Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 16th April 2013 Commons Chamber

[Mark Menzies (Fylde) (Con)]

6. What steps his Department plans to take to improve dementia diagnosis rates and to reduce regional variations in such diagnoses.

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

Dementia diagnosis rates vary across the country, from 75% in the best areas to a shocking 31% in the worst areas. That is totally unacceptable, given the difference that we know a diagnosis and a good care plan can make to people who have dementia.

[Mark Menzies]

What steps is my right hon. Friend’s Department taking to ensure that GPs are adequately supported, so that his ambitious targets for dementia diagnosis are met?

[Mr Hunt]

My hon. Friend makes an important point. There is a misconception among some GPs that a dementia diagnosis is pointless and cannot make a difference, when we know that in fact the correct medicines can help between one in three and one in four of those who have the condition. However, some GPs also have a point when they are concerned that it is difficult to access good services for people who have dementia. The way we will change GPs’ minds is for them to appreciate that something will change if someone gets a dementia diagnosis. That is the big challenge that this ministerial team has set the Department.

[Jim Shannon (Strangford) (DUP)]

Does the Minister agree that there is much to be learned from the high rate of dementia diagnosis in Northern Ireland? Is not that an example of how important it is for the devolved powers to share information and tactics for success in their own areas with the other devolved bodies?

[Mr Hunt]

I agree with the hon. Gentleman. Some of the devolved Administrations, particularly Scotland, actually do better than England in regard to dementia diagnosis, and one thing that we must learn from them is the value of a properly integrated care plan. I am working closely with the Minister of State to ensure that we deliver that in England.

[Mr Stephen Dorrell (Charnwood) (Con)]

My right hon. Friend said in his answer to my hon. Friend the Member for Fylde (Mark Menzies) that certain aspects of the treatment of dementia patients had to change. Does he agree that that should include the services that are delivered to them becoming more integrated, not only between hospitals and community health care services but between social care services and social housing support, in order to provide a proper joined-up package of care for people who receive such diagnoses?

[Mr Hunt]

I wholeheartedly agree with my right hon. Friend. I was in the accident and emergency unit at Watford hospital last week when a lady with advanced dementia was admitted. She had bruises all over her face after having had a fall. The shocking reality was that that A and E department knew nothing about that lady. It did not know her medical history, and it did not know whether that was her normal condition. There was no proper joined-up link between the social care system and the NHS. Tackling that issue is probably the single biggest long-term and strategic challenge that we have to address in the NHS.

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

Was Professor Malcolm Grant, the chairman of NHS England, talking about dementia sufferers when he said today that the NHS would have to charge for particular treatments? If not, will the Secretary of State specifically rule that out?

[Mr Hunt]

Professor Malcolm Grant did not say that. What he actually said was that if the NHS considered charging, he would oppose it. I agree with him; I would oppose it, too.

[Patrick Mercer (Newark) (Con)]

I should like to thank the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), for his visit to Newark, which was a huge success. However, it has been pointed out that there is a distinct feeling in Newark that dementia patients are not being treated quite so quickly there as they are in other parts of Nottinghamshire. Will the Secretary of State please give that matter his attention?

[Mr Hunt]

I entirely agree with my hon. Friend the Member for Newark (Patrick Mercer). We must urgently tackle the variation in dementia diagnosis rates. In the end, the litmus test of whether we are able to cope with an ageing population in the NHS will be how we deal with dementia, which now affects one in three people over the age of 65. There is still a lot of misunderstanding about the impact that a good diagnosis and care plan can have, and for the sake of my hon. Friend’s constituents and everyone else, this is an area in which we need to make urgent change.

[Mr Graham Allen (Nottingham North) (Lab)]

9. If his Department will make early intervention a priority for clinical commissioning groups and public health officers.

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[David Rutley (Macclesfield) (Con)]

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

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

In a week when we are remembering the remarkable contribution made by Margaret Thatcher to our national life, we should also mark the extraordinary contribution made by someone else who died last week—Professor Sir Robert Edwards, the Nobel prize-winning doctor who pioneered modern IVF treatment. One in seven couples in this country experience fertility problems and he has given them hope and, in many cases, wonderful happiness. The whole House will want to applaud not just his scientific boldness, but his moral courage in confronting what was considered at the time to be an extremely difficult ethical issue.

[David Rutley]

In the light of the recent measles outbreak in south Wales, does my right hon. Friend agree that the claims made by Dr Andrew Wakefield about the MMR vaccine are both discredited and completely wrong?

[Mr Hunt]

I absolutely agree with my hon. Friend. What Andrew Wakefield said had no scientific basis and caused huge damage and worry to many thousands of parents. It is very important to reiterate that the scientific way to prevent measles, which can be a horrible and even a fatal disease, is to make sure that children have had two doses of MMR. Parents of children of any age who have not had those doses should contact their GP, particularly in the current circumstances.

[Andy Burnham (Leigh) (Lab)]

Accident and emergency departments across England are being closed, even though all are under intense pressure. For 11 weeks running, the NHS has missed the Government’s national A and E target. Last week, in places, one in three patients waited more than four hours in scenes not seen since the bad old days of the mid-1990s. What clearer symbol of the growing crisis in A and E is there than a tent as a makeshift ward in the car park at Norwich? The Secretary of State’s failure to address that cannot continue. Nursing jobs have been lost, ambulances are queuing outside A and E and patients are being treated in car parks. When will he get a grip?

[Mr Hunt]

The statistic that the right hon. Gentleman will not give the House is that for the year as a whole, which ended last March, the Government hit our A and E target. Furthermore, he still will not tell the House about the disaster that is happening in Labour-controlled Wales, where the A and E target has not been hit since 2009. He still refuses to condemn what is happening there. There is a lot of pressure on A and E, because 1 million more people are using A and E every year, compared with just two years ago. What are the root causes? They are poor primary care alternatives that date directly to the disastrous GP contract negotiated by his Government, since when more than 4 million additional people have been using A and E every year, social care and hospital sectors that are not joined up—Labour had 13 years to sort that out but did nothing—and problems in recruitment that have been made a great deal worse by his disastrous decision to implement the working time directive. It is time he sorted out his own issues before trying to criticise the Government for sorting them out.

[Paul Uppal (Wolverhampton South West) (Con)]

T2. The all-party group on men’s health, of which I am vice-chairman, has assisted in research that seems to show that men’s poor sexual health is often symptomatic of more serious problems, such as type 2 diabetes and cardiovascular disease. Will my hon. Friend assure me that all robust measures are being put in place to ensure that that is not overlooked and that men do not die unnecessarily because that situation is taken for granted?

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[Priti Patel (Witham) (Con)]

T4. The Secretary of State is aware of the widespread management failures of East of England ambulance trust, and last month we saw the belated resignation of its chair. Will he ensure that the trust makes patient care the No. 1 priority, and will he join me in calling for its remaining non-executive directors, who presided over these management failings, to reflect on their own positions?

[Mr Jeremy Hunt]

I congratulate my hon. Friend on her campaigning on this. There must be full accountability for what went wrong in that ambulance trust. It is absolutely a top priority for me and my Ministers, two of whom represent Norfolk and Suffolk, to sort out what is happening in the trust, and that is why very decisive action has been taken.

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

T7. Further to the question from my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah), several of my constituents with desperately ill relatives are very angry about the Government referring to NICE a decision on the use of eculizumab. The continuing delay is risking lives and also means that people have several invasive treatments that could well cost more. To save space in the Minister’s diary, may I add a request to join the meeting with my hon. Friend to talk about how this dangerous delay is causing very great distress to many constituents?

[Mr Philip Hollobone (Kettering) (Con)]

T8. Kettering general hospital’s new £30 million foundation wing has a new 16-bed intensive care unit, 28-bed cardiac unit and 32-bed children’s unit, and it opens to patients for the first time this coming Saturday. Will my right hon. Friend the Secretary of State take this opportunity to congratulate all those at Kettering general hospital who have brought this project to fruition?

[Mr Jeremy Hunt]

I would be absolutely delighted to do that. I had an excellent visit to Kettering hospital that was hosted by my hon. Friend, and I saw at first hand just how hard people are working in tough circumstances, with big increases in A and E admissions causing a great deal of pressure throughout the hospital. One had a sense at the hospital that there was a mission to turn things around and make things better, and a management team who were totally committed to doing that. I congratulate them and all the front-line staff who are doing such an important job for the people of Kettering.

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

A year ago, GPs in Hackney bid to run the out-of-hours services. Earlier this year, they were told that it had to be tendered because the board was fearful of legal challenge from private health companies. Who is running the NHS—the Secretary of State or the private health company lawyers?

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[John Pugh (Southport) (LD)]

T9. What is the Department doing to deal with the difficulties presented by poor data sharing between health and social care agencies and the threat to integration that that presents?

[Mr Jeremy Hunt]

My hon. Friend makes a very good point, and I pay tribute to him for raising this issue frequently. We will not have properly integrated, joined-up health and care services unless we crack the issue of data sharing. There need to be protections for people so that they can prevent their data from being shared if they do not want that, but by the same merit we have to make sure that there is better availability. For example, delayed discharges from hospitals, which are causing pressure on A and Es, would be directly helped if we cracked this. That is why we have called for a paperless NHS by 2018.

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

Under the previous Government, my constituents could get an appointment with their GP within 48 hours. I recently heard of a wait for a routine appointment taking three weeks. Is not this one of the reasons there is such pressure on A and Es, and will the Secretary of State reintroduce the 48-hour appointment?

[Mr Hunt]

The reason there is so much pressure on A and Es is the disastrous GP contract negotiated by the hon. Lady’s party in government, since when—I do not know whether she was listening to what I said earlier—an additional 4 million people every year are going to our A and Es. That is what is causing the huge pressure, and that is what we are determined to put right.

[Steve Brine (Winchester) (Con)]

T10. The Secretary of State will know that the number of people donating organs after their death has risen by 50% in the past five years. Does he credit the network of specialist nurses who support bereaved families in hospital for that increase and, if so, what lessons does he take from that?

[Mr Hunt]

This is an example of a programme that has been a huge success and I pay tribute to the work done by the previous Government as well as this Government in making sure that we can tackle this very serious problem. All I would say to my hon. Friend is that three people still die every day, I believe, because we are not able to get the organ donations we need. We should not think that, despite the success, we have solved this problem. There is much work to do and I personally think that it is something that everyone should think about doing. It can be a source of personal pride to put oneself on the organ donation list and we should all encourage our constituents to think about it as well.

[Jenny Chapman (Darlington) (Lab)]

I have listened very carefully to what the Secretary of State has said on A and E, but he has not addressed the fact that under the previous Government waiting times reduced and under his Government they are growing and are now at their longest for more than a decade, so what is he going to do?

[Mr Hunt]

As I said to the right hon. Member for Leigh (Andy Burnham) earlier, we actually hit our A and E waiting time target last year. If the hon. Lady is talking about waiting times in general, the number of people waiting for more than a year for an operation was 18,000 under the previous Government, and the figure has fallen to just 800 under this Government.

[Andrew George (St Ives) (LD)]

If there is a smidgeon of space in any of the Ministers’ diaries, is there a chance that they could meet me and representatives of the nursing profession to address not the issue that I think the Government are saying they are opposed to—mandatory nurse to patient ratios on wards—but that of adequate registered nurse levels on hospital wards?

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

The Secretary of State said earlier that 1 million extra people are attending A and Es annually, but a few minutes later he said that the figure was 4 million. Which one is it?

[Mr Hunt]

It is an additional 4 million since the disastrous changes to the GP contract and an additional 1 million since the last election.

[Dr Sarah Wollaston (Totnes) (Con)]

In Brixham in my constituency, 94% of five-year-olds are protected against measles. Just up the road in Totnes the figure is only 70%. There are many reasons for the variation, but does the Secretary of State share my concern that if parents believe they are protected by, for example, homeopathy products, they might be less likely to use an evidence-based treatment? Will he make an unequivocal statement that such products will not give any protection?

[Mr Hunt]

I am happy to do so and thank my hon. Friend for bringing up the issue. There is no scientific evidence whatsoever that homeopathic products can provide protection against measles. The right thing to do is to get two doses of the MMR jab. As I said earlier, anyone whose children, whatever their age, have not had those two doses should contact their GP.

[Lucy Powell (Manchester Central) (Lab/Co-op)]

As we have heard, A and E waiting times are at their worst level for a decade, yet we hear of proposed A and E reconfigurations based on tackling so-called inappropriate presentations. Does the Secretary of State agree that that approach is the wrong way around and that he would be better off tackling why people are going to A and E first, before he embarks on any reconfigurations?

[Mr Hunt]

That is exactly what we are doing. We are looking at the root causes of the fact that admissions to A and E are going up so fast—namely, that there is such poor primary care provision; that, as we discussed earlier, changes to the GP contract led to a big decline in the availability of out-of-hour services; and, that health and social care services are so badly joined up. That is how we are going to tackle this issue with A and E, and that is what we are doing.

[Mr Stewart Jackson (Peterborough) (Con)]

I am delighted to learn that there will shortly be a new national clinical director for neurological conditions, focusing in particular on conditions such as Tourette’s syndrome. Will the Secretary of State reassure us that that appointment, which is so long overdue, will be expedited at the earliest opportunity?

Heart Surgery (Leeds)

Jeremy Hunt Excerpts

Monday 15th April 2013 Commons Chamber

[Stuart Andrew (Pudsey) (Con)]

(Urgent Question): To ask my right hon. Friend the Secretary of State for Health if he will make a statement on Leeds children’s heart surgery unit.

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

Following the deaths of 30 to 35 children at the Bristol royal infirmary between 1991 and 1995 and the subsequent inquiry, children’s heart surgery is rightly the subject of great public concern.

With respect to Leeds general infirmary, there are three issues that the House will want to be updated on: was it right to suspend children’s heart services at Leeds on 28 March; was the decision handled in the best way possible; and, given his public comments, is it appropriate for Professor Sir Roger Boyle to have a continuing role in the Safe and Sustainable review of children’s heart surgery?

First, was the right decision made? The answer is categorically yes. The principle of “first do no harm” must run through the very heart of the NHS. If there is evidence that patient safety is at risk, it is absolutely right that the NHS acts quickly and decisively to prevent harm to patients. However difficult or controversial, we must never repeat the mistakes made at both Mid Staffs and Bristol, where arguments over the quality of data prevented action that could have saved patients’ lives.

Secondly, was the decision handled properly? On 26 and 27 March, Sir Bruce Keogh, NHS England’s medical director, was given a range of critical information about the quality of care at Leeds: statistical data that indicated higher than expected mortality rates; concerns about staffing rotas; and further concerns from parents and a national charity about the way the most complex cases were referred. With the agreement of the LGI, Sir Bruce took the entirely appropriate decision to suspend children’s heart surgery while further investigations were made. The families were informed on the day the decision was taken to suspend services, 28 March.

On 29 March—Good Friday—the day that decision became public, I spoke with the right hon. Member for Leeds Central (Hilary Benn) and my hon. Friends the Members for Pudsey (Stuart Andrew) and for Leeds North West (Greg Mulholland) to inform them of the situation. My conclusion is that, on the basis of the information available to him, Sir Bruce behaved entirely properly. He was also right to authorise the restarting of surgery from 10 April for low-risk patients on the basis of more complete data and assurances from the trust.

The third question is whether, in the light of his recent comments, Professor Sir Roger Boyle can have a continuing role in the Safe and Sustainable process. Sir Roger is one of our leading heart surgeons. He did the right thing in informing Sir Bruce of his concerns over Leeds’ mortality data. He has also played an important role as an adviser to the Safe and Sustainable review of children’s heart services. However, it is the view of Sir Bruce Keogh, with which I concur fully, that Sir Roger’s comments to the media on 11 April could be seen as prejudging any future conclusions of that review. It is therefore right that Sir Roger plays no further role in its deliberations.

[Stuart Andrew]

I am grateful to my right hon. Friend for his answers. No one would disagree with the point that information that is provided about the safety of a unit should be investigated. However, the quality of the information and the source of the complaints raise serious questions about the proportionality of the action that was taken and, more importantly, about the motives of the complainants. Sir Roger Boyle was a key adviser to the Safe and Sustainable review, which proposed an illogical outcome for northern England. His recent actions and comments surely prove that the decision to close the Leeds unit was predetermined.

Sir Roger leaked data that were unverified to argue for the suspension of surgery—an action that was described as “appalling” by their author. The information was inaccurate and, when corrected, demonstrated that the Leeds unit was safe. In fact, it showed that it is in a similar position to the units at Guy’s and Alder Hey. Why did Sir Roger not recommend the suspension of surgery at those units? Is it because those are the ones that he and the Safe and Sustainable review recommended as designated centres?

Furthermore, on Friday, despite detailed scrutiny that proved that Leeds was safe, Sir Roger claimed that it was on the edge of acceptability and that he would not send his daughter there. Those comments demonstrated a clear bias against Leeds and were irresponsible in respect of parents whose children are facing surgery. In addition, one of the whistleblowers has been identified as a surgeon from the Newcastle unit, which is another example of vested interests.

The suspension of surgery and Sir Roger’s comments have caused huge anxiety and concern among patients and staff, and have hurt the reputation of the hospital, which it has taken years to build. I therefore ask the following questions of my right hon. Friend.

How can we have faith in the Safe and Sustainable review, given that its key adviser has behaved in such an appalling and biased manner? Despite the fact that he will no longer take any part in the review, the decisions remain. Does this matter not prove that Sir Roger acted in a predetermined manner? Is it not vital to put the patient’s interests first, rather than NHS politics? Does my right hon. Friend agree that Leeds has been treated disproportionately when compared with other units that have similar figures? Is he aware that there are reports of surgeons being anxious about providing data for fear of reprisals? Is there not an urgent need for the Independent Reconfiguration Panel to report to resolve the uncertainty that exists across the country with regard to children’s heart surgery? Is it not time to give serious consideration to the proposal that both Leeds and Newcastle should stay open, which is supported by clinicians and patients as it is in their best interests? Finally, will he pay tribute to the staff and patients at Leeds, who have acted with great dignity in the face of hostile criticism?

[Mr Hunt]

I do pay tribute to the staff at Leeds and to the families of patients. I recognise that this is an issue of huge concern. As my hon. Friend rightly says, they have behaved with great dignity in a difficult situation. I also pay tribute to him for the responsible way in which he has behaved in this difficult situation, as have many Leeds MPs.

My hon. Friend will understand, given that the NHS nationally was provided with data that suggested that mortality could be up to 2.75 times greater at that unit and given that there was a potentially busy holiday weekend ahead, when it did not know how complex the cases would be and when there were locums on the staff rota who may or may not have been up to the standard of the permanent staff, that Professor Sir Bruce Keogh had genuine concerns that led to his decision. But I hope the fact that surgery was restarted on 10 April will assuage my hon. Friend’s worry that the initial decision was linked to the Safe and Sustainable review—it was not; it was a concern about patient safety and because that concern has been addressed, surgery has restarted.

There were, however, issues about the quality of the data, which at least in part was because the hospital was not supplying data properly in the way it needed to. That was one reason why the mortality data were not as accurate and good as they should have been. Although I entirely agree that patient safety must always come first, and not NHS or national politics or whatever it may be, that also means that sometimes difficult decisions have to be taken. What happened at Mid Staffs, where we had a big argument about data that meant nothing happened for too long, and what happened originally at Bristol, where up to 35 children may have lost their lives, is a warning about the dangers of inaction. On this occasion, I think that overall the NHS got it right.

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

First, let me apologise to the House on behalf of my right hon. Friend the Member for Leigh (Andy Burnham) who cannot be here today because he is in Liverpool attending the memorial service for victims of the Hillsborough disaster.

This situation has descended into yet another trademark Government shambles. Just 24 hours after the High Court announced that the decision to close the children’s cardiac unit at Leeds was “legally flawed”, Leeds Teaching Hospitals NHS Trust was effectively instructed to stop surgery. The timing of the decision was strange to say the least, but to quote the head of the central cardiac audit database:

“It rings of politics rather than proper process.”

We now know that the instruction was based on incomplete and unverified data, and that Dr Tony Salmon, president of the British Congenital Cardiac Association, was “very concerned” at the way the data were being used, and that any conclusions drawn from the data were “premature”. The Opposition are therefore pleased that this urgent question has been granted as the House clearly deserves some answers.

First, the Secretary of State needs to outline to the House exactly when he was informed that NHS England had concerns about the centre, and say whether he gave his approval to suspend surgery there. If so, was he satisfied that the data presented were accurate and had clinical support? On the issue of data, why did it take this recent episode at Leeds for the information to be released into the public domain—information that my hon. Friend the Member for Leicester West (Liz Kendall), and others, had asked to be released for some time?

Secondly, does the Secretary of State accept that the suspension of surgery, with all the consequent anxiety that it caused patients and staff, was at best a mistake and at worst an irresponsible and disproportionate action? Thirdly, does he accept that the timing of the decision to suspend surgery so soon after the High Court’s ruling caused a great deal of suspicion in Leeds and gave the distinct impression that it was a political decision and not based on clinical evidence? Finally—this point goes beyond Leeds—the Health Secretary’s record so far has failed to inspire confidence in the process of reconfiguration. Will he therefore conduct an urgent investigation into Leeds and how this happened, and consider what lessons can be learned from this unedifying episode for the children’s cardiac review and future reviews?

We owe it to the dedicated staff who work in our NHS to ensure that whatever disagreements we may have in Westminster, and whatever our politics, we do not hinder their ability to provide high-quality care to patients. We also owe it to patients and their families not to add to the anxiety and stress of undergoing treatment. On both those counts the Government have failed, and I hope that when the Secretary of State returns to the Dispatch Box, he will have the decency to apologise and start answering these very serious questions.

[Mr Hunt]

I am afraid the hon. Gentleman has let the Labour party down with the total inadequacy of that response. He spoke of an irresponsible and disproportionate decision, but I ask him to reflect on that as someone who would like to be a Health Minister. Would he seriously have wanted anything different to happen? If the NHS nationally is informed of data that show that mortality rates at a particular hospital could be up to three times higher than they should be, would he sanction the continuation of surgery, or would he say, “We need to get to the bottom of the statistics before deciding whether there will be any more operations”? If he is saying that he would have wanted surgery to continue, I put it to him that he and his party have learned nothing from the lessons of Bristol and nothing from the lessons of Mid Staffs. I did not authorise the decision, but wholeheartedly supported it because it was an operational decision made by NHS England. It is right that such decisions are made by clinicians, who understand such things better than we politicians do.

On reconfigurations, the hon. Gentleman’s party closed or downgraded 12 A and Es and nine maternity units in its period in office. The shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), has said that Labour would not fall into the “easy politics” of opposing every single reconfiguration, but that is exactly what the Opposition are doing. It is not just easy politics; it is what Tony Blair last week called the “comfort zone” of being a “repository for people’s anger” rather than having the courage to argue for difficult reforms.

[Sir Edward Garnier (Harborough) (Con)]

My right hon. Friend mentioned at the outset of his response three principles, the first of which was to do no harm. Following discussions that he and I have had—I am sure he has had such discussions with our hon. Friend the Member for Loughborough (Nicky Morgan) and no doubt other Leicester and Leicestershire MPs—does he agree that there is a read-across from Leeds to Glenfield, where we have the Leicester children’s heart unit? It is unquestionably a unit of international repute and certainly one of national repute. The death rates for that hospital, which deals with particularly difficult patients and highly complicated operations, are right at the top. I urge him to learn from the Leeds fiasco—I do not put the fiasco at his door—that the Glenfield hospital should be preserved for the good of the nation and of the people of the east midlands, so that we do no harm.

[Mr Hunt]

I am grateful to my hon. and learned Friend for his question. I am waiting to hear advice from the Independent Reconfiguration Panel on its assessment of the Safe and Sustainable review. I will wait until I get that advice before making any decisions, and in particular before making any decisions on Glenfield, Leeds or any other hospital involved.

It is important to recognise, however, that there two separate issues: the first is the mortality rates at particular hospitals, but the second is whether we can improve mortality rates overall by concentrating surgery in fewer hospitals. I will wait to hear from the IRP on both before making any decisions.

[Hilary Benn (Leeds Central) (Lab)]

The Secretary of State will be well aware of the deep disquiet in Leeds about what has happened to the children’s heart surgery unit in my constituency, and I am grateful to him for the conversation we had on Good Friday. Given that the High Court has decided that the decision to close Leeds is unlawful, and given that we have now had it confirmed that the Leeds unit was safe before and is safe still, when will he be able to reassure worried parents of very sick children that the future of the Leeds unit is safe?

[Mr Hunt]

I thank the right hon. Gentleman for the constructive conversation we had on Good Friday about what I entirely agree is an extremely difficult issue for the families and for the staff at the LGI. My intention is to try to resolve the matter as quickly as possible. I obviously cannot comment on what view I will take while legal proceedings are under way and while I wait for advice from the IRP, but I agree with him about the uncertainty, which I would like to resolve as quickly as possible. He would want me to be guided by what is in the best interests of his constituents and people across the country who need children’s heart surgery.

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

I, too, thank the Secretary of State for his private phone call to me, but we should have heard from him on this fiasco before today in response to an urgent question. I have to say that his response has simply not been good enough, considering what has happened. To correct one thing that he said, it was not with the agreement of the LGI that services were suspended. Clearly, Sir Bruce Keogh marched into the LGI at 8 o’clock in the morning and said that if surgery was not suspended, people would be sacked. That was no way to behave even if the data were accurate, but Sir Bruce has now backtracked and admitted the data passed to him by his friend Sir Roger Boyle were not accurate.

The decision to close children’s heart surgery in a safe unit, which is what we now know Leeds always was, puts children at greater risk. To make a decision of that nature that is incorrect is simply unacceptable. Will the Secretary of State do what is now clearly necessary and have a full investigation of this fiasco, including the conduct, judgment and motivations of senior NHS officials involved?

[Mr Hunt]

I simply say to the hon. Gentleman that if, as he has alleged consistently in the media, this was some kind of political ploy linked to Safe and Sustainable, we would not have reopened children’s heart surgery in Leeds on 10 April as we did. I spoke to him at the time and told him that it was my hope that operations would be able to resume as soon as possible and that we would get to the bottom of the data to find that the concerns were unnecessary because the unit was safe. In the end, that is what happened.

It would have been utterly irresponsible for Professor Sir Bruce Keogh, in view of the evidence he was faced with—including incomplete data that the hospital had not supplied in the way that it should have done—not to ask the hospital to suspend surgery. That would have been taking a risk with the lives of the hon. Gentleman’s constituents and the people of Leeds in a way that would have been wholly inappropriate. The NHS needs to move in a totally different direction on patient safety, and this is a good example of the NHS medical director behaving promptly and properly in exactly the way he should.

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

In his opening statement, the Secretary of State mentioned that one of Sir Bruce Keogh’s concerns was the complaints made by families in Yorkshire about the treatment their children had received at Leeds children’s heart surgery unit. If there had been those concerns, does the Secretary of State not think that over the three years of the Safe and Sustainable review at least one complaint would have been made via Members of Parliament in Yorkshire or local media outlets? The fact that no complaints were received over three years surely tells him that generally the families were very satisfied with the way their children were treated. Will he now apologise to the families of Yorkshire for the closure between 28 March and 10 April?

[Mr Hunt]

The apology would have been due to those families if Sir Bruce Keogh had not acted promptly in the face of data that showed the possibility of a serious problem at that hospital. He was right to react promptly and to get to the bottom of those data. I put it to the hon. Gentleman that if he had been a Health Minister at the time he would not have wanted the NHS medical director to do anything other than give absolute priority to patient safety. That is what happened. Like the hon. Gentleman, I am delighted that it was possible for operations to resume on 10 April.

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

However we got to this point, I urge my right hon. Friend—on behalf of one of the leading campaigners for Leeds heart surgery, my constituent Lois Brown—to do everything he can to ensure that we move as quickly as possible to a decision on Leeds, based on the full facts and made in a transparent manner.

[Mr Hunt]

I can absolutely assure my hon. Friend that that is my intention. There is legal due process—legal proceedings are under way—and he would want that to be respected. I am also anxious to read and digest the report of the Independent Reconfiguration Panel. I would like that all to happen as quickly as possible within the law, so that we can conclude this matter and remove the great uncertainty that I know is unsettling so many people.

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

Does the Secretary of State not accept that Sir Roger’s unacceptable remarks, which came 24 hours after the court decision confirmed the review as flawed, unfair and unlawful, have dented severely the credibility of the Safe and Sustainable review in the eyes of the public? The Secretary of State has suggested that he will wait until the configuration board comes back with a recommendation, but does he not think that it would have been better if he had come to the Chamber to tell hon. Members and the public what steps he would be taking to restore credibility to the Safe and Sustainable review?

[Mr Hunt]

I think that NHS England has taken firm action: it has said that Professor Boyle will not take any further part in Safe and Sustainable. However, the hon. Gentleman will understand that as the review is currently subject to legal proceedings, I cannot comment any further. As the final decision will end up on my desk, I want to wait until the legal proceedings are complete and I have the report of the IRP to consider before I make that decision. I stress what I said to my hon. Friend the Member for Skipton and Ripon (Julian Smith): I would like it to conclude as quickly as possible. I know that is in the best interests of the people of Leeds.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

I thank my right hon. Friend for his statement. NHS bosses are right to take seriously any concerns regarding patient safety, particularly in the light of the Mid Staffs crisis. There has been significant anger and confusion locally surrounding the chaos of the decision to close the unit. Does my right hon. Friend agree that the use of data, which are incomplete and described by the doctors that produced them as not fit for purpose, has led to precipitate and disproportionate actions that have worried patients and their families? We have, after all, a culture in which NHS managers are extremely familiar with handling data. They must have known that precipitate actions would come from looking at leaked partial data.

[Mr Hunt]

I entirely understand the concern of families, staff and doctors at the LGI. I simply say to my hon. Friend that the reason the data were not complete was because the hospital had failed to supply them. There is, therefore, an important warning to all hospitals to ensure that they supply accurate and timely information on their surgery survival rates.

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

Does the Secretary of State still accept the underlying premise of the Safe and Sustainable review, which is that there should be a smaller number of centres of excellence for children’s specialist heart surgery? If he still accepts that premise, will he say something to the House today about his timetable for bringing the issue, which has gone on for 12 years, to a conclusion?

[Mr Hunt]

I certainly accept the premise, on the basis of considerable clinical evidence, that for complex surgery greater specialisation leads to higher survival rates. On whether that is the right thing to do in this particular case, I would like to wait for the outcome of the legal process and the advice of the Independent Reconfiguration Panel, but I will just say this: I would like to conclude this as quickly as possible. I am subject, rightly, to legal due process. Families who feel strongly want this to be concluded quickly, but they also want to know that it has been concluded fairly, and I think that that underlies a lot of the concerns raised by Members this afternoon. The timetable is not within my gift but what is within my gift in terms of timings I will try to expedite as quickly as possible.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

Does my right hon. Friend recognise that whatever challenge there may be to the evidence relating to Leeds, there has been no challenge to the evidence of the successful outcomes in Newcastle? Can he assure me that clinical evidence will predominate in his final decision?

[Mr Hunt]

I can absolutely give my right hon. Friend that assurance. It is very important, when dealing with very difficult decisions of this nature, that we are led by clinical evidence on what will save the most lives. We have an absolute responsibility to all of our constituents to ensure that clinical evidence informs the final decision.

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

I was contacted by a mother whose son’s operation was cancelled, and it had also been delayed on two previous occasions for other reasons. Given this unedifying situation, in which the two leading clinicians who advise on these areas for the NHS have lowered themselves to saying whether they would send their child to this unit for an operation, what advice should I give to my constituent?

[Mr Hunt]

I am certain that the right hon. Gentleman’s constituent would not want surgery to proceed anywhere in the NHS if there are question marks over its safety. Of course, when such decisions are made in a very short period of time, it is greatly discomfiting and worrying for the many families involved, who have enough to worry about anyway—I completely understand that. He should remember, however, how we in the NHS let down the families in Bristol and Mid Staffs by not acting when data suggested that there might be a problem. It is better to act quickly and decisively and then, if possible, to resume surgery, as happened on this occasion, than not to act at all and to find out later that we have been responsible for much, much worse outcomes.

[Nigel Adams (Selby and Ainsty) (Con)]

On behalf of right hon. and hon. Members across Yorkshire, may I use this opportunity to thank my hon. Friend the Member for Pudsey (Stuart Andrew) for how he has worked in a consensual, cross-party and non-political way on this issue?

Did the Secretary of State not find it at least odd that the concerns about the Leeds unit came to light within hours of the High Court’s ruling against the decision to close the Leeds unit?

[Mr Hunt]

The truth is that whenever the NHS medical director—

[Karl Turner (Kingston upon Hull East) (Lab)]

Come on Jeremy, answer the question.

[Mr Hunt]

Whenever he receives information, the medical director is under an absolute obligation to act. What he did was absolutely correct: he said that he would look at the data and get to the bottom of them and that if it turned out that the data were not as accurate as they should have been, surgery would resume. That is exactly what happened.

[Mr Speaker]

The hon. Member for Kingston upon Hull East (Karl Turner) is a very excitable fellow—he might remind some people of his predecessor in the House in that respect.

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

A baby born with a heart condition in Sheffield who needs a complex intervention would normally go to Leeds. One of the concerns about the Safe and Sustainable review was that children from my constituency would have had to travel further. The decision to suspend the Leeds unit created that very situation. The Secretary of State needs to acknowledge that children could, as it turns out, have been put at risk unnecessarily by closing a unit that was in fact safe, because they would have had to travel further, which for very ill babies is a risk in itself. At the heart of this has been a lack of transparency and a failure to put information into the public domain. I have had to table parliamentary questions to try to get information about what is happening. Nobody wants an unsafe situation. Will the Secretary of State now commit to complete transparency in respect of all the information?

[Mr Hunt]

This situation arose because of the much greater data transparency and because the Government have been encouraging people to come forward if they have concerns about things going wrong. As a result, we were presented with data on the basis of which the NHS director decided that the safe and sensible thing to do was to suspend surgery while we got to the bottom of these data, which could have demonstrated some very serious outcomes. We need to take good advice from clinicians about the balance of risk. Yes, there might be some risks with people having to travel further for the surgery, but surely the risks are much greater if potentially unsafe operations are allowed to continue. That was why, on that balance of risk, it was decided to suspend surgery at Leeds until we could get to the bottom of whether the data were right.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

In the week after surgery at the heart unit was suspended, my wife and I met a constituent in Rothwell whose child was due to go in for surgery. She was completely and utterly exhausted and overwrought with worry and concern. Many people were concerned not just about the suspension, but about the distances that they would have had to travel if Leeds had not reopened. That possibility, which we had previously mentioned, became a reality. Sir Roger has now been suspended from the review, but he had already reported. In order that we can take one positive out of what has happened in the past couple of weeks, will the Secretary of State ensure that the distances people have to travel are now taken seriously in the review?

--- Later in debate ---

[Mr Hunt]

That is exactly the purpose of a review. Let me reassure my hon. Friend that before I make any decision, I will be getting on my desk independent advice from the Independent Reconfiguration Panel. One thing that that advice does is weigh up the balance of advantage between the greater distances that people have to travel and the advantages of specialisation for complex surgery. My heart goes out, as I know his does, to people who were made extremely worried by what happened over Easter at Leeds. However, he will also understand that if there are concerns, the last thing his constituents would want is an NHS that did nothing because of an argument about data. The right thing to do was to get to the bottom of the data, and I am sure that his constituents are as delighted as he and I are that surgery has now resumed.

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

What does the Secretary of State think of the opinion of one of my constituents, who said to me over the weekend, “What a right old mess all this has been”? The fact is that it has been a mess. I have supported the all-party campaign on the basis that we go for the best clinically safe outcomes for all my constituents. My constituents have gone to Leeds general infirmary, as have my children. It is a hospital of great renown, in which the people of Yorkshire have tremendous faith, but in today’s statement the Secretary of State has two or three times put us in the same frame as Mid Staffordshire and Bristol. There is no question but that Leeds general infirmary is a fine institution. Will he put it on the record today that this is not the same sort of case? This is a fine hospital struggling to deliver under a cloud that has been over it for three or four years.

[Mr Hunt]

What I say to the hon. Gentleman is that it is a fine hospital and a safe hospital, but data were presented to the NHS medical director that said that mortality rates there for children’s heart surgery were two and three quarter times higher than should be expected. In that situation, there is of course a great deal of inconvenience and worry caused by a decision to suspend surgery, but I would rather have that inconvenience and worry than continue with surgery when we have not got to the bottom of whether there is any truth in those data. That must be the right thing to do for the people who are due to have operations at that hospital.

[Martin Vickers (Cleethorpes) (Con)]

Parents whose children face major surgery are already particularly anxious and distressed, and that is before an unseemly public dispute breaks out between the medical experts that they rely on. This also highlights the fact that the investigation has been going on for far too long. The uncertainty is unacceptable. May I urge my right hon. Friend to do everything possible to bring the matter to a speedy conclusion?

[Mr Hunt]

I completely agree with my hon. Friend. I want this to be resolved as quickly as possible. We have to operate within legal due process, but the sooner we can resolve the uncertainty, the better.

[Mr Gerry Sutcliffe (Bradford South) (Lab)]

I know the Secretary of State likes dancing, but his fancy footsteps today are doing him no favours. The position in Leeds is that the public have lost confidence after what has taken place. Sir Roger Boyle has condemned the hospital and the Secretary of State has not condemned him for the comments he has made. Can he do that now?

[Mr Hunt]

Let me be clear: I do not want anyone in the NHS who has concerns about mortality to sit on those concerns, so if Sir Roger had concerns, he was right to raise them with Professor Sir Bruce Keogh. Sir Roger also made comments that suggested that he might have prejudged the outcome of Safe and Sustainable, so I think it is right that he does not take any further role in that, and we will be getting independent advice on whether Safe and Sustainable made the right recommendations, which I shall consider before making any decision. I have to say to the hon. Gentleman that there is no fancy footwork. I am absolutely clear that if anyone, anywhere in the NHS, has concerns about safety and if the view of the NHS medical director is that we need to investigate those concerns and, in the meantime, suspend surgery at that institution, I will support the NHS medical director. That is the right thing to do and I think the hon. Gentleman would do exactly the same if he were in my shoes.

[Mr David Ward (Bradford East) (LD)]

This whole thing stinks; it really does. We now know that the unit is perfectly safe, which means that, for a period of time, children’s health was put at risk while it was closed. That is the seriousness of the situation. The decision was not made after careful, thoughtful consideration of authoritative, verified data; it was a kneejerk reaction to what must, in all probability, have been malicious allegations made against the unit. We have been told over and over again to ask ourselves what Sir Roger could have done, other than close the unit, but what did he actually do? That is what we need to find out, and the matter needs to be investigated. We know what the context was, following the court case, and we need to find out what follow-up work he did in that context to verify the allegations before he took that risk with the health of young children.

[Mr Hunt]

There are some risks, of course, in suspending surgery, but when we have mortality data such as those that Professor Sir Bruce Keogh was faced with, there are also considerable risks involved in doing nothing in response. The decision was taken not to close the children’s heart unit but to suspend surgery until he could get to the bottom of whether there was any truth in the data. He had a very difficult decision to make, given that situation, but I think he made the right decision.

[Nic Dakin (Scunthorpe) (Lab)]

Parents of very poorly children in the Scunthorpe area who have been very effectively supported by the Leeds unit have been dismayed to hear what has been happening over the past month or so. The Secretary of State has given us clear answers this afternoon, and I thank him for that. He has said that there will be a resolution to the Safe and Sustainable review as soon as possible. Will that be in 2013 or at some point beyond that?

[Mr Hunt]

I very much hope that this does not go beyond 2013, but I am afraid that that is not in my hands, because of legal due process. Legal proceedings are under way at the moment and I have to consider the advice of the Independent Reconfiguration Panel, but I want to stress to the hon. Gentleman, as I have to many hon. Members, my determination to resolve the situation as quickly as possible.

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

Children living in Thirsk and Malton will be operated on either at Leeds hospital or at Newcastle hospital. What is becoming apparent in this and other debates on the health service is the desire of parents and other family members to have their loved ones—young children in this case—operated on as close as possible to where they live, whereas clinicians and the Government seem, at every stage of the NHS reforms, to be making decisions based on clinical excellence. This is a debate that needs to be had.

[Mr Hunt]

I agree with my hon. Friend. There are two types of reason for people going into hospital. With geriatric care, for example, there are clear advantages in someone being treated as near as possible to their home. All other things being equal, it makes sense for people to be treated where it is easy for friends and family to visit them, as that can aid recuperation and convalescence. When more complex surgery is required, however, there is clinical evidence that mortality rates are better if we specialise surgery in a fewer number of centres. That is the debate that we are having about children’s heart surgery, and I hope to resolve the matter as quickly as possible.

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

Given that the Safe and Sustainable review is being dogged by so many problems, and given the inaccuracies and the prejudice against Leeds in particular, has the Secretary of State thought about scrapping the whole process?

[Mr Hunt]

That is the subject of legal proceedings at the moment, and I want to ensure that we have a process that is fair and that is recognised to be fair by all the people who are affected by this possible decision. I therefore want to ensure that the decision will be judicially robust, but I also want to get independent advice from the IRP before I make my final decision. If that means that it takes longer to get to a decision, then I am afraid that that might be the case, but the most important thing is to get to a decision that is fair and that is recognised to be so.

[Jenny Chapman (Darlington) (Lab)]

It is right that such decisions should be made on the basis of data, but those data must be more reliable. Such decisions are made in this way up and down the country on maternity and accident and emergency units, for example. How will the Secretary of State ensure that such data are reliable and robust, that they can be challenged, and that such situations can be dealt with far more quickly than has been the case in Leeds?

[Mr Hunt]

The hon. Lady makes an important point. At the heart of this is a change happening in the NHS, where heart surgery is leading the way and we are discovering that we can make dramatic improvements to mortality rates. It has happened in heart surgery, where we have moved from being one of the worst performers in Europe to one of the best, because of the collection of risk-adjusted data. That has now been extended to cancer outcomes and to a total of 10 specialities. We shall gradually collect those data over the next two years, which will allow peer review in a way that cannot normally happen. It is a big change and part of the issue was that the hospital in Leeds did not realise how seriously the data would be taken, which may have meant that it did not supply as complete data as it should have, and that led to the problem. There is a big change, but also a big opportunity for the NHS to improve its outcomes.

[Jonathan Ashworth (Leicester South) (Lab)]

I want to reinforce entirely the point put to the Secretary of State by the hon. and learned Member for Harborough (Sir Edward Garnier) a few moments ago. Safe and Sustainable made recommendations about Leeds and about closing children’s heart surgery at Leicester, but in recent days published data show that Leicester has one of the lowest mortality rates. Can the Secretary of State guarantee that the Independent Reconfiguration Panel will fully take into account those data published just a few days ago?

[Mr Hunt]

Absolutely.

[Paul Blomfield (Sheffield Central) (Lab)]

We have seen an extraordinary sequence of events that have unnecessarily tarnished the reputation of what the Secretary of State described as a fine hospital, and caused enormous anxiety to families across Yorkshire and the wider region. Does the Secretary of State not agree therefore that we need a full inquiry into how the decision was taken?

[Mr Hunt]

I think the most important thing is properly to establish the truth of the data and then to make sure that any lessons learned from that are reflected in decisions made about the Safe and Sustainable Review, so that the influence of mortality data on any decisions in Safe and Sustainable is based on proper analysis of those data. That is certainly something we will learn from.

Mid Staffordshire NHS Foundation Trust

Jeremy Hunt Excerpts

Tuesday 26th March 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 Government’s response to the Mid Staffordshire NHS Foundation Trust public inquiry.

I congratulate my predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), on setting up the public inquiry and on the many changes that he made in foreseeing its likely recommendations. I also pay tribute to Robert Francis QC for his work in producing a seminal report that will, I believe, mark a turning point in the history of the NHS.

Many terrible things happened at Mid Staffs, in what has rightly been described as the NHS’s darkest hour. Both the current and former Prime Minister have apologised. However, when people have suffered on such a scale and died unnecessarily, our greatest responsibility lies not in our words, but in our actions. Our actions must ensure that the NHS is what every health professional and patient wants: a service that is true to NHS values, that puts patients first, and that treats people with dignity, respect and compassion.

The Government accept the essence of the inquiry’s recommendations and will respond to them in full in due course. However, given the urgency of the need for change, I am today announcing the key elements of our response so that we can proceed to implementation as quickly as possible. I have divided our response into five areas: preventing problems from arising by putting the needs of patients first; detecting problems early; taking action promptly; ensuring that there is robust accountability; and leadership. Let me take each in turn.

To prevent problems from arising in the first place, we need to embed a culture of zero harm and compassionate care throughout the NHS; a culture in which the needs of patients are central, whatever the pressures of a busy, modern health service. As Robert Francis said,

“The system as a whole failed in its most essential duty—to protect patients from unacceptable risks of harm and from unacceptable, and in some cases inhumane, treatment that should never be tolerated in any hospital.”

At the heart of this problem is the fact that current definitions of success for hospitals fail to prioritise the needs of patients. Too often, the focus has been on compliance with regulation rather than on what those regulations aim to achieve. Furthermore, the way hospitals are inspected is fundamentally flawed, with the same generalist inspectors looking at slimming clinics, care homes and major teaching hospitals—sometimes in the same month. We will therefore set up a new regulatory model under a strong, independent chief inspector of hospitals, working for the Care Quality Commission. Inspections will move to a new specialist model based on rigorous and challenging peer review. Assessments will include judgments about hospitals’ overall performance, including whether patients are listened to and treated with dignity and respect, the safety of services, responsiveness, clinical standards and governance.

The Nuffield Trust has reported on the feasibility of assessments and Ofsted-style ratings, and I am very grateful for its thorough work. I agree with its conclusion that there is a serious gap in the provision of clear, comprehensive and trusted information on the quality of care. In order therefore to expose failure, recognise excellence and incentivise improvement, the chief inspector will produce a single aggregated rating for every NHS trust. Because the patient experience will be central to the inspection, it will not be possible for hospitals to get a good inspection result without the highest standards of patient care.

The Nuffield Trust rightly says, however, that in organisations as large and as complex as hospitals, a single rating on its own would be misleading. The chief inspector will therefore also assess hospital performance at speciality or department level. This will mean that cancer patients will be told of the quality of cancer services, and prospective mothers the quality of maternity services. We will also introduce a chief inspector of social care and look into the merits of a chief inspector of primary care to ensure that the same rigour is applied across the health and care system.

We must also build a culture of zero harm throughout the NHS. This does not mean there will never be mistakes, just as a safety-first culture in the airline industry does not mean there are no plane crashes, but it does mean an attitude to harm that treats it as totally unacceptable and takes enormous trouble to learn from mistakes. We await the report on how to achieve this in the NHS from Professor Don Berwick. Zero harm means listening to and acting on complaints, so I will ask the chief inspector to assess hospital complaints procedures, drawing on the work being done by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart to look at best practice.

Given that one of the central complaints of nurses is that they are required to do too much paperwork and thus spend less time with patients, I have asked the NHS Confederation to review how we can reduce the bureaucratic burden on front-line staff and NHS providers by a third. I will also be requiring the new Health and Social Care Information Centre to use its statutory powers to eliminate duplication and reduce bureaucratic burdens.

Secondly, we must have a clearer picture of what is happening within the NHS and social care system so that, where problems exist, they are detected more quickly. As Francis recognised, the disjointed system of regulation and inspection smothered the NHS, collecting too much information but producing too little intelligence. We will therefore introduce a new statutory duty of candour for providers to ensure that honesty and transparency are the norm in every organisation, and the new chief inspector of hospitals will be the nation’s whistleblower-in-chief.

To ensure that there is no conflict in that role, the CQC will no longer be responsible for putting right any problems identified in hospitals. Its enforcement powers will be delegated to Monitor and the NHS Trust Development Authority, which it will be able to ask to act when necessary. We know that publishing survival results improves standards, as has been shown in heart surgery, so I am very pleased that we will be doing the same for a further 10 disciplines—cardiology, vascular, upper gastrointestinal, colorectal, orthopaedic, bariatric, urological, head and neck, and thyroid and endocrine surgery.

The third part of our response is to ensure that any concerns are followed by swift action. The problem with Mid Staffs was not that the problems were unknown; it was that nothing was done. The Francis report sets out a timeline of around 50 warning signs between 2001 and 2009, yet Ministers and managers in the wider system failed to act on those warnings. Some were not aware of them; others dodged responsibility. That must change. No hospital will be rated as good or outstanding if fundamental standards are breached, and trusts will be given a strictly limited period of time to rectify any such breaches. If they fail to do that, they will be put into a failure regime that could ultimately lead to special administration and the automatic suspension of the board.

The fourth part of our response concerns accountability for wrongdoers. It is important to say that what went wrong at Mid Staffs was not typical of our NHS, and that the vast majority of doctors and nurses give excellent care day in, day out. We must ensure that the system does not crush the innate sense of decency and compassion that drives people to give their lives to the NHS.

Francis said that primary responsibility for what went wrong at Mid Staffs lies with the board. We will, therefore, look at new legal sanctions at corporate level for organisations that wilfully generate misleading information or withhold information that they are required to provide. We will also consult on a barring scheme to prevent managers found guilty of gross misconduct from finding a job in another part of the system. In addition, we intend to change the practices around severance payments, which have caused great public disquiet.

The General Medical Council, the Nursing and Midwifery Council and other professional regulators have been asked to tighten their procedures for breaches of professional standards. I will wait to hear how they intend to do that, and for Don Berwick’s conclusions on zero harm, before deciding whether it is necessary to take further action. The chief inspector will also ensure that hospitals are meeting their existing legal obligations to ensure that unsuitable health care support workers are barred.

The final part of our response will be to ensure that NHS staff are properly led and motivated. As Francis said,

“all who work in the system, regardless of their qualifications or role, must recognise that they are part of a very large team who all have but one objective, the proper care and treatment of their patients”.

Today I am announcing some important changes in training for nurses. I want NHS-funded student nurses to spend up to a year working on the front line as support workers or health care assistants as a prerequisite for receiving funding for their degree. That will ensure that people who become nurses have the right values and understand their role. Health care support workers and adult social care workers will now have a code of conduct and minimum training standards, both of which are being published today. I will also ask the chief inspector to ensure that hospitals are properly recruiting, training and supporting health care assistants, drawing on the recommendations being produced by Camilla Cavendish. The Department of Health will learn from the criticisms of its own role by becoming the first Department in which every civil servant will have real and extensive experience of the front line.

The events at Stafford Hospital were a betrayal of the worst kind—a betrayal of patients, families, and the vast majority of NHS staff who do everything in their power to give their patients the high-quality, compassionate care they deserve. I want Mid Staffs to be not a byword for failure but a catalyst for change, and to create an NHS where everyone can be confident of safe, high-quality, compassionate care, and where best practice becomes common practice, and the way a person is made to feel as a human being is every bit as important as the treatment they receive. That must be our mission and I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement and for the measured way in which he introduced it.

The NHS is 65 this year, and if it is to be ready for the challenges of this century, it must learn from the darkest hours of its past. The NHS was founded on compassion and, as the Secretary of State said, what happened at Stafford was a betrayal of that. Rightly, apologies have been given, but it is now time to act and make this a moment of change.

Robert Francis delivered 290 careful recommendations after a three-year public inquiry and, like the Secretary of State, I pay tribute to him today. In response, the Prime Minister promised a detailed response to each recommendation by the end of this month. Although the Opposition welcome much of what the Secretary of State has said today, his statement falls short of that promised full response and contains serious omissions on which I would like to press him, in particular, on four of Robert Francis’s flagship recommendations, which I shall take in turn.

First, we welcome the move to place a duty of candour on health care providers and believe it could help bring about the culture change the NHS needs. The Francis report, however, goes further and recommends a duty of candour on individual members of staff. Will the Secretary of State say more about why he has only accepted this recommendation in part and not applied it to staff? Has he ruled that out or is he prepared to give it further consideration?

Will the Secretary of State assure the House that the duty will apply equally to all providers of NHS services, including private providers? His statement was a little vague on that point. More generally, with more private providers coming into the NHS, is it not the case that we will not get the transparency we need unless the provisions of freedom of information apply fully to all holders of NHS contracts and information cannot be withheld under commercial confidentiality?

Secondly, on patient voice, the Government have announced new chief inspectors of hospitals and social care. Those were not Francis recommendations and, while we give them a cautious welcome, I am sure that the Secretary of State will agree that regulation alone will not be enough to prevent another Mid Staffs. Instead, we need a powerful patient voice in every community that is able to sound the alarm if things are going wrong. Rather than pulling down the shutters, as the NHS has a tendency to do, complaints should be embraced as opportunities to learn and improve.

It is just a matter of days until the new NHS comes into being and the concern is that patient voice has not been embedded at the heart of the new system. A third of councils say that their local healthwatch will not be up and running by the 1 April deadline, and there are wide variations in both structure and membership. Will the Government accept Robert Francis’s recommendation of a consistent basic structure for healthwatch programmes throughout the country before it is too late and they go their separate ways?

Thirdly, on regulation and training, Robert Francis has made a very clear case for a new system of regulation of health care assistants to improve basic standards—a case that we made during the passage of the Health and Social Care Act 2012—yet it did not feature in the Secretary of State’s statement. Have the Government accepted in principle the regulation of health care assistants?

We support moves to rebalance nurse training and to include more hands-on experience, but student nurses already spend 50% of their time in clinical practice and face significant financial barriers when completing their training. Will the Secretary of State assure the House that requiring a year on the ward will not increase the financial barriers to young people entering nursing and, if more trainees are to be on the wards, will he ensure that there are enough staff with the time to train the extra students?

That takes me to my fourth point and the most glaring omission from the Secretary of State’s statement, namely safe staffing levels. We will never get the right culture on our wards if they are understaffed and over-stretched, but there is evidence that things are going in the wrong direction and the Secretary of State was silent on the issue today.

The CQC has recently reported that one in 10 hospitals in England do not have adequate staffing levels. Just last week, work force figures showed that there had been a reduction of 843 nurses between November and December last year. Does that not sound the clearest of alarm bells that some parts of the NHS are already in danger of forgetting the lessons of its recent past by cutting the front line too far? Do not communities need a clear, objective benchmark so that they can challenge staffing levels on wards, and would it not be a great help to them for the Francis recommendation on staff-patient ratios to be accepted? We learned last week that the Department has handed £2.2 billion from last year’s budget back to the Treasury. Surely that money would have been better invested in the front line and in bringing all hospitals in England back up to safe staffing levels.

Finally, I want to turn to Stafford hospital itself, which Monitor has recommended should be placed in administration. This doubt about the hospital’s future will be causing real concern to the people of Stafford. After all they have been through, I think we can all agree that they deserve a safe and sustainable hospital, and I hope the Secretary of State will soon set out a plan to achieve that.

Learning the lessons of Stafford cannot be done overnight. We all have to play our part. The Government have made a start today, but much more needs to be done and we will hold them to that.

[Mr Hunt]

The right hon. Gentleman talks about glaring omissions in the Government’s response, but there were glaring omissions in his response too. Where was the apology for Labour’s targets culture that led to so many of the problems; the apology for failing to set up a regulatory structure that had proper safeguards; and the apology for missing all those warning signs? This was not just the darkest day in NHS history, but the darkest day in Labour’s management of the NHS. It is time the Labour party recognised the policy mistakes it made.

Let me go through what the right hon. Gentleman says are omissions. First, on the duty of candour, we accept the principle of the duty of candour when it applies to hospital boards, but we want to be absolutely sure that there are not unintended consequences of applying it to hospital staff, because another part of the Francis report is on the importance of a culture of openness and transparency, and we do not want a culture of fear. We have therefore not ruled out criminal sanctions for hospital employees who breach a duty of candour—they already have a contractual duty of candour —but, as I said in my statement, we want to wait for the result of Don Berwick’s report on zero harm to ensure that we do not take any measure that impedes the openness we need in hospitals.

The inspection regime will apply to all providers. It is important that it should, but I remind the right hon. Gentleman, who mentioned private providers, that the problems happened at an NHS hospital. Trying to turn this into a debate on privatisation tells people that Labour is missing the point in the response to Francis.

We will not introduce statutory regulation of health care assistants, but we will introduce minimum standards of training for them. We will not introduce statutory regulation because we believe there is a risk that a database of 0.5 million to 1.5 million people could end up being a box-ticking exercise that fails to raise standards in the way we need. We believe we have another way to achieve the same end, which is what we will implement.

On nurse training, we believe it is important that nurses have hands-on experience of the front line, because nurses, when they are properly qualified, will be managing health care assistants. It is therefore important that nurses understand what it is like to be a health care assistant. We will be very careful in how we implement that to ensure that we do not create financial barriers because, obviously, we want to attract the best people into nursing, regardless of income.

On staffing levels and nursing numbers, I remind the right hon. Gentleman that the problems at Mid Staffs happened when Labour was in power, when budgets were going up quite significantly, and when numbers were going up. To distil the problem to one of numbers is, again, to miss the point. This is about the values of the people on the ward. If he wants to talk about numbers, he must accept that, because this Government have protected the NHS budget, which he wants to cut from its current levels, there are 6,000 more clinical staff in the NHS today than there were at the time of the last election.

On Stafford hospital, it is extremely important that, when we have problems such as the ones at Mid Staffs, we create a structure that makes it impossible not to deal with them. That is a difficult process. We are announcing today a time-limited process to ensure that Ministers and the system cannot duck difficult decisions when we have a failing hospital. Obviously, we will follow the Monitor trust special administrators’ recommendations and look at them carefully, but it is important to address the issues. The wrong thing to do would be to fail to do so, because that would lead to clinical failure.

I welcome the fact that the right hon. Gentleman broadly accepts the Francis recommendations. He asked whether we would respond to all of them. The inquiry was a public inquiry, which he refused to set up. As a result of that detailed public inquiry, there are 290 recommendations. It takes time to go through all of them in detail, but I thought it was right to come to the House today with our initial response so that we can get cracking with the important things right away.

[Several hon. Members]

rose—

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

I thank the Secretary of State for coming to the House and making a statement that helps to restore our confidence in the NHS, which has been so badly undermined by Labour’s appalling stewardship. Will he take steps to ensure that any complaints procedure provides protection to patients and relatives who raise concerns?

[Mr Hunt]

My right hon. Friend makes an important point. The thing about complaints procedures is that we must have a system that is not about process and whether there is a response to a complaint in three days. The question is whether a hospital looks at and learns from a complaints procedure and changes its behaviour. That is what the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart are looking into. Hospitals will be inspected against best practice to try to encourage as many of them as possible to adopt the very best complaints procedures.

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

The Secretary of State has announced that he will consult on a barring scheme to prevent managers who are found guilty of gross misconduct from finding a job in another part of the system. To how many managers of Mid Staffordshire would he expect that to apply?

[Mr Hunt]

The hon. Lady will know that, when it comes to individuals—appalled as I am, and as appalled as all hon. Members are, by what happened at Mid Staffs—I must try not to prejudge due process. If we are to bar people from employment, we must have a fair process and system and a right of appeal, which is required under our law anyway. However, I would not expect any manager responsible for the kind of things that happened at Mid Staffs to be able to get a job in the health service ever again.

[John Pugh (Southport) (LD)]

Peter Walsh from Action against Medical Accidents has described the legally enforceable duty of candour as the

“the biggest advance in patient safety and patients rights in the history of the NHS.”

Does the Secretary of State agree?

--- Later in debate ---

[Mr Hunt]

I listened to Peter Walsh’s thoughtful contribution to the “Today” programme this morning. We will consider carefully whether to apply the statutory duty of candour, backed up with criminal sanctions, to hospital employees. The review on zero harm and creating the right culture in hospitals will report not in a long time, but before the summer break, so it is right to wait until we have it before making our final decision.

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

The Francis report said that three areas went wrong: the first was unprofessional behaviour; the second was a lack of leadership; and the third was that the overwhelming prevalent factors were lack of staff in terms of both absolute numbers and appropriate skills. Given that we have lost thousands of nursing posts in the past few years, is the Secretary of State missing the point?

[Mr Hunt]

If the right hon. Gentleman had listened to what I have said, he would know that the number of clinical staff has gone up by 6,000 since the last election, which would not have been possible had we cut the NHS budget, which is what Labour Front Benchers want. It is important to ensure that we have the right numbers in wards to care for people. That is exactly what the new chief inspector will look at. There is evidence that hospitals that have the highest and most respected standards of care ensure they have adequate numbers not just of nurses, but of health care assistants. The whole NHS needs to learn the lesson that it must not cut corners when it comes to care.

[Jeremy Lefroy (Stafford) (Con)]

My right hon. Friend’s welcome statement shows just how important the inquiry was, and how vital its lessons will be for patient care and safety. The royal colleges have a great responsibility. Will he call them together on a regular basis to discuss how they are checking and raising standards in their professions to ensure first-class care for patients?

[Mr Hunt]

First, I thank my hon. Friend for his extraordinarily tireless work and for the extremely measured and mature attitude he has taken to the problems in the hospital, which is on his patch. Hon. Members on both sides of the House welcome that. He is right about the role of the royal colleges. There are some challenging suggestions in the Francis report for some of those colleges, but when we are seeking to raise standards, it is important that setting up that scorecard for the new chief inspector happens with the help of the royal colleges, whose business it is to raise standards in the NHS.

[Valerie Vaz (Walsall South) (Lab)]

I thank the Secretary of State for his statement, and we welcome the continuation of this discussion at the Health Committee. One of the recommendations of Francis was for the Secretary of State to look at the overlap between the CQC and Monitor, both of which were involved and have accepted they were part of the failings. Under the new inspection regime, will the chief inspector report to the Secretary of State or to the NHS Commissioning Board?

[Mr Hunt]

Neither. The chief inspector will report to the CQC. The hon. Lady is right that one of the problems is the overlapping roles and the confusion of roles. What we are announcing today is a significant change in the responsibilities of the CQC. It will no longer be involved in putting right problems in hospitals: its job will simply be to identify problems, so it is not compromised in its ability to be the nation’s whistleblower-in-chief. The responsibility for putting right problems will lie with Monitor, the NHS Trust Development Authority, the NHS Commissioning Board and the wider NHS system. We want to make sure that the chief inspector is unconstrained and unconflicted, when his or her team goes into hospitals, from shouting loudly if there is a problem and continuing to shout loudly until it is solved.

[Sir Tony Baldry (Banbury) (Con)]

These changes all come against a background of other changes in the NHS, such as clinical commissioning groups, Healthwatch and health and wellbeing boards, and I wonder whether my right hon. Friend would be kind enough to put in the Library a plain person’s guide, so that we can understand how these new regulators, inspectors and various other bodies fit in with each other—who is accountable to whom—so we as constituency MPs will know whom to approach and on what occasion. I am sure that all these changes are very welcome, but we need to understand how they relate to each other.

[Mr Hunt]

I am sure that my hon. Friend’s sentiments are shared on both sides of the House. Indeed, I could have done with such a guide when I started this job last September. I am happy to do as he requests, but from today’s announcement the most important thing that the country should know is that when it comes to failures in care, the buck stops in one place. It will be the chief inspector’s job to identify such failures and shout publicly about them, and that will be an important clarification that the system needs.

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

This is not a debate about private or public, but will the Secretary of State ensure that the duty of candour is applied equally to private providers of NHS services?

[Mr Hunt]

Yes, it will be, as it will to providers in the social care sector.

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

Can the Secretary of State confirm that it is his intention that the statutory duty of candour—and the introduction of a ratings system—will apply to home care and care homes, not just NHS providers?

[Mr Hunt]

Yes, I can confirm that. My hon. Friend is right, because part of the big change that we need is to see a big increase in provision of domiciliary care, and an increase in the standard of that care.

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

The Secretary of State talks about severance and follow-on employment. Does he think it is acceptable that when the former chief executive of Morecambe Bay hospitals trust had to step down in February last year, because of the problems there, he was kept on the books in secret and paid £250,000 from local trust budgets—which could otherwise have gone to local health care—and was transferred to the NHS Confederation where his responsibilities could include teaching future leaders and helping to redesign the system?

--- Later in debate ---

[Mr Hunt]

That is the kind of shocking practice that is totally unacceptable.

[Margot James (Stourbridge) (Con)]

I very much welcome the return of student nurses to the wards for a year of their training. Project 2000 has much to answer for. On the subject of resourcing and staff to patient ratios, may I remind my right hon. Friend that many of the reports we have seen in the last few years, criticising hospitals for poor care and lack of dignity in the care of older people in particular, have shown that wards in the same hospitals have had very different standards of care? How can that be about resourcing?

[Mr Hunt]

My hon. Friend makes an important point. It is important that these assessments are made not just at an organisation level, but drill down into the different parts of a hospital, and we have taken that message on board from the Nuffield report on ratings. She is right that it is not just about resources, but sometimes it is about resources. Parts of a hospital can be understaffed when it comes to people who are required to perform basic and important roles in terms of care. Because it is a complex picture—and because numbers can be part of the problem, but are certainly not the whole problem—we want a chief inspector who will take a holistic view of every aspect of the performance of a hospital and be able to give proper feedback that a hospital can use to improve its performance.

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

May I press the Health Secretary on this point? I have raised several times the point that adequate staffing levels are crucial to patient safety and good care, but we seem to dodge around saying that it is a question of values, not of numbers. Francis said clearly that one of the issues was numbers. I have given examples of my local hospital, which views it as crucial that it has the right staffing mix, which it adjusts every single day, for the patients that it has. Will he stop avoiding this question and address it directly, because one in 10 hospitals do not have adequate staffing levels?

[Mr Hunt]

I am not avoiding it. I agree that adequate staffing levels are essential to patient care. I remind the hon. Lady that the shadow Health Secretary said to the Francis inquiry:

“I do not think that the Government could ever mandate a headcount in organisations. Whilst we could recommend staff levels, we were moving into an era when trusts were being encouraged to work differently and cleverly, and take responsibility for delivering safe care whilst meeting targets”.

[Mr William Cash (Stone) (Con)]

The Secretary of State rightly talks about a betrayal of trust of the worst kind, and he is right. He is also right about zero harm, and about much else that he has done. But there is one serious omission—of accountability—and that must be robust and include the resignation of Sir David Nicholson. I also apportion responsibility to those former Secretaries of State who were not called to give evidence but bear a heavy responsibility for not having done the right thing at the right time.

[Mr Hunt]

My hon. Friend knows that I have a different view of the level of responsibility of Sir David Nicholson, but I agree that everyone working in the system at that time shares some responsibility for what happened. We must make sure that it can never happen again. The accountability that we are introducing, including criminal sanctions for boards that fail in their statutory duties, will be a significant change. The body that was responsible for what went wrong at Mid Staffs, according to Francis, was the board of the hospital, so that is where our focus must be. Today is also about getting the right structures outside the hospital to make sure there is accountability there too.

[Mark Durkan (Foyle) (SDLP)]

The Secretary of State has referred to the fact the chief inspector will inspect hospital performance at specialty or department level. How will that be done? If records, paperwork and bureaucracy are being reduced in hospitals, will hospitals’ own records be used to make those assessments or will the inspector use other information?

[Mr Hunt]

Of course we need to rely on good information being supplied by hospitals, and that is why we have said today that it will be a criminal offence for hospitals knowingly to supply wrong information. This goes back to an earlier question, and we will work closely with outside bodies, such as the royal colleges, to ensure that we establish the best way to judge, for example, cancer survival rates. One of the lessons of the success of measuring heart surgery survival rates is the importance of having a good risk-adjustment process in place. We will do that across the other 10 specialties that I announced today.

[Dr Phillip Lee (Bracknell) (Con)]

Although I acknowledge the Secretary of State’s genuine desire to improve hospital standards by the introduction of his new inspectorate, I am concerned about the further reliance on systems above individual responsibility. Will he assure the House that his new inspectorate will not become yet another component of the merry-go-round of management employment schemes currently found in the NHS? Will he also assure me that those implicated in previous hospital management scandals will not be employed as inspectors in the future?

[Mr Hunt]

My hon. Friend is right: we have to ensure that the inspectorate works in the successful way that Ofsted has worked in the school system, and does not make the mistakes that have been made by other regulators inside the NHS system. It is important that it is based on respected peer review, is thorough and is respected in terms of the input that it is able to give hospitals on improving their performance. We will work hard to make sure that we deliver that.

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

Who is expected to pay for the additional year that nurses will spend as health care assistants?

[Mr Hunt]

We are piloting the scheme to ensure that we do not end up discriminating against nurses for financial reasons. We want to attract the best people into the profession, whatever their financial background.

[Mr Edward Leigh (Gainsborough) (Con)]

Every time there is a scandal, the response of the British political establishment is to load more controls, accountability and bureaucracy on professionals, yet every nurse and doctor I meet is fed up with what already happens. As a result of the reforms, will the Secretary of State assure us that we will now trust professionals to get on with the job they love?

[Mr Hunt]

I agree with those sentiments strongly. In parallel to this process and these changes, I have asked the NHS Confederation to recommend how we can reduce the bureaucratic burden on hospital front-line staff by a third, precisely because I want to avoid the issues that my hon. Friend mentions. This is about freeing up time for people at the front line, and one way is to have an inspection system in which everyone has confidence. Once there is the confidence that problems will be identified, it becomes much easier, as has happened in the education system, to give more freedom to people on the front line.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement. The public inquiry has been thorough, with new standards put in place and lessons learned from the NHS in Staffordshire. Health in Northern Ireland is a devolved matter. Will he confirm that the report will be sent to the Northern Ireland Assembly Health Minister, Edwin Poots, so that improvements and guidelines can be improved for everyone in the United Kingdom of Great Britain and Northern Ireland?

[Mr Hunt]

I am happy to do so.

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

May I commend my right hon. Friend’s emphasis on leadership? In Colchester, we have seen periods of good and bad leadership, and good leadership is self-evidently the right answer to hospital management. Can I therefore ask him to lay more emphasis on what constitutes good leadership and trust between good leaders and their employees in the health service right through the system, including from Sir David Nicholson downwards, and not to rely overmuch on regulation, which is no substitute for good leadership?

[Mr Hunt]

I agree wholeheartedly. It is very important that we understand that the benefit of the new inspection regime will not just be that it identifies failing hospitals, but outstanding hospitals too, so that we have a good model of leadership in the system from which other managers can learn. Yes, it is really important to have the right relationships between managers and their staff, but we should not mandate or regulate that from the centre. We want to have a system where people can learn from each other.

[Jane Ellison (Battersea) (Con)]

I received a distressing piece of constituency casework yesterday that underlines the importance of the announcement my right hon. Friend has made today. Does he feel that his reforms will build more of a culture of compassion in nursing care?

[Mr Hunt]

That is at the heart of what the reforms intend to achieve. An organisation as complex and as large as the NHS needs corporate objectives and targets—for example, we need to do a lot better on dementia—and we do set system-wide objectives. However, we have to ensure that those objectives, set by whichever party happens to be in power, never compromise the fundamental care and compassion that needs to be at the heart of what the NHS does. We are putting in the safeguards that ensure that that cannot happen.

[Naomi Long (Belfast East) (Alliance)]

Given the mobility of both the work force and students, what discussions has the Secretary of State had with the devolved Administrations regarding the proposed changes to funding nurse places and training?

[Mr Hunt]

We have not had those discussions yet, but we will be introducing them through pilot schemes to give the devolved Administrations plenty of time to talk to us about any knock-on impacts they may have in their areas.

[Mr Aidan Burley (Cannock Chase) (Con)]

Does the Secretary of State agree that the decision to grant foundation trust status to Mid Staffs in 2008 was catastrophic in terms of the trust taking its eye off the ball and focusing on targets rather than on care, and that, now it is being abolished just five years later, never again must a Government pressurise a trust into a particular organisational form just to validate its ideological policy, rather than because it improves the care of patients?

[Mr Hunt]

I would also like to thank my hon. Friend for the work that he does for his local hospital in difficult circumstances directly involved in this terrible scandal. I agree with him: the corporate objective to become a foundation trust overrode everything else in the hospital, at huge expense to patient care. We must never allow that to happen again.

[John Glen (Salisbury) (Con)]

What most people want when they use the NHS is a reliable, accessible service, and to know that when something goes wrong somebody will be held to account and brought to book. Clearly, that has not happened. What can the Secretary of State say to reassure our constituents that people will be held accountable on an individual level, and that we will not see this happen again?

[Mr Hunt]

That accountability is extremely important and happens on many different levels. In particular, we have professional codes of conduct for doctors and nurses, so that in the exceptional situations where those codes are breached, we know, as members of the public, they will be held to account. Those are done at arm’s length from the Government by the General Medical Council and the Nursing and Midwifery Council, but we are talking to them about why it is that still no doctor or nurse has been struck off following what happened at Mid Staffs—I think that is completely wrong.

[Andrew George (St Ives) (LD)]

I know I repeat myself, but adequate registered nurse-to-patient ratios are often at the heart of these failings, yet on page 68 of the report my right hon. Friend rejects the idea of any kind of national benchmarking or guidelines with regard to patient ratios. Will my right hon. Friend keep an open mind and meet me, Professor Elizabeth Robb of the Florence Nightingale Foundation and others from the profession so that we can explore this issue?

--- Later in debate ---

[Mr Hunt]

We are not saying that minimum standards of adequate staffing levels are not needed, but we reject the idea that they should be mandated from the centre—I think there is cross-party agreement on that. The chief inspector will look at and highlight the reasons for poor care and, if they are due to inadequate staffing levels, ensure that something is done about it.

[Sir Peter Bottomley (Worthing West) (Con)]

On the rare occasions when a clinician or other member of hospital staff raises a problem and it is not taken care of, may I suggest that employers have a box in which to put in a note saying what the problem is? There should be a receipt so that if there is an inquiry later, it can be shown what the hospital should have paid attention to right at the beginning.

[Mr Hunt]

That sounds like something that would definitely encourage the duty of candour that we have been talking about today. I am sure that different hospitals will want to have different ways of doing that, but we will definitely note my hon. Friend’s comments.

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

Staffing levels are important, but so are bed numbers. Many of the 41,000 beds lost under the previous Government were in my constituency. Consequently, we have massive pressure on beds, wards on purple alerts and very high mortality rates. Will any inspection regime include an assessment of safe bed levels?

[Mr Hunt]

The inspection regime will of course cover such issues as part of its inspection of whether basic standards of care are being met. Yes, of course such issues matter, but there are challenges beyond what an inspection regime can deliver which we will need to address to deal with these issues. In particular, a problem we are wrestling with at the moment is who will take responsibility for the frail elderly when they are discharged from hospital. One reason why they stay in hospital for a long time is because geriatricians are nervous about sending them back into the community. They do not think anyone will take responsibility for them and that is something we have to look at.

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

On the respective roles of CQC and Monitor, can my right hon. Friend indicate that he expects Monitor to use the full regulatory tools at its disposal and give appropriate challenge to the boards of foundation trusts and hospitals where failure is indicated?

[Mr Hunt]

My hon. Friend is absolutely right. One of the changes we are announcing today is that, in the case of foundation trusts, CQC will be delegating its enforcement powers to Monitor so that it has more powers to insist on necessary changes and ensure that fundamental standards are not being breached.

[Jonathan Evans (Cardiff North) (Con)]

Will my right hon. Friend note that the Patients Association and campaigners such as the Powell family in Wales will not be satisfied by what he has had to say about the duty of candour until we have a full statutory duty in line with what Robert Francis recommended?

--- Later in debate ---

[Mr Hunt]

We will have a full statutory duty, in line with what Robert Francis says, when it comes to the boards of hospitals. We are carefully considering whether that should apply to individual hospital employees, but we want to wait until we have Don Berwick’s review of zero harm.

[Dr Julian Lewis (New Forest East) (Con)]

Does my right hon. Friend accept that the best system in the world will not succeed if individuals who behave inhumanely get away with it and people who observe them behaving inhumanely do not report it? I therefore re-emphasise what my hon. Friend the Member for Cardiff North (Jonathan Evans) has just said: if individuals see this inhumane behaviour, they must report it.

[Mr Hunt]

I agree with what my hon. Friend says.

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

I congratulate my right hon. Friend on his statement, particularly the parts about where perverse effects of the old target culture kick into the NHS. When the dust has settled on the Francis report and its conclusions, will he look at targets that affect the ambulance service and how they directly affect rural communities across the country?

[Mr Hunt]

We will absolutely do that, but I should also reassure my hon. Friend that the inspection regime will apply to the ambulance service as well as hospital trusts.

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

I very much welcome the Secretary of State’s statement, but does he share my sorrow that it has taken so long and so many deaths to reach this stage, when Labour was presented with reports by Don Berwick himself highlighting bad quality assessment, when 120 bodies had overlapping responsibilities and when he said that patient safety was not central to the NHS? Is it not tragic that it has taken this long?

[Mr Hunt]

I thank my hon. Friend. Sadly, I agree with her sentiments. We have a responsibility to ensure that we have structures in place that make it impossible to delay addressing these difficult issues. That is the central challenge that I now face.

[Kris Hopkins (Keighley) (Con)]

We are fortunate to have a high-performing general hospital in Keighley and Ilkley, but does my right hon. Friend agree that even hospitals such as Airedale hospital must not be complacent? Quality must be paramount. Every member of staff has a responsibility to deliver the high level of compassionate care that he spoke about.

[Mr Hunt]

I agree with my hon. Friend. I visited Airedale hospital and was very impressed with the level of care I saw there. It is one of the only hospital trusts in the country—if not the only one—where doctors can see the full history of what patients going into A and E have been prescribed by their GPs, which has an important impact on patient safety.

[Mr Nick Gibb (Bognor Regis and Littlehampton) (Con)]

I congratulate my right hon. Friend on the action he has taken, particularly re-instilling the importance of compassion in the NHS and the changes he is proposing to the training of nurses. Can he inform the House of any other NHS trust where similar concerns are being investigated?

[Mr Hunt]

One of the problems at the moment is that we do not have a good way of identifying other hospitals. The hospital inspection regime will start this year. That will obviously be the start, but prior to that we are conducting an investigation into 14 hospitals with higher than average mortality rates. That is one indicator: it might not mean there is a problem, but it is something we think is worth checking out.

Finally, let me say that my hon. Friend has an extremely good record on improving standards in education by understanding the importance of rigour. That is something we can learn from in the inspection regime for hospitals.

[Mr Philip Hollobone (Kettering) (Con)]

Will my right hon. Friend ensure that any revised patient care ratings include an enhanced emphasis on the degree to which things are explained clearly to patients and relatives and how relatives are kept informed?

[Mr Hunt]

My hon. Friend makes an important point. It is absolutely essential that the new chief inspector’s team talks to patients and relatives to get that feedback. One of the biggest changes from what we have now to what we will have is the element of judgment in the assessments made. We will not just be looking at the data, the dials or the numbers; there will be someone going to a hospital, smelling the coffee, understanding the culture of the place and talking to patients and relatives.

[Stephen Lloyd (Eastbourne) (LD)]

I commend the Secretary of State for his statement and for what I think is an absolutely outstandingly powerful report. However, I have concerns about recently proposed changes to the consultant-led maternity services at Eastbourne district general hospital. Will he confirm for the record that any changes that I and others have concerns about will be considered by the new chief inspector of hospitals?

[Mr Hunt]

I congratulate my hon. Friend on his ingenious segue. All hospitals—all NHS trusts—will be inspected by the chief inspector, so everything that happens at Eastbourne will be covered by the new regime. It will be strong, rigorous and independent, so that any concerns that my hon. Friend has should be picked up by anything that the chief inspector reports on.

Fair Playing Field Review

Jeremy Hunt Excerpts

Tuesday 26th March 2013 Written Statements

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

The Fair Playing Field Review has been laid in Parliament today, in line with the requirement set out in section 1G of the National Health Service Act 2006.

The aim of the review is to ensure that patients are able to access NHS services delivered by the best possible providers. In June 2012, Monitor—the independent health care regulator—was asked to look into any matters that might undermine this aim, and to report back with options for addressing such matters. The Department would like to thank Monitor for its work, the results of which have been published as part of the review.

Immigrants (NHS Treatment)

Jeremy Hunt Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Frank Field (Birkenhead) (Lab)]

(Urgent Question): To ask the Secretary of State for Health what moves the Government intend to take to prevent the national health service becoming an international health service.

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

The current system of policing and enforcing the entitlement of foreign nationals to free NHS care is chaotic and often out of control. At a time when we are having to face the challenges of an ageing society, it places a significant and unjustified burden on our GP surgeries and hospitals and may well impact on the standard of care received by British citizens.

As the Prime Minister said earlier today, the Government are determined to ensure that anyone not entitled to receive free NHS services should be properly identified and charged for the use of those services. Currently, we identify less than half of those who should be paying and collect payment from less than half those we identify.

We also have some of the most generous rules in the world on access to free health care. Our rules allow free access to primary care for any visitor to the UK, including tourists, and free access to all NHS care for foreign students and temporary visitors. But ours is a national, not an international, health service, so last year, under my predecessor, we began a wholesale review of the rules and procedures on charging visitors for NHS care, with a view to making the regime simpler, fairer and easier to implement. In particular, we focused on who should be charged and how the rules can be applied and enforced more effectively. We have examined the qualifying residency criteria for free treatment; the full range of other current criteria that exempt particular services or visitors from charges for their treatment; whether visitors should be charged for GP services and other NHS services outside hospitals; establishing a more effective and efficient process across the NHS to screen for eligibility and to make and recover charges; and whether to introduce a requirement for health insurance tied to visas.

The initial phase of the review has concluded and we will shortly start a consultation on a range of options, including plans to extend charging to some visitors and temporary residents who were previously exempt so that the default qualification for free NHS care would be permanent, not temporary, residence; ending free access to primary care for all visitors and tourists; introducing a prepayment or insurance requirement for temporary visitors to pay for NHS health care; and improving how the NHS can identify, charge and recover charges where they should apply. We will retain exemptions for emergency treatment and public health issues.

We will work closely with medical professionals, NHS staff and partner NHS organisations during the consultation and then seek to introduce agreed changes as quickly as possible. We will need to take a staged approach, because some changes are likely to require primary legislation before they can be introduced, which will take longer to put in place. However, some changes can be made immediately, and we should proceed with those as quickly as possible.

[Mr Field]

I thank the Health Secretary for his reply. If he wants us to take him seriously, will he today give a commitment in respect of the directive his Department issued just as the House was rising for the summer recess, compelling doctors, if they have vacancies, to admit all those who have been in the country for 24 hours or more, including illegal immigrants? Will he ensure that someone in the NHS—not doctors—works out whether or not a person is entitled to claim, and will he implement such proposals forthwith?

[Mr Hunt]

The directive to which the right hon. Gentleman refers was issued by an independent NHS body, not my Department. The sorry truth is that it is consistent with the current rules on access to primary health care, which is what we believe is wrong. I think that one of the big problems in the current system is that we have free access to primary care for anyone visiting the UK, however short their visit is. Through that access to primary care, they get an NHS number, which should not entitle them to free care but is often treated by hospitals as such. That is what we have to put right. He is absolutely right that we need a system that properly identifies whether people should have care that is free at the point of access without impinging on the ease of access for British citizens, which is one of the things they treasure most about the NHS.

[Nicholas Soames (Mid Sussex) (Con)]

Does my right hon. Friend agree that it is through access to primary care that the initial control must take place, but that all hospitals should have an overseas visitors manager who should be designated and required to collect overseas visitors’ moneys on a more regular basis and using a more joined-up and coherent way of working with the other agencies involved?

[Mr Hunt]

What my right hon. Friend says bears very careful consideration. He is absolutely right that primary care is a critical access point, and we need to look at that. We also need to look at the burdens we place on GPs. I think that ultimately the easy way we will do that is through proper digital patient records, which will allow NHS professionals to find out about the medical history of people accessing the NHS at any point, including whether they are likely to be eligible for free treatment.

With regard to hospitals, my right hon. Friend makes a very interesting point about an overseas visitors manager. One of the problems we have is that the incentives in the system positively disincentivise hospitals from declaring foreign users of the NHS. If they declare someone not to be entitled to free NHS care, they have to collect the money from that person themselves, whereas if they do not declare the person not to be entitled to free NHS care, they get paid automatically by their primary care trust or clinical commissioning group. The incentives in the system have acted to suggest that this is a much smaller problem than I believe it is.

[Andy Burnham (Leigh) (Lab)]

The NHS must not be open to abuse. Where people do not have entitlement to free treatment, steps should always be taken to recover the costs from individuals and Governments. That clear principle is shared by Members across this House.

For some time, hospitals have rightly had a legal duty to recover any charges owed from overseas patients. The previous Government proposed a number of further steps, including amending immigration rules so that anyone with substantial medical debts is not allowed back into the country. We welcome efforts to build on that, while always guarding against overblown rhetoric, which does not help the immigration debate. We therefore need more precision and clarity from the Secretary of State. First, on the scale of the problem, as ever with this Government’s announcements, there is already confusion to clear up. Earlier today, the Prime Minister’s spokesperson put the cost to the NHS of health tourism at £10 million to £20 million. On “World at One” this lunchtime, the Secretary of State said that he thinks it is more like £200 million. So which is it? Will the Secretary of State publish the evidence he has to support his claim?

Secondly, we need more detail on what the Government are proposing. Has the Secretary of State consulted those in Scotland, Wales and Northern Ireland on any proposed changes? There are practical questions on which health professionals will need reassurance. We have heard in the news today about the problems in the UK Border Agency. What assurances can the Secretary of State give to health professionals that they will not be used to plug the gaps that have been created by the Government’s severe cuts to the front line of the UK Border Force? Will they be given a simple way of checking eligibility and not be burdened by extra bureaucracy? Will these changes apply equally to planned and emergency care? If so, that could put health professionals in a difficult ethical position. Does the Secretary of State agree that care should always be provided in life-threatening situations, and will he take this opportunity to reassure health professionals on that important point?

Finally, the Secretary of State told “World at One” that one of the main reasons he was doing this was to relieve pressure on accident and emergency departments, particularly in London. While we commend moves to prevent abuse of the system, could he not better achieve his aim if he was not planning to close so many A and Es in London?

The Government have made a lot of assertions, but there is a real lack of policy clarity and evidence. Unless the Secretary of State can provide convincing answers to my questions, the House will be left with the distinct whiff of a cooked-up a story to suit the Government’s political purposes rather than a real drive to protect the NHS from abuse.

[Mr Hunt]

The Government are not going to take any lessons in overblown rhetoric when Labour Members talked about this problem for 13 years and did absolutely nothing about it. What was missing from the right hon. Gentleman’s remarks was a proper apology for Labour’s total failure to control our borders during a period in office that saw a quadrupling of net migration. We do not know how many people are residing in this country illegally, but in January the London School of Economics published a report stating that it could be nearly 900,000 people, in which case the cost will not be a few millions but many, many times that. In 13 years, Labour did not change eligibility for access to free NHS services and did nothing to improve the collection of proper dues from people coming from outside the European Union.

The £20 million figure that the Prime Minister’s spokesman used this morning is the amount of uncollected debt that is owed to the NHS by foreign nationals. If the right hon. Gentleman had listened to my response, he would know that we believe—of course it is impossible to get exact figures on this because of the total mess that the previous Government created—that we identify less than half the people who should be paying for NHS care and collect less than half the money that should be collected.

Of course we will work with very closely with Scotland, Wales and Northern Ireland to ensure a co-ordinated approach. If the right hon. Gentleman had listened to what I said, he would have heard that the exemption for emergency care and for public health issues will remain in place, which is extremely important.

Let me finish by talking about A and E issues. The reality is that the LSE estimates that about 70% of those living illegally in the UK live in London, where A and Es happen to face some of the biggest pressures. University College London Hospitals NHS Foundation Trust opened a new A and E only in the past few years and it was built for a capacity of 65,000 people a year, but it is now seeing 120,000 a year. If the right hon. Gentleman’s Government had done something about this rather than talk about it, A and Es across London would not be facing the pressure they are now facing.

[Dr Sarah Wollaston (Totnes) (Con)]

Will the Secretary of State publish the names of those trusts that are abjectly failing to identify and recover charges from those who are not entitled to free care?

[Mr Hunt]

My hon. Friend makes a reasonable point. Part of the problem is that when we should be identifying someone as a foreign national who should pay for their NHS care, that does not happen a lot of the time because of the incentives in the system. Under the NHS improvement initiative, which is taking place in London at present—it is worth looking at that closely, because it has a lot of promise—there is a centralised collection of debt from foreign nationals who owe the NHS so that that does not become the responsibility of individual hospitals, which is something that is putting them off registering people as eligible for their NHS care.

[Keith Vaz (Leicester East) (Lab)]

May I invite the Secretary of State to comment on the view that one of the reasons why these proposals are being made at this stage is the conclusion of transitional arrangements for Romanians and Bulgarians at the end of this year? The Minister for Immigration is sitting on his right. Is it possible for the Health Department and the Home Office jointly to commission research so that we can have some actual figures on how many people might be coming at the end of this year?

[Mr Hunt]

The right hon. Gentleman will have to raise the matter of the actual number of people coming to the UK with the Home Secretary or, indeed, the Minister for Immigration.

The right hon. Gentleman is right to say that the issues that we are dealing with are not just about foreign nationals from outside the EU or the European economic area. The rules for EEA members are complex. If people come here to work, we have an obligation under EU law to allow them access to free treatment, but if they are economically inactive or if they are temporary visitors, we should be able to reclaim the cost of that treatment from their home country in the EEA. The fact is that we do that very poorly indeed at the moment and that is one of the things we need to change.

[Jake Berry (Rossendale and Darwen) (Con)]

I particularly welcome the linking of visas to health insurance, but will my right hon. Friend explain what will happen if someone who is already in the UK is asked to pay but simply cannot? Will they be refused treatment?

[Mr Hunt]

No one will be refused treatment in a life or death situation. It is important that we state that up front. However, we also want to remove any expectation that people who are not entitled to NHS care are able to come to the UK and get it, and to ask whether we should be giving free NHS care to people such as foreign students who come to the UK and get it. If they went to Australia or America—our two main competitor countries—they would have to take out health insurance or pay a levy to access the local health care system. If those countries do that, I think we should do the same.

[Mr Dennis Skinner (Bolsover) (Lab)]

Is the Health Secretary aware that when I was in a London hospital some years ago I counted more than 40 staff from different nations? I am proud of my United Nations heart bypass. The message from this Government and many others, including the UK Independence party, is that those of a similar colour, of different colours and of different nationalities can change the bed sheets and operate, but woe betide them if they want to put their head on a pillow when they are ill. What hypocrisy.

[Mr Hunt]

The hon. Gentleman should do a lot better than that. He should think of his elderly constituents—people with multiple long-term conditions—who are having to wait much longer than they need to because A and Es not just in London, but in many parts of the country, are clogged up with people who may not be entitled to free NHS care because we have a system that culturally and operationally is not able to track these measures. It is in their interests that we must ensure that the NHS is available to people who are entitled to free care. When people are not entitled to free care, the point is not that the NHS is not available to them, but that they should pay for it.

[Several hon. Members]

rose—

[Dr Julian Huppert (Cambridge) (LD)]

The former public health Minister, the hon. Member for Guildford (Anne Milton), revealed in a written answer on 17 March 2011 that the sums not collected from overseas patients totalled less than £7 million a year. If we double that and double it again, as the Health Secretary suggests, that is £28 million. Private finance initiative schemes cost the NHS that much every two weeks. Which issue is more important in ensuring that we have a properly funded NHS?

[Mr Hunt]

We need to deal with all those issues, and they are all failures of the last Government.

[Chris Bryant (Rhondda) (Lab)]

There is a problem with recruitment in the NHS not only in England, but in Wales. Last year, Welsh NHS trusts tried to recruit 32 A and E consultants from the UK, but failed to do so and had to go abroad. Is there not a danger that the rhetoric in which the Government are indulging will put off the talented doctors that the NHS in this country needs?

[Mr Hunt]

We owe a great debt to the many talented doctors, nurses and health care assistants who come from overseas and make our NHS what it is. Nothing in our immigration laws will change that.

[Conor Burns (Bournemouth West) (Con)]

My right hon. Friend will be aware that the overwhelming majority of our constituents who travel abroad put in place provision to protect themselves if they fall ill. My constituents and his will be appalled to learn that we do not expect the same of foreign visitors to the United Kingdom. May I congratulate him on his initiative, which began before the Prime Minister’s speech today?

[Mr Hunt]

My hon. Friend is right. We have one of the most generous systems of health provision for overseas visitors of any country in the world. Most other European countries are less generous because they operate a social insurance system, which makes it much easier to collect the money that they are owed by the people who are not entitled to free care. We have to change the system here. The key thing that is wrong with it is free access to primary care, because that is the gateway into the NHS. Although primary care itself is not the most expensive part of the NHS, because of its gateway role, unless we control it, we will not get the overall system under control.

[Heidi Alexander (Lewisham East) (Lab)]

If the child of an asylum seeker who is yet to have their asylum application determined requires NHS primary care, will they still be eligible for free treatment?

[Mr Hunt]

Yes, they will.

[Sir Tony Baldry (Banbury) (Con)]

I am finding it rather difficult to ask a question, because I have been rendered speechless by the chutzpah of Labour Members in not saying that what the Secretary of State proposes is sheer common sense and in not agreeing with him. I have a simple question. How will GPs know which foreign nationals are entitled to NHS care and which are not?

[Mr Hunt]

My hon. Friend asks a very important question. We have to recognise the pressure on GPs and must be careful not to increase the bureaucratic burden on them. The long-term answer is to have proper digital patient records. If the first thing that people are asked for when they enter any part of the NHS is an NHS number that allows the person they are seeing to look at their medical history, which could be a trigger to identify someone who should be paying for their NHS care. We are seeing whether there is a non-bureaucratic way of achieving that in the short term, while we put that technological system in place.

[Mr Gerry Sutcliffe (Bradford South) (Lab)]

The Secretary of State and the Conservative party should remember that the coalition has been in power for nearly three years and nothing has happened on this issue. There are two things that he could do. He could withdraw the circular today and he could consider introducing an entitlement card that people could carry with them.

[Mr Hunt]

I congratulate the hon. Gentleman on his chutzpah in criticising the Government for not doing anything in two and a half years, when his Government did nothing in 13 years.

[Mr David Ruffley (Bury St Edmunds) (Con)]

The Secretary of State has made it clear why the figure of £20 million a year is a ridiculous underestimate of the true state of affairs. He will be thanked by every British taxpayer in this country, no matter what the saving, because they are getting increasingly tired of services being accessed by people who do not have a proper entitlement to them.

[Mr Hunt]

I thank my hon. Friend for his comment. Of course I want to do a good job for taxpayers, but also for the 3 million British citizens who use the NHS every week and who find a service that, although the Government have protected its budget, is under increased pressure. I want to ensure that the system whereby people from other countries access those same services is one thing, and one thing only: fair.

[Emma Reynolds (Wolverhampton North East) (Lab)]

It would be useful if the Secretary of State provided clarity and accuracy on the numbers we are talking about. The Prime Minister’s spokesperson said that unclaimed costs amount to £20 million, but the Secretary of State seems to be saying £200 million. I wonder whether he can account for the difference. Did he just add a zero?

[Mr Hunt]

I explained where the figure of £20 million came from, and why I believe that it is probably the tip of the iceberg. If the hon. Lady really wants to know the answer, we do not know the full extent of the abuse of NHS services because the previous Government left them in such an appalling mess.

[Charlie Elphicke (Dover) (Con)]

I understand that under the European health insurance card scheme the UK paid out about £1.7 billion for Brits abroad, but claimed only £125 million back. Is that also receiving attention?

[Mr Hunt]

Yes it is. We are always likely to pay out more than we receive under that scheme because we have a number of pensioners who decide to retire to slightly sunnier climes and there is a cost to the UK under EU treaty law with those decisions. My hon. Friend is right to point out that just as inadequate as our failure to charge people from outside the EU when we should is our failure to collect money from inside the EU when we are able to, and we must also look at that.

[Mr Kevan Jones (North Durham) (Lab)]

The Secretary of State has clarified the Prime Minister’s figure of £20 million, but he used inflammatory language to my hon. Friend the Member for Bolsover (Mr Skinner) about health tourists clogging up A and Es. He claims that £200 million could be the tip of the iceberg, but if he does not know the figure is that not the worst example of dog-whistle politics?

[Mr Hunt]

If we do not know the figure, is not the right thing to do to find it out and sort out the problem, unlike what the hon. Gentleman’s party did during 13 years in office?

[Mr Robin Walker (Worcester) (Con)]

I congratulate the right hon. Member for Birkenhead (Mr Field), who in raising this issue is, as always, streets ahead of those on his own Front Bench.

May I thank my right hon. Friend the Health Secretary for the extra £20 million funding that the NHS in Worcestershire will receive this year, and urge him to take that agenda forward and ensure that as much funding as possible goes to the residents of Worcestershire and to addressing the kinds of pressures that we saw over the last week in A and E?

[Mr Hunt]

Obviously, I want to ensure that as much money as possible goes to residents throughout the country by tackling abuse, and I would not want to minimise what the issue might be in Worcestershire. I stress, however, that the biggest problem we face is in big urban centres where there are large numbers of illegal immigrants, and we must get a grip of that problem for the sake of the elderly population in those cities.

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

If the Secretary of State is concerned to protect NHS budgets, why is he allowing a £2.2 billion raid from the Treasury? Is that not a much more serious cut in the NHS services we can pay for in this country?

[Mr Hunt]

If the hon. Lady is worried about that, perhaps she might like to complain to her own party leadership, which, during Labour’s last five years in office, had an average underspend in the NHS of £2 billion.

[Henry Smith (Crawley) (Con)]

I, too, congratulate the right hon. Member for Birkenhead (Mr Field) on his urgent question, and my right hon. Friend the Secretary of State for Health on following my private Member’s Bill, the NHS Audit Requirements (Foreign Nationals) Bill. When will that primary legislation receive Government time to start its passage through this place?

[Mr Hunt]

I congratulate my hon. Friend on his excellent private Member’s Bill, which looked forward to many of the problems we are trying to address. Our first step is to identify the scale of the problem. We will then identify the right legislative response, but the response will not all be legislative. That is when we will consider including it in the parliamentary timetable.

[Kevin Brennan (Cardiff West) (Lab)]

In answer to the hon. Member for Rossendale and Darwen (Jake Berry), the Secretary of State said that when someone does not have the funds, treatment will not be refused if it is a life-and-death situation. For clarity, will he will us what the threshold will be? For example, if someone has a broken leg, or if someone needs another treatment that requires hospital admission, and they do not have the funds, will treatment be refused under his scheme?

[Mr Hunt]

The hon. Gentleman will be relieved to know that that will be a matter for clinicians, not politicians.

[Bob Stewart (Beckenham) (Con)]

Roughly, in percentage terms, how many babies born in maternity wards are born to mothers from the EU?

[Mr Hunt]

I cannot tell my hon. Friend the answer except for one detail: my two children were not born to a mother from the EU.

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

The Secretary of State has explained that the July guidance was from an independent body and in line with the existing rules. Who wrote the existing rules? Will he confirm that he will change them?

[Mr Hunt]

The rules existed for 13 years under the Labour Government, who did absolutely nothing to change them. We are tackling the problem. If Labour Members had any grace, they would thank us for doing so.

[John Pugh (Southport) (LD)]

When I tabled questions last year, I was told that we collect £51 million a year for treatment from EU countries, but that they collect £451 million—nine times more—back from us. Is this an issue not of immigration, but of coding, charging and collecting?

[Mr Hunt]

My hon. Friend might be right—we need to look at that—but as I have told my hon. Friend the Member for Dover (Charlie Elphicke), one factor is that a number of our pensioners retire to sunnier climates, which leads to that imbalance.

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

Is the Health Secretary aware that general practitioners have been calling for the measures to be taken for some time? The Bedfordshire and Hertfordshire local medical committee wrote to me some time ago expressing its concerns that overseas nationals were coming here for expensive operations. It will be very pleased at what he has done today.

[Mr Hunt]

My hon. Friend speaks wisely. NHS professionals on the front line have been conscious of the problem for a long time, but have been frustrated that nothing has been done. I therefore hope that they very much welcome today’s announcement.

[Richard Graham (Gloucester) (Con)]

Now that Labour has realised it is legitimate to discuss immigration, does my right hon. Friend agree that it is time for the Opposition to acknowledge that legitimate charges by the NHS to EU and other residents were not collected properly for 13 years; that identifying the £20 million as the tip of the unpaid iceberg is the right thing to do; and that a tightening of procedures on debt collection will be welcomed by my constituents and fair to all our constituents throughout the country?

[Mr Hunt]

Absolutely. It is astonishing that the Labour party complains in one breath about pressures on A and E, and the next moment tries to make light of the serious attempts the Government are making to get a grip of the problem.

[David T. C. Davies (Monmouth) (Con)]

Does the Secretary of State agree that the vast majority of people in the UK will welcome these long-overdue proposals? Will he explain what he will do to ensure that those who are denied treatment because they are here illegally and not entitled to it cannot simply slip over the border to Wales or Scotland, which, unfortunately, are in the throes of an NHS run by socialist Governments?

[Mr Hunt]

We will work closely with the devolved authorities to ensure we have a co-ordinated response to the problem, but I agree that today’s announcement will be welcomed by the vast majority of people in the country, who will be astonished that the Labour party, even now, seeks to minimise the problem.

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

Given that the UK has one of very few genuine free-at-the-point-of-need health care systems, does my right hon. Friend agree that, without his sensible reforms, the UK will continue to be seen as the destination of choice for anyone around the world seeking high-quality, free medical treatment paid for by the UK taxpayer?

[Mr Hunt]

I agree with my hon. Friend. It is because I support the principle of free-at-the-point-of-use health care that I do not want anything to undermine it, and abuse of the system by people who are not entitled to free NHS care is the single thing that would most shake the public’s trust in an important part of what the NHS has to offer. That is why we must tackle this problem.

[Harriett Baldwin (West Worcestershire) (Con)]

The Secretary of State rightly recognises that accident and emergency is a special case, but when I broke my fingers in Brussels I was asked to pay by credit card at the end of my treatment. A lot of people who present at A and E have non-life threatening conditions. Is that something we could do here?

[Mr Hunt]

I understand my hon. Friend’s sense of unfairness at being asked to pay for her treatment by credit card, when we do not do that to foreign nationals who are treated in the NHS. I do not, however, want the NHS to become a service where the first question people are asked relates to their credit card or cheque book. If we are going to protect that much-cherished principle of NHS treatment, we need to get a grip on the kind of abuse that has run unchecked for far too long.

[Mr Peter Bone (Wellingborough) (Con)]

Does the Secretary of State agree that the House is divided by two schools: the Opposition, who believe that the NHS should not charge anyone, which is why they did nothing for 13 years; and Government Members, who believe that foreign nationals who should pay, must pay.

[Mr Hunt]

I agree, and nothing we have heard this afternoon will give the British public any comfort at all that the Opposition get this problem.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

I welcome my right hon. Friend’s statement. Does he agree that the previous Government’s failure to tackle health tourism encouraged overseas visitors to abuse our NHS?

[Mr Hunt]

My hon. Friend is right. One reason why we are tackling this problem is not just the health agenda we have been discussing this afternoon, but that abuse of NHS services fuels broader immigration problems. That is one of the core reasons the previous Government failed to get a grip of net migration in particular.

[Jason McCartney (Colne Valley) (Con)]

Calderdale and Huddersfield NHS Foundation Trust spent £305,341 on interpreter services between 2009 and 2011. Will my right hon. Friend include the costs of translation services when working out the costs of health tourism?

[Mr Hunt]

I would want to be careful to discriminate between the needs of British citizens and people who are entitled to free NHS care who have not had the education or support they need to learn English but who should still continue to receive free, high quality NHS care, and foreign nationals who are not entitled to free NHS care and who should pay the cost of any translation required.

[Mr Philip Hollobone (Kettering) (Con)]

My constituents are absolutely furious that non-entitled foreign nationals are effectively getting free access to our NHS, and I welcome the steps my right hon. Friend is making to tackle this issue. Will he ensure that Her Majesty’s Government fast-track legislation, with an announcement in the Queen’s Speech, and challenge the Opposition either to bring down or pass that legislation in the next parliamentary year?

[Mr Hunt]

I have visited Kettering hospital, and I know just how hard its front-line professionals work and the pressures they are under. All I can say to my hon. Friend is that the Leader of the House of Commons is sitting here and has heard what he has said, and I would certainly support the early introduction of legislation on this matter.

Accountability and Transparency in the NHS

Jeremy Hunt Excerpts

Thursday 14th March 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing this important and timely debate.

We should start by remembering why we are having this debate. Truly shameful things happened at Stafford hospital. Patients were left unwashed for days, sometimes in sheets soiled with urine and excrement. Relatives had to take bed sheets home to wash them because the hospital would not. Patients with dementia went hungry with their meals sitting right in front of them, because no one realised or cared that they were unable to feed themselves. If we are to prevent that from happening again, accountability for what happened is vital. I will talk plainly about that, including about the role of Sir David Nicholson.

At the outset, let me reiterate that the NHS is one of our most cherished institutions. We can be proud that for 65 years it has ensured that everyone is entitled to treatment, regardless of their background or income. We can be proud of the excellent treatment and care that is the hallmark of most parts of the NHS. Most of all, we can be proud of the front-line doctors, nurses and health care assistants who look after 3 million people every week, with dedication, commitment and compassion.

If we love the NHS, we must be prepared to be honest about its failures, and to criticise me for doing so suggests, I am afraid, dangerous complacency from the right hon. Member for Leigh (Andy Burnham). The tragedy of Mid Staffs shows how the desire to celebrate success got in the way of speaking out when things went wrong, and if we are to prevent such things from recurring, we must never allow our love of the NHS to stifle our determination to hold systems and individuals to account.

Where does that accountability lie? Sir David Nicholson has been the focus of much attention, and as a manager in the system that failed to spot and rectify the appalling cases at Mid Staffs, he bears some responsibility. As he said, the focus was lost, and he has apologised and been held to account by this House and many others. However, I do not believe that he bears total, or indeed personal, responsibility for what happened. He was at the strategic health authority for 10 months during the period in question, overseeing 50 hospitals at a time when his main responsibility was the merger of three SHAs into one. He consistently warned both Ministers and managers of the dangers of hitting the target and missing the point.

It is just not true that if there had been no David Nicholson at the SHA, there would have been no Mid Staffs; others bear far more direct responsibility and the Francis report tells us who. It makes it clear that the primary responsibility for what went wrong lies with the board of the trust. Astonishingly, members of that board seem to have melted into thin air, some moving to other jobs in the system, and others receiving generous payoffs.

[Mr Cash]

As my right hon. Friend knows, I do not agree with his assessment of Sir David Nicholson in this context. There was a systems failure that affected not only Staffordshire but the entire health service, and that lies very much at the heart of the problem. In my speech I will quote some statements made by Sir David at a conference a few months ago.

[Mr Hunt]

I obviously take on board what my hon. Friend says, but I want to move on to other aspects of the report.

[Nicholas Soames]

rose—

[Mr Hunt]

I shall give way on that point, and then I will make some progress.

[Nicholas Soames]

I am grateful to the Secretary of State. May I follow up on one point that he raised? He said that a number of those managers have disappeared or melted away to other jobs in the service. Does he agree that whatever else happened, there was a monumental failure of leadership at many levels, and that it is a failing of public services in this country—and the national health service in particular—that failing managers are too often recycled through the service to the great and constant cost of patient care?

[Mr Hunt]

I absolutely agree with my right hon. Friend. We will respond to the Francis report this month, as the Prime Minister has committed to do, and make plain measures to ensure that the situation cannot continue. My right hon. Friend is right to raise that point.

[Mr Jenkin]

rose—

[Mr Hunt]

I will make some progress and then I will take more interventions.

My response will detail how we intend to restore accountability to the boards of hospitals, and today I have removed the ability of any hospital to insert gagging clauses on patient safety in compromise agreements made with senior staff. My hon. Friend the Member for Bristol North West asked whether that will be retrospective, and I have written to all trusts to remind them of their responsibilities towards whistleblowers in respect of contracts and compromise agreements already signed. If we are to protect patients, we need an atmosphere of openness and transparency in the NHS—something to which the motion rightly refers.

[Several hon. Members]

rose—

[Mr Hunt]

I will make some progress and then I will take interventions from both sides of the House.

Sir David Nicholson told the Health Committee last week that in the NHS as a whole, patients were not the centre of the way the system operated. Which party was in power when that culture was allowed to operate? If Sir David has been held to account, so too must the Labour party be held to account. The Francis report rightly states that Ministers were not personally responsible for what happened at Mid Staffs, and I have no doubt that no Labour Minister would have condoned, knowingly allowed or wanted the events at Mid Staffs to happen. We also know from the report that the pursuit of targets at any cost was a central driver of what went wrong. As the report set out, above all Mid Staffordshire NHS Foundation Trust failed to tackle an “insidious negative culture” involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities. It went on:

“This failure was in part the consequence of allowing a focus on reaching national access targets,”.

Ministers, not civil servants, are ultimately responsible for the culture of the NHS, and it is clear that during that period a culture of neglect was allowed to take root in which the pursuit of targets at any cost compromised the quality of care that patients received, and made it harder for front-line staff to treat people with dignity and compassion.

[Andy Burnham]

I am listening carefully to the Secretary of State but it is not fair to people in the NHS for him to say that Stafford equals everywhere in the NHS, and that we can take one failing—a terrible failing, as I said in my speech—in a locality and apply it to the whole NHS. He must acknowledge that NHS staff did an incredible job to end the situation when people were spending months and years on waiting lists, and even dying on them.

[Mr Hunt]

I acknowledge the brilliant work done by NHS staff and, contrary to what the right hon. Gentleman says, I do that in every speech that I make on these matters. I will not, however, accept the complacency that says that problems at Stafford hospital were localised and happened only in one place. If we are to sort out those problems, we have a duty to root them out anywhere in the NHS that they occur.

The right hon. Gentleman talked about waiting times targets. Let us be clear: there is an important role for targets in a large organisation such as the NHS. Without the four-hour A and E target, or the 18-week elective waiting time target, access to NHS services would not have been transferred and I accept that the previous Government deserve credit for that. It was right to increase spending on the NHS, although it is curious that Labour now wants to cut the NHS budget. Labour did however—this is where Labour Members should listen rather than barrack—make three huge policy mistakes, and the right hon. Gentleman must accept that it is not simply a question of Government policy not being implemented in every corner of the NHS. Those three mistakes contributed to the culture of neglect that we are now dealing with.

The first mistake—a huge mistake—was that Labour failed to put in place safeguards to stop weak, inexperienced or bad managers pursuing not only bureaucratic targets but targets at any cost. That is exactly what happened at Mid Staffs, where patient safety and care were compromised in a blind rush to achieve foundation trust status. Secondly, Labour failed to set up proper, independent, peer-led inspections of hospital quality and safety that told the public how good and safe their local hospital was. Instead of a zero-harm attitude to patient safety, we have a culture of compliance and the bureaucratic morass that is the current Care Quality Commission. Thirdly, Labour failed to spot clear warnings when things went wrong. The Francis report lays out a timeline of 50 key warning signs between 2001 and 2009. Why did Ministers not act sooner? If those warnings were not being brought to the attention of Ministers, why did they not build a system in which they were? Instead, there was a climate in which NHS employees who spoke out about poor care were ignored, intimidated or bullied.

[Alan Johnson]

The Secretary of State is making an interesting speech and there is no way that the Labour party can escape criticism for what happened at Stafford. Does he accept, however, that before 2000 there was no independent regulation of the NHS and no standardised mortality ratios, complaints in hospitals stayed in the hospital and there was no recourse to any independent observance of those complaints, and A and E—a particular problem at Stafford—was a data-free zone?

[Mr Hunt]

I accept that progress was made in the collection of data and that the previous Government set up a star rating system. The problem, however, was what it measured. It did not measure the quality of patient care but basically focused on access targets. It was possible for a hospital to get a three-star rating by transforming its 18-week access targets, even at the expense of patient care.

[Stephen Barclay]

It is correct that improvements were made in the collation of data. In fact, the Dr Foster data were published in national newspapers from 2001, but what is remarkable is that they were not acted on. That is the central charge for Ministers. We were the world leader in the collation of mortality data. We had the data, but Ministers did nothing with them.

[Mr Hunt]

My hon. Friend speaks wisely. Hospitals display 1,400 different pieces of data, but the question is why nothing is done when the data give dangerous messages.

[Several hon. Members]

rose—

--- Later in debate ---

[Mr Hunt]

I will make some progress.

The question the right hon. Member for Leigh needs to answer is why he refused 81 separate requests to set up that public inquiry. He says that he did not want to distract the hospital from the essential task of making immediate improvements, but does he now accept that if he wants people to take his party seriously on NHS accountability he needs to apologise? That was a mistake. Until we have a proper apology—not just for what happened, but for the catastrophic policy mistakes made by his party—no one will believe that Labour would not make the same errors of judgment again. On the Government Benches, we are clear that accountability, dignity and respect for patients, particularly vulnerable, older people who are unable to speak out for themselves, must be embedded in every corner of the NHS.

We will announce measures to set up a proper, independent peer review inspection regime led by a new chief inspector of hospitals that will not simply look at targets, but make judgments on whether hospitals are putting patients first. We will set up a single failure regime, where the suspension of the board can be triggered by failures in care as well as failures in finance; a patient-centred culture, by making the friends and family test a key part of the hospital inspection regime; clinically led commissioning, so that key decisions are made by people who see patients in their own surgeries; and an overhaul of the hospital complaints procedures led by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart. We will do that with the minimum of upheaval. It is worth emphasising that Robert Francis himself says that the changes he calls for can largely be implemented within the system that has now been created by the new reforms.

[Several hon. Members]

rose—

[Mr Hunt]

I am going to make some progress.

This debate is about accountability. I have been doing this job for six months, and in nearly every exchange on the Floor of the House, the Opposition have avoided engaging in substance, preferring instead to make baseless allegations about the Government’s motives in respect of the NHS. I put it to the House that we have shown our commitment to the NHS time and again through a protection of the budget; a willingness to face up to big challenges, whether in clinical commissioning, the funding of social care or the need to ensure that care is prioritised throughout the system—

[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Hunt]

No, the right hon. Gentleman needs to listen to my point. If Labour is truly committed to the NHS, it, too, has to show that it has learned. I did not hear that in his speech. Labour Members need to accept that they made some terrible policy mistakes that led to a culture of neglect. They must recognise that the party that claims to speak for the most vulnerable in society betrayed many vulnerable people, with tragic consequences. Only then will the public know that the lessons of Mid Staffs have been learnt—not just by the NHS, not just by civil servants, not just by Government, but by all sides of this House.

[Several hon. Members]

rose—

--- Later in debate ---

[Alan Johnson]

On the question of a public inquiry, when Francis reported on his first inquiry, commissioned by my right hon. Friend the Member for Leigh, he made the point that it was about people affected being able to come and tell their story, and Francis said in his first report:

“I am confident that many of the witnesses who have assisted the inquiry in written or oral evidence would not have done so had the inquiry been conducted in public.”

It is very important that that first inquiry allowed people to come forward. The right hon. Member for South Cambridgeshire (Mr Lansley) may also well have been right to make the second stage of that a public inquiry, which was authorised because of one of the Francis recommendations, because we now have all the information, provided before a Queen’s counsel, about what happened there.

Francis is very clear about no blame being apportioned to any Minister. It is of course right for Ministers to be accountable if anyone knew what was going on and did nothing to stop it, or if something that was going on was a result of a Government edict or policy, but that was not the case at Stafford.

Targets had to be introduced to get a grip on this terrible situation of lack of access to health care. Targets did not cost lives; they helped to save lives. They were accompanied by the resources, the capacity and the political will that transformed waiting lists of 18 months to two years to a maximum of 18 weeks and an average of nine.

This is what Francis said about targets:

“It is important to make clear that it is not suggested that properly designed targets, appropriately monitored cannot provide considerable benefits and serve a useful purpose…indeed the inquiry accepts that they can be an important part of the health system in which the democratically elected Government of the day sets its expectations of providers who are funded by the taxpayer.”

The right hon. Member for Charnwood (Mr Dorrell) was absolutely right to say that long waiting lists have dogged the NHS since it was created in 1948. Rudolf Klein, the great historian of the NHS, says every Health Secretary shouted their orders from the bridge and the crew carried on regardless. Something had to be done to deal with that, and it was done.

[Mr Jeremy Hunt]

Does the right hon. Gentleman not accept that the issue was not targets, but the failure to put in place safeguards to stop managers twisting a targets culture into a culture of targets at any cost? That was the fundamental policy mistake. The lack of those safeguards meant Mid Staffs could happen.

[Alan Johnson]

The Secretary of State is right. Of course there need to be safeguards to ensure any system has a backstop to stop people misusing targets. The guidance from the Department of Health was very clear. In no way must the pursuance of targets interfere with the need for good patient care. The Stafford chief executive must have translated that into saying it was fine to put receptionists on triage nursing. With all due respect to the Secretary of State, I do not think that he or any of his successors or predecessors can make regulations to meet every eventuality, including for someone like that chief executive of the Mid Staffs trust.

--- Later in debate ---

[Barbara Keeley]

Indeed. It is disturbing that the people responsible for advising Ministers on legislation are not aware of what is going on. In fact, they started by trying to tell me that they thought that community services were still expanding, as they had been up to 2010. They did not have a picture of the services. Indeed, they told us that there was no routine collection of waiting times for mental health services and they did not have data on readmissions. They did not even seem to understand the trends involved in those important issues.

The exchange left me feeling very concerned about accountability in our new NHS structures. If staff at the most senior levels of the Department of Health who are responsible for strategy and legislation have no idea what is going on in health services across the country, that is serious. The major restructuring of the NHS seems to us—this has been mentioned by fellow members of the Health Committee—to represent a decline in accountability.

We need to learn from good practice to improve patient safety, which has been touched on by my hon. Friends the Members for West Lancashire (Rosie Cooper) and for Walsall South (Valerie Vaz). A major review is taking place of the 14 hospitals with the worst mortality rates. In recent Health questions, I told the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) that good practice in hospitals with low mortality rates should be investigated alongside the review of high mortality rates and poor practice in the worst-performing 14 hospitals. He did not take that point on board, so I will try again today.

I want to talk about what has been achieved at my constituency’s local hospital trust, Salford Royal NHS Foundation Trust. I visited the hospital recently in the wake of the Francis report and was impressed to hear what it has achieved over the past five or six years. It already seemed to have in place many of Robert Francis’s recommended actions, which I touched on earlier. Salford Royal has taken action on nurse staffing ratios, which my right hon. Friend the Member for Leigh (Andy Burnham) touched on; reducing MRSA infection and pressure sores; the transparency of patient information; and involving clinical staff in quality improvement.

[Mr Jeremy Hunt]

I completely agree with the approach that the hon. Lady is taking. One of the jobs of the new chief inspector of hospitals will be to identify the outstanding hospitals, the safest hospitals and the hospitals with the best compassionate care, so that other hospitals can learn to do the same things.

[Barbara Keeley]

That is very good. I hope that the Secretary of State will make that point to the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, because he did not seem to appreciate it when I made it to him in Health questions.

Let me touch on what other hospitals might find if they start looking at the excellent practices at Salford Royal. I do not underestimate the importance of the terrible examples that we have heard about, but at the same time, my trust has had a quality improvement strategy since 2008, with specific projects that are aimed at reducing falls, unexpected cardiac arrests, surgical site infections, sepsis and other harms. Because harm tends to be caused to patients much more over the weekend—we have seen many examples of that in the cases that we have looked at—the trust has moved back to seven-day working in an attempt to achieve the same standard of care on the weekend and overnight as people receive on a weekday during working hours.

I believe that having the right nurse staffing ratios is vital to patient safety, but that issue keeps being glossed over by NHS leaders and Ministers. I have asked questions about it repeatedly in this House. Salford Royal uses a safe staffing tool to ensure that it works to safe staffing levels. There are minimum staffing requirements throughout the hospital and incident reports are completed if the ratios are not met. Each division reviews its staffing establishment every day and escalates concerns if the numbers fall below the minimum safe level. Salford Royal is a mentor site for nurse rounding which, as we have heard, means that nurses go round their patients each hour to ensure that their needs are being met.

My right hon. Friend the Member for Cynon Valley gave examples that showed the impact of hospital-acquired infections. All the work that is done to reduce MRSA and other infections is crucial. As in the other examples of flattened hierarchies that we have heard about, anyone at Salford Royal can challenge others on issues related to infection control. There is also mandatory training in aseptic non-touch techniques.

Teams design their own quality improvement projects in a clinical quality academy. There has been a specific quality improvement project over the past two years that is aimed at reducing the number of pressure ulcers. Each pressure ulcer is declared, the root causes are analysed and the patients are involved in the investigations. Nurses can monitor the positioning of patients on their hourly rounds and help to turn them if required. Those examples of good patient care can help us to get over the kinds of awful care that have been described today.

My final point is about transparency. Patients and families can check the harm data, because they are shown on a whiteboard at the entrance to every ward. The board records not only how many days it is since the last MRSA infection or pressure ulcer, but provides assessment scores on 13 fundamental nursing standards. Such public reporting to patients and families is important because it aids accountability and helps staff to feel accountable for the standards on their ward. We need that now more than ever.

Unsurprisingly, Salford Royal has achieved the highest rating in the NHS staff satisfaction survey for acute trusts in the NHS. Staff are supported to challenge existing systems and test new ideas to improve standards. I am aware of how much of a contrast that is to what we have heard this afternoon. The NHS is a system in which one area has had a catastrophic failure at all levels of patient safety, while other areas have achieved the highest standards of safety and patient care. We must look at both if we want to understand why that is.

NHS Pay Review Body

Jeremy Hunt Excerpts

Thursday 14th March 2013 Written Statements

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

I am responding on behalf of my right hon. Friend the Prime Minister to the 27th report of the NHS Pay Review Body (NHSPRB). The report has been laid before Parliament today (Cm 8555). Copies of the report are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. I am grateful to the chair and members of the NHSPRB for their report.

We welcome the NHS Pay Review Body’s 27th report, note its observations and accept its recommendations in full.

I am pleased to confirm that:

all NHS staff on agenda for change pay, terms and conditions will receive a 1% rise in their basic pay effective from 1 April 2013: and

those NHS staff on agenda for change pay, terms and conditions who work in London will receive a 1% increase to the minima and maxima of their high cost area supplement.

Review Body on Doctors' and Dentists' Remuneration

Jeremy Hunt Excerpts

Thursday 14th March 2013 Written Statements

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

I am responding on behalf of my right hon. Friend the Prime Minister to the 41st report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The report has been laid before Parliament today (Cm 8577). Copies of the report are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. I am grateful to the chair and members of the DDRB for their report.

We welcome the 41st report of the Review Body on Doctors’ and Dentists’ Remuneration and note its observations and:

accept its recommendations in respect of salaried doctors and dentists; and

accept the recommendation of a 1% increase in GP pay but abate the recommended allowance for GP practice staff costs from 3.4% to 1% to reflect public sector pay policy, giving an overall increase in general medical services payments of 1.32% rather than the 2.29% recommended by DDRB.

We will take forward DDRB’s suggested actions, which will help us continue to improve our support for the DDRB’s important work.

Reducing Preventable Mortality

Jeremy Hunt Excerpts

Tuesday 5th March 2013 Written Statements

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

Today, I am publishing “Living Well for Longer: A call to action to reduce avoidable premature mortality”. This document focuses attention on premature mortality and challenges the health and care system to do something about it.

Despite the great strides that have been made in improving the health of the nation in recent decades, far too many people are dying too young from diseases that are largely preventable. We want England to be among the best in Europe when it comes to tackling the leading causes of early death, starting with the five big killer diseases—cancer, heart, stroke, respiratory and liver disease. If everyone had access to the best diagnosis and treatment that is already available, we could avoid an extra 30,000 deaths per year by 2020.

Our ambition to reduce our rates of premature mortality to the level of our European peers is ambitious and challenging. Government will play their part but cannot do this alone. It will take concerted action across the health and care system locally and nationally. The call to action therefore poses some challenging questions and is designed to generate open and honest debate, leading to action, to see what more we collectively can do to reduce premature mortality. If we as a country are to tackle the challenge we face, we need to make improvements across the spectrum of prevention, early diagnosis and treatment.

“Living Well for Longer” also sets out actions to drive transparency and accountability. I want every locality in the new system to understand how it compares for health outcomes with similar areas in England and how England compares across Europe. Knowing how well we are doing is critical to driving improvement.

My Department has worked closely with partners across the health and care system, including the statutory and third sector, in developing this call to action. We will bring these partners together over the coming months and years to see how well we are doing in reducing premature mortality, and to see what more we can do together.

We are also publishing today a “Cardiovascular Disease Outcomes Strategy”. This strategy will contribute to delivery of improved mortality rates by providing advice to local authority and NHS commissioners and providers about actions in relation to cardiovascular disease that can help deliver our ambition.

Copies of “Living Well for Longer: A call to action to reduce avoidable premature mortality” and of the “Cardiovascular Disease Outcomes Strategy” have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

The documents are also available at: www.dh.gov.uk/health/2013/03/mortality.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 26th February 2013 Commons Chamber

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

1. What assessment he has made of the benefits of comparative performance data in raising standards in the NHS.

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

Comparative performance data are essential to raise standards in the NHS. I have therefore commissioned a review from the Nuffield Trust to consider whether aggregate ratings of provider performance should be used in health and social care, and if so, how best this should be done.

[Angie Bray]

My right hon. Friend will be aware that NHS North West London has made considerable use of comparative performance data to justify closing four A and E departments in one concentrated part of its area. Charing Cross, Ealing, Hammersmith and Central Middlesex are the four A and E departments closest to my constituents, who will be wondering how their closure will raise standards of health care provision locally. Does my right hon. Friend appreciate that there will be strong support among my constituents for any calls to review the decision and the use of comparative performance data?

[Mr Hunt]

I first congratulate my hon. Friend on campaigning extremely hard on behalf of the views and concerns of her constituents throughout the process of the decision that was finally made by NHS North West London last Tuesday. Comparative performance data have a very important role to play, particularly with regard to excess mortality of people who use A and E on weekends. I am, however, aware of my hon. Friend’s concerns and will consider them carefully if, as is likely, the decision is reviewed by Ealing council.

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

I thank the Secretary of State for his previous answer. Comparative data are essential in compiling an evidence base on which to plan effective health interventions. Will he use the radiotherapy data sets that his Department publishes as a basis to inform planned investments in advanced radiotherapy systems, particularly in regions like mine which lack such equipment?

[Mr Hunt]

I know that the hon. Gentleman asks a lot of questions about radiotherapy. We use a strict evidence base before we make any investments. We also want to embrace innovation, but our absolute priority is to save as many lives as possible from cancer. He will know that we are in the lower half of the European league tables when it comes to cancer survival rates, and that is something that we are determined to put right.

[John Pugh (Southport) (LD)]

On collecting performance data, has the Secretary of State seen the NHS Confederation publication “Information overload: tackling bureaucracy in the NHS”, which points to a great deal of duplication in information? What is his reaction to it?

[Mr Hunt]

There is far too much bureaucracy in the NHS, which is why I have asked the chief executive of the NHS Confederation to report to me on how we could reduce the bureaucratic burden on hospitals by a third. If there is a lesson from the Francis report on the tragedy at Mid Staffs, it is that we need to free up the time of people on the front line to care, which is what they went into the NHS to do.

[Mr Jamie Reed (Copeland) (Lab)]

The hon. Member for Ealing Central and Acton (Angie Bray) asked a key question. Under the secondary legislation being introduced by the Secretary of State under section 75 of the Health and Social Care Act 2012, local commissioning groups will be forced to allow private providers into the NHS. These private providers will be exempt from the Freedom of Information Act, which will make it harder for patients to compare data between providers. It cannot benefit NHS patients for core clinical services to be given to private providers that do not have to conform to the same standards of transparency as those in the NHS. Will the Secretary of State see reason, ensure a level playing field for the NHS and withdraw the section 75 regulations without delay?

[Mr Hunt]

Who exactly are the section-75 bogeymen that the hon. Gentleman hates: Whizz-Kidz who are supplying services to disabled children in Tower Hamlets, or Mind, which is supplying psychological therapy to people in Middlesbrough? The reality is that those regulations are completely consistent with the procurement guidelines that his Government sent to primary care trusts. He needs to stop trying to pretend that we are doing something different from what his Government were doing when in fact we are doing exactly the same.

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

2. What support his Department has given to local authorities in respect of their new public health responsibilities.

--- Later in debate ---

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

3. What recent assessment he has made of the future demand for accident and emergency and maternity services at (a) Guy’s and St Thomas’ NHS Foundation Trust and (b) King’s College Hospital NHS Foundation Trust.

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

I have accepted the trust special administrator’s broad recommendations on the future of A and E and maternity services in south-east London. Appendix E of the administrator’s final report outlines the forecast A and E activity and births in south-east London, and the methodology used to determine that information. That includes activity at Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospital NHS Foundation Trust.

[Simon Hughes]

I am grateful for the Secretary of State’s answer. Following his statement and decision, does he recognise that there are still two significant concerns? The first is that any downgrade of A and E and maternity services in Lewisham will put pressure on the other trusts which they cannot cope with. The second is that there is not yet support among all GPs and clinicians, including in Lewisham, for the current plan. Will he assure me that he will seek their support before anything is implemented, and that he will give us the assurances that we need?

[Mr Hunt]

I recognise the concerns that the right hon. Gentleman outlines. As he knows, we have allocated £37 million to help the other four A and E departments that will take the 25% of cases that will no longer go to Lewisham to deal with that extra capacity. He is right to say that the way in which the plan is implemented will be critical. We need to do it properly and extremely carefully to ensure that we meet the concerns that he talks about.

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

When the Secretary of State announced his decision to downgrade Lewisham’s A and E services and transfer the patients to St Thomas’ and King’s, he said that Sir Bruce Keogh, the medical director of the NHS, had reviewed those proposals and that:

“He believes that…these proposals…could save up to 100 lives every year”. —[Official Report, 31 January 2013; Vol. 557, c. 1075.]

Having read Sir Bruce Keogh’s review, I can tell the House that he makes no mention whatsoever of saving 100 lives each year. Will the Secretary of State now apologise for misleading the House?

[Mr Hunt]

No. What Sir Bruce Keogh did—

[Mr Speaker]

Order. Just before the Secretary of State replies, I ought to say to the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) that she is perhaps suggesting that the Secretary of State may have inadvertently, rather than deliberately, misled the House. Could she just confirm that? A nod of the head would suffice.

[Mr Speaker]

That is the right hon. Lady’s suggestion, and it is for the Secretary of State to respond as he thinks fit.

[Mr Hunt]

Thank you, Mr Speaker.

Sir Bruce Keogh accepts the calculations that were made in the proposals put forward by the trust special administrator that the plans would be likely to save about 100 lives a year, because they would allow the hospitals in south-east London to move towards the London quality standard, which would mean reducing excess mortality at weekends. Sir Bruce Keogh accepted that, and I accepted his view of it.

[Patrick Mercer (Newark) (Con)]

rose—

--- Later in debate ---

[Heidi Alexander (Lewisham East) (Lab)]

Demand for A and E services at Guy’s and St Thomas’ and at King’s will go through the roof if Lewisham’s full A and E closes. The Secretary of State may claim that he is keeping a smaller A and E at Lewisham, but that is nothing more than dangerous spin. No blue-light ambulances will call at Lewisham under his plans, and even the College of Emergency Medicine says that they do not meet its definition of an emergency department. How on earth can the Secretary of State be so confident that other hospitals in south-east London will be able to cope once he has taken the axe to Lewisham?

[Mr Hunt]

I recognise that the hon. Lady has been campaigning hard for her constituents, but she massively overstates her case. The reality of the proposals is that 25% of the people who go to Lewisham A and E will no longer go there—the most complex cases among her constituents, who will get better treatment as a result. Those 25% will be spread among four other A and E departments, and we are allocating £37 million to help them upgrade their capacity. That is a sensible proposal that will save the lives of her constituents.

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

Local Members of Parliament are right to raise concerns about future capacity at Guy’s and St Thomas’ and at King’s. The recent King’s Fund report showed that between October and December 2012, many A and E departments in England faced their worst winter in almost a decade. Standards of care are deteriorating, with too many people waiting too long to be seen and many being left on trolleys in corridors or waiting in ambulances stuck outside A and E. Does the Secretary of State now accept that the NHS is struggling to cope with the toxic mix of cuts and reorganisation, and that patients in south-east London and elsewhere are paying the price for this Government’s mismanagement of the NHS?

[Mr Hunt]

Really, from a party that closed or downgraded 12 A and E departments when in office, I would expect a slightly more mature attitude to an extremely difficult and complex problem. We will not take any lessons in meeting A and E targets from that lot. The reality is that we met our A and E targets last year, but in Wales, where Labour cut the NHS budget by 8%, they have not met their A and E targets since 2009.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

4. What the reason is for the time taken to produce the Government’s sexual health policy document; and when he now expects it to be published.

--- Later in debate ---

[Mrs Madeleine Moon (Bridgend) (Lab)]

7. What funding his Department has allocated to research into pre-senile dementia.

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

The National Institute for Health Research supports a wide range of research, including a number of studies of pre-senile dementias, more commonly known as early-onset dementias. This includes 85 studies recruiting patients with dementia and a further 17 in the set-up phase.

[Mrs Moon]

I declare an interest.

Dementia in the ageing population is beginning to be better understood and recognised—I appreciate the Government’s efforts on this—but there are also the frontotemporal dementias, such as Pick’s, corticobasal degeneration, Lewy body, progressive supranuclear palsy, Parkinson’s and stroke-related dementias, which are early onset. There is less understanding and awareness of these dementias. I welcome the Government’s commitment to research in this area, but we also need to extend understanding among nurses, general practitioners and care providers. Will the Government ensure that this wider understanding is available and extended?

[Mr Hunt]

I thank the hon. Lady for her interest in early-onset dementia. She is absolutely right: there is a widespread lack of understanding of dementia in general, and of early-onset dementia in particular. In addition to the research that I mentioned in my earlier answer, we are also looking at a major programme to engage GPs. Sadly, some GPs still think that it is not worth diagnosing someone with dementia, and there is a lack of understanding that we absolutely have to put right.

[Jason McCartney (Colne Valley) (Con)]

Government and charitable spending on dementia research is 12 times lower than spending on cancer research, with £590 million a year being spent on cancer research and only £50 million being invested in dementia research. What steps can we all, including the Government, take to increase the amount of investment in dementia research?

[Mr Hunt]

My hon. Friend makes an important point, and he will be pleased to learn that the Government are more than doubling the amount of money that we put into dementia research. We need to catalyse the private sector companies because although they know that the size of their potential market of people with dementia is huge, they have been frustrated in their attempts to find the breakthrough medicine that we urgently need. We need to use the research to excite their interest and keep them focused on this truly tragic disease.

[Julian Sturdy (York Outer) (Con)]

8. What steps his Department plans to take to improve dementia diagnosis rates and to reduce regional variations in such diagnoses.

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

There are unacceptable variations in the level of dementia diagnosis across the country, and we are committed to driving significant improvements. We have asked local areas, through the NHS mandate, to make measurable progress in improving dementia diagnosis over the next two years.

[Julian Sturdy]

In North Yorkshire and York, only 43% of those suffering from dementia receive a diagnosis. Given the ageing population in the county, that means that about 7,000 people with dementia remain undiagnosed. Does my right hon. Friend agree that the clinical commissioning groups have a large role to play in the delivery of dementia services, and will he tell us what support those groups will get?

[Mr Hunt]

My hon. Friend is absolutely right. It is a tragedy for those 7,000 people and their families that they are not getting a diagnosis. With a diagnosis, medicines and drugs could have a big impact and stave off the condition for between one in three and one in four people, and support services could also be put in place for carers. We need a massive transformation, and we need to make it much easier for people to get a diagnosis. We need much better understanding among GPs, as I mentioned earlier, and among hospitals as well, given that 25% of all in-patients have dementia.

--- Later in debate ---

[Henry Smith (Crawley) (Con)]

13. What steps he has taken to support research on the most common causes of premature mortality.

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

We are still far too low in the European league tables for premature mortality, particularly in respect of cancer, liver disease and respiratory diseases. I have therefore made improving our performance a key priority.

[Henry Smith]

Can the Minister say a little more about what is being done to prevent early mortality as a result of heart disease?

[Mr Hunt]

We are investing £34 million in cardiovascular research. Much excellent work is being done at, in particular, the Oxford Biomedical Research Centre, which will help us to make great strides.

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

19. It is widely accepted that late diagnosis of cancer makes for premature mortality. Will the Government recommend the inclusion of proxy measures such as staging and accident and emergency admissions in the outcomes indicator set, as a way of complementing the one and five-year survival measures? That would give us a more complete picture of how CCGs are performing in encouraging earlier diagnosis.

[Mr Hunt]

I congratulate my hon. Friend on his campaigning. No sooner do we agree to the inclusion of one indicator in relation to early cancer diagnosis than he finds another that should also be included.

I will certainly consider the issue that my hon. Friend has raised, but I think that there is a broader question about the role of GPs. They should see themselves as being in the front line when it comes to early diagnosis of not just people who walk through the doors of their surgeries, but people in their communities who are at high risk. That is a much more fundamental change that we need to think about.

[Paul Blomfield (Sheffield Central) (Lab)]

14. What was the change in the level of spending in real terms on adult mental health services in 2011-12.

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[Alun Cairns (Vale of Glamorgan) (Con)]

15. What recent estimate he has made of the potential savings to the NHS of making better use of technology.

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

PricewaterhouseCoopers estimates that the NHS could save £4.4 billion every year through proper investment in IT, which is one of the reasons I set the NHS the challenge of becoming fully paperless by 2018.

[Alun Cairns]

I am grateful to the Secretary of State for his answer, but can he assure me that investment in new technology will release resources for patient care, rather than follow the pattern over the past 15 years, when investment in new technology has detracted from the available resources?

[Mr Hunt]

My hon. Friend makes an important point. In encouraging such investment, we are thinking about the nurse who recently reported that in order to admit someone to trauma she had to fill out a 22-page admission form and another 10 forms after that. The whole point of this move is to free up the time of professionals on the front line so that they can spend more time with patients.

[Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)]

The Secretary of State will be aware that the general practice extraction service contract has recently been awarded to French IT firm Atos Healthcare. Given the concerns expressed by the Public Accounts Committee and the National Audit Office about the way in which Atos has performed in respect of other contracts let by the Government, what has the Secretary of State got in mind to ensure that there are safeguards for patient data under the general practice extraction service contract?

[Mr Hunt]

With respect to all IT contracts, all I will say is that we have learned a great deal from the mistakes made by the previous Government.

[Ms Margaret Ritchie (South Down) (SDLP)]

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

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

The last month has seen the Government take two radical steps that will fundamentally improve the quality of health care in this country. First, in our response to the Francis report on the appalling tragedy at Mid Staffs, we announced the setting up of a chief inspectorate of hospitals based at the Care Quality Commission. That will introduce compassionate care, patient feedback and expert peer review into a system that has been too long dominated by targets and box-ticking. Secondly, in response to the Dilnot report, the Government announced a long-term solution to the funding of social care, which will both help thousands of low-income pensioners avoid having to sell their homes and make us one of the first countries in the world where it is as normal to save for social care costs as it is to save for a pension.

[Ms Ritchie]

This week I will meet my constituents Neal and Rita Denvir, whose son, Fionn, made a miraculous recovery from meningitis. Many are not so fortunate, however, so will the Secretary of State pledge his support to the Meningitis UK “Beat it now” campaign, and include the newly licensed vaccine for meningitis B in the NHS childhood immunisation programme, so that no family has to live with the terror of that terrifying disease?

[Mr Hunt]

As the father of two young children, I completely share the hon. Lady’s passion for this issue and I am happy to give my support to Meningitis UK. The decision on whether to include a meningitis jab in the immunisation campaign is made by an independent expert panel, and I will always follow its advice.

[Nick Herbert (Arundel and South Downs) (Con)]

T2. We used to believe that tuberculosis was beaten in this country, but the number of instances of it is increasing, and there were more than 9,000 new cases last year. Does that not suggest, particularly when the incidence of drug-resistant TB is a concern, that a comprehensive public health strategy is needed to tackle the disease? What steps is the Department taking to lead that strategy?

[Andy Burnham (Leigh) (Lab)]

I am sure that, like me, the Secretary of State has spent recent weeks absorbing the Francis report and its recommendations; there are lessons for everyone at every level, particularly on staffing. New analysis to be published later today will show that the NHS is set to lose 12,000 nurses over the course of this Parliament, raising doubts about its ability to respond to Robert Francis’s recommendations on staffing. Will the Government say today whether they accept those recommendations and the principle of a minimum staff-to-patient ratio?

[Mr Jeremy Hunt]

If the right hon. Gentleman had read the Francis report carefully he would have, first, observed that the appalling tragedies covered in that report happened between 2005 and 2009, when nursing numbers were going up. So to say that this is an issue about nursing numbers is to miss the point completely. This is not an issue where there is a quick fix; it is an issue about the NHS having become dominated for far too long by a culture of targets at any cost. Unpicking that culture is the biggest challenge we face if we are to return a culture of compassionate care to the NHS.

[Andy Burnham]

I have read both Francis reports, and I think it is essential that everybody learns the lessons—that is what I said—including Labour Members. It is also important that we do not repeat the mistakes, and the first Francis report said that the problems were caused because the trust cut staff to dangerously low levels. The most worrying thing from the analysis that will be published today is that four in 10 of the jobs being lost come directly from services linked to the care of older people. Does the Secretary of State therefore agree that there is a danger that the NHS is already failing to learn the lessons of the recent past? Will he join me in sending a message to the NHS that care of older people should be a priority for improvement, not an easy target for cuts?

[Mr Hunt]

If we are to learn the lessons of the Francis report and admit to our mistakes, perhaps the right hon. Gentleman will reflect on the fact that, because we decided to protect the NHS budget, there are 8,000 more clinical staff in the NHS today, yet he still wants to cut the NHS budget from its current levels, as he confirmed only last December.

[Mr Christopher Chope (Christchurch) (Con)]

T3. In today’s edition of the Daily Express, the Prime Minister promises to prevent immigrants freeloading on our NHS. Words are one thing, but can the Secretary of State spell out exactly what actions will be taken to deliver on the Prime Minister’s pledge?

[Mr Jeremy Hunt]

I am happy to confirm to my hon. Friend that we intend to take some profound steps in this area, because we have a national health service, not an international health service. We have to ask whether it is appropriate for us to be giving free health care to short-term visitors, to students, to people on temporary visas. We will be saying more about that issue shortly.

[Paul Blomfield (Sheffield Central) (Lab)]

T6. On 13 March 2012, the former Secretary of State said of the Health and Social Care Bill:“There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector.”—[Official Report, 13 March 2012; Vol. 542, c. 169.]However, the new NHS competition regulations break those promises by creating a requirement for almost all commissioning to be carried out through competitive markets, forcing privatisation through the back door, regardless of local will. Will the Secretary of State agree to make the regulations subject to a full debate and vote of both Houses?

[Mr Jeremy Hunt]

If the hon. Gentleman had listened to my previous answer, he would have heard that the regulations are consistent with the procurement guidelines that his own Government sent out to PCTs. It is not our job to be a champion for the private sector or the NHS sector; we want to be there to do the best job for patients. That is the purpose of the regulations.

[Tessa Munt (Wells) (LD)]

T4. Two years ago, the Prime Minister welcomed the installation of CyberKnife, the latest in cancer radio surgery equipment at the world-leading Royal Marsden cancer centre, as an example of how the NHS has progressed. Since then, the Royal Marsden has invited successive Health Ministers to visit the cancer centre but no one has accepted the invitation, and I am aware that Ministers have been to see other cancer treatment systems. Will the Secretary of State follow the Prime Minister’s lead and visit the Royal Marsden to see for himself the great progress that has been made there?

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[Mr Andy Slaughter (Hammersmith) (Lab)]

Last week’s decision to close four north-west London A and Es, including Charing Cross and Hammersmith in my constituency, will shortly be on the Secretary of State’s desk, as he predicts. It was referred by Labour Ealing council because Tory Hammersmith and Fulham council supports the closures. Will the Secretary of State refer the matter for independent review? This is the biggest hospital closure programme in the history of the NHS. It will see a world-class hospital downgraded to 3% of its size.

[Mr Jeremy Hunt]

I am aware how concerned people are throughout north-west London about the proposals. If the matter is referred to me by Ealing council, I will indeed ask the independent reconfiguration panel for its independent view on the proposals.

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

T9. The cancer drugs fund has been a huge success and has helped up to 25,000 patients, but the negotiations between the Government and the pharmaceutical companies on its replacement—value-based pricing—is causing real uncertainty for cancer patients and clinicians alike. For example, will new medicines be available to new patients under the new system and what guidance is being given to local cancer drugs funds as they wind down? Can we please have clarity urgently?