NHS England (Mandate)

Jeremy Hunt Excerpts

Friday 5th July 2013 Written Statements

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

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

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

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

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

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

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

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

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

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

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

Migrant Access to the NHS

Jeremy Hunt Excerpts

Wednesday 3rd July 2013 Written Statements

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

The United Kingdom successfully attracts many millions of visitors and migrants each year. If our country is to remain competitive, we need to continue to welcome those who come here to work and to study. At the same time public services like the NHS are under increasing strain, coping with the demands of an ageing population and financial pressures. The NHS is and will remain free at the point of delivery for its residents, but it cannot continue as an international rather than a national health service. We urgently need to address this or the system is likely to become unsustainable.

Our health system is very generous to overseas visitors, perhaps one of the most generous in the world. We allow people who are living here temporarily to use the NHS and exempt many of them from charging, while any visitor, including tourists, can visit a general practitioner free of charge. These sorts of services are often not available for our citizens when they are abroad.

The NHS struggles to identify and recover the cost from those not entitled to free treatment. NHS resources, both financial and clinical, are used to treat and care for people who have no long-term commitment to our country and should contribute towards it.

To address these issues, I am launching a consultation today inviting views on proposed changes to the way temporary migrants and visitors access the NHS in England. The purpose of this consultation is to examine critically who should be charged in the future; what services they should be charged for; and how we can ensure that the system is better able to identify chargeable patients and recover costs. As health is a devolved matter, this consultation is looking specifically at how to address the challenges for the NHS in England. The aim is to ensure they make a fair contribution to the cost of treatment, while not restricting access and maintaining the essential public health role of the NHS.

The Home Office will be running a linked consultation on UK-wide proposals to regulate migrant access to the NHS. This will explore proposals to ensure migrants contribute fairly to the cost of NHS care across the UK, including extending charging for primary care to visitors and illegal migrants, introducing a new qualifying test for non-EEA nationals accessing the NHS and a new mandatory health levy for temporary non-EEA migrants.

In the Department of Health consultation, the Government are proposing a new set of rules for accessing free NHS care, based on a principle of “everyone makes a fair contribution” such that free treatment should only be provided to those people with settled residence here who have an established relationship with the UK.

This would mean that temporary migrants, including students and some workers, would in future have to contribute through a levy or a fee that would then allow them to register with the NHS and subsequently receive all necessary treatment without further payment. We propose to add a provision to waive the fee for some high-value workers who choose to waive their right to free NHS care in favour of private health care provision.

In line with the principle of the established relationship we propose to extend the rights of ex-residents who have a long-term record of national insurance payments to access free NHS treatment when returning to visit the UK—currently some are chargeable or have entitlement only to limited treatment. Short-term non-EEA visitors who are here for less than six months, and illegal migrants will continue to be directly chargeable.

The consultation considers the operational and clinical case for charging for NHS care in all settings including GP, community services and will also consider A and E and emergency GP consultations for chargeable patients. Not compromising patient access would be a fundamental requirement for any such future change.

Finally the consultation addresses the current major weaknesses in the administration of charging. The consultation provides, in outline only, a potential new system, including a revamped registration system with data that identifies a person’s chargeable status. We will seek extensive front-line NHS input to develop a detailed, fit-for-purpose model that has its support. This engagement will continue beyond the end of the formal consultation process.

The consultation will run for eight weeks and will close on 28 August 2013.

The consultation document and supporting evidence 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.

It is also available at: www.dh.gov.uk/consultations.

Care Quality Commission (Morecambe Bay Hospitals)

Jeremy Hunt Excerpts

Wednesday 19th June 2013 Commons Chamber

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

I wish to make a statement about today’s independent report on the Care Quality Commission’s regulatory oversight of University Hospitals of Morecambe Bay NHS Foundation Trust. What happened at Morecambe Bay is, above all, a terrible personal tragedy for all of the families involved, and before saying anything else, I want to apologise on behalf of the Government and the NHS for all the appalling suffering that those families have endured. In that context, I know that the whole House will wish to extend our condolences to every single one of them.

Joshua Titcombe’s tragic death was one of 12 serious untoward incidents, including five in the maternity department. His family and others have had to work tirelessly to expose the truth, and I pay tribute to them for that, but the fact is that they should not have had to go to such lengths. As we saw in the case of Mid Staffs, a culture in the NHS had been allowed to develop in which defensiveness and secrecy were put ahead of patient safety and care. Today I want to explain to the House what the Government are doing to root out that culture and ensure that that kind of cover-up never happens again.

The independent report was commissioned by the new chief executive of the CQC, and the members of the new team that is running it have made it clear that there was a completely unacceptable attempt to cover up the deficiencies in their organisation. The report lists what went wrong over a period of many years. There were unclear regulatory processes, a report was commissioned and then withheld, key information was not shared, and there were communication problems throughout the organisation. Most of the facts are not in dispute, and all of them are unacceptable. They have compounded the grief of the Titcombe family and many others.

The role of the regulator is to be a champion for patients, to expose poor care and to ensure that steps are taken to root it out. The regulator must do that without fear or favour, but it is clear that at Morecambe Bay, the CQC failed in that fundamental duty. We now have a new leadership at the CQC, and we should recognise its role in turning things around. David Behan was appointed chief executive in July 2012, and one of his very first acts was to commission the report that we are now debating. David Prior was appointed the new chairman in January this year, and has rightly insisted that the report be published as soon as possible. Those two outstanding individuals have never shrunk from addressing head-on the failings of the organisation that they inherited, and are wholly committed to turning the CQC into the fearless, independent regulator that the House would like to see. While I do not underestimate the challenge, I have every confidence in their ability to undertake it.

David Prior will now report back to me on what further actions the CQC will take in response to the report, including internal disciplinary procedures and other appropriate sanctions. The whole truth must now come out, and individuals must be accountable for their actions.

With respect to Morecambe Bay itself, an independent inquiry led by Dr Bill Kirkup started work earlier this year. More broadly, following the Francis report into the tragedy at Mid Staffs, the Government are putting in place far-reaching measures to put patient care and patient safety at the heart of how the NHS is regulated.

The CQC is appointing three new chief inspectors—of hospitals, social care and general practice. This will provide an authoritative, independent voice on the quality of care in all the providers that it regulates. The commission has already announced the appointment of Professor Sir Mike Richards as the new chief inspector of hospitals, and on Monday, the CQC launched a consultation, “A new start”, which outlines its much tougher regulatory approach. This includes putting in place more specialist inspection teams with clinical expertise. It will include Ofsted-style performance ratings so that every member of the public can know how well their local hospital is doing just as they do for their local school.

The Government will also amend the CQC registration requirements so that they include an emphasis on fundamental standards—the basic levels below which care must never fall, such as making sure patients are properly fed, washed and treated with dignity and respect. Failure to adhere to these will result in serious consequences for providers, including potentially criminal prosecution. The revised registration requirements will also include a new statutory duty of candour on providers that will require them to tell patients and regulators where there are failings in care—a failure clearly identified in today’s report.

Finally, we are putting in place, through the Care Bill, a new robust single failure regime for NHS hospitals. This will provide a more effective mechanism to address persistent failings in the quality of care, including the automatic suspension of trust boards when failings are not addressed promptly.

The events at Morecambe Bay, Mid Staffs and many other hospitals should never have been covered up, but they should never have happened in the first place, either. To prevent such tragedies we need to transform the approach to patient safety in our NHS.

The Prime Minister has therefore asked Professor Don Berwick, President Obama’s former health adviser and one of the world’s foremost experts on patient safety, to advise us on how to create the right safety culture in the NHS. He and his committee will report later this summer.

In addition, later this year we will start to publish surgeon-level outcomes data for a wide range of surgical specialties. Most of all, we need a culture where, from the top to the bottom of NHS organisations, everyone is focused on reducing the chances of harming a patient in the course of their care, and a culture of openness and transparency to ensure that, when tragedies do occur, they are dealt with honestly so that any lessons can be learnt. Our thousands of dedicated doctors, nurses and health care assistants want nothing less. We must not let them down, or any of the families who suffered so tragically in Morecambe Bay. I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement and for early sight of it, and I welcome what he has just said. Today’s report will have left people stunned. The Secretary of State began with an apology and we on the Opposition side echo it. It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What is never acceptable is when people or organisations try to hide those mistakes. As Professor Sir Liam Donaldson, the former chief medical officer, says:

“To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.”

Sadly, that is precisely what appears to have happened in this case.

The report covers a four-year period from autumn 2008 to autumn 2012. It details failures in regulation, but also subsequent attempts at a cover-up. It was published only because of the efforts of James Titcombe and his family. Like the Secretary of State, I pay tribute to them today, as does my hon. Friend the Member for Barrow and Furness (John Woodcock), who has supported the family. As he rightly said, that family’s suffering has been intensified by the actions of the NHS—something that should never happen. It is now essential that they and all the other Cumbria and Lancashire families affected get all the answers they are looking for—and I fully commit the Opposition to making sure that happens.

The most shocking revelation in this report is that, in March 2012, an instruction was given by a member of senior management at the CQC to “delete” the findings of a critical internal review. Let me remind the House of the context in which that March 2012 instruction was given. At that time, we were midway through a major public inquiry into the terrible failings at Mid Staffs. This was two years after the completion of an earlier independent inquiry—also led by Robert Francis, QC—following which all parts of the NHS had committed to full openness and transparency. It also came after failings at other trusts—most notably Basildon and Thurrock—which led me to request an in-depth look at all hospitals so that problems could be flushed out and a system put in place to ensure that people had a comprehensive picture of local standards. That was the context in which this instruction was given, and it explains why today’s revelations beggar belief and are hard to comprehend. The report raises questions for the CQC and the Department; I will take each in turn.

The new chief executive, David Behan, commissioned this report and we pay tribute to him for doing so. The chair has said today that he now wants to draw a line under this issue, but does the Secretary of State agree that it will be possible to do that only when further questions raised by this report are answered?

On hospital regulation, there is a recognition on all sides that it has not been good enough for too long. While we note the important work of Don Berwick, should we not also be getting on with the job of implementing the recommendations of the three-year Francis report in this regard? The Secretary of State mentioned a duty of candour on providers, but he will know that Robert Francis recommended that that should extend to individual clinicians, too. Will the right hon. Gentleman work with the Opposition to implement that recommendation as soon as possible?

On the cover-up, paragraph 1.17 of today’s report says that the order to delete

“may constitute a broader and on-going cover-up.”

Will the Secretary of State address that point directly and tell the House whether he is confident that this cover-up is no longer happening? Is he satisfied that the CQC has taken all appropriate steps, and does he have full confidence in it going forward, or does he believe a further process of investigation is necessary?

More specifically, is anybody who was involved in the decision to delete still working at the CQC or elsewhere in the NHS? If they are, people will find that hard to accept and they will want answers on that specific point. Given that accountability is essential, does the Secretary of State agree that people will find it hard to accept if data protection laws stand in the way of that accountability, and will he therefore review the decision to shield the identities of those involved? Today’s report makes it clear that the “deleted” report still exists. Should it not now be published?

Now let me turn to the Department of Health. Was the decision to delete taken solely by senior management at the CQC or is there evidence that anyone outside the CQC was either involved in the decision or aware of it? Was anyone in the Department of Health aware of the internal report being produced, and did any contact take place between the CQC and the Department running up to the decision to delete it?

Unfortunately, this matter does not end with deletion of the report. The Prime Minister said earlier that there should always be support for whistleblowers, and he was right, but there are serious doubts about whether that has happened in this case. Concerns about the CQC were raised by an internal whistleblower who was on the board. We know there was an attempt to remove her from the board and to question her character. Has the Secretary of State looked into these issues and considered whether appropriate support was provided—by both the CQC and the Department—to the individual who raised these concerns? The same whistleblower told the CQC today that she had raised issues internally first, then within the Department and then directly with the former Secretary of State in a meeting. Will the Secretary of State provide details of that meeting and publish a minute of it? What actions were taken by Ministers subsequent to that meeting? Were Ministers consulted about the decision to remove her from the CQC board, and did they support that decision?

Finally, the only real answer to all of these deep-rooted problems that go back a long way is for both sides of the House to recommit to full openness and transparency in the national health service. Will the Secretary of State join me today in restating that commitment and together sending the clearest and most unambiguous signal we can to the rest of the NHS?

In conclusion, there are difficult questions here for people at every level of the system. If we are to restore confidence, it is essential that they are answered and that people are held accountable for their actions. Learning from this failure and others, this House must a deliver a regulator that the public can trust, one that puts patients before its own interests. We will support the Government in that process and not stop until it is completed.

[Mr Hunt]

I welcome much of what the right hon. Gentleman says, but let me say this: he talks about getting on with implementing the Francis report, and that is exactly what has been happening. The report came to the House on 6 February. A new chief inspector of hospitals was appointed by 31 May, and the new inspections will start towards the end of this year. That will mean that many of the things talked about in the Francis report as being fundamentally important will start to be looked at independently and rigorously for the very first time.

I can confirm that there will be a duty of candour in the new Care Bill. We are looking at the extent to which it should apply to individuals, but we want to wait until Professor Berwick produces his report, because it is important to create a culture of openness, and we do not want to pass a measure that might inadvertently mean people clam up when they see a potential safety breach. We need to encourage an atmosphere where everyone talks openly about any concerns they have.

David Prior will be looking in his response to today’s independent report at whether anyone still working in the NHS, or, indeed, the CQC, may have been responsible for some of the shocking things that have been revealed. He will pass that report to me within the next two months. As I said in my statement, there will be full consideration of any sanctions or appropriate disciplinary procedures. In our response to the Francis report, we have said we want to introduce a new barring scheme to make sure that managers who have been found guilty of behaving in a bad way do not get jobs in another part of the NHS.

With respect to what the right hon. Gentleman said about my colleague, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), I gently say to him that it was not my right hon. Friend or myself or this Government’s Ministers who rejected 81 requests for a public inquiry into what happened at Mid Staffs. My right hon. Friend was the person who called the public inquiry into Mid Staffs. He is the person who changed the management of the CQC. He is the person who put clinicians in charge of budgets in the NHS, precisely to make sure these kinds of safety issues do not arise.

Finally, the right hon. Gentleman talks about accountability. If the Opposition really wanted to give confidence that they take the issues raised today seriously, they would recognise that it was fundamentally wrong to set up an inspection regime that was not carried out by specialists, and where the same person was inspecting a dental clinic, a slimming clinic, a hospital or a GP practice, perhaps in the same month. That may have contributed to the CQC’s decision in 2009 not to investigate the maternity deaths at Morecambe Bay, and to its decision in April 2010 to register the hospital without conditions.

When it comes to accountability, the right hon. Gentleman needs to explain to the House why the former head of the CQC, Barbara Young, said in her evidence to the Francis inquiry:

“We were under more pressure…when Andy Burnham became minister, from the politics.”

Is it the case that the head of the CQC felt under pressure not to speak out about care issues?

On the substantive policy point, the right hon. Gentleman continues to criticise the appointment of a chief inspector of hospitals and continues to criticise me when I single out hospital management who coast when it comes to raising standards. Just how much evidence will it take for the right hon. Gentleman and the Labour party to realise that when it comes to NHS policies, they really need to change?

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

As Member of Parliament for Lancaster, which is covered by the Morecambe Bay trust, may I reassure the Secretary of State and the House in general that thousands of my constituents are receiving a good service from hundreds of hard-working NHS doctors and nurses at the Royal Lancaster Infirmary? Does he think the problems began with the setting up of the CQC on 1 April 2009, and its being appointed as an independent regulator and being expected by the previous Government to inspect and register 378 NHS trusts within 12 months, by April 2010, which was an impossible target for any system to cope with?

[Mr Hunt]

My hon. Friend is absolutely right. That regime was utterly flawed, and as far as we can tell, inspectors looking at hospitals and care homes had targets of inspections they had to complete in a way that was totally counter-productive to the concept of a rigorous, thorough, independent inspection where people speak out without fear or favour when they find problems.

I also thank my hon. Friend for the other point he makes: that the people who work at the University Hospitals of Morecambe Bay NHS Foundation Trust are working extremely hard and under great pressure. I think they are doing a very good job by and large, but there are clearly very severe problems with the trust that we need to get to the bottom of, and it is very important that we recognise that if we are going to create a safety culture in the NHS, we need to back the people on the front line. They did not go into the NHS to have to deal with these terrible breaches in health and safety; they went into the NHS because they care for people and they want to do the best for people at their most vulnerable.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

May I first thank the Secretary of State and the shadow Secretary of State for those words of apology to the Titcombe family and other families who have long been pressing for an inquiry and this kind of day of reckoning for the CQC? It is hard to imagine what it must be like to lose a child, but then to be faced with an almost impenetrable wall of bureaucracy, with one organisation and one group of people passing them over to another group, and with all of them ultimately washing their hands of accountability, is truly shocking. That has been laid bare in this report, and I commend its authors for bringing it to the attention of the public.

What the Secretary of State says about the staff in this trust is very important, because these are front-line people who have been failed by poor leadership and a poor inspection regime, which absolutely has to change.

The report says the particular issue here

“may constitute a broader and ongoing cover-up.”

Is the Secretary of State satisfied that that is not the case? If he is, how can he be? What can he do to look more widely than just at the CQC itself when looking into this allegation?

--- Later in debate ---

[Mr Hunt]

First, may I say I agree with what the hon. Gentleman says, and commend him on his work with his constituents and local families who have suffered so terribly from what happened? He is absolutely right to say we have created a system that is a nightmare for families who identify problems, and the real problem is a lack of clarity as to where the buck stops: where the buck stops in terms of the decision to say that a hospital is safe or not safe, and where the buck stops in terms of sorting out a problem when it is identified. Those are the areas where we are putting through big changes this year, as a result of the Francis report.

I completely understand why the issue of whether there is a continuing cover-up is a concern. All I can say is that I have total confidence in the new leadership of the CQC. They are on the side of the public. They understand that the CQC’s job is to be the nation’s whistleblower-in-chief. They absolutely get that, but changing the culture in the broader NHS takes more than the appointment of two new individuals at the CQC; it takes a complete change in the leadership so that people on the front line always feel supported if they want to raise safety concerns. That is a much bigger job. I do not want to pretend that we are going to be able to solve it overnight, but that is the big change we have to make.

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

My constituents can be forgiven for wondering whether, when the watchdog chooses to muzzle itself, it is time to put it to sleep. The report shows that the CQC discovered the truth about the deaths of babies at Furness General, but chose to suppress the truth, and to seek to subvert the Freedom of Information Act—and this morning I have asked the police to investigate that point.

Grieving families like the Titcombes deserve to know who made these decisions, so will the Secretary of State agree to ensure the removal of anonymity for those guilty of putting institutional convenience ahead of the lives of mothers and babies?

I completely agree with my right hon. Friend about backing those on the front line, but we have a culpable ex-chief executive of the trust on a £200,000 payout while the excellent nurses and doctors in the trust are struggling under immense pressure, so will he agree to work with me and all colleagues across Morecambe Bay to help the trust recover, which includes agreeing not to now demand that the trust make £25 million-worth of savings by March, as that would further threaten the pursuit of patient safety?

[Mr Hunt]

I agree with much of what my hon. Friend says. He is absolutely right that accountability for what went wrong is crucial in this. I know that the CQC wanted to publish the report in full today, including the names of the individuals involved, but was given legal advice that it would be against the law to do so. However, the CQC is keen to have maximum transparency as soon as possible and is looking into how it can make sure that happens. There should be no anonymity, no hiding place, no opportunity to get off scot-free for anyone at all who was responsible for this. This is the problem we have to address in the NHS: all too often, people are not held accountable for what went wrong. However, the system also bears responsibility. This is not just about bad apples and how we root them out more quickly; it is also about creating a system that brings out the best in people—that plays to the decent instincts that got people to join the NHS in the first place, rather than making them think that targets at any cost matter more than the care and dignity of the patients in their trust.

[Mr Ben Bradshaw (Exeter) (Lab)]

The CQC’s chairman said on the radio this morning that he could not publish the names of those responsible for this scandal because of the Data Protection Act, but there are clear and explicit exemptions to the Act when it comes to

“protecting members of the public from dishonesty, malpractice, incompetence or seriously improper conduct, or in connection with health and safety”.

Will the Secretary of State please challenge the CQC’s interpretation of the Act and, if necessary, ask the Information Commissioner to rule on this flawed decision?

[Mr Hunt]

I can reassure the right hon. Gentleman that neither the chairman of the CQC nor I have any interest whatsoever in keeping these names secret. He did receive legal advice telling him that he could not publish them, but I will go back to him with what the right hon. Gentleman says. I know that the CQC chairman would like to be as transparent as possible. The choice he had, on the basis of the legal advice, was either not to publish the report or to publish it without the names. I think he took the right decision, given the advice he had, but I will ask him to consider what the right hon. Gentleman says.

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

It is appalling what has come out in the press today and it is appalling what has been suppressed in the past. It is alleged by Lady Barbara Young, a former CQC chair, that under the previous Labour Government she was leant on by Labour Ministers not to criticise the NHS under their tenure. In her Mid Staffs inquiry evidence she stated:

“There was huge government pressure, because the government hated the idea that…a regulator would criticise it”.

She also alleges that the right hon. Member for Leigh (Andy Burnham), the then Health Secretary in the last Labour Government, needs to answer these very serious allegations, especially given what has happened in my local NHS trust.

[Mr Hunt]

That is the big culture change we need to see; we need to see Governments who are prepared, in all circumstances, however difficult and however politically inconvenient it is, to recognise that when there are safety issues, when there are terrible failures in care and compassion, we need to support the people who want to speak up, because if we do not do that, we will never root out these problems.

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

I support the comments made by my right hon. Friend the Member for Exeter (Mr Bradshaw). A real concern is being expressed by Members on both sides of the House, because a person committed this cover-up by deleting this report and we really want to know—there should be an investigation—whether they are currently working for the CQC or working in the NHS anywhere. It is vital to know that.

Today, the CQC’s chair has said that it is not currently capable of carrying out hospital inspections. The Health Secretary has talked about putting in place more specialist inspection teams, and I, of course, support that. However, CQC inspectors have had access to specialists for a long time—they have talked about it before the Health Committee—so if they are not using them, that is an issue to address. What measures will the Health Secretary put in place to ensure that from this day onwards—not at some future point—we can have the CQC competently carrying out inspections?

[Mr Hunt]

When the CQC was set up in 2009, it was decided, with full ministerial approval, to go for a generalist inspection model—a model where inspection was not carried out by specialists; the same people would inspect dental clinics, GP practices, hospitals and slimming clinics. That was the wrong decision to take. Making sure that we have enough specialist inspectors in place, with appropriate clinical expertise, takes time—it is a very big recruitment job—and that is what the new chief inspector of hospitals, Professor Sir Mike Richards, is now setting about doing. It is also expensive—it costs money—but he has said to me that when his teams are in place he will start those inspections before the end of this year. So we are going as fast as we possibly can to try to put these problems right.

[Mr Ben Wallace (Wyre and Preston North) (Con)]

My wife gave birth to all three of our children at the Royal Lancaster Infirmary, which is part of the University Hospitals of Morecambe Bay NHS Foundation Trust. Although the midwifery care was excellent, when we had complications with the third my wife received such neglect and ill treatment, at about the same time as Joshua Titcombe’s death, that the trust resorted to lying to us. No one should have to endure that treatment.

I have with me a litany of complaints, ignored by the management, the non-execs, and the Department of Health, going back to 2005. Constituents were lied to and nothing was done—no one came to help. I support the Secretary of State’s attempt to reform the CQC, but may I urge him to sort out governance at a more local level? Unless we improve the non-execs and the chairs of these trusts, none of these reforms will make a difference. Unless we improve clinical leadership, as well as managerial leadership, it will all be for nothing.

[Mr Hunt]

My hon. Friend speaks extremely wisely, and I know that the whole House will want to say how sorry we are to hear about the personal problems he had with that trust. All the international safety studies say that if we are to transform safety culture, it has to come from better leadership. It has to come from leadership that really cares; that frees up people on the front line to raise safety concerns in a way that they do not feel will be career-threatening; that encourages them to rethink procedures to minimise the risk of harm to patients; and that encourages the open and transparent approach that has enabled hospitals such as Salford Royal to become one of the safest in the country, because of the inspirational leadership of David Dalton. That change in leadership is fundamental, but having a chief inspector who goes without fear and favour and says where we have that leadership and, more importantly, where we do not have it, will be vital to ensuring that we start to get the changes that my hon. Friend is concerned about.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my right hon. Friend agree that in the long litany in this report of events that were inexplicable and completely unacceptable, one of the most inexplicable and unacceptable things it lays bare is that at the same time as concern was being expressed to the CQC about the quality of maternity services delivered in the trust, to which the CQC did not respond, the trust itself commissioned a report into the future of maternity services and did not see fit to report the existence of the Fielding review to the regulator to which it was responsible? Will my right hon. Friend make it crystal clear that that is completely inconsistent with any concept of duty of candour for health care deliverers?

[Mr Hunt]

I could not agree more with my right hon. Friend. What happened beggars belief, and I very much agreed with his comments on that on the radio this morning. The point about duty of candour is that there will be a criminal liability for boards that do not tell patients or their families where there has been harm and that do not tell the regulator; boards will have a responsibility to be honest, open and transparent about their record. That has to be the starting point if we are going to turn this around.

[Dr Sarah Wollaston (Totnes) (Con)]

The public will be horrified, but probably not surprised, to hear that Ministers were leaning on the CQC not to criticise NHS hospitals. Leadership has to start at the top, so will the Secretary of State confirm that he will be fearless in standing up for whistleblowers and those protecting patients in the NHS? [Interruption.]

[Mr Hunt]

I thank my hon. Friend for that. She is absolutely right to say that the biggest responsibility Ministers have when faced with such tragedies is to be open and transparent about the scale of the problems; otherwise, they will never be addressed. Let me put it this way: people who love the NHS and are proud of it are the people who most want to sort out these problems when they arise. That is why it is incredibly important that we are open and candid. [Interruption.] The right hon. Member for Leigh (Andy Burnham) has stood up and criticised me in the media every single time I have given a speech drawing attention to some of the problems facing the NHS. He needs to be very careful every time he does that, because I will continue to do this, and I do it because I want the NHS to get better and believe it can be better.

[Stephen Barclay (North East Cambridgeshire) (Con)]

James Titcombe this morning spoke of ministerial pressure on the CQC. Further to the statement by the right hon. Member for Leigh (Andy Burnham) about full transparency and the fact that data protection should not be an impediment, will the Secretary of State have discussions with him as to whether, within the very narrow remit of the Department’s dealings over Morecambe Bay with the CQC, he will apply full transparency to his involvement in this issue?

[Mr Hunt]

I will absolutely do that, yes.

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

I echo the sentiments of the right hon. Member for Exeter (Mr Bradshaw) and ask the Secretary of State to look urgently at the application of the Data Protection Act if accountability is to mean anything at all. I urge him also to look at the lessons that a change of leadership effected in the CQC and the era of transparency that that heralded. There is a cover-up which is not just about Morecambe Bay; it is about Mid Staffs, and I suspect that, sadly, other stories may emerge of other such horrors. Does my right hon. Friend think there should be an inquiry into the culture of lack of transparency and cover-up that involved senior managers, and will he consider a change of leadership in order to herald a proper culture change in the NHS?

[Mr Hunt]

My hon. Friend has campaigned with great assiduity and distinction on this issue. The report about the culture of cover-ups and secrecy was the Francis report, and my job now is to do what is necessary to bring forward the change so that we move on and have a culture of openness and transparency. That means, yes, openness and transparency in this place and among Government Departments and regulators, but it also means creating a culture for front-line staff where they feel that they can raise concerns. We do not do that as well as we should, and it is even more important.

[Mr Jamie Reed (Copeland) (Lab)]

I share a great deal of the sentiments that the Secretary of State has expressed. He said at the Dispatch Box that the involvement of lay inspectors in the CQC was a problem, yet the Keogh review, which I comprehensively support, is involving significant numbers of lay inspectors. Does the Secretary of State agree with that approach? Is it the right or the wrong way forward?

[Mr Hunt]

As I understand it, the terms of reference, the way it is conducted and the timetable for the review happening at the moment are being set independently, but we should give every support to the people doing that review to make sure that they have access to the clinical expertise they need.

[Dr Phillip Lee (Bracknell) (Con)]

I very much welcome the Secretary of State’s desire to see published appropriately contextualised surgical outcome data for each surgeon. Those surgeons, however, have to work within structures created by managers, so in the interests of transparency would he support the publication of each manager’s performance so that the public can see where failure is taking place? First, that could prevent the merry-go-round of jobs, Cynthia Bower being the classic example. Secondly, appropriate financial penalties can be applied to the said managers if they fail, as they clearly have done in Morecombe.

[Mr Hunt]

My hon. Friend speaks extremely wisely. One of the key issues raised by the Francis report was the fact that we have a form of accountability for doctors and nurses—it does not always work as well as it should—through the possibility of being struck off by the GMC and the Nursing and Midwifery Council, but there is no equivalent accountability for managers. In a way, that is what the chief inspector is going to do. That is why I was so keen that as well as looking at whether a hospital is safe or not, the chief inspector should rate hospitals with Ofsted-style rankings, which look clearly at the quality of leadership in every organisation. The score that a hospital or a trust gets from the chief inspector will ultimately be the determinant of whether or not an organisation is well led. That is why I think it will give the public vital information about leadership, which they do not have at present.

[John Stevenson (Carlisle) (Con)]

As the Secretary of State knows, there have been issues about patient care in the North Cumbria University Hospitals NHS Trust. I therefore fully support the introduction of a more robust CQC regime than the one that previously existed. What does the Secretary of State intend to do to ensure that failing trusts are taken over in a timely and efficient manner so that new leadership and new management may be put in place as soon as possible?

[Mr Hunt]

My hon. Friend speaks well. Even under the current system, when problems are identified they seem to fester without being properly addressed. Under the new single failure regime for hospitals, when failure is identified there will be a maximum period of one year to sort it out or the board’s trust will be suspended. There will be a cut-off which does not exist at present to make sure that the local NHS, the trust board and, in the end, even Ministers bite the bullet when there are problems so that we do not allow them to continue.

[John Pugh (Southport) (LD)]

After Francis, after the Health and Social Care Act 2012, are we not asking a deeply dysfunctional and damaged organisation to shoulder additional responsibilities? Is not that in itself risky? In the Secretary of State’s statement he mentions “potentially criminal prosecution” of providers. Exactly who will be prosecuted? Managers? Clinicians? Board members? And exactly on what charge?

[Mr Hunt]

The criminal sanctions apply to boards for withholding information about safety breaches at their trust, and as I mentioned earlier, we are considering whether those sanctions should apply below board level. We want to wait for Professor Berwick’s advice on that, because there is a balance between proper accountability for mistakes and the need to create that culture of openness, where people report mistakes that they might see a colleague making, which might not happen if they were worried about criminal prosecutions. I want to take the advice of an expert on that.

[Andrew Stephenson (Pendle) (Con)]

I and the people I represent are rightly proud of our NHS. However, from Morecambe Bay to Mid Staffordshire we have had a series of scandals. Can the Secretary of State reassure patients that the previous Government’s culture of secrecy and neglect will now be torn apart and replaced by a new, transparent, accountable health service that treats patients with dignity, rather than as numbers?

[Mr Hunt]

The big challenge of our times for the NHS is to make that culture change, and it is a huge organisation. With 1.3 million people, we will do this only if we tap into and harness the desire that they have to do their jobs to the highest standards of patient safety, treating people with dignity and respect. That will be the key to unlocking success.

[Mark Pritchard (The Wrekin) (Con)]

The Secretary of State rightly said that individuals must be held accountable for their actions. To what extent does he think some former Labour Ministers were complicit in this disgraceful cover-up?

[Mr Hunt]

They need to explain why Barbara Young made the comments that she did. I think there was a general desire to talk up the NHS and not to talk about some of the very deep-seated problems that have now come to light. It is our duty in all parts of the House to make sure that we have a more mature discussion about the NHS when problems arise, and that we do not always seek to throw party political stones but recognise when problems arise. We should talk about them, not cover them up.

[Margot James (Stourbridge) (Con)]

I attended a presentation given by the CQC in early 2011 and I was shocked at the low calibre of what I heard. In particular, I found the CEO at that time to be out of her depth. My right hon. Friend will know that the individual concerned was previously CEO of the West Midlands strategic health authority between 2006 and 2008, at the time of the scandal of Mid Staffs. Will my right hon. Friend say a little more about what he plans to do to improve the appointment process for senior positions in the wider health service to ensure that proper scrutiny of people’s prior performance takes place?

[Mr Hunt]

That is a very good question from my hon. Friend. We need to make sure that we have absolutely the right people in place. One of the lessons that we have learned from Ofsted, which has been an extremely successful regulator in the education sector, is that what works is having people who are prepared to speak truth to power—who are prepared to say uncomfortable things even to the people who have appointed them. I have had this conversation with Mike Richards, because I have the highest opinion of Mike, and I also know that he will say things while I am Secretary of State that will make me deeply uncomfortable. We have to understand that part of the way that we will make sure that the NHS is and continues to be one of the very best health services in the world is having that rigour in the inspection process.

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

Many families in Bury, Ramsbottom and Tottington in my constituency will have elderly relatives living in care homes, which they will have chosen on the basis of CQC assessments. Can my right hon. Friend reassure them that these care homes, inspected and approved by the CQC, are in fact up to standard?

[Mr Hunt]

We have not talked very much about care homes during these questions, but anyone who saw the horrific “Panorama” programme earlier this week on the BBC will know that there are some appalling problems in some of our care homes. We need that same independent, rigorous inspection in care homes as well. That is why, alongside the chief inspector of hospitals, we are appointing a chief inspector of social care who will once again—it is a great shame that we stopped doing this—rate care homes on the quality of care that they give and speak without fear or favour, so that we can reassure my hon. Friend and his constituents.

[Greg Mulholland (Leeds North West) (LD)]

Last week and this week, the Secretary of State has made bold and helpful statements in the interests of NHS accountability, and I commend him for doing that, but does he accept that we have a real problem in the structure of democratic accountability in the NHS? As he knows, there has been great leadership, including from some of his Back Benchers, and will he commission a review now so that we can all have confidence that there is a proper democratic structure of accountability to oversee all parts of the NHS?

[Mr Hunt]

I thank the hon. Gentleman for his comments, and I hope that he will bear with me as the profound changes that we are introducing this year are rolled out. The most important element of democratic accountability is making sure that the public have the same information as the experts, so that they know whether their local hospital, GP surgery and care home are doing well. That is one of the biggest imbalances and that is why I am putting a lot of emphasis on the new chief inspectors, who will have the status, authority and resources to make those judgments, so that the public know what sometimes only the system has known. Then we will help to address some of the issues that he raised.

Health Select Committee Report (Public Expenditure)

Jeremy Hunt Excerpts

Thursday 13th June 2013 Written Statements

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

I have today laid before Parliament “Government Response to the House of Commons Health Select Committee report into Public Expenditure on Health and Care Services: Eleventh Report of Session 2012-13”, Cm 8624.

Even with this Government’s £12.7 billion investment in the NHS and additional £7.2 billion investment in adult social care, I acknowledge that our health and care system is facing enormous pressures from rising demands for its services. Yet both the NHS and local authorities are rising to these challenges, and through a combination of increased efficiency and wiser spending are continuing to deliver high-quality care for their patients and service users.

However, we do need to go further than just delivering the same service. If we are to meet the needs of our ageing population, the NHS and its partners in social care need to look seriously at how care is being provided, particularly to older patients and those with long-term conditions.

Our healthcare services need to be more efficient. This does not mean cutting services or finding short-term fixes—it means getting better services to people in a timely way. The number of people over 85 is set to double in coming decades. Doing things differently is the only way we will meet people’s expectations within a constrained budget.

Since April—under this Government’s reforms—GPs, local authorities and hospitals are now working together to make sure that services are integrated and that more is provided in the community and closer to patients’ homes.

Children’s Heart Surgery

Jeremy Hunt Excerpts

Wednesday 12th June 2013 Commons Chamber

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

With permission, Mr Speaker, I would like to make a statement on the Safe and Sustainable review of children’s congenital heart services.

On average, around 3,700 heart procedures are carried out each year on children who have been diagnosed with congenital heart conditions. The mortality rates at Bristol royal infirmary identified as far back as 1989 indicated that we are not as successful as we should be in such operations. The Safe and Sustainable review began in 2008 and set out to ensure that children’s heart services are the best they can be for all children across the country. Whatever the controversy about the location of such services, we all have a responsibility to ensure the best possible outcomes for children and their families, who must always come first in any decision about service provision.

Sir Ian Kennedy, in his Bristol inquiry report in 2001, recommended the concentration of medical and nursing expertise in a smaller number of centres. Subsequent working groups and reports have endorsed that recommendation, including the Royal College of Surgeons in 2007. The public consultation on the Safe and Sustainable review received more than 75,000 responses. This was the largest review of its kind, conducted independently of Government by the NHS. In July 2012, the then Joint Committee of Primary Care Trusts, on behalf of local NHS commissioners, decided that children’s heart surgery networks should be formally structured around specialist surgical centres in Bristol, Birmingham, Liverpool, Newcastle and Southampton, as well as Great Ormond Street and the Evelina children’s hospital in London. The JCPCT recommended that services should no longer be provided in Leicester, Leeds and Oxford or at the Royal Brompton or Harefield in London.

Following the JCPCT’s announcement, three local health overview and scrutiny committees formally referred its decision for me to review. I wrote to the Independent Reconfiguration Panel asking it to undertake a full review of the proposals. I received that report on 30 April, and I would like to thank the IRP for producing such a comprehensive review of such a challenging topic. It strongly agrees with the case for change—specifically, that congenital cardiac surgery and interventional cardiology should be provided only by specialist teams large enough to sustain a comprehensive range of interventions, round-the-clock care, specialist training and research. I agree with the IRP’s analysis.

However, the report also concludes that the outcome of the Safe and Sustainable review was based on a flawed analysis of the impact of incomplete proposals and leaves too many questions about sustainability and implementation. This is clearly a serious criticism of the Safe and Sustainable process. I therefore accept the recommendation that the proposals cannot go ahead in their current form, and I am suspending the review today. NHS England will also seek to withdraw its appeal against the judicial review successfully achieved by Save Our Surgery in Leeds. None the less, the IRP is clear that the clinical case for change remains, and its report is helpful in setting out the way forward in terms of broadening the scope of the discussion and looking in detail at the affordability and sustainability of the proposals. The IRP says, and I agree, that this is not a mandate for the status quo or for going back over all the ground already covered during the last five years. The case for change commands widespread support, and we must continue to seek every opportunity to improve services for children.

The recommendations in the report set out the IRP’s view of what needs to be done to bring about the desired improvements in services in a way that addresses the gaps and weaknesses in the original proposals. Specifically, they include better co-ordination with the review of adult heart surgery services; expanding the detailed work on the clinical model and associated service standards for the whole pathway of care, beyond surgery; services to be fully modelled, and their affordability re-tested; NHS England to establish a systematic, transparent, authoritative and continuous stream of data and information about the performance of congenital heart services; NHS England and the relevant professional associations to put in place the means to continuously review the pattern of activity and optimise outcomes for the more rare, innovative and complex procedures; NHS England to reflect on the criticisms of the JCPCT’s assessment of quality and to learn lessons to avoid similar situations in its future commissioning of specialist services; and NHS England to use the lessons from this review to create with its partners a more resource-effective and time-effective process for achieving genuine involvement and engagement in its commissioning of specialist services.

NHS England now must move forward on the basis of these clear recommendations and the Leeds court judgment. I have therefore written today to NHS England, and to the local overview and scrutiny committees that originally referred the JCPCT’s decision to me, to explain that the IRP’s report shows that the proposals of the Safe and Sustainable review clearly cannot go ahead in their current form. It is right to give all the parties some time to reflect on the best way forward, now that the IRP report is in the public domain, so I have asked NHS England to report back to me by the end of July on how it intends to proceed. In the meantime, it is important to stress that I believe that care for children with congenital heart conditions is safe in the NHS, and that ensuring it continues to be will be the top priority for all involved in this process.

I know that many families have found the Safe and Sustainable review to be a traumatic experience. People are rightly proud of the hospitals and the staff that have saved, or tried their very best to save, the lives of their children. However, there is overwhelming consensus that we cannot stick with the model of care that we have now. To do so would be a betrayal of the families who lost loved ones in Bristol and who want nothing more than for the NHS to learn the lessons from their personal tragedies. So it is right we continue with this process, albeit in a different way. But it is also essential that the process should be performed correctly so that any decisions, as difficult as they might ultimately be, carry the confidence of the public. I commend the report and this statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for giving me early sight of his statement. He was right to begin by reminding the House of the events that led to the Safe and Sustainable review. Terrible failings in the care of very sick children at the Bristol royal infirmary in the 1980s and 1990s led Sir Ian Kennedy to call for expertise to be concentrated in fewer surgical sites—a call supported by more recent events, including those at the John Radcliffe hospital in 2010. Since Bristol, Sir Ian’s important conclusion has had the full support of the health professions and of those on both sides of this House. As we digest what the Secretary of State has just said, two considerations must remain at the forefront of our minds. First, that this issue must continue to transcend party politics. Secondly, that the complexity it presents should not derail our determination to deliver the safest possible care for children in England.

That said, changes of this magnitude must be able to command public confidence and consensus, but that has not emerged since the decision on site selection by the Joint Committee. I fully support the reduction in sites, but when the decision was published I expressed concern about the distribution of the seven sites, which was skewed towards the western half of England and left a large swath of the east, from Newcastle to London, without a surgical centre. For a family in Hull or Lincoln, already at their wits’ end with worry, the wrench of leaving home to travel hundreds of miles, along with the cost of accommodation and time off work, would add to high levels of stress and anxiety. That is why the issue has aroused such strength of feeling, particularly across Yorkshire, the Humber and the east midlands—a concern well voiced and represented by Members throughout the House.

Although clinical safety must predominate, does the Secretary of State agree that the NHS needs to give more consideration to public access and travel times when reconfiguring services? The truth is that the NHS has a habit of minimising these concerns in all reconfigurations—in this case, as the IRP report points out, the Joint Committee considered access the least important factor. The IRP concluded, surely rightly, that

“the decision used a flawed and incomplete analysis of accessibility”.

Going forward, will the Secretary of State ensure that this is corrected and that access is made a significant factor in any future decision?

Turning to the review itself, the Secretary of State will know that one of the main concerns has been that the mortality data were not given enough weight. Although decisions of this kind cannot be based on death rates alone, we agree with John Deanfield, director of the National Institute for Cardiovascular Outcomes Research, who wrote in his letter to NHS England in April:

“Mortality is only one measure of quality, but currently is the most…available outcome.”

Will the right hon. Gentleman confirm that these data will feature more prominently in the further process of review announced today?

My main concern with what the Secretary of State has just announced is the proposal to link the children’s review with the review of adult heart services, and the implications that might have for the timetable. The Secretary of State will know that there are around 30 centres across England carrying out adult heart surgery. The seven selected children’s centres are not all co-located with adult heart surgery and, indeed, a number of them are on specialist children sites, so the link between children’s and adult heart surgery is not clear. Is there not a real danger that by linking the review with adult heart surgery, the Secretary of State is introducing more complexity and, potentially, controversy, risking a loss of focus and more delay? By broadening out in this way, is there not a danger that we will lose the consensus that has already been gained over the future of children’s heart surgery? I would be grateful if the right hon. Gentleman would say more on those points.

This decision will also have implications for the timetable of the children’s review and it will not have escaped the House’s notice that that Secretary of State has not announced a clear timetable. Can he set out more precisely a timetable for the decision making that will now follow? He says that the review will be concluded by the autumn. What people will want to know is when the decisions will be made and implemented. Can he say more about that? The statement sets out a major role for NHS England and questions may be asked about the independence of the review he has announced. What guarantees can he give that NHS England will operate independently of vested interests linked to the 10 sites?

Finally, I am sure the right hon. Gentleman will agree that we cannot risk any loss of confidence in the process, damaging confidence in all 10 existing sites. Will he say more about what he will do in the interim to support all existing units and ensure that there is no loss of expertise?

In conclusion, it is, of course, essential that the public have confidence in the process and the final decision. Balanced against that, however, is the fact that unnecessary delay will not bring the best results for the children who most need our help. The Secretary of State is right to say that we need a process that is seen to be fair by all concerned, but, equally, a point will come when decisions must be made. In the end, I want to assure the Secretary of State that when he comes to face up to those difficult decisions, he will have our support in doing so.

[Mr Hunt]

I thank the right hon. Gentleman for the tone of his comments and the bipartisan way in which he has approached these issues. I particularly welcome his last point. We have many debates in this House, but this is one issue where we are completely at one. If there is a difficult decision to be made that will save children’s lives, we must have the courage to take it. I am grateful for the right hon. Gentleman’s support on that.

I think that the right hon. Gentleman will also agree with me that while this issue transcends party politics, it is one from which all of us—on both sides of the House, throughout the NHS and indeed in local authorities—have things to learn. I think that the biggest issue for us all to consider is the sheer amount of time that it has taken. The original concerns about what happened in Bristol were raised in 1989. I am pleased to say that they have been dealt with, but there are broader, system-wide lessons to be learnt. It took until 2001 for Sir Ian Kennedy’s report to be completed, it took until 2008 for the Safe and Sustainable review to begin, and now, in 2013, we are having to suspend the process yet again. What has happened is not the right outcome for children, and we must all learn the lessons from that.

The right hon. Gentleman mentioned site selection. I consider that to be one of the most crucial areas in which the process was flawed. Whether we should involve adult heart services is a difficult question, but one of the key recommendations in the IRP’s report is that they should be taken into account. I think that we should pay attention to that recommendation, because the panel thought about it very carefully. The reason for its view was that the same surgeons often operate on children and on adults. Adults also have congenital heart conditions that require operations. The panel also says that if the best outcomes are to be achieved for children, services must be concentrated in teams that have four full-time surgeons, provide specialist training, and conduct research. The knock-on impact of what is happening in adult heart services is relevant.

I agree with the thrust of what the right hon. Gentleman said about mortality data, but I know that he will also understand the difficulty of publishing such data on a very small number of cases when they may not be statistically significant. That was one of the great debates that we had over the temporary suspension of services at Leeds. We must be careful not to publish data that could lead the public to make the wrong conclusions. In principle, however, transparency is the most important thing for us to bring about.

I entirely agree with the right hon. Gentleman about the timetable. I think that we must get on with this process: I do not want to delay it any more than is necessary. I have talked extensively to NHS England about how it should be approached. NHS England—along with all the stakeholders involved—needs time in which to digest the contents of the IRP report, which was published only today. I consider that the minimum period that I need to allow it to come up with the timetable is until the end of next month. I appreciate that that is six weeks, but I think that it is a sensible period. I certainly want to be able to publish an indicative timetable by then, so that people can understand how the process will continue and how we will learn the lessons.

I also agree with the right hon. Gentleman that nothing in my statement should undermine the public’s confidence in the brilliant work being done by heart surgeons all over the country for adults and children. Our heart surgery survival rates have improved so much that they are now some of the best in Europe, and we can be very proud of the work that those surgeons do, day in, day out. However, that does not mean that we cannot strive to be even better.

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the statement, although, in a sense, I welcome it with a heavy heart. Does my right hon. Friend agree that the Safe and Sustainable process could not go ahead because it had fundamentally lost the confidence of patients and clinicians, and therefore did not form a proper basis for necessary change?

Given that it is now more than 12 years since the publication of Sir Ian Kennedy’s report, does my right hon. Friend agree that this is not a success for the NHS? Does he agree that it is a real challenge for NHS England to put a proper time frame around necessary change for these services, and then to use that as a basis for changes that we know to be needed in other specialist services in the national health service?

--- Later in debate ---

[Mr Hunt]

I agree with my right hon. Friend on both those points, as, indeed, on many others. It is true that the Safe and Sustainable process did not have the confidence of the public. It should be emphasised that when a controversial and difficult change is proposed, there is always likely to be public opposition. However—as I am sure we shall hear from Leeds Members in particular—this process did not command confidence in Leeds, or in other centres, because there was a sense that the outcome had been determined before the start of the consultation. The public found that totally unacceptable, and indeed it is unacceptable. The point of a consultation is for those who initiate it to listen genuinely, and to engage with stakeholders. That must be one of the most important lessons to learn.

My right hon. Friend was also right to suggest that, in general, this is not a success for the NHS. We need a much better process to enable us to face difficult decisions about reconfigurations of services, and, in particular, carrying the public with us when we must make a difficult change that will save lives. We have not done that as well as we need to.

[Hilary Benn (Leeds Central) (Lab)]

It has been clear to many of us for a long time that this process was flawed, and that has now been recognised by the IRP. I pay tribute to the extraordinary campaign in support of the Leeds children’s heart surgery unit in my constituency, which has helped to bring us to this day.

I welcome the Secretary of State’s statement, but does he agree that it is important for the process to be open and transparent this time, and to focus on what it is meant to be about, namely ensuring that the very best surgery is available for our very sick children?

[Mr Hunt]

That is entirely right. On this occasion, it is clear that the concerns of the campaigners were valid, and that the process was not conducted as it should have been. Interestingly, the campaigners commented that they felt that their engagement with the IRP was a much more open process than their engagement with the NHS.

Many people in the NHS believe passionately, and for absolutely the right reasons, that we need to change the way in which services are delivered. I agree with them, and specialised services such as those that we are discussing today provide a very good example of that. We know that the more operations a heart surgeon performs, the better he or she will become at his or her job, and the more likely a successful outcome is. However, if we are to carry the public with us—and they are, after all, the people whom the NHS is there for—we must do a much better job of genuine engagement.

[Sir Edward Garnier (Harborough) (Con)]

I thank the Secretary of State for an intelligent and thoroughly considered statement which will have brought great joy to many people in Leicestershire. I also commend the shadow Secretary of State for dealing with the matter on a cross-party basis. We in Leicestershire have dealt with it on that basis as well: my hon. Friend the Member for Loughborough (Nicky Morgan) and the hon. Member for Leicester West (Liz Kendall) have been, if I may say so, the leading ladies in the Glenfield hospital campaign.

I am grateful for the respite that we are being given by the Secretary of State. What advice can he give us to give to the clinicians, nurses and parents of patients at Glenfield hospital about how best to present, or re-present, their case between now and the time at which he and his advisers will reach a final conclusion about the disposition of children’s heart services?

[Mr Hunt]

We must all engage with the process thoroughly and fully. We, as Members of Parliament, have a responsibility to engage with our constituents about some of the complexities involved. The issue of mortality rates, which was raised by the right hon. Member for Leigh (Andy Burnham), is one of those complexities. They are very important, but they are not the only consideration, and, when it comes to specialised services, they are extremely difficult to interpret properly. We must engage in an intelligent and constructive way, and reassure our constituents that all of us—Government and Opposition—want the best outcome for children, the outcome that will save the most children’s lives.

Let me return to what the Prime Minister said earlier. I have no problem with explaining to my constituents that in the case of certain services, they are better off travelling further. I did not respond earlier to the right hon. Gentleman’s point about travel, so let me say now that I agree with him that it must be taken into consideration. According to the IRP’s report, the whole care pathway needs to be examined. That means not just the visit to the hospital for surgery, but follow-up care and early assessments. In that context, travel becomes much more important.

If we are honest with our constituents about the fact that there may be a difficult decision at the end of the process, we are much more likely to earn their trust.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

How much public money has been spent on taking us to the point that we have now reached? Is the IRP report available to Members of Parliament? Will the Secretary of State say a little more about the process that will take place between now and the day on which he must come to the Dispatch Box and announce very difficult and controversial decisions to the House, and will his decisions stick?

[Mr Hunt]

The cost to date of the Safe and Sustainable process is about £6 million and Members of this House will rightly ask whether that money has been spent well, given the flaws in the process identified today by the IRP. I would also say, however, that it is right to spend money on carrying out such processes properly. It would be the wrong approach to say that, based on the cost of the process, we are not prepared to consider how we can improve services.

On the timetable, now that the report is public—it is available to Members of the House and the public as of today—I have given NHS England and all stakeholders until the end of next month to come back to me with a revised plan.

[Jason McCartney (Colne Valley) (Con)]

I agree with the Secretary of State that families must come first. For me, that means the families of Ben Pogson and Joel Bearder, young constituents of mine who have been treated at the wonderful Leeds unit. Will my right hon. Friend give an assurance that the new review will be based on the fundamental principle of patient choice and that doctors should go where the patients are, rather than the other way around?

[Mr Hunt]

Patient choice is very important, but it is also fair to say that there are other considerations in such a review, such as clinical best practice and what outcomes will get the best results for children. We need to be up front with the public that that will not mean specialist children’s heart surgery being offered in every major city in this country. There will be some difficult decisions at the end of the process. The broader point about patient choice, when it comes to considering mortality rates, is that it ties in very well with the concept of peer review. The way we can get better outcomes for children is by being able to compare what happens in different centres, and that is a very important part of the process.

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

Will the Secretary of State acknowledge one fact that has complicated this process? A foundation trust that loses children’s heart surgery will probably lose paediatric intensive care and, therefore, all the rest of its paediatric service activities, doing potentially catastrophic damage to the budgets of some trusts. Are the institutional pressures on individual trusts not one reason why it has been so hard to get a collaborative approach to that fundamental change? How does the Secretary of State intend to resolve that issue as he moves forward with the review?

[Mr Hunt]

The independent review says that the knock-on effects on adult heart surgery, and the interrelationship between the two, need to be considered. There are always knock-on effects of a service reconfiguration. Within reason, one must consider them, but one must also bear in mind what the right hon. Member for Leigh said: one must ensure that one does not overcomplicate the reviews. If we consider every single knock-on effect of every single change, the danger is that we end up not being able to change anything at all, which on this occasion would be an abdication of our important responsibilities.

[Greg Mulholland (Leeds North West) (LD)]

I have called consistently for leadership and accountability. I believe that we have had those things today, and I thank the Secretary of State and his colleagues in the Department for that. I have said consistently that there was something wrong with the decision-making process. We were right, whereas those who told us that we should be quiet and ignore the serious flaws, clear bias and utter lack of transparency were wrong. May we have a full investigation into the clear maladministration in the course of the review? Will the Secretary of State assure the House that lessons will be learned, which is key, and that those conflicted people who have let children down and wasted taxpayers’ money will play no part in any further review in the NHS?

[Mr Hunt]

I can confirm that a thorough process of learning the lessons will happen. As I said earlier, we must learn big lessons about the time it takes to make very important service changes in the NHS, not just in children’s heart surgery but in many other areas. We need to learn those lessons. The person who was responsible for the JCPCT, Sir Neil McKay, is no longer responsible and has retired from the NHS. We need to look at everyone who was involved in the process and see where the right calls were and were not made. If we do not, we will never be able to make important changes in the NHS—and we have a big responsibility to make those changes.

[Mrs Mary Glindon (North Tyneside) (Lab)]

The proposed reconfiguration of children’s heart surgery has gone on for years. Meanwhile, children are suffering and even dying. Why cannot the Secretary of State have a more rigorous timetable based on the lessons learned from the review so far?

[Mr Hunt]

That is what I absolutely want to do. One huge frustration for those on both sides of the House has been how the process has dragged on. If I could have come to the House today with a detailed timetable, I would have. Although we had internal access to the report before today while I considered its findings and reached a judgment, we believed that it was necessary for external stakeholders to see the report and give their view of how the timetable should proceed. That is why I have given NHS England until the end of July to come back with that timetable.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

The Health Secretary is absolutely right that parents in my constituency have found this process deeply destabilising. Although they also want to see quality, they felt that their concerns about building up a good relationship with their medical teams and about accessibility and co-located services were simply dismissed. Will the Health Secretary assure me that that will not be the case in the future, and will he look more closely at the networking solution we have in Oxford and Southampton, which strikes a good balance between having a quality site further away and providing aftercare in an accessible site with trusted medical teams?

[Mr Hunt]

That is a very interesting thought. My hon. Friend will be pleased to note that the IRP report states that the whole care pathway, not just the surgery on its own, needs to be considered when we make this very difficult decision. I agree with her that this has been a very distressing process for every family involved and although we are suspending the process today, we have a responsibility to be honest with people. At the end of the process, there will be a difficult decision to take and we will honestly do our duty as Members of this House.

[Fabian Hamilton (Leeds North East) (Lab)]

I know that all the families of children affected throughout Yorkshire will welcome today’s statement from the Secretary of State. Will he reassure the House that any future review panel, following whatever timetable he decides, will comprise representatives fairly and equally chosen from all the centres that will be affected by any decisions? Secondly, what assurances can he give that rather than the data used in flawed reports, such as the now infamous National Institute for Cardiovascular Outcomes Research 8 April report on mortality data in children’s heart surgery units, we will use data that are consistent and reliable?

--- Later in debate ---

[Mr Hunt]

On the hon. Gentleman’s second point, we need to be very careful about how we use any mortality data, particularly on specialist services where distortions can be based on just one or two operations. I know that he will agree, however, that we have a responsibility to act if we have genuine concerns. That is what happened and the process over Easter was very difficult. One lesson we have learned in the NHS is that in Bristol it took a very long time—years—before anything was done about the higher mortality rates and we do not want to make that mistake again. I take on board the hon. Gentleman’s other point, too.

[Jane Ellison (Battersea) (Con)]

I know that many of the staff and patients at the Royal Brompton hospital will very much welcome my right hon. Friend’s statement today. Although the hospital is not in my constituency, many of the staff live in my constituency and other hon. Members have been extremely active in making the Royal Brompton’s case over recent months. There was particular concern about the possible impact on other specialisms of any decision to withdraw children’s heart surgery, so can my constituents be assured that such concern will be taken into account in any future process?

[Mr Hunt]

The IRP report says that we must consider the broader impact of any changes beyond the narrow question of children’s heart surgery, so I am sure that that is one of the lessons that will be learned.

[Several hon. Members]

rose—

[Dr Phillip Lee (Bracknell) (Con)]

My apologies, Mr Speaker. As someone who has long argued for the reconfiguration of acute and surgical services, I consider the management of this clinical consolidation to be of great importance. Does the Secretary of State agree that best clinical outcomes should be the primary driver of any reconfiguration and that there is a need for a national plan for the reconfiguration of all acute and emergency services? If such a plan were drawn up, it should receive cross-party support.

[Mr Hunt]

May I commend my hon. Friend, because he is one of the few Members of this House who has been prepared to campaign for changes in acute services in his own constituency, which might not necessarily be what his constituents would want? He has shown considerable bravery on this issue. I will mention his idea of a national plan for acute and emergency services to Sir Bruce Keogh, who is carrying out the review of emergency services as part of the vulnerable older people plan. We definitely need to have a different national approach to service reconfigurations.

[John Healey (Wentworth and Dearne) (Lab)]

What a waste of everybody’s time. Why should anyone believe that the new review process will be better than the last one or that the Secretary of State will make decisions at the end of it? Will he apologise now to the parents, the families and the staff for allowing this flawed and failing process to go on for so long and for the anguish that they have suffered during it?

[Mr Hunt]

I think we have been having a constructive discussion about an extremely difficult issue, in which I hope I have spoken for the whole House in saying that there are things that we need to learn on all sides, as the earliest signs went back as far as 1984 and still, in 2013, we have not been able to make the progress we should. It is important that we maintain that bipartisan approach, because at the end of this process there will be difficult decisions to make and we need to maintain public confidence that we are thinking about this in a non-party-political way.

[Stuart Andrew (Pudsey) (Con)]

I think I can hear the cheers in Leeds as I speak. May I put on the record my thanks to the IRP and to my right hon. Friend the Secretary of State for listening to our concerns in a very difficult situation? These findings clearly vindicate what we have been saying all along, but as we move forward will he agree to meet me and clinicians to maximise confidence in the future review? Will he assure us that co-location of services, accessibility and patient experience are paramount and that all units will have the same scrutiny as the one in Leeds has undergone? May I invite him to visit the unit in Leeds, so that he can meet the patients, families and staff with whom it has been my privilege to work?

[Mr Hunt]

I congratulate my hon. Friend on campaigning for children’s heart surgery in Leeds in an exemplary way, and he deserves huge credit for the responsible approach he has taken throughout. I would be delighted to meet him and clinicians from Leeds. Many things need to be learned, but his points about the importance of the patient experience, of clinical outcomes and of an impartial process in site selection, which is at the heart of the concerns people had about this process, are ones we need to reflect on very hard indeed.

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

I welcome the statement that the right hon. Gentleman has made today. Notwithstanding the fact that we would all want the best possible outcomes from this surgery, wherever it takes place, site selection or geography is a concern for us, for the health service and for patients and their families, so can we make sure it is taken into account? If skills are seen to be weak in certain geographical areas of the UK, we should improve those skills, not think about moving people elsewhere.

[Mr Hunt]

The right hon. Gentleman makes an important point. Site selection needs to be done by people who are completely independent of any local interest in where the surgery should happen. That is the crucial point we need to learn, but the point about skills is also important.

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

May I praise my right hon. Friend for his brave and eminently sensible statement today on this most emotive of topics? However, will he assure the House that any future plans to remove children’s cardiac services from the Glenfield hospital in Leicester will take full account of the world-leading extra corporeal membrane oxygenation services which will also have to be moved? The Secretary of State is completely right on this issue and many others: we do not need a quick solution; we need the right solution.

[Mr Hunt]

I agree with my hon. Friend, but I would actually like a solution that happens as quickly as possible, provided the process is done properly. He will be pleased to know that the IRP report does say that the impact of suspending the review and thinking again should be borne in mind in respect of decisions that have already been made as to the siting of ECMO services, and I know that NHS England will be reflecting on that.

[Dr Alan Whitehead (Southampton, Test) (Lab)]

Does the Secretary of State appreciate the sheer difficulty in respect of recruitment, retention, planning and maintenance of an excellent service that has been incurred by the units affected, particularly the one in Southampton? Is he prepared to look at the possibility of providing additional resources to those trusts affected to enable them to maintain those excellent services during a continued period of uncertainty? Not only is it a continued period of uncertainty, but there has been continued oscillation between near certainty, uncertainty, no certain and possible certainty as a result of this interminable review and the way it has been conducted.

[Mr Hunt]

I actually agree with the hon. Gentleman: one of the biggest casualties of the length of time it is taking to resolve this very difficult issue is morale at the excellent children’s heart units that we have across this country, and recruitment is one of the biggest concerns in that regard. Resources are now allocated independently by NHS England, but I know that its priority is to ensure the safety of services.

[Steve Brine (Winchester) (Con)]

May I thank the Secretary of State for his statement? Once he received the IRP report, he had little choice but to make this decision. I feel sure that it will be met with a deep sigh in Southampton, just because of the lack of certainty that it now extends for the trust there. To what extent will the Safe and Sustainable process now be rolled back? How far will it be rolled back? Is the number of centres now back in the “not sure” box? As he has said, we still face an incredibly difficult decision and there is still a reduction in the number of centres—or is there?

[Mr Hunt]

There will be a reduction in the number of centres at the end of this process, as is clear from what the IRP report says. It thinks we would have better outcomes for children if we concentrated surgery in fewer places, with more comprehensive facilities offered in all those places. However, we need to get the process right in order to get there.

[Mr George Mudie (Leeds East) (Lab)]

I thank the Secretary of State for, and congratulate him on, his decision. However, as an outsider I watched this process descending into almost a medical beauty contest, with comparing and deciding. Surely if we are rationalising the centres, the key starting point should be their placement for the maximum benefit of the populations, the patients and the parents, not this business of who has the lowest mortality rate. Doctors can move, but populations cannot.

--- Later in debate ---

[Mr Hunt]

The answer is this needs to be a mix of both; this needs to be about clinical excellence and issues such as accessibility and travel. A wide range of factors are involved. I accept, and this is widely accepted, that it is particularly difficult with specialist services to interpret mortality rates in a meaningful way, but that does not mean we should not look at them and seek to learn what we can.

[David Tredinnick (Bosworth) (Con)]

My right hon. Friend’s statement will have given great hope to all those in and around Leicestershire who campaigned to keep Glenfield hospital, and we welcome the acceptance that the original site selection was flawed and the implicit acceptance of bias against the east midlands and against the east of the country in general. On a positive note, if we are going to have the clinical case for change accepted and consolidation in the future, what is his understanding of the number of lives that would be saved if we have to go through this painful process?

[Mr Hunt]

I do not want to pluck a number out of the air; I want to listen to the clinical evidence on that. However, it is important to say that as a result of the excess mortality identified at Bristol the Kennedy report said that up to 170 lives could have been saved over a 10-year period in just one location. That is why it is so important that we get this decision right.

[Nic Dakin (Scunthorpe) (Lab)]

The Secretary of State is right to say that, sadly, the process did not have the confidence of the public. I very much welcome his statement. In moving forward, will he ensure that any data used are independent, transparent and credible, and that patient experience and access are given the right priority in the decision making?

[Mr Hunt]

Those are all things that the IRP talked about in its review, and I very much accept its recommendations in those areas.

[Mr Philip Hollobone (Kettering) (Con)]

I congratulate the Secretary of State on calling in the Independent Reconfiguration Panel, which has successfully exposed this shambles. I imagine that my constituents strongly suspect that the thick end of the £6 million cost of the exercise has gone on fat fees for management consultants. Given that the IRP concludes that there was flawed analysis and too many questions left unanswered, surely those management consultants should be banned from taking part in any further NHS reviews?

[Mr Hunt]

If there are management consultants responsible for what went wrong, I am sure that the NHS will draw the appropriate conclusions.

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

I am pleased to hear that care pathways as a whole will be looked at and given consideration. Will the Secretary of State confirm, as he made clear in response to a number of questions, that the genuine concerns of constituents, including mine in Hull, will be listened to? Transport and access are very important to my constituents because of the city’s geographical location. Whoever makes these decisions should fully understand the geography of the country and be able to make a proper decision.

--- Later in debate ---

[Mr Hunt]

I completely accept what the hon. Lady says, and obviously transport and access do matter; that comes out in the IRP report. However, we have to be honest about the fact that if we are conducting surgery at fewer sites, the end result is that some people in the country will have to travel further than they currently do. That is why this is such a difficult decision. She will understand that a choice has to be made in that respect.

[Bob Stewart (Beckenham) (Con)]

Last Saturday I attended the funeral of a girl, with my wife and my daughter Delphine. The girl was a 16-year-old in my daughter’s class. A month ago, she suddenly dropped dead. She had not been aware of any problem. Arabella Campbell was a beautiful, highly intelligent, vivacious girl who had everything to live for, and nothing was known about her problem. Can Arabella’s death, and the death of hundreds of other children and young adults, be used as a spur to reinvigorate the NHS campaign to identify young people who may suffer a heart attack as a result of a problem that has not been detected before, difficult as that may be?

[Mr Hunt]

I know that the whole House will want to send its condolences to Arabella Campbell’s family, and the way that my hon. Friend has brought the issue to the attention of the House shows the seriousness of the issues that we are considering. Part of what the IRP talks about is a proper review of the screening process for people who have congenital heart failure. Yesterday I met a group of campaigners on sudden adult death syndrome who had an equally tragic story, and I am waiting for advice from the national immunisation and screening committee on the right way forward in this respect. I thank my hon. Friend for his comments.

[Jonathan Ashworth (Leicester South) (Lab)]

Clinicians at Glenfield hospital, and people across Leicester and the wider east midlands, will welcome what the Secretary of State said today on the suspension of Safe and Sustainable, but I want to ask him a further question on the point that the hon. Member for North West Leicestershire (Andrew Bridgen) made about the future of the extra corporeal membrane oxygenation centre. The decision to move ECMO from Leicester to Birmingham was a direct consequence of Safe and Sustainable. That decision is now suspended—I hope that is what the Secretary of State is saying. Will he reconfirm that the future of ECMO provision will be fully taken into account by NHS England?

[Mr Hunt]

I can confirm that. One of the recommendations of the review was that the ECMO decision be linked to what is decided under Safe and Sustainable, and I know that NHS England will want to consider that carefully. I hope to be able to come back to the House to report what it decides as soon as possible.

[Martin Vickers (Cleethorpes) (Con)]

My Cleethorpes constituency is on the very edge of the area served by the Leeds unit, and I particularly welcome the acknowledgement that future investigations will consider geography, but as well as feeling isolated geographically, many of my constituents felt somewhat isolated from the whole process. We do not want to prolong the process unnecessarily, but will the Secretary of State assure me that there will be some mechanism allowing input from individual constituents?

--- Later in debate ---

[Mr Hunt]

I can absolutely give that assurance. The fact that the engagement with the public in this process was not as genuine as it should have been is one of the biggest lessons for the NHS to learn.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

Two years ago, almost to the day, we debated the issue in the House. I said at the time, and reiterate today, that the issue must be resolved as quickly as possible to end the damaging delay and uncertainty, and to secure the safety of children and the best clinical care for them. The Secretary of State has given a variety of reassurances, but I would like to hear a cast-iron reassurance, for my constituents, that in any future decision, clinical expertise and care will be paramount, and that this will be resolved as quickly as possible.

[Mr Hunt]

I am very happy firmly to give both those assurances.

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

The Health Secretary is absolutely right to push ahead with specialisation in cardiology services. I represent one of the most rural constituencies in England, and I thank him for taking on board the need for more focus on access. In the future, I recommend that more money and time be spent working with members of review panels, because about a year and a half ago, when MPs met them, it was clear that some of them were out of their depth. It would do everybody a lot of good if we spent more money and time helping them.

[Mr Hunt]

I thank my hon. Friend, and I am sure that that lesson will be learned.

[Julian Sturdy (York Outer) (Con)]

I very much welcome the Secretary of State’s statement, as will concerned families across my constituency of York Outer, and across the county of Yorkshire. Will he ensure that the new review recognises that units where paediatric and maternity services are located on a single site offer the optimal patient experience?

[Mr Hunt]

I think we need to be guided by the clinical evidence in that respect, but I urge my hon. Friend and his constituents, if they have a strong representation to make in that respect, to make it to the review when it re-proceeds.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 11th June 2013 Commons Chamber

[Hugh Bayley (York Central) (Lab)]

1. What plans the Government have to change the NHS formula for funding clinical commissioning groups; and if he will make a statement.

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

Allocations to CCGs are the responsibility of NHS England. However, I have been advised that NHS England will rely on advice from the Advisory Committee on Resource Allocation (ACRA) for changes in the CCG formula.

[Hugh Bayley]

The failure of the Government to use the long-established funding formula for the NHS in dividing the budget between CCGs in north Yorkshire has left us with glaring anomalies, so that in York, the funding is £1,050 per head, but for Scarborough and Ryedale, which is served by the same NHS foundation trust, the funding is £1,234 per head. That is quite unsustainable and will lead to further postcode rationing. The same funding formula must be applied to all CCGs throughout the country. When will that happen?

[Mr Hunt]

I share the hon. Gentleman’s concerns about the way that NHS funding is allocated to different parts of the country. The allocation in my constituency is about the same as in his constituency, and I have long worried that things like age and rurality are not factored into the final amounts in the way that they need to be. However, in this case NHS England decided that if it was to follow precisely the ACRA recommendations, it would lead to higher growth for areas with better health outcomes and lower growth, or even cuts, for areas with less good outcomes, which it thought would be inconsistent with its responsibility to reduce health inequalities. That is why it is conducting a fundamental review, which it says it hopes will inform the next set of allocations for 2013-14.

[John Penrose (Weston-super-Mare) (Con)]

The Secretary of State will be aware that in my area of north Somerset, in Weston-super-Mare, the actual allocations versus the intended amounts of cash which should arrive with us based on the existing formula, are well below what they should be; so even without changing the funding formula, we are still getting dramatically less cash than we should. I urge the Secretary of State to look at that swiftly and see what can be done, within the existing spending envelopes, to make the allocations fairer.

[Mr Hunt]

As I said, I share my hon. Friend’s concerns about the way funding works at the moment. We are in a very difficult situation because if we were to move closer to the formula proposed by ACRA—I am sure he would agree with me that it is right that it is done independently of Ministers, and in this case it is done under NHS England—it would mean cuts in real terms for the budgets in other areas. Given the pressures overall in the NHS, that was obviously a decision that NHS England was very reluctant to make.

[Andy Burnham (Leigh) (Lab)]

The last Government matched health funding to health need and reduced the gap in male life expectancy and infant mortality, but this Government have reduced the weighting for health inequalities. The Secretary of State’s public health allocations mean that the areas he has identified today with the biggest health challenges do not get a fair share. The area with longest male life expectancy, Kensington and Chelsea, gets £133 per head, but Liverpool gets £89, Manchester £86, Luton £61, and Slough just £37. If he really wants to do something about health inequalities, should he not match his words with deeds and give more to the areas with the greatest challenges?

[Mr Hunt]

The right hon. Gentleman really cannot have it both ways. The budget for public health is also decided by an independent body, and we gave everyone a real-terms increase and then used any remaining money to even out the differences, to get everyone as close as possible to the independent formula. But if we are talking about spending, I think the right hon. Gentleman needs to say precisely whether he stands by his assertion that Governments should cut spending on the NHS by £600 million—[Interruption.] He says he has never said it before, but actually, up till now he has always said that it was irresponsible for the Government to increase spending in real terms. We have increased it; we have increased it by £600 million. He needs to come clean on whether he still wants to cut the NHS budget.

[Julian Sturdy (York Outer) (Con)]

Given that age is the main driver for an individual’s health care needs, why has not age been given more weighting in the funding formula in the past? I urge the Secretary of State to request NHS England to give as much weighting as possible to age in any future funding formula.

[Mr Hunt]

I recognise that my hon. Friend has campaigned on that issue a great deal, and I have great sympathy, because areas with high age profiles do have much greater needs for the NHS. That obviously must be weighted against things like social deprivation, which also have an impact. It is right for these things to be decided independently, which they are. The question is how we get closest to those independent allocations, and I know that that is preoccupying NHS England at the moment.

[Mr David Amess (Southend West) (Con)]

2. What steps his Department is taking to ensure consistent and continuous provision of pre-natal and post-natal care.

--- Later in debate ---

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

I asked the Independent Reconfiguration Panel to undertake a full review of the “Safe and Sustainable” review of children’s congenital heart services. I have received and am currently considering that advice, and will make my decision known shortly—perhaps very shortly.

[Stuart Andrew]

I am grateful for that answer. Will my right hon. Friend accept that the Leeds unit has undergone the greatest scrutiny of any of the units included in the review, and has met all the standards required? Will he therefore assure patients, families and staff that both he and NHS England have every confidence in the performance and standards of the Leeds unit? If we are to have informed choices on the future of heart units, surely all units must be subject to the same scrutiny.

[Mr Hunt]

First, I want to congratulate my hon. Friend on the sustained campaigning that he has done for that children’s heart unit, and on the very responsible way that he has conducted himself in what has been an extremely difficult campaign for the people of Leeds. I have full confidence in children’s heart surgery at Leeds; I know that the Leeds unit does an excellent job. He will understand, as I do, that when there are safety concerns, they have to be investigated, but I am delighted that those issues have been resolved, and that surgery is continuing.

[John Healey (Wentworth and Dearne) (Lab)]

The hon. Member for Pudsey (Stuart Andrew) is right that the Leeds unit has been subject to greater scrutiny than any other unit, and the decisions in its case have been more seriously flawed than in the case of any other unit. What guarantee can the Secretary of State give those families across Yorkshire who depend on this major, life-changing surgery that the unit will not simply be removed from our county and put beyond their reach, taking away this vital service for them and their families?

[Mr Hunt]

The right hon. Gentleman will understand that I cannot prejudge the decision that I will take on reflection, having read the Independent Reconfiguration Panel report, so this morning I cannot give him an answer as to what will happen. However, I can reassure families in Yorkshire, and throughout the country, that where there are safety concerns, we will take them very seriously indeed and investigate them promptly, and where there are difficult reconfiguration debates to be had, we will not duck them, but in all cases, the interests of patients—patient safety and reducing mortality—must be our primary concern.

[Greg Mulholland (Leeds North West) (LD)]

18. There seems to have been little reliable evidence for the suspension of services at Leeds, but rather for the safe and sustainable review itself. Will the Secretary of State now do what NHS England has so far refused to do to the Independent Reconfiguration Panel, despite the recommendation of the health and overview scrutiny committee in Yorkshire, and finally publish all the official e-mails between the Joint Committee of Primary Care Trusts and the National Specialised Commissioning Team between 2008 and 2013, so that he can finally learn the truth about the review and what has gone so wrong with it?

[Mr Hunt]

I know that NHS England is totally committed to transparency and when I make my final decision on the Safe and Sustainable review, we will publish a lot of information. But all the things that he refers to are subject to normal freedom of information processes, and I am sure that he will pursue those.

[Paul Flynn (Newport West) (Lab)]

4. What his policy is on the introduction of standardised tobacco packaging; and if he will make a statement.

--- Later in debate ---

[Gavin Barwell (Croydon Central) (Con)]

7. What steps he is taking to increase accountability in the NHS.

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

We have transformed accountability in the health system by setting up Healthwatch and introducing stronger local democratic accountability through health and wellbeing boards.

[Gavin Barwell]

Croydon PCT’s accounts for 2010-11 showed a £5.5 million surplus; it subsequently turned out to be a £23 million deficit. The former chief executive and two former finance officers have adamantly refused to give evidence to a scrutiny committee set up by councils in south-west London. Does the Secretary of State agree that that is unacceptable and that NHS managers must be held to account, and given that two of these individuals still work in the NHS, does he have the power to compel them to give evidence?

[Mr Hunt]

Accountability is extremely important. Local authorities can require members or employees of local health service commissioners to appear and answer questions, and NHS organisations and individuals should co-operate with that. I am extremely concerned by what my hon. Friend says. He knows that I have received a report on this from the joint overview and scrutiny committees for six south-west London boroughs, and I will be responding shortly.

[Helen Jones (Warrington North) (Lab)]

Does the Secretary of State agree that accountability would be improved if the private providers who are increasingly providing NHS services were subject to the Freedom of Information Act 2000? Will he ensure that as more and more services become privatised under this Government, those people are subject to the same freedom of information provisions as those in the NHS, because otherwise no committee can hold them to account?

[Mr Hunt]

Perhaps I could gently remind the hon. Lady that the previous Labour Government did not do this, despite making huge efforts to get more private sector involvement in the NHS. Providers must operate on a level playing field, and so the inspection regime that we are setting up, with a new chief inspector of hospitals, will apply equally to the private sector and the public sector.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my right hon. Friend agree that the introduction of health and wellbeing boards represents a very welcome introduction of democratic accountability into the management of the health and care system? Does he further agree that the acid test of health and wellbeing boards will be their ability to increase the pace of integration between health and care so that the service we deliver is more closely matched to the needs of patients?

[Mr Hunt]

As is so often the case, my right hon. Friend speaks extremely wisely on this issue. Integrated services will be the big thing that transforms the service we offer vulnerable older people, which the right hon. Member for Leigh (Andy Burnham) mentioned earlier. Health and wellbeing boards will have an extremely important role to play in bringing together local authorities and clinical commissioning groups so that we have joint commissioning of services for those very vulnerable people.

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

On accountability, whenever I have asked the Secretary of State how lives might be saved by downgrading Lewisham’s A and E he has cited the medical advice of Sir Bruce Keogh. My colleagues and I have repeatedly sought meetings with Sir Bruce and it is unprecedented in my experience to not receive a response to such a request. Is the Secretary of State satisfied with that? Is Sir Bruce free to meet Lewisham MPs, or has the Secretary of State told him not to?

[Mr Hunt]

Sir Bruce is free to meet anyone he likes. Actually, he had a meeting with MPs last month, which the right hon. Lady could have attended if she had wanted to do so, and there was extensive engagement with local south-east London MPs before the decision on Lewisham hospital was made.

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

8. How many accident and emergency departments he visited in an official capacity in winter 2012-13.

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

I regularly visit a range of services across the NHS. Since taking up post in September 2012, I have visited 28 NHS front-line services, including seven A and E departments.

[Tom Blenkinsop]

Will the Secretary of State confirm that a freedom of information request to the Department of Health revealed that he did not visit an A and E unit until April 2013, a full six months after his appointment and despite a clear A and E crisis over the winter-spring period under his supervision?

[Mr Hunt]

As ever, the Labour party is being selective in its use of information. As I have said, I visited seven A and E departments, including over the Easter period when we had some severe A and E pressures that I wanted to investigate for myself. Let me tell the hon. Gentleman about another thing that this Government have done that his Government never did: it is not just Ministers who are going out on to the front line; we have asked all our civil servants to go on to the front line for up to four weeks. I am extremely proud that my Department will be the first to connect with the front line in that way, and am even prouder of the response from my own civil servants, who embraced the scheme with great enthusiasm.

[Clive Efford (Eltham) (Lab)]

Could we have some accountability for the strategic planning of A and E services across London? Nine of them face closure and 28 ambulances were redirected to Lewisham, which the Secretary of State intends to downgrade. Without a strategic approach, how can patients be confident that their best interests are being served?

[Mr Hunt]

We do have a strategic approach, but we also have some very important safeguards that any big change in approach has to go through before it is implemented. That is why I asked for a report from the Independent Reconfiguration Panel on the plans for north-west London, and I will consider that report very carefully before I make any decision.

[Paul Burstow (Sutton and Cheam) (LD)]

When considering issues relating to A and E closures, particularly the proposed closure of the A and E department at St Helier hospital, which serves my constituents, will the Secretary of State ensure that those who propose such plans make sure that there is also a costed plan for developing out-of-hospital care, which is an essential prerequisite for any changes to acute services?

[Mr Hunt]

I agree with my right hon. Friend on this issue. It is extremely important that all these plans take a holistic view both locally and nationally. That is why, in looking at how to resolve the A and E issues we have faced and the severe pressures last winter, we are looking not just at what happens inside A and E departments, but at primary care alternatives and the integration of social care services, which are all equally important.

[Mr Jamie Reed (Copeland) (Lab)]

Perhaps it took the Secretary of State so long to visit an A and E unit because he could not get in. In the midst of England’s A and E services experiencing their worst waiting times for a decade, the Secretary of State criticised hospitals for coasting. Does he regret waiting for six months before first visiting an A and E unit and finding out for himself what damage his policies were doing to the front line of the NHS? Hospital consultants, A and E consultants and patients look forward with interest to hearing his answer.

[Mr Hunt]

We will take no lessons on being connected with the front line from the party that missed 50 warning signs about what was happening at Mid Staffs. The hon. Gentleman cannot make the narrow point about how many A and Es I visited during a particular period without addressing the broad point about how connected Ministers in his party were when they were in power. They rejected 81 requests for a public inquiry because they did not know what was happening at Mid Staffs.

[Andrew George (St Ives) (LD)]

10. Whether he has any plans to review his policy on resource allocation in the NHS.

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

Allocations to the NHS are the responsibility of NHS England. However, I have been advised that it will rely on the advice of the Advisory Committee on Resource Allocation for changes to the allocations formula.

[Andrew George]

While many wealthy areas are overfunded, Cornwall is more underfunded than anywhere else in the country. In the past six years, it has received in excess of £200 million less than the Government say it should receive. It also receives the lowest tariff in the country for acute care. Is the Secretary of State prepared to meet me and other representatives from Cornwall to address the serious issues that that is causing in front-line care?

[Mr Hunt]

My hon. Friend has had meetings with my ministerial colleagues on that issue and knows that such decisions are made at arm’s length from Ministers by NHS England. The allocation for NHS Kernow is £1,235 per head and the average baseline clinical commissioning group allocation is £1,184 per head. However, I recognise that there are issues with rurality and the age profile of the population. That is why a fundamental review is taking place of the approach that ACRA takes.

[Steve Rotheram (Liverpool, Walton) (Lab)]

In response to a parliamentary question that I tabled, the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), stated that circa £15 million in underspend was handed back to Public Health England by the now dissolved primary care trusts on Merseyside. Given that Liverpool has been identified as having some of the greatest health inequalities, will the Secretary of State guarantee that every penny of that £15 million will be spent in Merseyside alone?

[Mr Hunt]

What I can guarantee is that there will be a real-terms increase in the public health budget for all local authorities under a two-year settlement, which they did not have before. I hope that the information that was published this morning, which shows how cities that are comparable to Liverpool are managing to get better health outcomes, will help the local authority in Liverpool to improve its results.

[Mike Thornton (Eastleigh) (LD)]

11. What progress he has made in delivering parity of esteem between mental and physical health.

--- Later in debate ---

[Chris Heaton-Harris (Daventry) (Con)]

T1. If he will make a statement on his departmental responsibilities.

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

There have been two important developments since the previous Health questions. First, in response to pressure on A and E departments, my Department, together with NHS England, has started work on a vulnerable older people’s plan that will act quickly to address the underlying causes of the issues, including services that are not integrated, poor IT systems, confused emergency care offered to the public and poor primary care alternatives.

Secondly, following the tragedy at Mid Staffs, I am delighted to announced that Professor Sir Mike Richards has been appointed as England’s first ever chief inspector of hospitals. He is an inspirational leader who has personally championed huge improvements in cancer survival rates. He will lead the vital work of driving up standards of safety and care throughout NHS hospitals.

[Chris Heaton-Harris]

I thank the Secretary of State for that statement. Will he give the House an assurance that he will look at GP contracts, with a view to amending them to ensure that better care is given to older patients?

[Mr Hunt]

My hon. Friend makes an important point. Talk to any A and E department in the country, and they will say that poor alternatives in the primary care sector are one of the things that are driving the pressures on them. It is important that we look at the structures put in place by the 2004 GP contract to see whether they are the right way to provide the care we need to give to older people.

[Liz Kendall (Leicester West) (Lab)]

Last week, the Select Committee on Health took expert evidence on the increased pressures in emergency departments and the causes of the worst A and E crisis in a decade. On Wednesday, the Chair of the Committee told this House that the 2004 GP contract

“is not why those pressures exist.”—[Official Report, 5 June 2013; Vol. 563, c. 1605.]

Will the Secretary of State tell us whether the right hon. Member for Charnwood (Mr Dorrell) is wrong?

[Mr Hunt]

I advise the hon. Lady to listen more carefully to what the Chair of the Select Committee said. He actually said that he agreed with much of what I said on the GP contract. While the Opposition are defending the status quo of the 2004 contract, independent support for reforming primary care is coming from the College of Emergency Medicine, the Royal College of Physicians, the NHS Alliance, the Family Doctor Association and even the head of the Royal College of General Practitioners.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

T2. In my borough of Southwark we have higher than average smoking rates, and the Cabinet member responsible for health has said that hundreds of people are dying early because they smoke. Can Ministers help me to persuade our Labour council that it is inconsistent to say “Don’t smoke” on the one hand and invest £2.6 million of pension funds in British American Tobacco on the other?

--- Later in debate ---

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

T5. I listened carefully to the Public Health Minister’s answer just three questions ago, but the Government have disproportionately cut funding to the most deprived local authorities, including Liverpool, and these local authorities have today been shown to have higher mortality rates. How does the Secretary of State expect to close, rather than widen, health inequalities?

[Mr Jeremy Hunt]

We actually gave a real-terms increase to all areas, including Liverpool, and followed the independent advice. If funding for public health in Liverpool is lower than it should be, that is because the last Government set the baseline way lower than it should have been.

[Adam Afriyie (Windsor) (Con)]

T9. For the last decade, in the face of constant threats of closure to Heatherwood and Wexham Park, I have campaigned alongside local councillors, activists and residents to try to get the right balance of services across my constituency. The people I work with are very reasonable, as is the Secretary of State, so will he meet me and a small delegation from Windsor to discuss their options?

[Mr Hunt]

It would be my great pleasure to do so.

[Alex Cunningham (Stockton North) (Lab)]

T6. Three Health Ministers have indicated their support, and one even voted for it, so will the Secretary of State either introduce his own legislation or back new clause 17 to the Children and Families Bill to ban smoking in cars with children present?

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

Does the Secretary of State agree that any criminal investigation into the 200 to 300 deaths at Mid Staffs should extend not only to front-line staff, who risk getting scapegoated, but to all managerial levels, Department of Health officials and the heart of Government, so that we get answers about who knew what and when, and what action they took or—more importantly—did not take that could have prevented this tragic scandal?

[Mr Jeremy Hunt]

I congratulate my hon. Friend on her determined campaigning on this issue. She will agree that we must allow the law to follow its course. The police are looking at the five reports on hospital safety that were undertaken, the inquests and the lists of patients who appear to have been treated badly, and they are talking to the relatives of those patients. We must allow them to do their work, but no one is above the law, and particularly in this case it is important that justice be done.

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

T10. With the Department of Health having awarded Cleveland fire brigade £198,000 from its social enterprise investment fund, will the Minister confirm, pursuant to concerns raised by the Fire Industry Association, that his Department undertook an assessment as to the compliance with the European state aid regulations of the state’s funding of community interest companies that compete to take business away from the private sector?

--- Later in debate ---

[Jason McCartney (Colne Valley) (Con)]

Does the Minister agree that children’s heart surgery units such as the one in Leeds now need certainty so that they can continue to attract the highest calibre of staff?

[Mr Jeremy Hunt]

I agree with my hon. Friend and the sooner we can make a decision and announce it, the better. This issue is of huge importance to the people of Leeds and I want to do all I can to expedite the process.

[Jim Shannon (Strangford) (DUP)]

When a patient is ill and visits their GP, they will do as the doctor orders. One hundred thousand people will die of lung cancer this year. When will the Government do as the doctor orders and bring in plain packaging for tobacco?

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[Geraint Davies (Swansea West) (Lab/Co-op)]

Is the Secretary of State aware of the alcohol treatment centre in the middle of Cardiff, which treats people who are drunk on Friday and Saturday nights and therefore takes pressure off A and E, ambulance services and the police? Will he look at this model, as we are in Swansea, and pilot it elsewhere?

[Mr Jeremy Hunt]

That is definitely worth looking at and is exactly the kind of proposal that we could think about for NHS England. It could make a very big difference.

[George Freeman (Mid Norfolk) (Con)]

Will my right hon. Friend clarify the position regarding NHS spending, in light of the recent comments from the shadow Health Secretary? My understanding is that spending increased from £99.7 billion in 2009-10 to £106 billion in 2012-13; an increase of £600 million, or 14,000 nurses or 6,000 doctors. Does not this show that the shadow Health Secretary’s reference to cuts is just irresponsible scaremongering?

[Mr Hunt]

My hon. Friend is right. There has been a £600 million real- terms increase in spending, something that the right hon. Member for Leigh (Andy Burnham) said was irresponsible. He will have to do a U-turn on this, and it will be an embarrassing one. He has talked about cuts in every single debate in the House and it turns out that those cuts never happened.

[Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)]

Life expectancy in Liverpool is 10 and a half years less than it is in Kensington and Chelsea. Does the Secretary of State think that he has any responsibility to address that?

[Mr Hunt]

Yes I do, which is why we have published a website today that gives much more detail than there ever has been before about health inequalities. it is why, nationally, the Government have been responsible for a huge amount of initiatives to boost public health, including calorie labelling in restaurants, action on point of sale display tobacco advertising, alcohol unit labelling and a range of other things. We will play our part.

[Jane Ellison (Battersea) (Con)]

In April, the BBC’s “Casualty” programme highlighted the vital role that health professionals have in spotting young girls at risk of being taken abroad or of having female genital mutilation carried out on them in this country. We are approaching the most difficult time of the year over the long summer holidays, when girls are most at risk. Will Ministers do all they can to draw the attention of health professionals to the vital role that they have in these critical next two months?

[Ian Austin (Dudley North) (Lab)]

I listened to the answer to Question 7 earlier, but surely the best way to improve accountability in the NHS would be much greater consumer choice and competition when it comes to GP services, for which there are virtually no comparative data at the moment. With modern IT, why can patients not choose to have their own medical records and then ring round to find a GP who will treat them when they want to and not when their own GP deigns to see them?

[Mr Jeremy Hunt]

What the hon. Gentleman says has a lot of merit. We need to have transportable digital medical records that can be accessed anywhere in the system. That would make better out-of-hours care much more possible than it is at the moment.

[Several hon. Members]

rose—

Accident and Emergency Waiting Times

Jeremy Hunt Excerpts

Wednesday 5th June 2013 Commons Chamber

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

What we have heard today will rank as one of the poorest speeches ever given by an Opposition on the NHS. [Interruption.] I predict—[Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. [Interruption.] Mr Karl Turner, thank you for your advice, but we can manage without it today. I make this appeal to both sides: I want to hear what the Secretary of State has to say, just as I wanted to hear what the Opposition had to say.

[Mr Hunt]

Thank you, Mr Deputy Speaker.

I repeat: it was one of the poorest speeches ever given by an Opposition on the NHS, and I predict that the right hon. Member for Leigh (Andy Burnham) will bitterly regret choosing to make an issue of A and E pressures, because the root causes of the problem have Labour’s fingerprints all over them.

The right hon. Gentleman was right on one thing, however: there is complacency on this issue—not from the Government, who have been gripping it right from the start, but rather from Labour, which still does not understand why things went so badly wrong in the NHS on its watch.

Labour’s narrative has, I am afraid, a single political purpose at its heart: to undermine public confidence in one of our greatest institutions—an institution which, in challenging circumstances, is performing extremely well for the millions of vulnerable people who depend on it day in, day out.

Labour’s story today is a totally irresponsible misrepresentation of reality. One million more people are now going through A and Es every year than in 2010, which creates a lot of pressure, so how are A and E departments actually performing? The latest figures show performance, against the 95% target, of 96.7%. The week before it was 96.5%, then before that 96.3%, 96.6% and 95.6%. Yes, we had a difficult winter and a cold Easter, and I will come to the causes of the problems we had then, but, thanks to the hard work of NHS doctors and nurses, our A and E departments are performing extremely well.

[Henry Smith (Crawley) (Con)]

The Secretary of State is absolutely right to say that we should point to the record of the previous Government, who closed the A and E department in Crawley.

[Mr Hunt]

Indeed. We were having a discussion about walk-in centres. It is true that Labour opened a lot of those, just as it closed or downgraded 12 A and E departments during its time in office. That is one of the reasons we face the problems we have today.

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

My right hon. Friend should know that my constituents welcome his decision to refer to an independent review the plans to close the four A and Es closest to my constituency. Does he agree that the review will need to look carefully at whether due consideration was given to the impact of those four closures on the neighbouring hospitals and their A and E departments?

[Mr Hunt]

I absolutely agree with my hon. Friend that the impact on neighbouring A and Es in all reconfiguration decisions is extremely important, and I will not authorise any changes in service provision unless I am satisfied that they will be consistent with improved patient safety.

[Several hon. Members]

rose—

--- Later in debate ---

[Mr Hunt]

I will make some progress and then give way. I want to ask why the Opposition have chosen to call this debate. I am afraid it is nothing less than a smokescreen, because their objective is to try to dress up the pressures on A and E as a short-term crisis when, as every A and E department in the country will tell us, to deal with the pressures we need to address long-term structural problems that the previous Government either ignored or made worse.

[Bill Esterson (Sefton Central) (Lab)]

May we talk about one of the pressures on A and E, which is the pressure of social care? I hope that the Secretary of State will accept that significant cuts have been made in social care under this Government and that the role of social care is crucial in keeping people in their homes in the first place and in returning them to their homes after they have been in hospital. As a result of those cuts, it is very difficult for social care to perform that role. Will he examine the suggestion by my right hon. Friend the Member for Leigh (Andy Burnham) to use the underspend from the Department of Health to support social care to perform its essential role?

[Mr Hunt]

I will come to that suggestion, but I agree with the hon. Gentleman. If we are going to deal with bed blocking, which is one of the root causes of the problems that many A and E departments talk about, we have to have better integration between the health and social care systems—that is essential. I say to him that the problem of the underfunding of social care did not start in 2010; as my hon. Friend the Member for Stourbridge (Margot James) said, it is a problem that goes back many years, and the failure to integrate health and social care was a failure that happened over 13 long Labour years.

[Several hon. Members]

rose—

[Mr Hunt]

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

There is something else that the Labour party does not want the public to notice and it is another elephant in the room: the NHS is actually doing better under the coalition than it ever did under Labour. Let no one forget the NHS we had in 2010: no cancer drugs fund for the 26,000 people who now benefit from it; 400,000 fewer operations every year; double the number of MRSA infections; and 18 times more people waiting for more than a year for their operation.

[Several hon. Members]

rose—

[Mr Hunt]

I am going to make some progress. The right hon. Member for Leigh talked about grip. There is one place where grip is badly lacking. Labour does not like to hear about this because it is Labour-run Wales, where, as the Prime Minister said this morning, the A and E target has not been met since 2009. It is where performance—[Interruption.] I know that Labour Members do not want to hear this, but I suggest they listen to it, because performance in Wales—[Interruption.] Let me finish making the point. Performance was worse in Wales than in England for every one of the weeks that we missed our A and E target this winter. If the right hon. Gentleman really cared about patients, he would be condemning what is happening in Wales.

[Several hon. Members]

rose—

--- Later in debate ---

[Mr Hunt]

I will make my point and then I will give way. Labour Members need to hear about what is happening in Wales, because Labour runs the NHS in Wales. One patient in Wales had a cardiac arrest—[Interruption.] I know that this is difficult for Labour Members, but they need to hear about what is happening in Labour-run Wales. One patient had a—

[Several hon. Members]

rose—

[Mr Hunt]

I will give way to the shadow Health Secretary in a minute. One patient there had a cardiac arrest in the eye-examination room as there was no room in the resuscitation bay, and 24 to 36-hour waits for beds are now common in Wales. One patient spent a full three days in a Welsh emergency department. So let me give him a chance finally to condemn what is happening in Wales.

[Andy Burnham]

People watching this debate will be wondering why the Secretary of State is talking about something that is not his responsibility; nor is it mine. He is not responsible for the NHS in Wales; nor am I. I have put to him today serious questions about the NHS in England right now. He is the Secretary of State for the NHS in England, so will he now address the questions I put to him?

[Mr Hunt]

So there we are. Labour totally fails again to condemn the appalling shambles in the part of the country where it runs the NHS. I will tell the right hon. Gentleman why what is happening in Wales is completely relevant to the debate in England.

[Wayne David (Caerphilly) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

The hon. Gentleman should listen to this. One reason for the problems in Wales is that Labour cut the NHS budget in Wales by 8%, or £814 million, and cutting the NHS budget is exactly what the shadow Health Secretary wants to do in England—

[Chris Bryant (Rhondda) (Lab)]

Will the Secretary of State give way to a Welsh MP?

[Mr Hunt]

The hon. Gentleman, as a Welsh MP, might want to listen to this. Both the NHS budget and spending—

[Wayne David]

Will the Secretary of State give way to a Welsh MP?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We want a little more calm. Mr David, you are getting far too excited. It is not good for you and it is not good for the Chamber—[Interruption.] Order. I do not want you to repeat your point. I have just explained to you that I need you to be a little calmer. It is up to the Secretary of State whether he wishes to give way and at the moment he is not doing so. It is his choice and shouting will not make any difference whatsoever.

[Mr Hunt]

Thank you, Mr Deputy Speaker—

[Wayne David]

rose—

[Mr Hunt]

I will give way to the hon. Gentleman, if he will just take his place for a moment while I make my point. I will also give way to my hon. Friend the Member for Enfield North (Nick de Bois)—[Interruption.] I will reflect on whether I want to give way to the hon. Member for Rhondda (Chris Bryant), but I will certainly give way to the hon. Member for Caerphilly (Wayne David).

What is happening in Wales is directly relevant to what is happening in England, because in England the NHS budget has increased in real terms and NHS spending has increased in real terms. If we did not increase them both, that would mean fewer doctors, fewer nurses and longer waits for operations—[Interruption.] The shadow Secretary of State shouts from a sedentary position that the NHS—

[Andy Burnham]

On a point of order, Mr Deputy Speaker. The Secretary of State has just said at the Dispatch Box that the budget for the NHS has increased in real terms. In December, I referred the Secretary of State’s comments to the UK Statistics Authority and I received a letter back saying that they were incorrect. Will you ask the Secretary of State to correct the parliamentary record and ensure that when the statistics commissioner makes a ruling it is adhered to by the Secretary of State?

[Mr Deputy Speaker]

That is not a point of order, but the right hon. Gentleman has certainly made his clarification for the record.

[Mr Hunt]

I thought that the shadow Health Secretary might try to do that, so let me give him the figures. I have the figures provided by the Department of Health finance department, based on the latest GDP deflators, as published at the Budget. Spending in the NHS—not the budget—in 2009-10 was £99.7 billion and for 2012-13 it is forecast to be £106.6 billion. That is a cash increase of £6.9 billion and a real-terms increase of £0.6 billion, so there is a real-terms increase in the NHS budget. The shadow Secretary of State does not agree with the real-terms increase of £600 million in the NHS today; there would be a Labour cut in NHS spending and I suggest that he might want to correct the record, as I am afraid he has got this wrong.

[Nick de Bois (Enfield North) (Con)]

My right hon. Friend knows, as his predecessor does and as the Prime Minister does, of my consistent opposition to the downgrading of Chase Farm hospital. Does he agree with me that it is utterly inacceptable for the hon. Member for Hammersmith (Mr Slaughter), who is no longer in his place, to suggest otherwise in this Chamber?

[Mr Hunt]

I agree, but I am afraid that the Opposition are playing fast and loose with the facts today, so it is perhaps not a surprise.

The hon. Member for Caerphilly has been extremely patient, so let me listen to his point.

[Wayne David]

I thank the Secretary of State for eventually giving way. Does he not accept that, despite the fact that the block grant to the Welsh Government has been cut by £1.4 billion, Welsh spending on the health service has been maintained in real terms?

[Mr Hunt]

What Labour did in Wales was cut the NHS budget by 8% and that is why that Government have not met their A and E targets since 2009. Those on the Labour Front Bench in England want to cut the NHS budget here. That would not help pressures on A and E; it would make them a great deal worse.

[Several hon. Members]

rose—

--- Later in debate ---

[Mr Hunt]

I shall make some progress, because this gets even worse for Labour.

The shadow Secretary of State wrote to me at the weekend, asking me to relieve pressure on A and E by using the health underspend to put extra money into social care. There is a way of releasing resources into social care, but it is not that, because the underspend he talks of sits largely with NHS trusts and clinical commissioning groups, which are allowed to keep their underspends and roll them over to subsequent years. If we took away that money and put it into social care, we would therefore have to take it away from hospitals, where it is needed most to help tackle pressures in A and E and other places.

Let us look at some of the hospitals that would lose money under Labour’s plans. Wigan and Leigh NHS Foundation Trust, in the right hon. Gentleman’s own constituency, had a £4 million underspend in 2012-13. It would be prevented from using that money to reduce A and E pressures, as would the Royal Cornwall, the Royal United hospital Bath, Nottingham University hospitals—

[Chris Bryant]

rose—

[Mr Hunt]

I am going to make some progress. The Royal Wolverhampton, East Lancashire, Royal Liverpool and Broadgreen, North Bristol, Coventry and many other hospitals would also be prevented from using the money. So Labour’s solution to the A and E crisis is to cut funding to hospitals—about as logical as wanting to reduce debt by increasing the deficit.

From a Labour party that wants to be a Government in waiting, this is not good enough. It is against a cut in NHS spending that did not happen, but when there is a real cut in Wales it says nothing. It is against hospital reconfigurations in England, where we are hitting the A and E target, yet says nothing about reconfigurations in Wales, where Labour is missing the A and E target. It says it is against reorganisations and it has just proposed its own huge structural reorganisation to merge the health and social care system. Why is that? It is because in the end it is more interested—we have seen this today—in party politics than the right policies. I think we can expect better from someone who used to be a Health Secretary.

[Several hon. Members]

rose—

[Mr Hunt]

I shall make some progress because I have some important points to make.

A and E pressures are not the only thing that happened to the NHS this winter; we also had the Francis report into Mid Staffs. That tragedy is also relevant to A and E pressures, because at the height of its failures in care, Mid Staffs, unbelievably, was actually hitting its A and E target. In fact, between 2004 and 2009, there were only three quarters in which Mid Staffs failed to see 95% of people within four hours—hitting the target and missing the point. But in Labour’s NHS, hitting the target was all that counted, because Ministers ignored three reports, 50 warning signs and 81 requests for a public inquiry into Mid Staffs and what was going on.

Things have changed in the NHS, and I say this plainly. It is harder now for hospitals to hit their A and E target, because we will not condone cutting corners to get there. Targets matter, but not at any cost, and we are determined to reach them by doing things properly, making sure that we always treat patients with dignity and respect.

[Several hon. Members]

rose—

[Mr Hunt]

I shall make some progress.

Labour’s complacency on that issue is revealed as even more shocking when we look at the root causes of pressures on A and E departments, because nearly all of them involve issues that Labour either failed to tackle in office or made a great deal worse—for example, the IT fiasco, so heavily criticised by the National Audit Office. It is completely unacceptable that A and E departments are not able to access, with their consent, people’s GP records. Last year, there were 30,000 wrong prescriptions in the NHS and 11 deaths—something we know would be significantly improved with e-prescribing in hospitals. The Government have addressed that, with a fund that I announced last month and an ambitious programme to make the NHS paperless by 2018, learning from that procurement debacle for which we are now paying the price.

Let us look at other causes. The working time directive, which Labour signed up to, makes the recruitment of A and E staff very much harder.

[Chris Bryant]

rose—

[Mr Hunt]

I think the hon. Gentleman should listen to this. Professor John Temple described that as having the biggest impact on the emergency and out-of-hours parts of the NHS, which is why the Government are now having to increase recruitment into A and E through the mandate that the Government have set Health Education England. Or there is the total failure—

[Gloria De Piero (Ashfield) (Lab)]

In one week in April 2012, 75 people in Sherwood Forest trust waited longer than four hours at A and E. In the same week in April this year, 266 people waited longer than four hours at A and E. That is a 255% increase. How does the Secretary of State account for that?

[Mr Hunt]

I agree that A and E departments are under huge pressure, and that is why we are taking a lot of measures to deal with them, which is what I am talking about. But I am saying that we have to deal with the root causes, which were things that the shadow Secretary of State’s Government failed to deal with. [Interruption.] Labour Members need to listen. We listened to the shadow Secretary of State’s solutions, which were not really solutions; now I am telling them what we think needs to happen.

We welcome the fact that the Labour party has now seen the light and recognises the need for integration, but Labour Members need to show some humility, because it was the Labour Government who put in place many of the barriers—in particular payment by results mechanisms—that make that so hard to achieve. We are now trying to make integration a reality through the 10 pilots on removing barriers to integration announced by the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), as part of the vulnerable older people’s plan announced to the House last month. Without integration, we will not solve the problem of bed blocking, which is at the heart of the pressures on A and E.

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

The Secretary of State is right to say that many of the present failures started in the Labour years, particularly the problems with integration. Does he share the concern that I and many of my constituents feel about the 50,000 beds that were lost under Labour Government? We lost the beds, but the intermediate care services and step up, step down facilities were never created to deal with the consequences. That is what is behind a lot of the A and E referrals today.

[Mr Hunt]

That is part of the problem with Labour’s approach to the NHS—a top-down approach of closing or downgrading A and E units and making the NHS sort out the problems. We are not doing that.

It is time that Labour took responsibility for the disastrous changes to the GP contract, which contributed to making it so much harder to get a GP appointment and piled further pressure on A and E departments—[Interruption.] No, they need to listen; this is important. The changes in 2004 handed responsibility for providing out-of-hours services to administrators in primary care trusts, at a stroke removing the 24/7 responsibility for patients that until then had always been a core part of being a family doctor. As we heard earlier today, even a former Labour Health Minister regretted those changes, saying before the last election:

“In many ways, GPs got the best deal they ever had from that 2004 contract and since then we have, in a sense, been recovering.”

It is important that Labour Members hear the list of independent voices all saying that we need fundamental change in primary care if we are to deal with pressures on A and E: the College of Emergency Medicine, the Royal College of Physicians, the NHS Alliance, the Family Doctor Association, the head of the Royal College of General Practitioners, who—surprisingly—said something in support of the Government in The Guardian this morning, the Foundation Trust Network and so on. All those voices were ignored by Labour as it put its head in the sand about that disastrous change to the GP contract.

[Ian Swales (Redcar) (LD)]

Does the Secretary of State share my horror that the out-of-hours contracts awarded by the previous Government to companies such as Serco give them a financial incentive to call an ambulance rather than deal with cases through GPs or in the community?

[Mr Hunt]

The system is dysfunctional, and at the heart of the problem is Labour’s creation of a system in which GPs lost round-the-clock responsibility for the patients on their list. That is fundamentally wrong and we need to deal with it.

[Yasmin Qureshi (Bolton South East) (Lab)]

Today’s debate is about the increase in waiting times at accident and emergency departments. In 2010, when Labour left office, 98% of people were seen within four hours; three years later, after three years of Conservative Government, the number of people who have to wait more than four hours has trebled. What is the Secretary of State going to do about that?

--- Later in debate ---

[Mr Hunt]

Let me say very directly to the hon. Lady that since 2010 two things have happened that have contributed—[Interruption.] I am answering the question. First, 1 million more people are now going through A and E; secondly, the target has been reduced from 98% to 95% on the advice of the College of Emergency Medicine and the Royal College of Nursing. Labour has decided to do the same thing in Wales. Obviously, in that situation, the result is an increase in the absolute numbers; however, year on year since 2010, this Government have hit our A and E targets and we intend to continue to do so.

[Sir Bob Russell]

Mention has been made of an additional 1 million people going to accident and emergency. The derision I received earlier was an attack on organisations such as St John Ambulance, which trains first aiders, because the simple fact is, as I said when speaking to my ten-minute rule Bill 10 years ago, that first aiders will

“reduce visits to overstretched accident and emergency departments by people whose injuries did not warrant hospital attention”—[Official Report, 19 November 2003; Vol. 413, c. 809.]

We should be getting more first aiders out there. If the last Labour Government had listened to that, we would have 1 million more first aiders.

[Mr Hunt]

I welcome all things that can reduce the pressure on A and E, and I am sure that there is a role for increasing knowledge of first aid.

[Several hon. Members]

rose—

[Mr Hunt]

No, I will make my concluding remarks. We will address these fundamental issues in our vulnerable older people’s plan, which is being published later this year. I have asked Sir Bruce Keogh, NHS England’s medical director, to lead an urgent review of demands on our emergency care and how services should respond in future. In the short term, we have changed the tariff arrangements for A and E payment to give hospitals a say in the use of funds earmarked to prevent avoidable admissions. The result is that A and E targets are now being met, not missed; long-term challenges are being confronted, not avoided; and the NHS, with its extraordinary professionals, is facing up to the great challenges of an ageing population with resilience and determination, treating more people more quickly and more safely than ever before in its history, and rather than deriding that performance for party political purposes the House should be celebrating its success.

[Several hon. Members]

rose—

A and E Departments

Jeremy Hunt Excerpts

Tuesday 21st May 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on what evidence he has to show how his plans to change GP services will solve the current crisis in accident and emergency departments.

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

A and E departments are under great pressure, and the whole House will want to pay tribute to the thousands of doctors, nurses and health care assistants who work extraordinary hours in very challenging conditions. They are there for us when we need them, and we owe them a great debt.

More than 1 million more people visit A and E every year compared with just three years ago—those are additional numbers—and the simple fact is that if growth continues at that rate it will be unsustainable. It also means that when there are short-term pressures on the system, such as a very cold winter, teething problems with NHS 111 or bank holidays, the system cannot cope as well as it needs to and the quality of care is affected.

Let us be clear: A and Es are currently hitting the 95% target. The latest figures show that 96.3% of patients are seen within four hours, and people are waiting on average 55 minutes for treatment. However, if A and E services are to be sustainable, we need both short-term and long-term measures to address the underlying causes of the pressure they are under.

Last week, NHS England announced that it would change the basis on which tariff money for certain A and E cases is spent. For the first time, hospitals will have a say in how money is spent to alleviate demand when that money is withheld for numbers exceeding the 2009 baseline. We also need to address more fundamental issues, which is why I announced to the House on 13 May that the Government will publish in the autumn a vulnerable older people’s plan that will tackle those long-term underlying causes of pressure in our A and Es, particularly for the frail elderly who are the heart of many of the issues we face in both quality of care and service performance.

The changes the Labour Government made to the GP contract took responsibility for out-of-hours care away from GPs. [[Interruption.] Labour Members may not like to hear the facts about the consequences of those changes, but let us go through them—they asked the question. Since those changes, 90% of GPs have opted out of providing out-of-hours care, and they got a pay rise in addition. As a result of those disastrous changes to the GP contract, we have seen a significant rise in attendances at A and E—4 million more people are using A and E every year than when the contract was changed. As researchers from the university of Nottingham found, to give just one example, a reduction in out-of-hours services provided by patients’ usual family doctors is a direct cause of increased A and E attendance by children.

There are other issues too, including the lack of integration with social care, and vulnerable patients being discharged from hospital with no one co-ordinating proper health and social care to support them in their own homes. That lack of integration was something else that the previous Government failed to address over 13 long years.

Then there are the problems inside A and E departments caused by the disastrous failure of Labour’s IT contract. When people are admitted to A and E departments, the departments are unable to see their medical records, which could have an enormous impact—[Interruption.]

[Mr Speaker]

Order. First of all, the Secretary of State should not have to shout to be heard. Secondly, the more heckling there is, the slower progress tends to be. I want to accommodate colleagues, but as a matter both of courtesy and of practicality the Secretary of State should be heard in silence.

[Mr Hunt]

We will address those problems inside A and Es and the system-wide issues. It is not all about the GP contract, but that is a significant part of it, because confidence in primary care alternatives is a key driver in decisions on whether to go to A and E. We will take responsibility for sorting out those problems, but the Labour party must take responsibility for creating a number of them.

[Andy Burnham]

The Secretary of State could brief the newspapers last night, but he could not give a straight answer to my question today. He has not outlined his plans to change GP services.

The facts are that A and Es are under severe pressure and people are waiting hours on trolleys in corridors or in the back of queuing ambulances to be seen. Last week, a third of major A and Es missed the Government’s lowered targets—some were seriously adrift. At University Hospitals of Leicester, 78% of patients were seen within four hours. Seventy-nine per cent. of patients were seen within four hours in Portsmouth. Things have taken a more serious turn today, with news that 20 senior A and E doctors say they are unable to guarantee patient safety.

For weeks, the Opposition have warned the Secretary of State to get a grip. His only substantive response was to tour the TV studios to blame the 2004 GP contract. We today read that his answer is yet another costly NHS reorganisation, this time of GP services. Where is the evidence to support his contention that that will solve the A and E crisis? Why did he not outline his plans to the House—he has already given the news to newspapers?

This morning, the chief executive of the NHS Confederation told the Select Committee on Health that there is no link between today’s pressures on A and E and the 2004 contract, echoing expert analysis from the King’s Fund. If the GP contract is the root cause, as the Secretary of State claims, will he explain why 98% of people were seen within four hours in 2009, five years after the contract was signed? That figure has deteriorated sharply under his Government, and mainly on his watch. Major A and Es have missed the target in 33 of the 35 weeks when he has been Health Secretary. His complacency is dangerous. Is it not time he stopped blaming GPs to divert attention from a mess of the Government’s own making and addressed the real causes?

Two weeks ago, NHS England told the Secretary of State what those causes were. He needs to provide convincing answers on each. What steps is he taking to prevent the collapse of adult social care in England? What is he doing to ensure that all A and Es in England have enough doctors and nurses to provide safe care? Will he update the House on the status of his plans to cobble together a £400 million A and E crisis fund, news of which was leaked a fortnight ago? Will he halt the closure of NHS walk-in centres and personally review all planned A and E closures? What is he doing to sort out the failing 111 service? Did he not speed up implementation against official advice?

The truth is that this is a mess of the Government’s own making. It will not be solved by the Secretary of State’s spin or by blaming GPs. He has been found playing politics when he should be dealing with the real causes of today’s chaos. Faced with a real crisis, he has been found wanting. He needs to cut the spin and get a grip.

[Mr Hunt]

What the right hon. Gentleman says would have some credibility if he looked at the facts. Fact: under this Government, we hit the A and E target for last year. Fact: Wales, where Labour is in control, has not hit the A and E target since 2009.

[Andy Burnham]

Forget Wales!

[Mr Hunt]

The right hon. Gentleman says, “Forget Wales,” but why has he never once been prepared to condemn the appalling failures in A and E in Wales, caused by the Welsh Labour Government’s decision to cut NHS spending by 8%? What he says would have some credibility were he at least prepared to condemn what has happened in Wales, but he never does.

The right hon. Gentleman asks for the evidence, and I will tell him. Patrick Cadigan of the Royal College of Physicians says that the pressures on A and E are caused because many people assume that, after 5 pm, the lights in the NHS go out everywhere except A and E departments—a direct consequence of those disastrous 2004 changes to the contract. Nottingham university conducted an independent study, and last year’s GP patient survey found that only 58% of patients know how to contact their local out-of-hours service, 20% find it difficult to contact their out-of-hours service, and 37% feel that the service is too slow—problems that we are trying to address. Perhaps he should visit some A and E departments and talk to consultants, doctors and nurses, because they will tell him that the changes to the GP contract, which he says have nothing to do with the pressures on A and E, have had a huge and devastating impact.

He talks about taking responsibility for these problems. Let us see if he is prepared to take responsibility. Is he prepared to take responsibility for the target-at-any-cost culture in some parts of the NHS under Labour, which led to the disaster of Mid-Staffs? Is he prepared to take responsibility for the IT failures that mean that A and E departments cannot access GP records? Will he nod his head if he is prepared to take responsibility? [Interruption.] He is not prepared. Is he prepared to take responsibility—

[Mr Speaker]

Order. Let us get this back on track. There are two very simple points: first, those on the Opposition Front Bench should not be yelling at the Secretary of State; secondly, for the avoidance of doubt, the responsibility of the Secretary of State is to answer questions, not ask them.

[Mr Hunt]

I was answering, in a questioning way, the issue of—

[Mr Speaker]

Order. I have told the Secretary of State what the position is. It is not for argument or debate. His responsibility is to get on with answering in the way the House of Commons expects.

[Mr Hunt]

And I would always seek to do so, Mr Speaker.

Finally, the right hon. Gentleman constantly seeks to run down the performance of the NHS. Where is the recognition of the outstanding performance of the NHS under this Government: the fact that under this Government 400,000 more operations are happening every year than under Labour; the fact that the number of people waiting for more than a year for an operation has gone down from 18,000 under Labour to fewer than 1,000 under this Government; the fact that MSRA rates have been halved; and the fact that mixed-sex wards have nearly been eliminated? We will stick up for the great achievements of our NHS and we will not allow people to run it down. However, we will also tackle problems honestly and ensure that we address crises, many of which were caused by the previous Government.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my right hon. Friend agree that patients seeking urgent care will go to that part of the health service where the lights are on, and that the failure of the Opposition, over 13 years, to create genuinely integrated emergency care is the fruit we are now harvesting?

[Mr Hunt]

As ever, my right hon. Friend speaks with great wisdom. When it comes to the frail elderly, the key is to have a system that heads off problems before they arrive so that people do not find that they end up having to be rushed into A and E in the middle of the night. That can often be the very worst place for someone with advanced dementia or any condition that makes them extremely fragile and vulnerable. We need to integrate systems properly, and that did not happen under the previous Government. One of the key work streams of the vulnerable older people’s plan will be to look at barriers to integration, particularly the barriers to joint commissioning of social care and health. We intend to make good progress on that front.

[Frank Dobson (Holborn and St Pancras) (Lab)]

Does the Secretary of State accept that when NHS Direct was operating, nurses had the professional competence to decide not to refer people to A and E, and to provide reassuring advice? They have been replaced by call handlers who, understandably, opt to send people to A and E because they have neither the professional competence nor the professional confidence to do anything else?

[Mr Hunt]

I agree that there have been teething problems with 111 and we are addressing those problems. [Hon. Members: “ Teething problems?”] There is laughter on the Opposition Benches. We are hitting our A and E targets at the moment, and 111 is available in more than 90% of the country. We are dealing with those teething issues, but I take on board the right hon. Gentleman’s point. The 111 service needs to be quicker at getting advice to people from a GP or a nurse. The fundamental issue with 111 is that giving the public an easy number to remember has highlighted how inaccessible GP out-of-hours services have become. We have to address that if we are to restore public confidence in 111.

[Dr Sarah Wollaston (Totnes) (Con)]

If someone cannot get an appointment with their family doctor, they are undoubtedly more likely to end up in A and E, but does the Secretary of State agree that we will not increase capacity in primary care unless we address the work force shortage in general practice and broaden the skill mix of those who can see people in primary care?

[Mr Hunt]

I agree with my hon. Friend. Under this Government, we have 6,000 more doctors than we had under Labour, but we need more people going into general practice as well. [Interruption.] Yes, the training might have started under the Labour Government, but the funding happened under this Government, and it would not be possible if we cut the budget, which is what the Labour party still wants to do. She is right to point out those issues, however. One way of making general practice more attractive is to restore the personal link between GPs and the people on their list and a sense of personal responsibility and accountability. We need to find the right way of doing that, given the pressures on general practice at the moment, and I hope to work with her and many others to do that.

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

May I tell this complacent Secretary of State that in 28 out of the last 30 weeks Southampton general hospital has missed the waiting time A and E target? In the week beginning 7 April, only six out of 10 patients were seen within four hours. It is clear that this is a crisis of the whole health system. Given that in the last six months his own specialist advisers have praised the Southampton health economy for the role that primary care has played in reducing pressures on A and E, will he think again before simply blaming one group of doctors for a problem that runs right through the health system and into social care?

[Mr Hunt]

I am not blaming any doctors; I am blaming the Labour party for making disastrous decisions in office. We are addressing the issues that his party failed to address. If Southampton is not meeting its A and E targets, that is unacceptable. We are talking to all the hospitals struggling to meet those targets, but they all say—I am sure that people in Southampton would say this as well—that we need to look at the fundamental issues, which are barriers between the health and social care systems, poor primary care alternatives and problems inside hospitals with how A and E is handled. We are addressing all those issues.

[John Pugh (Southport) (LD)]

Better co-ordination of ambulance trusts and A and E departments is essential, but it will not happen by accident. Are we not now missing the strategic health authorities, given that ambulances are being sent to units already working at full capacity?

--- Later in debate ---

[Mr Hunt]

By getting rid of the layers of bureaucracy we had with strategic health authorities and primary care trusts—a brave and important decision made by my predecessor—we have been able to invest in more front-line staff. The NHS is doing much more, in terms of the number of operations, out-patient appointments and people being seen by A and E, because we are investing in the front line, but it is the responsibility of the new clinical commissioning groups to ensure proper co-ordination, and I would expect them to do that.

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

The Secretary of State attributes the current crisis in A and E in part to a contract that doctors signed back in 2004 and the fact that large parts of the NHS turn off the lights at 5 pm or 6 pm, which they have done for 60 years. Is there anything for which this Government have been responsible in the NHS since 2010?

[Mr Hunt]

Yes, we have been responsible for a huge increase in performance, many more people being operated on, the virtual elimination of mixed-sex wards, MRSA rates being halved, more operations than ever before, more outpatient operations than ever before and more GP appointments than ever before.

[Dr Phillip Lee (Bracknell) (Con)]

I am struck by the fact that no mention has yet been made of the drivers of the reported chaos in A and E and the pressures on primary care out of hours. What of ageing? What of obesity? What of the changes in behaviour, the absence of stoicism, the increase in medical technology costs? Whatever the system that either the Government or the Opposition talk about, it will come under pressure. When will we have some reality in this Chamber about the causes of this problem, because the sooner we have, the better we will all be?

[Mr Hunt]

I recognise my hon. Friend’s clinical background. When I talk to clinicians in A and E wards, they tell me that the long-term drivers of the pressures they are under are an increase in the number of older people and an increase in the acuteness of the conditions of people coming through the doors. That is why at the heart of our long-term solution is a vulnerable older people’s plan that ensures we look after them with the dignity, compassion and respect they deserve.

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

Why does the Secretary of State not increase access to primary care during normal working hours by reintroducing the requirement on primary care services to see patients within 48 hours, as happened under the Labour Government?

[Mr Hunt]

That target led to many problems, as the hon. Lady well knows. She might remember, from the 2005 general election campaign, the issues of people being denied appointments for three, four or five days because GP surgeries were being paid to meet specific 48-hour appointments. That is one issue. Too often, if people call GPs for an appointment, they are told that the earliest they can have one is in two, three or four weeks, which makes them think, “What are my alternatives?” and leads them into A and E. We must think about how we can change that and alter the incentives in GP contracts so that they can give the kind of service to their lists they would like to.

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

Do I need to remind my right hon. Friend that the outgoing Labour Government in 2010 left a note on the desk of the Chief Secretary to the Treasury saying, “There’s no money left”? Is not the challenge the need to make the NHS work on more or less flat funding—though we are doing our best to increase it—while dealing with huge increases in demand? Is not the only answer to do more in the general practice setting, where it can be done more responsibly, more local to patients’ needs and more cheaply, in order to take the pressure off A and E services?

[Mr Hunt]

My hon. Friend speaks extremely wisely. We must do just that, particularly for the frail elderly, people with long-term complex conditions, because they are the people for whom an A and E department can be a bewildering place, especially if it knows nothing about them and cannot access their medical records. Prevention is far better than cure, and I agree that that is one way of doing it.

[Stephen Pound (Ealing North) (Lab)]

The Secretary of State advises us to visit A and E departments. Were he to visit the one in the excellent Ealing hospital in the constituency of my hon. Friend the Member for Ealing, Southall (Mr Sharma), he would see the grotesque, confusing and expensive sight of a spatchcocked urgent care centre next to an A and E department, one acting as a gateway for the other. It is confusing, divisive and expensive. Is he entirely comfortable with this concept?

[Mr Hunt]

The hon. Gentleman makes an important point. We have failed as an NHS to give the public confidence in there being anything between an A and E department and a GP surgery. Whether they are urgent care centres or other centres, the public do not have that confidence and do not understand their role. We need other things, besides those two extremes, and to do a better job of informing the public about how they work. That is part of the reason for reforming primary care.

[Sir Gerald Howarth (Aldershot) (Con)]

May I invite my right hon. Friend to visit Frimley Park hospital, which serves his constituents and mine? I went there on Friday and saw the magnificent new A and E facilities in which it has invested. Yes, it has been under pressure in the past year or so, but it has managed and the out-of-hours service is being provided by GPs. I encourage him to come and see what a magnificent service is provided. Its excellent chief executive, Andrew Morris, raised with me the question of the tariff. Will my right hon. Friend explain a bit more his proposals to recompense hospitals such as Frimley Park, which are doing a fantastic job in A and E, for the additional burden they have had to assume?

[Mr Hunt]

I agree with my hon. Friend: Frimley Park is a terrific hospital and Andrew Morris a first-class chief executive. In fact, I am visiting Frimley Park in the next month and I will certainly have that discussion with him. My hon. Friend is right that one issue that A and E departments frequently raise is the tariff and the fact that they get paid only 30% of it for any A and E admissions over the 2009 baseline. That was why NHS England announced an important change a few weeks ago. Previously, hospitals had no say over how the money that is withheld from them is spent—it is meant to be used to reduce demand. We are now setting up urgent care boards, and hospitals will have a seat round the table to ensure that the money is spent in a way that reduces pressures on their A and E departments.

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

Can the Secretary of State say how the numbers attending A and E in south-west London will be reduced by the closure of St Helier hospital’s A and E department, which saw 80,000 people last year?

[Mr Hunt]

I have not seen any plans for the closure of St Helier. I know that NHS London is looking at possibilities to improve services in those areas, but, as the hon. Lady will know and should take comfort from, if a major reconfiguration is proposed and then referred to the Secretary of State by the local overview and scrutiny committee, I will not approve the change unless I am convinced that it will improve patient care.

[David Tredinnick (Bosworth) (Con)]

Does my right hon. Friend agree that we could make better use of the ambulance service and that if we had more fully trained ambulance men who could assess whether a patient needed to go to hospital, we could reduce A and E admissions that way?

[Mr Hunt]

My hon. Friend rightly draws attention to the importance of the ambulance service, which is also feeling the pressure on A and E departments. We need to help the ambulance service to do its job better too. One thing that it always strikes me would make a huge difference to ambulance services is if staff could access the GP records of someone they were picking up on a 999 call, so that they would know that the patient was a diabetic with mild dementia and a heart condition, for instance. That kind of information can be incredibly helpful. I hope that by sorting out the IT issues with which the last Government struggled, we can help ambulance services to do that.

[Valerie Vaz (Walsall South) (Lab)]

The Select Committee on Health heard evidence today from the College of Emergency Medicine about a 50% shortfall in trainee doctors and consultants. On average, trusts—I was going to say PCTs—spend £500,000 on locums. What does the Secretary of State intend to do about that?

[Mr Hunt]

We certainly intend to address A and E departments’ recruitment issues, which I recognise are one of the causes of the pressure. Over-reliance on locum doctors is not a long-term solution to improving the performance of A and E departments either, so those are both areas that we will be looking at.

[Andrew George (St Ives) (LD)]

The Government—Governments generally—cannot legislate to predict or control accidents or genuine emergencies, but they can direct resources. Hospital bed numbers have been cut by about 30% in the last 10 years. Does my right hon. Friend agree that it is difficult for A and E departments to function effectively if they do not have adequate bed capacity behind them?

[Mr Hunt]

I do agree, but what hospitals say is that the issue is not the number of beds, but the people in them who are not being properly discharged into the social care system. I was at King’s College hospital last week, where I was told that the hospital had probably two wards full of people who could be discharged into the social care system but had not been. Breaking down those barriers—something that I am afraid the last Government did not get round to doing in 13 years—will be an important priority.

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

The A and E department at Wolverhampton’s New Cross hospital recently saw a record 365 patients in one day. Those pressures will increase with the downgrading of Mid Staffordshire hospital. Does the Secretary of State agree that it will be deeply unfair to patients in both Wolverhampton and Staffordshire if the added burden on Wolverhampton’s New Cross A and E department is not met with increased resources from him, in terms of size and staff, to cope with the increased pressures?

[Mr Hunt]

We have not had the final recommendation from the special administrator appointed by Monitor for what will happen at Mid Staffordshire hospital, but we will make absolutely sure that any changes made improve patient safety and care.

[Neil Carmichael (Stroud) (Con)]

Does the Secretary of State agree that the new role that GPs will play in commissioning will greatly assist the production of better community services and more integration with social care, all of which has been championed so frequently by the King’s Fund?

[Mr Hunt]

I completely agree with that. I pay tribute to my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) for piloting those important reforms through the health service. I just hope that the Labour party, which claimed to support practice-based, clinically led commissioning, will see the error of its ways and understand that proper clinical commissioning holds the key to solving many of these problems.

[Bill Esterson (Sefton Central) (Lab)]

One of the concerns raised with me is about the lack of commissioning of community services to help patients to be discharged from hospital, which has a knock-on effect on A and E and queuing ambulances. Is not the reality that, as health professionals tell me, the lack of community services, which is what causes the problem in A and E, is a direct result of this Government’s reorganisation?

[Mr Hunt]

Quite the opposite: the changes introduced by my predecessor make it possible to have truly joint commissioning between clinical commissioning groups and local authorities, which are responsible for social care. I hope that will deal precisely with the problems the hon. Gentleman talks about. That is what we have to encourage and facilitate in every way we can.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

One million more patients a year are going through A and E departments and an increasing number of family doctors are progressively opting out of out-of-hours care. Why does the Secretary of State think that the King’s Fund can see the correlation but the Labour party cannot?

[Mr Hunt]

Because, I am afraid, the Labour party is completely failing to take responsibility for some catastrophically bad decisions that it made when it was in power. Labour Members might want to talk not only to people such as the King’s Fund, but to their own constituents, who say that traditional family doctoring is something they would like to see return.

[Mike Gapes (Ilford South) (Lab/Co-op)]

How does the decision to close the A and E unit at King George hospital in Ilford, which was taken by the Secretary of State’s predecessor, who is sitting next to him, and confirmed by him recently, help to take the pressure off Queen’s hospital in Romford?

[Mr Hunt]

As the hon. Gentleman knows, the decision has been taken, but the A and E department has not been closed and will not be closed until it is clinically safe to do so.

[Henry Smith (Crawley) (Con)]

The last Labour Government closed accident and emergency at Crawley hospital, but in the last few years the urgent treatment centre has been able to see more and more patients. Does my right hon. Friend agree that upskilling urgent treatment centres is part of the answer to the problem?

[Mr Hunt]

I do, and my hon. Friend is right to point out that the last Labour Government closed or downgraded 12 A and E departments. The Opposition have criticised us in the press—indeed, the shadow Minister, the hon. Member for Copeland (Mr Reed), who is sitting on the Front Bench, has criticised me for not getting on and closing more A and E departments, which is what he seems to want to happen. Every time there has been a controversial reconfiguration, Labour has opposed it all the way. I think we could expect a bit more consistency from a shadow Secretary of State who was once a Health Secretary.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

About eight weeks ago, the Secretary of State made a commitment to refer the decision to close four out of nine A and E departments in north-west London. Can he tell the House why he has not kept his word?

[Mr Hunt]

It is a very important, complex and difficult decision, so I thought it was right to get independent advice from the Independent Reconfiguration Panel, and that is what I have done.

[Sir Tony Baldry (Banbury) (Con)]

There is a general acknowledgement and recognition that one of the problems for A and E departments, particularly at night and on weekends and bank holidays, is people going to them who do not need to. Does my right hon. Friend think there is scope for the new clinical commissioning groups to commission primary triage at the entrance of A and E departments, so that those who need only primary care treatment are directed towards to it, and those who need A and E treatment go through to A and E?

--- Later in debate ---

[Mr Hunt]

My hon. Friend will be pleased to know that that actually happens in many places throughout the country, but we need to go even further. When it comes to the most frail, vulnerable older people, we need to commission services in a way that ensures that someone outside hospital knows what is happening with them the whole time, is accountable for their care and treatment, and can pre-empt the need to seek emergency care in the middle of the night. That will be the key to ensuring that the pressures on A and E are sustainable.

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

Today, the Health Committee heard that this Government’s cuts to social care were a direct cause of increased A and E attendances: patients cannot be returned home on time, and all the services that used to keep people well have been cut. This Government cut local authority budgets, resulting in £2 billion going out of adult social care. Will the Health Secretary now accept what the experts are telling us on the Health Committee: that that is the direct cause of the increased A and E attendances?

[Mr Hunt]

Once again, the Labour party opposes every single cut made by this Government then tries to pretend that it is serious about getting the deficit under control. On this point, I remind the hon. Lady that the NHS is giving £7.2 billion of support to the social care system for health-related needs, precisely in order to ensure that services are not compromised. Where they have been compromised, we are looking into it and we are disappointed about it, but we continue to monitor the situation and to urge local authorities to ensure that they discharge their responsibilities properly.

[Jeremy Lefroy (Stafford) (Con)]

As my hon. Friend the Member for St Ives (Andrew George) said, we cannot divorce emergency care from the provision of acute beds. The Secretary of State mentioned the fact that an increasing number of patients with acute illnesses are going into hospital. May I urge him to look carefully at any proposals to reduce the number of acute beds anywhere in the country, because I believe that we shall need them all?

[Mr Hunt]

My hon. Friend makes an important point. I commend him for the extremely responsible and committed way in which he has been keeping an eye on what is happening in his local hospital. He is absolutely right to suggest that, before implementing any big reconfiguration, we need to be certain that what we are doing will improve patient care and not damage it. I will continue to ensure that that is the case.

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

We know that walk-in centres alleviate the pressure on A and Es. How many walk-in centres have shut since May 2010?

[Mr Hunt]

I can assure the hon. Gentleman that many more walk-in centres would be shut if we had to cut the NHS budget, which is what the Labour party wants to do.

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

The issue of out-of-hours care and the additional pressure on A and E has been present in Suffolk since before the election. Just last Friday, I was in Felixstowe to meet the four patient participation groups there, and yet again out-of-hours care was identified as a real problem. I welcome the reforms that might be announced later this week, but can we ensure that patients realise that we are on their side and that we want them to be back with their family doctor?

[Mr Hunt]

Absolutely. It is extraordinary that in this debate in Parliament today, Labour Members have their heads in the sand about the low public confidence in out-of-hours GP care, which is a major driver of the problems in A and E departments. We are going to sort out that problem—[Interruption.] If they do not want us to, they are just going to have to watch while we do it.

[Ann Clwyd (Cynon Valley) (Lab)]

I ask the Secretary of State to deplore the personal attacks that are being made on Julie Bailey, who was responsible for drawing attention to the many deficiencies in Mid Staffordshire hospital. She has suffered personal attacks in the street and has had faeces pushed through her letterbox. We should all deplore the fact that that is happening to such an important and brave whistleblower.

[Mr Hunt]

The right hon. Lady speaks wisely, and I completely concur with her comments. Those attacks are totally reprehensible and I condemn them utterly. Julie Bailey is a remarkable lady, and it is thanks to her that the standard of compassionate care in hospitals across the country is going to improve dramatically. We all owe her a huge debt.

[Mr Philip Hollobone (Kettering) (Con)]

Thanks must go to all the staff at Kettering general hospital’s A and E for doing their best to cope with a 12% year-on-year rise in A and E admissions, which is being driven by one of the fastest household growth rates in the country. My hon. Friend the Member for Wellingborough (Mr Bone), the hon. Member for Corby (Andy Sawford) and I have written to the Minister responsible for A and E services, as part of a cross-party campaign, to request a meeting to discuss the special circumstances that Kettering’s A and E faces. Does the Secretary of State agree that that meeting should take place at the earliest opportunity?

[Mr Hunt]

Of course. I have visited Kettering hospital myself and seen just how hard people are working there. They are doing a terrific job. My hon. Friend is right to say that the significant increase in attendance has been driven by changes in the local population.

[Helen Goodman (Bishop Auckland) (Lab)]

The basic problem with the 111 service is the national specification of the triage system. The ambulance drivers in my constituency warned of this two years ago when the service was trialled, and last year the north-east local medical committee also told the Department of Health that the system was not working. It is the Secretary of State who has his head in the sand. Why does he not listen to the professionals on the ground?

[Mr Hunt]

I am listening. I have said that we have teething problems and that we want to sort them out. I am prepared to look at the whole of the 111 service to see whether it is delivering the service that the public need. However, I would say to the hon. Lady that the issues with 111 have focused public attention on the poor standard of out-of-hours care in many parts of the country. There is a particular issue of enabling people to speak out of hours to a GP who can, with their permission, look at their medical record, which is a pretty basic starting point. Until we sort that out, we will not be able to sort out the wider issue of confidence in 111.

[John Mann (Bassetlaw) (Lab)]

Despite my warnings in the Chamber, this Government closed the Newark accident and emergency department, as a consequence of which there has been a 37% increase in deaths. I know that the Secretary of State is too much of a survivor ever to dare to mess with Bassetlaw A and E, but does he agree that the reconfiguration of services in London has absolutely nothing to do with the reconfiguration of services in north Nottinghamshire?

[Mr Hunt]

All decisions on reconfigurations have to be taken on a case-by-case basis. The really important thing is to ensure that, when we reconfigure services, we have a good alternative in place and we are able to give the public the confidence that it is in place. As the hon. Gentleman knows, we follow the four tests before any ministerial approval is given for a reconfiguration to go ahead.

[Mr Andy Slaughter (Hammersmith) (Lab)]

Tomorrow is the 40th anniversary of the opening of the present Charing Cross hospital. The Secretary of State is welcome to come to the party, although he might be unpopular, as the A and E department there is one of the four in west London that he wishes to close. Three months ago, at Health questions, he told me that he would refer those decisions to the IRP, but he now appears to be telling my hon. Friend the Member for Ealing, Southall (Mr Sharma) that he is taking advice on whether to do that. Will he stick to his promise and make that referral for a full review?

[Mr Hunt]

Yes, I will.

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

In 2009, long after the GP contract was introduced, accident and emergency units were hitting their 98% target. The Secretary of State has reduced that target to 95%, but we are now hearing that units around the country are not even achieving that. How can that possibly be? What steps is he going to take to deal with the situation?

[Mr Speaker]

The Secretary of State appears to have managed to make the hon. Member for Hammersmith (Mr Slaughter) smile. The occasion should be noted.

[Mr Hunt]

Thank you, Mr Speaker. That is probably the nicest thing you have ever said to me. I shall dine out on it.

The answer to the question from the hon. Member for Edmonton (Mr Love) is that the changes in the 2004 GP contract are not the only cause of pressure on A and Es, but they are a significant cause. They set in train a process of declining public confidence in GP out-of-hours care, which has fuelled the growth in A and E attendances, and that growth has continued so that in the three years since 2009, attendances have gone up by more than 1 million. That is why those changes are having a significant impact on A and E services.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

I recently visited the London ambulance service. When ambulance staff cannot hand over a patient to A and E, the patient is kept waiting in the ambulance. Will the Secretary of State confirm that the number of handover delays lasting more than 30 minutes has doubled to 200,000 in the past three years? Will he also update the House on when he expects that trend to be reversed?

[Mr Hunt]

Handover delays are unacceptable, and the short-term and longer-term measures that I am putting in place will, I hope, help to reduce them. The hon. Lady might want to talk to her own Front Benchers about this, however, because they seem to be setting their face against improving primary care as a way of reducing the pressures on A and E departments, even though that goes against the grain of what the public and the NHS want.

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

I support the request from the hon. Members for Kettering (Mr Hollobone) and for Wellingborough (Mr Bone) for a meeting with the Secretary of State to discuss resources for Kettering general hospital, which is in a fast-growing area. Corby has the highest birth rate in England and is one of the fastest growing towns in Europe. I urge the Secretary of State also to recognise that the issues with the 111 service are rather more than “teething problems”. Twice this year, Kettering general hospital’s A and E has had to close its doors to all patients other than those arriving by ambulance and to notify the public not to come to the unit. That is extremely worrying for my constituents.

[Mr Hunt]

As I said, we need to address all the problems with 111. The lack of confidence in GP out-of-hours care is one of the contributing factors to a lack of public confidence. The meeting that the hon. Gentleman mentions will be going ahead.

[Lilian Greenwood (Nottingham South) (Lab)]

Eighteen months ago, Nottingham University Hospitals NHS Trust experienced a sustained increase in visits to A and E and hospital admissions, resulting in thousands of cancelled operations. The trust conducted an independent investigation to help it to understand and respond to the crisis, which had multiple causes. Will the Secretary of State confirm that the study did not conclude that poor provision by GPs or the out-of-hours service was to blame?

[Mr Hunt]

If I recall correctly, the study said that there were multiple causes, but it was Nottingham university that said that poor out-of-hours GP provision was responsible for an increase in paediatric A and E admissions, so Nottingham university understands this issue.

[Julie Hilling (Bolton West) (Lab)]

On Sunday, some of my constituents dialled 999 for an ambulance for an 83-year-old woman who had fallen in the street. They were told to ring 111, but after 15 minutes, with the operator saying he was still assessing needs and the lady still lying in the street, they abandoned the call and rang 999, when an ambulance was dispatched. Is that the norm for this service?

[Mr Hunt]

No, it is not the norm; it is totally unacceptable. That is why the changes we are introducing will hopefully eliminate the vast majority of those kinds of issues. No, we are not going to stand by failures such as that when they happen.

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

The Secretary of State seems to have decided that changing GP out-of-hours services is part of the solution to the A and E crisis. In the Public Accounts Committee a few weeks ago, we heard from clinical commissioning groups that they fear a single tender just to GPs because of the threat of legal action. We have seen that played out in Hackney, where GPs have been knocked back by the clinical commissioning group. When will the right hon. Gentleman get a grip on his Department and let the CCGs have the freedom to commission local GPs rather than fear the legal action that prevents them from doing so?

[Mr Hunt]

I want them to have that freedom, but they are operating under the same constraints as primary care trusts, which means having to abide by European procurement law. It is the Labour party that is against any changes in our relationship with the European Union.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Can the Secretary of State confirm how many walk-in centres have closed since May 2010? Will he accept that those closures are linked to the rise in A and E attendance?

[Mr Hunt]

We absolutely need better alternatives to A and E, but let me remind the hon. Lady that if we followed her party’s Front-Bench policy of cutting the NHS budget from its current levels, many more urgent and walk-in centres would have to be closed.

[Jim Shannon (Strangford) (DUP)]

In Northern Ireland as in England there have been lots of problems with increasing numbers presenting at A and E. The Northern Ireland Minister of Health, Social Services and Public Safety introduced the triage system, which enabled more effective processing of patients and allowed people to get the level of care and medical attention they needed. Will the Secretary of State agree to discussions with that Northern Ireland Minister to see what can be learned from what has been done in Northern Ireland?

[Mr Hunt]

I always welcome discussions with the devolved Administrations to see what we can learn. Better triaging at the point of entry to A and E is certainly one of the things that makes a difference between A and E trusts that are managing to meet their targets despite very high pressures and those that are not.

[Mr Speaker]

I am grateful to the Secretary of State, the shadow Secretary of State and the 40 Back Benchers who contributed to the debate on the urgent question.

Health and Social Care

Jeremy Hunt Excerpts

Monday 13th May 2013 Commons Chamber

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

In challenging circumstances, the NHS is performing extremely well. Front-line staff are making heroic efforts to control costs as they cope with the pressures of an ageing population and when 1 million more people are using A and E every year than at the time of the last election.

The Opposition run down NHS performance, but the reality is a service delivering more than it ever did on their watch: 400,000 more operations every year than under Labour; the number of people waiting more than a year for an operation down from over 18,000 in May 2010, to just 665 at the end of February; MRSA infections halved; mixed-sex accommodation nearly abolished; dementia diagnosis rates going up; and more than 28,000 people receiving life-saving drugs from the cancer drugs fund that Labour refused to set up. As we debate health, care and support today, I take the opportunity to commend and thank all the dedicated professionals who work extraordinary hours, day in, day out, for their part in making this happen.

If we are to prepare for the future, however, we need to do more. In our generation, the number of over-85s will double, the number of people with dementia will pass the 1 million mark, and 3 million people will have not one, not two, but three chronic conditions to cope with, on top of the other pressures of old age. We must be there for each and every one of them—the founding values of the NHS would accept nothing less—and to do so we must be able to answer three big questions: how can we be certain that people receive compassionate care even when they are not able to speak for themselves; how can we deliver joined-up care to people who use the NHS and social care system on a regular basis; and how can we ensure that sustainable funding is in place for care and support?

[David Tredinnick (Bosworth) (Con)]

The Secretary of State will be aware of widespread concern among the herbal medical community that there is no statutory regulation on that area in the Care Bill. Does he agree that if polymorbidity is to be dealt with we must have firm regulation, and that just licensing herbs, as the European Union wants, would destroy the industry?

[Mr Hunt]

My hon. Friend follows such matters extremely closely and I reassure him that the Government will update the House on that issue very soon.

The Care Bill will take a critical step forward in addressing each of the big questions that I raised, so let us consider how. First is compassionate care. Labour’s target culture led to warped priorities in our NHS and appalling human tragedy. No one disputes the value of targets, and the four-hour target played an important role in improving A and E departments. We do not, however, need targets at any cost, as we saw at Stoke Mandeville, Maidstone and Mid Staffs.

[Stephen Timms (East Ham) (Lab)]

I agree with the Secretary of State about the value of the four-hour target. Is he disappointed, as I am, that that target has so often been missed in major A and E units over the past few months?

[Mr Hunt]

I am pleased that we hit our A and E target in the NHS last year, but disappointed that in Wales, which is controlled by the Labour party, the A and E target has been missed since 2009. Those on the Opposition Front Bench still refuse to condemn that.

[Toby Perkins (Chesterfield) (Lab)]

Will the right hon. Gentleman give way?

[Mr Hunt]

I will make some progress.

Even worse, when signs of how the targets policy was going wrong became clear, Labour’s response was to ignore or cover up the findings.

[Andy Burnham (Leigh) (Lab)]

Rubbish!

[Mr Hunt]

The right hon. Gentleman says “rubbish” from a sedentary position, but the Francis report—if he read it—mentioned 50 warning signs that were missed by his Government about Mid Staffs. He himself rejected 81 separate requests for a public inquiry into what happened. The Labour party created a lame duck Care Quality Commission, unable to speak out or force change, and an NHS where too often the system was more important than the individual.

[Andy Burnham]

At the outset, will the Secretary of State correct the record and remind the House that it was my decision, two months after being appointed Secretary of State in June 2009, to appoint Robert Francis to conduct an independent inquiry?

[Mr Hunt]

The right hon. Gentleman’s decision not to have a public inquiry that revealed extremely important information has meant that we are finally addressing the issue that his Government failed to address.

The Care Bill will include a vital element of our response to the Francis report, including regulatory clarity on who is responsible for identifying problems, driving up standards, and operating a single failure regime when urgent changes are not made.

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

My right hon. Friend will be aware that there have been teething problems with the 111 telephone service, which could be an essential tool to treat people in their own homes, certainly for palliative care. Will he provide stringent new guidelines to all providers to ensure that such teething problems are addressed and to enable the 111 service to operate as it should?

--- Later in debate ---

[Mr Hunt]

My hon. Friend makes an important point. Teething problems have led to unacceptable levels of service in some parts of the country, which we are in the process of sorting out. As we sort them out, we also need to look at the long-term causes of the problems of out-of-hours provision and the fact that the general practitioner contract of 2004 has led to a removal of GP responsibility for out-of-hours care, which means that there is much less public confidence than there needs to be in the whole picture. We need to sort that out, too.

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

Will the Secretary of State give way?

[Mr Hunt]

I will make some progress, then take more interventions.

The Care Bill will allow for comprehensive Ofsted-style ratings for hospitals and care homes, so that no one can pull the wool over the public’s eyes as to how well or badly institutions are performing. The Bill will make it a criminal offence for any provider to supply or publish deliberately false or misleading information. We cannot legislate for compassion, but in a busy NHS, we can ensure that no institution is recognised as successful unless it places the needs of patients at the heart of what it does. The Care Bill will be a vital step forward in making that happen. That compassion should extend not just to patients, but to carers. The Bill will put carers’ rights on a par with the people for whom they care. They will have a right to a care assessment of their own and new rights to support from their local authority.

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

Is the Secretary of State as disturbed as I am that the Bill puts young carers backwards a step? Adult carers’ rights might be taking a step forward, but young carers’ rights are not. We must address that during the passage of the Bill.

[Mr Hunt]

We are not putting young carers backwards. We very much recognise their needs—and a children’s Bill will address their concerns in a way that I hope will put the hon. Lady’s mind at rest.

The second issue that we need to address for the NHS going forward is joined-up care. It is shocking that, in today’s NHS, out-of-hours GP services are unable to access people’s medical records; that paramedics and ambulances answer a 999 call without knowing the medical history of the person whom they are attending; and that A and Es are forced to treat patients with advanced dementia, who are often unable to speak, without knowing a thing about their medical history.

[Dame Joan Ruddock]

I am grateful to the Secretary of State—out-of-hours is relevant to my point. He will be familiar with Newark. He closed the A and E department and the rate of deaths among local residents went up from 3.5% to 4.9%. Why does he therefore persist in saying that, if he downgrades Lewisham A and E, 100 lives will be saved across the south-east of London?

[Mr Hunt]

Because that is what the independent medical advice I have received has told me. The right hon. Lady should be very careful about the Newark statistics, because the increase in mortality rates, which is worrying and should not happen, happened before the A and E was downgraded. It is very important that we do not get the figures wrong.

[Jim Dowd (Lewisham West and Penge) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress.

Before I took the right hon. Lady’s intervention, I was talking about joined-up care. The truth is that Labour’s disastrous IT contract wasted billions and failed to deliver the single digital medical record that would transform the treatment received by so many vulnerable older people. Yes, it was a financial scandal, but it was also a care scandal. Last year, 42 people died because they received the wrong medicines. There were more than 20,000 medication errors that caused harm to patients, and 127,000 near misses. On top of that, structures such as payment by results were left unreformed for more than 13 years, making hospitals focus on the volume of treatment over and above the needs of individual patients. The Care Bill will help to address those issues by promoting integrated care. It creates a duty on local authorities and their partners to co-operate on the planning and delivery of care; it emphasises the importance of prevention and the reduction of people’s care needs; and, by making personal budgets the default and not the exception, it will significantly increase the control people feel over their care.

[Andy Burnham]

I am grateful to the Secretary of State for giving way, but the trouble with him is that, often, there is a huge gap between the rhetoric he comes out with at the Dispatch Box and the reality on the ground. He says he is promoting integrated care, but what does he say about the pioneers of integrated care in Torbay, who are threatening to take legal action because of the requirement for compulsory competitive tendering of services? Under this Government, are not the beacons of integration being demolished by his free market?

[Mr Hunt]

It is the right hon. Gentleman who has a problem with the difference between rhetoric and reality. Let me tell him about the reality of what happened to integrated care under Labour. Between 2001—[Interruption.] The right hon. Gentleman intervened, so perhaps he would like to hear the reply. We are talking about integrated care. On his watch, between 2001 and 2009—eight years during which Labour was in power—hospital admissions went up by 36%. In Sweden, where people started thinking about integrated care, such admissions went up by 1%. That is how badly Labour failed to do anything about integrated care when it had the chance. We are doing something about it. If the Opposition listen, I shall explain what.

[Jim Dowd]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress.

The third question that the Care Bill addresses is about sustainable funding for care. We are all going to have to pay more for social care costs, either for ourselves or our families. Tragically, every year, up to 40,000 people have to sell the homes that they have worked so hard for all their lives to fund their care.

Our system does not just fail to help those who need it; it actively discourages people from saving to ensure that they have the funds. In 1997, Labour promised a royal commission on long-term care. The commission reported in 1999, and its recommendations were ignored. We then waited 10 whole years for a Green Paper, which arrived in 2009 and, again, was able to deliver nothing.

In stark contrast, in just three years, the coalition Government commissioned a report from Andrew Dilnot, have accepted it and are now legislating for it. The Care Bill will introduce a cap on the costs that people have to pay for care in their lifetimes. With a finite maximum cost, people will now be able to plan through their pension plan or an insurance policy. With a much higher asset threshold for state support, many more people will get help in paying for their care.

[Sheila Gilmore (Edinburgh East) (Lab)]

I respectfully suggest that the Secretary of State should look at the situation north of the border, where reform to change who pays has worsened the situation because no extra funding was put into care; all that happened was that we shuffled around who actually paid. Will he look carefully at that situation so that it is not repeated? How much extra funding is he going to put into the system?

[Mr Hunt]

I agree with the hon. Lady that the amount of financial support is important. I gently say to her that her party wants to cut the NHS budget, which would make the situation vastly worse.

The Bill is a vital element of our plans to improve the lives of the frail and elderly and of people with long-term conditions and disabilities, but it is only one element. Other areas that do not require legislation will come together in a plan for vulnerable older people. The plan will consider all aspects of how we look after older people most in need of support from the NHS and social care system. It will look at how our hospitals are set up to support frail and elderly patients, particularly those with dementia, in emergencies. Of course, we must continue to give people with serious needs immediate access to highly specialised skill, but in many cases we could offer better alternatives outside hospital. That would improve clinical outcomes and reduce pressure on A and E departments.

Secondly, the plan will look at primary care—in particular, the role of GPs in supporting vulnerable older people. Active case management of vulnerable people is making a huge difference in some parts of the country and we will look at whether the primary care sector as a whole has the incentives, investment and skills to deliver that. We will also consider the provision of out-of-hours services and how to restore public confidence in them following the disastrous changes to the GP contract in 2004.

Thirdly, the plan will look at the barriers and incentives that prevent joint commissioning and stop people from getting joined-up care. In particular, it will consider the operation of financial incentives in the system, which can act as an unnecessary and counter-productive barrier. The Minister responsible for care, my hon. Friend the Member for North Norfolk (Norman Lamb), who is leading on integration, will announce further practical steps forward later this week.

I intend to announce the plan in the autumn, with implementation from April 2014. It will require a great deal of careful work, ask difficult questions and make tough decisions, but if it leads to more personal, more integrated and more compassionate care, it will stand alongside the Care Bill as an important step forward in reforming the care received by millions of people.

[Mr Dave Watts (St Helens North) (Lab)]

Does the Secretary of State agree that that can work only if social services budgets are increased? Where will the resources come from to deal with the problems we face, and will there be an increase in social services budgets to pay for the services we need?

[Mr Hunt]

There is currently a difficult environment for public finance, for which the hon. Gentleman’s party bears considerable responsibility. The Labour party has given up on the budget; it says it wants to cut the NHS budget. We say that these changes are possible without cutting the NHS budget and in dealing with the inefficiencies caused when care is not joined up. Taken together, the measures represent more progress in three years than the Labour party made in 13 years. They represent our determination to prepare the country for the consequences of an ageing population.

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

The right hon. Gentleman knows that the cap on costs of care is a little way off the Dilnot proposals. How many weeks—surely his Department has made some calculations—would that involve for a typical older person before they reach the £72,000 cap?

[Mr Hunt]

The point of a cap is not that we expect everyone to have to pay £72,000 towards their care. First, through pension plans and insurance policies people can make provision so that they never have to pay that £72,000. Secondly, as part of the package, we are increasing the threshold, below which the Government help, to £118,000—much higher than it is currently—so that it will be available to help, I think, around 40,000 more people than are currently helped because of the level of the means-testing threshold.

[Chris Bryant (Rhondda) (Lab)]

Will the right hon. Gentleman give way?

[Mr Hunt]

No, I am going to make some progress.

Finally, the values of the NHS—compassionate care and free at the point of need—are its greatest asset, but they open it up to risk of abuse from health tourists coming to this country to exploit that generosity.

[Chris Bryant]

Will the right hon. Gentleman give way?

[Mr Hunt]

I am going to make some progress.

Over the summer, we will consult on proposals to make the system fairer and ensure that people who should pay for NHS services do in fact do so. That will also help to ensure that our NHS remains sustainable at a time of tight public finance.

These proposals represent our commitment to ensuring a compassionate, fully integrated and sustainable system of health and social care built entirely around the needs of the patient. They represent a commitment to the NHS and social care system, which lies at the heart of our determination to make Britain the best country in the world to grow old in. [Interruption.]

[Mr Speaker]

Order. It is not altogether obvious whether the Secretary of State is giving way or has concluded his speech. [Interruption.] He has concluded his speech. It is usually helpful to have some indication of that.

--- Later in debate ---

[Andy Burnham]

My hon. Friend is absolutely right. The cap is a mirage, and this will not feel like progress to people who are paying care charges. Indeed, it is a cruel con trick. The Government are loading extra charges on people while telling them that they might benefit from a cap in a number of years. This simply means that more people will be paying right up to the level of that £72,000 cap.

How can it be fair to pay for the cap by raiding council support? That does not make sense. Those of us who were involved in the cross-party talks—the failed cross-party talks, I might add—will remember that a question was put directly to Andrew Dilnot. He was asked whether, if there was not enough money around, it would be better to pay for a cap or to pay to support councils to ensure that the baseline was not cut further. His clear answer was that we had to do both. He said that it would not make sense to do one without the other, yet that is what this Government are doing—

[Mr Jeremy Hunt]

indicated dissent.

[Andy Burnham]

That is what this Government are doing. A cap is ineffective without long-term funding for the future of social care, and the failure to face up to the crisis in adult social care budgets that Conservative councillors are talking about will leave people with the impression that this Health Secretary is fiddling while Rome burns. The social care system in England is close to collapse, and the reality behind the Government spin is that, under this Government, people’s savings are being washed away more quickly than ever before.

I want to turn now to our accident and emergency services. The crisis in social care is the predominant driver of what we are now seeing in our accident and emergency departments. If people’s services are withdrawn, or if they cannot afford to pay for them, they are more likely to struggle and fall ill at home and to end up in hospital. That is bad for them, and it costs the NHS more. Also, NHS staff are finding that people who are ready to leave hospital cannot be discharged because the necessary support cannot be put in place. Beds are not being freed up on the wards, and A and E therefore cannot admit people to the wards because there is no space. A and E then becomes full, which results in ambulances queuing up outside because they cannot hand over patients. The system is now backing up right through A and E.

[Mr Hunt]

indicated assent.

[Andy Burnham]

The Secretary of State is nodding; he should do something about it. This is happening on his watch. Across the country, hospitals are operating at levels way beyond safe bed occupancy—[Interruption.] He nods, but I am saying, “Do something. Don’t just nod!” We need action from the Secretary of State.

Let me return to the quote that I mentioned earlier. People love to say that I would have cut the NHS. For the record, I have never said that I would cut the NHS. At the last election, I promised real-terms protection for the NHS. The Conservatives promised real-terms increases, which have never been delivered. Let me read that quote in full:

“It is irresponsible to increase NHS spending if the effect is that it is damaging, in a serious way, the ability of other services to cope…that are intimately linked to the NHS. The health service needs functioning day care, and housing”

and meals on wheels.

That warning has now come true.

[Mr Hunt]

rose—

[Andy Burnham]

I will give way to the Secretary of State, but I ask him to address this point. He has paid for the so-called ring fence on the NHS by ransacking local government funding, and that makes no sense whatever.

--- Later in debate ---

[Mr Hunt]

If the right hon. Gentleman looks at the figures, he will see that real-terms spending on the NHS has gone up since Labour was in power. Given that he thinks it irresponsible to increase the NHS budget, does he agree that if he were to follow his own policy, he would now need to cut that budget from its current level? That is Labour policy.

[Andy Burnham]

I do not think the right hon. Gentleman is listening. I said that if there were to be any increase, it should go into supporting social care. I now hear that Government Members are proposing emergency transfers from the NHS budget to social care because of the crisis that the Secretary of State has created.

--- Later in debate ---

[Andy Burnham]

The former Secretary of State said that it was full steam ahead and that is what they would do. This Secretary of State comes in and says nothing about the issue. Then, a right-wing Australian lobbyist arrives, and all of a sudden no one mentions it at all. Has the Secretary of State ever met Lynton Crosby and discussed this issue with him? I think we have a right to know. [Interruption.] He nods; I should be interested to know the substance—[Interruption.] He has not met him to discuss the issue. He looks very uncomfortable all of a sudden.

[Mr Jeremy Hunt]

Just to put the right hon. Gentleman out of his misery, I have not discussed this matter on any occasion with Lynton Crosby.

[Andy Burnham]

We are going to have to get to the bottom of this—not just the Secretary of State, but all his Ministers and advisers and all the No. 10 advisers—because it looks to us as though this Government have raised the white flag on having any semblance of a progressive public health policy. I cannot believe that the Liberal Democrats put their name to such reactionary stuff. Where is minimum alcohol pricing? Where is public health in this Queen’s Speech? They are totally absent.

Care Bill

Jeremy Hunt Excerpts

Friday 10th May 2013 Written Statements

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

To accompany the Care Bill, which was introduced yesterday, I am today laying before Parliament “The Care Bill Explained—including a response to consultation and pre-legislative scrutiny on the Draft Care and Support Bill” (Cm 8627).

This document describes the measures in the Care Bill. It explains the importance of reforming care and support legislation, of taking steps to drive up the quality of care following the findings of Robert Francis’s inquiry into the Mid Staffordshire NHS Foundation Trust, and of establishing Health Education England and the Health Research Authority as non-departmental public bodies.

Parts 1 and 3 of the Care Bill build on the provisions in the draft Care and Support Bill, which was published in July 2012. “The Care Bill Explained” sets out the changes that have been made to those provisions. It is the Government’s response to the public consultation and to the report of the Joint Committee on the Draft Care and Support Bill.

The Government are grateful to the Joint Committee for its careful scrutiny, and to everyone who expressed their views during the consultation. The feedback we received has considerably improved the final provisions in this critical and historic piece of legislation.