope she will understand that at every stage I have taken the decisions, often difficult decisions politically, that I think will best serve her constituents and the people of Lewisham. I accepted the advice of the medical director of the NHS that that decision on Lewisham would save a significant number of lives. That is why I took that decision. As to what we do going forward, I will continue to do what I think is the right thing for her constituents. If she does not agree with the decisions I make, I hope she will at least show greater respect for the motives behind them.

[Gavin Barwell (Croydon Central) (Con)]

I have discussed with my right hon. Friend on many occasions the issues facing Croydon University hospital. I am very grateful for the £4.5 million that has been announced today. May I ask him both to look kindly on the bid for capital investment for the A and E department there, and to pay tribute to the doctors and nurses in my A and E department and others across the country who are working so hard under such pressure?

[Mr Hunt]

I thank my hon. Friend for making that point. It cannot be said enough how hard A and E staff in particular work—antisocial hours in very challenging conditions. Many hon. Members will have seen that in their local hospitals. With respect to the capital allocations, I hope that the House has a sense from today that we are looking to solve the long-term problems facing A and E departments, as well as giving immediate help for this winter and next winter, so of course we will look carefully at the business case put forward by his local hospital for capital.

[Valerie Vaz (Walsall South) (Lab)]

The Royal College of Physicians, the College of Emergency Medicine and others have already come up with a 10-point plan for what to do about emergency care. That is the professional view. When will the Secretary of State act on it?

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[Mr Hunt]

The royal colleges have come up with a number of important and good ideas. I hope that the hon. Lady has seen from my announcement today that we are making some profound changes to address the underlying problems in A and E which incorporate much of their thinking, but there are other ideas. We will continue to engage closely with the royal colleges because they can give us a lot of help in ensuring that we get the right answer.

[Mr Peter Bone (Wellingborough) (Con)]

Wellingborough’s nearest A and E is Kettering general hospital, which is 30 minutes or more for most of my constituents to get to. However, the proposal for an urgent care centre at the Isebrook hospital in Wellingborough will allow 40% of those constituents to go locally and relieve pressure on Kettering. Is this the sort of thing that the Secretary of State wants to encourage?

[Mr Hunt]

I always try to support the ideas that come up from different parts of the NHS because people on the ground usually have the best ideas about what needs to be done, but when decisions cross my desk it is important that I consider the knock-on effect on other areas, and I get independent advice on that as well. I shall follow closely the proposal that my hon. Friend mentions.

[Nic Dakin (Scunthorpe) (Lab)]

Does the Secretary of State believe that he has done enough to avoid a crisis in A and E this winter?

[Mr Hunt]

I think we have done everything we can, and we have tried to listen hard to the suggestions for what can help in the short term and what can address the underlying problems. I believe it is possible for the NHS to meet its targets this winter, but I do not want to say that it is going to be easy. It will be a very tough winter and we need to get behind the doctors and nurses on the front line who are doing their very best to deliver a great service to the public.

[Nigel Mills (Amber Valley) (Con)]

I welcome the extra £4.5 million for the Derby hospitals trust. On a separate matter, can the Secretary of State reassure my constituents that if they ring 111 they will now get a quality service that gives them the advice they need?

[Mr Hunt]

I thank my hon. Friend for mentioning the support that we are giving to Derby, which I hope will be a great help over this winter and next winter. Improving 111 is an important part of the long-term solution for A and E. If there is one thing that could persuade people not to go to their local A and E, it is to pick up the phone and get a good service. We have 92% satisfaction rates with 111 now, after the teething problems earlier in the year, but I think it can be even better. One of the things that would make the biggest difference is if we did something that has never happened before, which is to make it possible for doctors at the end of the 111 lines to access people’s medical records, with their consent. Then people would be talking to someone who knew about them, their allergies and their medical history. That is a big change. It never happened under the previous Government. Their attempts—[Interruption.] NHS Direct had no access to people’s medical records, which is what we are talking about. That would be a profound change and could make a big difference.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It appears that the Secretary of State is not listening to the Health Committee, which has looked into the issue. The Chair, the right hon. Member for Charnwood (Mr Dorrell), has made it clear that he does not think the 2004 GP contract is to blame for these issues, but we found out that only 16% of hospital trusts have the recommended level of emergency consultants, and we noted that nearly £2 billion has been taken out of adult social care. When will the Secretary of State deal with the staffing cuts and budget issues that are actually causing the A and E crisis?

[Mr Hunt]

My right hon. Friend said to the House that he largely agreed with the changes that I wanted to make to the GP contract. I always listen very carefully to what the Select Committee says, but I point out to the hon. Lady what Professor Keith Willett, who is the person at NHS England who is in charge of all A and E departments, said. He said that between 15% and 30% of the people attending A and E departments could be looked after by primary care. If we ignore that—I am afraid that what Labour did in 2004 has made the problem a great deal worse—we will not solve the underlying problems with A and E.

[Iain Stewart (Milton Keynes South) (Con)]

I warmly welcome the additional £2.7 million for Milton Keynes hospital, which will help address short-term pressures this winter, but, looking at the longer term, I urge my right hon. Friend to look again at the case that I and my hon. Friend the Member for Milton Keynes North (Mark Lancaster) and the Milton Keynes Citizen have been making for an expanded A and E centre in Milton Keynes to meet the needs of a vastly increasing population.

[Mr Hunt]

I congratulate my hon. Friend and his Milton Keynes colleague on their assiduous and regular conversations with me on the pressures on their A and E. I recognise that it is operating way above its original planned capacity and hope that today’s announcement will make some difference, but we will continue to look at long-term solutions because we recognise that there are long-term pressures.

[Mr Andy Slaughter (Hammersmith) (Lab)]

In view of the continuing and worsening crisis in A and E, will the Secretary of State concede that closing four out of nine A and E departments and 500 beds at Charing Cross hospital is now unsustainable? Will he abandon those plans, or at least suspend them until the crisis is over?

[Mr Hunt]

I take issue with the hon. Gentleman’s suggestion that this is a worsening crisis in A and E. We have hit our A and E target for the last 22 weeks. We recognise that there are real pressures and are seeking to address them. On the proposals for north-west London, he knows that I cannot comment until I have received the Independent Reconfiguration Panel’s advice. I will look at it very carefully, but obviously, considering the pressures on A and E departments across the country, I will want to ensure that any proposed solution makes sure that his constituents get the service they need when it comes to urgent and emergency care.

[Julian Smith (Skipton and Ripon) (Con)]

I welcome the £1.5 million for Airedale hospital in Yorkshire and urge the Secretary of State to keep a watchful eye on those hospitals serving some of the most rural parts of our country, such as the Yorkshire dales, which I represent.

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[Mr Hunt]

Absolutely. I have visited Airedale hospital, which I think is excellent. It is one of the few hospitals in the country where the A and E department has access to GP records, which means it can give patients a much better service. It also has fantastically innovative ways of looking after the frail elderly in the community. I think that some of the smaller rural hospitals are blazing a trail when it comes to the changes we need to make elsewhere.

[Andy Sawford (Corby) (Lab/Co-op)]

Kettering general hospital’s A and E department was built for 20,000 people a year but is now trying to meet the needs of 80,000 people. The money announced today is of course welcome, but I ask the Secretary of State to look seriously at our bid—a joint bid from neighbouring MPs too—for capital investment in Kettering’s A and E.

[Mr Hunt]

I will of course look at that closely. I have been to Kettering hospital and recognise that it is very busy and that people there are working very hard, but I think that the staff are doing a fantastic job.

[Andrew Bridgen (North West Leicestershire) (Con)]

Will my right hon. Friend pledge to do everything in his power to undo the mess created by Labour’s 2004 GP contract give-away in order to help restore the essential link between patients and family doctors, which will lead to better patient outcomes and reduce pressure on our A and E departments?

[Mr Hunt]

My hon. Friend is absolutely right. I am astonished that the Labour party seeks to defend those changes to the GP contract, which got rid of named GPs, removed responsibility for out-of-hours services from them and broke the personal responsibility that the best GPs always wanted to feel for the people on their list. In fact, many brave practices refused to go along with those contract changes and continue to have named GPs. There is clear evidence that people who have named GPs use hospital services less. If we are going to give older people the right care, we need to undo those damaging changes.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Secretary of State has spoken confidently about how his changes will make a difference in the short term, but over the weekend the BBC revealed that A and E departments are, on average, 10% understaffed and that one trust in London is 75 nurses down. Despite what he has announced today, how can he be sure that those vacancies can be filled?

[Mr Hunt]

The hon. Lady is right that there are staff shortages, and it is not because trusts do not want to employ people; it is because it is difficult to find people to fill all those vacancies. Those are some of the longer-term problems that we will have to address when looking at how to make working in A and E more attractive. There are a number of things we can do in the short term to alleviate the pressure, such as putting GPs on the front desks at A and E departments so that people can get help, ensuring that the social care system is open seven days a week so that people can be discharged on Saturdays and Sundays, and extending consultant cover late into the evenings and at weekends, when A and E departments are busiest. I think that it is right that we do those things straight away while trying to address the longer-term problems.

[Glyn Davies (Montgomeryshire) (Con)]

My constituents depend on A and E services in Shropshire, which in many cases are already a long way distant. Does my right hon. Friend agree that when reorganisation takes place, which will happen in Shropshire, proper account should be taken of the distances that people living in rural areas will have to travel for emergency and urgent services?

[Mr Hunt]

I absolutely agree. It is really important that we recognise those challenges in rural areas, and indeed semi-rural areas such as my constituency, where we have had similar issues. I can assure my hon. Friend that when we make structural changes, we take those issues closely into account.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

How many walk-in centres have been closed since May 2010?

[Mr Hunt]

I do not have the figure at my fingertips, but I will happily write to the hon. Gentleman.

[Andrew Selous (South West Bedfordshire) (Con)]

I would like to praise very highly the A and E staff at Luton and Dunstable hospital, whose work I have seen at close quarters on a number of recent occasions. If A and E staff had access to GP records, would there not be better diagnosis and would not time be saved? If some of our smaller hospitals are doing that, it raises the question why all of them are not.

[Mr Hunt]

My hon. Friend is absolutely right. The truth is that many in the NHS had their fingers burnt when the previous Government, with the best of intentions, tried to address the problem, unfortunately with abysmal results and billions of pounds wasted. I do not think that we should let that failure stop us doing what we know can transform services. When we look at the changes that have been made in the banking, airline and retail industries, we see that we need to use the benefits of modern technology in the NHS. It will save thousands of lives.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

How could any Secretary of State imagine that it is okay to preside over a situation in which there are only five consultants working overnight in A and Es across the entire country?

[Mr Hunt]

I agree with the hon. Gentleman that consultant cover is not as good as it needs to be, and not just in A and E departments, but across NHS hospitals, so I hope that he will support me in moving forward with a seven-day NHS, which is a very big change and might be opposed by people working in the NHS. I am delighted that I can be assured of his support.

[Neil Carmichael (Stroud) (Con)]

Does the Secretary of State agree that putting patients first is at the heart of this and that that means, in part, ensuring that they can navigate the system and go to places such as the excellent Vale community hospital in Dursley where appropriate?

[Mr Hunt]

I am delighted to hear about the excellent Vale community hospital in Dursley. On my hon. Friend’s general point, we have not been good at persuading the public that there is anything between GP surgeries and A and E departments. The NHS has tried repeatedly to come up with walk-in centres and urgent care centres. Some have been successful, and some have not. At the heart of the challenge is the fact that the public want a 24/7 service for accidents and emergencies and urgent care. We have to ensure that they have it and that they understand where it is.

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

Last year, Central Manchester University Hospitals NHS Foundation Trust and University Hospital of South Manchester NHS Foundation Trust both missed their A and E waiting targets on 30 out of 35 weeks. This year, of course, they will be coping with the additional challenge of absorbing the fallout of the downgrading of the A and E at Trafford general hospital. I note that neither trust has been awarded additional funding today. Can the Secretary of State assure me that the risk model that NHS England applied has properly taken account of the consequences of having to absorb major organisational change and, if it turns out that there are more pressures on those A and E departments this winter, that provisional funding will be looked at again?

[Mr Hunt]

I can absolutely reassure the hon. Lady on that point. We are extremely careful—I have had good discussions with her about this—before making any structural changes, to ensure that the impact on neighbouring A and E departments is properly thought through. Since the statement to the House about Trafford hospital, we have approved a capital funding programme for one of the neighbouring hospitals that will be affected. That is extremely important and we will continue to monitor it closely.

[Henry Smith (Crawley) (Con)]

The A and E unit that my constituents have to access is at East Surrey hospital, and I welcome last year’s investment of £4 million to refurbish it, but does my right hon. Friend agree that Labour’s closure of Crawley A and E in 2005 certainly did not help with the pressure on local A and E departments?

[Mr Hunt]

A number of things have contributed to these changes, one of which is that we have not succeeded, as an NHS or as a Parliament, in getting the way in which we do reconfigurations right: they do not command the confidence of the public and people are not satisfied that there are alternatives that they can trust or that good alternatives will be put in place when a change is proposed. We need to learn the lessons from what happened in my hon. Friend’s constituency.

[Derek Twigg (Halton) (Lab)]

Since 2010 the new Whiston hospital has seen an increase of 25% in emergency demand, but it has not been funded for it. I met the chief executive and vice-chair of the governing board last Friday and asked them whether they would be able to guarantee a safe service if that level of activity continues with the winter pressures, and they said that they might not. Will the Secretary of State urgently look at the situation at Whiston and come up with some solutions?

[Mr Hunt]

I hope that when the hon. Gentleman looks at today’s announcement it will reassure him that we are addressing not just the immediate pressures in the most difficult areas, but the underlying pressures. That 25% increase at Whiston—I pay tribute to the staff in its A and E department, who will no doubt be working extremely hard to cope with it—has come about because we have not had better alternatives to A and E and because departments have often found it difficult to discharge people from hospital into the community, which has further increased the pressure on them. What we have announced in the past few months and today will make a real difference to alleviating those pressures.

[Robert Halfon (Harlow) (Con)]

My right hon. Friend will be aware that Princess Alexandra hospital in Harlow is an outstanding hospital with outstanding staff. My constituents will be incredibly grateful for the £5.7 million announced today, which comes on top of a £470,000 grant provided to St Clare hospice by the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), who has responsibility for care. Does my right hon. Friend agree that that shows that this Government invest in the NHS in Harlow, and will he come to Princess Alexandra hospital to see the excellent work that is being done?

[Mr Hunt]

I would be delighted to go to Princess Alexandra hospital, where I am sure the work is indeed excellent. I agree with my hon. Friend’s fundamental point, which is that this Government took the very difficult decision not just to protect the NHS budget, but to increase it. That was described as irresponsible by the right hon. Member for Leigh (Andy Burnham). We are spending £600 million more in real terms this year than we would have spent if we had followed his advice. That makes a very big difference to hospitals such as that in my hon. Friend’s constituency.

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

Will the Secretary of State be clear: did the risk register warn the Government that their reorganisation would hit the A and E performance targets?

[Mr Hunt]

There has been exhaustive analysis of the problems in A and E departments and whenever I have visited such departments I have not heard a single person say that the reorganisation was the cause of them. What they talk about is the underlying problems, which we are addressing today.

[Mr Philip Hollobone (Kettering) (Con)]

Despite the best efforts of its hard-working staff, the A and E department at Kettering general hospital has been under huge pressure for some time. It has failed to meet its targets and the chief executive resigned recently as a result. Would my right hon. Friend be kind enough to confirm the amount of additional funding to the A and E department at Kettering, and what is his assessment of the analysis that up to a third of those who present themselves to A and E departments could receive better, quicker and more appropriate treatment elsewhere?

[Mr Hunt]

My hon. Friend has campaigned assiduously for Kettering hospital, including by inviting me there to see it for myself. I think that its staff are working extremely hard. I am pleased to confirm that today’s announcement means that an extra £3.9 million will be given to the hospital to help it meet those pressures over this winter. I think that the people working in A and E would be the first to say that where there are alternatives in the community, they should be used. The long-term change we need to make is to reverse what has happened over the past decade, which is that it has become easier and easier to go to an A and E department and harder and harder to get an appointment with a GP. That was the profoundly wrong change made by the previous Government and that is what we have to put right.

[Mr Andrew Love (Edmonton) (Lab/Co-op)]

The Secretary of State will be aware that the major reason given for the reconfiguration of services at Chase Farm hospital was the need to increase the number of consultants and specialist staff in accident and emergency, but we discovered over the weekend, as colleagues have indicated, that there is a massive shortage of specialist staff and consultants, particularly in outer London, where there are special pressures. The Secretary of State has indicated some of the short-term measures, but my constituents want reassurance that steps will be taken to bolster the number of A and E consultants and specialist staff to look after them.

[Mr Hunt]

The hon. Gentleman is right to say that that is one of the key issues in the underlying pressures on A and E departments. About a quarter of the money announced today will be used to increase the capacity of A and E departments, including increasing consultant cover. In the end, however, we need more trained consultants; we need more doctors who want to work in A and E departments. That is a longer-term challenge, but one of the ways in which we will make A and E more attractive is by convincing doctors that we have a long-term, sustainable strategy to make sure that it does not become an impossible job. That is what the measures on improving GP access, IT systems and the social care system aim to achieve.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

The Secretary of State may be interested to know that in a parliamentary seminar earlier this year the College of Emergency Medicine said that walk-in centres provided temporary help with A and E attendances but that their closure has had no impact at all. More importantly, does my right hon. Friend agree that we should praise those hospital trusts that have not needed extra money and that that is a ringing endorsement of their leadership?

[Mr Hunt]

My hon. Friend speaks extremely wisely, as ever. She is right. The reason why the 100 or so hospitals that have not benefited today did not get money is that our assessment is that they have outstanding leadership and will be able to cope. That is not, however, to minimise the pressure they will be under or the fact that it will be extremely hard work. I pay tribute to them because, as good hospitals, they often have to deal with more people wanting to go through their doors than through those of other hospitals with less good reputations. We need to support everyone and my hon. Friend is right to say so.

[Chris Bryant (Rhondda) (Lab)]

One pressure that applies equally in Wales and in England is that on the recruitment of consultants for A and E. Last year, Welsh health boards advertised for 14 A and E consultants but managed to appoint only one, and that was after a nine-month interregnum. May I urge the Secretary of State—this has been impressed on me many times by those who work in the NHS—to speak to the Minister for Immigration, because many trusts and hospitals are saying that the new operation of the immigration rules makes it impossible to recruit from overseas, even from countries that deliberately train for the international market?

[Mr Hunt]

We have designed the immigration rules so that they are flexible enough to make sure that NHS hospitals can recruit trained staff where they are needed and where we cannot find people with those skills in the UK. I say to the hon. Gentleman that although some challenges may be the same in England and Wales, one challenge is very different in Wales, because Labour there decided to cut the budget by 8%, which has made life a great deal harder for NHS trusts.

[Mr Marcus Jones (Nuneaton) (Con)]

Since May 2010 an extra 300 clinical staff are working at the George Eliot Hospital NHS Trust, which is now recruiting more nurses and more A and E consultants in response to the Keogh review. Does that not show that under this Government more resources are being directed towards front-line patient care?

[Mr Hunt]

It absolutely does. There are nearly 4,000 more front-line staff under this Government than there were under the previous Government at the time of the last election. More importantly, where there are problems in hospitals—my hon. Friend’s hospital has had a number of problems—this Government are not sitting on them or seeking to cover them up. We are addressing them and I hope that by the time of the next election we will be able to demonstrate that we have turned around my hon. Friend’s hospital and a number of others and that finally these serious problems are being addressed.

[Mr Robert Buckland (South Swindon) (Con)]

Will my right hon. Friend join me in thanking A and E staff at the Great Western hospital for their hard and successful work? Will he assure me that, if hospitals such as the GWH and the Royal Berkshire just down the M4 corridor incur any additional needs this winter, there is contingency in the budget?

[Mr Hunt]

We do have a contingency built into these plans, but it is also important for trusts to plan in advance. One of the reasons why we announced this funding in August and why we have today announced where it will go is in order to enable people to make long-term plans. The lesson we have learned from previous years is that if we come up with these packages in the middle of winter it is too late for anything to happen. I totally join my hon. Friend in commending the hard work at Great Western hospital.

NHS Winter Planning

Jeremy Hunt Excerpts

Tuesday 10th September 2013 Written Statements

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

Today the Government can announce their plans for winter and the allocation of £250 million funding to NHS England. This money will be distributed by NHS England to the areas that need it most in 2013-14, working with Monitor and the NHS Trust Development Authority (TDA). This follows the Prime Minister’s announcement in August that A&E departments will benefit from an additional £500 million over the next two years to address seasonal pressures.

It is important to provide the NHS with greater support during the winter period, particularly at a time when the scale of the challenge facing the NHS and wider health and care system is becoming increasingly clear. It is essential that even when demand is at its highest, patients get the excellent support they need and rightly expect. Emergency admissions have risen by 32% over the last decade and our main priority is to make sure the NHS can cope with this increasing pressure, not only this winter but also for the future.

As in previous years, a robust monitoring process will be in place from the beginning of November until the end of February and data will be available online to local organisations to support their management and co-ordination.

NHS England, Monitor and the NHS Trust Development Authority have been working jointly to determine where this funding will make the greatest impact and make a demonstrable difference to patients. The funding will be targeted in the following way:

£15 million towards securing a reliable NHS 111 service throughout the winter period;

subject to completion of current scrutiny of plans, a total provisional amount of £221 million for the 53 high-risk systems; and

a small contingency of £14 million for use for final settlements for trusts to use in the winter.



Indicative amounts have been allocated, subject to change, to the following trusts outlined as follows:

NHS Modernisation (Costs and Benefits)

Jeremy Hunt Excerpts

Thursday 18th July 2013 Written Statements

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

The Government’s estimates of the costs and benefits of implementing policies in the Health and Social Care Act were contained in the “Coordinating document for the Impact Assessments and Equality Analysis” published in September 2011. These estimates reflected the changes that the Government made to their proposals following the listening exercise and the report of the NHS Future Forum.

Officials have continued to track closely the actual costs and benefits of the changes. Last September I reported to the House that the current estimate of costs was in the range £1.5 billion to £1.6 billion, which is equivalent to £1.6 billion to £1.7 billion in today’s prices. I can confirm today that I expect the costs—including spending on redundancy—to be no higher than announced last year. Indeed, the costs are likely to be nearer the estimate in the business case for the programme (£1.5 billion in today’s prices).

I can also announce that, up to 31 March 2013, costs of £1,096 million had been incurred across the health and care system on developing and establishing the new arrangements, comprising:

£435 million on staff redundancies;

£54 million on IT for the new organisations;

£42 million on estates costs of closing bodies and setting up new organisations;

£22 million on internal departmental costs (e.g. programme management);

£299 million on setting up clinical commissioning groups (excluding items above); and

£244 million on other costs of closing bodies (e.g. primary care trusts (PCTs)) and setting up new organisations.

In the impact assessment, long-term annual savings arising from the changes were estimated at £1.5 billion per year from 2014-15 onwards. Gross savings over the transition period (2010-11 to 2014-15) were estimated at £4.5 billion.

Annual savings are still expected to be £1.5 billion from 2014-15. Over the period 2010-11 to 2014-15, on a comparable basis with the impact assessment, the cumulative savings in administration costs arising from the reforms are still expected to be at least £5.5 billion. This sets aside administration costs of around £1.5 billion that are expected to be incurred on implementing the changes across this period.

I am today publishing “Business Case for the Health and Care Modernisation Transition Programme” which was prepared for the major programme established to take forward implementation of the reforms. A copy has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. This publication meets a commitment made in “Health and Social Care Reforms: Transition Programme Scheme for Publication” (published in May 2012). The business case reflects the landscape that existed in December 2011, after the Government had responded to the listening exercise. Although the financial estimates in the business case are largely consistent with the impact assessment they took account of some costs (estimated at £127 million in total) that were excluded from the impact assessment either because they were out of scope (for example, because they related to measures not requiring legislation) or because they were redacted (for example, because they were commercially sensitive). The business case estimated the costs of implementing the changes at £1.5 billion at today’s prices

Francis Inquiry (Costs)

Jeremy Hunt Excerpts

Thursday 18th July 2013 Written Statements

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

Robert Francis QC published his “Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry” on 6 February 2013. The public inquiry report looked at the roles and responsibilities of the wider health system in the events at Mid Staffordshire NHS Foundation Trust between 2005 and 2009. The inquiry itself sat for a total of 139 days; its oral hearings began on 8 November 2010 in Stafford and concluded on 1 December 2011. The inquiry took 352 separate witness statements in total, with 164 witness statements heard in person.

On the day of publication, the Prime Minister made a statement to Parliament. The Department of Health published the initial Government and system-wide response. “Patients First and Foremost”, on 26 March 2013. A further response to Robert Francis’s report will be published in autumn 2013.

Officials have compiled the costs of providing evidence to the inquiry incurred by the Department and the relevant NHS organisations, including foundation trusts.

I can now report to the House that the expenditure incurred by the Department and NHS organisations in their role as witnesses amounted to £6 million. A breakdown by type of cost is shown below.

Managing Risk in the NHS

Jeremy Hunt Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

Thank you, Mr Deputy Speaker.

Alarming patients, demoralising staff and casually trading figures about deaths in the pursuit of political advantage is no way to run the NHS, and those are not the actions of a responsible Government. Today people are asking what kind of Government this is, if they are willing to cause further damage to fragile hospitals for their own self-serving political ends. Yesterday the Secretary of State told the BBC that he had no idea who had put the 13,000 figure in the public domain. Does he seriously expect us to believe that?

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

Yes.

[Andy Burnham]

He seriously expects us to believe it? Why are we being told that those responsible were representatives of Conservative Central Office? [Interruption.] Yes, that is what is being said. The Secretary of State should go back and check his facts. If he does not have control of his advisers, it will not be the first time, will it? We have heard this before, have we not? “I do not know what the advisers are doing.”

The “my adviser is out of control” defence may have worked for the Secretary of State once, but it will not work for him twice. He must take responsibility for his own advisers, and for the advisers at Conservative headquarters. We were told explicitly that that is where the briefings came from, and the Secretary of State owes the House a full answer. He owes it to the House to put that on the record. [Interruption.] I will not put the name in the public domain, but I have a name. I will send it to the Secretary of State immediately after the debate, and he must come straight back to me, having asked that person whether or not he briefed the press. If the Secretary of State agrees to that, let us leave it there. I have a name, and I will put it to him straight after the debate. He must take responsibility.

--- Later in debate ---

[Andy Burnham]

I will acknowledge that. A moment ago, I mentioned the Francis report, which I commissioned, which revealed the dangerous cuts to front-line staffing that the hospital pursued as the primary cause. I accept what the hon. Gentleman has just said. Rather than always pursuing central regulation as the solution, if local communities had identifiable benchmarks that they could use to check up on their local hospitals, surely that would be progress we could all get behind.

On the duty of candour, the Government are legislating for a duty on organisations, but not on individuals. I think that we all agree that changing the culture of NHS organisations is essential if we are to move forward. The Francis recommendation is a necessary part of bringing about that culture change. Rather than being a threat to staff, as some have argued, it would protect them when they make known any concerns. Will the Government look at that again and legislate for the full Francis recommendation in the Care Bill? That is incredibly important in the light of yesterday’s report by Sir Bruce Keogh. He revealed—this will shock anyone who has not spotted it yet—that some trusts were telling members of staff what they could and could not say to his review. Surely we can all agree that is fundamentally unacceptable.

[Mr Jeremy Hunt]

indicated assent.

[Andy Burnham]

I am glad that the Secretary of State nods. Does that not make the case, however, for a duty of candour on individuals, which would have allowed staff to say to management, “No, I’m going to speak to the Keogh review and I won’t face action afterwards because it is my duty to do so”?

--- Later in debate ---

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

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

“welcomes the Government’s swift action in response to the Francis Report; notes the rapid establishment of reviews on key components of the Report’s findings, including the Cavendish review on healthcare assistants, the Clwyd-Hart review on complaints and the Berwick review on patient safety; further notes the drive to improve standards through the appointment of a Chief Inspector of Hospitals, the introduction of Ofsted-style ratings and the recruitment of specialist hospital inspectors; regrets the Opposition’s continued refusal to support these practical measures to expose and improve poor care; welcomes the watershed decision to expose and investigate 14 hospitals with high death rates through the recent Keogh review; further notes the Government’s decisive action to drive improvements in these hospitals by placing 11 hospitals in special measures; and applauds the Government’s wide-ranging efforts to introduce greater transparency and accountability in the NHS.”

I am honoured to see you, Mr Speaker, in your place for my speech. The right hon. Member for Leigh (Andy Burnham) talked about yesterday, and I for one hope that he has had a chance to reflect on Labour’s shockingly inappropriate behaviour. Let me give him one fact to think about: on a day when a review described appalling failings at 14 hospitals, my speech mentioned patients 19 times—his mentioned them just twice. Does that not say it all about Labour’s attitude to the NHS?

[Andy Burnham]

I listened carefully to what the Health Secretary just said about our speeches. Does he think it appropriate for a Secretary of State introducing a report on mortality rates in the NHS to begin, within seconds of getting to his feet, by making political attacks on the previous Government? On reflection, was that the right thing to do?

[Mr Hunt]

It is funny how the Labour party decided to make the NHS its main campaigning issue for the past three years, yet the moment people start to scrutinise its own record on the NHS it says the NHS is being used as a political football. What does that say about Labour’s approach to the NHS?

I want to consider the specifics of the motion before looking at the wider issue of risk. The motion mentions the Francis inquiry. One of this Government’s first acts on coming to power was to set up the full public inquiry into Mid Staffs that families had been denied by the right hon. Gentleman’s Government for too long. We are implementing it, and fast. That is why a new chief inspector of hospitals started work yesterday, just five months after the report was published. [Interruption.] The right hon. Gentleman says that a chief inspector of hospitals is not in the report, but how are we going to make sure that the report’s recommendations are implemented throughout all 266 NHS trusts? That will be done because we will have independent inspection of hospitals, which has not been done before because the situation was so undermined by the previous Government. That is how we are going to make sure that Francis actually happens.

We intend to implement the spirit of everything that Robert Francis proposed, even if the details may vary in places from his 290 recommendations. Francis himself endorsed that approach when that he said that the Government have indicated their

“determination to make positive changes to the culture of the NHS, in part by adopting some of my recommendations and in part through other initiatives.”

Francis talked about five themes, so let us look at the progress being made on them. First, on information and transparency, yesterday showed that this Government are determined to root out, once and for all, an NHS culture of solving problems behind closed doors. This is about not just the decision to hold a public inquiry into Mid Staffs, which the right hon. Member for Leigh and his colleagues rejected doing 81 times, but the Keogh review, which reported yesterday that 14 hospital trusts have excess mortality rates. This is the first time the NHS has ever conducted such a review. We have also published individual surgeon outcomes—the first country in the world to do so across an entire health system. The independent rating of hospitals will start this autumn, so for the first time people will know how good their local hospital is, just as they do for their local school.

Francis also mentioned standards. The new chief inspector of hospitals—a position that Labour still refuses to support—began work yesterday. In Professor Sir Mike Richards, we have a new whistleblower-in-chief whose sole job is to drive up standards and root out poor care. He will be supported by a team of expert inspectors, in stark contrast to the generalist inspection model set out by the right hon. Gentleman’s Government in 2009. That is plain common sense. We have put it right. The work of the inspectors will be informed by the independent review of hospital safety that is being conducted by Professor Don Berwick, who will advise on how to embed a culture of patient safety throughout the NHS. He will report back later this summer.

[Derek Twigg]

Yesterday, when I asked the Secretary of State whether mortality had fallen before 2010, his answer was:

“According to Professor Jarman…it has been falling slightly.”—[Official Report, 16 July 2013; Vol. 566, c. 944.]

The Keogh report states that it had fallen by 30% over 10 years. Figures from the House of Commons Library, which were sourced from the NHS, show that there has been a significant fall in deaths within 30 days of non-elective hospital procedures. Will he correct the record?

--- Later in debate ---

[Mr Hunt]

I am afraid that that intervention sums up where the spin is happening. The 14 hospitals were investigated by Professor Keogh because they had excess mortality rates. The Labour party thinks that that started in 2010, but it goes right back to 2005 in those hospitals and earlier than that in many of them. That is the ugly truth that Labour refuses to confront: 14 hospitals had high mortality rates for years and years, and Labour did nothing to sort it out.

The Francis report—

[Derek Twigg]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress. The Francis report also talked about leadership.

[Andy Burnham]

Will the Secretary of State give way?

[Mr Hunt]

I will give way in a moment.

The right hon. Member for Leigh talked about leadership. I want our NHS to attract the brightest and best leaders that this country has to offer. I have asked the NHS leadership academy to develop a new leadership programme to support clinicians to become clinical chief executives and to fast-track professionals from outside the NHS into leadership roles. We urgently need more talented managers in our NHS, and that will make a big difference.

[Andrew Percy]

I want to take my right hon. Friend back to the comments of the right hon. Member for Leigh, which I found shockingly complacent. I will give the example of Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, which is one of those that is in special measures. Our mortality rates started to go up in 2007 and started to fall in 2011, but our nursing numbers have been increasing over that whole period. I find it shockingly complacent for somebody to suggest that there is not an issue or to downplay those figures. In my area, that has potentially cost hundreds of lives.

[Mr Hunt]

My hon. Friend makes an important point.

I say to the shadow Secretary of State that it is a question not just of whether he responded to the warnings that he received, but of whether he received the warnings that he should have received in the first place because the inspection system might not have been up to scratch.

[Andy Burnham]

I mentioned a moment ago that when I saw the mortality data in late 2009, action was taken at Basildon and a review was ordered of all hospitals in England, so I did respond.

The Secretary of State needs to correct for the record something that he said a moment ago. He implied that the mortality ratio had not come down at the 14 hospitals. If I have got him wrong, he needs to be clear about it. Yesterday, a group of Back-Bench MPs was informed by Sir Bruce that mortality ratios at the 14 hospitals had fallen since 2005 by between 30% and 50%, but that they were still above the average for England. Overall, the mortality rate is down at all hospitals, but the 14 hospitals have rates that are above the average. Will he correct that point because it is incredibly important?

[Mr Hunt]

Let me help the right hon. Gentleman out. Those 14 hospitals were investigated by Professor Keogh because they had excess mortality rates that go right the way back to 2005. Labour cannot be in denial. Professor Brian Jarman said that under Labour, there was “total denial” in the Department of Health over the issue of excess mortality—

[Several hon. Members]

rose—

[Mr Speaker]

Order. We must try to preserve some sense of order and decorum in this debate. The Secretary of State can be expected to answer only one intervention at once. It is unseemly and arguably discourteous of other Members to jump up and try to interrupt the Secretary of State when he is dealing with the previous intervention. Let us deal with that first. Members must show some sensitivity to that.

[Mr Hunt]

Thank you, Mr Speaker. Let me make some progress.

On leadership, there has to be accountability for failed leadership through the introduction of a national barring list for unfit managers, similar to the one that we have for teachers.

[Chris Kelly (Dudley South) (Con)]

The Dudley Group NHS Foundation Trust is one of the 14 trusts that were reviewed by Sir Bruce Keogh. Will my right hon. Friend confirm what changes this Government have made to provide central accounting in the NHS for compensation payments that were inherited from the Labour party, under which there were no financial consequences for unacceptably poor performance and weak leadership, such as that experienced in my constituency?

[Mr Hunt]

This is the appalling fact: we have inherited from the previous Government a system of compensation payments with no significant financial penalty on trusts that have to pay out litigation claims. The focus on patient safety, the biggest discipline of all that any trust should have is to reduce patient safety incidents, should be the thought of having to pay compensation. That disincentive was removed. Absolutely, we will look at that.

[Grahame M. Morris (Easington) (Lab)]

Will the right hon. Gentleman give way?

[Mr Hunt]

I am going to make some progress and I will give way more later.

Francis also talked about compassionate care. We are going to follow the advice of Camilla Cavendish’s study on training for health care assistants, so we can be sure that no one is giving basic care to our NHS patients without proper training on how to treat people with dignity and respect. We have also proposed that, subject to pilots that are starting in September, every student who wants to receive NHS funding for their nursing degree will first work for up to a year as a health care assistant, so that before they open the textbooks they learn real care and compassion at the coal face.

[Mr Andrew Smith (Oxford East) (Lab)]

Will the right hon. Gentleman give way?

[Mr Hunt]

I am going to make some progress and then I will give way.

In addition, in September the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart will present their recommendations on how we can turn NHS complaints handling into an engine for improving compassionate care.

The right hon. Member for Leigh mentioned nursing numbers. Getting the right number of staff on wards does matter, and where that is not happening for hospitals in special measures it will be sorted out. However, to suggest that that is the only issue, or indeed the main issue, is completely to misunderstand what has gone wrong. Eight of the 11 failing hospitals had increases in nurse numbers since 2010, but they still needed to go into special measures. Training, values, clinical safety and, above all, leadership are often as important.

Labour has been calling for mandatory minimum staffing numbers. Let us look at what the experts say about that idea. Robert Francis said:

“To lay down in a regulation, ‘Thou shalt have N number of nurses per patient’ is not the answer. The answer is, ‘How many patients do I need today in this ward to treat these patients?’”

He also said:

“The government was criticised for not implementing one, which it is said I recommended, which I didn’t.”

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

I am grateful to my right hon. Friend for giving way, because he knows that Buckinghamshire Healthcare NHS Trust was included in the statement yesterday. The trust welcomes his leadership and the opportunity to improve its performance, so that it can give the best possible care to patients in Buckinghamshire. Does my right hon. Friend agree that training goes to the heart of quality, particularly of agency staff? Would he like to say something about the competence, quality and checks that are made on agency staff, which will help to improve the health service across the country?

[Mr Hunt]

My right hon. Friend makes an important point. There are many locums who work extremely hard and are very committed. However, it is true that one feature of a number of the failing hospitals in yesterday’s report was that they had a high proportion of locum staff. It is harder to build up a sense of teamwork if there is a huge turnover in the people working in NHS organisations, and I know that many will reflect on that.

[Liz Kendall (Leicester West) (Lab)]

Will the right hon. Gentleman give way?

[John Pugh (Southport) (LD)]

Will the right hon. Gentleman give way?

[Mr Hunt]

I will make some progress and then give way, because I want to come on to one of the main things that the right hon. Member for Leigh said, which was to criticise an NHS reorganisation that has put 8,000 more people on the frontline of the NHS.

The right hon. Gentleman said that that reorganisation cost £3 billion, when he knows full well that the National Audit Office shows that it will be half that amount. It will save £5.5 billion in this Parliament alone. For the avoidance doubt, it is that £5.5 billion saving that means we are now employing 1,000 more health visitors, 1,400 more midwives and 5,600 more doctors than at the previous election.

The right hon. Gentleman talked about the risk register. Let us look at what he said about publishing the risk register when he was Health Minister in 2007. These are his own words:

“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]

I agree with him.

The right hon. Gentleman is right that pressures on A and E are building, so why does he oppose changing the GP contract to make primary care more accessible? Why does he criticise the extra £2 billion being put into joint commissioning by health and social care systems to reduce the number of delayed discharges? Why does he tell the NHS Confederation he supports the reconfiguration of services and then refuse to support every difficult reconfiguration, such as at Trafford or Lewisham?

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

Is the Secretary of State aware that in the league table of the busiest A and Es in London, St Thomas’s, Queen Elizabeth and King’s occupy the second, fourth and sixth places? Does he really think there is no risk in moving tens of thousands of patients from Lewisham A and E to those three utterly overburdened and full-to-capacity hospitals?

[Mr Hunt]

I take the risks the right hon. Lady talks about very seriously, and we need to be very careful in managing any change, but there are also big risks in not making change. South London Health Care Trust is one of the worst-performing in the country, and it was used by her constituents. I have a duty to sort out these problems in the NHS, which have been left unsorted for many years.

The right hon. Member for Leigh said we should look at our record since 2010. Let us look at that record: the numbers of people waiting longer than 18 weeks, 26 weeks and 52 weeks to start treatment are lower than at any time under the last Government; as I said, we have 5,600 more doctors; and we have a £650 million cancer drugs fund, giving more than 30,000 people access to cancer drugs—his Government refused to set up such a fund; the number of mixed-sex wards is down by 98%; and hospital infection rates have halved. These are real achievements for a service under great pressure, and we should recognise the hard work and dedication of the NHS staff who have delivered them.

[Mr Graham Stuart]

My right hon. Friend will have heard me earlier referring to the work of Professor Sheena Asthana and will know of my concerns about the allocations underpinning some of the risks in the NHS. Will he agree to meet Professor Sheena Asthana and me, perhaps over the summer recess, to discuss the matter further?

[Mr Hunt]

I would be delighted to do so. I have studied her work and am an admirer of it, so I would be more than happy to meet my hon. Friend to discuss further the issues he wants to raise.

I want to turn to the substance of the motion, which is about risk for the NHS. Two big risks face the NHS. They face not only the NHS, but all major health care systems. The first is financial sustainability and the second is an ageing population. The litmus test for the success of the NHS in the next 65 years will be whether it confronts those huge challenges while looking after people with dignity, compassion and respect. I believe that there are three pillars on which we must build to make that possible. The first is a radical transformation of out-of-hospital care. We know that a consultant is responsible for us when we are inside hospital, but who is responsible for a vulnerable older person when they leave hospital? Too often, their care falls between the cracks, with no one being accountable. The NHS could lead the world in this, but we have made it impossible for GPs to look after people proactively because of how the GP contract works. We need to change that, so that in an integrated, joined-up system of care, there is always an accountable clinician or named GP and the patient knows who it is. In the consultation on the changes to the NHS mandate for next year, therefore, I have asked NHS England to ensure a named clinician responsible for every vulnerable older person.

The second of the three pillars we need to reduce risk in the NHS is technology. The technology revolution has transformed many other sectors, but has barely touched the NHS. A and E departments cannot access GP notes and so give medicine without knowing people’s medication history. Ambulances pick up the frail elderly without knowing whether they are diabetic or have dementia. This has to change. Technology can also cut costs. Retail banks have reduced their costs by a third, and we need those precious savings for the NHS, which is why I have said I want the NHS to go paperless by 2018 at the latest, with online prescriptions and booking of GP appointments by 2015. Technology is also a vital key to delivering integrated care, which is why data sharing will be a key condition of accessing the £3.8 billion joint health and social care fund announced by the Chancellor in the spending review.

The final pillar to help the NHS cope with new risks is science. It might surprise hon. Members that I mention that today, but the UK has a long track record as a world leader in medical science. We were the first to unlock the secrets of DNA in 1953; we did the first combined heart, liver and lung transplant; we invented in vitro fertilisation, alongside many other advances, and we must play to those strengths. Science can transform our understanding of disease, and help us deliver truly personalised care. Our aim is by 2015 to put the UK at the forefront of the genome revolution worldwide, and I have set up Genomics England, led by Sir John Chisholm, to deliver that vision.

In conclusion, the NHS faces many risks, but it also delivers many successes day in, day out. No organisation anywhere in the world has more staff dedicated to the noblest ambition anyone can have—to be there for us and our loved ones at our most vulnerable.

[Mr Andrew Smith]

rose—

[Mr Hunt]

I am concluding now. We owe it to those people to tackle head-on the risks the NHS faces alongside health care systems in every other country. We do so with confidence and optimism that by confronting failure, nurturing excellence, and supporting the brilliant work of people on the front line, we will be able to deliver an NHS that remains the envy of the world.

[Several hon. Members]

rose—

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 16th July 2013 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

4. What plans he has to implement the recommendation of the Francis report on safe staffing levels.

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

We agree with Robert Francis that there is a need for evidence-based guidance and tools to inform appropriate staffing levels. We have set out a number of recommended actions to support appropriate staffing levels in “Compassion in Practice”—the nursing, midwifery and care staff vision and strategy for England.

[Valerie Vaz]

I thank the Secretary of State for his answer, but Robert Francis said in his report that minimum safe staffing levels lead to helping patient safety. If the Secretary of State agrees with Robert Francis, why does he not implement that recommendation now?

[Mr Hunt]

I do agree with Robert Francis, but as he said in Nursing Times, there is an apparent misunderstanding by many people about what his recommendations actually were. This is what he said:

“I did not recommend there should be a national minimum staffing standard for nursing. The government was criticised for not implementing one, which it is said I recommended, which I didn’t.”

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

As someone who worked in the public services before my election here, I well understand the pressure put on public servants to cover up bad news. I was contacted by a nurse yesterday who informed me that concerns that were raised at a training day were dismissed by a matron—people were told to put them in the bin. Can the Secretary of State assure us that he will do everything to ensure that nurses who are concerned about staffing levels feel free to speak out and will be protected?

[Mr Hunt]

What my hon. Friend says is incredibly important. We must have a culture of openness and transparency inside the NHS, which means that people at the front line feel empowered to speak up if they think there is a problem. That has not happened in the past, and we are going to put it right.

[Andy Burnham (Leigh) (Lab)]

The Secretary of State will make a statement shortly about the Keogh review. Two of the hospitals investigated are Basildon and Tameside. The previous Government left a warning in place on both trusts about patient safety. This Government have ignored those warnings and allowed both trusts to make severe cuts to front-line staff. Tameside has cut 128 nursing posts and Basildon an unbelievable 345. Given the warnings he inherited, why on earth has he allowed that to happen?

[Mr Hunt]

I am very surprised that the right hon. Gentleman wants to mention what happened at Tameside. Tameside had high death rates for eight years under Labour. The previous Government ignored a whistleblower in 2005, warnings to Parliament in 2006, a coroner’s report in 2006 and warnings from my predecessor in 2009. To cap it all, in 2009 the hospital was given a “good” rating by the Care Quality Commission. How bad is that?

[Andy Burnham]

I am afraid the Secretary of State is simply wrong. At the instigation of my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), I ordered unannounced inspections into Tameside. The Secretary of State should get his facts straight before he comes to this Dispatch Box. He did not answer on staffing, and it gets worse, Mr Speaker. Seven of the 14 hospitals in the Keogh review have between them cut a shocking 1,117 nursing jobs on this Government’s watch. Unsurprisingly, A and E performance has plummeted at all seven. All 14 hospitals were meeting the A and E target in my time in office; none of them are meeting it under the Secretary of State. Is not the right response to the Keogh review to stop dithering and act now on safe staffing levels?

[Mr Hunt]

I am surprised that the right hon. Gentleman wants to talk about the Keogh review before we have made our statement. I am particularly surprised because the Keogh review is the review that Labour never wanted to have, with high death rates in all those hospitals stretching back to 2005 and a record of inaction by Labour. As former—[Interruption.] I think the House might be interested to hear this. as former Labour councillor and Mid Staffs campaigner Ken Lownds said today:

“Can you imagine a Keogh review under Andy Burnham or any Labour Health Secretary? Not a chance.”

[Jason McCartney (Colne Valley) (Con)]

5. Whether the new review of children’s heart surgery units will cover adult as well as paediatric cardiac surgery.

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[Siobhain McDonagh (Mitcham and Morden) (Lab)]

9. What assessment he has made of the roll-out of the NHS 111 telephone service.

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

NHS 111 is now available in more than 90% of England. Despite some problems with the sites where it was launched around Easter, performance has now stabilised significantly. NHS 111 is now the principal entry route for access to the urgent care system, and nearly 600,000 patients accessed the service in May.

[Siobhain McDonagh]

Let me take the opportunity to make a confession to the House. Six weeks ago on Friday, I rang 111 as I watched one of my best friends vomit. She had been vomiting for 10 days, had been to see her GP four times, and had telephoned 111 on two occasions, on each of which she was told to go away and take antibiotics.

I did what no Member of Parliament wants to do. I said to the operator, “I am an MP, and I will take this up in the House if you do not deal with it properly.” Forty minutes later an ambulance arrived, and my friend was saved from a massive heart attack. What happens to people who have no one to speak for them, and no one who can say “I am an MP”?

[Mr Hunt]

The hon. Lady makes a very important point and I do not want to defend that service in the instance she cited at all. It is completely unacceptable if that kind of thing has to happen. The principle of 111—which is for people to have an easy-to-remember number and to be able to be connected to a clinician directly if they need to be, which did not happen with NHS Direct—is a good one, but it is not happening in practice as much as it needs to be. We are broadly meeting our operational standards, but it is not good enough and she has given a very good example as to why.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

First, may I thank the Under-Secretary of State, my hon. Friend the Member for Broxtowe (Anna Soubry), for responding to the recent debate we held on this issue? When it was my own father in those circumstances, I did not say that I was an MP, as I felt that would be an abuse of the system. I am delighted that North Yorkshire has reported no problems since 111 was introduced, but there is the issue of the deficit for clinical commissioning groups, which we hope will not detract from the 111 service. Can the Secretary of State assure us that the review of funding will be brought forward at the earliest possible moment?

[Mr Hunt]

I am pleased the 111 service worked more satisfactorily in my hon. Friend’s case. NHS England is working on the funding formula and it hopes to make any necessary changes in time for the next funding round, which starts in April 2014.

[Liz Kendall (Leicester West) (Lab)]

Ministers were repeatedly warned about problems with their 111 roll-out by the Royal College of Nursing, the British Medical Association, the Ambulance Service Network and private providers, but they ploughed on regardless. The result was patients left waiting hours for call-backs, more ambulances sent out and more pressure on already struggling A and Es. I am sure the Secretary of State is aware of the pattern of the seasons, so if he wants to avoid another A and E crisis this winter, can he explain why Bruce Keogh’s review of urgent and emergency care will not even report until next spring?

[Mr Hunt]

Actually, the hon. Lady is wrong, because Bruce Keogh’s review of urgent and emergency care with respect to vulnerable older people, and particularly with respect to the way the 111 service operates, will report this autumn, precisely so that we can make sure we learn any lessons we need to learn for this winter, and it is very important that we should do so.

--- Later in debate ---

[Margot James (Stourbridge) (Con)]

11. What steps he is taking to improve the care of vulnerable older people.

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

We are taking a great deal of measures to improve services for vulnerable older people, who make up the bulk of the work the NHS does, and in particular to make sure they are always treated with dignity and respect.

[Margot James]

I thank my right hon. Friend for his answer. Earlier this year the Care Quality Commission found that people with dementia end up in hospital more often, stay longer and are more likely to die there. What can he do to encourage greater provision of good-quality specialist care places for patients with dementia in the community?

[Mr Hunt]

My hon. Friend makes an important point. Nearly 60% of people with dementia are in a care setting, but one of the tragedies is that many of them could continue to live healthily and happily at home for much longer if they were given the support that they needed. Often, however, that support does not arrive until it is too late, when the carer or family member is under too much pressure to be able to look after them. The dementia diagnosis rate at the beginning of this Parliament was less than 40%, but our objective is to get that up to two thirds by the end of the Parliament. Also, we want to ensure that a proper care plan is in place for the two thirds who are diagnosed, so that we can avoid the problems that my hon. Friend has highlighted.

[Hazel Blears (Salford and Eccles) (Lab)]

Last week, the all-party parliamentary group on dementia published its report, “Dementia does not discriminate”, which deals particularly with the impact of dementia on people from black and minority ethnic communities. There are now 25,000 people from those communities living with dementia—far more than we expected—yet they often receive their diagnoses even later than people with dementia in the rest of the population. Will the Secretary of State fund an awareness campaign through Public Health England aimed at those communities to drive up the diagnosis rates? Will he also ensure that the clinical commissioning groups are commissioning appropriate support services in those communities so that we can provide proper services for everyone living with dementia?

[Mr Hunt]

I congratulate the right hon. Lady, who is a long-time campaigner on dementia issues. She has raised a really important issue, and I will certainly talk to Public Health England about raising awareness. For those groups, as for everyone, we need to ensure that there is a good care plan in place when they are diagnosed. There is some resistance in the GP community to giving a dementia diagnosis, partly because many GPs worry that not much will happen as a result. We need to ensure that there is a good plan in place, and that is particularly the case for ethnic minority communities.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

Does the Secretary of State agree that areas that are grappling with the highest burdens of chronic illness and disability should receive the highest NHS allocations? Does he have any idea why the NHS Commissioning Board has rejected the advice of the Advisory Committee on Resource Allocation and decided instead to perpetuate the systematic underfunding of areas that serve older people?

[Mr Hunt]

My hon. Friend is absolutely right to say that NHS resources must be allocated in a way that fairly reflects the need for the NHS in every area. Rurality and age are two important factors in that regard. I can reassure him that the current allocations are not set in aspic. The problem with the recommendations from the Advisory Committee on Resource Allocation that NHS England received before was that they would have meant increasing resources to the areas with the best health outcomes at the expense of those with the worst ones. NHS England thought that that would be inconsistent with its duty to reduce health inequalities, but it is looking at the issue this year and we all hope that it will make good progress.

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

We all know that one of the most important drivers for improving the quality of care for vulnerable and elderly patients is to ensure the adequate training and regulation of health care assistants. That is something that Labour and Sir Robert Francis QC have called for, but that the Government have so far ducked. Will the Secretary of State now accept that crucial Francis recommendation to help to drive up care standards for the elderly and the vulnerable—yes or no?

[Mr Hunt]

The reasons that Robert Francis recommended statutory regulation of health care assistants were twofold. First, he wanted to ensure that people who had been involved in incidents of poor care could not pop up somewhere else in the system. Secondly, he wanted to ensure that everyone had proper training. We are going to solve both those problems, but I am not convinced that a big new national database of 300,000 people is the way to do it.

[Heidi Alexander (Lewisham East) (Lab)]

12. What recent progress his Department has made on negotiations with acute providers on the capital and revenue costs of implementing the recommendations of the special administrator of the South London Healthcare NHS Trust.

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

13. What plans he has to increase the management capability of doctors elected to clinical commissioning groups.

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

Clinical commissioning groups have the freedom and autonomy to determine the skills and expertise needed to enable them to deliver improved outcomes for their local communities, and NHS England is developing an assurance framework to ensure that they all have the capacity and capability to do that.

[Mr Sheerman]

Is the Secretary of State aware that a number of doctors, certainly the ones I have talked to, are deeply concerned about the inadequacy of their management capabilities to run these complex organisations? Is he worried that many of them are saying that they have to turn to private health care people to back them up and give them advice? Is that healthy in the NHS?

[Mr Hunt]

I am absolutely aware that there a lack of clinical leadership, and when we go on to the statement later today, I am sure that we will be discussing what needs to be done to improve the quality of leadership, particularly clinical leadership. Very often the best leadership in any hospital or any commissioning group comes from clinicians, and we have much work to do to make that happen. But I do not think that that means that we should duck the challenge; we just have to get on and make sure that people have the right training and can be supported to do the job we need them to do.

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

The Secretary of State seems to be answering a different question. The question was about management training for doctors who are being put in the position, without any training and with no consultation—many are doing this against their wishes—of having to manage in a way that they have never been trained to do and are not inclined to do. Would it not be better to put in place the assurance and the training he talks about before rushing into this madcap reorganisation, which the Government did?

[Mr Hunt]

May I reassure the hon. Gentleman that, first, these people are not doing these jobs against their will, as they volunteered to do them? Secondly, the quality of CCGs is being assured very closely, and they are receiving a lot of support. But it is a big job because, generally speaking, we want more clinical leaders. They need support in learning management skills in order to do that job well, and across the whole NHS we need to be doing that better.

[Fiona Mactaggart (Slough) (Lab)]

Will the training of clinical leaders include training in legal advice about mergers? I was shocked to see a response from Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Poole Hospital NHS Foundation Trust showing that they had already spent more than £1.5 million on legal advice about their merger, which has been prevented by the Competition Commission, and that in future they expect to spend £6 million on this scheme. Is it right that our health money should be going on legal advice?

[Mr Hunt]

No, and I am as concerned as the hon. Lady that it is difficult to push through the mergers that local commissioners want to happen. We have to operate within the framework of European law, but we are looking at what we can do to make it easier for these things to happen.

[Henry Smith (Crawley) (Con)]

14. What steps he is taking to tackle health tourism and ensure a fair system of contribution to the costs of the NHS.

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

On 3 July, my Department and the Home Office launched co-ordinated consultations on a range of proposals on a new charging system for visitors and migrants in which everyone makes a fair contribution to health care. Those include making temporary migrants from outside the European economic area contribute to the cost of their health care, and introducing easier and more practical ways for the NHS to identify and charge those not entitled to free health care.

[Henry Smith]

I very much welcome the statement by my right hon. Friend and support the new visa fee proposal for non-EU foreign nationals who come here and receive NHS treatment. May we also have an assurance that the treatment of EU nationals will be properly audited in the NHS, so that those costs can be recovered through the European health insurance card scheme?

[Mr Hunt]

My hon. Friend is right to point to the fact that we estimate that we collect less than half the money for which we invoice for “overseas operations” and we identify fewer than half the people who should be invoiced in the first place—that applies in respect of those from inside the EU as well as from outside the EU. We can get refunded for the care we give EU nationals if we are sensible about collecting this money and we put those systems in place. Given the pressures in the NHS, we are absolutely determined to make sure we do so.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement. Last year health tourism cost the NHS £24 million—that was in one year alone. He has outlined the new system coming in, but will he say how it will be administered? Many of us feel that it might not be as easy to do in practice as it is on paper.

[Mr Hunt]

The hon. Gentleman is absolutely right. If this is to work, we need a slick system that is easy for hospitals to operate. We have done this in another area, as the NHS successfully and seamlessly invoices insurance companies for the costs of coping with road traffic accidents. At the moment, however, if hospitals declare that someone is chargeable for their NHS care, they do not get paid by the NHS for that care, meaning that they have to collect the money themselves from overseas, so the incentives for hospitals are wrong and we need to sort them out.

[Mr Tobias Ellwood (Bournemouth East) (Con)]

20. I welcome the Government’s initiatives to tackle health tourism, but what is being done to help hospitals on the front line, such as Bournemouth hospital, better to identify chargeable visitors?

[Mr Hunt]

We are considering whether something can be done with the NHS number. At the moment, people can visit any GP and, completely legally—whether or not they are entitled to NHS care—get an NHS number. That number can then become a passport that can be used throughout the system, so we are examining whether there is a way of giving people either a temporary NHS number, or a different NHS number, that can be tracked through the system so that if they undergo complex medical care that is chargeable, we are able to trace that and collect the money from them.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

If we are to make this work, do not we need a clearer idea about the real cost? Is it the £200 million that the Secretary of State has been quoted as using, the £10 million suggested by the Prime Minister, or the £33 million that the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), has cited in a parliamentary written answer?

[Mr Hunt]

The truth is that we do not know the cost, which is why we are carrying out an independent audit this summer. The £12 million figure is the amount written off by the NHS each year because of unpaid overseas invoices, but many people think that the costs are much greater. We want an answer for the hon. Gentleman and everyone in the House, so we are carrying out that independent audit and we will publish the results later in the autumn.

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

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 want to recognise the fact that this month marks the 65th anniversary of the NHS. This country blazed a trail by introducing universal health care coverage in 1948, and the NHS remains the single biggest reason why most people are proud to be British. The whole House will want to note that whatever failings are being exposed by a new era of transparency in NHS care, the overwhelming majority of doctors, nurses, health care assistants and managers do a remarkable job, working incredibly long hours for the benefit of us and our families, and we salute them for all they do.

[Kate Green]

When changes were made at Lewisham hospital, the Secretary of State refused to meet local campaigners. Following his announcement last week about changes to services at Trafford general hospital, local campaigners from Trafford would like to know if he is prepared to meet them.

[Mr Hunt]

That is not quite a fair representation of what happened in the case of Lewisham, or indeed for Trafford, because I agreed to meet all local MPs regarding Lewisham. These things are carefully constrained by what is legally possible so as to be fair to all sides, but I met all Lewisham MPs. As the hon. Lady knows, I have agreed to meet her—I think that we are meeting later this afternoon—and I am sure that she will express the concerns of campaigners in Trafford.

[David Rutley (Macclesfield) (Con)]

T5. Integrating health and social care is an especially important priority in areas with the fastest-ageing populations. With that in mind, do Ministers agree that it is vital to support joined-up initiatives such as Caring Together in north-east Cheshire, which involves the local clinical commissioning group, council and NHS trust?

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[Mr Speaker]

Order. The hon. Gentleman should not abuse topical questions to ask two questions, and he should be asking not about the policies of the previous Government, but about the policies of the present Government, on which I know the Secretary of State will briefly reply. We are grateful.

[Mr Jeremy Hunt]

We will, of course, give every support to the management at Basildon to turn around their hospitals. The wonders of modern technology have informed us that the shadow Health Secretary was wrong to say that there has been a decline in nursing numbers in Basildon: they have actually gone up by nearly 100 since the last election.

[Sarah Champion (Rotherham) (Lab)]

T3. The Francis report recommended that the National Institute for Health and Care Excellence draw up minimum safe staffing levels that would be policed by the Care Quality Commission. It stated that NICE should develop“evidence-based tools for establishing”the staffing needs of each service in the NHS which is likely to be required“as a minimum in terms of staff numbers and skill mix.”Will the Minister tell us when the Government will act on this and all the recommendations in the report?

[Mr Hunt]

If the hon. Lady heard the exchange earlier, she will know that what Robert Francis was recommending was evidence-based tools, not a national minimum staffing level. The reason for that is that the number of nurses needed varies from hospital to hospital and ward to ward. We need to make sure that that happens. In the best hospitals it already does. The system that we have—this was supported by the shadow Health Secretary in his evidence to the Francis review—is not one where the Secretary of State sits behind his desk and dictates the number of nurses required in every hospital. If we did that, we would not be able to run the NHS properly, but we need to make sure that there are proper standards in place, which is why we have a chief inspector of hospitals to make sure that that happens.

[Stuart Andrew (Pudsey) (Con)]

T9. It is right that clinicians should speak out about safety in our hospitals, but does my right hon. Friend agree that now is probably not the right time for clinicians to be speculating in the national media about the safety at Leeds heart unit, given that the Department has yet to release the second phase of the review, as this endless speculation is causing great anxiety to already worried parents?

[Mr Hunt]

I agree with my hon. Friend. He has campaigned very honourably and sensibly for children’s heart services at Leeds. This is not a time for speculation. We will announce this month what the new process will be for resolving Safe and Sustainable. He and I both want this to happen as quickly as possible to remove that uncertainty. Also, we have to find a way of making sure that the data are solid and that we can trust them.

[Keith Vaz (Leicester East) (Lab)]

T4. Will the Secretary of State join me in congratulating Abbey primary school on becoming the first “silver star” school in Leicester for banning sugary drinks and for promoting healthy eating and exercise? Does he agree that this is the best way of preventing diabetes and obesity in later life?

[Andrew George (St Ives) (LD)]

Further to the question raised by the hon. Member for Walsall South (Valerie Vaz), I have met the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) regarding safe staffing levels and I provided a substantial file of evidence on behalf of the Florence Nightingale Foundation in support of its 1:8 registered nurse to patient ratio. What part of that evidence are Ministers unconvinced by?

[Mr Jeremy Hunt]

I am sure the evidence to which the hon. Gentleman refers is very persuasive, but I am sure he would agree that a ratio such as 1:8 cannot be applied uniformly across his local hospital or across all local hospitals. It can vary from day to day, depending on the level of illness and the age of the people going into particular wards. The best hospitals have computer models that change the numbers of nurses operating in different wards on a daily basis. Other hospitals do not do that, except on a quarterly basis. That is the change that we need to make.

[Rosie Cooper (West Lancashire) (Lab)]

T6. Does the Secretary of State believe that making data on individual consultants public is pointless if hospitals are using informal mechanisms to frustrate patient choice, such as having a team of specialist nurses decide which consultant a patient is referred to? Will he reinforce patient choice and dissuade hospitals from doing that?

--- Later in debate ---

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

T7. The guidance that the Government have produced on transferring funds from the NHS to local authority social care makes it clear that the money can be used to plug gaps in social care caused by cuts. Does that not just mean that the local authorities that are under most pressure because they have had the biggest cuts will not be in a position to develop the integrated health and care services that we would all like to see?

[Mr Jeremy Hunt]

I hope that I can reassure the hon. Lady, because the conditions for accessing that £3.8 billion fund are absolutely clear. Local authorities will not be able to access it unless they can promise to maintain services at their current levels. They are allowed to make financial efficiencies, as is the NHS, and everyone needs to look at that, but not if it means a deterioration in services.

[Jeremy Lefroy (Stafford) (Con)]

Being able to be visited frequently by one’s loved ones is a vital part of improving care for vulnerable older people in acute settings. How is closeness to home being taken into account in any service changes proposed by Monitor or the NHS Trust Development Authority?

[Mr Hunt]

First, I congratulate my hon. Friend on the admirable way he sticks up for his constituents in Stafford in incredibly difficult circumstances. I think that the whole House recognises what he has done. Secondly, in answer to his question, there is always a balance to be found, because we all recognise that, all things being equal, people would rather be treated nearer to where they live for exactly the reasons he gave. We also need to ensure that people get the best care when they arrive at hospital, which is why it is very important to go through these difficult processes to work out where that balance lies.

[Mr Kevin Barron (Rother Valley) (Lab)]

Is the Secretary of State aware of the increasing problems there are in A and E because of alcohol? If so, will he tell us what he is going to do about it?

[Mr Hunt]

There are problems, particularly in large cities and at weekends. In fact, in the case of the reorganisation of services at Trafford general hospital, one of the things that we can invest in as a result is mental health facilities in neighbouring A and Es so that people have better access to the services they need.

[Tessa Munt (Wells) (LD)]

The Secretary of State will be aware of the case of Nadejah, the face of the Teenage Cancer Trust, who at the age of 23 has been refused the CyberKnife cancer treatment that could save her life. Her mother Michelle is here today. Will he intervene so that this young woman gets the treatment that her consultant, Professor Hochhauser, recommends, and will he meet Nadejah’s mother and me so that we can work together to unblock the funding so that she can get the treatment she so desperately needs?

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Since 2010, thousands of NHS staff have left the NHS with big, fat redundancy cheques, only to go through the revolving door and get new jobs in the NHS, often months later. Will the Secretary of State tell us how much has been spent on redundancy payments and whether he regrets that waste of NHS money?

[Mr Jeremy Hunt]

The hon. Lady asks that question as if that kind of thing never happened under Labour. The answer is that it is not acceptable, which is why we are changing the rules to ensure that people cannot get payoffs and then walk straight into another NHS job. The other answer is that the reorganisation that she criticises means that we have put more money on the front line, including for 6,000 more doctors, which I think was the right thing to do.

[Charlotte Leslie (Bristol North West) (Con)]

Does the Secretary of State agree it is a scandal that those, such as Gary Walker, Amanda Pollard and Kim Holt, who have exposed the horrors buried in our NHS have either been fired or do not have jobs, but those who are heavily implicated in such cases, such as Barbara Hakin—about whom I have written to the Secretary of State—David Nicholson, and others, still do?

[Mr Hunt]

My hon. Friend has campaigned long and hard on issues of accountability, and I agree with her basic case, even if I do not agree with her about all the individuals she mentioned. One issue that will arise during today’s statement is that of how people are held accountable. That has been missing in our NHS, and we must put it right.

[Grahame M. Morris (Easington) (Lab)]

There has been much talk about action plans and I am sorry that the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), is not in his place. Is the Health Secretary aware that Mencap has expressed concerns that the Government’s response to the “Six Lives” progress report by the Department of Health does not set goals or time scales for tackling the issues highlighted in that report?

[Mr Hunt]

I know that the care services Minister would have liked to be here but he is at his son’s graduation today. I will pass on the hon. Gentleman’s question and ensure that he receives a full response.

[Richard Fuller (Bedford) (Con)]

At the end of this month, the East of England Multi-Professional Deanery will remove junior doctors in paediatric services from Bedford hospital. That will reduce paediatric services, which will obviously cause major concerns for families with children in Bedford and Kempston and north Bedfordshire. Will my right hon. Friend join me and my hon. Friend the Member for North East Bedfordshire (Alistair Burt) in calling for an open and independent inquiry into why clinical supervisory failures continued at Bedford hospital and were not addressed, and into the terrible consequences that resulted from that?

--- Later in debate ---

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

Further to the question from the hon. Member for Bristol North West (Charlotte Leslie), Ministers often—quite rightly—mention the importance of whistleblowers, so why have the Government weakened protection for whistleblowers through the Enterprise and Regulatory Reform Act 2013?

[Mr Jeremy Hunt]

We are strengthening protection for whistleblowers and are going much further by creating a culture of openness and transparency in the NHS, where people are not bullied if they speak out about poor care.

[Mr Adrian Sanders (Torbay) (LD)]

Torbay is often held up as a model for an integrated care service, but two important services are not fully integrated—mental health care and children’s services. Will the Government encourage the incorporation of all services into a fully integrated health care system?

[Mr Hunt]

My hon. Friend makes an important point and the heart of what he says is that integrated, joined-up care is most important for those who are regular users of the NHS. Children with complex needs or people with mental health conditions that can improve but not necessarily be cured can really benefit from an integrated approach. I salute what Torbay has done in blazing a trail. We are learning from that and hope that such a process will be rolled out in every part of the country as soon as possible.

[Several hon. Members]

rose—

Hospital Mortality Rates

Jeremy Hunt Excerpts

Tuesday 16th July 2013 Commons Chamber

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

I would like to make a statement about Professor Sir Bruce Keogh’s review of hospitals with high mortality rates, which is being published today.

Let me start by saying that in the health service’s 65th year, this Government are deeply proud of our NHS. We salute the doctors, nurses and other professionals, who have never worked harder to look after each and every one of us at our most vulnerable. We recognise that the problems identified today are not typical of the whole NHS or of the care given by many wonderful NHS staff; but those staff are the ones who are most betrayed when we ignore or pass over poor care. The last Government left the NHS with a system that covered up weak hospital leadership—[Interruption.]

[Mr Speaker]

Order. As is the normal practice, right hon. and hon. Members can expect extensive questions—as can the Secretary of State—but the statement must be heard.

[Mr Hunt]

Thank you, Mr Speaker. The last Government also failed to prioritise compassionate care. The system’s reputation—[Interruption.] This is uncomfortable for hon. Members. The system’s reputation mattered more than individual patients; targets mattered more than people. We owe it to the 3 million people who use the NHS every week to tackle and confront abuse, incompetence and weak leadership head-on.

Following the Francis report into the tragedy at Mid Staffs, the Prime Minister asked Professor Sir Bruce Keogh, the NHS medical director, to conduct a series —Interruption.] I know they tried to shout down whistleblowers such as Julie Bailey, but we are not going to let that happen here. The Prime Minister asked Professor Keogh to conduct a series of “deep-dive” reviews of other hospitals with worrying mortality rates. No statistics are perfect, but mortality rates suggest that since 2005, thousands more people may have died than would normally be expected at the 14 trusts reviewed by Sir Bruce.

Worryingly, in half those trusts, the Care Quality Commission—the regulator specifically responsible for patient safety and care—failed to spot any real cause for concern, rating them as “compliant” with basic standards. Each of those trusts has seen substantial changes to its management since 2010, including a new chief executive or chair at nine of the 14. However, although some have improved, failure or mediocrity is so deeply entrenched at others that they have continued to decline, making the additional measures I am announcing today necessary.

This time, the process was thorough, expert-led and consisted of planned, unannounced and out-of-hours visits, placing particular weight on the views of staff and patients. Where failures were found that presented an immediate risk to patients, they were confronted straight away, rather than waiting until the report was finished. We will be publishing all the reports today, alongside unedited video footage of the review panel’s conclusions—all of which I am placing in the Library. Today I will also set out the actions the Government are taking to deal with the issues raised. I would also like to record my sincere thanks to Sir Bruce and his team for doing an extremely difficult job very thoroughly and rapidly.

Sir Bruce judged that none of the 14 hospitals is providing a consistently high quality of care to patients, with some very concerning examples of poor practice. He identified patterns across many of them, including professional and geographic isolation, failure to act on data or information that showed cause for concern, the absence of a culture of openness, a lack of willingness to learn from mistakes, a lack of ambition, and ineffectual governance and assurance processes. In some cases, trust boards were shockingly unaware of problems discovered by the review teams in their own hospitals. Today I can therefore announce that 11 of the 14 hospitals will be placed into special measures for fundamental breaches of care. In addition, the NHS Trust Development Authority and Monitor have today placed all 14 trusts on notice to fulfil all the recommendations made by the review. All will be inspected again within the next 12 months by the new chief inspector of hospitals, Professor Sir Mike Richards, who starts work today.

The hospitals in special measures are as follows: Tameside Hospital NHS Foundation Trust, where patients spoke of being left on unmonitored trolleys for excessive periods and where the panel found a general culture of “accepting sub-optimal care”; North Cumbria University Hospitals NHS Trust, where the panel found evidence of poor maintenance in two operating theatres, which were closed immediately; Burton Hospitals NHS Foundation Trust, where the panel found evidence of staff working for 12 days in a row without a break; and North Lincolnshire and Goole NHS Foundation Trust, where the panel identified serious concerns in relation to out-of-hours stroke services at Diana, Princess of Wales hospital. The panel also witnessed a patient who was inappropriately exposed where both male and female patients were present. [Interruption.]

The list continues: United Lincolnshire Hospitals NHS Trust, where there were a staggering 12 “never events” in just three years and the panel had serious concerns about the way “Do not attempt resuscitation” forms were being completed; Sherwood Forest Hospitals NHS Foundation Trust, where patients told of being unaware of who was caring for them, and of buzzers going unanswered and poor attention being paid to oral hygiene; East Lancashire Hospitals NHS Trust—[Interruption.]

[Mr Speaker]

Order. We cannot have a running commentary on the statement as it is delivered. I remind the House that last Wednesday—when there were scenes of grave disorder manifested by Members on both sides of the House—the public reaction to that exceptionally bad behaviour was understandably negative. I appeal to right hon. and hon. Members on both sides of the Chamber to show courtesy and restraint. They can rely upon me to protect their interests—if they were here on time for the statement—to question the Secretary of State, but the statement must be heard.

[Mr Hunt]

The panel also highlighted issues of poor governance, inadequate staffing levels and high mortality rates at weekends at East Lancashire Hospitals NHS Trust. Patients and their families complained of a lack of compassion and being talked down to by medical staff whenever they expressed concerns.

The remaining hospitals in special measures are as follows: Basildon and Thurrock University Hospitals NHS Foundation Trust, where there were seven “never events” in three years and concerns over infection control and overnight staffing levels; George Eliot Hospital NHS Trust, where the panel identified low levels of clinical cover, especially out of hours, a growing incidence of bed sores and too much unnecessary shifting of patients between wards; Medway NHS Foundation Trust, where a public consultation heard stories of poor communication with patients, poor management of deteriorating patients, inappropriate referrals and medical interventions, delayed discharges and long accident and emergency waiting times; and Buckinghamshire Healthcare NHS Trust, where the panel found significant shortcomings in the quality of nursing care relating to patient medication, nutrition and observations, and heard complaints from families about the way patients with dementia were treated.

For those 11 trusts, special measures mean that each hospital will be required to implement the recommendations of the Keogh review, with external teams sent in to help them do this. Their progress will be tracked and made public. The TDA or Monitor will assess the quality of leadership at each hospital, requiring the removal of any senior managers unable to lead the improvements required. Each hospital will also be partnered with a high-performing NHS organisation to provide mentorship and guidance in improving the quality and safety of care.

Three of the 14 hospitals are not going into special measures. They are the Colchester Hospital University NHS Foundation Trust, the Dudley Group NHS Foundation Trust and the Blackpool Teaching Hospitals NHS Foundation Trust. Although there were still concerns about the quality of care provided, Monitor has confidence that the leadership teams in place can deliver the recommendations of the Keogh review and will hold them to account for doing so.

This is a proportionate response in line with the findings of the review. Inevitably, there will be widespread public concern not just about these hospitals but about any NHS hospital, and some have chosen to criticise me for pointing out where there are failures in care, but the best way to restore trust in our NHS is transparency and honesty about problems, followed by decisiveness in sorting them out. The public need to know that we will stop at nothing to give patients the high-quality care they deserve for themselves and their loved ones. Today’s review and the rigorous actions that we are taking demonstrate the progress this Government are making in response to the Francis report. I shall update the House in the autumn on all of the wide-ranging measures that we are implementing, when the House will be given a chance to debate them in Government time.

The NHS exists to provide patients with safe, compassionate and effective care. In the vast majority of places it does just this, and we should remember that there continues to be much good care even in the hospitals reviewed today. Just as we cannot tolerate mediocre or weak leadership, we must not tolerate any attempts to cover up such failings. It is never acceptable for Government Ministers to put pressure on the NHS to suppress bad news, because in doing so they make it less likely that poor care will be tackled.

We have today begun a journey to change this culture. These 14 failing hospital trusts are not the end of the story. Where there are other examples of unacceptable care, we will find them and we will root them out. Under the new rigorous inspection regime led by the chief inspector of hospitals, if a hospital is not performing as it should, the public will be told. If a hospital is failing, it will be put into special measures with a limited time period to sort out its problems. There will be accountability, too: failure in the NHS should never be a consequence-free zone, so we will stop unjustified pay-offs and ensure it will no longer be possible for failed managers to get new positions elsewhere in the system.

Hand in hand with greater accountability, there will be greater support. Drawing inspiration from education, where super-heads have helped to turn around failing schools, I have asked the NHS Leadership Academy to develop a programme that will identify, support and train outstanding leaders. We have many extraordinary leaders such as David Dalton in Salford Royal and Dame Julie Moore of University hospital Birmingham, but we need many more to provide the leadership required in our weaker hospitals.

At all times, this Government will stand up for hard-working NHS staff and patients who know that poor care and weak leadership have no place in our NHS. It was set up 65 years ago with a pledge to provide us all with the best available care, and I am determined that the NHS will stand by that pledge. We owe its patients nothing less. I commend this statement to the House.

--- Later in debate ---

[Andy Burnham (Leigh) (Lab)]

First, let me join the Secretary of State in thanking Sir Bruce Keogh and his team for this important review. Having worked closely with Sir Bruce, I know him well and have the utmost respect for him. His review presents a challenging but accurate picture of care standards and failings at the 14 trusts. As with both Francis reports, we accept the findings of this report in full.

The statement we have just heard, however—the partisan statement—was not worthy of the excellent report that Sir Bruce has delivered today. The Health Secretary claimed at Health questions that this was a historical report, all about the past and the last Government. Well, I have got news for him: it is not. Trusts were identified on the basis of mortality data for 2011 and 2012. This report is about the right hon. Gentleman’s Government and failings that are happening now on this Government’s watch.

Anyone who supports the NHS must always be prepared to shine a spotlight on its failings, so it can face up to them and improve. In so doing, we must be fair to staff and the NHS as a whole. I am pleased to say that Sir Bruce is fair in his report. He says early in the report that the failings of the 14 hospitals must be put in context, stating that mortality in “all NHS hospitals” has been falling over the last decade by about 30%. He rightly reminds us of

“decades of neglect in the NHS in the 1980s and 1990s”,

and he speaks of the challenge facing the last Government in their early days. The key issue, he said,

“was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment.”

The last Labour Government dealt with that issue; I am proud of it and we are proud of our record on the NHS.

The balanced picture presented in this report is not recognisable from the Government briefing appearing in the weekend newspapers. In fact, this report exposes one of the more cynical spin operations of recent times. Nowhere in this report does the claim of 13,000 avoidable deaths appear. Sir Bruce is clear, so let me quote him directly:

“However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths”,

but that is precisely what this Government chose to do in advance of this report. They made unfounded claims, which will have alarmed people in the areas served by the 14 hospitals, and they have questioned the integrity of the staff working in those hospitals in difficult circumstances—and all for their own self-serving political ends. That is simply unworthy of any responsible Government. On reading this review, the diversionary spin operation now makes sense because it reveals evidence of deterioration at all 14 hospitals on their watch.

Let me turn to one of Sir Bruce’s central findings—unsafe staffing. One of the report’s major concerns is that trusts have allowed staffing levels to drop to dangerously low levels. It says:

“When the review teams visited the hospitals, they found frequent examples of inadequate numbers of nursing staff in some ward areas.”

Already, the review team has had to intervene on staffing levels in three trusts to protect patient safety.

The Secretary of State claimed in his comments that the Care Quality Commission had failed to spot any problems. Working with the CQC during the last Government, I left in place warnings about five of these hospitals. The Secretary of State claims that we were covering up, so let me answer on the question of Ministers’ integrity and cite the Francis report, which said that there was no evidence that any Minister received or ignored advice that would have led to safe outcomes. Let me quote to him from a letter sent by Baroness Young to the Prime Minister yesterday:

“CQC was not pressurised by the previous Government to tone down its regulatory judgments or to hide quality failures.”

It is outrageous for the Secretary of State to come to the House today and repeat those concerns without a shred of evidence to back them up.

Five of the trusts examined by Keogh had warnings in place, and it is shocking that they have been allowed to cut staff to unsafe levels on this Government’s watch. Overall, seven of the trusts in the review have cut front-line staff by a shocking 1,117. The great sadness is that it appears Ministers are in danger of forgetting the lessons of Stafford, where Robert Francis identified “dangerous cuts” to the front line as a primary cause of care failures. Like Robert Francis, Sir Bruce makes recommendations on appropriate staffing levels. Is it not the case that the Secretary of State can no longer ignore these authoritative calls, and will he take urgent action on safe staffing levels in these 14 trusts and across the NHS? Will he accept that the loss of over 4,000 nursing jobs that has now been laid bare under this Government is a monumental mistake, while £3 billion has been siphoned out of the NHS front line to pay for reorganisation that nobody wanted and nobody voted for?

Let me turn to A and E performance, the barometer of the health service and a wider indication of problems across hospitals. The report highlights major failings in A and E at many of the trusts and we know that the NHS has just come through the worst winter for a decade. At the end of last year, all 14 trusts were in breach of the Government’s A and E target—when, under the previous Government, all 14 were meeting the A and E target.

Sir Bruce is clear that urgent action is needed to improve A and E. Let me quote the report:

“We have established that one of the primary causes of high mortality in these hospitals are found primarily in urgent and emergency care, and particularly in care for frail and elderly patients…All trusts were functioning at high levels of capacity in the urgent care pathway. This frequently led to challenges in A&E and, as a consequence, cancellation of operations due to bed shortages and difficulty meeting waiting time targets.”

Will the Secretary of State now take immediate action, working with the whole health economy in these 14 areas, to bring each trust back up to the national standards on A and E that his Government have set? Will he accept that it is not fair to these hospitals to blame them alone, as the devastating cuts to social care are a major driver of pressure in hospitals?

Finally, on what happens next, the simple truth is that people watching will want solutions rather than point scoring. Surely the right response to the Keogh review is now to accept the Francis recommendations in full, particularly on minimum staffing. A duty of candour on individuals will help bring the culture change we need at local level and, of course, we need to see the regulation of health care assistants. Will the Secretary of State work with us now on early implementation of the Francis recommendations? He spoke earlier of a new era of transparency. If he means what he says, will he now publish the NHS risk register? For all we know, it might well have predicted some of the failings we are reading about today.

It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What matters is how the NHS responds. Rather than pulling down the shutters and pushing people away, it is right that we should hold a mirror up to the NHS so that it can act on its failings. We must also be fair to people working in the NHS by ensuring that an accurate picture is presented. Sir Bruce has had to take the extraordinary step already of distancing himself from the Government briefings that appeared at the weekend. I hope the Government will learn a painful lesson from this: you should not play politics with people’s lives and you should not play politics with the NHS, on which all people depend.

[Mr Hunt]

Mr Speaker, it is hard for a serving Health Secretary to admit that things can go wrong in the NHS, but we know today that it is even harder for a former Health Secretary. We have heard nothing but shameful denial. The right hon. Gentleman—[Interruption.]

[Mr Speaker]

Order. Mr Irranca-Davies, you look as though you are about to explode. I am worried about you. I think you probably need to have a lie down or to take some sort of medicament—it might be of benefit to you. You must calm yourself.

--- Later in debate ---

[Mr Hunt]

The right hon. Gentleman talked about being partisan and party political. It is not party political to highlight poor care; it is doing the right thing for patients.

Let us look at what independent people have said about Labour’s time in office. Roger Davidson, the former head of media at the CQC, said that

“there were conversations between the CQC and Ministers to the effect that the CQC would not cause any trouble…The message that ‘we don’t want bad news’ infected the whole organisation”.

Professor Brian Jarman—[Interruption.] I think Opposition Members might want to listen to this, because it is what independent people are saying. Professor Jarman, who invented hospital standardised mortality indices, said that

“the problem was ministerial pressure, even from Number 10.”

This is most damaging: the right hon. Gentleman talked about what Barbara Young, Labour peer and head of the CQC, said under pressure from the Labour Whips, but what did she say under oath to the Francis inquiry? She said that

“the government hated the idea…the regulator would criticise it… We were under more pressure, I think, when Andy Burnham became minister, from the politics.”

That is what a Labour peer said. These people are not Government supporters—at least, not of this Government —but were trying to do their job in exposing poor care and the right hon. Gentleman stopped them.

The right hon. Gentleman talks of spin, but I will tell him who had to fight hardest against spin: the whistleblowers he tried to shut up. What do they say? James Titcombe, who tragically lost his son at Morecambe bay, tweeted that

“you made big mistakes Andy, it’s time you admitted it.”

Julie Bailey, who lost her mother at Mid Staffs, said that Labour crushed the culture of care from the NHS. [Interruption.] Deb Hazeldine, from Mid Staffs, who lost a relative, said that the shadow Secretary of State was trying to “defend the indefensible”—[Interruption.]

[Mr Speaker]

Order. It is very difficult to imagine how anyone can hear these exchanges. The content of questions and answers is to be determined by Members, but I gently remind the House of the need for good order and that this is not a debate. There will be debates, but this is not a debate but a statement on which there is questioning, to which there is then a ministerial answer. This is not an opportunity for general speechifying but for responses to specific questions made with economy so that I can accommodate all interested colleagues.

[Mr Hunt]

Thank you, Mr Speaker. I would have hoped that the Opposition would want to listen more respectfully to what whistleblowers said about their attempts to expose poor care.

Let me respond to what the right hon. Gentleman says. He says that Labour tackled the problems, but the evidence shows the opposite. We talked about Tameside earlier, but what about Basildon? There were high death rates for nine years under Labour—in every year since 2001. Half the staff said they would not want their own friends and family treated there. Ministers received 237 letters between 2005 and 2010, yet what did the CQC do? It rated the hospital as “good” and within four weeks Ministers were shamed into launching an investigation into high mortality rates—[Interruption.]

[Mr Speaker]

Order. I have tried to explain the position calmly—[Interruption.] Order. I shall do so once more. I think the Secretary of State will appreciate that he has been asked questions about present arrangements to which we need pithy replies, not a lengthy statement about events of the past that happened before he had responsibility. We cannot have that. If that is what he is planning to read out, we will simply move on. A brief conclusion to his answer is now required and sought by the House.

[Mr Hunt]

So, Mr Speaker, let me briefly take the final two points raised by the right hon. Gentleman. He says the trusts have got worse since 2010, but what does he do when I criticise the lack of progress—[Interruption.]

[Mr Speaker]

Order. My impression is that the Secretary of State is now seeking to treat of matters since May 2010 and he must be given the opportunity to do so, with colleagues and people outside being able to hear the answers.

[Mr Hunt]

Thank you, Mr Speaker.

What does the right hon. Gentleman do when I criticise the lack of rapid progress in tackling failure in our hospitals? He criticises me for making an unbelievable statement and states that there are no coasting hospitals, but today proves that he is wrong. What is unbelievable is his total refusal to admit that it is not just a question of coasting hospitals, but a Labour party that has coasted for too long on its reputation on the NHS.

Finally, the right hon. Gentleman says that we are trying—[Interruption.] This is difficult for Labour Members to hear, so let us get to the point. He says that we are trying to run down the NHS. Let me say this: if we did not believe in the NHS, we would not be tackling these problems. The best way to support the NHS is not to ignore poor care, not to muzzle the CQC, not to ignore requests for public inquiries and not to ignore warnings constantly. If founding the NHS is considered Labour’s proudest achievement, today is its darkest moment as a Labour Government are exposed as caring more about their own reputation than about our most vulnerable citizens in the NHS—[Interruption.]

[Mr Speaker]

Order. Has the Secretary of State finished his answer? He has. We are grateful and I thank him for saying that he has finished.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

Those who want to make the case for change in an organisation—and, after the Francis review, who can doubt the need for change in parts of the national health service—must first demonstrate the need for change. Does this review not build on the distinguished record of both Bruce Keogh and Sir Brian Jarman in demonstrating the need for change in parts of our national health service?

[Mr Hunt]

My right hon. Friend speaks very wisely. As I know he agrees, identifying problems publicly is incredibly difficult, but the way to ensure that those problems are dealt with is to be totally honest and transparent about them in the knowledge that they will be sorted out as a result, and that is what is happening today.

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

Thankfully, the quality of Sir Bruce Keogh’s report is vastly superior to that of the statement that we heard from the Secretary of State. Is it not the case that Sir Bruce Keogh—[Interruption.]

[Alan Johnson]

Is it not the case that Sir Bruce may have given us a blueprint for better regulation, provided that the Secretary of State faces up to his responsibility and ends the tawdry and squalid attempts by his party to denigrate his predecessors?

[Mr Hunt]

I am sure that the right hon. Gentleman, who is one of those predecessors, would accept at a quieter moment outside the Chamber that one of the biggest mistakes made during his time as Secretary of State—or at least it was initiated then—was the appalling change that was made to the regulation of hospitals. The CQC was stripped of expert inspectors, and hospitals began to be inspected by generalists. The same group of people would inspect a slimming clinic, a dental practice, a GP’s surgery, and a major London teaching hospital. That very significant mistake lies at the heart of the reason why the CQC approved and certified so many failing hospitals.

I am happy to work with the right hon. Gentleman, and to say that honest mistakes were made and we will put them right, but today there must be honesty about what those mistakes were.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

Patients and their families outside this place will join me in congratulating the Secretary of State on his brave decision not to sweep NHS failures under the carpet.

You and I know, Mr. Speaker, that Buckinghamshire contains many areas of health care that are of high quality, but the report identifies some failings, one of which is the quality of out-of-hours and weekend nursing and medical cover for acute medical patients. That is clearly linked to difficulties relating to the recruitment, retention and availability of competent clinicians and nurses. What more can the Department do to help our trusts improve out-of-hours provision and, in particular, the quality of temporary staff, so that those problems can be eliminated?

[Mr Hunt]

My right hon. Friend is right. Serious problems were identified in Buckinghamshire relating to out-of-hours care and also to dementia patients, who themselves often need help out of hours. I raised the difficult issue of the GP contract because, in order to solve such problems, we need more joined-up care in the community. The Chancellor has announced an additional £2.8 billion for joint commissioning arrangements between local authorities and health care bodies, and I think that the combination of those two measures will secure a vastly improved out-of-hours service for my right hon. Friend’s constituents.

[Mr Jack Straw (Blackburn) (Lab)]

I welcome the Keogh report and the action that the Secretary of State has announced, which, although it will be uncomfortable for my local health trust, I believe to be necessary. However, I hope that, on reflection, the right hon. Gentleman will realise that the comments that he has made demean his office. I sat in the Cabinet with my right hon. Friends the Members for Leigh (Andy Burnham) and for Kingston upon Hull West and Hessle (Alan Johnson). I saw how anxious they were to root out inefficiency and failings, and to cover nothing up, and I think it inappropriate for the Secretary of State to suggest that he and his party have a monopoly when it comes to concern about the transparency and effectiveness of the health service.

Last Thursday, the Secretary of State commended Royal Blackburn hospital for its vascular services and accepted the excellence of many of its staff. While we are navigating through this difficult period, is it not crucially important for us to echo the Keogh report and point out that, overwhelmingly, hospitals in areas such as mine employ high-quality staff who require better leadership?

[Mr Hunt]

Improving leadership is vital throughout the NHS. All Governments must take responsibility for what happens on their watch, and I have taken responsibility today for those 14 hospitals and all their serious problems. The right hon. Gentleman should accept that between 2005 and 2010 his Government received 142 letters about his hospital which they did nothing about, and introduced a regulatory system that did not expose poor care and ensure that it was addressed.

[Andrew George (St Ives) (LD)]

I welcome Sir Bruce Keogh’s important report. However, although I admire my right hon. Friend, I totally dissociate myself from his ill-judged attempt to drag this important issue into the gutter of partisan politics and petty point-scoring. I expect better of him than that.

It is clear from annex A of the report that in all but one of the 14 hospitals, problems relating to staffing levels and the staff mix need to be addressed, and ambition 6 recommends action to address them. As my right hon. Friend knows, I campaign on this issue. What will the Government do to ensure that staffing levels are adequate in our acute hospitals?

[Mr Hunt]

Tackling failure in our NHS is not an easy path to take, but it is the right thing to do for patients. If my hon. Friend believes that all the care problems in the NHS started in 2010, I think he is the only Member who does. [Interruption.] Opposition Members must bear their share of the responsibility for the failures that they did not sort out. Staffing is indeed a problem that needs to be sorted out in many trusts, which is why we commissioned the review and why we are sending in turnaround teams to do just that.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

The Secretary of State has made an appalling attempt to smear my right hon. Friend the Member for Leigh (Andy Burnham). Will he now acknowledge that in 2009, my right hon. Friend sought a review of all the hospitals with high mortality rates, that 21 were registered with conditions, and that five had warnings placed on them, which he and he his predecessor inherited? Will he tell the House what he and his predecessor did in respect of those hospitals in 2010, 2011 and 2012?

[Mr Hunt]

As I said in my statement, in nine of these 14 trusts, the chief executive or chair has been either replaced or moved on. However, the most important thing that we are doing is setting up a transparent failure regime, so that when problems arise they will be made public, so the system will never know something that the public do not, and so that Ministers will be required to take action to sort out failing hospitals. That is what is happening under this Government, but I am afraid that it did not happen when the right hon. Lady’s party was in power.

[Mr William Cash (Stone) (Con)]

The Keogh report, which must be welcomed, followed the Francis report. Despite my continuous attempts to have a full public inquiry under the Inquiries Act 2005, successive Labour Secretaries of State refused. Can my right hon. Friend find out from the Department or in any other way how that happened? Will he be good enough to publish his findings, because the root of the real trouble is that they were not prepared to have an inquiry and it was a cover-up?

[Mr Hunt]

My hon. Friend knows that the Labour party refused 81 requests for a public inquiry into what happened at Mid Staffs—I repeat: 81 requests. He also knows that if it was not for that public inquiry, we would not be here now. That is the biggest lesson to learn about the benefits of a public inquiry, and that is why transparency matters. I hope he is also pleased that we will be having a debate on the Francis report in Government time later this year.

[Sir Tony Cunningham (Workington) (Lab)]

If the teams going into Cumbria recommend increased staffing and resources, will the Secretary of State fund that?

[Mr Hunt]

If the issues are around staffing, we will sort those out. If the issues are around leadership, we will sort those out. If the issues are around clinical practice, we will sort that out. My commitment to the House is that we will do what it takes to sort out these failing hospitals.

[Dr Phillip Lee (Bracknell) (Con)]

In 2006 the then Labour Government purchased 49% of Dr Foster, the intelligence unit from which a lot of these mortality data are emanating. Does the Secretary of State agree that for Secretaries of State from that point onwards to be claiming they were unaware of the data seems a bit rich?

[Mr Hunt]

There were repeatedly high mortality rates in all these 14 hospitals, and it took the public inquiry that Labour did not want to demonstrate to the world just how important hospital standardised mortality ratios are. They are the smoke alarm that was ignored in the case of Mid Staffs, and which could have led to the prevention of thousands of tragedies if we had taken action earlier. That is why we immediately insisted on this review by Sir Bruce.

[Grahame M. Morris (Easington) (Lab)]

I think there is widespread respect for Sir Bruce Keogh and his report and I certainly welcome it, but it is a cynical move by the Secretary of State to try to besmirch the reputation of my right hon. Friend the Member for Leigh (Andy Burnham). May I point out that on this Government’s watch clinical negligence claims are up 50%, A and E waits are at a nine-year high and “never events” have tripled? What is the Secretary of State going to do about them?

[Mr Hunt]

We spend more than £1 billion every year on clinical negligence because the hon. Gentleman’s Government changed the rules so that trusts suffer no financial penalty when they have to pay a clinical negligence claim. That is something we really need to look at, because it is removing one of the biggest possible incentives for trusts to treat people safely.

[Mark Reckless (Rochester and Strood) (Con)]

Is the Secretary of State aware that in Medway we were left with just three consultants to share cover of A and E, but we have now increased the number to six, and it will soon rise to eight?

[Mr Hunt]

These are precisely the problems that this review is designed to root out. There were problems with long A and E waits as well as with inappropriate medical interventions and poor communication with patients, but I hope my hon. Friend’s constituents will be reassured by the transparency of what is happening today, and the fact that I am making this Government accountable for sorting out those sorts of problems.

[Chris Bryant (Rhondda) (Lab)]

I suspect that in a quieter moment the Secretary of State will not think this statement was his proudest moment. [Interruption.] Well, it seems that he used to be run by Coulson and now he is run by Crosby.

Most voters will be more interested in the future and how we can make sure that people’s lives are protected, so what does the Secretary of State have to say about the fact that fewer people are coming from other countries to work in the NHS? Because of the Government’s immigration policy, there is a real danger that we will have a significant problem in A and E recruitment across the country.

[Mr Hunt]

I struggle to find the link between that question and Sir Bruce Keogh’s report on the 14 hospitals, but as the hon. Gentleman has asked about A and E, and as he is trying to take the moral high ground, perhaps he would explain why he has not been standing up in this House campaigning against Labour’s abysmal record, as it has missed its A and E targets in Wales since 2009.

[Rehman Chishti (Gillingham and Rainham) (Con)]

In 2005 and 2006 Medway Maritime hospital had the seventh worst mortality rate in the country, yet nothing was done. May I thank the Secretary of State for the actions he has put forward today, which will help improve the quality of care for my constituents and people from further afield?

[Mr Hunt]

My hon. Friend is right. There were high mortality rates in his hospital in six of the nine years they were measured under the last Labour Government, and there were problems with A and E and with inappropriate medical interventions. He can say to his constituents today that the Government have identified the problem and have been transparent about it, and we will be accountable for sorting it out.

[Mr Kevin Barron (Rother Valley) (Lab)]

How many health professional regulatory bodies has the Secretary of State met since the publication of the Francis report?

[Mr Hunt]

I think I have met most of them, but I have certainly met the General Medical Council and the Nursing and Midwifery Council, and I have talked to them about the reasons they are finding it difficult to remove doctors and nurses from their lists when there are questions about their poor performance.

[Tracey Crouch (Chatham and Aylesford) (Con)]

To complete the Medway Maritime hat trick, may I say I am very disappointed to hear from the Secretary of State that the hospital has gone into special measures? I have been assured that Sir Bruce Keogh’s recommendations are already being implemented, but will the Secretary of State say in what time frame he, and more importantly my constituents, should expect to see significant improvements at the Maritime?

[Mr Hunt]

We want these things to happen as quickly as possible, but all the hospitals Sir Bruce reviewed will be looked at again within the next year by the chief inspector of hospitals, Professor Sir Mike Richards, who starts work today, so we will be able to measure whether progress has been as swift as my hon. Friend and I would like.

[Helen Jones (Warrington North) (Lab)]

May I ask the Secretary of State to actually discharge one of the responsibilities of his office by answering a simple question? If he believes that managers should not be able to get another post if they fail, why was there a plan to transfer the chief nurse from the failed Morecambe Bay NHS Trust on secondment to Warrington and Halton on the Secretary of State’s watch, stopped only when my hon. Friend the Member for Halton (Derek Twigg) and I found out about it? Did he or his Ministers know about this plan, and if not, why not?

[Mr Hunt]

That is exactly the reason why we are introducing measures to make sure—[Interruption.] Well, the Francis report was introduced to this House on 6 February, and we have said we will change legislation this year. We have already appointed a chief inspector of hospitals. I do not think we could go much faster. The trouble for the Labour party is not that we are going too slowly but that we are going too fast and exposing all sorts of problems which it wishes did not happen.

[Andrew Griffiths (Burton) (Con)]

I thank the Secretary of State for shining a light on to the health care provided by Queen’s hospital in Burton. Although Queen’s has a lower unexpected death rate than other hospitals, any unnecessary death is a tragedy for the family concerned. Given that since 2005 Queen’s hospital had a higher mortality rate than Stafford hospital, does he understand the anger of my constituents who have seen their loved ones die unnecessarily and these concerns ignored by Labour?

[Mr Hunt]

My hon. Friend’s hospital had excess mortality rates for five of the nine years leading up to 2010 and not enough action was taken, and that is what today is all about. I hope that what his constituents will take from today is that this Government are committed to turning around failing hospitals and putting in place the right leadership, and the reassurance that when their loved ones go to Queen’s hospital or anywhere else in the country, they can get the kind of care they would want for themselves.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

May I say to the Secretary of State that there is a tone and a language that we should choose to employ for candid conversations about failure and it saddens me that he did not find that language today, because it will not do us any good? The Francis report recommended a duty of candour. Will he update the House as to just how much progress he has made on that?

[Mr Hunt]

Yes, I can. We have accepted the recommendation that there should be a duty of candour on the boards of hospitals, with criminal sanctions if they fail to tell members of the public that they or their loved ones have been harmed by the hospital, and if they fail to tell the system that those incidents have happened. We have commissioned a review of safety by Sir Don Berwick, one of the greatest experts in the world, and we shall ask him whether we should extend that duty of candour to below board level. We shall wait to hear what he says. We understand the reasons why people might want to do that, but we are also aware that others have expressed the concern that it might destroy an atmosphere of trust in a hospital if people were worried about criminal consequences if they did not talk about any failures they saw in their daily work.

[Margot James (Stourbridge) (Con)]

I warmly welcome my right hon. Friend’s break with the culture of cover-up that has been so prevalent in the past. I reject absolutely the shadow Health Secretary’s claim that the Dudley Group NHS Foundation Trust’s performance has deteriorated since 2010—[Interruption.]

[Margot James]

Thank you, Mr Speaker.

I reject the shadow Health Secretary’s claim. The new leadership that was appointed to the trust in 2009 found deep-seated problems there. Does my right hon. Friend the Secretary of State welcome, as I do, the positive notes in Sir Bruce Keogh’s report about that new leadership’s abilities, and Sir Bruce’s finding that the overall work force at our trust are

“committed, loyal, passionate, caring and motivated”?

[Mr Hunt]

I welcome that, and I am delighted that my hon. Friend’s trust was not one of the ones that it was necessary to put into special measures. We have learnt a lesson from the successful way in which the schools system is regulated. Ofsted distinguishes between failing schools that have in place good management who are able to turn the school round and those where a change of leadership is required, and I am pleased that the report found that Dudley had the right leadership in place.

[Gloria De Piero (Ashfield) (Lab)]

I welcome the report and I hope that the new chief executive at King’s Mill hospital in my constituency will provide the leadership that has been lacking in recent years. He assures me that he will implement all the report’s recommendations. The report mentions

“significant concerns around staffing levels at…King’s Mill Hospital”.

The trust has lost more than 200 nurses since 2010. Can we have them back?

[Mr Hunt]

Staffing levels are indeed one of the issues that contribute to poor care, if we get them wrong. That is why we are committed to implementing the Francis recommendations on safe staffing levels, and why, having protected and increased the NHS budget—contrary to what the shadow Secretary of State wanted—we now have 6,000 additional doctors working in the NHS. [Interruption.] In these individual cases, if staffing levels are the issue, they will be addressed.

[Mr John Baron (Basildon and Billericay) (Con)]

The Secretary of State has been absolutely right to highlight and pursue past failures for the benefit of future patients. That includes investigating why the regulatory system seems to have failed in these cases. Does he agree, however, that we must not allow the report to overshadow much of the good work that is being done in our hospitals, including Basildon hospital which now has new management and is instigating changes?

[Mr Hunt]

I agree with that. One reason why it is so important to reform the regulatory structures that we inherited is that they tried to identify only poor care—not terribly successfully—when we need a system that identifies outstanding care as well. We need such a system for the benefit of the general reputation of the NHS and the morale of the service. We also need one so that a failing hospital can have an organisation on which it can model itself, just as a failing school can model itself on a school that has received an outstanding Ofsted report. That provides a solution to the problem: we identify a problem transparently and we sort it out.

[Chris Williamson (Derby North) (Lab)]

The Secretary of State said that he was proud of the NHS, yet he and his Ministers have supported a top-down reorganisation of the national health service that will lead to 49% privatisation and cut 4,000 nurses. We know from the Francis report that staffing levels are key to the whole agenda, and the Secretary of State has just said he acknowledges that, so will he reinstate the 4,000 nurses he has cut from the NHS?

[Mr Hunt]

Perhaps the hon. Gentleman would like to acknowledge that more money has gone to the front line as a result of the reorganisation that this Government have introduced. We have 8,000 more clinical staff now than when the Labour Government were in office.

[Steve Baker (Wycombe) (Con)]

Walter Coles died because he was forgotten. Edward Maitland died because he was fed solid food. I could name others; those are just two of the patients who have died unnecessarily. And yet high mortality rates made it on to the board’s agenda in Buckinghamshire only because of a trigger relating to concern for reputational risk. The board had no robust risk management practices in place, and there were no plans to introduce any. Furthermore, certain key elements relating to changes in urgent care were missing. In setting out to champion patients, will my right hon. Friend set out how it will be possible to remove an entire board, or any members of a board who are not performing well?

[Mr Hunt]

Absolutely. I congratulate my hon. Friend on his extraordinary campaigning on behalf of his constituents. It is very difficult for a local Member to take on his own hospital when he finds failings, but he does it with great bravery. Yes, we need to ensure that the way we judge hospitals is not just about meeting waiting time and A and E targets, important though they are; it must also be about safety, about compassionate care and about governance. Other things matter as well. That is what we are changing.

[Jack Dromey (Birmingham, Erdington) (Lab)]

In a new low for British politics, the Secretary of State today descended into the gutter. How can he begin to blame the last Government for the deterioration at the 14 hospitals concerned, which took place under this Government, especially as the Government were warned about unacceptable standards in five of them?

[Mr Hunt]

The low in British politics is that it took so long for a Government to be honest about failings in the NHS. Many of those hospitals have a culture that entrenched failure for years and years under the last Labour Government, yet Labour Members refuse to accept that even now. What does that say to the public about whether they can be trusted with the future of our NHS?

[Martin Vickers (Cleethorpes) (Con)]

I welcome the robust and determined approach that my right hon. Friend is taking. It is right that the mistakes of the past should be thoroughly investigated, but my constituents—some of whom are waiting to go into Grimsby and Scunthorpe hospitals—need an assurance that action will be taken to remedy the situation immediately. There are many dedicated staff in our area, but recruitment has always been a problem in northern Lincolnshire. Will my right hon. Friend assure me that if additional support is needed to recruit the best clinicians and managers, it will be made available?

[Mr Hunt]

We will quite simply do what it takes to ensure that we implement the recommendations of the Keogh review for north Lincolnshire hospitals. We owe my hon. Friend’s constituents nothing less. The first step is to be honest about the problems. The big difference between the two sides of the House is illustrated by the fact that we will restore morale not by pretending that the problems do not exist but by being honest about them and confronting them. That is what we will do in my hon. Friend’s constituency.

[Sarah Champion (Rotherham) (Lab)]

I should like to start by offering my deepest sympathy to the patients and families. We are talking about mortality statistics, but these are actually loved ones who have been lost. For the second time today, I ask the Secretary of State whether he will accept, adopt and implement the recommendations in the Francis report.

[Mr Hunt]

And for the second time, I say yes.

[Sir Tony Baldry (Banbury) (Con)]

Professor Brian Jarman observed that, until recently, the Department of Health seemed to be a “denial machine” and that there was suppression and spin. Will the Secretary of State and the whole House at least agree that there is no room for denial, suppression or spin in the NHS, and that what we need for the future are total transparency, accountability and a Care Quality Commission that performs properly and professionally?

[Mr Hunt]

My hon. Friend speaks wisely, because the first step towards sorting out these problems is to have a system that Ministers cannot interfere with so that when there is failure, regulators are able to speak out without any political pressure—without any Ministers leaning on them in the run-up to elections—in the interests of patients. That is why we are completely changing the CQC. We are introducing a chief inspector of hospitals, who will be the nation’s whistleblower and who will have the independence and freedom that the old CQC never had. I hope that will help the public feel more confident that where there are problems they are properly tackled and not swept under the carpet.

[Alex Cunningham (Stockton North) (Lab)]

Several times the Secretary of State has admitted that staffing cut drastically on his watch is a major factor in deteriorating care in the NHS—an NHS that has been in the charge of the Conservative party for more than three years. What is he going to do about restoring staffing levels?

[Mr Hunt]

Clinical staff numbers have gone up by 8,000 since 2010: there are 6,000 more doctors, 1,000 more midwives and 1,000 more health visitors. The numbers have gone up since 2010. If we followed the shadow Secretary of State’s advice and cut the NHS budget from its current levels, that would not be possible.

[Mr Marcus Jones (Nuneaton) (Con)]

I am pleased that the Secretary of State has sought to take tough decisions to bring more openness and transparency to our NHS and not keep sweeping things under the carpet. Improving quality for patients is the immediate priority, and I support him in the decisive action he has taken, but will he also now seek to establish a sustainable future for the George Eliot hospital, which has suffered from a great deal of uncertainty since 2006?

[Mr Hunt]

I absolutely intend to do that. As my hon. Friend knows, I have been to the George Eliot hospital, working part of a shift in its accident and emergency department. I thought the staff there were working extremely hard, under great pressure. I noticed that the hospital did not have the systems in place that others have; I believe that hospital had 16 IT systems, which meant that if someone in the A and E department needed a blood test, all the details would have to be re-entered on a different system. That takes up a lot of clinical time, so making changes in these areas can make a big difference. But I do think it is important, as we expose these problems, that we recognise that even at the 14 hospitals mentioned today good care is being provided every day and the staff in those hospitals are working very hard. We need to back them, and the best way of doing so is to give them confidence that we are going to turn around their hospital.

[Andrew Miller (Ellesmere Port and Neston) (Lab)]

Management systems that are run on a blame culture inevitably create cover-ups and lead to people disguising the facts. Will the Secretary of State now show some leadership by trying to eradicate that from the health service? Will he take the advice Professor Ashton gave on Radio 4 this morning, because he expressed a firm way forward for the NHS? Will the Secretary of State stop playing these silly political games and follow Professor Ashton’s advice?

[Mr Hunt]

It is not playing silly political games to expose poor care; it is doing my duty as Health Secretary, and that is what I will continue to do. Improving systems, such as making sure there is safe staffing, is very important. It is ridiculous in this day and age that someone can be admitted to A and E but that department cannot access their GP record, and cannot see whether they are a diabetic or whether they have mild dementia. Those are things we are determined to sort out.

[Sir Bob Russell (Colchester) (LD)]

On 6 February, the Prime Minister asked Professor Sir Bruce Keogh to review the quality of hospital care. Although Colchester is only one hour from London, Sir Bruce did not make a single visit in the five months that elapsed. Although, obviously, I welcome the Secretary of State’s observation today that for Colchester general hospital this is more of a green light than a red light, will he do what Sir Bruce did not do and visit the hospital, so that he can, in the words of the panel, meet a large number of “committed and enthusiastic” staff?

--- Later in debate ---

[Mr Hunt]

I would be delighted to do that. I try to visit somewhere on the front line in the NHS every week, making sure I do not just visit the best places; I visit places that have problems and places like Colchester hospital which are improving—I am delighted that Sir Bruce’s report recognised that.

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

The Secretary of State began his statement with an alarming story about patients being left unmonitored on trolleys—I understand that took place at Tameside hospital. Does he agree that there may be a connection between that and the fact that there are 128 fewer nurses, midwives and health visitors in that hospital than there were in 2010? Given that the previous Government flagged up that hospital as one of particular concern, was he watching it to make sure that there were no cuts in nursing staff there?

[Mr Hunt]

As I have said many times, where there is not safe staffing we need to put that right. As I have also said, there are 8,000 more front-line staff under this Government than there were when the hon. Lady’s Government were in power. But those are not the only issues; we also need to address issues of leadership, of systems, which we talked about, and of clinical effectiveness. We need to sort out all those. On staffing numbers, I would just point out that plenty of hospitals under equivalent financial pressures are managing to deliver outstanding care, so a lot of this is about getting the right leadership in place at a board level.

[Andrew Bridgen (North West Leicestershire) (Con)]

On 1 July, just over two weeks ago, my aunt died unexpectedly and alone at Queen’s hospital, Burton. The Keogh review has now shown that hospital to have had a higher mortality rate than Stafford since at least 2005. Will my right hon. Friend pledge to work tirelessly to heal our NHS, so that my constituents, my friends and my relatives do not continue to die unnecessarily because of the failed policies of the previous Labour Government? [Interruption.]

[Mr Hunt]

This is the problem. [Interruption.] This is the denial we are getting from the Labour party; it is denying any responsibility for these deep-seated problems in some of our hospitals. As Health Secretary, I intend to do exactly as my hon. Friend describes. In order to try to measure the progress we are making, we will this year for the first time be asking every NHS in-patient whether they would recommend the quality of care that they received to a friend or a member of their family, because in the end that is what this is all about.

[Derek Twigg (Halton) (Lab)]

In May 2010, had mortality rates been falling in NHS hospitals?

[Mr Hunt]

According to Professor Jarman on the radio this morning, the answer is that it has been falling slightly.

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

I welcome the fact that Colchester general hospital is not being put in special measures. That expresses Monitor’s confidence in the current leadership of the hospital, which is already implementing improvements in the areas that it told the Keogh report about, which are reported to be the matters of concern. I also welcome my right hon. Friend’s emphasis on leadership, and openness and trust of leadership, but does he accept what we are finding in the Public Administration Committee’s inquiry into complaints handling in public services that that lack of trust and openness is found not just at trust level, but goes right up the command chain of the health service and has historically existed in the Department of Health? How will he challenge that culture and define the right kind of leadership that should be taught by the leadership academy?

[Mr Hunt]

My hon. Friend makes a very important point. The simple way we can change that culture, which will not be easy and will not happen immediately, is by making sure that where there is failure, there is someone who is independent and able to speak up about that failure without fear or favour—someone to be the nation’s whistleblower-in-chief. That is what we must have with the new chief inspector of hospitals, modelled on the chief inspector of schools and how well the whole Ofsted regulation system has worked. That has to be the first step; there must be no hiding place when there is failure. From there, we will have the pressure on the whole system, right the way up to Ministers, to make sure that failure is sorted out.

[Nic Dakin (Scunthorpe) (Lab)]

Sir Bruce Keogh warns us in his report about the very reaction we have seen today, which is in danger of shaming this House by focusing on politics instead of people. He wrote in his first few paragraphs that

“this is not a time for hasty reactions and recriminations”.

I read those words at five past 8 this morning when the Department of Health finally opened up to allow Members of Parliament to read what was there. Will the Secretary of State assure me and my constituents, who use Scunthorpe general hospital, that he will work to support people and put people before politics, because this afternoon he has put politics before people?

[Mr Hunt]

That is exactly what I am doing; the best hope we can give to the hon. Gentleman’s constituents is to say that we are putting them first by being honest about the problems and by tackling the mediocrity that has been a feature of too many hospitals for too long.

[Jackie Doyle-Price (Thurrock) (Con)]

Bereaved families in Thurrock have had their pain compounded by how the Basildon and Thurrock trust has investigated complaints and incidents. Does my right hon. Friend agree that the way in which hospitals investigate such incidents is an important aspect of the transparency and accountability agenda?

[Mr Hunt]

It is, and this year we will be introducing in law a duty of candour that will make it a criminal offence for boards not to be honest, not only with families if patients have been harmed, but with the system, which is extremely important. Salford Royal hospital has one of the most successful safety records in the country, and it has achieved that by creating an atmosphere of trust so that front-line staff are not afraid to speak out about the problems that they encounter, however junior they are. It takes outstanding leadership to get that right, and part of the turning point that we require today is an understanding of what is involved in such leadership, which we need in many more places.

[Jim Shannon (Strangford) (DUP)]

High mortality rates are unacceptable and their effect on people’s confidence in, and satisfaction with, the NHS is a problem. We in Northern Ireland are fortunate that there have not been such disclosures, but it is important that lessons can be learned. Does the Secretary of State intend to share the data and findings with regions of the United Kingdom and the devolved Administration in the Northern Ireland Assembly?

[Mr Hunt]

When there are excess mortality rates, there is some controversy about exactly how many avoidable deaths they correspond to, which is why Professor Keogh has asked Professor Nick Black and Lord Darzi to carry out a further study to try better to understand the link between excess mortality and avoidable deaths. We will be happy to share that information with the devolved Administrations.

[Several hon. Members]

rose—

[John Stevenson (Carlisle) (Con)]

I welcome the Keogh report. Patients should come first and patient care should be at the centre of our health service. Over the past 10 years, sadly, there has been a clear lack of leadership and management at North Cumbria University Hospitals NHS Trust, so I am not surprised by the report. However, there is a possible solution to improve health care in north Cumbria: the acquisition of the hospitals by Northumbria Healthcare NHS Foundation Trust. Will the Secretary of State work with me, the regulators and Northumbria to ensure that the acquisition proceeds as quickly as possible so that the people of Cumbria and Carlisle get the best possible health care?

[Mr Hunt]

I very much hope that that acquisition can proceed and I agree with my hon. Friend that it is the way forward. Although we have to ensure that that happens properly, Northumbria can give North Cumbria the leadership that it badly needs, so the process would be positive.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Since the publication of the Francis report, it seems that we have been going round and round the question of safe staffing levels, which I have raised several times. Ratios of two nurses to 29 patients, or worse, have been reported to me—I do not think that they are uncommon—and the CQC tells us that one in 10 hospitals has unsafe staffing levels. It must be accepted that the number of nurses has reached unsafe levels in these 14 hospitals and many parts of the country. The Secretary of State cited Salford Royal hospital, but will he act now to ensure that all wards in all hospitals publicise their staffing ratios, because I would not want a relative on a ward with a ratio of 2:29?

[Mr Hunt]

The right ratio of patients to nurses depends on the type of patients in a ward, because different wards have different requirements. Salford Royal has a good model through which it ensures that it has the right number of nurses. As I said to the hon. Member for Rotherham (Sarah Champion), I accept what Francis says about safe staffing, but he did not recommend the Labour party’s policy of minimum mandated national staffing levels. I am following the recommendation of the Francis report, which I think is the right way forward.

[Andrew Bingham (High Peak) (Con)]

My constituents in Glossop use Tameside hospital. For too long, people such as Liz Degnen have highlighted their worries about Tameside, and the recent departure of its chief executive was called for and welcomed by several hon. Members. Does my right hon. Friend agree that the Keogh report is a vindication of many of my constituents’ long-held beliefs?

[Mr Hunt]

Yes it is, but I hope that we can give them confidence today that the problems will finally be addressed.

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

I have welcomed the Keogh process from the beginning. Although the report on Tameside is hard hitting, I entirely welcome it—it is consistent with what has been in the public domain for two weeks—and the evidence that all Tameside MPs gave to Keogh to demand a change in leadership has been justified. Although I speak as an MP who has campaigned critically against his hospital, may I say that the tone and comments of the Secretary of State were neither helpful nor accurate with regard to Tameside? We need him to focus on implementing the reforms that are needed, one of which is clearly to deal with the inadequacy of the previous inspection regime. The extent of the scrutiny of these 14 trusts was great, but that is needed for all hospitals, so can he tell us what he will do to put that into effect?

[Mr Hunt]

I absolutely can. The new chief inspector of hospitals starts work today. We would like him to start the new inspection regime, adopting the same methodology as the Keogh review, as soon as possible, but it takes time to assemble a team of expert inspectors. He plans to start a pilot round of inspections this autumn before getting into full swing next year, and all the hospitals on today’s list will be inspected again within the next 12 months.

[Heather Wheeler (South Derbyshire) (Con)]

My constituents use Burton trust, so it is a sad day when it is on the list. Will the Secretary of State help to ensure that no barrier is placed between MPs and hospital boards so that there is total transparency and local MPs can help the boards in the future?

[Mr Hunt]

That open relationship between hon. Members and their local NHS trusts is extremely important and useful. We all have to recognise that sometimes we have to speak up publicly when there are problems at our local NHS trust, because we have to represent our constituents, and that is part of the change due to this process. In the end, the most important thing is to give people confidence that, when there are problems, we are a Government who are committed to sorting them out.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Page 22 of the Keogh report clearly states:

“Contrary to the pre-visit data, when the review teams visited the hospitals, they found frequent examples of inadequate numbers of nursing staff in some ward areas. The reported data did not provide a true picture of the numbers of staff actually working on the wards.”

It goes on to say that that

“was compounded by an over-reliance on unregistered staff and temporary staff”.

Given that the Government have sacked more than 1,000 people in front-line nursing roles in seven of the trusts involved, what conclusion does the Secretary of State draw from that paragraph?

[Mr Hunt]

It is funny how Labour Members like to accuse Government Members of making party political points, but then misrepresent the reality that there are 8,000 more clinical staff throughout the NHS than when their Government were in power.

[Jeremy Lefroy (Stafford) (Con)]

As my right hon. Friend says, transparency is vital. Stafford hospital has improved substantially since the spotlight was shone on it, although we are not complacent at all. One of the real problems we face is that good clinicians avoid management positions. What plans does he have to encourage young clinicians to undertake professional management training so that they can move into senior management positions in the course of their careers?

[Mr Hunt]

As ever, my hon. Friend speaks wisely, because we know a key point is that we need more good clinicians to go into management positions throughout the NHS. I am in close discussions with the NHS leadership academy, which this Government set up, to determine what more can be done to guarantee that able clinicians who pass muster and go into management can get a job at the end of that process. In addition, we have to encourage people to go into challenging trusts, rather than always being attracted to the best trusts. Such a change has been managed in the schools system, so we need to achieve that in health as well.

[Ian Austin (Dudley North) (Lab)]

I supported the inquiry and worked hard to provide details from Russells Hall patients and relatives, and to arrange for them to meet Sir Bruce’s team. Although the hospital has not been put into special measures, there are clearly areas of concern because people are waiting longer for A and E than in 2010, infection rates have increased and staff morale has gone down. The report cites

“Inadequate qualified nurse staffing levels on some wards”.

The Secretary of State said that if staffing levels were the problem, he would sort that out, so what assurances can he give people in Dudley and the staff at Russells Hall that he is going to address those inadequate nurse staffing levels?

[Mr Hunt]

The same assurances I have given everyone else representing a hospital with troubles: we are totally committed to sorting out those problems—[Interruption.] Labour Front Benchers ask when, but we have said that these hospitals will be re-inspected in the next year. The structures that we are putting in place to sort them out are a million times tougher than anything that happened when they were in office.

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

I am proud of our local NHS, especially the examples of good practice highlighted at Goole hospital. However, as someone who works as a volunteer in the NHS every weekend, I meet patients who are frightened of going into local hospitals precisely because of the failings highlighted in the report on North Lincolnshire and Goole Hospitals Foundation NHS Trust. Will the Secretary of State visit Goole and north Lincolnshire to meet my constituents and discuss such individuals as an 88-year-old whose nails were not cut for seven months, whose toilet calls went unanswered and who ultimately died after contracting E.coli in our local hospital?

[Mr Hunt]

Of course I would be delighted to visit my hon. Friend’s local hospital. I am sure there will be a great deal that I can learn, and I hope I will be able to give encouragement to the staff there, who are working very hard in a very difficult situation. I hope today will give them encouragement that this is a Government who are determined to turn around their hospital.

[Huw Irranca-Davies (Ogmore) (Lab)]

On the basis of the very good and welcome Keogh report and also the Francis recommendations on safe staffing levels, does the Secretary of State feel that the reduction of 4,000 nurses over the past two or three years is in any way contributing to the very issues that he has described today?

[Mr Hunt]

We welcome and accept the Francis report’s recommendations on safe staffing and we recognise that that involves having doctors. We recognise and are pleased that our protection of the NHS budget means that there are 6,000 more doctors than when the hon. Gentleman’s Government were in power. If he looks at what is happening in his own Wales, he might find that there are a few lessons that the NHS in Wales could learn.

[David Tredinnick (Bosworth) (Con)]

Sadly, the problems at George Eliot hospital go back well over a decade, so these special measures will be very welcome, but is not one of my right hon. Friend’s fundamental problems dealing with a culture of secrecy, where in the past a board with a problem would talk to a strategic health authority board and nobody would know what was going on? Is not sunlight the best disinfectant?

[Mr Hunt]

It is, absolutely. That is the big change. My hon. Friend speaks wisely. That is the big change that we have to make in our NHS. When there is failure, we must be open about it. It has to be public—we have to keep the public in the picture, because that is the best way of putting pressure on the system and on the politicians to make sure that they sort it out. That is not what happened before; it is going to happen now.

[Charlotte Leslie (Bristol North West) (Con)]

Does the Secretary of State share my dismay that just as Julie Bailey was hounded out of Mid Staffs by the local Labour party for revealing the truth, some of the tone of this debate—accusations, sanctimoniousness and false victimhood—is a very tangible illustration of what whistleblowers have had to face for the past decade when they have tried to get the truth out? What a tangible demonstration, sadly, this has been.

[Mr Hunt]

My hon. Friend is right. If some of those on the Opposition Benches knew exactly what Julie Bailey had to go through to expose the truth of what happened at Mid Staffs, they might think again about some of their behaviour this afternoon.

[Mr Philip Hollobone (Kettering) (Con)]

Although proud of our local hospital, residents in Kettering will be pleased that Sir Bruce has managed to expose some dangerously run parts of the NHS, but they will be concerned to know what can be done to make the future far better than what has happened in the past.

[Mr Hunt]

Absolutely, and the big point about the changes that we are bringing in—I congratulate my hon. Friend, who is a huge supporter of Kettering hospital, which he and I have visited together—is that the NHS in many ways is no different from other parts of our public services: there are excellent bits and there are bits where there is poor leadership. What we have to do if we are to sort out the poor leadership is to expose it and to make sure that the public know about it and the politicians cannot duck sorting it out. My hon. Friend’s constituents will be thinking, as a result of tomorrow’s headlines, “What about Kettering hospital?” That is why we will have an independent chief inspector who will go round and tell them how good Kettering hospital is. However much they love it, he may well find things that need to be improved, and my hon. Friend and his constituents will welcome that.

[David Morris (Morecambe and Lunesdale) (Con)]

Last week it was the CQC. Now it turns out that between 2005 and 2010 there were 386 separate warnings that the last Labour Secretary of State claims never to have received, yet the trust in my area was given foundation status. Does my right hon. Friend agree that given the new revelation by Sir Brian Jarman on suppression of warnings, along with existing allegations of spin and cover-up levelled against a former Secretary of State for Health, it is now time for the right hon. Gentleman to resign?

[Mr Hunt]

That is a matter for the leader of the Labour party. What concerns me most is that the Opposition do not understand the fundamental policy mistakes they made which led to the entrenched culture of failure in too much of our hospital sector.

[Nigel Mills (Amber Valley) (Con)]

Those of my constituents who use King’s Mill hospital will understandably be concerned about their future treatment. What reassurance can my right hon. Friend give me that this summer those patients will get the treatment that they rightly expect?

[Mr Hunt]

It is important to recognise that even at the hospitals that we are talking about this afternoon, there is good care happening every single day. The way that we will reassure my hon. Friend’s constituents is by having an independent inspection system which has not existed before, where regulators are not leaned on by Ministers to say the right thing in the run-up to elections. It is only when his constituents have confidence in that regulatory system that they will know the truth about their own hospital, and we want them to get there as soon as possible.

[Neil Carmichael (Stroud) (Con)]

I welcome Sir Bruce’s report and the Secretary of State’s robust approach to it. Does my right hon. Friend agree that if we take away the right lessons from the statement and the questions on it, that will be the catalyst for a change of culture, enhancing transparency and accountability and introducing a new pace of response for the changes necessary to bring about higher standards in our hospitals?

[Mr Hunt]

We do need to draw those lessons, and the sad lesson from this afternoon is that that change in culture with respect to transparency and accountability does not extend to the Labour party. Voters will notice how unwilling Labour Members are to accept that things went wrong on their patch.

[Andrew Stephenson (Pendle) (Con)]

Given what today’s report says about capacity issues at Blackburn hospital, and that the hospital is struggling to deal with the number of patients, serious questions again have to be asked about the decision to downgrade Burnley hospital’s accident and emergency department under the previous Government in 2007, which was consistently supported by the shadow Secretary of State when he was in office. Will my right hon. Friend visit Pendle to meet some of the affected families to reassure them that lessons have been learned from the mistakes of the past?

[Mr Hunt]

I will be delighted to visit my hon. Friend’s hospital, as well as those of many colleagues. I am sure I will learn a great deal when I do so.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

I congratulate my right hon. Friend on having put patients first in the whole process. As we move forward, we should approach the failures of the past more in sorrow than in anger, but we have to accept that that is a hard ask for my constituents who potentially have lost loved ones because of the catastrophic failures of the past inspection regime. That is why my constituents are impatient for change. If hospitals do not make the changes necessary in the required time, what sanctions will be imposed?

[Mr Hunt]

The entire system will be accountable for making sure that change is delivered. That is part of the change that we are making through the statement this afternoon. My hon. Friend’s hospital will be inspected again within the next 12 months and we will be able to see what progress has been made. There will be further independent inspections after that, so his constituents will have confidence that an independent expert is casting an eye over the health care that they are receiving and telling them the unvarnished truth about whether they can trust it or not.

Tobacco Products (Packaging)

Jeremy Hunt Excerpts

Friday 12th July 2013 Written Statements

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

The Government have today published “Consultation on the standardised packaging of tobacco products: summary report”. The consultation was undertaken, with the agreement of the devolved Administrations, on a UK-wide basis and the summary report has been prepared and published by the Department of Health.

Reducing in England the health harms caused by smoking tobacco is a public health priority for the Government and the United Kingdom is recognised across the world for having comprehensive, evidence-based tobacco control strategies.

Standardised packaging of tobacco products refers to measures that may be taken to restrict or end the use of logos, colours, brand images or promotional information on packaging other than brand names and product names that are displayed in a standard colour and typeface.

The consultation sought views on whether standardised tobacco packaging would:

reduce the appeal of tobacco products to consumers;

increase the effectiveness of health warnings on the packaging of tobacco products;

reduce the ability of tobacco packaging to mislead consumers about the harmful effects of smoking; and

have a positive effect on smoking-related attitudes, beliefs, intentions and behaviours,

particularly among children and young people.

Many thousands of responses to the consultation were received, and the views expressed were highly polarised, with strong views put forward on both sides of the debate and a range of organisations generating campaigns and petitions. Of those who provided detailed feedback, some 53% were in favour of standardised packaging, while 43% thought the Government should do nothing about tobacco packaging.

Having carefully considered these differing views, the Government have decided to wait until the emerging impact of the decision in Australia can be measured before we make a final decision on this policy in England.

Currently, only Australia has introduced standardised packaging, although the Governments of New Zealand and the Republic of Ireland have committed to introduce similar policies. Standardised packaging, therefore, remains a policy under consideration.

In the meantime, the Government in England will continue to work to reduce smoking rates through ending the display of tobacco in all shops, running national behaviour change campaigns to encourage smokers to quit and through supporting local authorities to provide effective stop smoking services. Our strategy is working—we are recognised as the leading country in Europe for tobacco control and for the first time since records began, adult smoking rates are under 20%.

“Consultation on the standardised packaging of tobacco products: summary report” has been placed in the Library. Copies are available to hon. Members from the Vote Office and noble Lords from the Printed Paper Office. The document is also available from:

www.gov.uk/government/consultations/standardised-packaging-of-tobacco-products.

The consultation exercise fulfilled our commitment in “Healthy Lives, Healthy People: A Tobacco Control Plan for England” which sets out our comprehensive, evidence-based, programme of tobacco control for England.

Health Services (North-West)

Jeremy Hunt Excerpts

Thursday 11th July 2013 Commons Chamber

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

With permission, Mr Speaker, I would like to make a statement about changes at Trafford general hospital and, separately, about the provision of vascular services in Cumbria and Lancashire.

Our primary objective as a Government must be for the NHS to provide the best service for patients. Sometimes that means taking difficult decisions. Both of the decisions I am announcing today fall into that category, but both are necessary if we are to provide safe and sustainable health care in the north-west.

Let me first address the changes at Trafford general hospital. Greater Manchester is home to some of the best and most innovative health care in the country. The reconfiguration of acute stroke services in Manchester has contributed to an overall reduction in deaths of around 250 since the changes were implemented. Salford Royal and Wythenshawe are two of the finest hospitals in the country. The area is blazing a trail in the integration of primary, secondary and social care services, but more needs to be done to ensure that emergency care continues to be safe, which is why the local NHS proposed some important but difficult service changes, which affect A and E provision at Trafford general hospital.

On 8 February 2013, I received a letter from the chair of the joint health scrutiny committee for Trafford borough council and Manchester city council, formally referring proposals about the future delivery of health care services at Trafford general hospital. I then asked the Independent Reconfiguration Panel for its advice on the proposals, which I received on 27 March 2013. Today, I have accepted its advice, which will be published on the panel’s website, in full. I have also written to the chairs of the panel and of the joint health scrutiny committee and to local MPs, informing them of my decision.

The clinical case for change in Trafford general hospital is clear. It is one of the smallest hospitals in the country. Its accident and emergency department is the second smallest in the country. Between midnight and 8 o’clock in the morning, the A and E department sees on average only two patients an hour. Even at peak times, the unit sees on average only seven patients an hour. Over half of local residents already use accident and emergency services outside Trafford. Trafford clinical commissioning group’s chief clinical officer, Dr Nigel Guest, himself a local GP, said:

“This makes it difficult to attract new doctors, it means that services cost more than they should and it compromises our ability to ensure good clinical outcomes. In short, it means that for too long local people have not been getting the type of service they should and deserve to receive.”

The problems are not confined to A and E. The low number of patients using intensive care means it, too, is not sustainable, and is likely to become unsafe in the future. According to the Greater Manchester critical care network, the unit needs to treat a minimum of 200 patients a year to be safe, but it treats fewer than 100. Emergency surgical services are also not sustainable. The Royal College of Surgeons states that emergency surgery should serve a population of at least 300,000— ideally 450,000 to 500,000. Trafford general hospital serves a population of around 100,000.

Trafford is currently able to provide a range of high-quality clinical services. However, it is becoming increasingly difficult to safeguard those services in a way that is sustainable in the long term. As a result, the National Clinical Advisory Team of independent health professionals has advised me that there will be clinical and safety issues if the hospital continues practising as it currently does. I accept its advice.

Initially, the A and E at Trafford general hospital will be replaced by an urgent care centre. The A and E currently sees just 100 patients a day. The majority of those patients—around 75%—will continue to be seen at the urgent care centre. That means around 25 patients a day will be treated at the three neighbouring large university hospitals, all within a 10-mile radius. In the longer term, as services are developed over the next two to three years, the urgent care centre will become a minor injuries unit. Trafford general hospital will become a centre of excellence for elective orthopaedic surgery.  That will see all other in-patient surgery stop, but there will be an expansion of day surgery, such as ophthalmology and other vital local services.

On 24 January this year, the PCT cluster, NHS Greater Manchester, approved the implementation of these proposals subject to the prior fulfilment of six conditions. Those included addressing transport issues for local residents, accelerating the implementation of a local integrated care system and ensuring continued access to out-of-hours mental health services when the urgent care centre eventually closes. Progress will be assessed and evaluated throughout the transition by NHS England in conjunction with the local joint health scrutiny committee. Following the advice from the Independent Reconfiguration Panel, I am also satisfied that the four tests for reconfiguration have been met.

As a result of the changes I am supporting today, Trafford CCG will be able to reinvest an additional £3.5 million to deliver what local people have asked for—more choice, more preventive care and more services closer to home. That will include community matrons and a community geriatrician, a 72-hour rapid response team, as well as an in-reach team to A and E to support people with complex needs and mental health issues.

I know that the right hon. Member for Wythenshawe and Sale East (Paul Goggins), the hon. Member for Stretford and Urmston (Kate Green) and my hon. Friend the Member for Altrincham and Sale West (Mr Brady) have met the Under-Secretary of State for Health to raise their concerns. Others, including the right hon. Member for Leigh (Andy Burnham), have written to me directly. That is why I have wanted to reassure myself since receiving the advice that the NHS has arrangements in place to ensure patient safety is not compromised during the transition to new services. I can assure all Members that there will be a rigorous assurance process overseen by NHS England and that no changes will occur until unequivocal assurances have been given by a provider’s board or chief executive that their organisation can safely receive additional patients and activity, however small.

Because A and Es around the country have been under increased pressure over the past few months, I also make a commitment today that changes at Trafford will take place only if the three neighbouring A and Es that will need to treat additional patients are consistently meeting their waiting time standards. Progress will be assessed and evaluated throughout the transition by NHS England in conjunction with the local joint health scrutiny committee. The Department of Health has also set aside funds to support investment by the University Hospital of South Manchester NHS Foundation Trust in expanding Wythenshawe hospital’s A and E department. That application for funding will be treated as a priority.

I turn to the provision of vascular services in Cumbria and Lancashire. On 19 February, the chair of Cumbria’s health scrutiny committee wrote to me formally to refer proposals about the provision of vascular services in Cumbria and Lancashire. I subsequently asked the Independent Reconfiguration Panel for its advice, which I received on 19 April. Today I have accepted its advice in full, which will be published on the panel’s website. I have also written to the chair of the panel and of the Cumbria health scrutiny committee, as well as to local MPs, informing them of my decision.

The changes will concentrate vascular services in three specialist centres, in line with the IRP’s advice for a population of around 2.8 million people. More routine services will continue to be provided locally. Seven hospitals, including the three specialist centres, will continue to provide services such as screening, out-patient clinics, day surgery, diagnostic tests and rehabilitation services. The centres will be at North Cumbria University Hospitals NHS Trust in Carlisle, East Lancashire Hospitals NHS Trust in Blackburn, and Lancashire Teaching Hospitals NHS Foundation Trust in Preston. Day casework and out-patients will continue to be assessed and treated in local hospitals across the region.

The three centres will provide sufficient cover both for the sparsely populated north of the region and for the densely populated south, which includes significant pockets of deprivation and unmet health needs. The concentration of vascular services is in line with national policy, as recommended by the Vascular Society of Great Britain and Ireland. The move will give patients access to better care and treatment than is currently possible with vascular services spread more thinly across the region.

The IRP accepts, as do I, that an inevitable consequence of concentrating specialist services at centres of excellence, is that some patients will have to travel further for treatment. However, the IRP informs me that the evidence in favour of concentrating services is particularly strong in relation to vascular surgery and that there is a strong clinical consensus that doing so will improve outcomes for patients. I know that Members representing north Lancashire and south Cumbria are particularly concerned about the distance patients will need to travel for specialist treatment. I do sympathise, but in the end have taken the difficult decision that the clinical benefits of concentrating specialist services outweigh any disadvantages in terms of additional travel times. I add that the Royal Lancaster Infirmary along with six other hospitals will continue to provide more routine vascular services.

These changes offer an opportunity to provide significantly improved vascular services to the people of Cumbria and Lancashire. I am therefore asking NHS England, working with local NHS organisations, to address the outstanding concerns raised by Cumbria health scrutiny committee. Local people need to know that changes are indeed leading to improved outcomes and that reasonable steps are being taken to support those with further to travel. In line with the IRP’s advice, I also want to see a programme of public information about the changes.

The public are rightly concerned about any major changes to health provision, and I particularly recognise the concerns people have about having to travel further, which is significant not just for patients but for their families and friends. However, my priority, and the Government’s priority, has to be what offers the safest and best clinical outcomes and what will save the most lives. That is why, after careful consideration, I have accepted independent clinical advice on both these decisions. I have also accepted the view of the IRP that the process leading to the decisions has been the right one, and I thank it for its work on these decisions.

I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement on matters that are of major significance to the NHS in the north-west of England, but I am not the only north-west MP taken by surprise this morning by the lack of advance notice. My hon. Friend the Member for Stretford and Urmston (Kate Green), in whose constituency Trafford hospital lies, was heading home, but had to abandon her journey at Stoke and is now heading back down to try to get here. This is not just a major discourtesy to her and the House, Mr Speaker; it is an insult to the people of Trafford, and it is no way to treat people who have campaigned to save their A and E, and who should have rightly been able to expect that their voice be heard in this House today through their elected Member of Parliament.

It says a lot about this Secretary of State. His advisers could find time to get texts sent to the Murdochs with market-sensitive information before an earlier statement he made, but he could not find time to give a local MP advance notice of a statement about the closure of her accident and emergency department: disgraceful.

This is not just any A and E: 65 years and six days after Nye Bevan opened the NHS at Trafford hospital, we have the spectacle of this Secretary of State scurrying to the House to rush out an announcement without the scrutiny of local MPs about a major downgrade of the hospital. What clearer symbol could we have of a Government who disrespect and disregard the views of NHS staff, patients and local people?

My hon. Friend the Member for Stretford and Urmston is trusting that the west coast main line will get her back before the close of this statement, and I hope you will allow her to contribute, Mr Speaker, even though she has clearly missed the opening of this statement.

Let me now turn to the substance of what the Secretary of State has said. He is right to say that the IRP provides excellent support and advice to Ministers. It did so to me and my predecessors in the last Government, and I am sure it is doing the same for the current Government. Where it can be shown that changes will save lives and reduce disability, in my view all Members of this House have a moral obligation to support them. Changes to vascular services in Cumbria and Lancashire clearly fall into that category. The concentration of this highly specialised surgery on three sites will save and improve lives, but given the geography it is essential that people are supported with travel. The Secretary of State made a vague commitment, but can he be more specific about the support that will be made available to patients, particularly in the sparsely populated northern part of our region, who will now have to travel much further to receive this life-saving surgery?

Although we support the Secretary of State’s decision on Lancashire and Cumbria, we have much greater concerns about the process that has led to the decisions today about Trafford hospital. While the IRP has undoubtedly done what it has been asked to do, I wrote to the Secretary of State in November last year to express serious reservations about the Trafford review proceeding ahead of Healthier Together, a much wider review of acute and emergency services across Greater Manchester. Speaking as a Greater Manchester MP, I cannot see why it makes sense to pick off Trafford hospital ahead of this review without looking at things in the round. It does not feel to me that this is part of a coherent plan for the NHS in our city region, and I ask the Secretary of State today why his decision is justified, given that the wider considerations affecting health services in Greater Manchester have not yet been completed.

The Secretary of State claims that the patients affected by the closure of Trafford can be easily and safely absorbed by the neighbouring A and Es. How can he say that when all the A and Es that will now have to absorb extra patients missed his own A and E target for at least four months during the worst winter in the NHS for a decade? Have the Secretary of State and the IRP made their decision looking at the very latest evidence of growing pressure on A and E departments in Greater Manchester? He mentions extra funding for Wythenshawe, which is welcome, as the hospital was built for 70,000 patients a year and is currently seeing almost 100,000, but will other affected A and Es also receive additional funding?

Finally, Mr Speaker, the appalling mishandling of this statement today, which has left the people affected unable to put the Secretary of State under scrutiny, is just the latest example of the wider mishandling of hospital reconfiguration under the coalition, which has seriously damaged public trust in our ability to make changes to hospitals. Picking off Trafford ahead of a wider review broke the illusory moratorium on hospital changes announced just days after the general election outside Chase Farm hospital by the Secretary of State’s predecessor and the Prime Minister—incidentally, that hospital is also now downgraded.

Sir David Nicholson has today said:

“If a political manifesto does not say that service change is absolutely essential and that you need to concentrate and centralise services—it will not be being straight forward with the British people.”

Might he just have had the last Conservative manifesto in mind when he made that statement? Will the Secretary of State today admit that this false moratorium was a cynical and dishonest policy designed to win votes in marginal seats, and will he commit never to repeat it?

Worse still, the Secretary of State’s officials have been in court in the past few days trying to justify the indefensible: a decision to rob a local community in south London of a successful A and E to solve problems in another trust that were not of its making. Is all this not causing severe damage to trust in how these decisions are made? Will he give a commitment to the House today that if the court finds against him, he will abandon his plans to downgrade Lewisham A and E? Labour Members will support changes where they are clinically justified, but where communities are picked off unfairly by this arrogant Government we will stand with them and fight for fairness.

[Mr Hunt]

Many members of the public are understandably concerned about these decisions, but from someone who was Health Secretary and who argued the case many times for changing services what we have heard today is not sensible argument, but political opportunism.

Let us examine what the right hon. Gentleman said only last week in Hastings. He said that people like him have a moral imperative to support the doctors who are making these decisions. Well, these changes are supported by the Trafford clinical commissioning group, Greater Manchester critical care network, the Royal College of Surgeons and many other doctors. How many doctors does he need to support this decision before he actually does what he said he would do last Friday, which is support doctors making difficult decisions? On the very day that NHS England is talking about the need to protect services for patients by facing up to difficult decisions, his approach is more than inconsistent—it is irresponsible, and he knows it. Let us examine what he said about changes in Trafford when he was Health Secretary—

[Andy Burnham]

Answer the questions.

[Mr Speaker]

Order. We must have order from those on the Opposition Front Bench, and I know that the Secretary of State will want to respond to the questions asked of him. I just remind the House that it is not a generalised debate; it is a statement and a response to questions.

[Mr Hunt]

Absolutely, Mr Speaker. I think that it is very important that on both sides of this House we have consistent arguments. It is very important to the questions that I was asked that I remind the right hon. Gentleman of what he said when he was Health Secretary. “I am disappointed,” he said, that politicians

“are going around Greater Manchester undermining the clinically-led process”.—[Official Report, 30 March 2010; Vol. 508, c. 620.]

The local medical director says that these changes will save—[Interruption.]

[Mr Speaker]

Order. The temperature needs to fall. This is a very highly charged matter, there is considerable sensitivity about it, it is extremely important and we want to hear what the Secretary of State has to say. When he has said it, everybody will get a chance to come in, but please let us lower the decibel level. We certainly do not want to imitate what happened to the considerable discredit of the House yesterday.

[Mr Hunt]

The other point the right hon. Member for Leigh (Andy Burnham) made was that we should not make these changes to A and E services when those in other hospitals are under pressure. It is important that I remind the House of what he did when he was Health Secretary. After 2004-05, Labour missed its A and E targets in 12 quarters but closed or downgraded 12 A and Es. Now, in Wales, the A and E target has not been met since 2009, yet Labour is embarking on a big reconfiguration programme with his full support. So it is one policy when Labour is in opposition, another when it is in power. There is one person who agrees with the right hon. Gentleman, and he was campaigning in Trafford on Friday—Len McCluskey. When it comes to a choice between supporting local doctors or the unions, the Opposition support the unions.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

On a point of order, Mr Speaker.

[Mr Speaker]

Order. We cannot have points of order in the middle of a statement. The Secretary of State has been asked specific questions and I know that he will now respond without any delay to those specific questions and nothing more. Other Members wish to contribute and there is other business. The Secretary of State is an extremely important man, of course, but there are a lot of other people involved, too, and we need to get on and hear them. I call the Secretary of State to respond briefly.

[Mr Hunt]

Thank you for that rare compliment, Mr Speaker.

The right hon. Member for Leigh asked a specific question about travel and I will ask the local NHS trusts to work closely with the overview and scrutiny committees to ensure that proper arrangements are put in place for people who have to travel further. He asked me about deferring the decision until the Healthier Together programme for the whole of Greater Manchester was decided, but the IRP specifically said that it would be wrong to defer the decision—the point is that local doctors are saying that doing so would not be safe for patients, and that is why I am accepting the advice.

The NHS is a great institution, but we have to take difficult decisions sometimes. The proposals will help patients, but I am afraid that the right hon. Gentleman is interested only in politics.

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

Many people will be disappointed, of course, by the decision on Trafford general, but I thank my right hon. Friend and his ministerial team for their openness in hearing the concerns of local Members and Trafford council in building up to what has obviously been a serious and carefully made decision. I thank him for the extra investment for Wythenshawe and for making the changes contingent on ensuring that the capacity is there in surrounding hospitals to ensure that this is safe. Will he also give us an assurance that the Trafford health economy will not suffer financially if those contingencies are not met in time?

[Mr Hunt]

I thank my hon. Friend for the constructive approach he has taken in this process. I assure him that this will help the local Trafford economy. Three major teaching hospitals are used by the people of Trafford. Two of the three are meeting their A and E targets and one is not. These proposals will help the one that is not meeting its target to do so. They will also mean that an extra £3.5 million can be invested in community and prevention services, including local geriatricians and community matrons. That will be of huge benefit to my hon. Friend’s constituents and to many other people in the local area.

[Mr Jack Straw (Blackburn) (Lab)]

May I first ask the Secretary of State to respond to the issue raised by my right hon. Friend the Member for Leigh (Andy Burnham) about the lack of notice of the statement? I have had good news for my constituency from the Secretary of State, but many of my colleagues have had bad news and it is genuinely discourteous for the House not to have been informed. This is not a market-sensitive issue, after all, and we could have been told yesterday or earlier.

Secondly, on the merits of the concentration of vascular services in Lancashire and Cumbria, may I thank the right hon. Gentleman for the decision that he has made, not least in respect of East Lancashire Hospitals Trust in Blackburn? This is an important vote of confidence in the excellence of the facilities in Blackburn at a time when many of the clinicians and others have been under great anxiety because they have been subject to the Keogh review. I think all my constituents recognise that sometimes they will have to travel, as mine have had to travel to Blackpool for many years, for very serious cardiovascular surgery. Provided the outcomes are much better where there is a concentration of resources, and assistance with travel is given in appropriate cases, I think my public and that across the north-west will accept these decisions.

[Mr Hunt]

I thank the right hon. Gentleman for his wise words. If we level with the public about these difficult changes, they do understand that there are times when they get a better outcome even if they have to travel further. Perhaps the most dramatic example of that has been how trauma services have been centralised on fewer hospitals. Even after incidents as dramatic and dangerous as road traffic accidents, people are not necessarily taken to their nearest A and E. They are stabilised and then they are taken to an A and E that has the equipment that is necessary to give them the treatment that is most likely to save their lives. The right hon. Gentleman is right to say that.

I absolutely followed and would always want to follow the procedures of the House with respect to advance notice of statements. The request for a statement went in only last night. The Speaker made his decision this morning. I am delighted that the hon. Member for Stretford and Urmston (Kate Green) is here and I hope she is allowed to speak. I said to her on the phone this morning that I am willing to meet her separately to go through any concerns that she has. [Interruption.]

[Mr Speaker]

Order. I thank the Secretary of State for his courtesy. I know the right hon. Gentleman well, and I know that he would not seek for one moment to mislead the House. He was trying candidly to respond to the right hon. Member for Blackburn (Mr Straw). For the avoidance of doubt, let us be absolutely clear. I can quite accept that the Secretary of State requested, within the Government machine, permission to make a statement today. However, the House will wish to be aware that I myself was aware of the request to make a statement only this morning. Let us be clear about that.

[Tim Farron (Westmorland and Lonsdale) (LD)]

There is a strong clinical case for the concentration of vascular services in Cumbria and Lancashire at three sites, but is it not ludicrous that the three that have been chosen are so geographically located that one is virtually on the Scottish border, then there is a gap of almost 100 miles, and then there are two that are nine miles apart? Does not that leave south Cumbria and north Lancashire dangerously under-provided for? Given the current difficulties, shall we say, at Morecambe Bay, does not robbing Morecambe Bay of those skills and that expertise make a difficult situation potentially even worse?

[Mr Hunt]

I know that my hon. Friend has campaigned, rightly, to represent the concerns of his constituents about the extra travel that they will have to undertake. I would like to reassure him that we considered that issue very carefully. The Independent Reconfiguration Panel recognises that travel is a consideration, but also believes that for his constituents, even for the people who have to travel further, there will be better clinical outcomes for specialist vascular surgery. We are not talking about routine surgery, diagnosis or rehabilitation work but about conditions such as aneurysms and carotid artery disease which require specialist care. Patients can get much better help if that is concentrated in specialist centres.

As to why those particular centres were chosen, it was a genuinely difficult decision. There is a bigger concentration of population in the south of the region and there is also more social deprivation and more unmet need. I know it was a difficult decision, but it was decided that that would be best for the 2.8 million people in the area and also better for my hon. Friend’s constituents.

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

I am very grateful to you, Mr Speaker, for allowing me to ask a question, and I apologise for missing the opening statements. As you know, I think, it was only when we saw this morning’s Order Paper that we knew that a statement would be made this morning, and I was on the way to Manchester at the time to meet constituents. I am very grateful indeed for the opportunity to ask the Secretary of State a question. My constituents would be horrified were I not in the Chamber this morning to do so.

This has been one of the most contentious and difficult issues facing the health economy in Trafford since my election. Although I welcome the Secretary of State’s offer to meet me and I was grateful for his time on the phone this morning, he will understand that people are concerned that doubts and fears about the future of Trafford general hospital are already leading to a downward spiral in people going to that hospital and the level of staffing and service that they receive there. What absolute guarantees can he give my constituents that there will be no diminution whatsoever of the service they receive during what may have to be a very protracted transition process, and that in particular there will be no repeat of our experiences over the most recent winter months, when neither Manchester Royal infirmary nor Wythenshawe A and Es were able to meet the accident and emergency waiting time targets on more than 15% of occasions?

[Mr Hunt]

I recognise that the hon. Lady would have liked to have been here for the statement, and indeed that she made a huge effort to get here. As I told her on the phone this morning, I am more than happy to meet her separately to discuss her concerns. With regard to her concern about a downward spiral, I hope today to reassure her constituents that a clear decision has been taken that will secure the hospital’s future as a successful and important hospital, a centre of excellence for elective orthopaedic work, and a hospital that has a very important role to play in the local health economy. We are making huge efforts to ensure that there will be no diminution of services but that services will improve. Of the three major teaching hospitals that will now provide A and E services for her constituency, one—Central Manchester university hospital—is not meeting its A and E targets. The measures announced today will help it meet those targets and make it more likely that her constituents will get a better service in A and E. However, as I made absolutely clear in my statement, I will not allow the changes to be made until all three hospitals are consistently meeting their A and E targets.

[Mr David Nuttall (Bury North) (Con)]

Can my right hon. Friend reassure my constituents that the decision on Trafford general hospital should not be seen as putting the provision of A and E services at Fairfield hospital at risk?

[Mr Hunt]

This decision is about Trafford general hospital’s A and E services. What we are considering in this decision is whether the other hospitals can absorb the extra patients who will come to them as a result. We think that the neighbouring A and Es will initially have to absorb only about 25 patients in total. It is not a decision about the future of other A and Es.

[Sir Tony Cunningham (Workington) (Lab)]

The new service in Cumbria will have to be managed, and part of the problem in Cumbria is poor management, yet we have been waiting for two and a half years for Northumbria Healthcare NHS Foundation Trust to take over in Cumbria. When will we see that acquisition?

[Mr Hunt]

I am keen to resolve that issue as soon as possible. Indeed, I think that it is really important, given what we heard this morning from NHS England about the big challenges facing the NHS, that we try to take these difficult decisions much more quickly than normally happens. When we have paralysis and decisions being put on hold, that creates uncertainty and the worries that the hon. Member for Stretford and Urmston (Kate Green) talked about, so I want to ensure that we decide these things as quickly as possible.

[Stephen Mosley (City of Chester) (Con)]

Dr Nigel Guest, chief clinical officer at Trafford clinical commissioning group, has said that making these changes to services at Trafford general hospital

“is vital to secure a long and vibrant future for the hospital.”

Can my right hon. Friend reassure the House that that will be the case?

[Mr Hunt]

Yes, and I hope that what we have announced today will give my hon. Friend that reassurance. We have announced a future for Trafford general hospital as a centre of excellence for elective orthopaedic work. We have also announced a significant increase in investment in community services, an extra £3.5 million that will pay for community matrons, community geriatricians, a 72-hour rapid response team and better support in A and Es for people with mental health needs. This is a very big step forward, but it is part of the country that has gone further and faster than many others in delivering integrated care. This announcement will take that further and will mean that it stands out as a beacon of what good care can look like in an ageing society.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

May I echo the comments of right hon. and hon. Friends about the lack of notice? It really is outrageous that Members with a constituency interest were not given adequate notice.

May I ask the Secretary of State specifically about the funds that he says have been earmarked for the expansion of the A and E department at Wythenshawe hospital? That is essential, because at least another 4,500 patients will be coming to the A and E following his decision. Can he confirm absolutely this morning that that funding will be made available in full, in advance of any changes? How will the funding be made available? University Hospital of South Manchester is a foundation trust, which means that it cannot receive NHS capital, and it has already borrowed to the limit.

[Mr Hunt]

First, let me say to the right hon. Gentleman that 25 extra patients a day will have to be absorbed by the three neighbouring hospitals to Trafford, so it is not a large number. We want to make sure that all hospitals, including Wythenshawe, which I have visited—it is a superb hospital—are able to absorb that capacity. It is currently meeting its A and E target. The application that has been made for extra capital grant to help it to expand its A and E department will be treated as a priority.

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

Safety should always be paramount, but public confidence is also important. As the Secretary of State faces further tough decisions on reconfiguration in the coming years, will he assure me and other Members of this House of two things: that he will be conscious of not applying urban solutions to rural areas; and that where alternative pathways of care can be put in place, that will happen before changes take place?

[Mr Hunt]

My hon. Friend makes two important points. I explicitly said that we will not proceed with any of these changes until neighbouring hospitals have been consistently meeting their A and E standards and any necessary changes have been put in place so that we can be sure that they will improve care for patients. That is really important if we are going to maintain confidence.

On my hon. Friend’s point about urban versus rural, part of the underlying reason for these changes is that we need to get more care out of big hospitals, which are often in urban areas, and into the community—into settings near people’s homes. That is very important for rural communities where there are often large concentrations of older people. Today’s decision will mean an additional investment in those community services. As we look at the big changes we need to make in the NHS, we will need to make more decisions that allow more to be invested in out-of-hospital care if we are to prevent the illnesses that ultimately put so much pressure on our A and E departments.

[Derek Twigg (Halton) (Lab)]

Is any consideration being given within the Secretary of State’s Department or NHS England to reconfiguring the A and E services between St Helens and Whiston hospitals and Warrington and Halton hospitals? He might not be aware that the chief executive of Warrington and Halton hospitals and the chair of its trust board recently told me and my hon. Friend the Member for Warrington North (Helen Jones) that they think they will run out of money in about 18 months’ time such are the pressures that they have at the moment. Will the Secretary of State investigate this and tell me whether any consideration of that reconfiguration is taking place?

[Mr Hunt]

With regard to pressures on A and E, we are working very hard with A and Es across the country to make sure that they learn the lessons from what happened last winter and are properly prepared for this winter. Those discussions will include the A and E departments that serve his constituents. He will know that any decisions about service changes or reconfigurations are a matter for the local NHS; they come to me only if they are referred to me following a formal proposal by a local health overview and scrutiny committee, and that has not happened in this case.

[Mr Jamie Reed (Copeland) (Lab)]

Like other Members across the House—I speak particularly on behalf of my hon. Friend the Member for Barrow and Furness (John Woodcock)—I condemn the poltroonish way in which this statement has been handled. Will the Secretary of State concede that instability is corroding health services right across Cumbria? Will he guarantee that when North Cumbria University Hospitals Trust is acquired by Northumbria Trust this decision will not be yet again reconsidered?

[Mr Hunt]

Today is a sitting Thursday and we have followed parliamentary procedures. I am doing everything I can to help the hon. Member for Stretford and Urmston (Kate Green) to have as much engagement as she needs given that she was not able to be here at the start of the process. With regard to stability, the hon. Gentleman cannot have it both ways. If he wants stability and wants decisions to be taken decisively, then he has to support the Government when they take difficult decisions like today’s and not be opportunistic, in the way that the shadow Secretary of State was.

[Graham Jones (Hyndburn) (Lab)]

I agree with my right hon. Friend the Member for Blackburn (Mr Straw) about the apparent benefits of relocating to Blackburn and concentrating resources, but despite seemingly being a beneficiary of this reconfiguration, I am worried about the treatment of Lancashire and Cumbria MPs. What notification was given to those Members, and what consultation took place with them on the decision?

[Mr Hunt]

The process has taken a long time because we have consulted extensively with the local community and local Members. There have been debates in the House about it, and Members have regularly asked about it during oral questions. I asked for hon. Members to be given advance notice of today’s statement. Consultation is important, and we asked for advice from the Independent Reconfiguration Panel—

[Andy Burnham]

No; wrong. You did not give advance notice.

--- Later in debate ---

[Mr Hunt]

I follow the procedures of the House, and the right hon. Gentleman should know that we did nothing different from what he did when he was Health Secretary.

[Andrew Miller (Ellesmere Port and Neston) (Lab)]

The Secretary of State cites social deprivation as a justification for his decision on the configuration for Cumbria and Lancashire. I fully support that principle, so will he take it further by ensuring that those of us who represent constituencies in which health outcomes are much worse than those in the south of England, for example, get larger allocations of cash in future distributions of moneys? If he is going to use the principle once, he must do so consistently.

[Mr Hunt]

That is already built into the funding formula. We made reducing health inequalities a duty of NHS England in the NHS mandate, and that needs to be done in a way that is also fair to socially deprived people living in the countryside, in rural areas and even in the fringes of affluent areas. We have to find a way of ensuring that the process is fair to everyone who is socially deprived and to do what we can to reduce health inequalities.

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

No one should be in any doubt that there will be huge shock back home in Greater Manchester at the announcement about Trafford. The conurbation has specific problems with its hospitals, such as mine in Tameside, where we have finally changed the management. We have the Healthier Together process, which is reviewing practically everything, and we are still coping with the impact of the reorganisation with which the whole country has to contend, and now we turn up at Parliament on a Thursday morning to hear the unilateral announcement that Trafford is going. Given the scope of the Healthier Together process, how can the Secretary of State honour the assurances that he gave in his statement? He could not answer the question asked by my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) about foundation trusts and capital at all. What further changes to hospitals in Greater Manchester is he going to spring on us in the future?

[Mr Hunt]

Foundation trusts can apply for a capital grant, and I said in my statement that, as soon as we get a business case, we will give that a high priority. We are sympathetic to awarding it, but we have to wait for the business case to be presented.

In a period in which the NHS faces huge pressures, it is important to show leadership, and that means local MPs understanding that difficult decisions sometimes need to be taken that are in the interests of their constituents, as a number of Members have done today. It also involves supporting what local doctors have been arguing for over many years, but taking the line of the right hon. Member for Leigh (Andy Burnham) by supporting the unions, not the doctors, is totally irresponsible.

--- Later in debate ---

[Heidi Alexander (Lewisham East) (Lab)]

I am grateful, Mr Speaker.

The Health Secretary repeatedly said that changes will be made at Trafford only if the neighbouring hospitals that have to take additional patients are consistently meeting their waiting time targets for A and E. Will he define “consistently” and clarify exactly what he means by that? Will it apply to all A and E reconfigurations throughout the country?

[Mr Hunt]

We are absolutely clear that we will not proceed with A and E reconfigurations unless the outcome will be an improvement in clinical care. That applies across the country as well as in Trafford.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

On a point of order, Mr Speaker.

NHS England (Mandate)

Jeremy Hunt Excerpts

Friday 5th July 2013 Written Statements

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

Today the Government are launching the consultation on the refresh of the mandate to NHS England for 2014-15. The consultation will close on 27 September in readiness for the publication of the refreshed mandate in the autumn to fit with the NHS planning round for 2014-15.

The mandate sets the Government’s ambitions for the NHS as well as the funding available to achieve and deliver the kind of care people need and expect. The first mandate set an ambitious agenda and was published in November 2012. It covered the period April 2013 to March 2015. The Government expect NHS England to demonstrate significant progress against all 24 objectives by March 2015 and will hold them to account for doing so. The Health and Social Care Act 2012 requires the mandate to be reviewed on an annual basis to ensure that it remains up to date. It is important to provide the NHS with stability and continuity of purpose and we therefore propose to carry forward all the existing 24 objectives.

At the same time, the scale of the challenge facing the NHS and wider health and care system is becoming increasingly clear. There have been crucial developments and new evidence that has emerged since the publication of the first mandate, which calls on Government and NHS England to act. The key proposed changes reflect these core priorities:

the actions being taken forward by NHS England in response to the Francis report to transform the care people receive;

working with NHS England to develop a vulnerable older people plan, which will improve support for older people and those with long-term conditions, particularly through reform of primary care given their pivotal role within communities; and

the need for the NHS to contribute to securing the recovery of the economy and make better use of resources in the light of the challenging fiscal climate.

On the second of these priorities, the Government are also launching today dedicated engagement on the vulnerable older people plan, working jointly with NHS England. The engagement will seek views from staff, patients and the public on how to achieve the ambition of how more integrated out-of-hospital care, building on the strong tradition and values of the family doctor.

In addition to the three priorities, the Government are also proposing to make a number of targeted changes to the current objectives which are thought to be essential to deliver the improvements in people’s care. The consultation document sets out where the Government are proposing to make these changes for the period April 2014 to March 2015.

The Government welcome views on the proposals and invites comments through the consultation process.

“Refreshing the Mandate to NHS England: 2014-15 Consultation” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.