Oral Answers to Questions
Jeremy Hunt Excerpts(12 years, 9 months ago)
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Stephen Metcalfe (South Basildon and East Thurrock) (Con)
12. What recent progress he has made on improving the performance of hospital trusts placed in special measures.
The Secretary of State for Health (Mr Jeremy Hunt)
Significant progress has been made at all 11 trusts placed in special measures in July, including changing the chair or chief executive officer and recruiting more nurses in every single one them and partnering each of them with a high-performing hospital so that they can make rapid progress in turning things around.
Martin Vickers
I thank the Secretary of State for his reply. He will be aware of my constituents’ concerns about services at Diana, Princess of Wales hospital in Grimsby. There are doubts about the future of the stroke unit and high mortality rates, and there are also problems with the East Midlands ambulance service. Will the Secretary of State give an assurance that he is satisfied that progress is being made at the hospital?
Mr Hunt
I think good progress is being made and I commend my hon. Friend for his campaigning on the issue. The trust concerned has introduced better privacy for patients, hired 154 nurses since the Keogh report and introduced electronic vital signs reporting at the bedside—all because we are being transparent and open about problems in the NHS and not sweeping them under the carpet.
Andrew Bridgen
Burton hospital, which serves part of my constituency, was one of the 11 hospitals placed in special measures following the Keogh report. Will my right hon. Friend assure my constituents that the improvements needed in those hospitals will be carried out in a culture of openness and transparency rather than one of opaqueness and cover-up, which so unfortunately typified the way in which the previous Government ran the NHS?
Mr Hunt
I know that my hon. Friend takes a very close interest in what happens at his hospital and I think that progress is being made in turning it around. What will be of concern to my hon. Friend is that, as far back as 2005-6, Burton’s mortality rate was 30% higher than the national average—it was even higher than that at Mid Staffs—and yet the problem was not sorted out. We are sorting it out.
John Stevenson
As the Secretary of State is aware, North Cumbria trust is in special measures. We have on our doorstep a potential solution to our problems, namely Northumbria trust. Will the Secretary of State give me an assurance that everything possible will be done to get North Cumbria out of special measures at the earliest opportunity and, much more importantly, that every support will be given to Northumbria in is acquisition of North Cumbria?
Mr Hunt
I can give my hon. Friend both assurances because Northumbria has been doing a huge amount to help North Cumbria turn itself around, including installing its patient experience systems to ensure that patients are treated with the dignity and respect that they deserve. The problems have been around since 2007 and he can tell his constituents that we are finally turning them around.
Stephen Metcalfe
As my right hon. Friend will be aware, Basildon university hospital in my constituency is one of the 11 hospitals that were placed in special measures following the failure of the previous Government to act on the information that they had. Will he tell the House what support the new management team, in whom I have great confidence, are receiving and when my constituents can expect to see sustained, long-term improvements?
Mr Hunt
I reassure my hon. Friend that the trust has hired 257 more nurses since the problems emerged this year, has better A and E processes, and has been partnered with the Royal Free in London to help it make even more progress. He will be as shocked as I am that when the Care Quality Commission identified problems at that hospital the last Government sat on the report for six months. That cannot be acceptable.
John Healey (Wentworth and Dearne) (Lab)
How can NHS patients and staff have any confidence in decisions about their local services when they are taken by the Competition Commission on the overriding grounds of what is best for a competitive market and not what is best for patients? Will he learn from the failure of the merger between the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and the Poole Hospital NHS Foundation Trust, and take merger off the table as an option for Rotherham hospital?
Mr Hunt
May I reassure the right hon. Gentleman that the competition authorities make their decisions based on what is in the best interests of patients and do not hold competition as an overriding ideology? He is right that we need to work closely with those authorities to ensure that they have the expertise to take decisions in the right way and with trusts to ensure that they have the expertise to ensure that they do not stumble when they go through those processes.
Jenny Chapman (Darlington) (Lab)
How can the public have confidence in their health service when police officers are taking patients who are sick and injured to A and E because ambulances are backed up outside A and E and take longer than an hour to arrive?
Mr Hunt
I will tell the hon. Lady why the public can have confidence in their health service: compared with three years ago, on broadly the same budget, the NHS is doing 800,000 more operations year in, year out; MRSA rates have halved; and the number of people who wait for a year or longer for operations has gone down from 18,000 to fewer than 400.
Clive Efford (Eltham) (Lab)
Will the Secretary of State explain why we have had a summer crisis in A and E? We are all used to the emergency services being overwhelmed in winter. Given the crisis that we have had, what will he do to assist the NHS in averting a winter crisis this year, rather than just blaming everybody else?
Andrew Gwynne (Denton and Reddish) (Lab)
The Secretary of State for Health is clearly not adequately monitoring performance. If he was, he would be aware that serious problems remain across the accident and emergency departments of the trusts that were placed in special measures by Professor Sir Bruce Keogh. On his watch, the A and E performance at eight of the 11 trusts has got worse since Keogh reported, including at my hospital in Tameside. The A and E performance has got substantially worse at East Lancashire Hospitals NHS Trust, where the number of patients waiting for more than four hours has doubled since Keogh reported, and at Medway NHS Trust, where the figure has quadrupled. When will he stop all the grandstanding, cut the spin and get a grip on his A and E crisis?
Mr Hunt
I hope that the hon. Gentleman will be pleased that something is happening under this Government that did not happen under the Labour Government: we are putting those hospitals into special measures and sorting out the problems, including the long-term problems with A and E such as the GP contract—a disaster that was imposed on this country by the Labour Government.
Andrew George (St Ives) (LD)
6. What the current (a) highest, (b) lowest and (c) mean average registered nurse-to-patient ratio is on acute hospital wards.
Alun Cairns (Vale of Glamorgan) (Con)
10. What steps his Department is taking to promote a culture of openness and transparency across the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
We need to change the culture of the NHS so that where there are problems with care or safety, people feel able to speak out. The Government have banned gagging clauses, they are introducing a statutory duty of candour, and they have for the first time published surgery outcomes for 10 specialties by consultant.
Alun Cairns
I commend the Secretary of State for his transparency agenda, which has uncovered previously untold horrors. What more can he do to ensure that in future no Minister can ever cover up failure in the NHS?
Mr Speaker
Order. I told the Secretary of State privately before, and I say it publicly now, that if he intends to devote part of his answer to talking about what happened under the previous Government, he can abandon that plan now and resume his seat. I suggest he resumes his seat.
Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)
As part of this openness and transparency, will the Government improve their relations with the police and prison services, so that we can have a clearer idea of why people with mental illnesses are spending time in police cells or being sent to prison?
Mr Hunt
I am pleased to tell the right hon. Gentleman that we are working closely with the police to try to ensure that some of the people held in police cells are given much faster access to mental health services. That includes a street triage pilot, which has had early and promising results.
Charlotte Leslie (Bristol North West) (Con)
I was informed this morning that the chair of the NHS property board has resigned. That follows the revelation last week, through parliamentary questions I asked, that the board has been raiding its capital allocation to subsidise its own revenue funding. In the interests of transparency, will the Secretary of State undertake to review and publish the recruitment and employment procedure of executive and non-executive members of the board—including civil servant Peter Coates who created the board, which oversees £3 billion-worth of assets—and conduct careful audit and scrutiny of the board’s accounts and minutes?
Mr Jamie Reed (Copeland) (Lab)
With regard to openness and transparency, the Secretary of State’s failure to extend the Freedom of Information Act to private providers delivering NHS services is fostering a culture of secrecy. As he forces clinical commissioning groups to tender more services to the private sector, and if he truly believes in openness and the independence of health regulators, will he follow the clear advice from Monitor and extend FOI legislation to private providers, or is he content to allow them to continue to withhold information from patients?
Mr Hunt
When it comes to transparency about care, there should be an absolute level playing field between private providers and NHS providers. To answer the hon. Gentleman’s question on regulators, what this Government are going to do, Mr Speaker, is ensure that the Care Quality Commission has statutory independence so that no Government can ever try to interfere with the processes of reporting poor care.
Mrs Linda Riordan (Halifax) (Lab/Co-op)
11. Whether he plans to close all or part of Calderdale Royal hospital’s accident and emergency ward.
The Secretary of State for Health (Mr Jeremy Hunt)
While always paying regard to the superb job done by most doctors, we should allow no hiding place for doctors who endanger patients’ lives by irresponsible or careless behaviour, which is why we have asked the Law Commission to come up with proposals to speed up General Medical Council investigations. We are also considering a new criminal offence of wilful neglect, as recommended by Professor Don Berwick.
Priti Patel
The cancer diagnosis of my constituent, Mrs Julia Wild, was delayed by nine months because of a mistake by the initial doctor at her first assessment. For four years, she has been fighting for an apology, for transparency and for the doctor to acknowledge what went wrong with her case. What can Mrs Wild, and other patients in the NHS who have had similar experiences, do to ensure that their complaints are taken seriously, that these life-changing mistakes are acknowledged and that the individuals responsible are held to account?
Mr Hunt
My hon. Friend speaks extremely well and I fully understand her concern about Mrs Julia Wild and the care she received. I cannot second-guess the clinical judgment of the GMC, but I agree that Mrs Wild is owed an apology. If the local NHS will not give it, I will give it now. We should have spotted the advanced lobular cancer and I apologise to her that we did not.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
On Friday I visited Cruddas Park surgery in my constituency to see the fantastic work that doctors and staff are doing in the face of huge levels of unmet need, health inequalities and rising mental health issues. If we hold doctors to account for their mistakes, is it not right that they should be able to hold Ministers to account for taking millions of pounds out of their funding and then telling my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) that it was nothing to do with him?
Mr Crispin Blunt (Reigate) (Con)
While we are always of course keen to hold doctors to account for their mistakes, I trust that we will be equally keen to reward them for examples of really good practice, such as those my right hon. Friend will see on Thursday when he makes his very welcome visit to the East Surrey hospital. I commend to him the work of Dr Ben Mearns and his emergency and acute team, who demonstrate good practice and also make it transparent to the rest of the national health service.
Mr Hunt
I am greatly looking forward to visiting my hon. Friend’s hospital on Thursday and going out on the front line. I agree that we need to celebrate success. This has been a difficult year for the NHS as we have learned to be much more transparent about problems when they exist, but one of the advantages of having a chief inspector is that his team will be able to identify and recognise outstanding practice, so that everyone will understand that, as well as some of the problems that get more attention, brilliant things are happening throughout our NHS.
Steve McCabe (Birmingham, Selly Oak) (Lab)
Is the Secretary of State comfortable with a surgeon such as Ian Paterson flitting between the NHS and the private sector, making the same blunders in both but being subject to different levels of accountability and his victims having access to different levels of redress?
Mr Hunt
As I said in response to an earlier question, the responsibility to be transparent about care should apply equally in the public and the private sector. Obviously, in the public sector we have more levers, because we are purchasing care and we can impose more conditions than it is possible to do in the private sector. The most important thing is to have a culture in which such problems come to light quickly when they happen, so that they are dealt with and not repeated.
Mr John Baron (Basildon and Billericay) (Con)
15. For what reasons the publication of data on one-year and five-year survival rates for all cancers within the Clinical Commissioning Group Outcomes Indicator Set has been deferred until March 2014.
Steve Baker (Wycombe) (Con)
16. What steps he is taking to ensure that the NHS becomes a more patient-led organisation.
The Secretary of State for Health (Mr Jeremy Hunt)
The big shift we need to make is to turn the NHS into a patient-led organisation. Two measures that will help that are: independent inspections by a new chief inspector that put the patient experience at their heart; and asking every NHS in-patient if they would recommend their treatment to a friend or member of their family.
Steve Baker
I am encouraged by that answer. Long ago, the medical establishment was held to account by what were essentially patient-led co-operatives, and today more and more voices are asking for more patient engagement. Will the Secretary of State consider a paper brought forward by Civitas and Anton Howes calling for the incremental implementation of patient-led commissioning to close this gap?
Mr Hunt
No one campaigns harder than my hon. Friend on the issue of putting patients first in his constituency and throughout the NHS. CCGs have a legal obligation to involve patients in decisions about services and about them personally. The ideas in the paper he mentions are interesting, and I respect them, but given that we have brand-new commissioners and inspectors going out this year, I think we should see how the current reforms work first.
Annette Brooke (Mid Dorset and North Poole) (LD)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
Today we published a report demonstrating that the NHS could recover as much as £500 million from better systems to monitor and track those who should be paying for the NHS treatment and introducing new charges to certain categories of people currently exempt. This is a significant sum of money that could fund 4,000 doctors, and far from being xenophobic, as some in the Opposition have alleged, the Government believe it is right that overseas visitors who do not pay for the NHS through the tax system should make a fair contribution through charges.
Annette Brooke
Poole hospital, which is much loved locally and has excellent care ratings, has a financial problem relating to tariffs that must be addressed. The £5 million spent on putting a failed case for a merger between Bournemouth and Poole hospitals to the Competition Commission raises questions about processes and openness with the public. I hope the Secretary of State can make some comments today, but will he meet me and other local MPs to discuss all these issues in greater detail?
Mr Hunt
I am happy to do so. I want to make it clear to my hon. Friend that I am keen to ensure we have a structure inside the NHS that makes it easy for high-performing hospitals that want to work more closely together and share services to do so, if it is in the interests of patients. We need to do more work in this area.
Andy Burnham (Leigh) (Lab)
The Secretary of State has been in post for a year, and in that time we have got used to his style: everything is always someone else’s fault, be it lazy GPs, uncaring nurses or the last Government. And today we see more diversion tactics—now immigration is to blame. But there is an inconvenient truth that gets clearer day by day and which he cannot spin away: A and E is getting worse and worse and worse on his watch. We have had ambulance queues, a treatment tent in a car park and now police cars doubling as ambulances, with a patient dying on the backseat. The NHS stands on the brink of a dangerous winter. Will he today set out in detail what he personally is doing to avert a crisis?
Mr Hunt
I welcome the right hon. Gentleman back to his place. It is a great pleasure to see him there, even if it is not entirely what the Labour leader wanted.
If the right hon. Gentleman is shocked that I breached the A and E target for one quarter last year, he will want to make a full apology for the fact that he breached it for two quarters when he was Health Secretary.
Andy Burnham
This complacent spin is no good to the NHS. If he wants to compare records, let us do that. Under me, 98 per cent. of people were seen within four hours; under him, over 1 million people in the last year waited more than four hours in A and E—not only a winter crisis, but the first summer A and E crisis in living memory. Today it gets worse. New figures this morning show a further 450 nursing jobs have been cut, taking the total close to 6,000 under this Government. But what were they doing last night? They were voting in the Lords against safe staffing levels. Will he now listen to the experts, stop the job cuts and take immediate action to ensure that all A and Es have enough staff to provide safe care this winter?
Mr Hunt
We will listen to no one on the Opposition Benches when it comes to safe care for patients in the NHS. They presided over a system where whistleblowers were bullied, patients were ignored and regulators felt leaned on if they tried to speak out about poor care. That is a record to be ashamed of.
Mark Pawsey (Rugby) (Con)
T5. There is evidence that a nutritional meal can be a real aid to the recovery of patients, yet the Campaign for Better Hospital Food found that 82,000 hospital meals are thrown in the bin every single day. Will the Minister update the House on the steps being taken to ensure that patients receive a hot balanced meal, served at an appropriate time?
Toby Perkins (Chesterfield) (Lab)
T4. My constituent Jemma Hill is 25 and suffers from chronic hip pain, for which a specialist has recommended hip arthroscopy surgery. However, she has now been told that her local clinical commissioning group does not fund such treatment. Does it not make a mockery of GP-led commissioning when a CCG will not fund the treatment recommended by a specialist to whom the GP referred my constituent in the first place?
Jason McCartney (Colne Valley) (Con)
T8. Does the Secretary of State agree that we need to learn from the mistakes of the Safe and Sustainable review of children’s heart surgery services and improve the forthcoming review in two ways? First, we should make the process a lot more transparent. Secondly, areas such as neo-natal, paediatric and adult intensive care unit services and transport and retrieval services should fall within the scope of the new review.
John Glen (Salisbury) (Con)
T10. Dr Elizabeth Stanger, a highly respected Salisbury GP, recently questioned me about the sustainability of providing multiple treatments for complex medical problems for several generations of the same family of foreign nationals. I welcome today’s announcement, and ask the Minister to reassure me that the mechanism to recover the funds will ensure that the money goes back to the clinical commissioning group so that it can provide a benefit locally.
Mr Hunt
I absolutely can reassure my hon. Friend about that. The point about the new, improved system for recovering charges is that we want the money to go back to the people providing the services so that they will be able to resource them better. This is not the diversionary tactic that some have accused us this morning of introducing; £500 million could have a huge impact on the NHS front line and allow his GPs to do a much better job.
Kate Green (Stretford and Urmston) (Lab)
This evening, the joint health overview and scrutiny committee for Trafford and Manchester will meet to consider whether the preconditions for the reconfiguration of services in Trafford, including those set down by the Secretary of State, have been met. I understand that the NHS area team has already confirmed that it believes the conditions have been fulfilled, but will the Secretary of State tell me what would happen if, as seems possible, the scrutiny committee were to take a different view tonight and decide that not all the conditions had been met?
Duncan Hames (Chippenham) (LD)
A written answer from the former Minister, my hon. Friend the Member for Broxtowe (Anna Soubry), to my recent parliamentary question has on this subject revealed that people living in the south-west of England are three times as likely to contract Lyme disease as those in the rest of the country, yet I have a constituent doing what he calls drug runs to the rest of Europe to access the medicines necessary to tackle his symptoms. Will the Minister meet me to discuss how we can ensure the continuing availability of treatments for Lyme disease on the NHS?
Miss Anne McIntosh (Thirsk and Malton) (Con)
When the Secretary of State meets the chairman of NHS England to discuss future priorities for NHS spending, will he ensure a fair deal for rural areas by ensuring that they reflect rurality, sparsity and the number of elderly patients and that we keep the minimum income guarantee for rural GP practices?
Mr Hunt
I can reassure my hon. Friend, as I am meeting some Yorkshire GPs later this week who have concerns about that very issue. The most important thing about the difficult issue of the funding formula is that it should be fair. That is why under the new legislation we have given the decision to an independent body so that it is taken at arm’s length from Ministers and so that it strikes the right balance between the issues of rurality, age and social deprivation.
Hazel Blears (Salford and Eccles) (Lab)
The NHS, with its massive purchasing power, can make a real difference to local areas through jobs and through supply chains. Some hospital trusts are enthusiastically implementing the Public Services (Social Value) Act 2012, including Barts and King’s. Will the Minister ensure that his new procurement strategy recognises the importance of social value?
Tim Loughton (East Worthing and Shoreham) (Con)
The Secretary of State knows Worthing hospital well; he has rolled his sleeves up there. When I went there a few weeks ago, I was told that the average age of patients in the hospital, stripping out maternity, is 85, yet we have qualified for no winter pressures money and we have a diminishing number of community hospital beds. Will he look into this anomaly, as he well knows the specific pressures we have on the south coast?
Mr Hunt
I understand my hon. Friend’s concerns and I know that there is a large elderly population in Worthing. I thought it was an excellent hospital with a fantastic atmosphere when I went and did part of a shift there. The winter pressures money went to the third of A and E departments that are struggling the most, so it is probably a compliment to his hospital that it did not receive it. We felt that with limited funds we had to concentrate resources where they were going to have the most impact. I hope that he understands why we had to make that difficult decision.
Joan Walley (Stoke-on-Trent North) (Lab)
This week, the report of the trust special administrator in respect of Stafford hospital is being presented to Monitor. Given that the preferred option is that the University Hospital of North Staffordshire should in some way take over, will the Secretary of State urgently meet all Members of Parliament for the north Staffordshire area to ensure that health care in north Staffordshire, where we already have a deficit of £31 million with an extra £18 million set to come over, will not be destabilised?
Mr Hunt
We are acutely aware of those concerns. In any reconfiguration, and particularly in this one, we want to ensure that there is no instability in the local health economy. We have given the trust special administrator a little longer to come up with a plan for Stafford hospital to try to secure local agreement, so I have not had a recommendation yet and I am going to wait and see what he says.
Jimmy Savile (Investigations Update)
Jeremy Hunt Excerpts(12 years, 9 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I wish to provide an update on progress with the Jimmy Savile investigations relating to national health service institutions.
There are currently three main investigations under way—Broadmoor, Stoke Mandeville and Leeds General Infirmary. Kate Lampard is providing independent scrutiny of the quality and rigour of these three investigations on behalf of the Department of Health. There are also investigations taking place at a further 10 trusts.
The Metropolitan Police Service, working with Kate Lampard, has established there was further relevant information regarding Jimmy Savile. The Department of Health asked the Metropolitan Police Service, through an agreed information-sharing process, to review information it held to ascertain if it included material related to health and care settings.
This review is still ongoing. We understand the material includes information about hospitals where investigations are already under way, and reference to other hospitals. Once this review is complete, the information will be passed on to the relevant trusts or investigations as quickly as possible. I will then issue another written statement, including the names of any other hospitals involved.
Although all 13 investigations are currently on track, this additional material means that the timetable will be affected. It is vital that the final NHS investigation reports are thorough and complete, and reflect all the evidence about Jimmy Savile’s pattern of offending. The final reports of all the investigations will now aim to be completed by June 2014, with publication sooner if that is possible.
Information Sharing (Caldicott Review)
Jeremy Hunt Excerpts(12 years, 10 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today I am publishing the Government’s response to Dame Fiona Caldicott’s review of information sharing. This review was recommended by the Future Forum on information which reported in January 2012.
I am grateful to Dame Fiona and her panel and to the many people who provided valuable input into her review. Building on the wealth of experience, viewpoints and insights gained through the review and the preceding NHS Future Forum’s work, this document sets out the overall ambition and actions to transform how our health and our care services use and share information to the benefit of patients and service users.
For citizens, patients and users of care services, this response sets out how a new approach to information sharing across health and care can support more joined up, safer, better care for us. Dame Fiona’s review and our response look at actions for clinicians and other care professionals, managers, commissioners, councillors, researchers, and many others.
There are four key themes in the response:
patient and citizen rights—they should have confidence in how their information is handled through knowing how it is used and shared and how to object and through having access to their electronic care records;
improving sharing for direct care—appropriate and legal data sharing to drive integrated, joined-up, person-centred and safer care for people (where information governance rules have, in the past, been seen as a barrier);
improving sharing for other purposes—the importance of information for research, commissioning and public health and improving practice in this area, recognising this can only be done effectively if people are given a say in how information about them is used; and
better protection for information boards and other leadership groups will take responsibility for good information practices in their organisations, professionals will be consistent in the rules they apply and front-line staff will have improved training and education on information sharing and confidential information.
In summary, this response sets out the overall ambition and the early actions that will enable better information sharing to support our health and our care services to meet our needs and expectations, for now and the future.
“Information: To share or not to share? The Information Governance Review” and “Information: To Share or not to share, Government Response to the Caldicott Review” have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
University Hospitals of Morecambe Bay Trust
Jeremy Hunt Excerpts(12 years, 10 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
University Hospitals of Morecambe Bay Trust (UHMBT) has been the subject of scrutiny for a number of years, following the high number of serious untoward incidents in its maternity and neonatal services. The families of those who were harmed or died under the care of the trust have persistently and courageously sought a full and independent investigation into the circumstances surrounding these deaths. I am today announcing to the House the terms of reference for the independent investigation into the management, delivery and outcomes of care provided by the maternity and neonatal services of UHMBT from January 2004 to June 2013, under the chairmanship of Dr Bill Kirkup CBE. Dr Kirkup is a former associate medical director at the Department of Health, and served on the Hillsborough independent panel.
The investigation will primarily focus on the service provided by the trust, and the response of the trust to shortcomings previously identified. It will look at evidence relating to organisations external to the trust where this will help shed light on the tragic events that occurred, and assist in producing recommendations for preventing such incidences in the future. The principle concern of this investigation is getting the answers the families have requested. Answers are required about what went so desperately wrong with the care they received, and the steps the trust must take to ensure no other families suffer in the future.
This is not an investigation into the regulatory and supervisory systems of the NHS, as these issues have only recently been examined by the second Mid Staffordshire inquiry, and the Department of Health will publish its full response in due course. Nor is it a public inquiry as the requirements for public evidence sessions are not considered suitable for the privacy and tact with which this investigation must be undertaken. To ensure that the investigation will meet the requirements of openness and transparency, all of its sessions will be open to family members.
The investigation is expected to report to me by next summer and a copy of the full terms of reference has been placed in the Library of the House. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Dr Kirkup plans to issue a method statement for the investigation in October 2013. I am grateful to him and the families for their significant contribution to the design of this investigation process. I sincerely hope that it will provide them with the answers that they seek.
Accident and Emergency Departments
Jeremy Hunt Excerpts(12 years, 10 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
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Andy Burnham (Leigh) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on 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.
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?
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?
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?
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.
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.
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?
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(12 years, 10 months ago)
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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:
Region | System as Identified by NHSTrust/NHS Foundation Trust | Provisional Amounts(£000s) |
|---|---|---|
London | Barking, Havering & Redbridge University Hospitals NHS Trust | £7,000 |
London | Barnet & Chase Farm Hospitals NHS Trust | £5,120 |
London | Barts Health NHS Trust | £12,800 |
London | Croydon Health Services NHS Trust | £4,500 |
London | Ealing Hospital NHS Trust | £2,900 |
London | North Middlesex University Hospital Trust | £3,800 |
London | North West London Hospitals NHS Trust | £6,400 |
London | South London Healthcare NHS Trust | £7,700 |
London | Whittington Health NHS Trust | £2,960 |
London | West Middlesex University Hospital NHS Trust | £2,300 |
Midlands and East | Basildon and Thurrock NHS FT | £2,490 |
Midlands and East | Bedford Hospital NHS Trust | £3,734 |
Midlands and East | Derby Hospitals NHS FT | £4,487 |
Midlands and East | Heart Of England NHS FT | £9,289 |
Midlands and East | Kettering General Hospital NHS FT | £3,919 |
Midlands and East | Mid Essex Hospital Services NHS Trust | £2,869 |
Midlands and East | Mid Staffordshire NHS FT | £3,747 |
Midlands and East | Milton Keynes Hospital NHS FT | £2,763 |
Midlands and East | Northampton General Hospital NHS Trust | £4,000 |
Midlands and East | Peterborough and Stamford NHS FT | £5,050 |
Midlands and East | Sandwell and West Birmingham Hospitals NHS Trust | £4,218 |
Midlands and East | Shrewsbury and Telford Hospital NHS Trust | £4,000 |
Midlands and East | The Queen Elizabeth Hospital, King's Lynn. NHS FT | £3,990 |
Midlands and East | The Princess Alexandra Hospital NHS Trust | £5,700 |
Midlands and East | United Lincolnshire Hospitals NHS Trust | £8,000 |
Midlands and East | University Hospital Coventry and Warwickshire NHS Trust | £4,000 |
Midlands and East | University Hospital Of North Staffordshire NHS Trust | £3,460 |
Midlands and East | University Hospitals Of Leicester NHS Trust | £10,000 |
Midlands and East | Worcester Acute Hospitals Trust | £1,000 |
North | Aintree University Hospital NHS FT | £1,520 |
North | Airdale NHS FT | £1,450 |
North | East Lancashire Hospitals NHS Trust | £1,403 |
North | Lancashire Teaching Hospitals NHS FT | £914 |
North | Leeds Teaching Hospitals NHS Trust | £1,890 |
North | Northern Lincolnshire and Goole Hospitals NHS FT | £1,044 |
North | North Cumbria University Hospitals NHS Trust | £2,292 |
North | Southport & Ormskirk Hospital NHS Trust | £4,042 |
North | Stockport NHS FT | £1,530 |
North | Tameside Hospital NHS FT | £2,475 |
North | University Hospitals Of Morecambe Bay NHS FT | £1,257 |
North | York Teaching Hospital NHS FT | £2,061 |
South | Brighton and Sussex University Hospitals NHS Trust | £2,326 |
South | Dartford and Gravesham NHS Trust | £4,080 |
South | East Sussex Healthcare NHS Trust | £2,300 |
South | Hampshire Hospitals NHS FT | £3,302 |
South | Heatherwood and Wexham Park Hospitals NHS FT | £6,644 |
South | Medway NHS FT | £6,120 |
South | North Bristol NHS Trust | £5,900 |
South | Oxford University Hospitals NHS Trust | £10,207 |
South | Plymouth Hospitals NHS Trust | £5,500 |
South | Portsmouth Hospitals NHS Trust | £1,427 |
The additional allocation will require an increase to the revenue budget for NHS England for 2013-14, as specified in the mandate. This revision to the mandate will be laid before Parliament in due course1.
One of the avoidable pressures on the NHS is flu. On average around 750,000 patients see their GP with flu symptoms and nearly 5,000 people die each year. Flu levels have been relatively low over the past two years but this does not mean they will not go up this year. And if cases of flu do increase, the pressure on A&Es will also increase. The best way for people at risk from flu to protect themselves, their families and—in the case of NHS staff—their patient is to get the flu vaccine.
For the first time, young children aged two and three will be offered the innovative nasal spray vaccine to protect them against flu. Young children’s close contact with each other means they are likely to transmit the virus to other more vulnerable groups—including infants and the elderly.
Front-line health care workers, by the very nature of their jobs, deal with people who are unwell every day and on average, around 27,000 people spend time in hospital with flu every year. NHS staff can play an important role in not picking up the flu virus and passing it on to other patients who are often people who are already poorly and vulnerable to infection by simply having the flu vaccine. Less than half of front-line NHS staff get vaccinated against flu, and in some hospitals this figure drops to fewer than one in five. This is why we want to significantly boost the number of health care workers getting the flu vaccine to 75%. Trusts will not be eligible to receive a portion of the money in future years if they do not vaccinate 75% of their staff this year, except in exceptional circumstances where they can prove to the TDA, Monitor and NHS England that they have robust plans in place to ensure they meet this ambitious target the following year.
1The mandate is the document published annually by the Secretary of State under section 13A of the National Health Service Act 2006, specifying for NHS England its objectives and revenue and capital budgets.
NHS Modernisation (Costs and Benefits)
Jeremy Hunt Excerpts(13 years ago)
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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(13 years ago)
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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.
£000 | |
|---|---|
Cost of dedicated staff | 712 |
Legal costs incurred | 5,227 |
Other staff related expenses (travel and subsistence) | 79 |
Other directly related costs | 23 |
Total | 6,041 |
The public inquiry was independent. The Department of Health acted as sponsor for the public inquiry. The costs incurred in the direct running of the public inquiry are published separately on the inquiry’s website.
Managing Risk in the NHS
Jeremy Hunt Excerpts(13 years ago)
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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?
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.
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.
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”?
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?
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—
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—
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.
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.
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 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.
Oral Answers to Questions
Jeremy Hunt Excerpts(13 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
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.
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?
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.
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.
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?
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?
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?
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?
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?
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.