Hospital Mortality Rates
Jeremy Hunt Excerpts(13 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I would like to make a statement about Professor Sir Bruce Keogh’s review of hospitals with high mortality rates, which is being published today.
Let me start by saying that in the health service’s 65th year, this Government are deeply proud of our NHS. We salute the doctors, nurses and other professionals, who have never worked harder to look after each and every one of us at our most vulnerable. We recognise that the problems identified today are not typical of the whole NHS or of the care given by many wonderful NHS staff; but those staff are the ones who are most betrayed when we ignore or pass over poor care. The last Government left the NHS with a system that covered up weak hospital leadership—[Interruption.]
Mr Speaker
Order. As is the normal practice, right hon. and hon. Members can expect extensive questions—as can the Secretary of State—but the statement must be heard.
Mr Hunt
Thank you, Mr Speaker. The last Government also failed to prioritise compassionate care. The system’s reputation—[Interruption.] This is uncomfortable for hon. Members. The system’s reputation mattered more than individual patients; targets mattered more than people. We owe it to the 3 million people who use the NHS every week to tackle and confront abuse, incompetence and weak leadership head-on.
Following the Francis report into the tragedy at Mid Staffs, the Prime Minister asked Professor Sir Bruce Keogh, the NHS medical director, to conduct a series —Interruption.] I know they tried to shout down whistleblowers such as Julie Bailey, but we are not going to let that happen here. The Prime Minister asked Professor Keogh to conduct a series of “deep-dive” reviews of other hospitals with worrying mortality rates. No statistics are perfect, but mortality rates suggest that since 2005, thousands more people may have died than would normally be expected at the 14 trusts reviewed by Sir Bruce.
Worryingly, in half those trusts, the Care Quality Commission—the regulator specifically responsible for patient safety and care—failed to spot any real cause for concern, rating them as “compliant” with basic standards. Each of those trusts has seen substantial changes to its management since 2010, including a new chief executive or chair at nine of the 14. However, although some have improved, failure or mediocrity is so deeply entrenched at others that they have continued to decline, making the additional measures I am announcing today necessary.
This time, the process was thorough, expert-led and consisted of planned, unannounced and out-of-hours visits, placing particular weight on the views of staff and patients. Where failures were found that presented an immediate risk to patients, they were confronted straight away, rather than waiting until the report was finished. We will be publishing all the reports today, alongside unedited video footage of the review panel’s conclusions—all of which I am placing in the Library. Today I will also set out the actions the Government are taking to deal with the issues raised. I would also like to record my sincere thanks to Sir Bruce and his team for doing an extremely difficult job very thoroughly and rapidly.
Sir Bruce judged that none of the 14 hospitals is providing a consistently high quality of care to patients, with some very concerning examples of poor practice. He identified patterns across many of them, including professional and geographic isolation, failure to act on data or information that showed cause for concern, the absence of a culture of openness, a lack of willingness to learn from mistakes, a lack of ambition, and ineffectual governance and assurance processes. In some cases, trust boards were shockingly unaware of problems discovered by the review teams in their own hospitals. Today I can therefore announce that 11 of the 14 hospitals will be placed into special measures for fundamental breaches of care. In addition, the NHS Trust Development Authority and Monitor have today placed all 14 trusts on notice to fulfil all the recommendations made by the review. All will be inspected again within the next 12 months by the new chief inspector of hospitals, Professor Sir Mike Richards, who starts work today.
The hospitals in special measures are as follows: Tameside Hospital NHS Foundation Trust, where patients spoke of being left on unmonitored trolleys for excessive periods and where the panel found a general culture of “accepting sub-optimal care”; North Cumbria University Hospitals NHS Trust, where the panel found evidence of poor maintenance in two operating theatres, which were closed immediately; Burton Hospitals NHS Foundation Trust, where the panel found evidence of staff working for 12 days in a row without a break; and North Lincolnshire and Goole NHS Foundation Trust, where the panel identified serious concerns in relation to out-of-hours stroke services at Diana, Princess of Wales hospital. The panel also witnessed a patient who was inappropriately exposed where both male and female patients were present. [Interruption.]
The list continues: United Lincolnshire Hospitals NHS Trust, where there were a staggering 12 “never events” in just three years and the panel had serious concerns about the way “Do not attempt resuscitation” forms were being completed; Sherwood Forest Hospitals NHS Foundation Trust, where patients told of being unaware of who was caring for them, and of buzzers going unanswered and poor attention being paid to oral hygiene; East Lancashire Hospitals NHS Trust—[Interruption.]
Mr Speaker
Order. We cannot have a running commentary on the statement as it is delivered. I remind the House that last Wednesday—when there were scenes of grave disorder manifested by Members on both sides of the House—the public reaction to that exceptionally bad behaviour was understandably negative. I appeal to right hon. and hon. Members on both sides of the Chamber to show courtesy and restraint. They can rely upon me to protect their interests—if they were here on time for the statement—to question the Secretary of State, but the statement must be heard.
Mr Hunt
The panel also highlighted issues of poor governance, inadequate staffing levels and high mortality rates at weekends at East Lancashire Hospitals NHS Trust. Patients and their families complained of a lack of compassion and being talked down to by medical staff whenever they expressed concerns.
The remaining hospitals in special measures are as follows: Basildon and Thurrock University Hospitals NHS Foundation Trust, where there were seven “never events” in three years and concerns over infection control and overnight staffing levels; George Eliot Hospital NHS Trust, where the panel identified low levels of clinical cover, especially out of hours, a growing incidence of bed sores and too much unnecessary shifting of patients between wards; Medway NHS Foundation Trust, where a public consultation heard stories of poor communication with patients, poor management of deteriorating patients, inappropriate referrals and medical interventions, delayed discharges and long accident and emergency waiting times; and Buckinghamshire Healthcare NHS Trust, where the panel found significant shortcomings in the quality of nursing care relating to patient medication, nutrition and observations, and heard complaints from families about the way patients with dementia were treated.
For those 11 trusts, special measures mean that each hospital will be required to implement the recommendations of the Keogh review, with external teams sent in to help them do this. Their progress will be tracked and made public. The TDA or Monitor will assess the quality of leadership at each hospital, requiring the removal of any senior managers unable to lead the improvements required. Each hospital will also be partnered with a high-performing NHS organisation to provide mentorship and guidance in improving the quality and safety of care.
Three of the 14 hospitals are not going into special measures. They are the Colchester Hospital University NHS Foundation Trust, the Dudley Group NHS Foundation Trust and the Blackpool Teaching Hospitals NHS Foundation Trust. Although there were still concerns about the quality of care provided, Monitor has confidence that the leadership teams in place can deliver the recommendations of the Keogh review and will hold them to account for doing so.
This is a proportionate response in line with the findings of the review. Inevitably, there will be widespread public concern not just about these hospitals but about any NHS hospital, and some have chosen to criticise me for pointing out where there are failures in care, but the best way to restore trust in our NHS is transparency and honesty about problems, followed by decisiveness in sorting them out. The public need to know that we will stop at nothing to give patients the high-quality care they deserve for themselves and their loved ones. Today’s review and the rigorous actions that we are taking demonstrate the progress this Government are making in response to the Francis report. I shall update the House in the autumn on all of the wide-ranging measures that we are implementing, when the House will be given a chance to debate them in Government time.
The NHS exists to provide patients with safe, compassionate and effective care. In the vast majority of places it does just this, and we should remember that there continues to be much good care even in the hospitals reviewed today. Just as we cannot tolerate mediocre or weak leadership, we must not tolerate any attempts to cover up such failings. It is never acceptable for Government Ministers to put pressure on the NHS to suppress bad news, because in doing so they make it less likely that poor care will be tackled.
We have today begun a journey to change this culture. These 14 failing hospital trusts are not the end of the story. Where there are other examples of unacceptable care, we will find them and we will root them out. Under the new rigorous inspection regime led by the chief inspector of hospitals, if a hospital is not performing as it should, the public will be told. If a hospital is failing, it will be put into special measures with a limited time period to sort out its problems. There will be accountability, too: failure in the NHS should never be a consequence-free zone, so we will stop unjustified pay-offs and ensure it will no longer be possible for failed managers to get new positions elsewhere in the system.
Hand in hand with greater accountability, there will be greater support. Drawing inspiration from education, where super-heads have helped to turn around failing schools, I have asked the NHS Leadership Academy to develop a programme that will identify, support and train outstanding leaders. We have many extraordinary leaders such as David Dalton in Salford Royal and Dame Julie Moore of University hospital Birmingham, but we need many more to provide the leadership required in our weaker hospitals.
At all times, this Government will stand up for hard-working NHS staff and patients who know that poor care and weak leadership have no place in our NHS. It was set up 65 years ago with a pledge to provide us all with the best available care, and I am determined that the NHS will stand by that pledge. We owe its patients nothing less. I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
First, let me join the Secretary of State in thanking Sir Bruce Keogh and his team for this important review. Having worked closely with Sir Bruce, I know him well and have the utmost respect for him. His review presents a challenging but accurate picture of care standards and failings at the 14 trusts. As with both Francis reports, we accept the findings of this report in full.
The statement we have just heard, however—the partisan statement—was not worthy of the excellent report that Sir Bruce has delivered today. The Health Secretary claimed at Health questions that this was a historical report, all about the past and the last Government. Well, I have got news for him: it is not. Trusts were identified on the basis of mortality data for 2011 and 2012. This report is about the right hon. Gentleman’s Government and failings that are happening now on this Government’s watch.
Anyone who supports the NHS must always be prepared to shine a spotlight on its failings, so it can face up to them and improve. In so doing, we must be fair to staff and the NHS as a whole. I am pleased to say that Sir Bruce is fair in his report. He says early in the report that the failings of the 14 hospitals must be put in context, stating that mortality in “all NHS hospitals” has been falling over the last decade by about 30%. He rightly reminds us of
“decades of neglect in the NHS in the 1980s and 1990s”,
and he speaks of the challenge facing the last Government in their early days. The key issue, he said,
“was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment.”
The last Labour Government dealt with that issue; I am proud of it and we are proud of our record on the NHS.
The balanced picture presented in this report is not recognisable from the Government briefing appearing in the weekend newspapers. In fact, this report exposes one of the more cynical spin operations of recent times. Nowhere in this report does the claim of 13,000 avoidable deaths appear. Sir Bruce is clear, so let me quote him directly:
“However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths”,
but that is precisely what this Government chose to do in advance of this report. They made unfounded claims, which will have alarmed people in the areas served by the 14 hospitals, and they have questioned the integrity of the staff working in those hospitals in difficult circumstances—and all for their own self-serving political ends. That is simply unworthy of any responsible Government. On reading this review, the diversionary spin operation now makes sense because it reveals evidence of deterioration at all 14 hospitals on their watch.
Let me turn to one of Sir Bruce’s central findings—unsafe staffing. One of the report’s major concerns is that trusts have allowed staffing levels to drop to dangerously low levels. It says:
“When the review teams visited the hospitals, they found frequent examples of inadequate numbers of nursing staff in some ward areas.”
Already, the review team has had to intervene on staffing levels in three trusts to protect patient safety.
The Secretary of State claimed in his comments that the Care Quality Commission had failed to spot any problems. Working with the CQC during the last Government, I left in place warnings about five of these hospitals. The Secretary of State claims that we were covering up, so let me answer on the question of Ministers’ integrity and cite the Francis report, which said that there was no evidence that any Minister received or ignored advice that would have led to safe outcomes. Let me quote to him from a letter sent by Baroness Young to the Prime Minister yesterday:
“CQC was not pressurised by the previous Government to tone down its regulatory judgments or to hide quality failures.”
It is outrageous for the Secretary of State to come to the House today and repeat those concerns without a shred of evidence to back them up.
Five of the trusts examined by Keogh had warnings in place, and it is shocking that they have been allowed to cut staff to unsafe levels on this Government’s watch. Overall, seven of the trusts in the review have cut front-line staff by a shocking 1,117. The great sadness is that it appears Ministers are in danger of forgetting the lessons of Stafford, where Robert Francis identified “dangerous cuts” to the front line as a primary cause of care failures. Like Robert Francis, Sir Bruce makes recommendations on appropriate staffing levels. Is it not the case that the Secretary of State can no longer ignore these authoritative calls, and will he take urgent action on safe staffing levels in these 14 trusts and across the NHS? Will he accept that the loss of over 4,000 nursing jobs that has now been laid bare under this Government is a monumental mistake, while £3 billion has been siphoned out of the NHS front line to pay for reorganisation that nobody wanted and nobody voted for?
Let me turn to A and E performance, the barometer of the health service and a wider indication of problems across hospitals. The report highlights major failings in A and E at many of the trusts and we know that the NHS has just come through the worst winter for a decade. At the end of last year, all 14 trusts were in breach of the Government’s A and E target—when, under the previous Government, all 14 were meeting the A and E target.
Sir Bruce is clear that urgent action is needed to improve A and E. Let me quote the report:
“We have established that one of the primary causes of high mortality in these hospitals are found primarily in urgent and emergency care, and particularly in care for frail and elderly patients…All trusts were functioning at high levels of capacity in the urgent care pathway. This frequently led to challenges in A&E and, as a consequence, cancellation of operations due to bed shortages and difficulty meeting waiting time targets.”
Will the Secretary of State now take immediate action, working with the whole health economy in these 14 areas, to bring each trust back up to the national standards on A and E that his Government have set? Will he accept that it is not fair to these hospitals to blame them alone, as the devastating cuts to social care are a major driver of pressure in hospitals?
Finally, on what happens next, the simple truth is that people watching will want solutions rather than point scoring. Surely the right response to the Keogh review is now to accept the Francis recommendations in full, particularly on minimum staffing. A duty of candour on individuals will help bring the culture change we need at local level and, of course, we need to see the regulation of health care assistants. Will the Secretary of State work with us now on early implementation of the Francis recommendations? He spoke earlier of a new era of transparency. If he means what he says, will he now publish the NHS risk register? For all we know, it might well have predicted some of the failings we are reading about today.
It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What matters is how the NHS responds. Rather than pulling down the shutters and pushing people away, it is right that we should hold a mirror up to the NHS so that it can act on its failings. We must also be fair to people working in the NHS by ensuring that an accurate picture is presented. Sir Bruce has had to take the extraordinary step already of distancing himself from the Government briefings that appeared at the weekend. I hope the Government will learn a painful lesson from this: you should not play politics with people’s lives and you should not play politics with the NHS, on which all people depend.
Mr Speaker
Order. Mr Irranca-Davies, you look as though you are about to explode. I am worried about you. I think you probably need to have a lie down or to take some sort of medicament—it might be of benefit to you. You must calm yourself.
Mr Hunt
The right hon. Gentleman talked about being partisan and party political. It is not party political to highlight poor care; it is doing the right thing for patients.
Let us look at what independent people have said about Labour’s time in office. Roger Davidson, the former head of media at the CQC, said that
“there were conversations between the CQC and Ministers to the effect that the CQC would not cause any trouble…The message that ‘we don’t want bad news’ infected the whole organisation”.
Professor Brian Jarman—[Interruption.] I think Opposition Members might want to listen to this, because it is what independent people are saying. Professor Jarman, who invented hospital standardised mortality indices, said that
“the problem was ministerial pressure, even from Number 10.”
This is most damaging: the right hon. Gentleman talked about what Barbara Young, Labour peer and head of the CQC, said under pressure from the Labour Whips, but what did she say under oath to the Francis inquiry? She said that
“the government hated the idea…the regulator would criticise it… We were under more pressure, I think, when Andy Burnham became minister, from the politics.”
That is what a Labour peer said. These people are not Government supporters—at least, not of this Government —but were trying to do their job in exposing poor care and the right hon. Gentleman stopped them.
The right hon. Gentleman talks of spin, but I will tell him who had to fight hardest against spin: the whistleblowers he tried to shut up. What do they say? James Titcombe, who tragically lost his son at Morecambe bay, tweeted that
“you made big mistakes Andy, it’s time you admitted it.”
Julie Bailey, who lost her mother at Mid Staffs, said that Labour crushed the culture of care from the NHS. [Interruption.] Deb Hazeldine, from Mid Staffs, who lost a relative, said that the shadow Secretary of State was trying to “defend the indefensible”—[Interruption.]
Mr Speaker
Order. It is very difficult to imagine how anyone can hear these exchanges. The content of questions and answers is to be determined by Members, but I gently remind the House of the need for good order and that this is not a debate. There will be debates, but this is not a debate but a statement on which there is questioning, to which there is then a ministerial answer. This is not an opportunity for general speechifying but for responses to specific questions made with economy so that I can accommodate all interested colleagues.
Mr Hunt
Thank you, Mr Speaker. I would have hoped that the Opposition would want to listen more respectfully to what whistleblowers said about their attempts to expose poor care.
Let me respond to what the right hon. Gentleman says. He says that Labour tackled the problems, but the evidence shows the opposite. We talked about Tameside earlier, but what about Basildon? There were high death rates for nine years under Labour—in every year since 2001. Half the staff said they would not want their own friends and family treated there. Ministers received 237 letters between 2005 and 2010, yet what did the CQC do? It rated the hospital as “good” and within four weeks Ministers were shamed into launching an investigation into high mortality rates—[Interruption.]
Mr Speaker
Order. I have tried to explain the position calmly—[Interruption.] Order. I shall do so once more. I think the Secretary of State will appreciate that he has been asked questions about present arrangements to which we need pithy replies, not a lengthy statement about events of the past that happened before he had responsibility. We cannot have that. If that is what he is planning to read out, we will simply move on. A brief conclusion to his answer is now required and sought by the House.
Mr Speaker
Order. My impression is that the Secretary of State is now seeking to treat of matters since May 2010 and he must be given the opportunity to do so, with colleagues and people outside being able to hear the answers.
Mr Hunt
Thank you, Mr Speaker.
What does the right hon. Gentleman do when I criticise the lack of rapid progress in tackling failure in our hospitals? He criticises me for making an unbelievable statement and states that there are no coasting hospitals, but today proves that he is wrong. What is unbelievable is his total refusal to admit that it is not just a question of coasting hospitals, but a Labour party that has coasted for too long on its reputation on the NHS.
Finally, the right hon. Gentleman says that we are trying—[Interruption.] This is difficult for Labour Members to hear, so let us get to the point. He says that we are trying to run down the NHS. Let me say this: if we did not believe in the NHS, we would not be tackling these problems. The best way to support the NHS is not to ignore poor care, not to muzzle the CQC, not to ignore requests for public inquiries and not to ignore warnings constantly. If founding the NHS is considered Labour’s proudest achievement, today is its darkest moment as a Labour Government are exposed as caring more about their own reputation than about our most vulnerable citizens in the NHS—[Interruption.]
Mr Speaker
Order. Has the Secretary of State finished his answer? He has. We are grateful and I thank him for saying that he has finished.
Mr Stephen Dorrell (Charnwood) (Con)
Those who want to make the case for change in an organisation—and, after the Francis review, who can doubt the need for change in parts of the national health service—must first demonstrate the need for change. Does this review not build on the distinguished record of both Bruce Keogh and Sir Brian Jarman in demonstrating the need for change in parts of our national health service?
Mr Hunt
My right hon. Friend speaks very wisely. As I know he agrees, identifying problems publicly is incredibly difficult, but the way to ensure that those problems are dealt with is to be totally honest and transparent about them in the knowledge that they will be sorted out as a result, and that is what is happening today.
Alan Johnson (Kingston upon Hull West and Hessle) (Lab)
Thankfully, the quality of Sir Bruce Keogh’s report is vastly superior to that of the statement that we heard from the Secretary of State. Is it not the case that Sir Bruce Keogh—[Interruption.]
Alan Johnson
Is it not the case that Sir Bruce may have given us a blueprint for better regulation, provided that the Secretary of State faces up to his responsibility and ends the tawdry and squalid attempts by his party to denigrate his predecessors?
Mr Hunt
I am sure that the right hon. Gentleman, who is one of those predecessors, would accept at a quieter moment outside the Chamber that one of the biggest mistakes made during his time as Secretary of State—or at least it was initiated then—was the appalling change that was made to the regulation of hospitals. The CQC was stripped of expert inspectors, and hospitals began to be inspected by generalists. The same group of people would inspect a slimming clinic, a dental practice, a GP’s surgery, and a major London teaching hospital. That very significant mistake lies at the heart of the reason why the CQC approved and certified so many failing hospitals.
I am happy to work with the right hon. Gentleman, and to say that honest mistakes were made and we will put them right, but today there must be honesty about what those mistakes were.
Mrs Cheryl Gillan (Chesham and Amersham) (Con)
Patients and their families outside this place will join me in congratulating the Secretary of State on his brave decision not to sweep NHS failures under the carpet.
You and I know, Mr. Speaker, that Buckinghamshire contains many areas of health care that are of high quality, but the report identifies some failings, one of which is the quality of out-of-hours and weekend nursing and medical cover for acute medical patients. That is clearly linked to difficulties relating to the recruitment, retention and availability of competent clinicians and nurses. What more can the Department do to help our trusts improve out-of-hours provision and, in particular, the quality of temporary staff, so that those problems can be eliminated?
Mr Hunt
My right hon. Friend is right. Serious problems were identified in Buckinghamshire relating to out-of-hours care and also to dementia patients, who themselves often need help out of hours. I raised the difficult issue of the GP contract because, in order to solve such problems, we need more joined-up care in the community. The Chancellor has announced an additional £2.8 billion for joint commissioning arrangements between local authorities and health care bodies, and I think that the combination of those two measures will secure a vastly improved out-of-hours service for my right hon. Friend’s constituents.
Mr Jack Straw (Blackburn) (Lab)
I welcome the Keogh report and the action that the Secretary of State has announced, which, although it will be uncomfortable for my local health trust, I believe to be necessary. However, I hope that, on reflection, the right hon. Gentleman will realise that the comments that he has made demean his office. I sat in the Cabinet with my right hon. Friends the Members for Leigh (Andy Burnham) and for Kingston upon Hull West and Hessle (Alan Johnson). I saw how anxious they were to root out inefficiency and failings, and to cover nothing up, and I think it inappropriate for the Secretary of State to suggest that he and his party have a monopoly when it comes to concern about the transparency and effectiveness of the health service.
Last Thursday, the Secretary of State commended Royal Blackburn hospital for its vascular services and accepted the excellence of many of its staff. While we are navigating through this difficult period, is it not crucially important for us to echo the Keogh report and point out that, overwhelmingly, hospitals in areas such as mine employ high-quality staff who require better leadership?
Mr Hunt
Improving leadership is vital throughout the NHS. All Governments must take responsibility for what happens on their watch, and I have taken responsibility today for those 14 hospitals and all their serious problems. The right hon. Gentleman should accept that between 2005 and 2010 his Government received 142 letters about his hospital which they did nothing about, and introduced a regulatory system that did not expose poor care and ensure that it was addressed.
Andrew George (St Ives) (LD)
I welcome Sir Bruce Keogh’s important report. However, although I admire my right hon. Friend, I totally dissociate myself from his ill-judged attempt to drag this important issue into the gutter of partisan politics and petty point-scoring. I expect better of him than that.
It is clear from annex A of the report that in all but one of the 14 hospitals, problems relating to staffing levels and the staff mix need to be addressed, and ambition 6 recommends action to address them. As my right hon. Friend knows, I campaign on this issue. What will the Government do to ensure that staffing levels are adequate in our acute hospitals?
Mr Hunt
Tackling failure in our NHS is not an easy path to take, but it is the right thing to do for patients. If my hon. Friend believes that all the care problems in the NHS started in 2010, I think he is the only Member who does. [Interruption.] Opposition Members must bear their share of the responsibility for the failures that they did not sort out. Staffing is indeed a problem that needs to be sorted out in many trusts, which is why we commissioned the review and why we are sending in turnaround teams to do just that.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
The Secretary of State has made an appalling attempt to smear my right hon. Friend the Member for Leigh (Andy Burnham). Will he now acknowledge that in 2009, my right hon. Friend sought a review of all the hospitals with high mortality rates, that 21 were registered with conditions, and that five had warnings placed on them, which he and he his predecessor inherited? Will he tell the House what he and his predecessor did in respect of those hospitals in 2010, 2011 and 2012?
Mr Hunt
As I said in my statement, in nine of these 14 trusts, the chief executive or chair has been either replaced or moved on. However, the most important thing that we are doing is setting up a transparent failure regime, so that when problems arise they will be made public, so the system will never know something that the public do not, and so that Ministers will be required to take action to sort out failing hospitals. That is what is happening under this Government, but I am afraid that it did not happen when the right hon. Lady’s party was in power.
Mr William Cash (Stone) (Con)
The Keogh report, which must be welcomed, followed the Francis report. Despite my continuous attempts to have a full public inquiry under the Inquiries Act 2005, successive Labour Secretaries of State refused. Can my right hon. Friend find out from the Department or in any other way how that happened? Will he be good enough to publish his findings, because the root of the real trouble is that they were not prepared to have an inquiry and it was a cover-up?
Mr Hunt
My hon. Friend knows that the Labour party refused 81 requests for a public inquiry into what happened at Mid Staffs—I repeat: 81 requests. He also knows that if it was not for that public inquiry, we would not be here now. That is the biggest lesson to learn about the benefits of a public inquiry, and that is why transparency matters. I hope he is also pleased that we will be having a debate on the Francis report in Government time later this year.
Sir Tony Cunningham (Workington) (Lab)
If the teams going into Cumbria recommend increased staffing and resources, will the Secretary of State fund that?
Mr Hunt
If the issues are around staffing, we will sort those out. If the issues are around leadership, we will sort those out. If the issues are around clinical practice, we will sort that out. My commitment to the House is that we will do what it takes to sort out these failing hospitals.
Dr Phillip Lee (Bracknell) (Con)
In 2006 the then Labour Government purchased 49% of Dr Foster, the intelligence unit from which a lot of these mortality data are emanating. Does the Secretary of State agree that for Secretaries of State from that point onwards to be claiming they were unaware of the data seems a bit rich?
Mr Hunt
There were repeatedly high mortality rates in all these 14 hospitals, and it took the public inquiry that Labour did not want to demonstrate to the world just how important hospital standardised mortality ratios are. They are the smoke alarm that was ignored in the case of Mid Staffs, and which could have led to the prevention of thousands of tragedies if we had taken action earlier. That is why we immediately insisted on this review by Sir Bruce.
Grahame M. Morris (Easington) (Lab)
I think there is widespread respect for Sir Bruce Keogh and his report and I certainly welcome it, but it is a cynical move by the Secretary of State to try to besmirch the reputation of my right hon. Friend the Member for Leigh (Andy Burnham). May I point out that on this Government’s watch clinical negligence claims are up 50%, A and E waits are at a nine-year high and “never events” have tripled? What is the Secretary of State going to do about them?
Mr Hunt
We spend more than £1 billion every year on clinical negligence because the hon. Gentleman’s Government changed the rules so that trusts suffer no financial penalty when they have to pay a clinical negligence claim. That is something we really need to look at, because it is removing one of the biggest possible incentives for trusts to treat people safely.
Mark Reckless (Rochester and Strood) (Con)
Is the Secretary of State aware that in Medway we were left with just three consultants to share cover of A and E, but we have now increased the number to six, and it will soon rise to eight?
Mr Hunt
These are precisely the problems that this review is designed to root out. There were problems with long A and E waits as well as with inappropriate medical interventions and poor communication with patients, but I hope my hon. Friend’s constituents will be reassured by the transparency of what is happening today, and the fact that I am making this Government accountable for sorting out those sorts of problems.
Chris Bryant (Rhondda) (Lab)
I suspect that in a quieter moment the Secretary of State will not think this statement was his proudest moment. [Interruption.] Well, it seems that he used to be run by Coulson and now he is run by Crosby.
Most voters will be more interested in the future and how we can make sure that people’s lives are protected, so what does the Secretary of State have to say about the fact that fewer people are coming from other countries to work in the NHS? Because of the Government’s immigration policy, there is a real danger that we will have a significant problem in A and E recruitment across the country.
Mr Hunt
I struggle to find the link between that question and Sir Bruce Keogh’s report on the 14 hospitals, but as the hon. Gentleman has asked about A and E, and as he is trying to take the moral high ground, perhaps he would explain why he has not been standing up in this House campaigning against Labour’s abysmal record, as it has missed its A and E targets in Wales since 2009.
Rehman Chishti (Gillingham and Rainham) (Con)
In 2005 and 2006 Medway Maritime hospital had the seventh worst mortality rate in the country, yet nothing was done. May I thank the Secretary of State for the actions he has put forward today, which will help improve the quality of care for my constituents and people from further afield?
Mr Hunt
My hon. Friend is right. There were high mortality rates in his hospital in six of the nine years they were measured under the last Labour Government, and there were problems with A and E and with inappropriate medical interventions. He can say to his constituents today that the Government have identified the problem and have been transparent about it, and we will be accountable for sorting it out.
Mr Kevin Barron (Rother Valley) (Lab)
How many health professional regulatory bodies has the Secretary of State met since the publication of the Francis report?
Mr Hunt
I think I have met most of them, but I have certainly met the General Medical Council and the Nursing and Midwifery Council, and I have talked to them about the reasons they are finding it difficult to remove doctors and nurses from their lists when there are questions about their poor performance.
Tracey Crouch (Chatham and Aylesford) (Con)
To complete the Medway Maritime hat trick, may I say I am very disappointed to hear from the Secretary of State that the hospital has gone into special measures? I have been assured that Sir Bruce Keogh’s recommendations are already being implemented, but will the Secretary of State say in what time frame he, and more importantly my constituents, should expect to see significant improvements at the Maritime?
Mr Hunt
We want these things to happen as quickly as possible, but all the hospitals Sir Bruce reviewed will be looked at again within the next year by the chief inspector of hospitals, Professor Sir Mike Richards, who starts work today, so we will be able to measure whether progress has been as swift as my hon. Friend and I would like.
Helen Jones (Warrington North) (Lab)
May I ask the Secretary of State to actually discharge one of the responsibilities of his office by answering a simple question? If he believes that managers should not be able to get another post if they fail, why was there a plan to transfer the chief nurse from the failed Morecambe Bay NHS Trust on secondment to Warrington and Halton on the Secretary of State’s watch, stopped only when my hon. Friend the Member for Halton (Derek Twigg) and I found out about it? Did he or his Ministers know about this plan, and if not, why not?
Mr Hunt
That is exactly the reason why we are introducing measures to make sure—[Interruption.] Well, the Francis report was introduced to this House on 6 February, and we have said we will change legislation this year. We have already appointed a chief inspector of hospitals. I do not think we could go much faster. The trouble for the Labour party is not that we are going too slowly but that we are going too fast and exposing all sorts of problems which it wishes did not happen.
Andrew Griffiths (Burton) (Con)
I thank the Secretary of State for shining a light on to the health care provided by Queen’s hospital in Burton. Although Queen’s has a lower unexpected death rate than other hospitals, any unnecessary death is a tragedy for the family concerned. Given that since 2005 Queen’s hospital had a higher mortality rate than Stafford hospital, does he understand the anger of my constituents who have seen their loved ones die unnecessarily and these concerns ignored by Labour?
Mr Hunt
My hon. Friend’s hospital had excess mortality rates for five of the nine years leading up to 2010 and not enough action was taken, and that is what today is all about. I hope that what his constituents will take from today is that this Government are committed to turning around failing hospitals and putting in place the right leadership, and the reassurance that when their loved ones go to Queen’s hospital or anywhere else in the country, they can get the kind of care they would want for themselves.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)
May I say to the Secretary of State that there is a tone and a language that we should choose to employ for candid conversations about failure and it saddens me that he did not find that language today, because it will not do us any good? The Francis report recommended a duty of candour. Will he update the House as to just how much progress he has made on that?
Mr Hunt
Yes, I can. We have accepted the recommendation that there should be a duty of candour on the boards of hospitals, with criminal sanctions if they fail to tell members of the public that they or their loved ones have been harmed by the hospital, and if they fail to tell the system that those incidents have happened. We have commissioned a review of safety by Sir Don Berwick, one of the greatest experts in the world, and we shall ask him whether we should extend that duty of candour to below board level. We shall wait to hear what he says. We understand the reasons why people might want to do that, but we are also aware that others have expressed the concern that it might destroy an atmosphere of trust in a hospital if people were worried about criminal consequences if they did not talk about any failures they saw in their daily work.
Margot James (Stourbridge) (Con)
I warmly welcome my right hon. Friend’s break with the culture of cover-up that has been so prevalent in the past. I reject absolutely the shadow Health Secretary’s claim that the Dudley Group NHS Foundation Trust’s performance has deteriorated since 2010—[Interruption.]
Margot James
Thank you, Mr Speaker.
I reject the shadow Health Secretary’s claim. The new leadership that was appointed to the trust in 2009 found deep-seated problems there. Does my right hon. Friend the Secretary of State welcome, as I do, the positive notes in Sir Bruce Keogh’s report about that new leadership’s abilities, and Sir Bruce’s finding that the overall work force at our trust are
“committed, loyal, passionate, caring and motivated”?
Mr Hunt
I welcome that, and I am delighted that my hon. Friend’s trust was not one of the ones that it was necessary to put into special measures. We have learnt a lesson from the successful way in which the schools system is regulated. Ofsted distinguishes between failing schools that have in place good management who are able to turn the school round and those where a change of leadership is required, and I am pleased that the report found that Dudley had the right leadership in place.
Gloria De Piero (Ashfield) (Lab)
I welcome the report and I hope that the new chief executive at King’s Mill hospital in my constituency will provide the leadership that has been lacking in recent years. He assures me that he will implement all the report’s recommendations. The report mentions
“significant concerns around staffing levels at…King’s Mill Hospital”.
The trust has lost more than 200 nurses since 2010. Can we have them back?
Mr Hunt
Staffing levels are indeed one of the issues that contribute to poor care, if we get them wrong. That is why we are committed to implementing the Francis recommendations on safe staffing levels, and why, having protected and increased the NHS budget—contrary to what the shadow Secretary of State wanted—we now have 6,000 additional doctors working in the NHS. [Interruption.] In these individual cases, if staffing levels are the issue, they will be addressed.
Mr John Baron (Basildon and Billericay) (Con)
The Secretary of State has been absolutely right to highlight and pursue past failures for the benefit of future patients. That includes investigating why the regulatory system seems to have failed in these cases. Does he agree, however, that we must not allow the report to overshadow much of the good work that is being done in our hospitals, including Basildon hospital which now has new management and is instigating changes?
Mr Hunt
I agree with that. One reason why it is so important to reform the regulatory structures that we inherited is that they tried to identify only poor care—not terribly successfully—when we need a system that identifies outstanding care as well. We need such a system for the benefit of the general reputation of the NHS and the morale of the service. We also need one so that a failing hospital can have an organisation on which it can model itself, just as a failing school can model itself on a school that has received an outstanding Ofsted report. That provides a solution to the problem: we identify a problem transparently and we sort it out.
Chris Williamson (Derby North) (Lab)
The Secretary of State said that he was proud of the NHS, yet he and his Ministers have supported a top-down reorganisation of the national health service that will lead to 49% privatisation and cut 4,000 nurses. We know from the Francis report that staffing levels are key to the whole agenda, and the Secretary of State has just said he acknowledges that, so will he reinstate the 4,000 nurses he has cut from the NHS?
Steve Baker (Wycombe) (Con)
Walter Coles died because he was forgotten. Edward Maitland died because he was fed solid food. I could name others; those are just two of the patients who have died unnecessarily. And yet high mortality rates made it on to the board’s agenda in Buckinghamshire only because of a trigger relating to concern for reputational risk. The board had no robust risk management practices in place, and there were no plans to introduce any. Furthermore, certain key elements relating to changes in urgent care were missing. In setting out to champion patients, will my right hon. Friend set out how it will be possible to remove an entire board, or any members of a board who are not performing well?
Mr Hunt
Absolutely. I congratulate my hon. Friend on his extraordinary campaigning on behalf of his constituents. It is very difficult for a local Member to take on his own hospital when he finds failings, but he does it with great bravery. Yes, we need to ensure that the way we judge hospitals is not just about meeting waiting time and A and E targets, important though they are; it must also be about safety, about compassionate care and about governance. Other things matter as well. That is what we are changing.
Jack Dromey (Birmingham, Erdington) (Lab)
In a new low for British politics, the Secretary of State today descended into the gutter. How can he begin to blame the last Government for the deterioration at the 14 hospitals concerned, which took place under this Government, especially as the Government were warned about unacceptable standards in five of them?
Mr Hunt
The low in British politics is that it took so long for a Government to be honest about failings in the NHS. Many of those hospitals have a culture that entrenched failure for years and years under the last Labour Government, yet Labour Members refuse to accept that even now. What does that say to the public about whether they can be trusted with the future of our NHS?
Martin Vickers (Cleethorpes) (Con)
I welcome the robust and determined approach that my right hon. Friend is taking. It is right that the mistakes of the past should be thoroughly investigated, but my constituents—some of whom are waiting to go into Grimsby and Scunthorpe hospitals—need an assurance that action will be taken to remedy the situation immediately. There are many dedicated staff in our area, but recruitment has always been a problem in northern Lincolnshire. Will my right hon. Friend assure me that if additional support is needed to recruit the best clinicians and managers, it will be made available?
Mr Hunt
We will quite simply do what it takes to ensure that we implement the recommendations of the Keogh review for north Lincolnshire hospitals. We owe my hon. Friend’s constituents nothing less. The first step is to be honest about the problems. The big difference between the two sides of the House is illustrated by the fact that we will restore morale not by pretending that the problems do not exist but by being honest about them and confronting them. That is what we will do in my hon. Friend’s constituency.
Sarah Champion (Rotherham) (Lab)
I should like to start by offering my deepest sympathy to the patients and families. We are talking about mortality statistics, but these are actually loved ones who have been lost. For the second time today, I ask the Secretary of State whether he will accept, adopt and implement the recommendations in the Francis report.
Sir Tony Baldry (Banbury) (Con)
Professor Brian Jarman observed that, until recently, the Department of Health seemed to be a “denial machine” and that there was suppression and spin. Will the Secretary of State and the whole House at least agree that there is no room for denial, suppression or spin in the NHS, and that what we need for the future are total transparency, accountability and a Care Quality Commission that performs properly and professionally?
Mr Hunt
My hon. Friend speaks wisely, because the first step towards sorting out these problems is to have a system that Ministers cannot interfere with so that when there is failure, regulators are able to speak out without any political pressure—without any Ministers leaning on them in the run-up to elections—in the interests of patients. That is why we are completely changing the CQC. We are introducing a chief inspector of hospitals, who will be the nation’s whistleblower and who will have the independence and freedom that the old CQC never had. I hope that will help the public feel more confident that where there are problems they are properly tackled and not swept under the carpet.
Alex Cunningham (Stockton North) (Lab)
Several times the Secretary of State has admitted that staffing cut drastically on his watch is a major factor in deteriorating care in the NHS—an NHS that has been in the charge of the Conservative party for more than three years. What is he going to do about restoring staffing levels?
Mr Hunt
Clinical staff numbers have gone up by 8,000 since 2010: there are 6,000 more doctors, 1,000 more midwives and 1,000 more health visitors. The numbers have gone up since 2010. If we followed the shadow Secretary of State’s advice and cut the NHS budget from its current levels, that would not be possible.
Mr Marcus Jones (Nuneaton) (Con)
I am pleased that the Secretary of State has sought to take tough decisions to bring more openness and transparency to our NHS and not keep sweeping things under the carpet. Improving quality for patients is the immediate priority, and I support him in the decisive action he has taken, but will he also now seek to establish a sustainable future for the George Eliot hospital, which has suffered from a great deal of uncertainty since 2006?
Mr Hunt
I absolutely intend to do that. As my hon. Friend knows, I have been to the George Eliot hospital, working part of a shift in its accident and emergency department. I thought the staff there were working extremely hard, under great pressure. I noticed that the hospital did not have the systems in place that others have; I believe that hospital had 16 IT systems, which meant that if someone in the A and E department needed a blood test, all the details would have to be re-entered on a different system. That takes up a lot of clinical time, so making changes in these areas can make a big difference. But I do think it is important, as we expose these problems, that we recognise that even at the 14 hospitals mentioned today good care is being provided every day and the staff in those hospitals are working very hard. We need to back them, and the best way of doing so is to give them confidence that we are going to turn around their hospital.
Andrew Miller (Ellesmere Port and Neston) (Lab)
Management systems that are run on a blame culture inevitably create cover-ups and lead to people disguising the facts. Will the Secretary of State now show some leadership by trying to eradicate that from the health service? Will he take the advice Professor Ashton gave on Radio 4 this morning, because he expressed a firm way forward for the NHS? Will the Secretary of State stop playing these silly political games and follow Professor Ashton’s advice?
Mr Hunt
It is not playing silly political games to expose poor care; it is doing my duty as Health Secretary, and that is what I will continue to do. Improving systems, such as making sure there is safe staffing, is very important. It is ridiculous in this day and age that someone can be admitted to A and E but that department cannot access their GP record, and cannot see whether they are a diabetic or whether they have mild dementia. Those are things we are determined to sort out.
Sir Bob Russell (Colchester) (LD)
On 6 February, the Prime Minister asked Professor Sir Bruce Keogh to review the quality of hospital care. Although Colchester is only one hour from London, Sir Bruce did not make a single visit in the five months that elapsed. Although, obviously, I welcome the Secretary of State’s observation today that for Colchester general hospital this is more of a green light than a red light, will he do what Sir Bruce did not do and visit the hospital, so that he can, in the words of the panel, meet a large number of “committed and enthusiastic” staff?
Mr Hunt
I would be delighted to do that. I try to visit somewhere on the front line in the NHS every week, making sure I do not just visit the best places; I visit places that have problems and places like Colchester hospital which are improving—I am delighted that Sir Bruce’s report recognised that.
Emily Thornberry (Islington South and Finsbury) (Lab)
The Secretary of State began his statement with an alarming story about patients being left unmonitored on trolleys—I understand that took place at Tameside hospital. Does he agree that there may be a connection between that and the fact that there are 128 fewer nurses, midwives and health visitors in that hospital than there were in 2010? Given that the previous Government flagged up that hospital as one of particular concern, was he watching it to make sure that there were no cuts in nursing staff there?
Mr Hunt
As I have said many times, where there is not safe staffing we need to put that right. As I have also said, there are 8,000 more front-line staff under this Government than there were when the hon. Lady’s Government were in power. But those are not the only issues; we also need to address issues of leadership, of systems, which we talked about, and of clinical effectiveness. We need to sort out all those. On staffing numbers, I would just point out that plenty of hospitals under equivalent financial pressures are managing to deliver outstanding care, so a lot of this is about getting the right leadership in place at a board level.
Andrew Bridgen (North West Leicestershire) (Con)
On 1 July, just over two weeks ago, my aunt died unexpectedly and alone at Queen’s hospital, Burton. The Keogh review has now shown that hospital to have had a higher mortality rate than Stafford since at least 2005. Will my right hon. Friend pledge to work tirelessly to heal our NHS, so that my constituents, my friends and my relatives do not continue to die unnecessarily because of the failed policies of the previous Labour Government? [Interruption.]
Mr Hunt
This is the problem. [Interruption.] This is the denial we are getting from the Labour party; it is denying any responsibility for these deep-seated problems in some of our hospitals. As Health Secretary, I intend to do exactly as my hon. Friend describes. In order to try to measure the progress we are making, we will this year for the first time be asking every NHS in-patient whether they would recommend the quality of care that they received to a friend or a member of their family, because in the end that is what this is all about.
Derek Twigg (Halton) (Lab)
In May 2010, had mortality rates been falling in NHS hospitals?
Mr Bernard Jenkin (Harwich and North Essex) (Con)
I welcome the fact that Colchester general hospital is not being put in special measures. That expresses Monitor’s confidence in the current leadership of the hospital, which is already implementing improvements in the areas that it told the Keogh report about, which are reported to be the matters of concern. I also welcome my right hon. Friend’s emphasis on leadership, and openness and trust of leadership, but does he accept what we are finding in the Public Administration Committee’s inquiry into complaints handling in public services that that lack of trust and openness is found not just at trust level, but goes right up the command chain of the health service and has historically existed in the Department of Health? How will he challenge that culture and define the right kind of leadership that should be taught by the leadership academy?
Mr Hunt
My hon. Friend makes a very important point. The simple way we can change that culture, which will not be easy and will not happen immediately, is by making sure that where there is failure, there is someone who is independent and able to speak up about that failure without fear or favour—someone to be the nation’s whistleblower-in-chief. That is what we must have with the new chief inspector of hospitals, modelled on the chief inspector of schools and how well the whole Ofsted regulation system has worked. That has to be the first step; there must be no hiding place when there is failure. From there, we will have the pressure on the whole system, right the way up to Ministers, to make sure that failure is sorted out.
Nic Dakin (Scunthorpe) (Lab)
Sir Bruce Keogh warns us in his report about the very reaction we have seen today, which is in danger of shaming this House by focusing on politics instead of people. He wrote in his first few paragraphs that
“this is not a time for hasty reactions and recriminations”.
I read those words at five past 8 this morning when the Department of Health finally opened up to allow Members of Parliament to read what was there. Will the Secretary of State assure me and my constituents, who use Scunthorpe general hospital, that he will work to support people and put people before politics, because this afternoon he has put politics before people?
Jackie Doyle-Price (Thurrock) (Con)
Bereaved families in Thurrock have had their pain compounded by how the Basildon and Thurrock trust has investigated complaints and incidents. Does my right hon. Friend agree that the way in which hospitals investigate such incidents is an important aspect of the transparency and accountability agenda?
Mr Hunt
It is, and this year we will be introducing in law a duty of candour that will make it a criminal offence for boards not to be honest, not only with families if patients have been harmed, but with the system, which is extremely important. Salford Royal hospital has one of the most successful safety records in the country, and it has achieved that by creating an atmosphere of trust so that front-line staff are not afraid to speak out about the problems that they encounter, however junior they are. It takes outstanding leadership to get that right, and part of the turning point that we require today is an understanding of what is involved in such leadership, which we need in many more places.
Jim Shannon (Strangford) (DUP)
High mortality rates are unacceptable and their effect on people’s confidence in, and satisfaction with, the NHS is a problem. We in Northern Ireland are fortunate that there have not been such disclosures, but it is important that lessons can be learned. Does the Secretary of State intend to share the data and findings with regions of the United Kingdom and the devolved Administration in the Northern Ireland Assembly?
Mr Hunt
When there are excess mortality rates, there is some controversy about exactly how many avoidable deaths they correspond to, which is why Professor Keogh has asked Professor Nick Black and Lord Darzi to carry out a further study to try better to understand the link between excess mortality and avoidable deaths. We will be happy to share that information with the devolved Administrations.
John Stevenson (Carlisle) (Con)
I welcome the Keogh report. Patients should come first and patient care should be at the centre of our health service. Over the past 10 years, sadly, there has been a clear lack of leadership and management at North Cumbria University Hospitals NHS Trust, so I am not surprised by the report. However, there is a possible solution to improve health care in north Cumbria: the acquisition of the hospitals by Northumbria Healthcare NHS Foundation Trust. Will the Secretary of State work with me, the regulators and Northumbria to ensure that the acquisition proceeds as quickly as possible so that the people of Cumbria and Carlisle get the best possible health care?
Barbara Keeley (Worsley and Eccles South) (Lab)
Since the publication of the Francis report, it seems that we have been going round and round the question of safe staffing levels, which I have raised several times. Ratios of two nurses to 29 patients, or worse, have been reported to me—I do not think that they are uncommon—and the CQC tells us that one in 10 hospitals has unsafe staffing levels. It must be accepted that the number of nurses has reached unsafe levels in these 14 hospitals and many parts of the country. The Secretary of State cited Salford Royal hospital, but will he act now to ensure that all wards in all hospitals publicise their staffing ratios, because I would not want a relative on a ward with a ratio of 2:29?
Mr Hunt
The right ratio of patients to nurses depends on the type of patients in a ward, because different wards have different requirements. Salford Royal has a good model through which it ensures that it has the right number of nurses. As I said to the hon. Member for Rotherham (Sarah Champion), I accept what Francis says about safe staffing, but he did not recommend the Labour party’s policy of minimum mandated national staffing levels. I am following the recommendation of the Francis report, which I think is the right way forward.
Andrew Bingham (High Peak) (Con)
My constituents in Glossop use Tameside hospital. For too long, people such as Liz Degnen have highlighted their worries about Tameside, and the recent departure of its chief executive was called for and welcomed by several hon. Members. Does my right hon. Friend agree that the Keogh report is a vindication of many of my constituents’ long-held beliefs?
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
I have welcomed the Keogh process from the beginning. Although the report on Tameside is hard hitting, I entirely welcome it—it is consistent with what has been in the public domain for two weeks—and the evidence that all Tameside MPs gave to Keogh to demand a change in leadership has been justified. Although I speak as an MP who has campaigned critically against his hospital, may I say that the tone and comments of the Secretary of State were neither helpful nor accurate with regard to Tameside? We need him to focus on implementing the reforms that are needed, one of which is clearly to deal with the inadequacy of the previous inspection regime. The extent of the scrutiny of these 14 trusts was great, but that is needed for all hospitals, so can he tell us what he will do to put that into effect?
Mr Hunt
I absolutely can. The new chief inspector of hospitals starts work today. We would like him to start the new inspection regime, adopting the same methodology as the Keogh review, as soon as possible, but it takes time to assemble a team of expert inspectors. He plans to start a pilot round of inspections this autumn before getting into full swing next year, and all the hospitals on today’s list will be inspected again within the next 12 months.
Heather Wheeler (South Derbyshire) (Con)
My constituents use Burton trust, so it is a sad day when it is on the list. Will the Secretary of State help to ensure that no barrier is placed between MPs and hospital boards so that there is total transparency and local MPs can help the boards in the future?
Mr Hunt
That open relationship between hon. Members and their local NHS trusts is extremely important and useful. We all have to recognise that sometimes we have to speak up publicly when there are problems at our local NHS trust, because we have to represent our constituents, and that is part of the change due to this process. In the end, the most important thing is to give people confidence that, when there are problems, we are a Government who are committed to sorting them out.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
Page 22 of the Keogh report clearly states:
“Contrary to the pre-visit data, when the review teams visited the hospitals, they found frequent examples of inadequate numbers of nursing staff in some ward areas. The reported data did not provide a true picture of the numbers of staff actually working on the wards.”
It goes on to say that that
“was compounded by an over-reliance on unregistered staff and temporary staff”.
Given that the Government have sacked more than 1,000 people in front-line nursing roles in seven of the trusts involved, what conclusion does the Secretary of State draw from that paragraph?
Jeremy Lefroy (Stafford) (Con)
As my right hon. Friend says, transparency is vital. Stafford hospital has improved substantially since the spotlight was shone on it, although we are not complacent at all. One of the real problems we face is that good clinicians avoid management positions. What plans does he have to encourage young clinicians to undertake professional management training so that they can move into senior management positions in the course of their careers?
Mr Hunt
As ever, my hon. Friend speaks wisely, because we know a key point is that we need more good clinicians to go into management positions throughout the NHS. I am in close discussions with the NHS leadership academy, which this Government set up, to determine what more can be done to guarantee that able clinicians who pass muster and go into management can get a job at the end of that process. In addition, we have to encourage people to go into challenging trusts, rather than always being attracted to the best trusts. Such a change has been managed in the schools system, so we need to achieve that in health as well.
Ian Austin (Dudley North) (Lab)
I supported the inquiry and worked hard to provide details from Russells Hall patients and relatives, and to arrange for them to meet Sir Bruce’s team. Although the hospital has not been put into special measures, there are clearly areas of concern because people are waiting longer for A and E than in 2010, infection rates have increased and staff morale has gone down. The report cites
“Inadequate qualified nurse staffing levels on some wards”.
The Secretary of State said that if staffing levels were the problem, he would sort that out, so what assurances can he give people in Dudley and the staff at Russells Hall that he is going to address those inadequate nurse staffing levels?
Mr Hunt
The same assurances I have given everyone else representing a hospital with troubles: we are totally committed to sorting out those problems—[Interruption.] Labour Front Benchers ask when, but we have said that these hospitals will be re-inspected in the next year. The structures that we are putting in place to sort them out are a million times tougher than anything that happened when they were in office.
Andrew Percy (Brigg and Goole) (Con)
I am proud of our local NHS, especially the examples of good practice highlighted at Goole hospital. However, as someone who works as a volunteer in the NHS every weekend, I meet patients who are frightened of going into local hospitals precisely because of the failings highlighted in the report on North Lincolnshire and Goole Hospitals Foundation NHS Trust. Will the Secretary of State visit Goole and north Lincolnshire to meet my constituents and discuss such individuals as an 88-year-old whose nails were not cut for seven months, whose toilet calls went unanswered and who ultimately died after contracting E.coli in our local hospital?
Mr Hunt
Of course I would be delighted to visit my hon. Friend’s local hospital. I am sure there will be a great deal that I can learn, and I hope I will be able to give encouragement to the staff there, who are working very hard in a very difficult situation. I hope today will give them encouragement that this is a Government who are determined to turn around their hospital.
Huw Irranca-Davies (Ogmore) (Lab)
On the basis of the very good and welcome Keogh report and also the Francis recommendations on safe staffing levels, does the Secretary of State feel that the reduction of 4,000 nurses over the past two or three years is in any way contributing to the very issues that he has described today?
Mr Hunt
We welcome and accept the Francis report’s recommendations on safe staffing and we recognise that that involves having doctors. We recognise and are pleased that our protection of the NHS budget means that there are 6,000 more doctors than when the hon. Gentleman’s Government were in power. If he looks at what is happening in his own Wales, he might find that there are a few lessons that the NHS in Wales could learn.
David Tredinnick (Bosworth) (Con)
Sadly, the problems at George Eliot hospital go back well over a decade, so these special measures will be very welcome, but is not one of my right hon. Friend’s fundamental problems dealing with a culture of secrecy, where in the past a board with a problem would talk to a strategic health authority board and nobody would know what was going on? Is not sunlight the best disinfectant?
Mr Hunt
It is, absolutely. That is the big change. My hon. Friend speaks wisely. That is the big change that we have to make in our NHS. When there is failure, we must be open about it. It has to be public—we have to keep the public in the picture, because that is the best way of putting pressure on the system and on the politicians to make sure that they sort it out. That is not what happened before; it is going to happen now.
Charlotte Leslie (Bristol North West) (Con)
Does the Secretary of State share my dismay that just as Julie Bailey was hounded out of Mid Staffs by the local Labour party for revealing the truth, some of the tone of this debate—accusations, sanctimoniousness and false victimhood—is a very tangible illustration of what whistleblowers have had to face for the past decade when they have tried to get the truth out? What a tangible demonstration, sadly, this has been.
Mr Philip Hollobone (Kettering) (Con)
Although proud of our local hospital, residents in Kettering will be pleased that Sir Bruce has managed to expose some dangerously run parts of the NHS, but they will be concerned to know what can be done to make the future far better than what has happened in the past.
Mr Hunt
Absolutely, and the big point about the changes that we are bringing in—I congratulate my hon. Friend, who is a huge supporter of Kettering hospital, which he and I have visited together—is that the NHS in many ways is no different from other parts of our public services: there are excellent bits and there are bits where there is poor leadership. What we have to do if we are to sort out the poor leadership is to expose it and to make sure that the public know about it and the politicians cannot duck sorting it out. My hon. Friend’s constituents will be thinking, as a result of tomorrow’s headlines, “What about Kettering hospital?” That is why we will have an independent chief inspector who will go round and tell them how good Kettering hospital is. However much they love it, he may well find things that need to be improved, and my hon. Friend and his constituents will welcome that.
David Morris (Morecambe and Lunesdale) (Con)
Last week it was the CQC. Now it turns out that between 2005 and 2010 there were 386 separate warnings that the last Labour Secretary of State claims never to have received, yet the trust in my area was given foundation status. Does my right hon. Friend agree that given the new revelation by Sir Brian Jarman on suppression of warnings, along with existing allegations of spin and cover-up levelled against a former Secretary of State for Health, it is now time for the right hon. Gentleman to resign?
Nigel Mills (Amber Valley) (Con)
Those of my constituents who use King’s Mill hospital will understandably be concerned about their future treatment. What reassurance can my right hon. Friend give me that this summer those patients will get the treatment that they rightly expect?
Mr Hunt
It is important to recognise that even at the hospitals that we are talking about this afternoon, there is good care happening every single day. The way that we will reassure my hon. Friend’s constituents is by having an independent inspection system which has not existed before, where regulators are not leaned on by Ministers to say the right thing in the run-up to elections. It is only when his constituents have confidence in that regulatory system that they will know the truth about their own hospital, and we want them to get there as soon as possible.
Neil Carmichael (Stroud) (Con)
I welcome Sir Bruce’s report and the Secretary of State’s robust approach to it. Does my right hon. Friend agree that if we take away the right lessons from the statement and the questions on it, that will be the catalyst for a change of culture, enhancing transparency and accountability and introducing a new pace of response for the changes necessary to bring about higher standards in our hospitals?
Mr Hunt
We do need to draw those lessons, and the sad lesson from this afternoon is that that change in culture with respect to transparency and accountability does not extend to the Labour party. Voters will notice how unwilling Labour Members are to accept that things went wrong on their patch.
Andrew Stephenson (Pendle) (Con)
Given what today’s report says about capacity issues at Blackburn hospital, and that the hospital is struggling to deal with the number of patients, serious questions again have to be asked about the decision to downgrade Burnley hospital’s accident and emergency department under the previous Government in 2007, which was consistently supported by the shadow Secretary of State when he was in office. Will my right hon. Friend visit Pendle to meet some of the affected families to reassure them that lessons have been learned from the mistakes of the past?
Stephen Metcalfe (South Basildon and East Thurrock) (Con)
I congratulate my right hon. Friend on having put patients first in the whole process. As we move forward, we should approach the failures of the past more in sorrow than in anger, but we have to accept that that is a hard ask for my constituents who potentially have lost loved ones because of the catastrophic failures of the past inspection regime. That is why my constituents are impatient for change. If hospitals do not make the changes necessary in the required time, what sanctions will be imposed?
Mr Hunt
The entire system will be accountable for making sure that change is delivered. That is part of the change that we are making through the statement this afternoon. My hon. Friend’s hospital will be inspected again within the next 12 months and we will be able to see what progress has been made. There will be further independent inspections after that, so his constituents will have confidence that an independent expert is casting an eye over the health care that they are receiving and telling them the unvarnished truth about whether they can trust it or not.
Tobacco Products (Packaging)
Jeremy Hunt Excerpts(13 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
The Government have today published “Consultation on the standardised packaging of tobacco products: summary report”. The consultation was undertaken, with the agreement of the devolved Administrations, on a UK-wide basis and the summary report has been prepared and published by the Department of Health.
Reducing in England the health harms caused by smoking tobacco is a public health priority for the Government and the United Kingdom is recognised across the world for having comprehensive, evidence-based tobacco control strategies.
Standardised packaging of tobacco products refers to measures that may be taken to restrict or end the use of logos, colours, brand images or promotional information on packaging other than brand names and product names that are displayed in a standard colour and typeface.
The consultation sought views on whether standardised tobacco packaging would:
reduce the appeal of tobacco products to consumers;
increase the effectiveness of health warnings on the packaging of tobacco products;
reduce the ability of tobacco packaging to mislead consumers about the harmful effects of smoking; and
have a positive effect on smoking-related attitudes, beliefs, intentions and behaviours,
particularly among children and young people.
Many thousands of responses to the consultation were received, and the views expressed were highly polarised, with strong views put forward on both sides of the debate and a range of organisations generating campaigns and petitions. Of those who provided detailed feedback, some 53% were in favour of standardised packaging, while 43% thought the Government should do nothing about tobacco packaging.
Having carefully considered these differing views, the Government have decided to wait until the emerging impact of the decision in Australia can be measured before we make a final decision on this policy in England.
Currently, only Australia has introduced standardised packaging, although the Governments of New Zealand and the Republic of Ireland have committed to introduce similar policies. Standardised packaging, therefore, remains a policy under consideration.
In the meantime, the Government in England will continue to work to reduce smoking rates through ending the display of tobacco in all shops, running national behaviour change campaigns to encourage smokers to quit and through supporting local authorities to provide effective stop smoking services. Our strategy is working—we are recognised as the leading country in Europe for tobacco control and for the first time since records began, adult smoking rates are under 20%.
“Consultation on the standardised packaging of tobacco products: summary report” has been placed in the Library. Copies are available to hon. Members from the Vote Office and noble Lords from the Printed Paper Office. The document is also available from:
www.gov.uk/government/consultations/standardised-packaging-of-tobacco-products.
The consultation exercise fulfilled our commitment in “Healthy Lives, Healthy People: A Tobacco Control Plan for England” which sets out our comprehensive, evidence-based, programme of tobacco control for England.
Health Services (North-West)
Jeremy Hunt Excerpts(13 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I would like to make a statement about changes at Trafford general hospital and, separately, about the provision of vascular services in Cumbria and Lancashire.
Our primary objective as a Government must be for the NHS to provide the best service for patients. Sometimes that means taking difficult decisions. Both of the decisions I am announcing today fall into that category, but both are necessary if we are to provide safe and sustainable health care in the north-west.
Let me first address the changes at Trafford general hospital. Greater Manchester is home to some of the best and most innovative health care in the country. The reconfiguration of acute stroke services in Manchester has contributed to an overall reduction in deaths of around 250 since the changes were implemented. Salford Royal and Wythenshawe are two of the finest hospitals in the country. The area is blazing a trail in the integration of primary, secondary and social care services, but more needs to be done to ensure that emergency care continues to be safe, which is why the local NHS proposed some important but difficult service changes, which affect A and E provision at Trafford general hospital.
On 8 February 2013, I received a letter from the chair of the joint health scrutiny committee for Trafford borough council and Manchester city council, formally referring proposals about the future delivery of health care services at Trafford general hospital. I then asked the Independent Reconfiguration Panel for its advice on the proposals, which I received on 27 March 2013. Today, I have accepted its advice, which will be published on the panel’s website, in full. I have also written to the chairs of the panel and of the joint health scrutiny committee and to local MPs, informing them of my decision.
The clinical case for change in Trafford general hospital is clear. It is one of the smallest hospitals in the country. Its accident and emergency department is the second smallest in the country. Between midnight and 8 o’clock in the morning, the A and E department sees on average only two patients an hour. Even at peak times, the unit sees on average only seven patients an hour. Over half of local residents already use accident and emergency services outside Trafford. Trafford clinical commissioning group’s chief clinical officer, Dr Nigel Guest, himself a local GP, said:
“This makes it difficult to attract new doctors, it means that services cost more than they should and it compromises our ability to ensure good clinical outcomes. In short, it means that for too long local people have not been getting the type of service they should and deserve to receive.”
The problems are not confined to A and E. The low number of patients using intensive care means it, too, is not sustainable, and is likely to become unsafe in the future. According to the Greater Manchester critical care network, the unit needs to treat a minimum of 200 patients a year to be safe, but it treats fewer than 100. Emergency surgical services are also not sustainable. The Royal College of Surgeons states that emergency surgery should serve a population of at least 300,000— ideally 450,000 to 500,000. Trafford general hospital serves a population of around 100,000.
Trafford is currently able to provide a range of high-quality clinical services. However, it is becoming increasingly difficult to safeguard those services in a way that is sustainable in the long term. As a result, the National Clinical Advisory Team of independent health professionals has advised me that there will be clinical and safety issues if the hospital continues practising as it currently does. I accept its advice.
Initially, the A and E at Trafford general hospital will be replaced by an urgent care centre. The A and E currently sees just 100 patients a day. The majority of those patients—around 75%—will continue to be seen at the urgent care centre. That means around 25 patients a day will be treated at the three neighbouring large university hospitals, all within a 10-mile radius. In the longer term, as services are developed over the next two to three years, the urgent care centre will become a minor injuries unit. Trafford general hospital will become a centre of excellence for elective orthopaedic surgery. That will see all other in-patient surgery stop, but there will be an expansion of day surgery, such as ophthalmology and other vital local services.
On 24 January this year, the PCT cluster, NHS Greater Manchester, approved the implementation of these proposals subject to the prior fulfilment of six conditions. Those included addressing transport issues for local residents, accelerating the implementation of a local integrated care system and ensuring continued access to out-of-hours mental health services when the urgent care centre eventually closes. Progress will be assessed and evaluated throughout the transition by NHS England in conjunction with the local joint health scrutiny committee. Following the advice from the Independent Reconfiguration Panel, I am also satisfied that the four tests for reconfiguration have been met.
As a result of the changes I am supporting today, Trafford CCG will be able to reinvest an additional £3.5 million to deliver what local people have asked for—more choice, more preventive care and more services closer to home. That will include community matrons and a community geriatrician, a 72-hour rapid response team, as well as an in-reach team to A and E to support people with complex needs and mental health issues.
I know that the right hon. Member for Wythenshawe and Sale East (Paul Goggins), the hon. Member for Stretford and Urmston (Kate Green) and my hon. Friend the Member for Altrincham and Sale West (Mr Brady) have met the Under-Secretary of State for Health to raise their concerns. Others, including the right hon. Member for Leigh (Andy Burnham), have written to me directly. That is why I have wanted to reassure myself since receiving the advice that the NHS has arrangements in place to ensure patient safety is not compromised during the transition to new services. I can assure all Members that there will be a rigorous assurance process overseen by NHS England and that no changes will occur until unequivocal assurances have been given by a provider’s board or chief executive that their organisation can safely receive additional patients and activity, however small.
Because A and Es around the country have been under increased pressure over the past few months, I also make a commitment today that changes at Trafford will take place only if the three neighbouring A and Es that will need to treat additional patients are consistently meeting their waiting time standards. Progress will be assessed and evaluated throughout the transition by NHS England in conjunction with the local joint health scrutiny committee. The Department of Health has also set aside funds to support investment by the University Hospital of South Manchester NHS Foundation Trust in expanding Wythenshawe hospital’s A and E department. That application for funding will be treated as a priority.
I turn to the provision of vascular services in Cumbria and Lancashire. On 19 February, the chair of Cumbria’s health scrutiny committee wrote to me formally to refer proposals about the provision of vascular services in Cumbria and Lancashire. I subsequently asked the Independent Reconfiguration Panel for its advice, which I received on 19 April. Today I have accepted its advice in full, which will be published on the panel’s website. I have also written to the chair of the panel and of the Cumbria health scrutiny committee, as well as to local MPs, informing them of my decision.
The changes will concentrate vascular services in three specialist centres, in line with the IRP’s advice for a population of around 2.8 million people. More routine services will continue to be provided locally. Seven hospitals, including the three specialist centres, will continue to provide services such as screening, out-patient clinics, day surgery, diagnostic tests and rehabilitation services. The centres will be at North Cumbria University Hospitals NHS Trust in Carlisle, East Lancashire Hospitals NHS Trust in Blackburn, and Lancashire Teaching Hospitals NHS Foundation Trust in Preston. Day casework and out-patients will continue to be assessed and treated in local hospitals across the region.
The three centres will provide sufficient cover both for the sparsely populated north of the region and for the densely populated south, which includes significant pockets of deprivation and unmet health needs. The concentration of vascular services is in line with national policy, as recommended by the Vascular Society of Great Britain and Ireland. The move will give patients access to better care and treatment than is currently possible with vascular services spread more thinly across the region.
The IRP accepts, as do I, that an inevitable consequence of concentrating specialist services at centres of excellence, is that some patients will have to travel further for treatment. However, the IRP informs me that the evidence in favour of concentrating services is particularly strong in relation to vascular surgery and that there is a strong clinical consensus that doing so will improve outcomes for patients. I know that Members representing north Lancashire and south Cumbria are particularly concerned about the distance patients will need to travel for specialist treatment. I do sympathise, but in the end have taken the difficult decision that the clinical benefits of concentrating specialist services outweigh any disadvantages in terms of additional travel times. I add that the Royal Lancaster Infirmary along with six other hospitals will continue to provide more routine vascular services.
These changes offer an opportunity to provide significantly improved vascular services to the people of Cumbria and Lancashire. I am therefore asking NHS England, working with local NHS organisations, to address the outstanding concerns raised by Cumbria health scrutiny committee. Local people need to know that changes are indeed leading to improved outcomes and that reasonable steps are being taken to support those with further to travel. In line with the IRP’s advice, I also want to see a programme of public information about the changes.
The public are rightly concerned about any major changes to health provision, and I particularly recognise the concerns people have about having to travel further, which is significant not just for patients but for their families and friends. However, my priority, and the Government’s priority, has to be what offers the safest and best clinical outcomes and what will save the most lives. That is why, after careful consideration, I have accepted independent clinical advice on both these decisions. I have also accepted the view of the IRP that the process leading to the decisions has been the right one, and I thank it for its work on these decisions.
I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
I thank the Secretary of State for his statement on matters that are of major significance to the NHS in the north-west of England, but I am not the only north-west MP taken by surprise this morning by the lack of advance notice. My hon. Friend the Member for Stretford and Urmston (Kate Green), in whose constituency Trafford hospital lies, was heading home, but had to abandon her journey at Stoke and is now heading back down to try to get here. This is not just a major discourtesy to her and the House, Mr Speaker; it is an insult to the people of Trafford, and it is no way to treat people who have campaigned to save their A and E, and who should have rightly been able to expect that their voice be heard in this House today through their elected Member of Parliament.
It says a lot about this Secretary of State. His advisers could find time to get texts sent to the Murdochs with market-sensitive information before an earlier statement he made, but he could not find time to give a local MP advance notice of a statement about the closure of her accident and emergency department: disgraceful.
This is not just any A and E: 65 years and six days after Nye Bevan opened the NHS at Trafford hospital, we have the spectacle of this Secretary of State scurrying to the House to rush out an announcement without the scrutiny of local MPs about a major downgrade of the hospital. What clearer symbol could we have of a Government who disrespect and disregard the views of NHS staff, patients and local people?
My hon. Friend the Member for Stretford and Urmston is trusting that the west coast main line will get her back before the close of this statement, and I hope you will allow her to contribute, Mr Speaker, even though she has clearly missed the opening of this statement.
Let me now turn to the substance of what the Secretary of State has said. He is right to say that the IRP provides excellent support and advice to Ministers. It did so to me and my predecessors in the last Government, and I am sure it is doing the same for the current Government. Where it can be shown that changes will save lives and reduce disability, in my view all Members of this House have a moral obligation to support them. Changes to vascular services in Cumbria and Lancashire clearly fall into that category. The concentration of this highly specialised surgery on three sites will save and improve lives, but given the geography it is essential that people are supported with travel. The Secretary of State made a vague commitment, but can he be more specific about the support that will be made available to patients, particularly in the sparsely populated northern part of our region, who will now have to travel much further to receive this life-saving surgery?
Although we support the Secretary of State’s decision on Lancashire and Cumbria, we have much greater concerns about the process that has led to the decisions today about Trafford hospital. While the IRP has undoubtedly done what it has been asked to do, I wrote to the Secretary of State in November last year to express serious reservations about the Trafford review proceeding ahead of Healthier Together, a much wider review of acute and emergency services across Greater Manchester. Speaking as a Greater Manchester MP, I cannot see why it makes sense to pick off Trafford hospital ahead of this review without looking at things in the round. It does not feel to me that this is part of a coherent plan for the NHS in our city region, and I ask the Secretary of State today why his decision is justified, given that the wider considerations affecting health services in Greater Manchester have not yet been completed.
The Secretary of State claims that the patients affected by the closure of Trafford can be easily and safely absorbed by the neighbouring A and Es. How can he say that when all the A and Es that will now have to absorb extra patients missed his own A and E target for at least four months during the worst winter in the NHS for a decade? Have the Secretary of State and the IRP made their decision looking at the very latest evidence of growing pressure on A and E departments in Greater Manchester? He mentions extra funding for Wythenshawe, which is welcome, as the hospital was built for 70,000 patients a year and is currently seeing almost 100,000, but will other affected A and Es also receive additional funding?
Finally, Mr Speaker, the appalling mishandling of this statement today, which has left the people affected unable to put the Secretary of State under scrutiny, is just the latest example of the wider mishandling of hospital reconfiguration under the coalition, which has seriously damaged public trust in our ability to make changes to hospitals. Picking off Trafford ahead of a wider review broke the illusory moratorium on hospital changes announced just days after the general election outside Chase Farm hospital by the Secretary of State’s predecessor and the Prime Minister—incidentally, that hospital is also now downgraded.
Sir David Nicholson has today said:
“If a political manifesto does not say that service change is absolutely essential and that you need to concentrate and centralise services—it will not be being straight forward with the British people.”
Might he just have had the last Conservative manifesto in mind when he made that statement? Will the Secretary of State today admit that this false moratorium was a cynical and dishonest policy designed to win votes in marginal seats, and will he commit never to repeat it?
Worse still, the Secretary of State’s officials have been in court in the past few days trying to justify the indefensible: a decision to rob a local community in south London of a successful A and E to solve problems in another trust that were not of its making. Is all this not causing severe damage to trust in how these decisions are made? Will he give a commitment to the House today that if the court finds against him, he will abandon his plans to downgrade Lewisham A and E? Labour Members will support changes where they are clinically justified, but where communities are picked off unfairly by this arrogant Government we will stand with them and fight for fairness.
Mr Hunt
Many members of the public are understandably concerned about these decisions, but from someone who was Health Secretary and who argued the case many times for changing services what we have heard today is not sensible argument, but political opportunism.
Let us examine what the right hon. Gentleman said only last week in Hastings. He said that people like him have a moral imperative to support the doctors who are making these decisions. Well, these changes are supported by the Trafford clinical commissioning group, Greater Manchester critical care network, the Royal College of Surgeons and many other doctors. How many doctors does he need to support this decision before he actually does what he said he would do last Friday, which is support doctors making difficult decisions? On the very day that NHS England is talking about the need to protect services for patients by facing up to difficult decisions, his approach is more than inconsistent—it is irresponsible, and he knows it. Let us examine what he said about changes in Trafford when he was Health Secretary—
Mr Speaker
Order. We must have order from those on the Opposition Front Bench, and I know that the Secretary of State will want to respond to the questions asked of him. I just remind the House that it is not a generalised debate; it is a statement and a response to questions.
Mr Hunt
Absolutely, Mr Speaker. I think that it is very important that on both sides of this House we have consistent arguments. It is very important to the questions that I was asked that I remind the right hon. Gentleman of what he said when he was Health Secretary. “I am disappointed,” he said, that politicians
“are going around Greater Manchester undermining the clinically-led process”.—[Official Report, 30 March 2010; Vol. 508, c. 620.]
The local medical director says that these changes will save—[Interruption.]
Mr Speaker
Order. The temperature needs to fall. This is a very highly charged matter, there is considerable sensitivity about it, it is extremely important and we want to hear what the Secretary of State has to say. When he has said it, everybody will get a chance to come in, but please let us lower the decibel level. We certainly do not want to imitate what happened to the considerable discredit of the House yesterday.
Mr Hunt
The other point the right hon. Member for Leigh (Andy Burnham) made was that we should not make these changes to A and E services when those in other hospitals are under pressure. It is important that I remind the House of what he did when he was Health Secretary. After 2004-05, Labour missed its A and E targets in 12 quarters but closed or downgraded 12 A and Es. Now, in Wales, the A and E target has not been met since 2009, yet Labour is embarking on a big reconfiguration programme with his full support. So it is one policy when Labour is in opposition, another when it is in power. There is one person who agrees with the right hon. Gentleman, and he was campaigning in Trafford on Friday—Len McCluskey. When it comes to a choice between supporting local doctors or the unions, the Opposition support the unions.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
On a point of order, Mr Speaker.
Mr Speaker
Order. We cannot have points of order in the middle of a statement. The Secretary of State has been asked specific questions and I know that he will now respond without any delay to those specific questions and nothing more. Other Members wish to contribute and there is other business. The Secretary of State is an extremely important man, of course, but there are a lot of other people involved, too, and we need to get on and hear them. I call the Secretary of State to respond briefly.
Mr Hunt
Thank you for that rare compliment, Mr Speaker.
The right hon. Member for Leigh asked a specific question about travel and I will ask the local NHS trusts to work closely with the overview and scrutiny committees to ensure that proper arrangements are put in place for people who have to travel further. He asked me about deferring the decision until the Healthier Together programme for the whole of Greater Manchester was decided, but the IRP specifically said that it would be wrong to defer the decision—the point is that local doctors are saying that doing so would not be safe for patients, and that is why I am accepting the advice.
The NHS is a great institution, but we have to take difficult decisions sometimes. The proposals will help patients, but I am afraid that the right hon. Gentleman is interested only in politics.
Mr Graham Brady (Altrincham and Sale West) (Con)
Many people will be disappointed, of course, by the decision on Trafford general, but I thank my right hon. Friend and his ministerial team for their openness in hearing the concerns of local Members and Trafford council in building up to what has obviously been a serious and carefully made decision. I thank him for the extra investment for Wythenshawe and for making the changes contingent on ensuring that the capacity is there in surrounding hospitals to ensure that this is safe. Will he also give us an assurance that the Trafford health economy will not suffer financially if those contingencies are not met in time?
Mr Hunt
I thank my hon. Friend for the constructive approach he has taken in this process. I assure him that this will help the local Trafford economy. Three major teaching hospitals are used by the people of Trafford. Two of the three are meeting their A and E targets and one is not. These proposals will help the one that is not meeting its target to do so. They will also mean that an extra £3.5 million can be invested in community and prevention services, including local geriatricians and community matrons. That will be of huge benefit to my hon. Friend’s constituents and to many other people in the local area.
Mr Jack Straw (Blackburn) (Lab)
May I first ask the Secretary of State to respond to the issue raised by my right hon. Friend the Member for Leigh (Andy Burnham) about the lack of notice of the statement? I have had good news for my constituency from the Secretary of State, but many of my colleagues have had bad news and it is genuinely discourteous for the House not to have been informed. This is not a market-sensitive issue, after all, and we could have been told yesterday or earlier.
Secondly, on the merits of the concentration of vascular services in Lancashire and Cumbria, may I thank the right hon. Gentleman for the decision that he has made, not least in respect of East Lancashire Hospitals Trust in Blackburn? This is an important vote of confidence in the excellence of the facilities in Blackburn at a time when many of the clinicians and others have been under great anxiety because they have been subject to the Keogh review. I think all my constituents recognise that sometimes they will have to travel, as mine have had to travel to Blackpool for many years, for very serious cardiovascular surgery. Provided the outcomes are much better where there is a concentration of resources, and assistance with travel is given in appropriate cases, I think my public and that across the north-west will accept these decisions.
Mr Hunt
I thank the right hon. Gentleman for his wise words. If we level with the public about these difficult changes, they do understand that there are times when they get a better outcome even if they have to travel further. Perhaps the most dramatic example of that has been how trauma services have been centralised on fewer hospitals. Even after incidents as dramatic and dangerous as road traffic accidents, people are not necessarily taken to their nearest A and E. They are stabilised and then they are taken to an A and E that has the equipment that is necessary to give them the treatment that is most likely to save their lives. The right hon. Gentleman is right to say that.
I absolutely followed and would always want to follow the procedures of the House with respect to advance notice of statements. The request for a statement went in only last night. The Speaker made his decision this morning. I am delighted that the hon. Member for Stretford and Urmston (Kate Green) is here and I hope she is allowed to speak. I said to her on the phone this morning that I am willing to meet her separately to go through any concerns that she has. [Interruption.]
Mr Speaker
Order. I thank the Secretary of State for his courtesy. I know the right hon. Gentleman well, and I know that he would not seek for one moment to mislead the House. He was trying candidly to respond to the right hon. Member for Blackburn (Mr Straw). For the avoidance of doubt, let us be absolutely clear. I can quite accept that the Secretary of State requested, within the Government machine, permission to make a statement today. However, the House will wish to be aware that I myself was aware of the request to make a statement only this morning. Let us be clear about that.
Tim Farron (Westmorland and Lonsdale) (LD)
There is a strong clinical case for the concentration of vascular services in Cumbria and Lancashire at three sites, but is it not ludicrous that the three that have been chosen are so geographically located that one is virtually on the Scottish border, then there is a gap of almost 100 miles, and then there are two that are nine miles apart? Does not that leave south Cumbria and north Lancashire dangerously under-provided for? Given the current difficulties, shall we say, at Morecambe Bay, does not robbing Morecambe Bay of those skills and that expertise make a difficult situation potentially even worse?
Mr Hunt
I know that my hon. Friend has campaigned, rightly, to represent the concerns of his constituents about the extra travel that they will have to undertake. I would like to reassure him that we considered that issue very carefully. The Independent Reconfiguration Panel recognises that travel is a consideration, but also believes that for his constituents, even for the people who have to travel further, there will be better clinical outcomes for specialist vascular surgery. We are not talking about routine surgery, diagnosis or rehabilitation work but about conditions such as aneurysms and carotid artery disease which require specialist care. Patients can get much better help if that is concentrated in specialist centres.
As to why those particular centres were chosen, it was a genuinely difficult decision. There is a bigger concentration of population in the south of the region and there is also more social deprivation and more unmet need. I know it was a difficult decision, but it was decided that that would be best for the 2.8 million people in the area and also better for my hon. Friend’s constituents.
Kate Green (Stretford and Urmston) (Lab)
I am very grateful to you, Mr Speaker, for allowing me to ask a question, and I apologise for missing the opening statements. As you know, I think, it was only when we saw this morning’s Order Paper that we knew that a statement would be made this morning, and I was on the way to Manchester at the time to meet constituents. I am very grateful indeed for the opportunity to ask the Secretary of State a question. My constituents would be horrified were I not in the Chamber this morning to do so.
This has been one of the most contentious and difficult issues facing the health economy in Trafford since my election. Although I welcome the Secretary of State’s offer to meet me and I was grateful for his time on the phone this morning, he will understand that people are concerned that doubts and fears about the future of Trafford general hospital are already leading to a downward spiral in people going to that hospital and the level of staffing and service that they receive there. What absolute guarantees can he give my constituents that there will be no diminution whatsoever of the service they receive during what may have to be a very protracted transition process, and that in particular there will be no repeat of our experiences over the most recent winter months, when neither Manchester Royal infirmary nor Wythenshawe A and Es were able to meet the accident and emergency waiting time targets on more than 15% of occasions?
Mr Hunt
I recognise that the hon. Lady would have liked to have been here for the statement, and indeed that she made a huge effort to get here. As I told her on the phone this morning, I am more than happy to meet her separately to discuss her concerns. With regard to her concern about a downward spiral, I hope today to reassure her constituents that a clear decision has been taken that will secure the hospital’s future as a successful and important hospital, a centre of excellence for elective orthopaedic work, and a hospital that has a very important role to play in the local health economy. We are making huge efforts to ensure that there will be no diminution of services but that services will improve. Of the three major teaching hospitals that will now provide A and E services for her constituency, one—Central Manchester university hospital—is not meeting its A and E targets. The measures announced today will help it meet those targets and make it more likely that her constituents will get a better service in A and E. However, as I made absolutely clear in my statement, I will not allow the changes to be made until all three hospitals are consistently meeting their A and E targets.
Mr David Nuttall (Bury North) (Con)
Can my right hon. Friend reassure my constituents that the decision on Trafford general hospital should not be seen as putting the provision of A and E services at Fairfield hospital at risk?
Mr Hunt
This decision is about Trafford general hospital’s A and E services. What we are considering in this decision is whether the other hospitals can absorb the extra patients who will come to them as a result. We think that the neighbouring A and Es will initially have to absorb only about 25 patients in total. It is not a decision about the future of other A and Es.
Sir Tony Cunningham (Workington) (Lab)
The new service in Cumbria will have to be managed, and part of the problem in Cumbria is poor management, yet we have been waiting for two and a half years for Northumbria Healthcare NHS Foundation Trust to take over in Cumbria. When will we see that acquisition?
Mr Hunt
I am keen to resolve that issue as soon as possible. Indeed, I think that it is really important, given what we heard this morning from NHS England about the big challenges facing the NHS, that we try to take these difficult decisions much more quickly than normally happens. When we have paralysis and decisions being put on hold, that creates uncertainty and the worries that the hon. Member for Stretford and Urmston (Kate Green) talked about, so I want to ensure that we decide these things as quickly as possible.
Stephen Mosley (City of Chester) (Con)
Dr Nigel Guest, chief clinical officer at Trafford clinical commissioning group, has said that making these changes to services at Trafford general hospital
“is vital to secure a long and vibrant future for the hospital.”
Can my right hon. Friend reassure the House that that will be the case?
Mr Hunt
Yes, and I hope that what we have announced today will give my hon. Friend that reassurance. We have announced a future for Trafford general hospital as a centre of excellence for elective orthopaedic work. We have also announced a significant increase in investment in community services, an extra £3.5 million that will pay for community matrons, community geriatricians, a 72-hour rapid response team and better support in A and Es for people with mental health needs. This is a very big step forward, but it is part of the country that has gone further and faster than many others in delivering integrated care. This announcement will take that further and will mean that it stands out as a beacon of what good care can look like in an ageing society.
Paul Goggins (Wythenshawe and Sale East) (Lab)
May I echo the comments of right hon. and hon. Friends about the lack of notice? It really is outrageous that Members with a constituency interest were not given adequate notice.
May I ask the Secretary of State specifically about the funds that he says have been earmarked for the expansion of the A and E department at Wythenshawe hospital? That is essential, because at least another 4,500 patients will be coming to the A and E following his decision. Can he confirm absolutely this morning that that funding will be made available in full, in advance of any changes? How will the funding be made available? University Hospital of South Manchester is a foundation trust, which means that it cannot receive NHS capital, and it has already borrowed to the limit.
Mr Hunt
First, let me say to the right hon. Gentleman that 25 extra patients a day will have to be absorbed by the three neighbouring hospitals to Trafford, so it is not a large number. We want to make sure that all hospitals, including Wythenshawe, which I have visited—it is a superb hospital—are able to absorb that capacity. It is currently meeting its A and E target. The application that has been made for extra capital grant to help it to expand its A and E department will be treated as a priority.
Andrew Percy (Brigg and Goole) (Con)
Safety should always be paramount, but public confidence is also important. As the Secretary of State faces further tough decisions on reconfiguration in the coming years, will he assure me and other Members of this House of two things: that he will be conscious of not applying urban solutions to rural areas; and that where alternative pathways of care can be put in place, that will happen before changes take place?
Mr Hunt
My hon. Friend makes two important points. I explicitly said that we will not proceed with any of these changes until neighbouring hospitals have been consistently meeting their A and E standards and any necessary changes have been put in place so that we can be sure that they will improve care for patients. That is really important if we are going to maintain confidence.
On my hon. Friend’s point about urban versus rural, part of the underlying reason for these changes is that we need to get more care out of big hospitals, which are often in urban areas, and into the community—into settings near people’s homes. That is very important for rural communities where there are often large concentrations of older people. Today’s decision will mean an additional investment in those community services. As we look at the big changes we need to make in the NHS, we will need to make more decisions that allow more to be invested in out-of-hospital care if we are to prevent the illnesses that ultimately put so much pressure on our A and E departments.
Derek Twigg (Halton) (Lab)
Is any consideration being given within the Secretary of State’s Department or NHS England to reconfiguring the A and E services between St Helens and Whiston hospitals and Warrington and Halton hospitals? He might not be aware that the chief executive of Warrington and Halton hospitals and the chair of its trust board recently told me and my hon. Friend the Member for Warrington North (Helen Jones) that they think they will run out of money in about 18 months’ time such are the pressures that they have at the moment. Will the Secretary of State investigate this and tell me whether any consideration of that reconfiguration is taking place?
Mr Hunt
With regard to pressures on A and E, we are working very hard with A and Es across the country to make sure that they learn the lessons from what happened last winter and are properly prepared for this winter. Those discussions will include the A and E departments that serve his constituents. He will know that any decisions about service changes or reconfigurations are a matter for the local NHS; they come to me only if they are referred to me following a formal proposal by a local health overview and scrutiny committee, and that has not happened in this case.
Mr Jamie Reed (Copeland) (Lab)
Like other Members across the House—I speak particularly on behalf of my hon. Friend the Member for Barrow and Furness (John Woodcock)—I condemn the poltroonish way in which this statement has been handled. Will the Secretary of State concede that instability is corroding health services right across Cumbria? Will he guarantee that when North Cumbria University Hospitals Trust is acquired by Northumbria Trust this decision will not be yet again reconsidered?
Mr Hunt
Today is a sitting Thursday and we have followed parliamentary procedures. I am doing everything I can to help the hon. Member for Stretford and Urmston (Kate Green) to have as much engagement as she needs given that she was not able to be here at the start of the process. With regard to stability, the hon. Gentleman cannot have it both ways. If he wants stability and wants decisions to be taken decisively, then he has to support the Government when they take difficult decisions like today’s and not be opportunistic, in the way that the shadow Secretary of State was.
Graham Jones (Hyndburn) (Lab)
I agree with my right hon. Friend the Member for Blackburn (Mr Straw) about the apparent benefits of relocating to Blackburn and concentrating resources, but despite seemingly being a beneficiary of this reconfiguration, I am worried about the treatment of Lancashire and Cumbria MPs. What notification was given to those Members, and what consultation took place with them on the decision?
Mr Hunt
The process has taken a long time because we have consulted extensively with the local community and local Members. There have been debates in the House about it, and Members have regularly asked about it during oral questions. I asked for hon. Members to be given advance notice of today’s statement. Consultation is important, and we asked for advice from the Independent Reconfiguration Panel—
Andrew Miller (Ellesmere Port and Neston) (Lab)
The Secretary of State cites social deprivation as a justification for his decision on the configuration for Cumbria and Lancashire. I fully support that principle, so will he take it further by ensuring that those of us who represent constituencies in which health outcomes are much worse than those in the south of England, for example, get larger allocations of cash in future distributions of moneys? If he is going to use the principle once, he must do so consistently.
Mr Hunt
That is already built into the funding formula. We made reducing health inequalities a duty of NHS England in the NHS mandate, and that needs to be done in a way that is also fair to socially deprived people living in the countryside, in rural areas and even in the fringes of affluent areas. We have to find a way of ensuring that the process is fair to everyone who is socially deprived and to do what we can to reduce health inequalities.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
No one should be in any doubt that there will be huge shock back home in Greater Manchester at the announcement about Trafford. The conurbation has specific problems with its hospitals, such as mine in Tameside, where we have finally changed the management. We have the Healthier Together process, which is reviewing practically everything, and we are still coping with the impact of the reorganisation with which the whole country has to contend, and now we turn up at Parliament on a Thursday morning to hear the unilateral announcement that Trafford is going. Given the scope of the Healthier Together process, how can the Secretary of State honour the assurances that he gave in his statement? He could not answer the question asked by my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) about foundation trusts and capital at all. What further changes to hospitals in Greater Manchester is he going to spring on us in the future?
Mr Hunt
Foundation trusts can apply for a capital grant, and I said in my statement that, as soon as we get a business case, we will give that a high priority. We are sympathetic to awarding it, but we have to wait for the business case to be presented.
In a period in which the NHS faces huge pressures, it is important to show leadership, and that means local MPs understanding that difficult decisions sometimes need to be taken that are in the interests of their constituents, as a number of Members have done today. It also involves supporting what local doctors have been arguing for over many years, but taking the line of the right hon. Member for Leigh (Andy Burnham) by supporting the unions, not the doctors, is totally irresponsible.
Heidi Alexander (Lewisham East) (Lab)
I am grateful, Mr Speaker.
The Health Secretary repeatedly said that changes will be made at Trafford only if the neighbouring hospitals that have to take additional patients are consistently meeting their waiting time targets for A and E. Will he define “consistently” and clarify exactly what he means by that? Will it apply to all A and E reconfigurations throughout the country?
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
On a point of order, Mr Speaker.
NHS England (Mandate)
Jeremy Hunt Excerpts(13 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today the Government are launching the consultation on the refresh of the mandate to NHS England for 2014-15. The consultation will close on 27 September in readiness for the publication of the refreshed mandate in the autumn to fit with the NHS planning round for 2014-15.
The mandate sets the Government’s ambitions for the NHS as well as the funding available to achieve and deliver the kind of care people need and expect. The first mandate set an ambitious agenda and was published in November 2012. It covered the period April 2013 to March 2015. The Government expect NHS England to demonstrate significant progress against all 24 objectives by March 2015 and will hold them to account for doing so. The Health and Social Care Act 2012 requires the mandate to be reviewed on an annual basis to ensure that it remains up to date. It is important to provide the NHS with stability and continuity of purpose and we therefore propose to carry forward all the existing 24 objectives.
At the same time, the scale of the challenge facing the NHS and wider health and care system is becoming increasingly clear. There have been crucial developments and new evidence that has emerged since the publication of the first mandate, which calls on Government and NHS England to act. The key proposed changes reflect these core priorities:
the actions being taken forward by NHS England in response to the Francis report to transform the care people receive;
working with NHS England to develop a vulnerable older people plan, which will improve support for older people and those with long-term conditions, particularly through reform of primary care given their pivotal role within communities; and
the need for the NHS to contribute to securing the recovery of the economy and make better use of resources in the light of the challenging fiscal climate.
On the second of these priorities, the Government are also launching today dedicated engagement on the vulnerable older people plan, working jointly with NHS England. The engagement will seek views from staff, patients and the public on how to achieve the ambition of how more integrated out-of-hospital care, building on the strong tradition and values of the family doctor.
In addition to the three priorities, the Government are also proposing to make a number of targeted changes to the current objectives which are thought to be essential to deliver the improvements in people’s care. The consultation document sets out where the Government are proposing to make these changes for the period April 2014 to March 2015.
The Government welcome views on the proposals and invites comments through the consultation process.
“Refreshing the Mandate to NHS England: 2014-15 Consultation” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Migrant Access to the NHS
Jeremy Hunt Excerpts(13 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
The United Kingdom successfully attracts many millions of visitors and migrants each year. If our country is to remain competitive, we need to continue to welcome those who come here to work and to study. At the same time public services like the NHS are under increasing strain, coping with the demands of an ageing population and financial pressures. The NHS is and will remain free at the point of delivery for its residents, but it cannot continue as an international rather than a national health service. We urgently need to address this or the system is likely to become unsustainable.
Our health system is very generous to overseas visitors, perhaps one of the most generous in the world. We allow people who are living here temporarily to use the NHS and exempt many of them from charging, while any visitor, including tourists, can visit a general practitioner free of charge. These sorts of services are often not available for our citizens when they are abroad.
The NHS struggles to identify and recover the cost from those not entitled to free treatment. NHS resources, both financial and clinical, are used to treat and care for people who have no long-term commitment to our country and should contribute towards it.
To address these issues, I am launching a consultation today inviting views on proposed changes to the way temporary migrants and visitors access the NHS in England. The purpose of this consultation is to examine critically who should be charged in the future; what services they should be charged for; and how we can ensure that the system is better able to identify chargeable patients and recover costs. As health is a devolved matter, this consultation is looking specifically at how to address the challenges for the NHS in England. The aim is to ensure they make a fair contribution to the cost of treatment, while not restricting access and maintaining the essential public health role of the NHS.
The Home Office will be running a linked consultation on UK-wide proposals to regulate migrant access to the NHS. This will explore proposals to ensure migrants contribute fairly to the cost of NHS care across the UK, including extending charging for primary care to visitors and illegal migrants, introducing a new qualifying test for non-EEA nationals accessing the NHS and a new mandatory health levy for temporary non-EEA migrants.
In the Department of Health consultation, the Government are proposing a new set of rules for accessing free NHS care, based on a principle of “everyone makes a fair contribution” such that free treatment should only be provided to those people with settled residence here who have an established relationship with the UK.
This would mean that temporary migrants, including students and some workers, would in future have to contribute through a levy or a fee that would then allow them to register with the NHS and subsequently receive all necessary treatment without further payment. We propose to add a provision to waive the fee for some high-value workers who choose to waive their right to free NHS care in favour of private health care provision.
In line with the principle of the established relationship we propose to extend the rights of ex-residents who have a long-term record of national insurance payments to access free NHS treatment when returning to visit the UK—currently some are chargeable or have entitlement only to limited treatment. Short-term non-EEA visitors who are here for less than six months, and illegal migrants will continue to be directly chargeable.
The consultation considers the operational and clinical case for charging for NHS care in all settings including GP, community services and will also consider A and E and emergency GP consultations for chargeable patients. Not compromising patient access would be a fundamental requirement for any such future change.
Finally the consultation addresses the current major weaknesses in the administration of charging. The consultation provides, in outline only, a potential new system, including a revamped registration system with data that identifies a person’s chargeable status. We will seek extensive front-line NHS input to develop a detailed, fit-for-purpose model that has its support. This engagement will continue beyond the end of the formal consultation process.
The consultation will run for eight weeks and will close on 28 August 2013.
The consultation document and supporting evidence has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
It is also available at: www.dh.gov.uk/consultations.
Care Quality Commission (Morecambe Bay Hospitals)
Jeremy Hunt Excerpts(13 years, 1 month ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I wish to make a statement about today’s independent report on the Care Quality Commission’s regulatory oversight of University Hospitals of Morecambe Bay NHS Foundation Trust. What happened at Morecambe Bay is, above all, a terrible personal tragedy for all of the families involved, and before saying anything else, I want to apologise on behalf of the Government and the NHS for all the appalling suffering that those families have endured. In that context, I know that the whole House will wish to extend our condolences to every single one of them.
Joshua Titcombe’s tragic death was one of 12 serious untoward incidents, including five in the maternity department. His family and others have had to work tirelessly to expose the truth, and I pay tribute to them for that, but the fact is that they should not have had to go to such lengths. As we saw in the case of Mid Staffs, a culture in the NHS had been allowed to develop in which defensiveness and secrecy were put ahead of patient safety and care. Today I want to explain to the House what the Government are doing to root out that culture and ensure that that kind of cover-up never happens again.
The independent report was commissioned by the new chief executive of the CQC, and the members of the new team that is running it have made it clear that there was a completely unacceptable attempt to cover up the deficiencies in their organisation. The report lists what went wrong over a period of many years. There were unclear regulatory processes, a report was commissioned and then withheld, key information was not shared, and there were communication problems throughout the organisation. Most of the facts are not in dispute, and all of them are unacceptable. They have compounded the grief of the Titcombe family and many others.
The role of the regulator is to be a champion for patients, to expose poor care and to ensure that steps are taken to root it out. The regulator must do that without fear or favour, but it is clear that at Morecambe Bay, the CQC failed in that fundamental duty. We now have a new leadership at the CQC, and we should recognise its role in turning things around. David Behan was appointed chief executive in July 2012, and one of his very first acts was to commission the report that we are now debating. David Prior was appointed the new chairman in January this year, and has rightly insisted that the report be published as soon as possible. Those two outstanding individuals have never shrunk from addressing head-on the failings of the organisation that they inherited, and are wholly committed to turning the CQC into the fearless, independent regulator that the House would like to see. While I do not underestimate the challenge, I have every confidence in their ability to undertake it.
David Prior will now report back to me on what further actions the CQC will take in response to the report, including internal disciplinary procedures and other appropriate sanctions. The whole truth must now come out, and individuals must be accountable for their actions.
With respect to Morecambe Bay itself, an independent inquiry led by Dr Bill Kirkup started work earlier this year. More broadly, following the Francis report into the tragedy at Mid Staffs, the Government are putting in place far-reaching measures to put patient care and patient safety at the heart of how the NHS is regulated.
The CQC is appointing three new chief inspectors—of hospitals, social care and general practice. This will provide an authoritative, independent voice on the quality of care in all the providers that it regulates. The commission has already announced the appointment of Professor Sir Mike Richards as the new chief inspector of hospitals, and on Monday, the CQC launched a consultation, “A new start”, which outlines its much tougher regulatory approach. This includes putting in place more specialist inspection teams with clinical expertise. It will include Ofsted-style performance ratings so that every member of the public can know how well their local hospital is doing just as they do for their local school.
The Government will also amend the CQC registration requirements so that they include an emphasis on fundamental standards—the basic levels below which care must never fall, such as making sure patients are properly fed, washed and treated with dignity and respect. Failure to adhere to these will result in serious consequences for providers, including potentially criminal prosecution. The revised registration requirements will also include a new statutory duty of candour on providers that will require them to tell patients and regulators where there are failings in care—a failure clearly identified in today’s report.
Finally, we are putting in place, through the Care Bill, a new robust single failure regime for NHS hospitals. This will provide a more effective mechanism to address persistent failings in the quality of care, including the automatic suspension of trust boards when failings are not addressed promptly.
The events at Morecambe Bay, Mid Staffs and many other hospitals should never have been covered up, but they should never have happened in the first place, either. To prevent such tragedies we need to transform the approach to patient safety in our NHS.
The Prime Minister has therefore asked Professor Don Berwick, President Obama’s former health adviser and one of the world’s foremost experts on patient safety, to advise us on how to create the right safety culture in the NHS. He and his committee will report later this summer.
In addition, later this year we will start to publish surgeon-level outcomes data for a wide range of surgical specialties. Most of all, we need a culture where, from the top to the bottom of NHS organisations, everyone is focused on reducing the chances of harming a patient in the course of their care, and a culture of openness and transparency to ensure that, when tragedies do occur, they are dealt with honestly so that any lessons can be learnt. Our thousands of dedicated doctors, nurses and health care assistants want nothing less. We must not let them down, or any of the families who suffered so tragically in Morecambe Bay. I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
I thank the Secretary of State for his statement and for early sight of it, and I welcome what he has just said. Today’s report will have left people stunned. The Secretary of State began with an apology and we on the Opposition side echo it. It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What is never acceptable is when people or organisations try to hide those mistakes. As Professor Sir Liam Donaldson, the former chief medical officer, says:
“To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.”
Sadly, that is precisely what appears to have happened in this case.
The report covers a four-year period from autumn 2008 to autumn 2012. It details failures in regulation, but also subsequent attempts at a cover-up. It was published only because of the efforts of James Titcombe and his family. Like the Secretary of State, I pay tribute to them today, as does my hon. Friend the Member for Barrow and Furness (John Woodcock), who has supported the family. As he rightly said, that family’s suffering has been intensified by the actions of the NHS—something that should never happen. It is now essential that they and all the other Cumbria and Lancashire families affected get all the answers they are looking for—and I fully commit the Opposition to making sure that happens.
The most shocking revelation in this report is that, in March 2012, an instruction was given by a member of senior management at the CQC to “delete” the findings of a critical internal review. Let me remind the House of the context in which that March 2012 instruction was given. At that time, we were midway through a major public inquiry into the terrible failings at Mid Staffs. This was two years after the completion of an earlier independent inquiry—also led by Robert Francis, QC—following which all parts of the NHS had committed to full openness and transparency. It also came after failings at other trusts—most notably Basildon and Thurrock—which led me to request an in-depth look at all hospitals so that problems could be flushed out and a system put in place to ensure that people had a comprehensive picture of local standards. That was the context in which this instruction was given, and it explains why today’s revelations beggar belief and are hard to comprehend. The report raises questions for the CQC and the Department; I will take each in turn.
The new chief executive, David Behan, commissioned this report and we pay tribute to him for doing so. The chair has said today that he now wants to draw a line under this issue, but does the Secretary of State agree that it will be possible to do that only when further questions raised by this report are answered?
On hospital regulation, there is a recognition on all sides that it has not been good enough for too long. While we note the important work of Don Berwick, should we not also be getting on with the job of implementing the recommendations of the three-year Francis report in this regard? The Secretary of State mentioned a duty of candour on providers, but he will know that Robert Francis recommended that that should extend to individual clinicians, too. Will the right hon. Gentleman work with the Opposition to implement that recommendation as soon as possible?
On the cover-up, paragraph 1.17 of today’s report says that the order to delete
“may constitute a broader and on-going cover-up.”
Will the Secretary of State address that point directly and tell the House whether he is confident that this cover-up is no longer happening? Is he satisfied that the CQC has taken all appropriate steps, and does he have full confidence in it going forward, or does he believe a further process of investigation is necessary?
More specifically, is anybody who was involved in the decision to delete still working at the CQC or elsewhere in the NHS? If they are, people will find that hard to accept and they will want answers on that specific point. Given that accountability is essential, does the Secretary of State agree that people will find it hard to accept if data protection laws stand in the way of that accountability, and will he therefore review the decision to shield the identities of those involved? Today’s report makes it clear that the “deleted” report still exists. Should it not now be published?
Now let me turn to the Department of Health. Was the decision to delete taken solely by senior management at the CQC or is there evidence that anyone outside the CQC was either involved in the decision or aware of it? Was anyone in the Department of Health aware of the internal report being produced, and did any contact take place between the CQC and the Department running up to the decision to delete it?
Unfortunately, this matter does not end with deletion of the report. The Prime Minister said earlier that there should always be support for whistleblowers, and he was right, but there are serious doubts about whether that has happened in this case. Concerns about the CQC were raised by an internal whistleblower who was on the board. We know there was an attempt to remove her from the board and to question her character. Has the Secretary of State looked into these issues and considered whether appropriate support was provided—by both the CQC and the Department—to the individual who raised these concerns? The same whistleblower told the CQC today that she had raised issues internally first, then within the Department and then directly with the former Secretary of State in a meeting. Will the Secretary of State provide details of that meeting and publish a minute of it? What actions were taken by Ministers subsequent to that meeting? Were Ministers consulted about the decision to remove her from the CQC board, and did they support that decision?
Finally, the only real answer to all of these deep-rooted problems that go back a long way is for both sides of the House to recommit to full openness and transparency in the national health service. Will the Secretary of State join me today in restating that commitment and together sending the clearest and most unambiguous signal we can to the rest of the NHS?
In conclusion, there are difficult questions here for people at every level of the system. If we are to restore confidence, it is essential that they are answered and that people are held accountable for their actions. Learning from this failure and others, this House must a deliver a regulator that the public can trust, one that puts patients before its own interests. We will support the Government in that process and not stop until it is completed.
Mr Hunt
I welcome much of what the right hon. Gentleman says, but let me say this: he talks about getting on with implementing the Francis report, and that is exactly what has been happening. The report came to the House on 6 February. A new chief inspector of hospitals was appointed by 31 May, and the new inspections will start towards the end of this year. That will mean that many of the things talked about in the Francis report as being fundamentally important will start to be looked at independently and rigorously for the very first time.
I can confirm that there will be a duty of candour in the new Care Bill. We are looking at the extent to which it should apply to individuals, but we want to wait until Professor Berwick produces his report, because it is important to create a culture of openness, and we do not want to pass a measure that might inadvertently mean people clam up when they see a potential safety breach. We need to encourage an atmosphere where everyone talks openly about any concerns they have.
David Prior will be looking in his response to today’s independent report at whether anyone still working in the NHS, or, indeed, the CQC, may have been responsible for some of the shocking things that have been revealed. He will pass that report to me within the next two months. As I said in my statement, there will be full consideration of any sanctions or appropriate disciplinary procedures. In our response to the Francis report, we have said we want to introduce a new barring scheme to make sure that managers who have been found guilty of behaving in a bad way do not get jobs in another part of the NHS.
With respect to what the right hon. Gentleman said about my colleague, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), I gently say to him that it was not my right hon. Friend or myself or this Government’s Ministers who rejected 81 requests for a public inquiry into what happened at Mid Staffs. My right hon. Friend was the person who called the public inquiry into Mid Staffs. He is the person who changed the management of the CQC. He is the person who put clinicians in charge of budgets in the NHS, precisely to make sure these kinds of safety issues do not arise.
Finally, the right hon. Gentleman talks about accountability. If the Opposition really wanted to give confidence that they take the issues raised today seriously, they would recognise that it was fundamentally wrong to set up an inspection regime that was not carried out by specialists, and where the same person was inspecting a dental clinic, a slimming clinic, a hospital or a GP practice, perhaps in the same month. That may have contributed to the CQC’s decision in 2009 not to investigate the maternity deaths at Morecambe Bay, and to its decision in April 2010 to register the hospital without conditions.
When it comes to accountability, the right hon. Gentleman needs to explain to the House why the former head of the CQC, Barbara Young, said in her evidence to the Francis inquiry:
“We were under more pressure…when Andy Burnham became minister, from the politics.”
Is it the case that the head of the CQC felt under pressure not to speak out about care issues?
On the substantive policy point, the right hon. Gentleman continues to criticise the appointment of a chief inspector of hospitals and continues to criticise me when I single out hospital management who coast when it comes to raising standards. Just how much evidence will it take for the right hon. Gentleman and the Labour party to realise that when it comes to NHS policies, they really need to change?
Eric Ollerenshaw (Lancaster and Fleetwood) (Con)
As Member of Parliament for Lancaster, which is covered by the Morecambe Bay trust, may I reassure the Secretary of State and the House in general that thousands of my constituents are receiving a good service from hundreds of hard-working NHS doctors and nurses at the Royal Lancaster Infirmary? Does he think the problems began with the setting up of the CQC on 1 April 2009, and its being appointed as an independent regulator and being expected by the previous Government to inspect and register 378 NHS trusts within 12 months, by April 2010, which was an impossible target for any system to cope with?
Mr Hunt
My hon. Friend is absolutely right. That regime was utterly flawed, and as far as we can tell, inspectors looking at hospitals and care homes had targets of inspections they had to complete in a way that was totally counter-productive to the concept of a rigorous, thorough, independent inspection where people speak out without fear or favour when they find problems.
I also thank my hon. Friend for the other point he makes: that the people who work at the University Hospitals of Morecambe Bay NHS Foundation Trust are working extremely hard and under great pressure. I think they are doing a very good job by and large, but there are clearly very severe problems with the trust that we need to get to the bottom of, and it is very important that we recognise that if we are going to create a safety culture in the NHS, we need to back the people on the front line. They did not go into the NHS to have to deal with these terrible breaches in health and safety; they went into the NHS because they care for people and they want to do the best for people at their most vulnerable.
John Woodcock (Barrow and Furness) (Lab/Co-op)
May I first thank the Secretary of State and the shadow Secretary of State for those words of apology to the Titcombe family and other families who have long been pressing for an inquiry and this kind of day of reckoning for the CQC? It is hard to imagine what it must be like to lose a child, but then to be faced with an almost impenetrable wall of bureaucracy, with one organisation and one group of people passing them over to another group, and with all of them ultimately washing their hands of accountability, is truly shocking. That has been laid bare in this report, and I commend its authors for bringing it to the attention of the public.
What the Secretary of State says about the staff in this trust is very important, because these are front-line people who have been failed by poor leadership and a poor inspection regime, which absolutely has to change.
The report says the particular issue here
“may constitute a broader and ongoing cover-up.”
Is the Secretary of State satisfied that that is not the case? If he is, how can he be? What can he do to look more widely than just at the CQC itself when looking into this allegation?
Mr Hunt
First, may I say I agree with what the hon. Gentleman says, and commend him on his work with his constituents and local families who have suffered so terribly from what happened? He is absolutely right to say we have created a system that is a nightmare for families who identify problems, and the real problem is a lack of clarity as to where the buck stops: where the buck stops in terms of the decision to say that a hospital is safe or not safe, and where the buck stops in terms of sorting out a problem when it is identified. Those are the areas where we are putting through big changes this year, as a result of the Francis report.
I completely understand why the issue of whether there is a continuing cover-up is a concern. All I can say is that I have total confidence in the new leadership of the CQC. They are on the side of the public. They understand that the CQC’s job is to be the nation’s whistleblower-in-chief. They absolutely get that, but changing the culture in the broader NHS takes more than the appointment of two new individuals at the CQC; it takes a complete change in the leadership so that people on the front line always feel supported if they want to raise safety concerns. That is a much bigger job. I do not want to pretend that we are going to be able to solve it overnight, but that is the big change we have to make.
Tim Farron (Westmorland and Lonsdale) (LD)
My constituents can be forgiven for wondering whether, when the watchdog chooses to muzzle itself, it is time to put it to sleep. The report shows that the CQC discovered the truth about the deaths of babies at Furness General, but chose to suppress the truth, and to seek to subvert the Freedom of Information Act—and this morning I have asked the police to investigate that point.
Grieving families like the Titcombes deserve to know who made these decisions, so will the Secretary of State agree to ensure the removal of anonymity for those guilty of putting institutional convenience ahead of the lives of mothers and babies?
I completely agree with my right hon. Friend about backing those on the front line, but we have a culpable ex-chief executive of the trust on a £200,000 payout while the excellent nurses and doctors in the trust are struggling under immense pressure, so will he agree to work with me and all colleagues across Morecambe Bay to help the trust recover, which includes agreeing not to now demand that the trust make £25 million-worth of savings by March, as that would further threaten the pursuit of patient safety?
Mr Hunt
I agree with much of what my hon. Friend says. He is absolutely right that accountability for what went wrong is crucial in this. I know that the CQC wanted to publish the report in full today, including the names of the individuals involved, but was given legal advice that it would be against the law to do so. However, the CQC is keen to have maximum transparency as soon as possible and is looking into how it can make sure that happens. There should be no anonymity, no hiding place, no opportunity to get off scot-free for anyone at all who was responsible for this. This is the problem we have to address in the NHS: all too often, people are not held accountable for what went wrong. However, the system also bears responsibility. This is not just about bad apples and how we root them out more quickly; it is also about creating a system that brings out the best in people—that plays to the decent instincts that got people to join the NHS in the first place, rather than making them think that targets at any cost matter more than the care and dignity of the patients in their trust.
Mr Ben Bradshaw (Exeter) (Lab)
The CQC’s chairman said on the radio this morning that he could not publish the names of those responsible for this scandal because of the Data Protection Act, but there are clear and explicit exemptions to the Act when it comes to
“protecting members of the public from dishonesty, malpractice, incompetence or seriously improper conduct, or in connection with health and safety”.
Will the Secretary of State please challenge the CQC’s interpretation of the Act and, if necessary, ask the Information Commissioner to rule on this flawed decision?
Mr Hunt
I can reassure the right hon. Gentleman that neither the chairman of the CQC nor I have any interest whatsoever in keeping these names secret. He did receive legal advice telling him that he could not publish them, but I will go back to him with what the right hon. Gentleman says. I know that the CQC chairman would like to be as transparent as possible. The choice he had, on the basis of the legal advice, was either not to publish the report or to publish it without the names. I think he took the right decision, given the advice he had, but I will ask him to consider what the right hon. Gentleman says.
David Morris (Morecambe and Lunesdale) (Con)
It is appalling what has come out in the press today and it is appalling what has been suppressed in the past. It is alleged by Lady Barbara Young, a former CQC chair, that under the previous Labour Government she was leant on by Labour Ministers not to criticise the NHS under their tenure. In her Mid Staffs inquiry evidence she stated:
“There was huge government pressure, because the government hated the idea that…a regulator would criticise it”.
She also alleges that the right hon. Member for Leigh (Andy Burnham), the then Health Secretary in the last Labour Government, needs to answer these very serious allegations, especially given what has happened in my local NHS trust.
Mr Hunt
That is the big culture change we need to see; we need to see Governments who are prepared, in all circumstances, however difficult and however politically inconvenient it is, to recognise that when there are safety issues, when there are terrible failures in care and compassion, we need to support the people who want to speak up, because if we do not do that, we will never root out these problems.
Barbara Keeley (Worsley and Eccles South) (Lab)
I support the comments made by my right hon. Friend the Member for Exeter (Mr Bradshaw). A real concern is being expressed by Members on both sides of the House, because a person committed this cover-up by deleting this report and we really want to know—there should be an investigation—whether they are currently working for the CQC or working in the NHS anywhere. It is vital to know that.
Today, the CQC’s chair has said that it is not currently capable of carrying out hospital inspections. The Health Secretary has talked about putting in place more specialist inspection teams, and I, of course, support that. However, CQC inspectors have had access to specialists for a long time—they have talked about it before the Health Committee—so if they are not using them, that is an issue to address. What measures will the Health Secretary put in place to ensure that from this day onwards—not at some future point—we can have the CQC competently carrying out inspections?
Mr Hunt
When the CQC was set up in 2009, it was decided, with full ministerial approval, to go for a generalist inspection model—a model where inspection was not carried out by specialists; the same people would inspect dental clinics, GP practices, hospitals and slimming clinics. That was the wrong decision to take. Making sure that we have enough specialist inspectors in place, with appropriate clinical expertise, takes time—it is a very big recruitment job—and that is what the new chief inspector of hospitals, Professor Sir Mike Richards, is now setting about doing. It is also expensive—it costs money—but he has said to me that when his teams are in place he will start those inspections before the end of this year. So we are going as fast as we possibly can to try to put these problems right.
Mr Ben Wallace (Wyre and Preston North) (Con)
My wife gave birth to all three of our children at the Royal Lancaster Infirmary, which is part of the University Hospitals of Morecambe Bay NHS Foundation Trust. Although the midwifery care was excellent, when we had complications with the third my wife received such neglect and ill treatment, at about the same time as Joshua Titcombe’s death, that the trust resorted to lying to us. No one should have to endure that treatment.
I have with me a litany of complaints, ignored by the management, the non-execs, and the Department of Health, going back to 2005. Constituents were lied to and nothing was done—no one came to help. I support the Secretary of State’s attempt to reform the CQC, but may I urge him to sort out governance at a more local level? Unless we improve the non-execs and the chairs of these trusts, none of these reforms will make a difference. Unless we improve clinical leadership, as well as managerial leadership, it will all be for nothing.
Mr Hunt
My hon. Friend speaks extremely wisely, and I know that the whole House will want to say how sorry we are to hear about the personal problems he had with that trust. All the international safety studies say that if we are to transform safety culture, it has to come from better leadership. It has to come from leadership that really cares; that frees up people on the front line to raise safety concerns in a way that they do not feel will be career-threatening; that encourages them to rethink procedures to minimise the risk of harm to patients; and that encourages the open and transparent approach that has enabled hospitals such as Salford Royal to become one of the safest in the country, because of the inspirational leadership of David Dalton. That change in leadership is fundamental, but having a chief inspector who goes without fear and favour and says where we have that leadership and, more importantly, where we do not have it, will be vital to ensuring that we start to get the changes that my hon. Friend is concerned about.
Mr Stephen Dorrell (Charnwood) (Con)
Does my right hon. Friend agree that in the long litany in this report of events that were inexplicable and completely unacceptable, one of the most inexplicable and unacceptable things it lays bare is that at the same time as concern was being expressed to the CQC about the quality of maternity services delivered in the trust, to which the CQC did not respond, the trust itself commissioned a report into the future of maternity services and did not see fit to report the existence of the Fielding review to the regulator to which it was responsible? Will my right hon. Friend make it crystal clear that that is completely inconsistent with any concept of duty of candour for health care deliverers?
Mr Hunt
I could not agree more with my right hon. Friend. What happened beggars belief, and I very much agreed with his comments on that on the radio this morning. The point about duty of candour is that there will be a criminal liability for boards that do not tell patients or their families where there has been harm and that do not tell the regulator; boards will have a responsibility to be honest, open and transparent about their record. That has to be the starting point if we are going to turn this around.
Dr Sarah Wollaston (Totnes) (Con)
The public will be horrified, but probably not surprised, to hear that Ministers were leaning on the CQC not to criticise NHS hospitals. Leadership has to start at the top, so will the Secretary of State confirm that he will be fearless in standing up for whistleblowers and those protecting patients in the NHS? [Interruption.]
Mr Hunt
I thank my hon. Friend for that. She is absolutely right to say that the biggest responsibility Ministers have when faced with such tragedies is to be open and transparent about the scale of the problems; otherwise, they will never be addressed. Let me put it this way: people who love the NHS and are proud of it are the people who most want to sort out these problems when they arise. That is why it is incredibly important that we are open and candid. [Interruption.] The right hon. Member for Leigh (Andy Burnham) has stood up and criticised me in the media every single time I have given a speech drawing attention to some of the problems facing the NHS. He needs to be very careful every time he does that, because I will continue to do this, and I do it because I want the NHS to get better and believe it can be better.
Stephen Barclay (North East Cambridgeshire) (Con)
James Titcombe this morning spoke of ministerial pressure on the CQC. Further to the statement by the right hon. Member for Leigh (Andy Burnham) about full transparency and the fact that data protection should not be an impediment, will the Secretary of State have discussions with him as to whether, within the very narrow remit of the Department’s dealings over Morecambe Bay with the CQC, he will apply full transparency to his involvement in this issue?
Charlotte Leslie (Bristol North West) (Con)
I echo the sentiments of the right hon. Member for Exeter (Mr Bradshaw) and ask the Secretary of State to look urgently at the application of the Data Protection Act if accountability is to mean anything at all. I urge him also to look at the lessons that a change of leadership effected in the CQC and the era of transparency that that heralded. There is a cover-up which is not just about Morecambe Bay; it is about Mid Staffs, and I suspect that, sadly, other stories may emerge of other such horrors. Does my right hon. Friend think there should be an inquiry into the culture of lack of transparency and cover-up that involved senior managers, and will he consider a change of leadership in order to herald a proper culture change in the NHS?
Mr Hunt
My hon. Friend has campaigned with great assiduity and distinction on this issue. The report about the culture of cover-ups and secrecy was the Francis report, and my job now is to do what is necessary to bring forward the change so that we move on and have a culture of openness and transparency. That means, yes, openness and transparency in this place and among Government Departments and regulators, but it also means creating a culture for front-line staff where they feel that they can raise concerns. We do not do that as well as we should, and it is even more important.
Mr Jamie Reed (Copeland) (Lab)
I share a great deal of the sentiments that the Secretary of State has expressed. He said at the Dispatch Box that the involvement of lay inspectors in the CQC was a problem, yet the Keogh review, which I comprehensively support, is involving significant numbers of lay inspectors. Does the Secretary of State agree with that approach? Is it the right or the wrong way forward?
Mr Hunt
As I understand it, the terms of reference, the way it is conducted and the timetable for the review happening at the moment are being set independently, but we should give every support to the people doing that review to make sure that they have access to the clinical expertise they need.
Dr Phillip Lee (Bracknell) (Con)
I very much welcome the Secretary of State’s desire to see published appropriately contextualised surgical outcome data for each surgeon. Those surgeons, however, have to work within structures created by managers, so in the interests of transparency would he support the publication of each manager’s performance so that the public can see where failure is taking place? First, that could prevent the merry-go-round of jobs, Cynthia Bower being the classic example. Secondly, appropriate financial penalties can be applied to the said managers if they fail, as they clearly have done in Morecombe.
Mr Hunt
My hon. Friend speaks extremely wisely. One of the key issues raised by the Francis report was the fact that we have a form of accountability for doctors and nurses—it does not always work as well as it should—through the possibility of being struck off by the GMC and the Nursing and Midwifery Council, but there is no equivalent accountability for managers. In a way, that is what the chief inspector is going to do. That is why I was so keen that as well as looking at whether a hospital is safe or not, the chief inspector should rate hospitals with Ofsted-style rankings, which look clearly at the quality of leadership in every organisation. The score that a hospital or a trust gets from the chief inspector will ultimately be the determinant of whether or not an organisation is well led. That is why I think it will give the public vital information about leadership, which they do not have at present.
John Stevenson (Carlisle) (Con)
As the Secretary of State knows, there have been issues about patient care in the North Cumbria University Hospitals NHS Trust. I therefore fully support the introduction of a more robust CQC regime than the one that previously existed. What does the Secretary of State intend to do to ensure that failing trusts are taken over in a timely and efficient manner so that new leadership and new management may be put in place as soon as possible?
Mr Hunt
My hon. Friend speaks well. Even under the current system, when problems are identified they seem to fester without being properly addressed. Under the new single failure regime for hospitals, when failure is identified there will be a maximum period of one year to sort it out or the board’s trust will be suspended. There will be a cut-off which does not exist at present to make sure that the local NHS, the trust board and, in the end, even Ministers bite the bullet when there are problems so that we do not allow them to continue.
John Pugh (Southport) (LD)
After Francis, after the Health and Social Care Act 2012, are we not asking a deeply dysfunctional and damaged organisation to shoulder additional responsibilities? Is not that in itself risky? In the Secretary of State’s statement he mentions “potentially criminal prosecution” of providers. Exactly who will be prosecuted? Managers? Clinicians? Board members? And exactly on what charge?
Mr Hunt
The criminal sanctions apply to boards for withholding information about safety breaches at their trust, and as I mentioned earlier, we are considering whether those sanctions should apply below board level. We want to wait for Professor Berwick’s advice on that, because there is a balance between proper accountability for mistakes and the need to create that culture of openness, where people report mistakes that they might see a colleague making, which might not happen if they were worried about criminal prosecutions. I want to take the advice of an expert on that.
Andrew Stephenson (Pendle) (Con)
I and the people I represent are rightly proud of our NHS. However, from Morecambe Bay to Mid Staffordshire we have had a series of scandals. Can the Secretary of State reassure patients that the previous Government’s culture of secrecy and neglect will now be torn apart and replaced by a new, transparent, accountable health service that treats patients with dignity, rather than as numbers?
Mr Hunt
The big challenge of our times for the NHS is to make that culture change, and it is a huge organisation. With 1.3 million people, we will do this only if we tap into and harness the desire that they have to do their jobs to the highest standards of patient safety, treating people with dignity and respect. That will be the key to unlocking success.
Mark Pritchard (The Wrekin) (Con)
The Secretary of State rightly said that individuals must be held accountable for their actions. To what extent does he think some former Labour Ministers were complicit in this disgraceful cover-up?
Mr Hunt
They need to explain why Barbara Young made the comments that she did. I think there was a general desire to talk up the NHS and not to talk about some of the very deep-seated problems that have now come to light. It is our duty in all parts of the House to make sure that we have a more mature discussion about the NHS when problems arise, and that we do not always seek to throw party political stones but recognise when problems arise. We should talk about them, not cover them up.
Margot James (Stourbridge) (Con)
I attended a presentation given by the CQC in early 2011 and I was shocked at the low calibre of what I heard. In particular, I found the CEO at that time to be out of her depth. My right hon. Friend will know that the individual concerned was previously CEO of the West Midlands strategic health authority between 2006 and 2008, at the time of the scandal of Mid Staffs. Will my right hon. Friend say a little more about what he plans to do to improve the appointment process for senior positions in the wider health service to ensure that proper scrutiny of people’s prior performance takes place?
Mr Hunt
That is a very good question from my hon. Friend. We need to make sure that we have absolutely the right people in place. One of the lessons that we have learned from Ofsted, which has been an extremely successful regulator in the education sector, is that what works is having people who are prepared to speak truth to power—who are prepared to say uncomfortable things even to the people who have appointed them. I have had this conversation with Mike Richards, because I have the highest opinion of Mike, and I also know that he will say things while I am Secretary of State that will make me deeply uncomfortable. We have to understand that part of the way that we will make sure that the NHS is and continues to be one of the very best health services in the world is having that rigour in the inspection process.
Mr David Nuttall (Bury North) (Con)
Many families in Bury, Ramsbottom and Tottington in my constituency will have elderly relatives living in care homes, which they will have chosen on the basis of CQC assessments. Can my right hon. Friend reassure them that these care homes, inspected and approved by the CQC, are in fact up to standard?
Mr Hunt
We have not talked very much about care homes during these questions, but anyone who saw the horrific “Panorama” programme earlier this week on the BBC will know that there are some appalling problems in some of our care homes. We need that same independent, rigorous inspection in care homes as well. That is why, alongside the chief inspector of hospitals, we are appointing a chief inspector of social care who will once again—it is a great shame that we stopped doing this—rate care homes on the quality of care that they give and speak without fear or favour, so that we can reassure my hon. Friend and his constituents.
Greg Mulholland (Leeds North West) (LD)
Last week and this week, the Secretary of State has made bold and helpful statements in the interests of NHS accountability, and I commend him for doing that, but does he accept that we have a real problem in the structure of democratic accountability in the NHS? As he knows, there has been great leadership, including from some of his Back Benchers, and will he commission a review now so that we can all have confidence that there is a proper democratic structure of accountability to oversee all parts of the NHS?
Mr Hunt
I thank the hon. Gentleman for his comments, and I hope that he will bear with me as the profound changes that we are introducing this year are rolled out. The most important element of democratic accountability is making sure that the public have the same information as the experts, so that they know whether their local hospital, GP surgery and care home are doing well. That is one of the biggest imbalances and that is why I am putting a lot of emphasis on the new chief inspectors, who will have the status, authority and resources to make those judgments, so that the public know what sometimes only the system has known. Then we will help to address some of the issues that he raised.
Health Select Committee Report (Public Expenditure)
Jeremy Hunt Excerpts(13 years, 1 month ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I have today laid before Parliament “Government Response to the House of Commons Health Select Committee report into Public Expenditure on Health and Care Services: Eleventh Report of Session 2012-13”, Cm 8624.
Even with this Government’s £12.7 billion investment in the NHS and additional £7.2 billion investment in adult social care, I acknowledge that our health and care system is facing enormous pressures from rising demands for its services. Yet both the NHS and local authorities are rising to these challenges, and through a combination of increased efficiency and wiser spending are continuing to deliver high-quality care for their patients and service users.
However, we do need to go further than just delivering the same service. If we are to meet the needs of our ageing population, the NHS and its partners in social care need to look seriously at how care is being provided, particularly to older patients and those with long-term conditions.
Our healthcare services need to be more efficient. This does not mean cutting services or finding short-term fixes—it means getting better services to people in a timely way. The number of people over 85 is set to double in coming decades. Doing things differently is the only way we will meet people’s expectations within a constrained budget.
Since April—under this Government’s reforms—GPs, local authorities and hospitals are now working together to make sure that services are integrated and that more is provided in the community and closer to patients’ homes.
Children’s Heart Surgery
Jeremy Hunt Excerpts(13 years, 1 month ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I would like to make a statement on the Safe and Sustainable review of children’s congenital heart services.
On average, around 3,700 heart procedures are carried out each year on children who have been diagnosed with congenital heart conditions. The mortality rates at Bristol royal infirmary identified as far back as 1989 indicated that we are not as successful as we should be in such operations. The Safe and Sustainable review began in 2008 and set out to ensure that children’s heart services are the best they can be for all children across the country. Whatever the controversy about the location of such services, we all have a responsibility to ensure the best possible outcomes for children and their families, who must always come first in any decision about service provision.
Sir Ian Kennedy, in his Bristol inquiry report in 2001, recommended the concentration of medical and nursing expertise in a smaller number of centres. Subsequent working groups and reports have endorsed that recommendation, including the Royal College of Surgeons in 2007. The public consultation on the Safe and Sustainable review received more than 75,000 responses. This was the largest review of its kind, conducted independently of Government by the NHS. In July 2012, the then Joint Committee of Primary Care Trusts, on behalf of local NHS commissioners, decided that children’s heart surgery networks should be formally structured around specialist surgical centres in Bristol, Birmingham, Liverpool, Newcastle and Southampton, as well as Great Ormond Street and the Evelina children’s hospital in London. The JCPCT recommended that services should no longer be provided in Leicester, Leeds and Oxford or at the Royal Brompton or Harefield in London.
Following the JCPCT’s announcement, three local health overview and scrutiny committees formally referred its decision for me to review. I wrote to the Independent Reconfiguration Panel asking it to undertake a full review of the proposals. I received that report on 30 April, and I would like to thank the IRP for producing such a comprehensive review of such a challenging topic. It strongly agrees with the case for change—specifically, that congenital cardiac surgery and interventional cardiology should be provided only by specialist teams large enough to sustain a comprehensive range of interventions, round-the-clock care, specialist training and research. I agree with the IRP’s analysis.
However, the report also concludes that the outcome of the Safe and Sustainable review was based on a flawed analysis of the impact of incomplete proposals and leaves too many questions about sustainability and implementation. This is clearly a serious criticism of the Safe and Sustainable process. I therefore accept the recommendation that the proposals cannot go ahead in their current form, and I am suspending the review today. NHS England will also seek to withdraw its appeal against the judicial review successfully achieved by Save Our Surgery in Leeds. None the less, the IRP is clear that the clinical case for change remains, and its report is helpful in setting out the way forward in terms of broadening the scope of the discussion and looking in detail at the affordability and sustainability of the proposals. The IRP says, and I agree, that this is not a mandate for the status quo or for going back over all the ground already covered during the last five years. The case for change commands widespread support, and we must continue to seek every opportunity to improve services for children.
The recommendations in the report set out the IRP’s view of what needs to be done to bring about the desired improvements in services in a way that addresses the gaps and weaknesses in the original proposals. Specifically, they include better co-ordination with the review of adult heart surgery services; expanding the detailed work on the clinical model and associated service standards for the whole pathway of care, beyond surgery; services to be fully modelled, and their affordability re-tested; NHS England to establish a systematic, transparent, authoritative and continuous stream of data and information about the performance of congenital heart services; NHS England and the relevant professional associations to put in place the means to continuously review the pattern of activity and optimise outcomes for the more rare, innovative and complex procedures; NHS England to reflect on the criticisms of the JCPCT’s assessment of quality and to learn lessons to avoid similar situations in its future commissioning of specialist services; and NHS England to use the lessons from this review to create with its partners a more resource-effective and time-effective process for achieving genuine involvement and engagement in its commissioning of specialist services.
NHS England now must move forward on the basis of these clear recommendations and the Leeds court judgment. I have therefore written today to NHS England, and to the local overview and scrutiny committees that originally referred the JCPCT’s decision to me, to explain that the IRP’s report shows that the proposals of the Safe and Sustainable review clearly cannot go ahead in their current form. It is right to give all the parties some time to reflect on the best way forward, now that the IRP report is in the public domain, so I have asked NHS England to report back to me by the end of July on how it intends to proceed. In the meantime, it is important to stress that I believe that care for children with congenital heart conditions is safe in the NHS, and that ensuring it continues to be will be the top priority for all involved in this process.
I know that many families have found the Safe and Sustainable review to be a traumatic experience. People are rightly proud of the hospitals and the staff that have saved, or tried their very best to save, the lives of their children. However, there is overwhelming consensus that we cannot stick with the model of care that we have now. To do so would be a betrayal of the families who lost loved ones in Bristol and who want nothing more than for the NHS to learn the lessons from their personal tragedies. So it is right we continue with this process, albeit in a different way. But it is also essential that the process should be performed correctly so that any decisions, as difficult as they might ultimately be, carry the confidence of the public. I commend the report and this statement to the House.
Andy Burnham (Leigh) (Lab)
I thank the Secretary of State for giving me early sight of his statement. He was right to begin by reminding the House of the events that led to the Safe and Sustainable review. Terrible failings in the care of very sick children at the Bristol royal infirmary in the 1980s and 1990s led Sir Ian Kennedy to call for expertise to be concentrated in fewer surgical sites—a call supported by more recent events, including those at the John Radcliffe hospital in 2010. Since Bristol, Sir Ian’s important conclusion has had the full support of the health professions and of those on both sides of this House. As we digest what the Secretary of State has just said, two considerations must remain at the forefront of our minds. First, that this issue must continue to transcend party politics. Secondly, that the complexity it presents should not derail our determination to deliver the safest possible care for children in England.
That said, changes of this magnitude must be able to command public confidence and consensus, but that has not emerged since the decision on site selection by the Joint Committee. I fully support the reduction in sites, but when the decision was published I expressed concern about the distribution of the seven sites, which was skewed towards the western half of England and left a large swath of the east, from Newcastle to London, without a surgical centre. For a family in Hull or Lincoln, already at their wits’ end with worry, the wrench of leaving home to travel hundreds of miles, along with the cost of accommodation and time off work, would add to high levels of stress and anxiety. That is why the issue has aroused such strength of feeling, particularly across Yorkshire, the Humber and the east midlands—a concern well voiced and represented by Members throughout the House.
Although clinical safety must predominate, does the Secretary of State agree that the NHS needs to give more consideration to public access and travel times when reconfiguring services? The truth is that the NHS has a habit of minimising these concerns in all reconfigurations—in this case, as the IRP report points out, the Joint Committee considered access the least important factor. The IRP concluded, surely rightly, that
“the decision used a flawed and incomplete analysis of accessibility”.
Going forward, will the Secretary of State ensure that this is corrected and that access is made a significant factor in any future decision?
Turning to the review itself, the Secretary of State will know that one of the main concerns has been that the mortality data were not given enough weight. Although decisions of this kind cannot be based on death rates alone, we agree with John Deanfield, director of the National Institute for Cardiovascular Outcomes Research, who wrote in his letter to NHS England in April:
“Mortality is only one measure of quality, but currently is the most…available outcome.”
Will the right hon. Gentleman confirm that these data will feature more prominently in the further process of review announced today?
My main concern with what the Secretary of State has just announced is the proposal to link the children’s review with the review of adult heart services, and the implications that might have for the timetable. The Secretary of State will know that there are around 30 centres across England carrying out adult heart surgery. The seven selected children’s centres are not all co-located with adult heart surgery and, indeed, a number of them are on specialist children sites, so the link between children’s and adult heart surgery is not clear. Is there not a real danger that by linking the review with adult heart surgery, the Secretary of State is introducing more complexity and, potentially, controversy, risking a loss of focus and more delay? By broadening out in this way, is there not a danger that we will lose the consensus that has already been gained over the future of children’s heart surgery? I would be grateful if the right hon. Gentleman would say more on those points.
This decision will also have implications for the timetable of the children’s review and it will not have escaped the House’s notice that that Secretary of State has not announced a clear timetable. Can he set out more precisely a timetable for the decision making that will now follow? He says that the review will be concluded by the autumn. What people will want to know is when the decisions will be made and implemented. Can he say more about that? The statement sets out a major role for NHS England and questions may be asked about the independence of the review he has announced. What guarantees can he give that NHS England will operate independently of vested interests linked to the 10 sites?
Finally, I am sure the right hon. Gentleman will agree that we cannot risk any loss of confidence in the process, damaging confidence in all 10 existing sites. Will he say more about what he will do in the interim to support all existing units and ensure that there is no loss of expertise?
In conclusion, it is, of course, essential that the public have confidence in the process and the final decision. Balanced against that, however, is the fact that unnecessary delay will not bring the best results for the children who most need our help. The Secretary of State is right to say that we need a process that is seen to be fair by all concerned, but, equally, a point will come when decisions must be made. In the end, I want to assure the Secretary of State that when he comes to face up to those difficult decisions, he will have our support in doing so.
Mr Hunt
I thank the right hon. Gentleman for the tone of his comments and the bipartisan way in which he has approached these issues. I particularly welcome his last point. We have many debates in this House, but this is one issue where we are completely at one. If there is a difficult decision to be made that will save children’s lives, we must have the courage to take it. I am grateful for the right hon. Gentleman’s support on that.
I think that the right hon. Gentleman will also agree with me that while this issue transcends party politics, it is one from which all of us—on both sides of the House, throughout the NHS and indeed in local authorities—have things to learn. I think that the biggest issue for us all to consider is the sheer amount of time that it has taken. The original concerns about what happened in Bristol were raised in 1989. I am pleased to say that they have been dealt with, but there are broader, system-wide lessons to be learnt. It took until 2001 for Sir Ian Kennedy’s report to be completed, it took until 2008 for the Safe and Sustainable review to begin, and now, in 2013, we are having to suspend the process yet again. What has happened is not the right outcome for children, and we must all learn the lessons from that.
The right hon. Gentleman mentioned site selection. I consider that to be one of the most crucial areas in which the process was flawed. Whether we should involve adult heart services is a difficult question, but one of the key recommendations in the IRP’s report is that they should be taken into account. I think that we should pay attention to that recommendation, because the panel thought about it very carefully. The reason for its view was that the same surgeons often operate on children and on adults. Adults also have congenital heart conditions that require operations. The panel also says that if the best outcomes are to be achieved for children, services must be concentrated in teams that have four full-time surgeons, provide specialist training, and conduct research. The knock-on impact of what is happening in adult heart services is relevant.
I agree with the thrust of what the right hon. Gentleman said about mortality data, but I know that he will also understand the difficulty of publishing such data on a very small number of cases when they may not be statistically significant. That was one of the great debates that we had over the temporary suspension of services at Leeds. We must be careful not to publish data that could lead the public to make the wrong conclusions. In principle, however, transparency is the most important thing for us to bring about.
I entirely agree with the right hon. Gentleman about the timetable. I think that we must get on with this process: I do not want to delay it any more than is necessary. I have talked extensively to NHS England about how it should be approached. NHS England—along with all the stakeholders involved—needs time in which to digest the contents of the IRP report, which was published only today. I consider that the minimum period that I need to allow it to come up with the timetable is until the end of next month. I appreciate that that is six weeks, but I think that it is a sensible period. I certainly want to be able to publish an indicative timetable by then, so that people can understand how the process will continue and how we will learn the lessons.
I also agree with the right hon. Gentleman that nothing in my statement should undermine the public’s confidence in the brilliant work being done by heart surgeons all over the country for adults and children. Our heart surgery survival rates have improved so much that they are now some of the best in Europe, and we can be very proud of the work that those surgeons do, day in, day out. However, that does not mean that we cannot strive to be even better.
Mr Stephen Dorrell (Charnwood) (Con)
I welcome the statement, although, in a sense, I welcome it with a heavy heart. Does my right hon. Friend agree that the Safe and Sustainable process could not go ahead because it had fundamentally lost the confidence of patients and clinicians, and therefore did not form a proper basis for necessary change?
Given that it is now more than 12 years since the publication of Sir Ian Kennedy’s report, does my right hon. Friend agree that this is not a success for the NHS? Does he agree that it is a real challenge for NHS England to put a proper time frame around necessary change for these services, and then to use that as a basis for changes that we know to be needed in other specialist services in the national health service?
Mr Hunt
I agree with my right hon. Friend on both those points, as, indeed, on many others. It is true that the Safe and Sustainable process did not have the confidence of the public. It should be emphasised that when a controversial and difficult change is proposed, there is always likely to be public opposition. However—as I am sure we shall hear from Leeds Members in particular—this process did not command confidence in Leeds, or in other centres, because there was a sense that the outcome had been determined before the start of the consultation. The public found that totally unacceptable, and indeed it is unacceptable. The point of a consultation is for those who initiate it to listen genuinely, and to engage with stakeholders. That must be one of the most important lessons to learn.
My right hon. Friend was also right to suggest that, in general, this is not a success for the NHS. We need a much better process to enable us to face difficult decisions about reconfigurations of services, and, in particular, carrying the public with us when we must make a difficult change that will save lives. We have not done that as well as we need to.
Hilary Benn (Leeds Central) (Lab)
It has been clear to many of us for a long time that this process was flawed, and that has now been recognised by the IRP. I pay tribute to the extraordinary campaign in support of the Leeds children’s heart surgery unit in my constituency, which has helped to bring us to this day.
I welcome the Secretary of State’s statement, but does he agree that it is important for the process to be open and transparent this time, and to focus on what it is meant to be about, namely ensuring that the very best surgery is available for our very sick children?
Mr Hunt
That is entirely right. On this occasion, it is clear that the concerns of the campaigners were valid, and that the process was not conducted as it should have been. Interestingly, the campaigners commented that they felt that their engagement with the IRP was a much more open process than their engagement with the NHS.
Many people in the NHS believe passionately, and for absolutely the right reasons, that we need to change the way in which services are delivered. I agree with them, and specialised services such as those that we are discussing today provide a very good example of that. We know that the more operations a heart surgeon performs, the better he or she will become at his or her job, and the more likely a successful outcome is. However, if we are to carry the public with us—and they are, after all, the people whom the NHS is there for—we must do a much better job of genuine engagement.
Sir Edward Garnier (Harborough) (Con)
I thank the Secretary of State for an intelligent and thoroughly considered statement which will have brought great joy to many people in Leicestershire. I also commend the shadow Secretary of State for dealing with the matter on a cross-party basis. We in Leicestershire have dealt with it on that basis as well: my hon. Friend the Member for Loughborough (Nicky Morgan) and the hon. Member for Leicester West (Liz Kendall) have been, if I may say so, the leading ladies in the Glenfield hospital campaign.
I am grateful for the respite that we are being given by the Secretary of State. What advice can he give us to give to the clinicians, nurses and parents of patients at Glenfield hospital about how best to present, or re-present, their case between now and the time at which he and his advisers will reach a final conclusion about the disposition of children’s heart services?
Mr Hunt
We must all engage with the process thoroughly and fully. We, as Members of Parliament, have a responsibility to engage with our constituents about some of the complexities involved. The issue of mortality rates, which was raised by the right hon. Member for Leigh (Andy Burnham), is one of those complexities. They are very important, but they are not the only consideration, and, when it comes to specialised services, they are extremely difficult to interpret properly. We must engage in an intelligent and constructive way, and reassure our constituents that all of us—Government and Opposition—want the best outcome for children, the outcome that will save the most children’s lives.
Let me return to what the Prime Minister said earlier. I have no problem with explaining to my constituents that in the case of certain services, they are better off travelling further. I did not respond earlier to the right hon. Gentleman’s point about travel, so let me say now that I agree with him that it must be taken into consideration. According to the IRP’s report, the whole care pathway needs to be examined. That means not just the visit to the hospital for surgery, but follow-up care and early assessments. In that context, travel becomes much more important.
If we are honest with our constituents about the fact that there may be a difficult decision at the end of the process, we are much more likely to earn their trust.
Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)
How much public money has been spent on taking us to the point that we have now reached? Is the IRP report available to Members of Parliament? Will the Secretary of State say a little more about the process that will take place between now and the day on which he must come to the Dispatch Box and announce very difficult and controversial decisions to the House, and will his decisions stick?
Mr Hunt
The cost to date of the Safe and Sustainable process is about £6 million and Members of this House will rightly ask whether that money has been spent well, given the flaws in the process identified today by the IRP. I would also say, however, that it is right to spend money on carrying out such processes properly. It would be the wrong approach to say that, based on the cost of the process, we are not prepared to consider how we can improve services.
On the timetable, now that the report is public—it is available to Members of the House and the public as of today—I have given NHS England and all stakeholders until the end of next month to come back to me with a revised plan.
Jason McCartney (Colne Valley) (Con)
I agree with the Secretary of State that families must come first. For me, that means the families of Ben Pogson and Joel Bearder, young constituents of mine who have been treated at the wonderful Leeds unit. Will my right hon. Friend give an assurance that the new review will be based on the fundamental principle of patient choice and that doctors should go where the patients are, rather than the other way around?
Mr Hunt
Patient choice is very important, but it is also fair to say that there are other considerations in such a review, such as clinical best practice and what outcomes will get the best results for children. We need to be up front with the public that that will not mean specialist children’s heart surgery being offered in every major city in this country. There will be some difficult decisions at the end of the process. The broader point about patient choice, when it comes to considering mortality rates, is that it ties in very well with the concept of peer review. The way we can get better outcomes for children is by being able to compare what happens in different centres, and that is a very important part of the process.
Mr John Denham (Southampton, Itchen) (Lab)
Will the Secretary of State acknowledge one fact that has complicated this process? A foundation trust that loses children’s heart surgery will probably lose paediatric intensive care and, therefore, all the rest of its paediatric service activities, doing potentially catastrophic damage to the budgets of some trusts. Are the institutional pressures on individual trusts not one reason why it has been so hard to get a collaborative approach to that fundamental change? How does the Secretary of State intend to resolve that issue as he moves forward with the review?
Mr Hunt
The independent review says that the knock-on effects on adult heart surgery, and the interrelationship between the two, need to be considered. There are always knock-on effects of a service reconfiguration. Within reason, one must consider them, but one must also bear in mind what the right hon. Member for Leigh said: one must ensure that one does not overcomplicate the reviews. If we consider every single knock-on effect of every single change, the danger is that we end up not being able to change anything at all, which on this occasion would be an abdication of our important responsibilities.
Greg Mulholland (Leeds North West) (LD)
I have called consistently for leadership and accountability. I believe that we have had those things today, and I thank the Secretary of State and his colleagues in the Department for that. I have said consistently that there was something wrong with the decision-making process. We were right, whereas those who told us that we should be quiet and ignore the serious flaws, clear bias and utter lack of transparency were wrong. May we have a full investigation into the clear maladministration in the course of the review? Will the Secretary of State assure the House that lessons will be learned, which is key, and that those conflicted people who have let children down and wasted taxpayers’ money will play no part in any further review in the NHS?
Mr Hunt
I can confirm that a thorough process of learning the lessons will happen. As I said earlier, we must learn big lessons about the time it takes to make very important service changes in the NHS, not just in children’s heart surgery but in many other areas. We need to learn those lessons. The person who was responsible for the JCPCT, Sir Neil McKay, is no longer responsible and has retired from the NHS. We need to look at everyone who was involved in the process and see where the right calls were and were not made. If we do not, we will never be able to make important changes in the NHS—and we have a big responsibility to make those changes.
Mrs Mary Glindon (North Tyneside) (Lab)
The proposed reconfiguration of children’s heart surgery has gone on for years. Meanwhile, children are suffering and even dying. Why cannot the Secretary of State have a more rigorous timetable based on the lessons learned from the review so far?
Mr Hunt
That is what I absolutely want to do. One huge frustration for those on both sides of the House has been how the process has dragged on. If I could have come to the House today with a detailed timetable, I would have. Although we had internal access to the report before today while I considered its findings and reached a judgment, we believed that it was necessary for external stakeholders to see the report and give their view of how the timetable should proceed. That is why I have given NHS England until the end of July to come back with that timetable.
Nicola Blackwood (Oxford West and Abingdon) (Con)
The Health Secretary is absolutely right that parents in my constituency have found this process deeply destabilising. Although they also want to see quality, they felt that their concerns about building up a good relationship with their medical teams and about accessibility and co-located services were simply dismissed. Will the Health Secretary assure me that that will not be the case in the future, and will he look more closely at the networking solution we have in Oxford and Southampton, which strikes a good balance between having a quality site further away and providing aftercare in an accessible site with trusted medical teams?
Mr Hunt
That is a very interesting thought. My hon. Friend will be pleased to note that the IRP report states that the whole care pathway, not just the surgery on its own, needs to be considered when we make this very difficult decision. I agree with her that this has been a very distressing process for every family involved and although we are suspending the process today, we have a responsibility to be honest with people. At the end of the process, there will be a difficult decision to take and we will honestly do our duty as Members of this House.
Fabian Hamilton (Leeds North East) (Lab)
I know that all the families of children affected throughout Yorkshire will welcome today’s statement from the Secretary of State. Will he reassure the House that any future review panel, following whatever timetable he decides, will comprise representatives fairly and equally chosen from all the centres that will be affected by any decisions? Secondly, what assurances can he give that rather than the data used in flawed reports, such as the now infamous National Institute for Cardiovascular Outcomes Research 8 April report on mortality data in children’s heart surgery units, we will use data that are consistent and reliable?
Mr Hunt
On the hon. Gentleman’s second point, we need to be very careful about how we use any mortality data, particularly on specialist services where distortions can be based on just one or two operations. I know that he will agree, however, that we have a responsibility to act if we have genuine concerns. That is what happened and the process over Easter was very difficult. One lesson we have learned in the NHS is that in Bristol it took a very long time—years—before anything was done about the higher mortality rates and we do not want to make that mistake again. I take on board the hon. Gentleman’s other point, too.
Jane Ellison (Battersea) (Con)
I know that many of the staff and patients at the Royal Brompton hospital will very much welcome my right hon. Friend’s statement today. Although the hospital is not in my constituency, many of the staff live in my constituency and other hon. Members have been extremely active in making the Royal Brompton’s case over recent months. There was particular concern about the possible impact on other specialisms of any decision to withdraw children’s heart surgery, so can my constituents be assured that such concern will be taken into account in any future process?
Dr Phillip Lee (Bracknell) (Con)
My apologies, Mr Speaker. As someone who has long argued for the reconfiguration of acute and surgical services, I consider the management of this clinical consolidation to be of great importance. Does the Secretary of State agree that best clinical outcomes should be the primary driver of any reconfiguration and that there is a need for a national plan for the reconfiguration of all acute and emergency services? If such a plan were drawn up, it should receive cross-party support.
Mr Hunt
May I commend my hon. Friend, because he is one of the few Members of this House who has been prepared to campaign for changes in acute services in his own constituency, which might not necessarily be what his constituents would want? He has shown considerable bravery on this issue. I will mention his idea of a national plan for acute and emergency services to Sir Bruce Keogh, who is carrying out the review of emergency services as part of the vulnerable older people plan. We definitely need to have a different national approach to service reconfigurations.
John Healey (Wentworth and Dearne) (Lab)
What a waste of everybody’s time. Why should anyone believe that the new review process will be better than the last one or that the Secretary of State will make decisions at the end of it? Will he apologise now to the parents, the families and the staff for allowing this flawed and failing process to go on for so long and for the anguish that they have suffered during it?
Mr Hunt
I think we have been having a constructive discussion about an extremely difficult issue, in which I hope I have spoken for the whole House in saying that there are things that we need to learn on all sides, as the earliest signs went back as far as 1984 and still, in 2013, we have not been able to make the progress we should. It is important that we maintain that bipartisan approach, because at the end of this process there will be difficult decisions to make and we need to maintain public confidence that we are thinking about this in a non-party-political way.
Stuart Andrew (Pudsey) (Con)
I think I can hear the cheers in Leeds as I speak. May I put on the record my thanks to the IRP and to my right hon. Friend the Secretary of State for listening to our concerns in a very difficult situation? These findings clearly vindicate what we have been saying all along, but as we move forward will he agree to meet me and clinicians to maximise confidence in the future review? Will he assure us that co-location of services, accessibility and patient experience are paramount and that all units will have the same scrutiny as the one in Leeds has undergone? May I invite him to visit the unit in Leeds, so that he can meet the patients, families and staff with whom it has been my privilege to work?
Mr Hunt
I congratulate my hon. Friend on campaigning for children’s heart surgery in Leeds in an exemplary way, and he deserves huge credit for the responsible approach he has taken throughout. I would be delighted to meet him and clinicians from Leeds. Many things need to be learned, but his points about the importance of the patient experience, of clinical outcomes and of an impartial process in site selection, which is at the heart of the concerns people had about this process, are ones we need to reflect on very hard indeed.
Mr Kevin Barron (Rother Valley) (Lab)
I welcome the statement that the right hon. Gentleman has made today. Notwithstanding the fact that we would all want the best possible outcomes from this surgery, wherever it takes place, site selection or geography is a concern for us, for the health service and for patients and their families, so can we make sure it is taken into account? If skills are seen to be weak in certain geographical areas of the UK, we should improve those skills, not think about moving people elsewhere.
Andrew Bridgen (North West Leicestershire) (Con)
May I praise my right hon. Friend for his brave and eminently sensible statement today on this most emotive of topics? However, will he assure the House that any future plans to remove children’s cardiac services from the Glenfield hospital in Leicester will take full account of the world-leading extra corporeal membrane oxygenation services which will also have to be moved? The Secretary of State is completely right on this issue and many others: we do not need a quick solution; we need the right solution.
Mr Hunt
I agree with my hon. Friend, but I would actually like a solution that happens as quickly as possible, provided the process is done properly. He will be pleased to know that the IRP report does say that the impact of suspending the review and thinking again should be borne in mind in respect of decisions that have already been made as to the siting of ECMO services, and I know that NHS England will be reflecting on that.
Dr Alan Whitehead (Southampton, Test) (Lab)
Does the Secretary of State appreciate the sheer difficulty in respect of recruitment, retention, planning and maintenance of an excellent service that has been incurred by the units affected, particularly the one in Southampton? Is he prepared to look at the possibility of providing additional resources to those trusts affected to enable them to maintain those excellent services during a continued period of uncertainty? Not only is it a continued period of uncertainty, but there has been continued oscillation between near certainty, uncertainty, no certain and possible certainty as a result of this interminable review and the way it has been conducted.
Mr Hunt
I actually agree with the hon. Gentleman: one of the biggest casualties of the length of time it is taking to resolve this very difficult issue is morale at the excellent children’s heart units that we have across this country, and recruitment is one of the biggest concerns in that regard. Resources are now allocated independently by NHS England, but I know that its priority is to ensure the safety of services.
Steve Brine (Winchester) (Con)
May I thank the Secretary of State for his statement? Once he received the IRP report, he had little choice but to make this decision. I feel sure that it will be met with a deep sigh in Southampton, just because of the lack of certainty that it now extends for the trust there. To what extent will the Safe and Sustainable process now be rolled back? How far will it be rolled back? Is the number of centres now back in the “not sure” box? As he has said, we still face an incredibly difficult decision and there is still a reduction in the number of centres—or is there?
Mr Hunt
There will be a reduction in the number of centres at the end of this process, as is clear from what the IRP report says. It thinks we would have better outcomes for children if we concentrated surgery in fewer places, with more comprehensive facilities offered in all those places. However, we need to get the process right in order to get there.
Mr George Mudie (Leeds East) (Lab)
I thank the Secretary of State for, and congratulate him on, his decision. However, as an outsider I watched this process descending into almost a medical beauty contest, with comparing and deciding. Surely if we are rationalising the centres, the key starting point should be their placement for the maximum benefit of the populations, the patients and the parents, not this business of who has the lowest mortality rate. Doctors can move, but populations cannot.
Mr Hunt
The answer is this needs to be a mix of both; this needs to be about clinical excellence and issues such as accessibility and travel. A wide range of factors are involved. I accept, and this is widely accepted, that it is particularly difficult with specialist services to interpret mortality rates in a meaningful way, but that does not mean we should not look at them and seek to learn what we can.
David Tredinnick (Bosworth) (Con)
My right hon. Friend’s statement will have given great hope to all those in and around Leicestershire who campaigned to keep Glenfield hospital, and we welcome the acceptance that the original site selection was flawed and the implicit acceptance of bias against the east midlands and against the east of the country in general. On a positive note, if we are going to have the clinical case for change accepted and consolidation in the future, what is his understanding of the number of lives that would be saved if we have to go through this painful process?
Mr Hunt
I do not want to pluck a number out of the air; I want to listen to the clinical evidence on that. However, it is important to say that as a result of the excess mortality identified at Bristol the Kennedy report said that up to 170 lives could have been saved over a 10-year period in just one location. That is why it is so important that we get this decision right.
Nic Dakin (Scunthorpe) (Lab)
The Secretary of State is right to say that, sadly, the process did not have the confidence of the public. I very much welcome his statement. In moving forward, will he ensure that any data used are independent, transparent and credible, and that patient experience and access are given the right priority in the decision making?
Mr Philip Hollobone (Kettering) (Con)
I congratulate the Secretary of State on calling in the Independent Reconfiguration Panel, which has successfully exposed this shambles. I imagine that my constituents strongly suspect that the thick end of the £6 million cost of the exercise has gone on fat fees for management consultants. Given that the IRP concludes that there was flawed analysis and too many questions left unanswered, surely those management consultants should be banned from taking part in any further NHS reviews?
Diana Johnson (Kingston upon Hull North) (Lab)
I am pleased to hear that care pathways as a whole will be looked at and given consideration. Will the Secretary of State confirm, as he made clear in response to a number of questions, that the genuine concerns of constituents, including mine in Hull, will be listened to? Transport and access are very important to my constituents because of the city’s geographical location. Whoever makes these decisions should fully understand the geography of the country and be able to make a proper decision.
Mr Hunt
I completely accept what the hon. Lady says, and obviously transport and access do matter; that comes out in the IRP report. However, we have to be honest about the fact that if we are conducting surgery at fewer sites, the end result is that some people in the country will have to travel further than they currently do. That is why this is such a difficult decision. She will understand that a choice has to be made in that respect.
Bob Stewart (Beckenham) (Con)
Last Saturday I attended the funeral of a girl, with my wife and my daughter Delphine. The girl was a 16-year-old in my daughter’s class. A month ago, she suddenly dropped dead. She had not been aware of any problem. Arabella Campbell was a beautiful, highly intelligent, vivacious girl who had everything to live for, and nothing was known about her problem. Can Arabella’s death, and the death of hundreds of other children and young adults, be used as a spur to reinvigorate the NHS campaign to identify young people who may suffer a heart attack as a result of a problem that has not been detected before, difficult as that may be?
Mr Hunt
I know that the whole House will want to send its condolences to Arabella Campbell’s family, and the way that my hon. Friend has brought the issue to the attention of the House shows the seriousness of the issues that we are considering. Part of what the IRP talks about is a proper review of the screening process for people who have congenital heart failure. Yesterday I met a group of campaigners on sudden adult death syndrome who had an equally tragic story, and I am waiting for advice from the national immunisation and screening committee on the right way forward in this respect. I thank my hon. Friend for his comments.
Jonathan Ashworth (Leicester South) (Lab)
Clinicians at Glenfield hospital, and people across Leicester and the wider east midlands, will welcome what the Secretary of State said today on the suspension of Safe and Sustainable, but I want to ask him a further question on the point that the hon. Member for North West Leicestershire (Andrew Bridgen) made about the future of the extra corporeal membrane oxygenation centre. The decision to move ECMO from Leicester to Birmingham was a direct consequence of Safe and Sustainable. That decision is now suspended—I hope that is what the Secretary of State is saying. Will he reconfirm that the future of ECMO provision will be fully taken into account by NHS England?
Mr Hunt
I can confirm that. One of the recommendations of the review was that the ECMO decision be linked to what is decided under Safe and Sustainable, and I know that NHS England will want to consider that carefully. I hope to be able to come back to the House to report what it decides as soon as possible.
Martin Vickers (Cleethorpes) (Con)
My Cleethorpes constituency is on the very edge of the area served by the Leeds unit, and I particularly welcome the acknowledgement that future investigations will consider geography, but as well as feeling isolated geographically, many of my constituents felt somewhat isolated from the whole process. We do not want to prolong the process unnecessarily, but will the Secretary of State assure me that there will be some mechanism allowing input from individual constituents?
Catherine McKinnell (Newcastle upon Tyne North) (Lab)
Two years ago, almost to the day, we debated the issue in the House. I said at the time, and reiterate today, that the issue must be resolved as quickly as possible to end the damaging delay and uncertainty, and to secure the safety of children and the best clinical care for them. The Secretary of State has given a variety of reassurances, but I would like to hear a cast-iron reassurance, for my constituents, that in any future decision, clinical expertise and care will be paramount, and that this will be resolved as quickly as possible.
Julian Smith (Skipton and Ripon) (Con)
The Health Secretary is absolutely right to push ahead with specialisation in cardiology services. I represent one of the most rural constituencies in England, and I thank him for taking on board the need for more focus on access. In the future, I recommend that more money and time be spent working with members of review panels, because about a year and a half ago, when MPs met them, it was clear that some of them were out of their depth. It would do everybody a lot of good if we spent more money and time helping them.
Julian Sturdy (York Outer) (Con)
I very much welcome the Secretary of State’s statement, as will concerned families across my constituency of York Outer, and across the county of Yorkshire. Will he ensure that the new review recognises that units where paediatric and maternity services are located on a single site offer the optimal patient experience?
Oral Answers to Questions
Jeremy Hunt Excerpts(13 years, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Hugh Bayley (York Central) (Lab)
1. What plans the Government have to change the NHS formula for funding clinical commissioning groups; and if he will make a statement.
The Secretary of State for Health (Mr Jeremy Hunt)
Allocations to CCGs are the responsibility of NHS England. However, I have been advised that NHS England will rely on advice from the Advisory Committee on Resource Allocation (ACRA) for changes in the CCG formula.
Hugh Bayley
The failure of the Government to use the long-established funding formula for the NHS in dividing the budget between CCGs in north Yorkshire has left us with glaring anomalies, so that in York, the funding is £1,050 per head, but for Scarborough and Ryedale, which is served by the same NHS foundation trust, the funding is £1,234 per head. That is quite unsustainable and will lead to further postcode rationing. The same funding formula must be applied to all CCGs throughout the country. When will that happen?
Mr Hunt
I share the hon. Gentleman’s concerns about the way that NHS funding is allocated to different parts of the country. The allocation in my constituency is about the same as in his constituency, and I have long worried that things like age and rurality are not factored into the final amounts in the way that they need to be. However, in this case NHS England decided that if it was to follow precisely the ACRA recommendations, it would lead to higher growth for areas with better health outcomes and lower growth, or even cuts, for areas with less good outcomes, which it thought would be inconsistent with its responsibility to reduce health inequalities. That is why it is conducting a fundamental review, which it says it hopes will inform the next set of allocations for 2013-14.
John Penrose (Weston-super-Mare) (Con)
The Secretary of State will be aware that in my area of north Somerset, in Weston-super-Mare, the actual allocations versus the intended amounts of cash which should arrive with us based on the existing formula, are well below what they should be; so even without changing the funding formula, we are still getting dramatically less cash than we should. I urge the Secretary of State to look at that swiftly and see what can be done, within the existing spending envelopes, to make the allocations fairer.
Mr Hunt
As I said, I share my hon. Friend’s concerns about the way funding works at the moment. We are in a very difficult situation because if we were to move closer to the formula proposed by ACRA—I am sure he would agree with me that it is right that it is done independently of Ministers, and in this case it is done under NHS England—it would mean cuts in real terms for the budgets in other areas. Given the pressures overall in the NHS, that was obviously a decision that NHS England was very reluctant to make.
Andy Burnham (Leigh) (Lab)
The last Government matched health funding to health need and reduced the gap in male life expectancy and infant mortality, but this Government have reduced the weighting for health inequalities. The Secretary of State’s public health allocations mean that the areas he has identified today with the biggest health challenges do not get a fair share. The area with longest male life expectancy, Kensington and Chelsea, gets £133 per head, but Liverpool gets £89, Manchester £86, Luton £61, and Slough just £37. If he really wants to do something about health inequalities, should he not match his words with deeds and give more to the areas with the greatest challenges?
Mr Hunt
The right hon. Gentleman really cannot have it both ways. The budget for public health is also decided by an independent body, and we gave everyone a real-terms increase and then used any remaining money to even out the differences, to get everyone as close as possible to the independent formula. But if we are talking about spending, I think the right hon. Gentleman needs to say precisely whether he stands by his assertion that Governments should cut spending on the NHS by £600 million—[Interruption.] He says he has never said it before, but actually, up till now he has always said that it was irresponsible for the Government to increase spending in real terms. We have increased it; we have increased it by £600 million. He needs to come clean on whether he still wants to cut the NHS budget.
Julian Sturdy (York Outer) (Con)
Given that age is the main driver for an individual’s health care needs, why has not age been given more weighting in the funding formula in the past? I urge the Secretary of State to request NHS England to give as much weighting as possible to age in any future funding formula.
Mr Hunt
I recognise that my hon. Friend has campaigned on that issue a great deal, and I have great sympathy, because areas with high age profiles do have much greater needs for the NHS. That obviously must be weighted against things like social deprivation, which also have an impact. It is right for these things to be decided independently, which they are. The question is how we get closest to those independent allocations, and I know that that is preoccupying NHS England at the moment.
Mr David Amess (Southend West) (Con)
2. What steps his Department is taking to ensure consistent and continuous provision of pre-natal and post-natal care.
The Secretary of State for Health (Mr Jeremy Hunt)
I asked the Independent Reconfiguration Panel to undertake a full review of the “Safe and Sustainable” review of children’s congenital heart services. I have received and am currently considering that advice, and will make my decision known shortly—perhaps very shortly.
Stuart Andrew
I am grateful for that answer. Will my right hon. Friend accept that the Leeds unit has undergone the greatest scrutiny of any of the units included in the review, and has met all the standards required? Will he therefore assure patients, families and staff that both he and NHS England have every confidence in the performance and standards of the Leeds unit? If we are to have informed choices on the future of heart units, surely all units must be subject to the same scrutiny.
Mr Hunt
First, I want to congratulate my hon. Friend on the sustained campaigning that he has done for that children’s heart unit, and on the very responsible way that he has conducted himself in what has been an extremely difficult campaign for the people of Leeds. I have full confidence in children’s heart surgery at Leeds; I know that the Leeds unit does an excellent job. He will understand, as I do, that when there are safety concerns, they have to be investigated, but I am delighted that those issues have been resolved, and that surgery is continuing.
John Healey (Wentworth and Dearne) (Lab)
The hon. Member for Pudsey (Stuart Andrew) is right that the Leeds unit has been subject to greater scrutiny than any other unit, and the decisions in its case have been more seriously flawed than in the case of any other unit. What guarantee can the Secretary of State give those families across Yorkshire who depend on this major, life-changing surgery that the unit will not simply be removed from our county and put beyond their reach, taking away this vital service for them and their families?
Mr Hunt
The right hon. Gentleman will understand that I cannot prejudge the decision that I will take on reflection, having read the Independent Reconfiguration Panel report, so this morning I cannot give him an answer as to what will happen. However, I can reassure families in Yorkshire, and throughout the country, that where there are safety concerns, we will take them very seriously indeed and investigate them promptly, and where there are difficult reconfiguration debates to be had, we will not duck them, but in all cases, the interests of patients—patient safety and reducing mortality—must be our primary concern.
Greg Mulholland (Leeds North West) (LD)
18. There seems to have been little reliable evidence for the suspension of services at Leeds, but rather for the safe and sustainable review itself. Will the Secretary of State now do what NHS England has so far refused to do to the Independent Reconfiguration Panel, despite the recommendation of the health and overview scrutiny committee in Yorkshire, and finally publish all the official e-mails between the Joint Committee of Primary Care Trusts and the National Specialised Commissioning Team between 2008 and 2013, so that he can finally learn the truth about the review and what has gone so wrong with it?
Mr Hunt
I know that NHS England is totally committed to transparency and when I make my final decision on the Safe and Sustainable review, we will publish a lot of information. But all the things that he refers to are subject to normal freedom of information processes, and I am sure that he will pursue those.
Paul Flynn (Newport West) (Lab)
4. What his policy is on the introduction of standardised tobacco packaging; and if he will make a statement.
Gavin Barwell (Croydon Central) (Con)
7. What steps he is taking to increase accountability in the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
We have transformed accountability in the health system by setting up Healthwatch and introducing stronger local democratic accountability through health and wellbeing boards.
Gavin Barwell
Croydon PCT’s accounts for 2010-11 showed a £5.5 million surplus; it subsequently turned out to be a £23 million deficit. The former chief executive and two former finance officers have adamantly refused to give evidence to a scrutiny committee set up by councils in south-west London. Does the Secretary of State agree that that is unacceptable and that NHS managers must be held to account, and given that two of these individuals still work in the NHS, does he have the power to compel them to give evidence?
Mr Hunt
Accountability is extremely important. Local authorities can require members or employees of local health service commissioners to appear and answer questions, and NHS organisations and individuals should co-operate with that. I am extremely concerned by what my hon. Friend says. He knows that I have received a report on this from the joint overview and scrutiny committees for six south-west London boroughs, and I will be responding shortly.
Helen Jones (Warrington North) (Lab)
Does the Secretary of State agree that accountability would be improved if the private providers who are increasingly providing NHS services were subject to the Freedom of Information Act 2000? Will he ensure that as more and more services become privatised under this Government, those people are subject to the same freedom of information provisions as those in the NHS, because otherwise no committee can hold them to account?
Mr Hunt
Perhaps I could gently remind the hon. Lady that the previous Labour Government did not do this, despite making huge efforts to get more private sector involvement in the NHS. Providers must operate on a level playing field, and so the inspection regime that we are setting up, with a new chief inspector of hospitals, will apply equally to the private sector and the public sector.
Mr Stephen Dorrell (Charnwood) (Con)
Does my right hon. Friend agree that the introduction of health and wellbeing boards represents a very welcome introduction of democratic accountability into the management of the health and care system? Does he further agree that the acid test of health and wellbeing boards will be their ability to increase the pace of integration between health and care so that the service we deliver is more closely matched to the needs of patients?
Mr Hunt
As is so often the case, my right hon. Friend speaks extremely wisely on this issue. Integrated services will be the big thing that transforms the service we offer vulnerable older people, which the right hon. Member for Leigh (Andy Burnham) mentioned earlier. Health and wellbeing boards will have an extremely important role to play in bringing together local authorities and clinical commissioning groups so that we have joint commissioning of services for those very vulnerable people.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
On accountability, whenever I have asked the Secretary of State how lives might be saved by downgrading Lewisham’s A and E he has cited the medical advice of Sir Bruce Keogh. My colleagues and I have repeatedly sought meetings with Sir Bruce and it is unprecedented in my experience to not receive a response to such a request. Is the Secretary of State satisfied with that? Is Sir Bruce free to meet Lewisham MPs, or has the Secretary of State told him not to?
Mr Hunt
Sir Bruce is free to meet anyone he likes. Actually, he had a meeting with MPs last month, which the right hon. Lady could have attended if she had wanted to do so, and there was extensive engagement with local south-east London MPs before the decision on Lewisham hospital was made.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
8. How many accident and emergency departments he visited in an official capacity in winter 2012-13.
The Secretary of State for Health (Mr Jeremy Hunt)
I regularly visit a range of services across the NHS. Since taking up post in September 2012, I have visited 28 NHS front-line services, including seven A and E departments.
Tom Blenkinsop
Will the Secretary of State confirm that a freedom of information request to the Department of Health revealed that he did not visit an A and E unit until April 2013, a full six months after his appointment and despite a clear A and E crisis over the winter-spring period under his supervision?
Mr Hunt
As ever, the Labour party is being selective in its use of information. As I have said, I visited seven A and E departments, including over the Easter period when we had some severe A and E pressures that I wanted to investigate for myself. Let me tell the hon. Gentleman about another thing that this Government have done that his Government never did: it is not just Ministers who are going out on to the front line; we have asked all our civil servants to go on to the front line for up to four weeks. I am extremely proud that my Department will be the first to connect with the front line in that way, and am even prouder of the response from my own civil servants, who embraced the scheme with great enthusiasm.
Clive Efford (Eltham) (Lab)
Could we have some accountability for the strategic planning of A and E services across London? Nine of them face closure and 28 ambulances were redirected to Lewisham, which the Secretary of State intends to downgrade. Without a strategic approach, how can patients be confident that their best interests are being served?
Mr Hunt
We do have a strategic approach, but we also have some very important safeguards that any big change in approach has to go through before it is implemented. That is why I asked for a report from the Independent Reconfiguration Panel on the plans for north-west London, and I will consider that report very carefully before I make any decision.
Paul Burstow (Sutton and Cheam) (LD)
When considering issues relating to A and E closures, particularly the proposed closure of the A and E department at St Helier hospital, which serves my constituents, will the Secretary of State ensure that those who propose such plans make sure that there is also a costed plan for developing out-of-hospital care, which is an essential prerequisite for any changes to acute services?
Mr Hunt
I agree with my right hon. Friend on this issue. It is extremely important that all these plans take a holistic view both locally and nationally. That is why, in looking at how to resolve the A and E issues we have faced and the severe pressures last winter, we are looking not just at what happens inside A and E departments, but at primary care alternatives and the integration of social care services, which are all equally important.
Mr Jamie Reed (Copeland) (Lab)
Perhaps it took the Secretary of State so long to visit an A and E unit because he could not get in. In the midst of England’s A and E services experiencing their worst waiting times for a decade, the Secretary of State criticised hospitals for coasting. Does he regret waiting for six months before first visiting an A and E unit and finding out for himself what damage his policies were doing to the front line of the NHS? Hospital consultants, A and E consultants and patients look forward with interest to hearing his answer.
Mr Hunt
We will take no lessons on being connected with the front line from the party that missed 50 warning signs about what was happening at Mid Staffs. The hon. Gentleman cannot make the narrow point about how many A and Es I visited during a particular period without addressing the broad point about how connected Ministers in his party were when they were in power. They rejected 81 requests for a public inquiry because they did not know what was happening at Mid Staffs.
Andrew George (St Ives) (LD)
10. Whether he has any plans to review his policy on resource allocation in the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
Allocations to the NHS are the responsibility of NHS England. However, I have been advised that it will rely on the advice of the Advisory Committee on Resource Allocation for changes to the allocations formula.
Andrew George
While many wealthy areas are overfunded, Cornwall is more underfunded than anywhere else in the country. In the past six years, it has received in excess of £200 million less than the Government say it should receive. It also receives the lowest tariff in the country for acute care. Is the Secretary of State prepared to meet me and other representatives from Cornwall to address the serious issues that that is causing in front-line care?
Mr Hunt
My hon. Friend has had meetings with my ministerial colleagues on that issue and knows that such decisions are made at arm’s length from Ministers by NHS England. The allocation for NHS Kernow is £1,235 per head and the average baseline clinical commissioning group allocation is £1,184 per head. However, I recognise that there are issues with rurality and the age profile of the population. That is why a fundamental review is taking place of the approach that ACRA takes.
Steve Rotheram (Liverpool, Walton) (Lab)
In response to a parliamentary question that I tabled, the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), stated that circa £15 million in underspend was handed back to Public Health England by the now dissolved primary care trusts on Merseyside. Given that Liverpool has been identified as having some of the greatest health inequalities, will the Secretary of State guarantee that every penny of that £15 million will be spent in Merseyside alone?
Mr Hunt
What I can guarantee is that there will be a real-terms increase in the public health budget for all local authorities under a two-year settlement, which they did not have before. I hope that the information that was published this morning, which shows how cities that are comparable to Liverpool are managing to get better health outcomes, will help the local authority in Liverpool to improve its results.
Mike Thornton (Eastleigh) (LD)
11. What progress he has made in delivering parity of esteem between mental and physical health.
Chris Heaton-Harris (Daventry) (Con)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
There have been two important developments since the previous Health questions. First, in response to pressure on A and E departments, my Department, together with NHS England, has started work on a vulnerable older people’s plan that will act quickly to address the underlying causes of the issues, including services that are not integrated, poor IT systems, confused emergency care offered to the public and poor primary care alternatives.
Secondly, following the tragedy at Mid Staffs, I am delighted to announced that Professor Sir Mike Richards has been appointed as England’s first ever chief inspector of hospitals. He is an inspirational leader who has personally championed huge improvements in cancer survival rates. He will lead the vital work of driving up standards of safety and care throughout NHS hospitals.
Chris Heaton-Harris
I thank the Secretary of State for that statement. Will he give the House an assurance that he will look at GP contracts, with a view to amending them to ensure that better care is given to older patients?
Mr Hunt
My hon. Friend makes an important point. Talk to any A and E department in the country, and they will say that poor alternatives in the primary care sector are one of the things that are driving the pressures on them. It is important that we look at the structures put in place by the 2004 GP contract to see whether they are the right way to provide the care we need to give to older people.
Liz Kendall (Leicester West) (Lab)
Last week, the Select Committee on Health took expert evidence on the increased pressures in emergency departments and the causes of the worst A and E crisis in a decade. On Wednesday, the Chair of the Committee told this House that the 2004 GP contract
“is not why those pressures exist.”—[Official Report, 5 June 2013; Vol. 563, c. 1605.]
Will the Secretary of State tell us whether the right hon. Member for Charnwood (Mr Dorrell) is wrong?
Mr Hunt
I advise the hon. Lady to listen more carefully to what the Chair of the Select Committee said. He actually said that he agreed with much of what I said on the GP contract. While the Opposition are defending the status quo of the 2004 contract, independent support for reforming primary care is coming from the College of Emergency Medicine, the Royal College of Physicians, the NHS Alliance, the Family Doctor Association and even the head of the Royal College of General Practitioners.
Simon Hughes (Bermondsey and Old Southwark) (LD)
T2. In my borough of Southwark we have higher than average smoking rates, and the Cabinet member responsible for health has said that hundreds of people are dying early because they smoke. Can Ministers help me to persuade our Labour council that it is inconsistent to say “Don’t smoke” on the one hand and invest £2.6 million of pension funds in British American Tobacco on the other?
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
T5. I listened carefully to the Public Health Minister’s answer just three questions ago, but the Government have disproportionately cut funding to the most deprived local authorities, including Liverpool, and these local authorities have today been shown to have higher mortality rates. How does the Secretary of State expect to close, rather than widen, health inequalities?
Mr Jeremy Hunt
We actually gave a real-terms increase to all areas, including Liverpool, and followed the independent advice. If funding for public health in Liverpool is lower than it should be, that is because the last Government set the baseline way lower than it should have been.
Adam Afriyie (Windsor) (Con)
T9. For the last decade, in the face of constant threats of closure to Heatherwood and Wexham Park, I have campaigned alongside local councillors, activists and residents to try to get the right balance of services across my constituency. The people I work with are very reasonable, as is the Secretary of State, so will he meet me and a small delegation from Windsor to discuss their options?
Alex Cunningham (Stockton North) (Lab)
T6. Three Health Ministers have indicated their support, and one even voted for it, so will the Secretary of State either introduce his own legislation or back new clause 17 to the Children and Families Bill to ban smoking in cars with children present?
Charlotte Leslie (Bristol North West) (Con)
Does the Secretary of State agree that any criminal investigation into the 200 to 300 deaths at Mid Staffs should extend not only to front-line staff, who risk getting scapegoated, but to all managerial levels, Department of Health officials and the heart of Government, so that we get answers about who knew what and when, and what action they took or—more importantly—did not take that could have prevented this tragic scandal?
Mr Jeremy Hunt
I congratulate my hon. Friend on her determined campaigning on this issue. She will agree that we must allow the law to follow its course. The police are looking at the five reports on hospital safety that were undertaken, the inquests and the lists of patients who appear to have been treated badly, and they are talking to the relatives of those patients. We must allow them to do their work, but no one is above the law, and particularly in this case it is important that justice be done.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
T10. With the Department of Health having awarded Cleveland fire brigade £198,000 from its social enterprise investment fund, will the Minister confirm, pursuant to concerns raised by the Fire Industry Association, that his Department undertook an assessment as to the compliance with the European state aid regulations of the state’s funding of community interest companies that compete to take business away from the private sector?
Jason McCartney (Colne Valley) (Con)
Does the Minister agree that children’s heart surgery units such as the one in Leeds now need certainty so that they can continue to attract the highest calibre of staff?
Mr Jeremy Hunt
I agree with my hon. Friend and the sooner we can make a decision and announce it, the better. This issue is of huge importance to the people of Leeds and I want to do all I can to expedite the process.
Jim Shannon (Strangford) (DUP)
When a patient is ill and visits their GP, they will do as the doctor orders. One hundred thousand people will die of lung cancer this year. When will the Government do as the doctor orders and bring in plain packaging for tobacco?
Geraint Davies (Swansea West) (Lab/Co-op)
Is the Secretary of State aware of the alcohol treatment centre in the middle of Cardiff, which treats people who are drunk on Friday and Saturday nights and therefore takes pressure off A and E, ambulance services and the police? Will he look at this model, as we are in Swansea, and pilot it elsewhere?
Mr Jeremy Hunt
That is definitely worth looking at and is exactly the kind of proposal that we could think about for NHS England. It could make a very big difference.
George Freeman (Mid Norfolk) (Con)
Will my right hon. Friend clarify the position regarding NHS spending, in light of the recent comments from the shadow Health Secretary? My understanding is that spending increased from £99.7 billion in 2009-10 to £106 billion in 2012-13; an increase of £600 million, or 14,000 nurses or 6,000 doctors. Does not this show that the shadow Health Secretary’s reference to cuts is just irresponsible scaremongering?
Mr Hunt
My hon. Friend is right. There has been a £600 million real- terms increase in spending, something that the right hon. Member for Leigh (Andy Burnham) said was irresponsible. He will have to do a U-turn on this, and it will be an embarrassing one. He has talked about cuts in every single debate in the House and it turns out that those cuts never happened.
Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)
Life expectancy in Liverpool is 10 and a half years less than it is in Kensington and Chelsea. Does the Secretary of State think that he has any responsibility to address that?
Mr Hunt
Yes I do, which is why we have published a website today that gives much more detail than there ever has been before about health inequalities. it is why, nationally, the Government have been responsible for a huge amount of initiatives to boost public health, including calorie labelling in restaurants, action on point of sale display tobacco advertising, alcohol unit labelling and a range of other things. We will play our part.
Jane Ellison (Battersea) (Con)
In April, the BBC’s “Casualty” programme highlighted the vital role that health professionals have in spotting young girls at risk of being taken abroad or of having female genital mutilation carried out on them in this country. We are approaching the most difficult time of the year over the long summer holidays, when girls are most at risk. Will Ministers do all they can to draw the attention of health professionals to the vital role that they have in these critical next two months?
Ian Austin (Dudley North) (Lab)
I listened to the answer to Question 7 earlier, but surely the best way to improve accountability in the NHS would be much greater consumer choice and competition when it comes to GP services, for which there are virtually no comparative data at the moment. With modern IT, why can patients not choose to have their own medical records and then ring round to find a GP who will treat them when they want to and not when their own GP deigns to see them?
Mr Jeremy Hunt
What the hon. Gentleman says has a lot of merit. We need to have transportable digital medical records that can be accessed anywhere in the system. That would make better out-of-hours care much more possible than it is at the moment.
Accident and Emergency Waiting Times
Jeremy Hunt Excerpts(13 years, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
What we have heard today will rank as one of the poorest speeches ever given by an Opposition on the NHS. [Interruption.] I predict—[Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. [Interruption.] Mr Karl Turner, thank you for your advice, but we can manage without it today. I make this appeal to both sides: I want to hear what the Secretary of State has to say, just as I wanted to hear what the Opposition had to say.
Mr Hunt
Thank you, Mr Deputy Speaker.
I repeat: it was one of the poorest speeches ever given by an Opposition on the NHS, and I predict that the right hon. Member for Leigh (Andy Burnham) will bitterly regret choosing to make an issue of A and E pressures, because the root causes of the problem have Labour’s fingerprints all over them.
The right hon. Gentleman was right on one thing, however: there is complacency on this issue—not from the Government, who have been gripping it right from the start, but rather from Labour, which still does not understand why things went so badly wrong in the NHS on its watch.
Labour’s narrative has, I am afraid, a single political purpose at its heart: to undermine public confidence in one of our greatest institutions—an institution which, in challenging circumstances, is performing extremely well for the millions of vulnerable people who depend on it day in, day out.
Labour’s story today is a totally irresponsible misrepresentation of reality. One million more people are now going through A and Es every year than in 2010, which creates a lot of pressure, so how are A and E departments actually performing? The latest figures show performance, against the 95% target, of 96.7%. The week before it was 96.5%, then before that 96.3%, 96.6% and 95.6%. Yes, we had a difficult winter and a cold Easter, and I will come to the causes of the problems we had then, but, thanks to the hard work of NHS doctors and nurses, our A and E departments are performing extremely well.
Henry Smith (Crawley) (Con)
The Secretary of State is absolutely right to say that we should point to the record of the previous Government, who closed the A and E department in Crawley.
Angie Bray (Ealing Central and Acton) (Con)
My right hon. Friend should know that my constituents welcome his decision to refer to an independent review the plans to close the four A and Es closest to my constituency. Does he agree that the review will need to look carefully at whether due consideration was given to the impact of those four closures on the neighbouring hospitals and their A and E departments?
Mr Hunt
I will make some progress and then give way. I want to ask why the Opposition have chosen to call this debate. I am afraid it is nothing less than a smokescreen, because their objective is to try to dress up the pressures on A and E as a short-term crisis when, as every A and E department in the country will tell us, to deal with the pressures we need to address long-term structural problems that the previous Government either ignored or made worse.
Bill Esterson (Sefton Central) (Lab)
May we talk about one of the pressures on A and E, which is the pressure of social care? I hope that the Secretary of State will accept that significant cuts have been made in social care under this Government and that the role of social care is crucial in keeping people in their homes in the first place and in returning them to their homes after they have been in hospital. As a result of those cuts, it is very difficult for social care to perform that role. Will he examine the suggestion by my right hon. Friend the Member for Leigh (Andy Burnham) to use the underspend from the Department of Health to support social care to perform its essential role?
Mr Hunt
I will come to that suggestion, but I agree with the hon. Gentleman. If we are going to deal with bed blocking, which is one of the root causes of the problems that many A and E departments talk about, we have to have better integration between the health and social care systems—that is essential. I say to him that the problem of the underfunding of social care did not start in 2010; as my hon. Friend the Member for Stourbridge (Margot James) said, it is a problem that goes back many years, and the failure to integrate health and social care was a failure that happened over 13 long Labour years.
Mr Hunt
I am going to make some progress and then I will give way.
There is something else that the Labour party does not want the public to notice and it is another elephant in the room: the NHS is actually doing better under the coalition than it ever did under Labour. Let no one forget the NHS we had in 2010: no cancer drugs fund for the 26,000 people who now benefit from it; 400,000 fewer operations every year; double the number of MRSA infections; and 18 times more people waiting for more than a year for their operation.
Mr Hunt
I am going to make some progress. The right hon. Member for Leigh talked about grip. There is one place where grip is badly lacking. Labour does not like to hear about this because it is Labour-run Wales, where, as the Prime Minister said this morning, the A and E target has not been met since 2009. It is where performance—[Interruption.] I know that Labour Members do not want to hear this, but I suggest they listen to it, because performance in Wales—[Interruption.] Let me finish making the point. Performance was worse in Wales than in England for every one of the weeks that we missed our A and E target this winter. If the right hon. Gentleman really cared about patients, he would be condemning what is happening in Wales.
Mr Hunt
I will make my point and then I will give way. Labour Members need to hear about what is happening in Wales, because Labour runs the NHS in Wales. One patient in Wales had a cardiac arrest—[Interruption.] I know that this is difficult for Labour Members, but they need to hear about what is happening in Labour-run Wales. One patient had a—
Mr Hunt
I will give way to the shadow Health Secretary in a minute. One patient there had a cardiac arrest in the eye-examination room as there was no room in the resuscitation bay, and 24 to 36-hour waits for beds are now common in Wales. One patient spent a full three days in a Welsh emergency department. So let me give him a chance finally to condemn what is happening in Wales.
Andy Burnham
People watching this debate will be wondering why the Secretary of State is talking about something that is not his responsibility; nor is it mine. He is not responsible for the NHS in Wales; nor am I. I have put to him today serious questions about the NHS in England right now. He is the Secretary of State for the NHS in England, so will he now address the questions I put to him?
Chris Bryant (Rhondda) (Lab)
Will the Secretary of State give way to a Welsh MP?
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. We want a little more calm. Mr David, you are getting far too excited. It is not good for you and it is not good for the Chamber—[Interruption.] Order. I do not want you to repeat your point. I have just explained to you that I need you to be a little calmer. It is up to the Secretary of State whether he wishes to give way and at the moment he is not doing so. It is his choice and shouting will not make any difference whatsoever.
Mr Hunt
I will give way to the hon. Gentleman, if he will just take his place for a moment while I make my point. I will also give way to my hon. Friend the Member for Enfield North (Nick de Bois)—[Interruption.] I will reflect on whether I want to give way to the hon. Member for Rhondda (Chris Bryant), but I will certainly give way to the hon. Member for Caerphilly (Wayne David).
What is happening in Wales is directly relevant to what is happening in England, because in England the NHS budget has increased in real terms and NHS spending has increased in real terms. If we did not increase them both, that would mean fewer doctors, fewer nurses and longer waits for operations—[Interruption.] The shadow Secretary of State shouts from a sedentary position that the NHS—
Andy Burnham
On a point of order, Mr Deputy Speaker. The Secretary of State has just said at the Dispatch Box that the budget for the NHS has increased in real terms. In December, I referred the Secretary of State’s comments to the UK Statistics Authority and I received a letter back saying that they were incorrect. Will you ask the Secretary of State to correct the parliamentary record and ensure that when the statistics commissioner makes a ruling it is adhered to by the Secretary of State?
Mr Deputy Speaker
That is not a point of order, but the right hon. Gentleman has certainly made his clarification for the record.
Mr Hunt
I thought that the shadow Health Secretary might try to do that, so let me give him the figures. I have the figures provided by the Department of Health finance department, based on the latest GDP deflators, as published at the Budget. Spending in the NHS—not the budget—in 2009-10 was £99.7 billion and for 2012-13 it is forecast to be £106.6 billion. That is a cash increase of £6.9 billion and a real-terms increase of £0.6 billion, so there is a real-terms increase in the NHS budget. The shadow Secretary of State does not agree with the real-terms increase of £600 million in the NHS today; there would be a Labour cut in NHS spending and I suggest that he might want to correct the record, as I am afraid he has got this wrong.
Nick de Bois (Enfield North) (Con)
My right hon. Friend knows, as his predecessor does and as the Prime Minister does, of my consistent opposition to the downgrading of Chase Farm hospital. Does he agree with me that it is utterly inacceptable for the hon. Member for Hammersmith (Mr Slaughter), who is no longer in his place, to suggest otherwise in this Chamber?
Wayne David
I thank the Secretary of State for eventually giving way. Does he not accept that, despite the fact that the block grant to the Welsh Government has been cut by £1.4 billion, Welsh spending on the health service has been maintained in real terms?
Mr Hunt
What Labour did in Wales was cut the NHS budget by 8% and that is why that Government have not met their A and E targets since 2009. Those on the Labour Front Bench in England want to cut the NHS budget here. That would not help pressures on A and E; it would make them a great deal worse.
Mr Hunt
I shall make some progress, because this gets even worse for Labour.
The shadow Secretary of State wrote to me at the weekend, asking me to relieve pressure on A and E by using the health underspend to put extra money into social care. There is a way of releasing resources into social care, but it is not that, because the underspend he talks of sits largely with NHS trusts and clinical commissioning groups, which are allowed to keep their underspends and roll them over to subsequent years. If we took away that money and put it into social care, we would therefore have to take it away from hospitals, where it is needed most to help tackle pressures in A and E and other places.
Let us look at some of the hospitals that would lose money under Labour’s plans. Wigan and Leigh NHS Foundation Trust, in the right hon. Gentleman’s own constituency, had a £4 million underspend in 2012-13. It would be prevented from using that money to reduce A and E pressures, as would the Royal Cornwall, the Royal United hospital Bath, Nottingham University hospitals—
Mr Hunt
I am going to make some progress. The Royal Wolverhampton, East Lancashire, Royal Liverpool and Broadgreen, North Bristol, Coventry and many other hospitals would also be prevented from using the money. So Labour’s solution to the A and E crisis is to cut funding to hospitals—about as logical as wanting to reduce debt by increasing the deficit.
From a Labour party that wants to be a Government in waiting, this is not good enough. It is against a cut in NHS spending that did not happen, but when there is a real cut in Wales it says nothing. It is against hospital reconfigurations in England, where we are hitting the A and E target, yet says nothing about reconfigurations in Wales, where Labour is missing the A and E target. It says it is against reorganisations and it has just proposed its own huge structural reorganisation to merge the health and social care system. Why is that? It is because in the end it is more interested—we have seen this today—in party politics than the right policies. I think we can expect better from someone who used to be a Health Secretary.
Mr Hunt
I shall make some progress because I have some important points to make.
A and E pressures are not the only thing that happened to the NHS this winter; we also had the Francis report into Mid Staffs. That tragedy is also relevant to A and E pressures, because at the height of its failures in care, Mid Staffs, unbelievably, was actually hitting its A and E target. In fact, between 2004 and 2009, there were only three quarters in which Mid Staffs failed to see 95% of people within four hours—hitting the target and missing the point. But in Labour’s NHS, hitting the target was all that counted, because Ministers ignored three reports, 50 warning signs and 81 requests for a public inquiry into Mid Staffs and what was going on.
Things have changed in the NHS, and I say this plainly. It is harder now for hospitals to hit their A and E target, because we will not condone cutting corners to get there. Targets matter, but not at any cost, and we are determined to reach them by doing things properly, making sure that we always treat patients with dignity and respect.
Mr Hunt
I shall make some progress.
Labour’s complacency on that issue is revealed as even more shocking when we look at the root causes of pressures on A and E departments, because nearly all of them involve issues that Labour either failed to tackle in office or made a great deal worse—for example, the IT fiasco, so heavily criticised by the National Audit Office. It is completely unacceptable that A and E departments are not able to access, with their consent, people’s GP records. Last year, there were 30,000 wrong prescriptions in the NHS and 11 deaths—something we know would be significantly improved with e-prescribing in hospitals. The Government have addressed that, with a fund that I announced last month and an ambitious programme to make the NHS paperless by 2018, learning from that procurement debacle for which we are now paying the price.
Let us look at other causes. The working time directive, which Labour signed up to, makes the recruitment of A and E staff very much harder.
Mr Hunt
I think the hon. Gentleman should listen to this. Professor John Temple described that as having the biggest impact on the emergency and out-of-hours parts of the NHS, which is why the Government are now having to increase recruitment into A and E through the mandate that the Government have set Health Education England. Or there is the total failure—
Gloria De Piero (Ashfield) (Lab)
In one week in April 2012, 75 people in Sherwood Forest trust waited longer than four hours at A and E. In the same week in April this year, 266 people waited longer than four hours at A and E. That is a 255% increase. How does the Secretary of State account for that?
Mr Hunt
I agree that A and E departments are under huge pressure, and that is why we are taking a lot of measures to deal with them, which is what I am talking about. But I am saying that we have to deal with the root causes, which were things that the shadow Secretary of State’s Government failed to deal with. [Interruption.] Labour Members need to listen. We listened to the shadow Secretary of State’s solutions, which were not really solutions; now I am telling them what we think needs to happen.
We welcome the fact that the Labour party has now seen the light and recognises the need for integration, but Labour Members need to show some humility, because it was the Labour Government who put in place many of the barriers—in particular payment by results mechanisms—that make that so hard to achieve. We are now trying to make integration a reality through the 10 pilots on removing barriers to integration announced by the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), as part of the vulnerable older people’s plan announced to the House last month. Without integration, we will not solve the problem of bed blocking, which is at the heart of the pressures on A and E.
Andrew Percy (Brigg and Goole) (Con)
The Secretary of State is right to say that many of the present failures started in the Labour years, particularly the problems with integration. Does he share the concern that I and many of my constituents feel about the 50,000 beds that were lost under Labour Government? We lost the beds, but the intermediate care services and step up, step down facilities were never created to deal with the consequences. That is what is behind a lot of the A and E referrals today.
Mr Hunt
That is part of the problem with Labour’s approach to the NHS—a top-down approach of closing or downgrading A and E units and making the NHS sort out the problems. We are not doing that.
It is time that Labour took responsibility for the disastrous changes to the GP contract, which contributed to making it so much harder to get a GP appointment and piled further pressure on A and E departments—[Interruption.] No, they need to listen; this is important. The changes in 2004 handed responsibility for providing out-of-hours services to administrators in primary care trusts, at a stroke removing the 24/7 responsibility for patients that until then had always been a core part of being a family doctor. As we heard earlier today, even a former Labour Health Minister regretted those changes, saying before the last election:
“In many ways, GPs got the best deal they ever had from that 2004 contract and since then we have, in a sense, been recovering.”
It is important that Labour Members hear the list of independent voices all saying that we need fundamental change in primary care if we are to deal with pressures on A and E: the College of Emergency Medicine, the Royal College of Physicians, the NHS Alliance, the Family Doctor Association, the head of the Royal College of General Practitioners, who—surprisingly—said something in support of the Government in The Guardian this morning, the Foundation Trust Network and so on. All those voices were ignored by Labour as it put its head in the sand about that disastrous change to the GP contract.
Ian Swales (Redcar) (LD)
Does the Secretary of State share my horror that the out-of-hours contracts awarded by the previous Government to companies such as Serco give them a financial incentive to call an ambulance rather than deal with cases through GPs or in the community?
Yasmin Qureshi (Bolton South East) (Lab)
Today’s debate is about the increase in waiting times at accident and emergency departments. In 2010, when Labour left office, 98% of people were seen within four hours; three years later, after three years of Conservative Government, the number of people who have to wait more than four hours has trebled. What is the Secretary of State going to do about that?
Mr Hunt
Let me say very directly to the hon. Lady that since 2010 two things have happened that have contributed—[Interruption.] I am answering the question. First, 1 million more people are now going through A and E; secondly, the target has been reduced from 98% to 95% on the advice of the College of Emergency Medicine and the Royal College of Nursing. Labour has decided to do the same thing in Wales. Obviously, in that situation, the result is an increase in the absolute numbers; however, year on year since 2010, this Government have hit our A and E targets and we intend to continue to do so.
Sir Bob Russell
Mention has been made of an additional 1 million people going to accident and emergency. The derision I received earlier was an attack on organisations such as St John Ambulance, which trains first aiders, because the simple fact is, as I said when speaking to my ten-minute rule Bill 10 years ago, that first aiders will
“reduce visits to overstretched accident and emergency departments by people whose injuries did not warrant hospital attention”—[Official Report, 19 November 2003; Vol. 413, c. 809.]
We should be getting more first aiders out there. If the last Labour Government had listened to that, we would have 1 million more first aiders.
Mr Hunt
No, I will make my concluding remarks. We will address these fundamental issues in our vulnerable older people’s plan, which is being published later this year. I have asked Sir Bruce Keogh, NHS England’s medical director, to lead an urgent review of demands on our emergency care and how services should respond in future. In the short term, we have changed the tariff arrangements for A and E payment to give hospitals a say in the use of funds earmarked to prevent avoidable admissions. The result is that A and E targets are now being met, not missed; long-term challenges are being confronted, not avoided; and the NHS, with its extraordinary professionals, is facing up to the great challenges of an ageing population with resilience and determination, treating more people more quickly and more safely than ever before in its history, and rather than deriding that performance for party political purposes the House should be celebrating its success.