A and E Departments
Jeremy Hunt Excerpts(13 years, 2 months ago)
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Andy Burnham (Leigh) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on what evidence he has to show how his plans to change GP services will solve the current crisis in accident and emergency departments.
The Secretary of State for Health (Mr Jeremy Hunt)
A and E departments are under great pressure, and the whole House will want to pay tribute to the thousands of doctors, nurses and health care assistants who work extraordinary hours in very challenging conditions. They are there for us when we need them, and we owe them a great debt.
More than 1 million more people visit A and E every year compared with just three years ago—those are additional numbers—and the simple fact is that if growth continues at that rate it will be unsustainable. It also means that when there are short-term pressures on the system, such as a very cold winter, teething problems with NHS 111 or bank holidays, the system cannot cope as well as it needs to and the quality of care is affected.
Let us be clear: A and Es are currently hitting the 95% target. The latest figures show that 96.3% of patients are seen within four hours, and people are waiting on average 55 minutes for treatment. However, if A and E services are to be sustainable, we need both short-term and long-term measures to address the underlying causes of the pressure they are under.
Last week, NHS England announced that it would change the basis on which tariff money for certain A and E cases is spent. For the first time, hospitals will have a say in how money is spent to alleviate demand when that money is withheld for numbers exceeding the 2009 baseline. We also need to address more fundamental issues, which is why I announced to the House on 13 May that the Government will publish in the autumn a vulnerable older people’s plan that will tackle those long-term underlying causes of pressure in our A and Es, particularly for the frail elderly who are the heart of many of the issues we face in both quality of care and service performance.
The changes the Labour Government made to the GP contract took responsibility for out-of-hours care away from GPs. [[Interruption.] Labour Members may not like to hear the facts about the consequences of those changes, but let us go through them—they asked the question. Since those changes, 90% of GPs have opted out of providing out-of-hours care, and they got a pay rise in addition. As a result of those disastrous changes to the GP contract, we have seen a significant rise in attendances at A and E—4 million more people are using A and E every year than when the contract was changed. As researchers from the university of Nottingham found, to give just one example, a reduction in out-of-hours services provided by patients’ usual family doctors is a direct cause of increased A and E attendance by children.
There are other issues too, including the lack of integration with social care, and vulnerable patients being discharged from hospital with no one co-ordinating proper health and social care to support them in their own homes. That lack of integration was something else that the previous Government failed to address over 13 long years.
Then there are the problems inside A and E departments caused by the disastrous failure of Labour’s IT contract. When people are admitted to A and E departments, the departments are unable to see their medical records, which could have an enormous impact—[Interruption.]
Mr Speaker
Order. First of all, the Secretary of State should not have to shout to be heard. Secondly, the more heckling there is, the slower progress tends to be. I want to accommodate colleagues, but as a matter both of courtesy and of practicality the Secretary of State should be heard in silence.
Mr Hunt
We will address those problems inside A and Es and the system-wide issues. It is not all about the GP contract, but that is a significant part of it, because confidence in primary care alternatives is a key driver in decisions on whether to go to A and E. We will take responsibility for sorting out those problems, but the Labour party must take responsibility for creating a number of them.
Andy Burnham
The Secretary of State could brief the newspapers last night, but he could not give a straight answer to my question today. He has not outlined his plans to change GP services.
The facts are that A and Es are under severe pressure and people are waiting hours on trolleys in corridors or in the back of queuing ambulances to be seen. Last week, a third of major A and Es missed the Government’s lowered targets—some were seriously adrift. At University Hospitals of Leicester, 78% of patients were seen within four hours. Seventy-nine per cent. of patients were seen within four hours in Portsmouth. Things have taken a more serious turn today, with news that 20 senior A and E doctors say they are unable to guarantee patient safety.
For weeks, the Opposition have warned the Secretary of State to get a grip. His only substantive response was to tour the TV studios to blame the 2004 GP contract. We today read that his answer is yet another costly NHS reorganisation, this time of GP services. Where is the evidence to support his contention that that will solve the A and E crisis? Why did he not outline his plans to the House—he has already given the news to newspapers?
This morning, the chief executive of the NHS Confederation told the Select Committee on Health that there is no link between today’s pressures on A and E and the 2004 contract, echoing expert analysis from the King’s Fund. If the GP contract is the root cause, as the Secretary of State claims, will he explain why 98% of people were seen within four hours in 2009, five years after the contract was signed? That figure has deteriorated sharply under his Government, and mainly on his watch. Major A and Es have missed the target in 33 of the 35 weeks when he has been Health Secretary. His complacency is dangerous. Is it not time he stopped blaming GPs to divert attention from a mess of the Government’s own making and addressed the real causes?
Two weeks ago, NHS England told the Secretary of State what those causes were. He needs to provide convincing answers on each. What steps is he taking to prevent the collapse of adult social care in England? What is he doing to ensure that all A and Es in England have enough doctors and nurses to provide safe care? Will he update the House on the status of his plans to cobble together a £400 million A and E crisis fund, news of which was leaked a fortnight ago? Will he halt the closure of NHS walk-in centres and personally review all planned A and E closures? What is he doing to sort out the failing 111 service? Did he not speed up implementation against official advice?
The truth is that this is a mess of the Government’s own making. It will not be solved by the Secretary of State’s spin or by blaming GPs. He has been found playing politics when he should be dealing with the real causes of today’s chaos. Faced with a real crisis, he has been found wanting. He needs to cut the spin and get a grip.
Mr Hunt
The right hon. Gentleman says, “Forget Wales,” but why has he never once been prepared to condemn the appalling failures in A and E in Wales, caused by the Welsh Labour Government’s decision to cut NHS spending by 8%? What he says would have some credibility were he at least prepared to condemn what has happened in Wales, but he never does.
The right hon. Gentleman asks for the evidence, and I will tell him. Patrick Cadigan of the Royal College of Physicians says that the pressures on A and E are caused because many people assume that, after 5 pm, the lights in the NHS go out everywhere except A and E departments—a direct consequence of those disastrous 2004 changes to the contract. Nottingham university conducted an independent study, and last year’s GP patient survey found that only 58% of patients know how to contact their local out-of-hours service, 20% find it difficult to contact their out-of-hours service, and 37% feel that the service is too slow—problems that we are trying to address. Perhaps he should visit some A and E departments and talk to consultants, doctors and nurses, because they will tell him that the changes to the GP contract, which he says have nothing to do with the pressures on A and E, have had a huge and devastating impact.
He talks about taking responsibility for these problems. Let us see if he is prepared to take responsibility. Is he prepared to take responsibility for the target-at-any-cost culture in some parts of the NHS under Labour, which led to the disaster of Mid-Staffs? Is he prepared to take responsibility for the IT failures that mean that A and E departments cannot access GP records? Will he nod his head if he is prepared to take responsibility? [Interruption.] He is not prepared. Is he prepared to take responsibility—
Mr Speaker
Order. Let us get this back on track. There are two very simple points: first, those on the Opposition Front Bench should not be yelling at the Secretary of State; secondly, for the avoidance of doubt, the responsibility of the Secretary of State is to answer questions, not ask them.
Mr Speaker
Order. I have told the Secretary of State what the position is. It is not for argument or debate. His responsibility is to get on with answering in the way the House of Commons expects.
Mr Hunt
And I would always seek to do so, Mr Speaker.
Finally, the right hon. Gentleman constantly seeks to run down the performance of the NHS. Where is the recognition of the outstanding performance of the NHS under this Government: the fact that under this Government 400,000 more operations are happening every year than under Labour; the fact that the number of people waiting for more than a year for an operation has gone down from 18,000 under Labour to fewer than 1,000 under this Government; the fact that MSRA rates have been halved; and the fact that mixed-sex wards have nearly been eliminated? We will stick up for the great achievements of our NHS and we will not allow people to run it down. However, we will also tackle problems honestly and ensure that we address crises, many of which were caused by the previous Government.
Mr Stephen Dorrell (Charnwood) (Con)
Does my right hon. Friend agree that patients seeking urgent care will go to that part of the health service where the lights are on, and that the failure of the Opposition, over 13 years, to create genuinely integrated emergency care is the fruit we are now harvesting?
Mr Hunt
As ever, my right hon. Friend speaks with great wisdom. When it comes to the frail elderly, the key is to have a system that heads off problems before they arrive so that people do not find that they end up having to be rushed into A and E in the middle of the night. That can often be the very worst place for someone with advanced dementia or any condition that makes them extremely fragile and vulnerable. We need to integrate systems properly, and that did not happen under the previous Government. One of the key work streams of the vulnerable older people’s plan will be to look at barriers to integration, particularly the barriers to joint commissioning of social care and health. We intend to make good progress on that front.
Frank Dobson (Holborn and St Pancras) (Lab)
Does the Secretary of State accept that when NHS Direct was operating, nurses had the professional competence to decide not to refer people to A and E, and to provide reassuring advice? They have been replaced by call handlers who, understandably, opt to send people to A and E because they have neither the professional competence nor the professional confidence to do anything else?
Mr Hunt
I agree that there have been teething problems with 111 and we are addressing those problems. [Hon. Members: “ Teething problems?”] There is laughter on the Opposition Benches. We are hitting our A and E targets at the moment, and 111 is available in more than 90% of the country. We are dealing with those teething issues, but I take on board the right hon. Gentleman’s point. The 111 service needs to be quicker at getting advice to people from a GP or a nurse. The fundamental issue with 111 is that giving the public an easy number to remember has highlighted how inaccessible GP out-of-hours services have become. We have to address that if we are to restore public confidence in 111.
Dr Sarah Wollaston (Totnes) (Con)
If someone cannot get an appointment with their family doctor, they are undoubtedly more likely to end up in A and E, but does the Secretary of State agree that we will not increase capacity in primary care unless we address the work force shortage in general practice and broaden the skill mix of those who can see people in primary care?
Mr Hunt
I agree with my hon. Friend. Under this Government, we have 6,000 more doctors than we had under Labour, but we need more people going into general practice as well. [Interruption.] Yes, the training might have started under the Labour Government, but the funding happened under this Government, and it would not be possible if we cut the budget, which is what the Labour party still wants to do. She is right to point out those issues, however. One way of making general practice more attractive is to restore the personal link between GPs and the people on their list and a sense of personal responsibility and accountability. We need to find the right way of doing that, given the pressures on general practice at the moment, and I hope to work with her and many others to do that.
Mr John Denham (Southampton, Itchen) (Lab)
May I tell this complacent Secretary of State that in 28 out of the last 30 weeks Southampton general hospital has missed the waiting time A and E target? In the week beginning 7 April, only six out of 10 patients were seen within four hours. It is clear that this is a crisis of the whole health system. Given that in the last six months his own specialist advisers have praised the Southampton health economy for the role that primary care has played in reducing pressures on A and E, will he think again before simply blaming one group of doctors for a problem that runs right through the health system and into social care?
Mr Hunt
I am not blaming any doctors; I am blaming the Labour party for making disastrous decisions in office. We are addressing the issues that his party failed to address. If Southampton is not meeting its A and E targets, that is unacceptable. We are talking to all the hospitals struggling to meet those targets, but they all say—I am sure that people in Southampton would say this as well—that we need to look at the fundamental issues, which are barriers between the health and social care systems, poor primary care alternatives and problems inside hospitals with how A and E is handled. We are addressing all those issues.
John Pugh (Southport) (LD)
Better co-ordination of ambulance trusts and A and E departments is essential, but it will not happen by accident. Are we not now missing the strategic health authorities, given that ambulances are being sent to units already working at full capacity?
Mr Hunt
By getting rid of the layers of bureaucracy we had with strategic health authorities and primary care trusts—a brave and important decision made by my predecessor—we have been able to invest in more front-line staff. The NHS is doing much more, in terms of the number of operations, out-patient appointments and people being seen by A and E, because we are investing in the front line, but it is the responsibility of the new clinical commissioning groups to ensure proper co-ordination, and I would expect them to do that.
Mr Kevin Barron (Rother Valley) (Lab)
The Secretary of State attributes the current crisis in A and E in part to a contract that doctors signed back in 2004 and the fact that large parts of the NHS turn off the lights at 5 pm or 6 pm, which they have done for 60 years. Is there anything for which this Government have been responsible in the NHS since 2010?
Mr Hunt
Yes, we have been responsible for a huge increase in performance, many more people being operated on, the virtual elimination of mixed-sex wards, MRSA rates being halved, more operations than ever before, more outpatient operations than ever before and more GP appointments than ever before.
Dr Phillip Lee (Bracknell) (Con)
I am struck by the fact that no mention has yet been made of the drivers of the reported chaos in A and E and the pressures on primary care out of hours. What of ageing? What of obesity? What of the changes in behaviour, the absence of stoicism, the increase in medical technology costs? Whatever the system that either the Government or the Opposition talk about, it will come under pressure. When will we have some reality in this Chamber about the causes of this problem, because the sooner we have, the better we will all be?
Mr Hunt
I recognise my hon. Friend’s clinical background. When I talk to clinicians in A and E wards, they tell me that the long-term drivers of the pressures they are under are an increase in the number of older people and an increase in the acuteness of the conditions of people coming through the doors. That is why at the heart of our long-term solution is a vulnerable older people’s plan that ensures we look after them with the dignity, compassion and respect they deserve.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
Why does the Secretary of State not increase access to primary care during normal working hours by reintroducing the requirement on primary care services to see patients within 48 hours, as happened under the Labour Government?
Mr Hunt
That target led to many problems, as the hon. Lady well knows. She might remember, from the 2005 general election campaign, the issues of people being denied appointments for three, four or five days because GP surgeries were being paid to meet specific 48-hour appointments. That is one issue. Too often, if people call GPs for an appointment, they are told that the earliest they can have one is in two, three or four weeks, which makes them think, “What are my alternatives?” and leads them into A and E. We must think about how we can change that and alter the incentives in GP contracts so that they can give the kind of service to their lists they would like to.
Mr Bernard Jenkin (Harwich and North Essex) (Con)
Do I need to remind my right hon. Friend that the outgoing Labour Government in 2010 left a note on the desk of the Chief Secretary to the Treasury saying, “There’s no money left”? Is not the challenge the need to make the NHS work on more or less flat funding—though we are doing our best to increase it—while dealing with huge increases in demand? Is not the only answer to do more in the general practice setting, where it can be done more responsibly, more local to patients’ needs and more cheaply, in order to take the pressure off A and E services?
Mr Hunt
My hon. Friend speaks extremely wisely. We must do just that, particularly for the frail elderly, people with long-term complex conditions, because they are the people for whom an A and E department can be a bewildering place, especially if it knows nothing about them and cannot access their medical records. Prevention is far better than cure, and I agree that that is one way of doing it.
Stephen Pound (Ealing North) (Lab)
The Secretary of State advises us to visit A and E departments. Were he to visit the one in the excellent Ealing hospital in the constituency of my hon. Friend the Member for Ealing, Southall (Mr Sharma), he would see the grotesque, confusing and expensive sight of a spatchcocked urgent care centre next to an A and E department, one acting as a gateway for the other. It is confusing, divisive and expensive. Is he entirely comfortable with this concept?
Mr Hunt
The hon. Gentleman makes an important point. We have failed as an NHS to give the public confidence in there being anything between an A and E department and a GP surgery. Whether they are urgent care centres or other centres, the public do not have that confidence and do not understand their role. We need other things, besides those two extremes, and to do a better job of informing the public about how they work. That is part of the reason for reforming primary care.
Sir Gerald Howarth (Aldershot) (Con)
May I invite my right hon. Friend to visit Frimley Park hospital, which serves his constituents and mine? I went there on Friday and saw the magnificent new A and E facilities in which it has invested. Yes, it has been under pressure in the past year or so, but it has managed and the out-of-hours service is being provided by GPs. I encourage him to come and see what a magnificent service is provided. Its excellent chief executive, Andrew Morris, raised with me the question of the tariff. Will my right hon. Friend explain a bit more his proposals to recompense hospitals such as Frimley Park, which are doing a fantastic job in A and E, for the additional burden they have had to assume?
Mr Hunt
I agree with my hon. Friend: Frimley Park is a terrific hospital and Andrew Morris a first-class chief executive. In fact, I am visiting Frimley Park in the next month and I will certainly have that discussion with him. My hon. Friend is right that one issue that A and E departments frequently raise is the tariff and the fact that they get paid only 30% of it for any A and E admissions over the 2009 baseline. That was why NHS England announced an important change a few weeks ago. Previously, hospitals had no say over how the money that is withheld from them is spent—it is meant to be used to reduce demand. We are now setting up urgent care boards, and hospitals will have a seat round the table to ensure that the money is spent in a way that reduces pressures on their A and E departments.
Siobhain McDonagh (Mitcham and Morden) (Lab)
Can the Secretary of State say how the numbers attending A and E in south-west London will be reduced by the closure of St Helier hospital’s A and E department, which saw 80,000 people last year?
Mr Hunt
I have not seen any plans for the closure of St Helier. I know that NHS London is looking at possibilities to improve services in those areas, but, as the hon. Lady will know and should take comfort from, if a major reconfiguration is proposed and then referred to the Secretary of State by the local overview and scrutiny committee, I will not approve the change unless I am convinced that it will improve patient care.
David Tredinnick (Bosworth) (Con)
Does my right hon. Friend agree that we could make better use of the ambulance service and that if we had more fully trained ambulance men who could assess whether a patient needed to go to hospital, we could reduce A and E admissions that way?
Mr Hunt
My hon. Friend rightly draws attention to the importance of the ambulance service, which is also feeling the pressure on A and E departments. We need to help the ambulance service to do its job better too. One thing that it always strikes me would make a huge difference to ambulance services is if staff could access the GP records of someone they were picking up on a 999 call, so that they would know that the patient was a diabetic with mild dementia and a heart condition, for instance. That kind of information can be incredibly helpful. I hope that by sorting out the IT issues with which the last Government struggled, we can help ambulance services to do that.
Valerie Vaz (Walsall South) (Lab)
The Select Committee on Health heard evidence today from the College of Emergency Medicine about a 50% shortfall in trainee doctors and consultants. On average, trusts—I was going to say PCTs—spend £500,000 on locums. What does the Secretary of State intend to do about that?
Mr Hunt
We certainly intend to address A and E departments’ recruitment issues, which I recognise are one of the causes of the pressure. Over-reliance on locum doctors is not a long-term solution to improving the performance of A and E departments either, so those are both areas that we will be looking at.
Andrew George (St Ives) (LD)
The Government—Governments generally—cannot legislate to predict or control accidents or genuine emergencies, but they can direct resources. Hospital bed numbers have been cut by about 30% in the last 10 years. Does my right hon. Friend agree that it is difficult for A and E departments to function effectively if they do not have adequate bed capacity behind them?
Mr Hunt
I do agree, but what hospitals say is that the issue is not the number of beds, but the people in them who are not being properly discharged into the social care system. I was at King’s College hospital last week, where I was told that the hospital had probably two wards full of people who could be discharged into the social care system but had not been. Breaking down those barriers—something that I am afraid the last Government did not get round to doing in 13 years—will be an important priority.
Mr Pat McFadden (Wolverhampton South East) (Lab)
The A and E department at Wolverhampton’s New Cross hospital recently saw a record 365 patients in one day. Those pressures will increase with the downgrading of Mid Staffordshire hospital. Does the Secretary of State agree that it will be deeply unfair to patients in both Wolverhampton and Staffordshire if the added burden on Wolverhampton’s New Cross A and E department is not met with increased resources from him, in terms of size and staff, to cope with the increased pressures?
Neil Carmichael (Stroud) (Con)
Does the Secretary of State agree that the new role that GPs will play in commissioning will greatly assist the production of better community services and more integration with social care, all of which has been championed so frequently by the King’s Fund?
Mr Hunt
I completely agree with that. I pay tribute to my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) for piloting those important reforms through the health service. I just hope that the Labour party, which claimed to support practice-based, clinically led commissioning, will see the error of its ways and understand that proper clinical commissioning holds the key to solving many of these problems.
Bill Esterson (Sefton Central) (Lab)
One of the concerns raised with me is about the lack of commissioning of community services to help patients to be discharged from hospital, which has a knock-on effect on A and E and queuing ambulances. Is not the reality that, as health professionals tell me, the lack of community services, which is what causes the problem in A and E, is a direct result of this Government’s reorganisation?
Mr Hunt
Quite the opposite: the changes introduced by my predecessor make it possible to have truly joint commissioning between clinical commissioning groups and local authorities, which are responsible for social care. I hope that will deal precisely with the problems the hon. Gentleman talks about. That is what we have to encourage and facilitate in every way we can.
Paul Maynard (Blackpool North and Cleveleys) (Con)
One million more patients a year are going through A and E departments and an increasing number of family doctors are progressively opting out of out-of-hours care. Why does the Secretary of State think that the King’s Fund can see the correlation but the Labour party cannot?
Mr Hunt
Because, I am afraid, the Labour party is completely failing to take responsibility for some catastrophically bad decisions that it made when it was in power. Labour Members might want to talk not only to people such as the King’s Fund, but to their own constituents, who say that traditional family doctoring is something they would like to see return.
Mike Gapes (Ilford South) (Lab/Co-op)
How does the decision to close the A and E unit at King George hospital in Ilford, which was taken by the Secretary of State’s predecessor, who is sitting next to him, and confirmed by him recently, help to take the pressure off Queen’s hospital in Romford?
Henry Smith (Crawley) (Con)
The last Labour Government closed accident and emergency at Crawley hospital, but in the last few years the urgent treatment centre has been able to see more and more patients. Does my right hon. Friend agree that upskilling urgent treatment centres is part of the answer to the problem?
Mr Hunt
I do, and my hon. Friend is right to point out that the last Labour Government closed or downgraded 12 A and E departments. The Opposition have criticised us in the press—indeed, the shadow Minister, the hon. Member for Copeland (Mr Reed), who is sitting on the Front Bench, has criticised me for not getting on and closing more A and E departments, which is what he seems to want to happen. Every time there has been a controversial reconfiguration, Labour has opposed it all the way. I think we could expect a bit more consistency from a shadow Secretary of State who was once a Health Secretary.
Mr Virendra Sharma (Ealing, Southall) (Lab)
About eight weeks ago, the Secretary of State made a commitment to refer the decision to close four out of nine A and E departments in north-west London. Can he tell the House why he has not kept his word?
Sir Tony Baldry (Banbury) (Con)
There is a general acknowledgement and recognition that one of the problems for A and E departments, particularly at night and on weekends and bank holidays, is people going to them who do not need to. Does my right hon. Friend think there is scope for the new clinical commissioning groups to commission primary triage at the entrance of A and E departments, so that those who need only primary care treatment are directed towards to it, and those who need A and E treatment go through to A and E?
Mr Hunt
My hon. Friend will be pleased to know that that actually happens in many places throughout the country, but we need to go even further. When it comes to the most frail, vulnerable older people, we need to commission services in a way that ensures that someone outside hospital knows what is happening with them the whole time, is accountable for their care and treatment, and can pre-empt the need to seek emergency care in the middle of the night. That will be the key to ensuring that the pressures on A and E are sustainable.
Barbara Keeley (Worsley and Eccles South) (Lab)
Today, the Health Committee heard that this Government’s cuts to social care were a direct cause of increased A and E attendances: patients cannot be returned home on time, and all the services that used to keep people well have been cut. This Government cut local authority budgets, resulting in £2 billion going out of adult social care. Will the Health Secretary now accept what the experts are telling us on the Health Committee: that that is the direct cause of the increased A and E attendances?
Mr Hunt
Once again, the Labour party opposes every single cut made by this Government then tries to pretend that it is serious about getting the deficit under control. On this point, I remind the hon. Lady that the NHS is giving £7.2 billion of support to the social care system for health-related needs, precisely in order to ensure that services are not compromised. Where they have been compromised, we are looking into it and we are disappointed about it, but we continue to monitor the situation and to urge local authorities to ensure that they discharge their responsibilities properly.
Jeremy Lefroy (Stafford) (Con)
As my hon. Friend the Member for St Ives (Andrew George) said, we cannot divorce emergency care from the provision of acute beds. The Secretary of State mentioned the fact that an increasing number of patients with acute illnesses are going into hospital. May I urge him to look carefully at any proposals to reduce the number of acute beds anywhere in the country, because I believe that we shall need them all?
Mr Hunt
My hon. Friend makes an important point. I commend him for the extremely responsible and committed way in which he has been keeping an eye on what is happening in his local hospital. He is absolutely right to suggest that, before implementing any big reconfiguration, we need to be certain that what we are doing will improve patient care and not damage it. I will continue to ensure that that is the case.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
We know that walk-in centres alleviate the pressure on A and Es. How many walk-in centres have shut since May 2010?
Dr Thérèse Coffey (Suffolk Coastal) (Con)
The issue of out-of-hours care and the additional pressure on A and E has been present in Suffolk since before the election. Just last Friday, I was in Felixstowe to meet the four patient participation groups there, and yet again out-of-hours care was identified as a real problem. I welcome the reforms that might be announced later this week, but can we ensure that patients realise that we are on their side and that we want them to be back with their family doctor?
Mr Hunt
Absolutely. It is extraordinary that in this debate in Parliament today, Labour Members have their heads in the sand about the low public confidence in out-of-hours GP care, which is a major driver of the problems in A and E departments. We are going to sort out that problem—[Interruption.] If they do not want us to, they are just going to have to watch while we do it.
Ann Clwyd (Cynon Valley) (Lab)
I ask the Secretary of State to deplore the personal attacks that are being made on Julie Bailey, who was responsible for drawing attention to the many deficiencies in Mid Staffordshire hospital. She has suffered personal attacks in the street and has had faeces pushed through her letterbox. We should all deplore the fact that that is happening to such an important and brave whistleblower.
Mr Hunt
The right hon. Lady speaks wisely, and I completely concur with her comments. Those attacks are totally reprehensible and I condemn them utterly. Julie Bailey is a remarkable lady, and it is thanks to her that the standard of compassionate care in hospitals across the country is going to improve dramatically. We all owe her a huge debt.
Mr Philip Hollobone (Kettering) (Con)
Thanks must go to all the staff at Kettering general hospital’s A and E for doing their best to cope with a 12% year-on-year rise in A and E admissions, which is being driven by one of the fastest household growth rates in the country. My hon. Friend the Member for Wellingborough (Mr Bone), the hon. Member for Corby (Andy Sawford) and I have written to the Minister responsible for A and E services, as part of a cross-party campaign, to request a meeting to discuss the special circumstances that Kettering’s A and E faces. Does the Secretary of State agree that that meeting should take place at the earliest opportunity?
Helen Goodman (Bishop Auckland) (Lab)
The basic problem with the 111 service is the national specification of the triage system. The ambulance drivers in my constituency warned of this two years ago when the service was trialled, and last year the north-east local medical committee also told the Department of Health that the system was not working. It is the Secretary of State who has his head in the sand. Why does he not listen to the professionals on the ground?
Mr Hunt
I am listening. I have said that we have teething problems and that we want to sort them out. I am prepared to look at the whole of the 111 service to see whether it is delivering the service that the public need. However, I would say to the hon. Lady that the issues with 111 have focused public attention on the poor standard of out-of-hours care in many parts of the country. There is a particular issue of enabling people to speak out of hours to a GP who can, with their permission, look at their medical record, which is a pretty basic starting point. Until we sort that out, we will not be able to sort out the wider issue of confidence in 111.
John Mann (Bassetlaw) (Lab)
Despite my warnings in the Chamber, this Government closed the Newark accident and emergency department, as a consequence of which there has been a 37% increase in deaths. I know that the Secretary of State is too much of a survivor ever to dare to mess with Bassetlaw A and E, but does he agree that the reconfiguration of services in London has absolutely nothing to do with the reconfiguration of services in north Nottinghamshire?
Mr Hunt
All decisions on reconfigurations have to be taken on a case-by-case basis. The really important thing is to ensure that, when we reconfigure services, we have a good alternative in place and we are able to give the public the confidence that it is in place. As the hon. Gentleman knows, we follow the four tests before any ministerial approval is given for a reconfiguration to go ahead.
Mr Andy Slaughter (Hammersmith) (Lab)
Tomorrow is the 40th anniversary of the opening of the present Charing Cross hospital. The Secretary of State is welcome to come to the party, although he might be unpopular, as the A and E department there is one of the four in west London that he wishes to close. Three months ago, at Health questions, he told me that he would refer those decisions to the IRP, but he now appears to be telling my hon. Friend the Member for Ealing, Southall (Mr Sharma) that he is taking advice on whether to do that. Will he stick to his promise and make that referral for a full review?
Mr Andrew Love (Edmonton) (Lab/Co-op)
In 2009, long after the GP contract was introduced, accident and emergency units were hitting their 98% target. The Secretary of State has reduced that target to 95%, but we are now hearing that units around the country are not even achieving that. How can that possibly be? What steps is he going to take to deal with the situation?
Mr Speaker
The Secretary of State appears to have managed to make the hon. Member for Hammersmith (Mr Slaughter) smile. The occasion should be noted.
Mr Hunt
Thank you, Mr Speaker. That is probably the nicest thing you have ever said to me. I shall dine out on it.
The answer to the question from the hon. Member for Edmonton (Mr Love) is that the changes in the 2004 GP contract are not the only cause of pressure on A and Es, but they are a significant cause. They set in train a process of declining public confidence in GP out-of-hours care, which has fuelled the growth in A and E attendances, and that growth has continued so that in the three years since 2009, attendances have gone up by more than 1 million. That is why those changes are having a significant impact on A and E services.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
I recently visited the London ambulance service. When ambulance staff cannot hand over a patient to A and E, the patient is kept waiting in the ambulance. Will the Secretary of State confirm that the number of handover delays lasting more than 30 minutes has doubled to 200,000 in the past three years? Will he also update the House on when he expects that trend to be reversed?
Mr Hunt
Handover delays are unacceptable, and the short-term and longer-term measures that I am putting in place will, I hope, help to reduce them. The hon. Lady might want to talk to her own Front Benchers about this, however, because they seem to be setting their face against improving primary care as a way of reducing the pressures on A and E departments, even though that goes against the grain of what the public and the NHS want.
Andy Sawford (Corby) (Lab/Co-op)
I support the request from the hon. Members for Kettering (Mr Hollobone) and for Wellingborough (Mr Bone) for a meeting with the Secretary of State to discuss resources for Kettering general hospital, which is in a fast-growing area. Corby has the highest birth rate in England and is one of the fastest growing towns in Europe. I urge the Secretary of State also to recognise that the issues with the 111 service are rather more than “teething problems”. Twice this year, Kettering general hospital’s A and E has had to close its doors to all patients other than those arriving by ambulance and to notify the public not to come to the unit. That is extremely worrying for my constituents.
Lilian Greenwood (Nottingham South) (Lab)
Eighteen months ago, Nottingham University Hospitals NHS Trust experienced a sustained increase in visits to A and E and hospital admissions, resulting in thousands of cancelled operations. The trust conducted an independent investigation to help it to understand and respond to the crisis, which had multiple causes. Will the Secretary of State confirm that the study did not conclude that poor provision by GPs or the out-of-hours service was to blame?
Julie Hilling (Bolton West) (Lab)
On Sunday, some of my constituents dialled 999 for an ambulance for an 83-year-old woman who had fallen in the street. They were told to ring 111, but after 15 minutes, with the operator saying he was still assessing needs and the lady still lying in the street, they abandoned the call and rang 999, when an ambulance was dispatched. Is that the norm for this service?
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
The Secretary of State seems to have decided that changing GP out-of-hours services is part of the solution to the A and E crisis. In the Public Accounts Committee a few weeks ago, we heard from clinical commissioning groups that they fear a single tender just to GPs because of the threat of legal action. We have seen that played out in Hackney, where GPs have been knocked back by the clinical commissioning group. When will the right hon. Gentleman get a grip on his Department and let the CCGs have the freedom to commission local GPs rather than fear the legal action that prevents them from doing so?
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Can the Secretary of State confirm how many walk-in centres have closed since May 2010? Will he accept that those closures are linked to the rise in A and E attendance?
Jim Shannon (Strangford) (DUP)
In Northern Ireland as in England there have been lots of problems with increasing numbers presenting at A and E. The Northern Ireland Minister of Health, Social Services and Public Safety introduced the triage system, which enabled more effective processing of patients and allowed people to get the level of care and medical attention they needed. Will the Secretary of State agree to discussions with that Northern Ireland Minister to see what can be learned from what has been done in Northern Ireland?
Mr Hunt
I always welcome discussions with the devolved Administrations to see what we can learn. Better triaging at the point of entry to A and E is certainly one of the things that makes a difference between A and E trusts that are managing to meet their targets despite very high pressures and those that are not.
Mr Speaker
I am grateful to the Secretary of State, the shadow Secretary of State and the 40 Back Benchers who contributed to the debate on the urgent question.
Health and Social Care
Jeremy Hunt Excerpts(13 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
In challenging circumstances, the NHS is performing extremely well. Front-line staff are making heroic efforts to control costs as they cope with the pressures of an ageing population and when 1 million more people are using A and E every year than at the time of the last election.
The Opposition run down NHS performance, but the reality is a service delivering more than it ever did on their watch: 400,000 more operations every year than under Labour; the number of people waiting more than a year for an operation down from over 18,000 in May 2010, to just 665 at the end of February; MRSA infections halved; mixed-sex accommodation nearly abolished; dementia diagnosis rates going up; and more than 28,000 people receiving life-saving drugs from the cancer drugs fund that Labour refused to set up. As we debate health, care and support today, I take the opportunity to commend and thank all the dedicated professionals who work extraordinary hours, day in, day out, for their part in making this happen.
If we are to prepare for the future, however, we need to do more. In our generation, the number of over-85s will double, the number of people with dementia will pass the 1 million mark, and 3 million people will have not one, not two, but three chronic conditions to cope with, on top of the other pressures of old age. We must be there for each and every one of them—the founding values of the NHS would accept nothing less—and to do so we must be able to answer three big questions: how can we be certain that people receive compassionate care even when they are not able to speak for themselves; how can we deliver joined-up care to people who use the NHS and social care system on a regular basis; and how can we ensure that sustainable funding is in place for care and support?
David Tredinnick (Bosworth) (Con)
The Secretary of State will be aware of widespread concern among the herbal medical community that there is no statutory regulation on that area in the Care Bill. Does he agree that if polymorbidity is to be dealt with we must have firm regulation, and that just licensing herbs, as the European Union wants, would destroy the industry?
Mr Hunt
My hon. Friend follows such matters extremely closely and I reassure him that the Government will update the House on that issue very soon.
The Care Bill will take a critical step forward in addressing each of the big questions that I raised, so let us consider how. First is compassionate care. Labour’s target culture led to warped priorities in our NHS and appalling human tragedy. No one disputes the value of targets, and the four-hour target played an important role in improving A and E departments. We do not, however, need targets at any cost, as we saw at Stoke Mandeville, Maidstone and Mid Staffs.
Stephen Timms (East Ham) (Lab)
I agree with the Secretary of State about the value of the four-hour target. Is he disappointed, as I am, that that target has so often been missed in major A and E units over the past few months?
Mr Hunt
The right hon. Gentleman says “rubbish” from a sedentary position, but the Francis report—if he read it—mentioned 50 warning signs that were missed by his Government about Mid Staffs. He himself rejected 81 separate requests for a public inquiry into what happened. The Labour party created a lame duck Care Quality Commission, unable to speak out or force change, and an NHS where too often the system was more important than the individual.
Andy Burnham
At the outset, will the Secretary of State correct the record and remind the House that it was my decision, two months after being appointed Secretary of State in June 2009, to appoint Robert Francis to conduct an independent inquiry?
Mr Hunt
The right hon. Gentleman’s decision not to have a public inquiry that revealed extremely important information has meant that we are finally addressing the issue that his Government failed to address.
The Care Bill will include a vital element of our response to the Francis report, including regulatory clarity on who is responsible for identifying problems, driving up standards, and operating a single failure regime when urgent changes are not made.
Miss Anne McIntosh (Thirsk and Malton) (Con)
My right hon. Friend will be aware that there have been teething problems with the 111 telephone service, which could be an essential tool to treat people in their own homes, certainly for palliative care. Will he provide stringent new guidelines to all providers to ensure that such teething problems are addressed and to enable the 111 service to operate as it should?
Mr Hunt
My hon. Friend makes an important point. Teething problems have led to unacceptable levels of service in some parts of the country, which we are in the process of sorting out. As we sort them out, we also need to look at the long-term causes of the problems of out-of-hours provision and the fact that the general practitioner contract of 2004 has led to a removal of GP responsibility for out-of-hours care, which means that there is much less public confidence than there needs to be in the whole picture. We need to sort that out, too.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
Will the Secretary of State give way?
Mr Hunt
I will make some progress, then take more interventions.
The Care Bill will allow for comprehensive Ofsted-style ratings for hospitals and care homes, so that no one can pull the wool over the public’s eyes as to how well or badly institutions are performing. The Bill will make it a criminal offence for any provider to supply or publish deliberately false or misleading information. We cannot legislate for compassion, but in a busy NHS, we can ensure that no institution is recognised as successful unless it places the needs of patients at the heart of what it does. The Care Bill will be a vital step forward in making that happen. That compassion should extend not just to patients, but to carers. The Bill will put carers’ rights on a par with the people for whom they care. They will have a right to a care assessment of their own and new rights to support from their local authority.
Barbara Keeley (Worsley and Eccles South) (Lab)
Is the Secretary of State as disturbed as I am that the Bill puts young carers backwards a step? Adult carers’ rights might be taking a step forward, but young carers’ rights are not. We must address that during the passage of the Bill.
Mr Hunt
We are not putting young carers backwards. We very much recognise their needs—and a children’s Bill will address their concerns in a way that I hope will put the hon. Lady’s mind at rest.
The second issue that we need to address for the NHS going forward is joined-up care. It is shocking that, in today’s NHS, out-of-hours GP services are unable to access people’s medical records; that paramedics and ambulances answer a 999 call without knowing the medical history of the person whom they are attending; and that A and Es are forced to treat patients with advanced dementia, who are often unable to speak, without knowing a thing about their medical history.
Dame Joan Ruddock
I am grateful to the Secretary of State—out-of-hours is relevant to my point. He will be familiar with Newark. He closed the A and E department and the rate of deaths among local residents went up from 3.5% to 4.9%. Why does he therefore persist in saying that, if he downgrades Lewisham A and E, 100 lives will be saved across the south-east of London?
Mr Hunt
Because that is what the independent medical advice I have received has told me. The right hon. Lady should be very careful about the Newark statistics, because the increase in mortality rates, which is worrying and should not happen, happened before the A and E was downgraded. It is very important that we do not get the figures wrong.
Jim Dowd (Lewisham West and Penge) (Lab)
Will the Secretary of State give way?
Mr Hunt
I am going to make some progress.
Before I took the right hon. Lady’s intervention, I was talking about joined-up care. The truth is that Labour’s disastrous IT contract wasted billions and failed to deliver the single digital medical record that would transform the treatment received by so many vulnerable older people. Yes, it was a financial scandal, but it was also a care scandal. Last year, 42 people died because they received the wrong medicines. There were more than 20,000 medication errors that caused harm to patients, and 127,000 near misses. On top of that, structures such as payment by results were left unreformed for more than 13 years, making hospitals focus on the volume of treatment over and above the needs of individual patients. The Care Bill will help to address those issues by promoting integrated care. It creates a duty on local authorities and their partners to co-operate on the planning and delivery of care; it emphasises the importance of prevention and the reduction of people’s care needs; and, by making personal budgets the default and not the exception, it will significantly increase the control people feel over their care.
Andy Burnham
I am grateful to the Secretary of State for giving way, but the trouble with him is that, often, there is a huge gap between the rhetoric he comes out with at the Dispatch Box and the reality on the ground. He says he is promoting integrated care, but what does he say about the pioneers of integrated care in Torbay, who are threatening to take legal action because of the requirement for compulsory competitive tendering of services? Under this Government, are not the beacons of integration being demolished by his free market?
Mr Hunt
It is the right hon. Gentleman who has a problem with the difference between rhetoric and reality. Let me tell him about the reality of what happened to integrated care under Labour. Between 2001—[Interruption.] The right hon. Gentleman intervened, so perhaps he would like to hear the reply. We are talking about integrated care. On his watch, between 2001 and 2009—eight years during which Labour was in power—hospital admissions went up by 36%. In Sweden, where people started thinking about integrated care, such admissions went up by 1%. That is how badly Labour failed to do anything about integrated care when it had the chance. We are doing something about it. If the Opposition listen, I shall explain what.
Mr Hunt
I am going to make some progress.
The third question that the Care Bill addresses is about sustainable funding for care. We are all going to have to pay more for social care costs, either for ourselves or our families. Tragically, every year, up to 40,000 people have to sell the homes that they have worked so hard for all their lives to fund their care.
Our system does not just fail to help those who need it; it actively discourages people from saving to ensure that they have the funds. In 1997, Labour promised a royal commission on long-term care. The commission reported in 1999, and its recommendations were ignored. We then waited 10 whole years for a Green Paper, which arrived in 2009 and, again, was able to deliver nothing.
In stark contrast, in just three years, the coalition Government commissioned a report from Andrew Dilnot, have accepted it and are now legislating for it. The Care Bill will introduce a cap on the costs that people have to pay for care in their lifetimes. With a finite maximum cost, people will now be able to plan through their pension plan or an insurance policy. With a much higher asset threshold for state support, many more people will get help in paying for their care.
Sheila Gilmore (Edinburgh East) (Lab)
I respectfully suggest that the Secretary of State should look at the situation north of the border, where reform to change who pays has worsened the situation because no extra funding was put into care; all that happened was that we shuffled around who actually paid. Will he look carefully at that situation so that it is not repeated? How much extra funding is he going to put into the system?
Mr Hunt
I agree with the hon. Lady that the amount of financial support is important. I gently say to her that her party wants to cut the NHS budget, which would make the situation vastly worse.
The Bill is a vital element of our plans to improve the lives of the frail and elderly and of people with long-term conditions and disabilities, but it is only one element. Other areas that do not require legislation will come together in a plan for vulnerable older people. The plan will consider all aspects of how we look after older people most in need of support from the NHS and social care system. It will look at how our hospitals are set up to support frail and elderly patients, particularly those with dementia, in emergencies. Of course, we must continue to give people with serious needs immediate access to highly specialised skill, but in many cases we could offer better alternatives outside hospital. That would improve clinical outcomes and reduce pressure on A and E departments.
Secondly, the plan will look at primary care—in particular, the role of GPs in supporting vulnerable older people. Active case management of vulnerable people is making a huge difference in some parts of the country and we will look at whether the primary care sector as a whole has the incentives, investment and skills to deliver that. We will also consider the provision of out-of-hours services and how to restore public confidence in them following the disastrous changes to the GP contract in 2004.
Thirdly, the plan will look at the barriers and incentives that prevent joint commissioning and stop people from getting joined-up care. In particular, it will consider the operation of financial incentives in the system, which can act as an unnecessary and counter-productive barrier. The Minister responsible for care, my hon. Friend the Member for North Norfolk (Norman Lamb), who is leading on integration, will announce further practical steps forward later this week.
I intend to announce the plan in the autumn, with implementation from April 2014. It will require a great deal of careful work, ask difficult questions and make tough decisions, but if it leads to more personal, more integrated and more compassionate care, it will stand alongside the Care Bill as an important step forward in reforming the care received by millions of people.
Mr Dave Watts (St Helens North) (Lab)
Does the Secretary of State agree that that can work only if social services budgets are increased? Where will the resources come from to deal with the problems we face, and will there be an increase in social services budgets to pay for the services we need?
Mr Hunt
There is currently a difficult environment for public finance, for which the hon. Gentleman’s party bears considerable responsibility. The Labour party has given up on the budget; it says it wants to cut the NHS budget. We say that these changes are possible without cutting the NHS budget and in dealing with the inefficiencies caused when care is not joined up. Taken together, the measures represent more progress in three years than the Labour party made in 13 years. They represent our determination to prepare the country for the consequences of an ageing population.
Huw Irranca-Davies (Ogmore) (Lab)
The right hon. Gentleman knows that the cap on costs of care is a little way off the Dilnot proposals. How many weeks—surely his Department has made some calculations—would that involve for a typical older person before they reach the £72,000 cap?
Mr Hunt
The point of a cap is not that we expect everyone to have to pay £72,000 towards their care. First, through pension plans and insurance policies people can make provision so that they never have to pay that £72,000. Secondly, as part of the package, we are increasing the threshold, below which the Government help, to £118,000—much higher than it is currently—so that it will be available to help, I think, around 40,000 more people than are currently helped because of the level of the means-testing threshold.
Mr Hunt
I am going to make some progress.
Over the summer, we will consult on proposals to make the system fairer and ensure that people who should pay for NHS services do in fact do so. That will also help to ensure that our NHS remains sustainable at a time of tight public finance.
These proposals represent our commitment to ensuring a compassionate, fully integrated and sustainable system of health and social care built entirely around the needs of the patient. They represent a commitment to the NHS and social care system, which lies at the heart of our determination to make Britain the best country in the world to grow old in. [Interruption.]
Mr Speaker
Order. It is not altogether obvious whether the Secretary of State is giving way or has concluded his speech. [Interruption.] He has concluded his speech. It is usually helpful to have some indication of that.
Andy Burnham
My hon. Friend is absolutely right. The cap is a mirage, and this will not feel like progress to people who are paying care charges. Indeed, it is a cruel con trick. The Government are loading extra charges on people while telling them that they might benefit from a cap in a number of years. This simply means that more people will be paying right up to the level of that £72,000 cap.
How can it be fair to pay for the cap by raiding council support? That does not make sense. Those of us who were involved in the cross-party talks—the failed cross-party talks, I might add—will remember that a question was put directly to Andrew Dilnot. He was asked whether, if there was not enough money around, it would be better to pay for a cap or to pay to support councils to ensure that the baseline was not cut further. His clear answer was that we had to do both. He said that it would not make sense to do one without the other, yet that is what this Government are doing—
Andy Burnham
That is what this Government are doing. A cap is ineffective without long-term funding for the future of social care, and the failure to face up to the crisis in adult social care budgets that Conservative councillors are talking about will leave people with the impression that this Health Secretary is fiddling while Rome burns. The social care system in England is close to collapse, and the reality behind the Government spin is that, under this Government, people’s savings are being washed away more quickly than ever before.
I want to turn now to our accident and emergency services. The crisis in social care is the predominant driver of what we are now seeing in our accident and emergency departments. If people’s services are withdrawn, or if they cannot afford to pay for them, they are more likely to struggle and fall ill at home and to end up in hospital. That is bad for them, and it costs the NHS more. Also, NHS staff are finding that people who are ready to leave hospital cannot be discharged because the necessary support cannot be put in place. Beds are not being freed up on the wards, and A and E therefore cannot admit people to the wards because there is no space. A and E then becomes full, which results in ambulances queuing up outside because they cannot hand over patients. The system is now backing up right through A and E.
Andy Burnham
The Secretary of State is nodding; he should do something about it. This is happening on his watch. Across the country, hospitals are operating at levels way beyond safe bed occupancy—[Interruption.] He nods, but I am saying, “Do something. Don’t just nod!” We need action from the Secretary of State.
Let me return to the quote that I mentioned earlier. People love to say that I would have cut the NHS. For the record, I have never said that I would cut the NHS. At the last election, I promised real-terms protection for the NHS. The Conservatives promised real-terms increases, which have never been delivered. Let me read that quote in full:
“It is irresponsible to increase NHS spending if the effect is that it is damaging, in a serious way, the ability of other services to cope…that are intimately linked to the NHS. The health service needs functioning day care, and housing”
and meals on wheels.
That warning has now come true.
Andy Burnham
I will give way to the Secretary of State, but I ask him to address this point. He has paid for the so-called ring fence on the NHS by ransacking local government funding, and that makes no sense whatever.
Mr Hunt
If the right hon. Gentleman looks at the figures, he will see that real-terms spending on the NHS has gone up since Labour was in power. Given that he thinks it irresponsible to increase the NHS budget, does he agree that if he were to follow his own policy, he would now need to cut that budget from its current level? That is Labour policy.
Andy Burnham
I do not think the right hon. Gentleman is listening. I said that if there were to be any increase, it should go into supporting social care. I now hear that Government Members are proposing emergency transfers from the NHS budget to social care because of the crisis that the Secretary of State has created.
Andy Burnham
The former Secretary of State said that it was full steam ahead and that is what they would do. This Secretary of State comes in and says nothing about the issue. Then, a right-wing Australian lobbyist arrives, and all of a sudden no one mentions it at all. Has the Secretary of State ever met Lynton Crosby and discussed this issue with him? I think we have a right to know. [Interruption.] He nods; I should be interested to know the substance—[Interruption.] He has not met him to discuss the issue. He looks very uncomfortable all of a sudden.
Mr Jeremy Hunt
Just to put the right hon. Gentleman out of his misery, I have not discussed this matter on any occasion with Lynton Crosby.
Andy Burnham
We are going to have to get to the bottom of this—not just the Secretary of State, but all his Ministers and advisers and all the No. 10 advisers—because it looks to us as though this Government have raised the white flag on having any semblance of a progressive public health policy. I cannot believe that the Liberal Democrats put their name to such reactionary stuff. Where is minimum alcohol pricing? Where is public health in this Queen’s Speech? They are totally absent.
Care Bill
Jeremy Hunt Excerpts(13 years, 2 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
To accompany the Care Bill, which was introduced yesterday, I am today laying before Parliament “The Care Bill Explained—including a response to consultation and pre-legislative scrutiny on the Draft Care and Support Bill” (Cm 8627).
This document describes the measures in the Care Bill. It explains the importance of reforming care and support legislation, of taking steps to drive up the quality of care following the findings of Robert Francis’s inquiry into the Mid Staffordshire NHS Foundation Trust, and of establishing Health Education England and the Health Research Authority as non-departmental public bodies.
Parts 1 and 3 of the Care Bill build on the provisions in the draft Care and Support Bill, which was published in July 2012. “The Care Bill Explained” sets out the changes that have been made to those provisions. It is the Government’s response to the public consultation and to the report of the Joint Committee on the Draft Care and Support Bill.
The Government are grateful to the Joint Committee for its careful scrutiny, and to everyone who expressed their views during the consultation. The feedback we received has considerably improved the final provisions in this critical and historic piece of legislation.
Oral Answers to Questions
Jeremy Hunt Excerpts(13 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mark Menzies (Fylde) (Con)
6. What steps his Department plans to take to improve dementia diagnosis rates and to reduce regional variations in such diagnoses.
The Secretary of State for Health (Mr Jeremy Hunt)
Dementia diagnosis rates vary across the country, from 75% in the best areas to a shocking 31% in the worst areas. That is totally unacceptable, given the difference that we know a diagnosis and a good care plan can make to people who have dementia.
Mark Menzies
What steps is my right hon. Friend’s Department taking to ensure that GPs are adequately supported, so that his ambitious targets for dementia diagnosis are met?
Mr Hunt
My hon. Friend makes an important point. There is a misconception among some GPs that a dementia diagnosis is pointless and cannot make a difference, when we know that in fact the correct medicines can help between one in three and one in four of those who have the condition. However, some GPs also have a point when they are concerned that it is difficult to access good services for people who have dementia. The way we will change GPs’ minds is for them to appreciate that something will change if someone gets a dementia diagnosis. That is the big challenge that this ministerial team has set the Department.
Jim Shannon (Strangford) (DUP)
Does the Minister agree that there is much to be learned from the high rate of dementia diagnosis in Northern Ireland? Is not that an example of how important it is for the devolved powers to share information and tactics for success in their own areas with the other devolved bodies?
Mr Hunt
I agree with the hon. Gentleman. Some of the devolved Administrations, particularly Scotland, actually do better than England in regard to dementia diagnosis, and one thing that we must learn from them is the value of a properly integrated care plan. I am working closely with the Minister of State to ensure that we deliver that in England.
Mr Stephen Dorrell (Charnwood) (Con)
My right hon. Friend said in his answer to my hon. Friend the Member for Fylde (Mark Menzies) that certain aspects of the treatment of dementia patients had to change. Does he agree that that should include the services that are delivered to them becoming more integrated, not only between hospitals and community health care services but between social care services and social housing support, in order to provide a proper joined-up package of care for people who receive such diagnoses?
Mr Hunt
I wholeheartedly agree with my right hon. Friend. I was in the accident and emergency unit at Watford hospital last week when a lady with advanced dementia was admitted. She had bruises all over her face after having had a fall. The shocking reality was that that A and E department knew nothing about that lady. It did not know her medical history, and it did not know whether that was her normal condition. There was no proper joined-up link between the social care system and the NHS. Tackling that issue is probably the single biggest long-term and strategic challenge that we have to address in the NHS.
Steve McCabe (Birmingham, Selly Oak) (Lab)
Was Professor Malcolm Grant, the chairman of NHS England, talking about dementia sufferers when he said today that the NHS would have to charge for particular treatments? If not, will the Secretary of State specifically rule that out?
Patrick Mercer (Newark) (Con)
I should like to thank the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), for his visit to Newark, which was a huge success. However, it has been pointed out that there is a distinct feeling in Newark that dementia patients are not being treated quite so quickly there as they are in other parts of Nottinghamshire. Will the Secretary of State please give that matter his attention?
Mr Hunt
I entirely agree with my hon. Friend the Member for Newark (Patrick Mercer). We must urgently tackle the variation in dementia diagnosis rates. In the end, the litmus test of whether we are able to cope with an ageing population in the NHS will be how we deal with dementia, which now affects one in three people over the age of 65. There is still a lot of misunderstanding about the impact that a good diagnosis and care plan can have, and for the sake of my hon. Friend’s constituents and everyone else, this is an area in which we need to make urgent change.
Mr Graham Allen (Nottingham North) (Lab)
9. If his Department will make early intervention a priority for clinical commissioning groups and public health officers.
David Rutley (Macclesfield) (Con)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
In a week when we are remembering the remarkable contribution made by Margaret Thatcher to our national life, we should also mark the extraordinary contribution made by someone else who died last week—Professor Sir Robert Edwards, the Nobel prize-winning doctor who pioneered modern IVF treatment. One in seven couples in this country experience fertility problems and he has given them hope and, in many cases, wonderful happiness. The whole House will want to applaud not just his scientific boldness, but his moral courage in confronting what was considered at the time to be an extremely difficult ethical issue.
David Rutley
In the light of the recent measles outbreak in south Wales, does my right hon. Friend agree that the claims made by Dr Andrew Wakefield about the MMR vaccine are both discredited and completely wrong?
Mr Hunt
I absolutely agree with my hon. Friend. What Andrew Wakefield said had no scientific basis and caused huge damage and worry to many thousands of parents. It is very important to reiterate that the scientific way to prevent measles, which can be a horrible and even a fatal disease, is to make sure that children have had two doses of MMR. Parents of children of any age who have not had those doses should contact their GP, particularly in the current circumstances.
Andy Burnham (Leigh) (Lab)
Accident and emergency departments across England are being closed, even though all are under intense pressure. For 11 weeks running, the NHS has missed the Government’s national A and E target. Last week, in places, one in three patients waited more than four hours in scenes not seen since the bad old days of the mid-1990s. What clearer symbol of the growing crisis in A and E is there than a tent as a makeshift ward in the car park at Norwich? The Secretary of State’s failure to address that cannot continue. Nursing jobs have been lost, ambulances are queuing outside A and E and patients are being treated in car parks. When will he get a grip?
Mr Hunt
The statistic that the right hon. Gentleman will not give the House is that for the year as a whole, which ended last March, the Government hit our A and E target. Furthermore, he still will not tell the House about the disaster that is happening in Labour-controlled Wales, where the A and E target has not been hit since 2009. He still refuses to condemn what is happening there. There is a lot of pressure on A and E, because 1 million more people are using A and E every year, compared with just two years ago. What are the root causes? They are poor primary care alternatives that date directly to the disastrous GP contract negotiated by his Government, since when more than 4 million additional people have been using A and E every year, social care and hospital sectors that are not joined up—Labour had 13 years to sort that out but did nothing—and problems in recruitment that have been made a great deal worse by his disastrous decision to implement the working time directive. It is time he sorted out his own issues before trying to criticise the Government for sorting them out.
Paul Uppal (Wolverhampton South West) (Con)
T2. The all-party group on men’s health, of which I am vice-chairman, has assisted in research that seems to show that men’s poor sexual health is often symptomatic of more serious problems, such as type 2 diabetes and cardiovascular disease. Will my hon. Friend assure me that all robust measures are being put in place to ensure that that is not overlooked and that men do not die unnecessarily because that situation is taken for granted?
Priti Patel (Witham) (Con)
T4. The Secretary of State is aware of the widespread management failures of East of England ambulance trust, and last month we saw the belated resignation of its chair. Will he ensure that the trust makes patient care the No. 1 priority, and will he join me in calling for its remaining non-executive directors, who presided over these management failings, to reflect on their own positions?
Mr Jeremy Hunt
I congratulate my hon. Friend on her campaigning on this. There must be full accountability for what went wrong in that ambulance trust. It is absolutely a top priority for me and my Ministers, two of whom represent Norfolk and Suffolk, to sort out what is happening in the trust, and that is why very decisive action has been taken.
Catherine McKinnell (Newcastle upon Tyne North) (Lab)
T7. Further to the question from my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah), several of my constituents with desperately ill relatives are very angry about the Government referring to NICE a decision on the use of eculizumab. The continuing delay is risking lives and also means that people have several invasive treatments that could well cost more. To save space in the Minister’s diary, may I add a request to join the meeting with my hon. Friend to talk about how this dangerous delay is causing very great distress to many constituents?
Mr Philip Hollobone (Kettering) (Con)
T8. Kettering general hospital’s new £30 million foundation wing has a new 16-bed intensive care unit, 28-bed cardiac unit and 32-bed children’s unit, and it opens to patients for the first time this coming Saturday. Will my right hon. Friend the Secretary of State take this opportunity to congratulate all those at Kettering general hospital who have brought this project to fruition?
Mr Jeremy Hunt
I would be absolutely delighted to do that. I had an excellent visit to Kettering hospital that was hosted by my hon. Friend, and I saw at first hand just how hard people are working in tough circumstances, with big increases in A and E admissions causing a great deal of pressure throughout the hospital. One had a sense at the hospital that there was a mission to turn things around and make things better, and a management team who were totally committed to doing that. I congratulate them and all the front-line staff who are doing such an important job for the people of Kettering.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
A year ago, GPs in Hackney bid to run the out-of-hours services. Earlier this year, they were told that it had to be tendered because the board was fearful of legal challenge from private health companies. Who is running the NHS—the Secretary of State or the private health company lawyers?
John Pugh (Southport) (LD)
T9. What is the Department doing to deal with the difficulties presented by poor data sharing between health and social care agencies and the threat to integration that that presents?
Mr Jeremy Hunt
My hon. Friend makes a very good point, and I pay tribute to him for raising this issue frequently. We will not have properly integrated, joined-up health and care services unless we crack the issue of data sharing. There need to be protections for people so that they can prevent their data from being shared if they do not want that, but by the same merit we have to make sure that there is better availability. For example, delayed discharges from hospitals, which are causing pressure on A and Es, would be directly helped if we cracked this. That is why we have called for a paperless NHS by 2018.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
Under the previous Government, my constituents could get an appointment with their GP within 48 hours. I recently heard of a wait for a routine appointment taking three weeks. Is not this one of the reasons there is such pressure on A and Es, and will the Secretary of State reintroduce the 48-hour appointment?
Mr Hunt
The reason there is so much pressure on A and Es is the disastrous GP contract negotiated by the hon. Lady’s party in government, since when—I do not know whether she was listening to what I said earlier—an additional 4 million people every year are going to our A and Es. That is what is causing the huge pressure, and that is what we are determined to put right.
Steve Brine (Winchester) (Con)
T10. The Secretary of State will know that the number of people donating organs after their death has risen by 50% in the past five years. Does he credit the network of specialist nurses who support bereaved families in hospital for that increase and, if so, what lessons does he take from that?
Mr Hunt
This is an example of a programme that has been a huge success and I pay tribute to the work done by the previous Government as well as this Government in making sure that we can tackle this very serious problem. All I would say to my hon. Friend is that three people still die every day, I believe, because we are not able to get the organ donations we need. We should not think that, despite the success, we have solved this problem. There is much work to do and I personally think that it is something that everyone should think about doing. It can be a source of personal pride to put oneself on the organ donation list and we should all encourage our constituents to think about it as well.
Jenny Chapman (Darlington) (Lab)
I have listened very carefully to what the Secretary of State has said on A and E, but he has not addressed the fact that under the previous Government waiting times reduced and under his Government they are growing and are now at their longest for more than a decade, so what is he going to do?
Mr Hunt
As I said to the right hon. Member for Leigh (Andy Burnham) earlier, we actually hit our A and E waiting time target last year. If the hon. Lady is talking about waiting times in general, the number of people waiting for more than a year for an operation was 18,000 under the previous Government, and the figure has fallen to just 800 under this Government.
Andrew George (St Ives) (LD)
If there is a smidgeon of space in any of the Ministers’ diaries, is there a chance that they could meet me and representatives of the nursing profession to address not the issue that I think the Government are saying they are opposed to—mandatory nurse to patient ratios on wards—but that of adequate registered nurse levels on hospital wards?
John Cryer (Leyton and Wanstead) (Lab)
The Secretary of State said earlier that 1 million extra people are attending A and Es annually, but a few minutes later he said that the figure was 4 million. Which one is it?
Dr Sarah Wollaston (Totnes) (Con)
In Brixham in my constituency, 94% of five-year-olds are protected against measles. Just up the road in Totnes the figure is only 70%. There are many reasons for the variation, but does the Secretary of State share my concern that if parents believe they are protected by, for example, homeopathy products, they might be less likely to use an evidence-based treatment? Will he make an unequivocal statement that such products will not give any protection?
Mr Hunt
I am happy to do so and thank my hon. Friend for bringing up the issue. There is no scientific evidence whatsoever that homeopathic products can provide protection against measles. The right thing to do is to get two doses of the MMR jab. As I said earlier, anyone whose children, whatever their age, have not had those two doses should contact their GP.
Lucy Powell (Manchester Central) (Lab/Co-op)
As we have heard, A and E waiting times are at their worst level for a decade, yet we hear of proposed A and E reconfigurations based on tackling so-called inappropriate presentations. Does the Secretary of State agree that that approach is the wrong way around and that he would be better off tackling why people are going to A and E first, before he embarks on any reconfigurations?
Mr Hunt
That is exactly what we are doing. We are looking at the root causes of the fact that admissions to A and E are going up so fast—namely, that there is such poor primary care provision; that, as we discussed earlier, changes to the GP contract led to a big decline in the availability of out-of-hour services; and, that health and social care services are so badly joined up. That is how we are going to tackle this issue with A and E, and that is what we are doing.
Mr Stewart Jackson (Peterborough) (Con)
I am delighted to learn that there will shortly be a new national clinical director for neurological conditions, focusing in particular on conditions such as Tourette’s syndrome. Will the Secretary of State reassure us that that appointment, which is so long overdue, will be expedited at the earliest opportunity?
Heart Surgery (Leeds)
Jeremy Hunt Excerpts(13 years, 3 months ago)
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Stuart Andrew (Pudsey) (Con)
(Urgent Question): To ask my right hon. Friend the Secretary of State for Health if he will make a statement on Leeds children’s heart surgery unit.
The Secretary of State for Health (Mr Jeremy Hunt)
Following the deaths of 30 to 35 children at the Bristol royal infirmary between 1991 and 1995 and the subsequent inquiry, children’s heart surgery is rightly the subject of great public concern.
With respect to Leeds general infirmary, there are three issues that the House will want to be updated on: was it right to suspend children’s heart services at Leeds on 28 March; was the decision handled in the best way possible; and, given his public comments, is it appropriate for Professor Sir Roger Boyle to have a continuing role in the Safe and Sustainable review of children’s heart surgery?
First, was the right decision made? The answer is categorically yes. The principle of “first do no harm” must run through the very heart of the NHS. If there is evidence that patient safety is at risk, it is absolutely right that the NHS acts quickly and decisively to prevent harm to patients. However difficult or controversial, we must never repeat the mistakes made at both Mid Staffs and Bristol, where arguments over the quality of data prevented action that could have saved patients’ lives.
Secondly, was the decision handled properly? On 26 and 27 March, Sir Bruce Keogh, NHS England’s medical director, was given a range of critical information about the quality of care at Leeds: statistical data that indicated higher than expected mortality rates; concerns about staffing rotas; and further concerns from parents and a national charity about the way the most complex cases were referred. With the agreement of the LGI, Sir Bruce took the entirely appropriate decision to suspend children’s heart surgery while further investigations were made. The families were informed on the day the decision was taken to suspend services, 28 March.
On 29 March—Good Friday—the day that decision became public, I spoke with the right hon. Member for Leeds Central (Hilary Benn) and my hon. Friends the Members for Pudsey (Stuart Andrew) and for Leeds North West (Greg Mulholland) to inform them of the situation. My conclusion is that, on the basis of the information available to him, Sir Bruce behaved entirely properly. He was also right to authorise the restarting of surgery from 10 April for low-risk patients on the basis of more complete data and assurances from the trust.
The third question is whether, in the light of his recent comments, Professor Sir Roger Boyle can have a continuing role in the Safe and Sustainable process. Sir Roger is one of our leading heart surgeons. He did the right thing in informing Sir Bruce of his concerns over Leeds’ mortality data. He has also played an important role as an adviser to the Safe and Sustainable review of children’s heart services. However, it is the view of Sir Bruce Keogh, with which I concur fully, that Sir Roger’s comments to the media on 11 April could be seen as prejudging any future conclusions of that review. It is therefore right that Sir Roger plays no further role in its deliberations.
Stuart Andrew
I am grateful to my right hon. Friend for his answers. No one would disagree with the point that information that is provided about the safety of a unit should be investigated. However, the quality of the information and the source of the complaints raise serious questions about the proportionality of the action that was taken and, more importantly, about the motives of the complainants. Sir Roger Boyle was a key adviser to the Safe and Sustainable review, which proposed an illogical outcome for northern England. His recent actions and comments surely prove that the decision to close the Leeds unit was predetermined.
Sir Roger leaked data that were unverified to argue for the suspension of surgery—an action that was described as “appalling” by their author. The information was inaccurate and, when corrected, demonstrated that the Leeds unit was safe. In fact, it showed that it is in a similar position to the units at Guy’s and Alder Hey. Why did Sir Roger not recommend the suspension of surgery at those units? Is it because those are the ones that he and the Safe and Sustainable review recommended as designated centres?
Furthermore, on Friday, despite detailed scrutiny that proved that Leeds was safe, Sir Roger claimed that it was on the edge of acceptability and that he would not send his daughter there. Those comments demonstrated a clear bias against Leeds and were irresponsible in respect of parents whose children are facing surgery. In addition, one of the whistleblowers has been identified as a surgeon from the Newcastle unit, which is another example of vested interests.
The suspension of surgery and Sir Roger’s comments have caused huge anxiety and concern among patients and staff, and have hurt the reputation of the hospital, which it has taken years to build. I therefore ask the following questions of my right hon. Friend.
How can we have faith in the Safe and Sustainable review, given that its key adviser has behaved in such an appalling and biased manner? Despite the fact that he will no longer take any part in the review, the decisions remain. Does this matter not prove that Sir Roger acted in a predetermined manner? Is it not vital to put the patient’s interests first, rather than NHS politics? Does my right hon. Friend agree that Leeds has been treated disproportionately when compared with other units that have similar figures? Is he aware that there are reports of surgeons being anxious about providing data for fear of reprisals? Is there not an urgent need for the Independent Reconfiguration Panel to report to resolve the uncertainty that exists across the country with regard to children’s heart surgery? Is it not time to give serious consideration to the proposal that both Leeds and Newcastle should stay open, which is supported by clinicians and patients as it is in their best interests? Finally, will he pay tribute to the staff and patients at Leeds, who have acted with great dignity in the face of hostile criticism?
Mr Hunt
I do pay tribute to the staff at Leeds and to the families of patients. I recognise that this is an issue of huge concern. As my hon. Friend rightly says, they have behaved with great dignity in a difficult situation. I also pay tribute to him for the responsible way in which he has behaved in this difficult situation, as have many Leeds MPs.
My hon. Friend will understand, given that the NHS nationally was provided with data that suggested that mortality could be up to 2.75 times greater at that unit and given that there was a potentially busy holiday weekend ahead, when it did not know how complex the cases would be and when there were locums on the staff rota who may or may not have been up to the standard of the permanent staff, that Professor Sir Bruce Keogh had genuine concerns that led to his decision. But I hope the fact that surgery was restarted on 10 April will assuage my hon. Friend’s worry that the initial decision was linked to the Safe and Sustainable review—it was not; it was a concern about patient safety and because that concern has been addressed, surgery has restarted.
There were, however, issues about the quality of the data, which at least in part was because the hospital was not supplying data properly in the way it needed to. That was one reason why the mortality data were not as accurate and good as they should have been. Although I entirely agree that patient safety must always come first, and not NHS or national politics or whatever it may be, that also means that sometimes difficult decisions have to be taken. What happened at Mid Staffs, where we had a big argument about data that meant nothing happened for too long, and what happened originally at Bristol, where up to 35 children may have lost their lives, is a warning about the dangers of inaction. On this occasion, I think that overall the NHS got it right.
Andrew Gwynne (Denton and Reddish) (Lab)
First, let me apologise to the House on behalf of my right hon. Friend the Member for Leigh (Andy Burnham) who cannot be here today because he is in Liverpool attending the memorial service for victims of the Hillsborough disaster.
This situation has descended into yet another trademark Government shambles. Just 24 hours after the High Court announced that the decision to close the children’s cardiac unit at Leeds was “legally flawed”, Leeds Teaching Hospitals NHS Trust was effectively instructed to stop surgery. The timing of the decision was strange to say the least, but to quote the head of the central cardiac audit database:
“It rings of politics rather than proper process.”
We now know that the instruction was based on incomplete and unverified data, and that Dr Tony Salmon, president of the British Congenital Cardiac Association, was “very concerned” at the way the data were being used, and that any conclusions drawn from the data were “premature”. The Opposition are therefore pleased that this urgent question has been granted as the House clearly deserves some answers.
First, the Secretary of State needs to outline to the House exactly when he was informed that NHS England had concerns about the centre, and say whether he gave his approval to suspend surgery there. If so, was he satisfied that the data presented were accurate and had clinical support? On the issue of data, why did it take this recent episode at Leeds for the information to be released into the public domain—information that my hon. Friend the Member for Leicester West (Liz Kendall), and others, had asked to be released for some time?
Secondly, does the Secretary of State accept that the suspension of surgery, with all the consequent anxiety that it caused patients and staff, was at best a mistake and at worst an irresponsible and disproportionate action? Thirdly, does he accept that the timing of the decision to suspend surgery so soon after the High Court’s ruling caused a great deal of suspicion in Leeds and gave the distinct impression that it was a political decision and not based on clinical evidence? Finally—this point goes beyond Leeds—the Health Secretary’s record so far has failed to inspire confidence in the process of reconfiguration. Will he therefore conduct an urgent investigation into Leeds and how this happened, and consider what lessons can be learned from this unedifying episode for the children’s cardiac review and future reviews?
We owe it to the dedicated staff who work in our NHS to ensure that whatever disagreements we may have in Westminster, and whatever our politics, we do not hinder their ability to provide high-quality care to patients. We also owe it to patients and their families not to add to the anxiety and stress of undergoing treatment. On both those counts the Government have failed, and I hope that when the Secretary of State returns to the Dispatch Box, he will have the decency to apologise and start answering these very serious questions.
Mr Hunt
I am afraid the hon. Gentleman has let the Labour party down with the total inadequacy of that response. He spoke of an irresponsible and disproportionate decision, but I ask him to reflect on that as someone who would like to be a Health Minister. Would he seriously have wanted anything different to happen? If the NHS nationally is informed of data that show that mortality rates at a particular hospital could be up to three times higher than they should be, would he sanction the continuation of surgery, or would he say, “We need to get to the bottom of the statistics before deciding whether there will be any more operations”? If he is saying that he would have wanted surgery to continue, I put it to him that he and his party have learned nothing from the lessons of Bristol and nothing from the lessons of Mid Staffs. I did not authorise the decision, but wholeheartedly supported it because it was an operational decision made by NHS England. It is right that such decisions are made by clinicians, who understand such things better than we politicians do.
On reconfigurations, the hon. Gentleman’s party closed or downgraded 12 A and Es and nine maternity units in its period in office. The shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), has said that Labour would not fall into the “easy politics” of opposing every single reconfiguration, but that is exactly what the Opposition are doing. It is not just easy politics; it is what Tony Blair last week called the “comfort zone” of being a “repository for people’s anger” rather than having the courage to argue for difficult reforms.
Sir Edward Garnier (Harborough) (Con)
My right hon. Friend mentioned at the outset of his response three principles, the first of which was to do no harm. Following discussions that he and I have had—I am sure he has had such discussions with our hon. Friend the Member for Loughborough (Nicky Morgan) and no doubt other Leicester and Leicestershire MPs—does he agree that there is a read-across from Leeds to Glenfield, where we have the Leicester children’s heart unit? It is unquestionably a unit of international repute and certainly one of national repute. The death rates for that hospital, which deals with particularly difficult patients and highly complicated operations, are right at the top. I urge him to learn from the Leeds fiasco—I do not put the fiasco at his door—that the Glenfield hospital should be preserved for the good of the nation and of the people of the east midlands, so that we do no harm.
Mr Hunt
I am grateful to my hon. and learned Friend for his question. I am waiting to hear advice from the Independent Reconfiguration Panel on its assessment of the Safe and Sustainable review. I will wait until I get that advice before making any decisions, and in particular before making any decisions on Glenfield, Leeds or any other hospital involved.
It is important to recognise, however, that there two separate issues: the first is the mortality rates at particular hospitals, but the second is whether we can improve mortality rates overall by concentrating surgery in fewer hospitals. I will wait to hear from the IRP on both before making any decisions.
Hilary Benn (Leeds Central) (Lab)
The Secretary of State will be well aware of the deep disquiet in Leeds about what has happened to the children’s heart surgery unit in my constituency, and I am grateful to him for the conversation we had on Good Friday. Given that the High Court has decided that the decision to close Leeds is unlawful, and given that we have now had it confirmed that the Leeds unit was safe before and is safe still, when will he be able to reassure worried parents of very sick children that the future of the Leeds unit is safe?
Mr Hunt
I thank the right hon. Gentleman for the constructive conversation we had on Good Friday about what I entirely agree is an extremely difficult issue for the families and for the staff at the LGI. My intention is to try to resolve the matter as quickly as possible. I obviously cannot comment on what view I will take while legal proceedings are under way and while I wait for advice from the IRP, but I agree with him about the uncertainty, which I would like to resolve as quickly as possible. He would want me to be guided by what is in the best interests of his constituents and people across the country who need children’s heart surgery.
Greg Mulholland (Leeds North West) (LD)
I, too, thank the Secretary of State for his private phone call to me, but we should have heard from him on this fiasco before today in response to an urgent question. I have to say that his response has simply not been good enough, considering what has happened. To correct one thing that he said, it was not with the agreement of the LGI that services were suspended. Clearly, Sir Bruce Keogh marched into the LGI at 8 o’clock in the morning and said that if surgery was not suspended, people would be sacked. That was no way to behave even if the data were accurate, but Sir Bruce has now backtracked and admitted the data passed to him by his friend Sir Roger Boyle were not accurate.
The decision to close children’s heart surgery in a safe unit, which is what we now know Leeds always was, puts children at greater risk. To make a decision of that nature that is incorrect is simply unacceptable. Will the Secretary of State do what is now clearly necessary and have a full investigation of this fiasco, including the conduct, judgment and motivations of senior NHS officials involved?
Mr Hunt
I simply say to the hon. Gentleman that if, as he has alleged consistently in the media, this was some kind of political ploy linked to Safe and Sustainable, we would not have reopened children’s heart surgery in Leeds on 10 April as we did. I spoke to him at the time and told him that it was my hope that operations would be able to resume as soon as possible and that we would get to the bottom of the data to find that the concerns were unnecessary because the unit was safe. In the end, that is what happened.
It would have been utterly irresponsible for Professor Sir Bruce Keogh, in view of the evidence he was faced with—including incomplete data that the hospital had not supplied in the way that it should have done—not to ask the hospital to suspend surgery. That would have been taking a risk with the lives of the hon. Gentleman’s constituents and the people of Leeds in a way that would have been wholly inappropriate. The NHS needs to move in a totally different direction on patient safety, and this is a good example of the NHS medical director behaving promptly and properly in exactly the way he should.
Fabian Hamilton (Leeds North East) (Lab)
In his opening statement, the Secretary of State mentioned that one of Sir Bruce Keogh’s concerns was the complaints made by families in Yorkshire about the treatment their children had received at Leeds children’s heart surgery unit. If there had been those concerns, does the Secretary of State not think that over the three years of the Safe and Sustainable review at least one complaint would have been made via Members of Parliament in Yorkshire or local media outlets? The fact that no complaints were received over three years surely tells him that generally the families were very satisfied with the way their children were treated. Will he now apologise to the families of Yorkshire for the closure between 28 March and 10 April?
Mr Hunt
The apology would have been due to those families if Sir Bruce Keogh had not acted promptly in the face of data that showed the possibility of a serious problem at that hospital. He was right to react promptly and to get to the bottom of those data. I put it to the hon. Gentleman that if he had been a Health Minister at the time he would not have wanted the NHS medical director to do anything other than give absolute priority to patient safety. That is what happened. Like the hon. Gentleman, I am delighted that it was possible for operations to resume on 10 April.
Julian Smith (Skipton and Ripon) (Con)
However we got to this point, I urge my right hon. Friend—on behalf of one of the leading campaigners for Leeds heart surgery, my constituent Lois Brown—to do everything he can to ensure that we move as quickly as possible to a decision on Leeds, based on the full facts and made in a transparent manner.
Mr Hunt
I can absolutely assure my hon. Friend that that is my intention. There is legal due process—legal proceedings are under way—and he would want that to be respected. I am also anxious to read and digest the report of the Independent Reconfiguration Panel. I would like that all to happen as quickly as possible within the law, so that we can conclude this matter and remove the great uncertainty that I know is unsettling so many people.
Mr George Mudie (Leeds East) (Lab)
Does the Secretary of State not accept that Sir Roger’s unacceptable remarks, which came 24 hours after the court decision confirmed the review as flawed, unfair and unlawful, have dented severely the credibility of the Safe and Sustainable review in the eyes of the public? The Secretary of State has suggested that he will wait until the configuration board comes back with a recommendation, but does he not think that it would have been better if he had come to the Chamber to tell hon. Members and the public what steps he would be taking to restore credibility to the Safe and Sustainable review?
Mr Hunt
I think that NHS England has taken firm action: it has said that Professor Boyle will not take any further part in Safe and Sustainable. However, the hon. Gentleman will understand that as the review is currently subject to legal proceedings, I cannot comment any further. As the final decision will end up on my desk, I want to wait until the legal proceedings are complete and I have the report of the IRP to consider before I make that decision. I stress what I said to my hon. Friend the Member for Skipton and Ripon (Julian Smith): I would like it to conclude as quickly as possible. I know that is in the best interests of the people of Leeds.
Andrew Jones (Harrogate and Knaresborough) (Con)
I thank my right hon. Friend for his statement. NHS bosses are right to take seriously any concerns regarding patient safety, particularly in the light of the Mid Staffs crisis. There has been significant anger and confusion locally surrounding the chaos of the decision to close the unit. Does my right hon. Friend agree that the use of data, which are incomplete and described by the doctors that produced them as not fit for purpose, has led to precipitate and disproportionate actions that have worried patients and their families? We have, after all, a culture in which NHS managers are extremely familiar with handling data. They must have known that precipitate actions would come from looking at leaked partial data.
Mr Hunt
I entirely understand the concern of families, staff and doctors at the LGI. I simply say to my hon. Friend that the reason the data were not complete was because the hospital had failed to supply them. There is, therefore, an important warning to all hospitals to ensure that they supply accurate and timely information on their surgery survival rates.
Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)
Does the Secretary of State still accept the underlying premise of the Safe and Sustainable review, which is that there should be a smaller number of centres of excellence for children’s specialist heart surgery? If he still accepts that premise, will he say something to the House today about his timetable for bringing the issue, which has gone on for 12 years, to a conclusion?
Mr Hunt
I certainly accept the premise, on the basis of considerable clinical evidence, that for complex surgery greater specialisation leads to higher survival rates. On whether that is the right thing to do in this particular case, I would like to wait for the outcome of the legal process and the advice of the Independent Reconfiguration Panel, but I will just say this: I would like to conclude this as quickly as possible. I am subject, rightly, to legal due process. Families who feel strongly want this to be concluded quickly, but they also want to know that it has been concluded fairly, and I think that that underlies a lot of the concerns raised by Members this afternoon. The timetable is not within my gift but what is within my gift in terms of timings I will try to expedite as quickly as possible.
Sir Alan Beith (Berwick-upon-Tweed) (LD)
Does my right hon. Friend recognise that whatever challenge there may be to the evidence relating to Leeds, there has been no challenge to the evidence of the successful outcomes in Newcastle? Can he assure me that clinical evidence will predominate in his final decision?
Mr Hunt
I can absolutely give my right hon. Friend that assurance. It is very important, when dealing with very difficult decisions of this nature, that we are led by clinical evidence on what will save the most lives. We have an absolute responsibility to all of our constituents to ensure that clinical evidence informs the final decision.
Mr Kevin Barron (Rother Valley) (Lab)
I was contacted by a mother whose son’s operation was cancelled, and it had also been delayed on two previous occasions for other reasons. Given this unedifying situation, in which the two leading clinicians who advise on these areas for the NHS have lowered themselves to saying whether they would send their child to this unit for an operation, what advice should I give to my constituent?
Mr Hunt
I am certain that the right hon. Gentleman’s constituent would not want surgery to proceed anywhere in the NHS if there are question marks over its safety. Of course, when such decisions are made in a very short period of time, it is greatly discomfiting and worrying for the many families involved, who have enough to worry about anyway—I completely understand that. He should remember, however, how we in the NHS let down the families in Bristol and Mid Staffs by not acting when data suggested that there might be a problem. It is better to act quickly and decisively and then, if possible, to resume surgery, as happened on this occasion, than not to act at all and to find out later that we have been responsible for much, much worse outcomes.
Nigel Adams (Selby and Ainsty) (Con)
On behalf of right hon. and hon. Members across Yorkshire, may I use this opportunity to thank my hon. Friend the Member for Pudsey (Stuart Andrew) for how he has worked in a consensual, cross-party and non-political way on this issue?
Did the Secretary of State not find it at least odd that the concerns about the Leeds unit came to light within hours of the High Court’s ruling against the decision to close the Leeds unit?
Karl Turner (Kingston upon Hull East) (Lab)
Come on Jeremy, answer the question.
Mr Hunt
Whenever he receives information, the medical director is under an absolute obligation to act. What he did was absolutely correct: he said that he would look at the data and get to the bottom of them and that if it turned out that the data were not as accurate as they should have been, surgery would resume. That is exactly what happened.
Mr Speaker
The hon. Member for Kingston upon Hull East (Karl Turner) is a very excitable fellow—he might remind some people of his predecessor in the House in that respect.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
A baby born with a heart condition in Sheffield who needs a complex intervention would normally go to Leeds. One of the concerns about the Safe and Sustainable review was that children from my constituency would have had to travel further. The decision to suspend the Leeds unit created that very situation. The Secretary of State needs to acknowledge that children could, as it turns out, have been put at risk unnecessarily by closing a unit that was in fact safe, because they would have had to travel further, which for very ill babies is a risk in itself. At the heart of this has been a lack of transparency and a failure to put information into the public domain. I have had to table parliamentary questions to try to get information about what is happening. Nobody wants an unsafe situation. Will the Secretary of State now commit to complete transparency in respect of all the information?
Mr Hunt
This situation arose because of the much greater data transparency and because the Government have been encouraging people to come forward if they have concerns about things going wrong. As a result, we were presented with data on the basis of which the NHS director decided that the safe and sensible thing to do was to suspend surgery while we got to the bottom of these data, which could have demonstrated some very serious outcomes. We need to take good advice from clinicians about the balance of risk. Yes, there might be some risks with people having to travel further for the surgery, but surely the risks are much greater if potentially unsafe operations are allowed to continue. That was why, on that balance of risk, it was decided to suspend surgery at Leeds until we could get to the bottom of whether the data were right.
Alec Shelbrooke (Elmet and Rothwell) (Con)
In the week after surgery at the heart unit was suspended, my wife and I met a constituent in Rothwell whose child was due to go in for surgery. She was completely and utterly exhausted and overwrought with worry and concern. Many people were concerned not just about the suspension, but about the distances that they would have had to travel if Leeds had not reopened. That possibility, which we had previously mentioned, became a reality. Sir Roger has now been suspended from the review, but he had already reported. In order that we can take one positive out of what has happened in the past couple of weeks, will the Secretary of State ensure that the distances people have to travel are now taken seriously in the review?
Mr Hunt
That is exactly the purpose of a review. Let me reassure my hon. Friend that before I make any decision, I will be getting on my desk independent advice from the Independent Reconfiguration Panel. One thing that that advice does is weigh up the balance of advantage between the greater distances that people have to travel and the advantages of specialisation for complex surgery. My heart goes out, as I know his does, to people who were made extremely worried by what happened over Easter at Leeds. However, he will also understand that if there are concerns, the last thing his constituents would want is an NHS that did nothing because of an argument about data. The right thing to do was to get to the bottom of the data, and I am sure that his constituents are as delighted as he and I are that surgery has now resumed.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
What does the Secretary of State think of the opinion of one of my constituents, who said to me over the weekend, “What a right old mess all this has been”? The fact is that it has been a mess. I have supported the all-party campaign on the basis that we go for the best clinically safe outcomes for all my constituents. My constituents have gone to Leeds general infirmary, as have my children. It is a hospital of great renown, in which the people of Yorkshire have tremendous faith, but in today’s statement the Secretary of State has two or three times put us in the same frame as Mid Staffordshire and Bristol. There is no question but that Leeds general infirmary is a fine institution. Will he put it on the record today that this is not the same sort of case? This is a fine hospital struggling to deliver under a cloud that has been over it for three or four years.
Mr Hunt
What I say to the hon. Gentleman is that it is a fine hospital and a safe hospital, but data were presented to the NHS medical director that said that mortality rates there for children’s heart surgery were two and three quarter times higher than should be expected. In that situation, there is of course a great deal of inconvenience and worry caused by a decision to suspend surgery, but I would rather have that inconvenience and worry than continue with surgery when we have not got to the bottom of whether there is any truth in those data. That must be the right thing to do for the people who are due to have operations at that hospital.
Martin Vickers (Cleethorpes) (Con)
Parents whose children face major surgery are already particularly anxious and distressed, and that is before an unseemly public dispute breaks out between the medical experts that they rely on. This also highlights the fact that the investigation has been going on for far too long. The uncertainty is unacceptable. May I urge my right hon. Friend to do everything possible to bring the matter to a speedy conclusion?
Mr Gerry Sutcliffe (Bradford South) (Lab)
I know the Secretary of State likes dancing, but his fancy footsteps today are doing him no favours. The position in Leeds is that the public have lost confidence after what has taken place. Sir Roger Boyle has condemned the hospital and the Secretary of State has not condemned him for the comments he has made. Can he do that now?
Mr Hunt
Let me be clear: I do not want anyone in the NHS who has concerns about mortality to sit on those concerns, so if Sir Roger had concerns, he was right to raise them with Professor Sir Bruce Keogh. Sir Roger also made comments that suggested that he might have prejudged the outcome of Safe and Sustainable, so I think it is right that he does not take any further role in that, and we will be getting independent advice on whether Safe and Sustainable made the right recommendations, which I shall consider before making any decision. I have to say to the hon. Gentleman that there is no fancy footwork. I am absolutely clear that if anyone, anywhere in the NHS, has concerns about safety and if the view of the NHS medical director is that we need to investigate those concerns and, in the meantime, suspend surgery at that institution, I will support the NHS medical director. That is the right thing to do and I think the hon. Gentleman would do exactly the same if he were in my shoes.
Mr David Ward (Bradford East) (LD)
This whole thing stinks; it really does. We now know that the unit is perfectly safe, which means that, for a period of time, children’s health was put at risk while it was closed. That is the seriousness of the situation. The decision was not made after careful, thoughtful consideration of authoritative, verified data; it was a kneejerk reaction to what must, in all probability, have been malicious allegations made against the unit. We have been told over and over again to ask ourselves what Sir Roger could have done, other than close the unit, but what did he actually do? That is what we need to find out, and the matter needs to be investigated. We know what the context was, following the court case, and we need to find out what follow-up work he did in that context to verify the allegations before he took that risk with the health of young children.
Mr Hunt
There are some risks, of course, in suspending surgery, but when we have mortality data such as those that Professor Sir Bruce Keogh was faced with, there are also considerable risks involved in doing nothing in response. The decision was taken not to close the children’s heart unit but to suspend surgery until he could get to the bottom of whether there was any truth in the data. He had a very difficult decision to make, given that situation, but I think he made the right decision.
Nic Dakin (Scunthorpe) (Lab)
Parents of very poorly children in the Scunthorpe area who have been very effectively supported by the Leeds unit have been dismayed to hear what has been happening over the past month or so. The Secretary of State has given us clear answers this afternoon, and I thank him for that. He has said that there will be a resolution to the Safe and Sustainable review as soon as possible. Will that be in 2013 or at some point beyond that?
Mr Hunt
I very much hope that this does not go beyond 2013, but I am afraid that that is not in my hands, because of legal due process. Legal proceedings are under way at the moment and I have to consider the advice of the Independent Reconfiguration Panel, but I want to stress to the hon. Gentleman, as I have to many hon. Members, my determination to resolve the situation as quickly as possible.
Miss Anne McIntosh (Thirsk and Malton) (Con)
Children living in Thirsk and Malton will be operated on either at Leeds hospital or at Newcastle hospital. What is becoming apparent in this and other debates on the health service is the desire of parents and other family members to have their loved ones—young children in this case—operated on as close as possible to where they live, whereas clinicians and the Government seem, at every stage of the NHS reforms, to be making decisions based on clinical excellence. This is a debate that needs to be had.
Mr Hunt
I agree with my hon. Friend. There are two types of reason for people going into hospital. With geriatric care, for example, there are clear advantages in someone being treated as near as possible to their home. All other things being equal, it makes sense for people to be treated where it is easy for friends and family to visit them, as that can aid recuperation and convalescence. When more complex surgery is required, however, there is clinical evidence that mortality rates are better if we specialise surgery in a fewer number of centres. That is the debate that we are having about children’s heart surgery, and I hope to resolve the matter as quickly as possible.
Diana Johnson (Kingston upon Hull North) (Lab)
Given that the Safe and Sustainable review is being dogged by so many problems, and given the inaccuracies and the prejudice against Leeds in particular, has the Secretary of State thought about scrapping the whole process?
Mr Hunt
That is the subject of legal proceedings at the moment, and I want to ensure that we have a process that is fair and that is recognised to be fair by all the people who are affected by this possible decision. I therefore want to ensure that the decision will be judicially robust, but I also want to get independent advice from the IRP before I make my final decision. If that means that it takes longer to get to a decision, then I am afraid that that might be the case, but the most important thing is to get to a decision that is fair and that is recognised to be so.
Jenny Chapman (Darlington) (Lab)
It is right that such decisions should be made on the basis of data, but those data must be more reliable. Such decisions are made in this way up and down the country on maternity and accident and emergency units, for example. How will the Secretary of State ensure that such data are reliable and robust, that they can be challenged, and that such situations can be dealt with far more quickly than has been the case in Leeds?
Mr Hunt
The hon. Lady makes an important point. At the heart of this is a change happening in the NHS, where heart surgery is leading the way and we are discovering that we can make dramatic improvements to mortality rates. It has happened in heart surgery, where we have moved from being one of the worst performers in Europe to one of the best, because of the collection of risk-adjusted data. That has now been extended to cancer outcomes and to a total of 10 specialities. We shall gradually collect those data over the next two years, which will allow peer review in a way that cannot normally happen. It is a big change and part of the issue was that the hospital in Leeds did not realise how seriously the data would be taken, which may have meant that it did not supply as complete data as it should have, and that led to the problem. There is a big change, but also a big opportunity for the NHS to improve its outcomes.
Jonathan Ashworth (Leicester South) (Lab)
I want to reinforce entirely the point put to the Secretary of State by the hon. and learned Member for Harborough (Sir Edward Garnier) a few moments ago. Safe and Sustainable made recommendations about Leeds and about closing children’s heart surgery at Leicester, but in recent days published data show that Leicester has one of the lowest mortality rates. Can the Secretary of State guarantee that the Independent Reconfiguration Panel will fully take into account those data published just a few days ago?
Paul Blomfield (Sheffield Central) (Lab)
We have seen an extraordinary sequence of events that have unnecessarily tarnished the reputation of what the Secretary of State described as a fine hospital, and caused enormous anxiety to families across Yorkshire and the wider region. Does the Secretary of State not agree therefore that we need a full inquiry into how the decision was taken?
Mr Hunt
I think the most important thing is properly to establish the truth of the data and then to make sure that any lessons learned from that are reflected in decisions made about the Safe and Sustainable Review, so that the influence of mortality data on any decisions in Safe and Sustainable is based on proper analysis of those data. That is certainly something we will learn from.
Mid Staffordshire NHS Foundation Trust
Jeremy Hunt Excerpts(13 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I would like to make a statement on the Government’s response to the Mid Staffordshire NHS Foundation Trust public inquiry.
I congratulate my predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), on setting up the public inquiry and on the many changes that he made in foreseeing its likely recommendations. I also pay tribute to Robert Francis QC for his work in producing a seminal report that will, I believe, mark a turning point in the history of the NHS.
Many terrible things happened at Mid Staffs, in what has rightly been described as the NHS’s darkest hour. Both the current and former Prime Minister have apologised. However, when people have suffered on such a scale and died unnecessarily, our greatest responsibility lies not in our words, but in our actions. Our actions must ensure that the NHS is what every health professional and patient wants: a service that is true to NHS values, that puts patients first, and that treats people with dignity, respect and compassion.
The Government accept the essence of the inquiry’s recommendations and will respond to them in full in due course. However, given the urgency of the need for change, I am today announcing the key elements of our response so that we can proceed to implementation as quickly as possible. I have divided our response into five areas: preventing problems from arising by putting the needs of patients first; detecting problems early; taking action promptly; ensuring that there is robust accountability; and leadership. Let me take each in turn.
To prevent problems from arising in the first place, we need to embed a culture of zero harm and compassionate care throughout the NHS; a culture in which the needs of patients are central, whatever the pressures of a busy, modern health service. As Robert Francis said,
“The system as a whole failed in its most essential duty—to protect patients from unacceptable risks of harm and from unacceptable, and in some cases inhumane, treatment that should never be tolerated in any hospital.”
At the heart of this problem is the fact that current definitions of success for hospitals fail to prioritise the needs of patients. Too often, the focus has been on compliance with regulation rather than on what those regulations aim to achieve. Furthermore, the way hospitals are inspected is fundamentally flawed, with the same generalist inspectors looking at slimming clinics, care homes and major teaching hospitals—sometimes in the same month. We will therefore set up a new regulatory model under a strong, independent chief inspector of hospitals, working for the Care Quality Commission. Inspections will move to a new specialist model based on rigorous and challenging peer review. Assessments will include judgments about hospitals’ overall performance, including whether patients are listened to and treated with dignity and respect, the safety of services, responsiveness, clinical standards and governance.
The Nuffield Trust has reported on the feasibility of assessments and Ofsted-style ratings, and I am very grateful for its thorough work. I agree with its conclusion that there is a serious gap in the provision of clear, comprehensive and trusted information on the quality of care. In order therefore to expose failure, recognise excellence and incentivise improvement, the chief inspector will produce a single aggregated rating for every NHS trust. Because the patient experience will be central to the inspection, it will not be possible for hospitals to get a good inspection result without the highest standards of patient care.
The Nuffield Trust rightly says, however, that in organisations as large and as complex as hospitals, a single rating on its own would be misleading. The chief inspector will therefore also assess hospital performance at speciality or department level. This will mean that cancer patients will be told of the quality of cancer services, and prospective mothers the quality of maternity services. We will also introduce a chief inspector of social care and look into the merits of a chief inspector of primary care to ensure that the same rigour is applied across the health and care system.
We must also build a culture of zero harm throughout the NHS. This does not mean there will never be mistakes, just as a safety-first culture in the airline industry does not mean there are no plane crashes, but it does mean an attitude to harm that treats it as totally unacceptable and takes enormous trouble to learn from mistakes. We await the report on how to achieve this in the NHS from Professor Don Berwick. Zero harm means listening to and acting on complaints, so I will ask the chief inspector to assess hospital complaints procedures, drawing on the work being done by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart to look at best practice.
Given that one of the central complaints of nurses is that they are required to do too much paperwork and thus spend less time with patients, I have asked the NHS Confederation to review how we can reduce the bureaucratic burden on front-line staff and NHS providers by a third. I will also be requiring the new Health and Social Care Information Centre to use its statutory powers to eliminate duplication and reduce bureaucratic burdens.
Secondly, we must have a clearer picture of what is happening within the NHS and social care system so that, where problems exist, they are detected more quickly. As Francis recognised, the disjointed system of regulation and inspection smothered the NHS, collecting too much information but producing too little intelligence. We will therefore introduce a new statutory duty of candour for providers to ensure that honesty and transparency are the norm in every organisation, and the new chief inspector of hospitals will be the nation’s whistleblower-in-chief.
To ensure that there is no conflict in that role, the CQC will no longer be responsible for putting right any problems identified in hospitals. Its enforcement powers will be delegated to Monitor and the NHS Trust Development Authority, which it will be able to ask to act when necessary. We know that publishing survival results improves standards, as has been shown in heart surgery, so I am very pleased that we will be doing the same for a further 10 disciplines—cardiology, vascular, upper gastrointestinal, colorectal, orthopaedic, bariatric, urological, head and neck, and thyroid and endocrine surgery.
The third part of our response is to ensure that any concerns are followed by swift action. The problem with Mid Staffs was not that the problems were unknown; it was that nothing was done. The Francis report sets out a timeline of around 50 warning signs between 2001 and 2009, yet Ministers and managers in the wider system failed to act on those warnings. Some were not aware of them; others dodged responsibility. That must change. No hospital will be rated as good or outstanding if fundamental standards are breached, and trusts will be given a strictly limited period of time to rectify any such breaches. If they fail to do that, they will be put into a failure regime that could ultimately lead to special administration and the automatic suspension of the board.
The fourth part of our response concerns accountability for wrongdoers. It is important to say that what went wrong at Mid Staffs was not typical of our NHS, and that the vast majority of doctors and nurses give excellent care day in, day out. We must ensure that the system does not crush the innate sense of decency and compassion that drives people to give their lives to the NHS.
Francis said that primary responsibility for what went wrong at Mid Staffs lies with the board. We will, therefore, look at new legal sanctions at corporate level for organisations that wilfully generate misleading information or withhold information that they are required to provide. We will also consult on a barring scheme to prevent managers found guilty of gross misconduct from finding a job in another part of the system. In addition, we intend to change the practices around severance payments, which have caused great public disquiet.
The General Medical Council, the Nursing and Midwifery Council and other professional regulators have been asked to tighten their procedures for breaches of professional standards. I will wait to hear how they intend to do that, and for Don Berwick’s conclusions on zero harm, before deciding whether it is necessary to take further action. The chief inspector will also ensure that hospitals are meeting their existing legal obligations to ensure that unsuitable health care support workers are barred.
The final part of our response will be to ensure that NHS staff are properly led and motivated. As Francis said,
“all who work in the system, regardless of their qualifications or role, must recognise that they are part of a very large team who all have but one objective, the proper care and treatment of their patients”.
Today I am announcing some important changes in training for nurses. I want NHS-funded student nurses to spend up to a year working on the front line as support workers or health care assistants as a prerequisite for receiving funding for their degree. That will ensure that people who become nurses have the right values and understand their role. Health care support workers and adult social care workers will now have a code of conduct and minimum training standards, both of which are being published today. I will also ask the chief inspector to ensure that hospitals are properly recruiting, training and supporting health care assistants, drawing on the recommendations being produced by Camilla Cavendish. The Department of Health will learn from the criticisms of its own role by becoming the first Department in which every civil servant will have real and extensive experience of the front line.
The events at Stafford Hospital were a betrayal of the worst kind—a betrayal of patients, families, and the vast majority of NHS staff who do everything in their power to give their patients the high-quality, compassionate care they deserve. I want Mid Staffs to be not a byword for failure but a catalyst for change, and to create an NHS where everyone can be confident of safe, high-quality, compassionate care, and where best practice becomes common practice, and the way a person is made to feel as a human being is every bit as important as the treatment they receive. That must be our mission and I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
I thank the Secretary of State for his statement and for the measured way in which he introduced it.
The NHS is 65 this year, and if it is to be ready for the challenges of this century, it must learn from the darkest hours of its past. The NHS was founded on compassion and, as the Secretary of State said, what happened at Stafford was a betrayal of that. Rightly, apologies have been given, but it is now time to act and make this a moment of change.
Robert Francis delivered 290 careful recommendations after a three-year public inquiry and, like the Secretary of State, I pay tribute to him today. In response, the Prime Minister promised a detailed response to each recommendation by the end of this month. Although the Opposition welcome much of what the Secretary of State has said today, his statement falls short of that promised full response and contains serious omissions on which I would like to press him, in particular, on four of Robert Francis’s flagship recommendations, which I shall take in turn.
First, we welcome the move to place a duty of candour on health care providers and believe it could help bring about the culture change the NHS needs. The Francis report, however, goes further and recommends a duty of candour on individual members of staff. Will the Secretary of State say more about why he has only accepted this recommendation in part and not applied it to staff? Has he ruled that out or is he prepared to give it further consideration?
Will the Secretary of State assure the House that the duty will apply equally to all providers of NHS services, including private providers? His statement was a little vague on that point. More generally, with more private providers coming into the NHS, is it not the case that we will not get the transparency we need unless the provisions of freedom of information apply fully to all holders of NHS contracts and information cannot be withheld under commercial confidentiality?
Secondly, on patient voice, the Government have announced new chief inspectors of hospitals and social care. Those were not Francis recommendations and, while we give them a cautious welcome, I am sure that the Secretary of State will agree that regulation alone will not be enough to prevent another Mid Staffs. Instead, we need a powerful patient voice in every community that is able to sound the alarm if things are going wrong. Rather than pulling down the shutters, as the NHS has a tendency to do, complaints should be embraced as opportunities to learn and improve.
It is just a matter of days until the new NHS comes into being and the concern is that patient voice has not been embedded at the heart of the new system. A third of councils say that their local healthwatch will not be up and running by the 1 April deadline, and there are wide variations in both structure and membership. Will the Government accept Robert Francis’s recommendation of a consistent basic structure for healthwatch programmes throughout the country before it is too late and they go their separate ways?
Thirdly, on regulation and training, Robert Francis has made a very clear case for a new system of regulation of health care assistants to improve basic standards—a case that we made during the passage of the Health and Social Care Act 2012—yet it did not feature in the Secretary of State’s statement. Have the Government accepted in principle the regulation of health care assistants?
We support moves to rebalance nurse training and to include more hands-on experience, but student nurses already spend 50% of their time in clinical practice and face significant financial barriers when completing their training. Will the Secretary of State assure the House that requiring a year on the ward will not increase the financial barriers to young people entering nursing and, if more trainees are to be on the wards, will he ensure that there are enough staff with the time to train the extra students?
That takes me to my fourth point and the most glaring omission from the Secretary of State’s statement, namely safe staffing levels. We will never get the right culture on our wards if they are understaffed and over-stretched, but there is evidence that things are going in the wrong direction and the Secretary of State was silent on the issue today.
The CQC has recently reported that one in 10 hospitals in England do not have adequate staffing levels. Just last week, work force figures showed that there had been a reduction of 843 nurses between November and December last year. Does that not sound the clearest of alarm bells that some parts of the NHS are already in danger of forgetting the lessons of its recent past by cutting the front line too far? Do not communities need a clear, objective benchmark so that they can challenge staffing levels on wards, and would it not be a great help to them for the Francis recommendation on staff-patient ratios to be accepted? We learned last week that the Department has handed £2.2 billion from last year’s budget back to the Treasury. Surely that money would have been better invested in the front line and in bringing all hospitals in England back up to safe staffing levels.
Finally, I want to turn to Stafford hospital itself, which Monitor has recommended should be placed in administration. This doubt about the hospital’s future will be causing real concern to the people of Stafford. After all they have been through, I think we can all agree that they deserve a safe and sustainable hospital, and I hope the Secretary of State will soon set out a plan to achieve that.
Learning the lessons of Stafford cannot be done overnight. We all have to play our part. The Government have made a start today, but much more needs to be done and we will hold them to that.
Mr Hunt
The right hon. Gentleman talks about glaring omissions in the Government’s response, but there were glaring omissions in his response too. Where was the apology for Labour’s targets culture that led to so many of the problems; the apology for failing to set up a regulatory structure that had proper safeguards; and the apology for missing all those warning signs? This was not just the darkest day in NHS history, but the darkest day in Labour’s management of the NHS. It is time the Labour party recognised the policy mistakes it made.
Let me go through what the right hon. Gentleman says are omissions. First, on the duty of candour, we accept the principle of the duty of candour when it applies to hospital boards, but we want to be absolutely sure that there are not unintended consequences of applying it to hospital staff, because another part of the Francis report is on the importance of a culture of openness and transparency, and we do not want a culture of fear. We have therefore not ruled out criminal sanctions for hospital employees who breach a duty of candour—they already have a contractual duty of candour —but, as I said in my statement, we want to wait for the result of Don Berwick’s report on zero harm to ensure that we do not take any measure that impedes the openness we need in hospitals.
The inspection regime will apply to all providers. It is important that it should, but I remind the right hon. Gentleman, who mentioned private providers, that the problems happened at an NHS hospital. Trying to turn this into a debate on privatisation tells people that Labour is missing the point in the response to Francis.
We will not introduce statutory regulation of health care assistants, but we will introduce minimum standards of training for them. We will not introduce statutory regulation because we believe there is a risk that a database of 0.5 million to 1.5 million people could end up being a box-ticking exercise that fails to raise standards in the way we need. We believe we have another way to achieve the same end, which is what we will implement.
On nurse training, we believe it is important that nurses have hands-on experience of the front line, because nurses, when they are properly qualified, will be managing health care assistants. It is therefore important that nurses understand what it is like to be a health care assistant. We will be very careful in how we implement that to ensure that we do not create financial barriers because, obviously, we want to attract the best people into nursing, regardless of income.
On staffing levels and nursing numbers, I remind the right hon. Gentleman that the problems at Mid Staffs happened when Labour was in power, when budgets were going up quite significantly, and when numbers were going up. To distil the problem to one of numbers is, again, to miss the point. This is about the values of the people on the ward. If he wants to talk about numbers, he must accept that, because this Government have protected the NHS budget, which he wants to cut from its current levels, there are 6,000 more clinical staff in the NHS today than there were at the time of the last election.
On Stafford hospital, it is extremely important that, when we have problems such as the ones at Mid Staffs, we create a structure that makes it impossible not to deal with them. That is a difficult process. We are announcing today a time-limited process to ensure that Ministers and the system cannot duck difficult decisions when we have a failing hospital. Obviously, we will follow the Monitor trust special administrators’ recommendations and look at them carefully, but it is important to address the issues. The wrong thing to do would be to fail to do so, because that would lead to clinical failure.
I welcome the fact that the right hon. Gentleman broadly accepts the Francis recommendations. He asked whether we would respond to all of them. The inquiry was a public inquiry, which he refused to set up. As a result of that detailed public inquiry, there are 290 recommendations. It takes time to go through all of them in detail, but I thought it was right to come to the House today with our initial response so that we can get cracking with the important things right away.
Mrs Cheryl Gillan (Chesham and Amersham) (Con)
I thank the Secretary of State for coming to the House and making a statement that helps to restore our confidence in the NHS, which has been so badly undermined by Labour’s appalling stewardship. Will he take steps to ensure that any complaints procedure provides protection to patients and relatives who raise concerns?
Mr Hunt
My right hon. Friend makes an important point. The thing about complaints procedures is that we must have a system that is not about process and whether there is a response to a complaint in three days. The question is whether a hospital looks at and learns from a complaints procedure and changes its behaviour. That is what the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart are looking into. Hospitals will be inspected against best practice to try to encourage as many of them as possible to adopt the very best complaints procedures.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)
The Secretary of State has announced that he will consult on a barring scheme to prevent managers who are found guilty of gross misconduct from finding a job in another part of the system. To how many managers of Mid Staffordshire would he expect that to apply?
Mr Hunt
The hon. Lady will know that, when it comes to individuals—appalled as I am, and as appalled as all hon. Members are, by what happened at Mid Staffs—I must try not to prejudge due process. If we are to bar people from employment, we must have a fair process and system and a right of appeal, which is required under our law anyway. However, I would not expect any manager responsible for the kind of things that happened at Mid Staffs to be able to get a job in the health service ever again.
John Pugh (Southport) (LD)
Peter Walsh from Action against Medical Accidents has described the legally enforceable duty of candour as the
“the biggest advance in patient safety and patients rights in the history of the NHS.”
Does the Secretary of State agree?
Mr Hunt
I listened to Peter Walsh’s thoughtful contribution to the “Today” programme this morning. We will consider carefully whether to apply the statutory duty of candour, backed up with criminal sanctions, to hospital employees. The review on zero harm and creating the right culture in hospitals will report not in a long time, but before the summer break, so it is right to wait until we have it before making our final decision.
Mr Kevin Barron (Rother Valley) (Lab)
The Francis report said that three areas went wrong: the first was unprofessional behaviour; the second was a lack of leadership; and the third was that the overwhelming prevalent factors were lack of staff in terms of both absolute numbers and appropriate skills. Given that we have lost thousands of nursing posts in the past few years, is the Secretary of State missing the point?
Mr Hunt
If the right hon. Gentleman had listened to what I have said, he would know that the number of clinical staff has gone up by 6,000 since the last election, which would not have been possible had we cut the NHS budget, which is what Labour Front Benchers want. It is important to ensure that we have the right numbers in wards to care for people. That is exactly what the new chief inspector will look at. There is evidence that hospitals that have the highest and most respected standards of care ensure they have adequate numbers not just of nurses, but of health care assistants. The whole NHS needs to learn the lesson that it must not cut corners when it comes to care.
Jeremy Lefroy (Stafford) (Con)
My right hon. Friend’s welcome statement shows just how important the inquiry was, and how vital its lessons will be for patient care and safety. The royal colleges have a great responsibility. Will he call them together on a regular basis to discuss how they are checking and raising standards in their professions to ensure first-class care for patients?
Mr Hunt
First, I thank my hon. Friend for his extraordinarily tireless work and for the extremely measured and mature attitude he has taken to the problems in the hospital, which is on his patch. Hon. Members on both sides of the House welcome that. He is right about the role of the royal colleges. There are some challenging suggestions in the Francis report for some of those colleges, but when we are seeking to raise standards, it is important that setting up that scorecard for the new chief inspector happens with the help of the royal colleges, whose business it is to raise standards in the NHS.
Valerie Vaz (Walsall South) (Lab)
I thank the Secretary of State for his statement, and we welcome the continuation of this discussion at the Health Committee. One of the recommendations of Francis was for the Secretary of State to look at the overlap between the CQC and Monitor, both of which were involved and have accepted they were part of the failings. Under the new inspection regime, will the chief inspector report to the Secretary of State or to the NHS Commissioning Board?
Mr Hunt
Neither. The chief inspector will report to the CQC. The hon. Lady is right that one of the problems is the overlapping roles and the confusion of roles. What we are announcing today is a significant change in the responsibilities of the CQC. It will no longer be involved in putting right problems in hospitals: its job will simply be to identify problems, so it is not compromised in its ability to be the nation’s whistleblower-in-chief. The responsibility for putting right problems will lie with Monitor, the NHS Trust Development Authority, the NHS Commissioning Board and the wider NHS system. We want to make sure that the chief inspector is unconstrained and unconflicted, when his or her team goes into hospitals, from shouting loudly if there is a problem and continuing to shout loudly until it is solved.
Sir Tony Baldry (Banbury) (Con)
These changes all come against a background of other changes in the NHS, such as clinical commissioning groups, Healthwatch and health and wellbeing boards, and I wonder whether my right hon. Friend would be kind enough to put in the Library a plain person’s guide, so that we can understand how these new regulators, inspectors and various other bodies fit in with each other—who is accountable to whom—so we as constituency MPs will know whom to approach and on what occasion. I am sure that all these changes are very welcome, but we need to understand how they relate to each other.
Mr Hunt
I am sure that my hon. Friend’s sentiments are shared on both sides of the House. Indeed, I could have done with such a guide when I started this job last September. I am happy to do as he requests, but from today’s announcement the most important thing that the country should know is that when it comes to failures in care, the buck stops in one place. It will be the chief inspector’s job to identify such failures and shout publicly about them, and that will be an important clarification that the system needs.
Yasmin Qureshi (Bolton South East) (Lab)
This is not a debate about private or public, but will the Secretary of State ensure that the duty of candour is applied equally to private providers of NHS services?
Paul Burstow (Sutton and Cheam) (LD)
Can the Secretary of State confirm that it is his intention that the statutory duty of candour—and the introduction of a ratings system—will apply to home care and care homes, not just NHS providers?
John Woodcock (Barrow and Furness) (Lab/Co-op)
The Secretary of State talks about severance and follow-on employment. Does he think it is acceptable that when the former chief executive of Morecambe Bay hospitals trust had to step down in February last year, because of the problems there, he was kept on the books in secret and paid £250,000 from local trust budgets—which could otherwise have gone to local health care—and was transferred to the NHS Confederation where his responsibilities could include teaching future leaders and helping to redesign the system?
Margot James (Stourbridge) (Con)
I very much welcome the return of student nurses to the wards for a year of their training. Project 2000 has much to answer for. On the subject of resourcing and staff to patient ratios, may I remind my right hon. Friend that many of the reports we have seen in the last few years, criticising hospitals for poor care and lack of dignity in the care of older people in particular, have shown that wards in the same hospitals have had very different standards of care? How can that be about resourcing?
Mr Hunt
My hon. Friend makes an important point. It is important that these assessments are made not just at an organisation level, but drill down into the different parts of a hospital, and we have taken that message on board from the Nuffield report on ratings. She is right that it is not just about resources, but sometimes it is about resources. Parts of a hospital can be understaffed when it comes to people who are required to perform basic and important roles in terms of care. Because it is a complex picture—and because numbers can be part of the problem, but are certainly not the whole problem—we want a chief inspector who will take a holistic view of every aspect of the performance of a hospital and be able to give proper feedback that a hospital can use to improve its performance.
Barbara Keeley (Worsley and Eccles South) (Lab)
May I press the Health Secretary on this point? I have raised several times the point that adequate staffing levels are crucial to patient safety and good care, but we seem to dodge around saying that it is a question of values, not of numbers. Francis said clearly that one of the issues was numbers. I have given examples of my local hospital, which views it as crucial that it has the right staffing mix, which it adjusts every single day, for the patients that it has. Will he stop avoiding this question and address it directly, because one in 10 hospitals do not have adequate staffing levels?
Mr Hunt
I am not avoiding it. I agree that adequate staffing levels are essential to patient care. I remind the hon. Lady that the shadow Health Secretary said to the Francis inquiry:
“I do not think that the Government could ever mandate a headcount in organisations. Whilst we could recommend staff levels, we were moving into an era when trusts were being encouraged to work differently and cleverly, and take responsibility for delivering safe care whilst meeting targets”.
Mr William Cash (Stone) (Con)
The Secretary of State rightly talks about a betrayal of trust of the worst kind, and he is right. He is also right about zero harm, and about much else that he has done. But there is one serious omission—of accountability—and that must be robust and include the resignation of Sir David Nicholson. I also apportion responsibility to those former Secretaries of State who were not called to give evidence but bear a heavy responsibility for not having done the right thing at the right time.
Mr Hunt
My hon. Friend knows that I have a different view of the level of responsibility of Sir David Nicholson, but I agree that everyone working in the system at that time shares some responsibility for what happened. We must make sure that it can never happen again. The accountability that we are introducing, including criminal sanctions for boards that fail in their statutory duties, will be a significant change. The body that was responsible for what went wrong at Mid Staffs, according to Francis, was the board of the hospital, so that is where our focus must be. Today is also about getting the right structures outside the hospital to make sure there is accountability there too.
Mark Durkan (Foyle) (SDLP)
The Secretary of State has referred to the fact the chief inspector will inspect hospital performance at specialty or department level. How will that be done? If records, paperwork and bureaucracy are being reduced in hospitals, will hospitals’ own records be used to make those assessments or will the inspector use other information?
Mr Hunt
Of course we need to rely on good information being supplied by hospitals, and that is why we have said today that it will be a criminal offence for hospitals knowingly to supply wrong information. This goes back to an earlier question, and we will work closely with outside bodies, such as the royal colleges, to ensure that we establish the best way to judge, for example, cancer survival rates. One of the lessons of the success of measuring heart surgery survival rates is the importance of having a good risk-adjustment process in place. We will do that across the other 10 specialties that I announced today.
Dr Phillip Lee (Bracknell) (Con)
Although I acknowledge the Secretary of State’s genuine desire to improve hospital standards by the introduction of his new inspectorate, I am concerned about the further reliance on systems above individual responsibility. Will he assure the House that his new inspectorate will not become yet another component of the merry-go-round of management employment schemes currently found in the NHS? Will he also assure me that those implicated in previous hospital management scandals will not be employed as inspectors in the future?
Mr Hunt
My hon. Friend is right: we have to ensure that the inspectorate works in the successful way that Ofsted has worked in the school system, and does not make the mistakes that have been made by other regulators inside the NHS system. It is important that it is based on respected peer review, is thorough and is respected in terms of the input that it is able to give hospitals on improving their performance. We will work hard to make sure that we deliver that.
Diana Johnson (Kingston upon Hull North) (Lab)
Who is expected to pay for the additional year that nurses will spend as health care assistants?
Mr Edward Leigh (Gainsborough) (Con)
Every time there is a scandal, the response of the British political establishment is to load more controls, accountability and bureaucracy on professionals, yet every nurse and doctor I meet is fed up with what already happens. As a result of the reforms, will the Secretary of State assure us that we will now trust professionals to get on with the job they love?
Mr Hunt
I agree with those sentiments strongly. In parallel to this process and these changes, I have asked the NHS Confederation to recommend how we can reduce the bureaucratic burden on hospital front-line staff by a third, precisely because I want to avoid the issues that my hon. Friend mentions. This is about freeing up time for people at the front line, and one way is to have an inspection system in which everyone has confidence. Once there is the confidence that problems will be identified, it becomes much easier, as has happened in the education system, to give more freedom to people on the front line.
Jim Shannon (Strangford) (DUP)
I thank the Secretary of State for his statement. The public inquiry has been thorough, with new standards put in place and lessons learned from the NHS in Staffordshire. Health in Northern Ireland is a devolved matter. Will he confirm that the report will be sent to the Northern Ireland Assembly Health Minister, Edwin Poots, so that improvements and guidelines can be improved for everyone in the United Kingdom of Great Britain and Northern Ireland?
Mr Bernard Jenkin (Harwich and North Essex) (Con)
May I commend my right hon. Friend’s emphasis on leadership? In Colchester, we have seen periods of good and bad leadership, and good leadership is self-evidently the right answer to hospital management. Can I therefore ask him to lay more emphasis on what constitutes good leadership and trust between good leaders and their employees in the health service right through the system, including from Sir David Nicholson downwards, and not to rely overmuch on regulation, which is no substitute for good leadership?
Mr Hunt
I agree wholeheartedly. It is very important that we understand that the benefit of the new inspection regime will not just be that it identifies failing hospitals, but outstanding hospitals too, so that we have a good model of leadership in the system from which other managers can learn. Yes, it is really important to have the right relationships between managers and their staff, but we should not mandate or regulate that from the centre. We want to have a system where people can learn from each other.
Jane Ellison (Battersea) (Con)
I received a distressing piece of constituency casework yesterday that underlines the importance of the announcement my right hon. Friend has made today. Does he feel that his reforms will build more of a culture of compassion in nursing care?
Mr Hunt
That is at the heart of what the reforms intend to achieve. An organisation as complex and as large as the NHS needs corporate objectives and targets—for example, we need to do a lot better on dementia—and we do set system-wide objectives. However, we have to ensure that those objectives, set by whichever party happens to be in power, never compromise the fundamental care and compassion that needs to be at the heart of what the NHS does. We are putting in the safeguards that ensure that that cannot happen.
Naomi Long (Belfast East) (Alliance)
Given the mobility of both the work force and students, what discussions has the Secretary of State had with the devolved Administrations regarding the proposed changes to funding nurse places and training?
Mr Aidan Burley (Cannock Chase) (Con)
Does the Secretary of State agree that the decision to grant foundation trust status to Mid Staffs in 2008 was catastrophic in terms of the trust taking its eye off the ball and focusing on targets rather than on care, and that, now it is being abolished just five years later, never again must a Government pressurise a trust into a particular organisational form just to validate its ideological policy, rather than because it improves the care of patients?
Mr Hunt
I would also like to thank my hon. Friend for the work that he does for his local hospital in difficult circumstances directly involved in this terrible scandal. I agree with him: the corporate objective to become a foundation trust overrode everything else in the hospital, at huge expense to patient care. We must never allow that to happen again.
John Glen (Salisbury) (Con)
What most people want when they use the NHS is a reliable, accessible service, and to know that when something goes wrong somebody will be held to account and brought to book. Clearly, that has not happened. What can the Secretary of State say to reassure our constituents that people will be held accountable on an individual level, and that we will not see this happen again?
Mr Hunt
That accountability is extremely important and happens on many different levels. In particular, we have professional codes of conduct for doctors and nurses, so that in the exceptional situations where those codes are breached, we know, as members of the public, they will be held to account. Those are done at arm’s length from the Government by the General Medical Council and the Nursing and Midwifery Council, but we are talking to them about why it is that still no doctor or nurse has been struck off following what happened at Mid Staffs—I think that is completely wrong.
Andrew George (St Ives) (LD)
I know I repeat myself, but adequate registered nurse-to-patient ratios are often at the heart of these failings, yet on page 68 of the report my right hon. Friend rejects the idea of any kind of national benchmarking or guidelines with regard to patient ratios. Will my right hon. Friend keep an open mind and meet me, Professor Elizabeth Robb of the Florence Nightingale Foundation and others from the profession so that we can explore this issue?
Mr Hunt
We are not saying that minimum standards of adequate staffing levels are not needed, but we reject the idea that they should be mandated from the centre—I think there is cross-party agreement on that. The chief inspector will look at and highlight the reasons for poor care and, if they are due to inadequate staffing levels, ensure that something is done about it.
Sir Peter Bottomley (Worthing West) (Con)
On the rare occasions when a clinician or other member of hospital staff raises a problem and it is not taken care of, may I suggest that employers have a box in which to put in a note saying what the problem is? There should be a receipt so that if there is an inquiry later, it can be shown what the hospital should have paid attention to right at the beginning.
Andrew Percy (Brigg and Goole) (Con)
Staffing levels are important, but so are bed numbers. Many of the 41,000 beds lost under the previous Government were in my constituency. Consequently, we have massive pressure on beds, wards on purple alerts and very high mortality rates. Will any inspection regime include an assessment of safe bed levels?
Mr Hunt
The inspection regime will of course cover such issues as part of its inspection of whether basic standards of care are being met. Yes, of course such issues matter, but there are challenges beyond what an inspection regime can deliver which we will need to address to deal with these issues. In particular, a problem we are wrestling with at the moment is who will take responsibility for the frail elderly when they are discharged from hospital. One reason why they stay in hospital for a long time is because geriatricians are nervous about sending them back into the community. They do not think anyone will take responsibility for them and that is something we have to look at.
Jackie Doyle-Price (Thurrock) (Con)
On the respective roles of CQC and Monitor, can my right hon. Friend indicate that he expects Monitor to use the full regulatory tools at its disposal and give appropriate challenge to the boards of foundation trusts and hospitals where failure is indicated?
Mr Hunt
My hon. Friend is absolutely right. One of the changes we are announcing today is that, in the case of foundation trusts, CQC will be delegating its enforcement powers to Monitor so that it has more powers to insist on necessary changes and ensure that fundamental standards are not being breached.
Jonathan Evans (Cardiff North) (Con)
Will my right hon. Friend note that the Patients Association and campaigners such as the Powell family in Wales will not be satisfied by what he has had to say about the duty of candour until we have a full statutory duty in line with what Robert Francis recommended?
Dr Julian Lewis (New Forest East) (Con)
Does my right hon. Friend accept that the best system in the world will not succeed if individuals who behave inhumanely get away with it and people who observe them behaving inhumanely do not report it? I therefore re-emphasise what my hon. Friend the Member for Cardiff North (Jonathan Evans) has just said: if individuals see this inhumane behaviour, they must report it.
Chris Heaton-Harris (Daventry) (Con)
I congratulate my right hon. Friend on his statement, particularly the parts about where perverse effects of the old target culture kick into the NHS. When the dust has settled on the Francis report and its conclusions, will he look at targets that affect the ambulance service and how they directly affect rural communities across the country?
Charlotte Leslie (Bristol North West) (Con)
I very much welcome the Secretary of State’s statement, but does he share my sorrow that it has taken so long and so many deaths to reach this stage, when Labour was presented with reports by Don Berwick himself highlighting bad quality assessment, when 120 bodies had overlapping responsibilities and when he said that patient safety was not central to the NHS? Is it not tragic that it has taken this long?
Kris Hopkins (Keighley) (Con)
We are fortunate to have a high-performing general hospital in Keighley and Ilkley, but does my right hon. Friend agree that even hospitals such as Airedale hospital must not be complacent? Quality must be paramount. Every member of staff has a responsibility to deliver the high level of compassionate care that he spoke about.
Mr Hunt
I agree with my hon. Friend. I visited Airedale hospital and was very impressed with the level of care I saw there. It is one of the only hospital trusts in the country—if not the only one—where doctors can see the full history of what patients going into A and E have been prescribed by their GPs, which has an important impact on patient safety.
Mr Nick Gibb (Bognor Regis and Littlehampton) (Con)
I congratulate my right hon. Friend on the action he has taken, particularly re-instilling the importance of compassion in the NHS and the changes he is proposing to the training of nurses. Can he inform the House of any other NHS trust where similar concerns are being investigated?
Mr Hunt
One of the problems at the moment is that we do not have a good way of identifying other hospitals. The hospital inspection regime will start this year. That will obviously be the start, but prior to that we are conducting an investigation into 14 hospitals with higher than average mortality rates. That is one indicator: it might not mean there is a problem, but it is something we think is worth checking out.
Finally, let me say that my hon. Friend has an extremely good record on improving standards in education by understanding the importance of rigour. That is something we can learn from in the inspection regime for hospitals.
Mr Philip Hollobone (Kettering) (Con)
Will my right hon. Friend ensure that any revised patient care ratings include an enhanced emphasis on the degree to which things are explained clearly to patients and relatives and how relatives are kept informed?
Mr Hunt
My hon. Friend makes an important point. It is absolutely essential that the new chief inspector’s team talks to patients and relatives to get that feedback. One of the biggest changes from what we have now to what we will have is the element of judgment in the assessments made. We will not just be looking at the data, the dials or the numbers; there will be someone going to a hospital, smelling the coffee, understanding the culture of the place and talking to patients and relatives.
Stephen Lloyd (Eastbourne) (LD)
I commend the Secretary of State for his statement and for what I think is an absolutely outstandingly powerful report. However, I have concerns about recently proposed changes to the consultant-led maternity services at Eastbourne district general hospital. Will he confirm for the record that any changes that I and others have concerns about will be considered by the new chief inspector of hospitals?
Mr Hunt
I congratulate my hon. Friend on his ingenious segue. All hospitals—all NHS trusts—will be inspected by the chief inspector, so everything that happens at Eastbourne will be covered by the new regime. It will be strong, rigorous and independent, so that any concerns that my hon. Friend has should be picked up by anything that the chief inspector reports on.
Fair Playing Field Review
Jeremy Hunt Excerpts(13 years, 4 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
The Fair Playing Field Review has been laid in Parliament today, in line with the requirement set out in section 1G of the National Health Service Act 2006.
The aim of the review is to ensure that patients are able to access NHS services delivered by the best possible providers. In June 2012, Monitor—the independent health care regulator—was asked to look into any matters that might undermine this aim, and to report back with options for addressing such matters. The Department would like to thank Monitor for its work, the results of which have been published as part of the review.
Immigrants (NHS Treatment)
Jeremy Hunt Excerpts(13 years, 4 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Mr Frank Field (Birkenhead) (Lab)
(Urgent Question): To ask the Secretary of State for Health what moves the Government intend to take to prevent the national health service becoming an international health service.
The Secretary of State for Health (Mr Jeremy Hunt)
The current system of policing and enforcing the entitlement of foreign nationals to free NHS care is chaotic and often out of control. At a time when we are having to face the challenges of an ageing society, it places a significant and unjustified burden on our GP surgeries and hospitals and may well impact on the standard of care received by British citizens.
As the Prime Minister said earlier today, the Government are determined to ensure that anyone not entitled to receive free NHS services should be properly identified and charged for the use of those services. Currently, we identify less than half of those who should be paying and collect payment from less than half those we identify.
We also have some of the most generous rules in the world on access to free health care. Our rules allow free access to primary care for any visitor to the UK, including tourists, and free access to all NHS care for foreign students and temporary visitors. But ours is a national, not an international, health service, so last year, under my predecessor, we began a wholesale review of the rules and procedures on charging visitors for NHS care, with a view to making the regime simpler, fairer and easier to implement. In particular, we focused on who should be charged and how the rules can be applied and enforced more effectively. We have examined the qualifying residency criteria for free treatment; the full range of other current criteria that exempt particular services or visitors from charges for their treatment; whether visitors should be charged for GP services and other NHS services outside hospitals; establishing a more effective and efficient process across the NHS to screen for eligibility and to make and recover charges; and whether to introduce a requirement for health insurance tied to visas.
The initial phase of the review has concluded and we will shortly start a consultation on a range of options, including plans to extend charging to some visitors and temporary residents who were previously exempt so that the default qualification for free NHS care would be permanent, not temporary, residence; ending free access to primary care for all visitors and tourists; introducing a prepayment or insurance requirement for temporary visitors to pay for NHS health care; and improving how the NHS can identify, charge and recover charges where they should apply. We will retain exemptions for emergency treatment and public health issues.
We will work closely with medical professionals, NHS staff and partner NHS organisations during the consultation and then seek to introduce agreed changes as quickly as possible. We will need to take a staged approach, because some changes are likely to require primary legislation before they can be introduced, which will take longer to put in place. However, some changes can be made immediately, and we should proceed with those as quickly as possible.
Mr Field
I thank the Health Secretary for his reply. If he wants us to take him seriously, will he today give a commitment in respect of the directive his Department issued just as the House was rising for the summer recess, compelling doctors, if they have vacancies, to admit all those who have been in the country for 24 hours or more, including illegal immigrants? Will he ensure that someone in the NHS—not doctors—works out whether or not a person is entitled to claim, and will he implement such proposals forthwith?
Mr Hunt
The directive to which the right hon. Gentleman refers was issued by an independent NHS body, not my Department. The sorry truth is that it is consistent with the current rules on access to primary health care, which is what we believe is wrong. I think that one of the big problems in the current system is that we have free access to primary care for anyone visiting the UK, however short their visit is. Through that access to primary care, they get an NHS number, which should not entitle them to free care but is often treated by hospitals as such. That is what we have to put right. He is absolutely right that we need a system that properly identifies whether people should have care that is free at the point of access without impinging on the ease of access for British citizens, which is one of the things they treasure most about the NHS.
Nicholas Soames (Mid Sussex) (Con)
Does my right hon. Friend agree that it is through access to primary care that the initial control must take place, but that all hospitals should have an overseas visitors manager who should be designated and required to collect overseas visitors’ moneys on a more regular basis and using a more joined-up and coherent way of working with the other agencies involved?
Mr Hunt
What my right hon. Friend says bears very careful consideration. He is absolutely right that primary care is a critical access point, and we need to look at that. We also need to look at the burdens we place on GPs. I think that ultimately the easy way we will do that is through proper digital patient records, which will allow NHS professionals to find out about the medical history of people accessing the NHS at any point, including whether they are likely to be eligible for free treatment.
With regard to hospitals, my right hon. Friend makes a very interesting point about an overseas visitors manager. One of the problems we have is that the incentives in the system positively disincentivise hospitals from declaring foreign users of the NHS. If they declare someone not to be entitled to free NHS care, they have to collect the money from that person themselves, whereas if they do not declare the person not to be entitled to free NHS care, they get paid automatically by their primary care trust or clinical commissioning group. The incentives in the system have acted to suggest that this is a much smaller problem than I believe it is.
Andy Burnham (Leigh) (Lab)
The NHS must not be open to abuse. Where people do not have entitlement to free treatment, steps should always be taken to recover the costs from individuals and Governments. That clear principle is shared by Members across this House.
For some time, hospitals have rightly had a legal duty to recover any charges owed from overseas patients. The previous Government proposed a number of further steps, including amending immigration rules so that anyone with substantial medical debts is not allowed back into the country. We welcome efforts to build on that, while always guarding against overblown rhetoric, which does not help the immigration debate. We therefore need more precision and clarity from the Secretary of State. First, on the scale of the problem, as ever with this Government’s announcements, there is already confusion to clear up. Earlier today, the Prime Minister’s spokesperson put the cost to the NHS of health tourism at £10 million to £20 million. On “World at One” this lunchtime, the Secretary of State said that he thinks it is more like £200 million. So which is it? Will the Secretary of State publish the evidence he has to support his claim?
Secondly, we need more detail on what the Government are proposing. Has the Secretary of State consulted those in Scotland, Wales and Northern Ireland on any proposed changes? There are practical questions on which health professionals will need reassurance. We have heard in the news today about the problems in the UK Border Agency. What assurances can the Secretary of State give to health professionals that they will not be used to plug the gaps that have been created by the Government’s severe cuts to the front line of the UK Border Force? Will they be given a simple way of checking eligibility and not be burdened by extra bureaucracy? Will these changes apply equally to planned and emergency care? If so, that could put health professionals in a difficult ethical position. Does the Secretary of State agree that care should always be provided in life-threatening situations, and will he take this opportunity to reassure health professionals on that important point?
Finally, the Secretary of State told “World at One” that one of the main reasons he was doing this was to relieve pressure on accident and emergency departments, particularly in London. While we commend moves to prevent abuse of the system, could he not better achieve his aim if he was not planning to close so many A and Es in London?
The Government have made a lot of assertions, but there is a real lack of policy clarity and evidence. Unless the Secretary of State can provide convincing answers to my questions, the House will be left with the distinct whiff of a cooked-up a story to suit the Government’s political purposes rather than a real drive to protect the NHS from abuse.
Mr Hunt
The Government are not going to take any lessons in overblown rhetoric when Labour Members talked about this problem for 13 years and did absolutely nothing about it. What was missing from the right hon. Gentleman’s remarks was a proper apology for Labour’s total failure to control our borders during a period in office that saw a quadrupling of net migration. We do not know how many people are residing in this country illegally, but in January the London School of Economics published a report stating that it could be nearly 900,000 people, in which case the cost will not be a few millions but many, many times that. In 13 years, Labour did not change eligibility for access to free NHS services and did nothing to improve the collection of proper dues from people coming from outside the European Union.
The £20 million figure that the Prime Minister’s spokesman used this morning is the amount of uncollected debt that is owed to the NHS by foreign nationals. If the right hon. Gentleman had listened to my response, he would know that we believe—of course it is impossible to get exact figures on this because of the total mess that the previous Government created—that we identify less than half the people who should be paying for NHS care and collect less than half the money that should be collected.
Of course we will work with very closely with Scotland, Wales and Northern Ireland to ensure a co-ordinated approach. If the right hon. Gentleman had listened to what I said, he would have heard that the exemption for emergency care and for public health issues will remain in place, which is extremely important.
Let me finish by talking about A and E issues. The reality is that the LSE estimates that about 70% of those living illegally in the UK live in London, where A and Es happen to face some of the biggest pressures. University College London Hospitals NHS Foundation Trust opened a new A and E only in the past few years and it was built for a capacity of 65,000 people a year, but it is now seeing 120,000 a year. If the right hon. Gentleman’s Government had done something about this rather than talk about it, A and Es across London would not be facing the pressure they are now facing.
Dr Sarah Wollaston (Totnes) (Con)
Will the Secretary of State publish the names of those trusts that are abjectly failing to identify and recover charges from those who are not entitled to free care?
Mr Hunt
My hon. Friend makes a reasonable point. Part of the problem is that when we should be identifying someone as a foreign national who should pay for their NHS care, that does not happen a lot of the time because of the incentives in the system. Under the NHS improvement initiative, which is taking place in London at present—it is worth looking at that closely, because it has a lot of promise—there is a centralised collection of debt from foreign nationals who owe the NHS so that that does not become the responsibility of individual hospitals, which is something that is putting them off registering people as eligible for their NHS care.
Keith Vaz (Leicester East) (Lab)
May I invite the Secretary of State to comment on the view that one of the reasons why these proposals are being made at this stage is the conclusion of transitional arrangements for Romanians and Bulgarians at the end of this year? The Minister for Immigration is sitting on his right. Is it possible for the Health Department and the Home Office jointly to commission research so that we can have some actual figures on how many people might be coming at the end of this year?
Mr Hunt
The right hon. Gentleman will have to raise the matter of the actual number of people coming to the UK with the Home Secretary or, indeed, the Minister for Immigration.
The right hon. Gentleman is right to say that the issues that we are dealing with are not just about foreign nationals from outside the EU or the European economic area. The rules for EEA members are complex. If people come here to work, we have an obligation under EU law to allow them access to free treatment, but if they are economically inactive or if they are temporary visitors, we should be able to reclaim the cost of that treatment from their home country in the EEA. The fact is that we do that very poorly indeed at the moment and that is one of the things we need to change.
Jake Berry (Rossendale and Darwen) (Con)
I particularly welcome the linking of visas to health insurance, but will my right hon. Friend explain what will happen if someone who is already in the UK is asked to pay but simply cannot? Will they be refused treatment?
Mr Hunt
No one will be refused treatment in a life or death situation. It is important that we state that up front. However, we also want to remove any expectation that people who are not entitled to NHS care are able to come to the UK and get it, and to ask whether we should be giving free NHS care to people such as foreign students who come to the UK and get it. If they went to Australia or America—our two main competitor countries—they would have to take out health insurance or pay a levy to access the local health care system. If those countries do that, I think we should do the same.
Mr Dennis Skinner (Bolsover) (Lab)
Is the Health Secretary aware that when I was in a London hospital some years ago I counted more than 40 staff from different nations? I am proud of my United Nations heart bypass. The message from this Government and many others, including the UK Independence party, is that those of a similar colour, of different colours and of different nationalities can change the bed sheets and operate, but woe betide them if they want to put their head on a pillow when they are ill. What hypocrisy.
Mr Hunt
The hon. Gentleman should do a lot better than that. He should think of his elderly constituents—people with multiple long-term conditions—who are having to wait much longer than they need to because A and Es not just in London, but in many parts of the country, are clogged up with people who may not be entitled to free NHS care because we have a system that culturally and operationally is not able to track these measures. It is in their interests that we must ensure that the NHS is available to people who are entitled to free care. When people are not entitled to free care, the point is not that the NHS is not available to them, but that they should pay for it.
Dr Julian Huppert (Cambridge) (LD)
The former public health Minister, the hon. Member for Guildford (Anne Milton), revealed in a written answer on 17 March 2011 that the sums not collected from overseas patients totalled less than £7 million a year. If we double that and double it again, as the Health Secretary suggests, that is £28 million. Private finance initiative schemes cost the NHS that much every two weeks. Which issue is more important in ensuring that we have a properly funded NHS?
Chris Bryant (Rhondda) (Lab)
There is a problem with recruitment in the NHS not only in England, but in Wales. Last year, Welsh NHS trusts tried to recruit 32 A and E consultants from the UK, but failed to do so and had to go abroad. Is there not a danger that the rhetoric in which the Government are indulging will put off the talented doctors that the NHS in this country needs?
Conor Burns (Bournemouth West) (Con)
My right hon. Friend will be aware that the overwhelming majority of our constituents who travel abroad put in place provision to protect themselves if they fall ill. My constituents and his will be appalled to learn that we do not expect the same of foreign visitors to the United Kingdom. May I congratulate him on his initiative, which began before the Prime Minister’s speech today?
Mr Hunt
My hon. Friend is right. We have one of the most generous systems of health provision for overseas visitors of any country in the world. Most other European countries are less generous because they operate a social insurance system, which makes it much easier to collect the money that they are owed by the people who are not entitled to free care. We have to change the system here. The key thing that is wrong with it is free access to primary care, because that is the gateway into the NHS. Although primary care itself is not the most expensive part of the NHS, because of its gateway role, unless we control it, we will not get the overall system under control.
Heidi Alexander (Lewisham East) (Lab)
If the child of an asylum seeker who is yet to have their asylum application determined requires NHS primary care, will they still be eligible for free treatment?
Sir Tony Baldry (Banbury) (Con)
I am finding it rather difficult to ask a question, because I have been rendered speechless by the chutzpah of Labour Members in not saying that what the Secretary of State proposes is sheer common sense and in not agreeing with him. I have a simple question. How will GPs know which foreign nationals are entitled to NHS care and which are not?
Mr Hunt
My hon. Friend asks a very important question. We have to recognise the pressure on GPs and must be careful not to increase the bureaucratic burden on them. The long-term answer is to have proper digital patient records. If the first thing that people are asked for when they enter any part of the NHS is an NHS number that allows the person they are seeing to look at their medical history, which could be a trigger to identify someone who should be paying for their NHS care. We are seeing whether there is a non-bureaucratic way of achieving that in the short term, while we put that technological system in place.
Mr Gerry Sutcliffe (Bradford South) (Lab)
The Secretary of State and the Conservative party should remember that the coalition has been in power for nearly three years and nothing has happened on this issue. There are two things that he could do. He could withdraw the circular today and he could consider introducing an entitlement card that people could carry with them.
Mr David Ruffley (Bury St Edmunds) (Con)
The Secretary of State has made it clear why the figure of £20 million a year is a ridiculous underestimate of the true state of affairs. He will be thanked by every British taxpayer in this country, no matter what the saving, because they are getting increasingly tired of services being accessed by people who do not have a proper entitlement to them.
Mr Hunt
I thank my hon. Friend for his comment. Of course I want to do a good job for taxpayers, but also for the 3 million British citizens who use the NHS every week and who find a service that, although the Government have protected its budget, is under increased pressure. I want to ensure that the system whereby people from other countries access those same services is one thing, and one thing only: fair.
Emma Reynolds (Wolverhampton North East) (Lab)
It would be useful if the Secretary of State provided clarity and accuracy on the numbers we are talking about. The Prime Minister’s spokesperson said that unclaimed costs amount to £20 million, but the Secretary of State seems to be saying £200 million. I wonder whether he can account for the difference. Did he just add a zero?
Mr Hunt
I explained where the figure of £20 million came from, and why I believe that it is probably the tip of the iceberg. If the hon. Lady really wants to know the answer, we do not know the full extent of the abuse of NHS services because the previous Government left them in such an appalling mess.
Charlie Elphicke (Dover) (Con)
I understand that under the European health insurance card scheme the UK paid out about £1.7 billion for Brits abroad, but claimed only £125 million back. Is that also receiving attention?
Mr Hunt
Yes it is. We are always likely to pay out more than we receive under that scheme because we have a number of pensioners who decide to retire to slightly sunnier climes and there is a cost to the UK under EU treaty law with those decisions. My hon. Friend is right to point out that just as inadequate as our failure to charge people from outside the EU when we should is our failure to collect money from inside the EU when we are able to, and we must also look at that.
Mr Kevan Jones (North Durham) (Lab)
The Secretary of State has clarified the Prime Minister’s figure of £20 million, but he used inflammatory language to my hon. Friend the Member for Bolsover (Mr Skinner) about health tourists clogging up A and Es. He claims that £200 million could be the tip of the iceberg, but if he does not know the figure is that not the worst example of dog-whistle politics?
Mr Robin Walker (Worcester) (Con)
I congratulate the right hon. Member for Birkenhead (Mr Field), who in raising this issue is, as always, streets ahead of those on his own Front Bench.
May I thank my right hon. Friend the Health Secretary for the extra £20 million funding that the NHS in Worcestershire will receive this year, and urge him to take that agenda forward and ensure that as much funding as possible goes to the residents of Worcestershire and to addressing the kinds of pressures that we saw over the last week in A and E?
Mr Hunt
Obviously, I want to ensure that as much money as possible goes to residents throughout the country by tackling abuse, and I would not want to minimise what the issue might be in Worcestershire. I stress, however, that the biggest problem we face is in big urban centres where there are large numbers of illegal immigrants, and we must get a grip of that problem for the sake of the elderly population in those cities.
Barbara Keeley (Worsley and Eccles South) (Lab)
If the Secretary of State is concerned to protect NHS budgets, why is he allowing a £2.2 billion raid from the Treasury? Is that not a much more serious cut in the NHS services we can pay for in this country?
Henry Smith (Crawley) (Con)
I, too, congratulate the right hon. Member for Birkenhead (Mr Field) on his urgent question, and my right hon. Friend the Secretary of State for Health on following my private Member’s Bill, the NHS Audit Requirements (Foreign Nationals) Bill. When will that primary legislation receive Government time to start its passage through this place?
Mr Hunt
I congratulate my hon. Friend on his excellent private Member’s Bill, which looked forward to many of the problems we are trying to address. Our first step is to identify the scale of the problem. We will then identify the right legislative response, but the response will not all be legislative. That is when we will consider including it in the parliamentary timetable.
Kevin Brennan (Cardiff West) (Lab)
In answer to the hon. Member for Rossendale and Darwen (Jake Berry), the Secretary of State said that when someone does not have the funds, treatment will not be refused if it is a life-and-death situation. For clarity, will he will us what the threshold will be? For example, if someone has a broken leg, or if someone needs another treatment that requires hospital admission, and they do not have the funds, will treatment be refused under his scheme?
Bob Stewart (Beckenham) (Con)
Roughly, in percentage terms, how many babies born in maternity wards are born to mothers from the EU?
Mark Reckless (Rochester and Strood) (Con)
The Secretary of State has explained that the July guidance was from an independent body and in line with the existing rules. Who wrote the existing rules? Will he confirm that he will change them?
John Pugh (Southport) (LD)
When I tabled questions last year, I was told that we collect £51 million a year for treatment from EU countries, but that they collect £451 million—nine times more—back from us. Is this an issue not of immigration, but of coding, charging and collecting?
Andrew Selous (South West Bedfordshire) (Con)
Is the Health Secretary aware that general practitioners have been calling for the measures to be taken for some time? The Bedfordshire and Hertfordshire local medical committee wrote to me some time ago expressing its concerns that overseas nationals were coming here for expensive operations. It will be very pleased at what he has done today.
Richard Graham (Gloucester) (Con)
Now that Labour has realised it is legitimate to discuss immigration, does my right hon. Friend agree that it is time for the Opposition to acknowledge that legitimate charges by the NHS to EU and other residents were not collected properly for 13 years; that identifying the £20 million as the tip of the unpaid iceberg is the right thing to do; and that a tightening of procedures on debt collection will be welcomed by my constituents and fair to all our constituents throughout the country?
David T. C. Davies (Monmouth) (Con)
Does the Secretary of State agree that the vast majority of people in the UK will welcome these long-overdue proposals? Will he explain what he will do to ensure that those who are denied treatment because they are here illegally and not entitled to it cannot simply slip over the border to Wales or Scotland, which, unfortunately, are in the throes of an NHS run by socialist Governments?
Mr Hunt
We will work closely with the devolved authorities to ensure we have a co-ordinated response to the problem, but I agree that today’s announcement will be welcomed by the vast majority of people in the country, who will be astonished that the Labour party, even now, seeks to minimise the problem.
Andrew Bridgen (North West Leicestershire) (Con)
Given that the UK has one of very few genuine free-at-the-point-of-need health care systems, does my right hon. Friend agree that, without his sensible reforms, the UK will continue to be seen as the destination of choice for anyone around the world seeking high-quality, free medical treatment paid for by the UK taxpayer?
Mr Hunt
I agree with my hon. Friend. It is because I support the principle of free-at-the-point-of-use health care that I do not want anything to undermine it, and abuse of the system by people who are not entitled to free NHS care is the single thing that would most shake the public’s trust in an important part of what the NHS has to offer. That is why we must tackle this problem.
Harriett Baldwin (West Worcestershire) (Con)
The Secretary of State rightly recognises that accident and emergency is a special case, but when I broke my fingers in Brussels I was asked to pay by credit card at the end of my treatment. A lot of people who present at A and E have non-life threatening conditions. Is that something we could do here?
Mr Hunt
I understand my hon. Friend’s sense of unfairness at being asked to pay for her treatment by credit card, when we do not do that to foreign nationals who are treated in the NHS. I do not, however, want the NHS to become a service where the first question people are asked relates to their credit card or cheque book. If we are going to protect that much-cherished principle of NHS treatment, we need to get a grip on the kind of abuse that has run unchecked for far too long.
Mr Peter Bone (Wellingborough) (Con)
Does the Secretary of State agree that the House is divided by two schools: the Opposition, who believe that the NHS should not charge anyone, which is why they did nothing for 13 years; and Government Members, who believe that foreign nationals who should pay, must pay.
Andrew Jones (Harrogate and Knaresborough) (Con)
I welcome my right hon. Friend’s statement. Does he agree that the previous Government’s failure to tackle health tourism encouraged overseas visitors to abuse our NHS?
Mr Hunt
My hon. Friend is right. One reason why we are tackling this problem is not just the health agenda we have been discussing this afternoon, but that abuse of NHS services fuels broader immigration problems. That is one of the core reasons the previous Government failed to get a grip of net migration in particular.
Jason McCartney (Colne Valley) (Con)
Calderdale and Huddersfield NHS Foundation Trust spent £305,341 on interpreter services between 2009 and 2011. Will my right hon. Friend include the costs of translation services when working out the costs of health tourism?
Mr Hunt
I would want to be careful to discriminate between the needs of British citizens and people who are entitled to free NHS care who have not had the education or support they need to learn English but who should still continue to receive free, high quality NHS care, and foreign nationals who are not entitled to free NHS care and who should pay the cost of any translation required.
Mr Philip Hollobone (Kettering) (Con)
My constituents are absolutely furious that non-entitled foreign nationals are effectively getting free access to our NHS, and I welcome the steps my right hon. Friend is making to tackle this issue. Will he ensure that Her Majesty’s Government fast-track legislation, with an announcement in the Queen’s Speech, and challenge the Opposition either to bring down or pass that legislation in the next parliamentary year?
Mr Hunt
I have visited Kettering hospital, and I know just how hard its front-line professionals work and the pressures they are under. All I can say to my hon. Friend is that the Leader of the House of Commons is sitting here and has heard what he has said, and I would certainly support the early introduction of legislation on this matter.
Accountability and Transparency in the NHS
Jeremy Hunt Excerpts(13 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing this important and timely debate.
We should start by remembering why we are having this debate. Truly shameful things happened at Stafford hospital. Patients were left unwashed for days, sometimes in sheets soiled with urine and excrement. Relatives had to take bed sheets home to wash them because the hospital would not. Patients with dementia went hungry with their meals sitting right in front of them, because no one realised or cared that they were unable to feed themselves. If we are to prevent that from happening again, accountability for what happened is vital. I will talk plainly about that, including about the role of Sir David Nicholson.
At the outset, let me reiterate that the NHS is one of our most cherished institutions. We can be proud that for 65 years it has ensured that everyone is entitled to treatment, regardless of their background or income. We can be proud of the excellent treatment and care that is the hallmark of most parts of the NHS. Most of all, we can be proud of the front-line doctors, nurses and health care assistants who look after 3 million people every week, with dedication, commitment and compassion.
If we love the NHS, we must be prepared to be honest about its failures, and to criticise me for doing so suggests, I am afraid, dangerous complacency from the right hon. Member for Leigh (Andy Burnham). The tragedy of Mid Staffs shows how the desire to celebrate success got in the way of speaking out when things went wrong, and if we are to prevent such things from recurring, we must never allow our love of the NHS to stifle our determination to hold systems and individuals to account.
Where does that accountability lie? Sir David Nicholson has been the focus of much attention, and as a manager in the system that failed to spot and rectify the appalling cases at Mid Staffs, he bears some responsibility. As he said, the focus was lost, and he has apologised and been held to account by this House and many others. However, I do not believe that he bears total, or indeed personal, responsibility for what happened. He was at the strategic health authority for 10 months during the period in question, overseeing 50 hospitals at a time when his main responsibility was the merger of three SHAs into one. He consistently warned both Ministers and managers of the dangers of hitting the target and missing the point.
It is just not true that if there had been no David Nicholson at the SHA, there would have been no Mid Staffs; others bear far more direct responsibility and the Francis report tells us who. It makes it clear that the primary responsibility for what went wrong lies with the board of the trust. Astonishingly, members of that board seem to have melted into thin air, some moving to other jobs in the system, and others receiving generous payoffs.
Mr Cash
As my right hon. Friend knows, I do not agree with his assessment of Sir David Nicholson in this context. There was a systems failure that affected not only Staffordshire but the entire health service, and that lies very much at the heart of the problem. In my speech I will quote some statements made by Sir David at a conference a few months ago.
Nicholas Soames
I am grateful to the Secretary of State. May I follow up on one point that he raised? He said that a number of those managers have disappeared or melted away to other jobs in the service. Does he agree that whatever else happened, there was a monumental failure of leadership at many levels, and that it is a failing of public services in this country—and the national health service in particular—that failing managers are too often recycled through the service to the great and constant cost of patient care?
Mr Hunt
I will make some progress and then I will take more interventions.
My response will detail how we intend to restore accountability to the boards of hospitals, and today I have removed the ability of any hospital to insert gagging clauses on patient safety in compromise agreements made with senior staff. My hon. Friend the Member for Bristol North West asked whether that will be retrospective, and I have written to all trusts to remind them of their responsibilities towards whistleblowers in respect of contracts and compromise agreements already signed. If we are to protect patients, we need an atmosphere of openness and transparency in the NHS—something to which the motion rightly refers.
Mr Hunt
I will make some progress and then I will take interventions from both sides of the House.
Sir David Nicholson told the Health Committee last week that in the NHS as a whole, patients were not the centre of the way the system operated. Which party was in power when that culture was allowed to operate? If Sir David has been held to account, so too must the Labour party be held to account. The Francis report rightly states that Ministers were not personally responsible for what happened at Mid Staffs, and I have no doubt that no Labour Minister would have condoned, knowingly allowed or wanted the events at Mid Staffs to happen. We also know from the report that the pursuit of targets at any cost was a central driver of what went wrong. As the report set out, above all Mid Staffordshire NHS Foundation Trust failed to tackle an “insidious negative culture” involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities. It went on:
“This failure was in part the consequence of allowing a focus on reaching national access targets,”.
Ministers, not civil servants, are ultimately responsible for the culture of the NHS, and it is clear that during that period a culture of neglect was allowed to take root in which the pursuit of targets at any cost compromised the quality of care that patients received, and made it harder for front-line staff to treat people with dignity and compassion.
Andy Burnham
I am listening carefully to the Secretary of State but it is not fair to people in the NHS for him to say that Stafford equals everywhere in the NHS, and that we can take one failing—a terrible failing, as I said in my speech—in a locality and apply it to the whole NHS. He must acknowledge that NHS staff did an incredible job to end the situation when people were spending months and years on waiting lists, and even dying on them.
Mr Hunt
I acknowledge the brilliant work done by NHS staff and, contrary to what the right hon. Gentleman says, I do that in every speech that I make on these matters. I will not, however, accept the complacency that says that problems at Stafford hospital were localised and happened only in one place. If we are to sort out those problems, we have a duty to root them out anywhere in the NHS that they occur.
The right hon. Gentleman talked about waiting times targets. Let us be clear: there is an important role for targets in a large organisation such as the NHS. Without the four-hour A and E target, or the 18-week elective waiting time target, access to NHS services would not have been transferred and I accept that the previous Government deserve credit for that. It was right to increase spending on the NHS, although it is curious that Labour now wants to cut the NHS budget. Labour did however—this is where Labour Members should listen rather than barrack—make three huge policy mistakes, and the right hon. Gentleman must accept that it is not simply a question of Government policy not being implemented in every corner of the NHS. Those three mistakes contributed to the culture of neglect that we are now dealing with.
The first mistake—a huge mistake—was that Labour failed to put in place safeguards to stop weak, inexperienced or bad managers pursuing not only bureaucratic targets but targets at any cost. That is exactly what happened at Mid Staffs, where patient safety and care were compromised in a blind rush to achieve foundation trust status. Secondly, Labour failed to set up proper, independent, peer-led inspections of hospital quality and safety that told the public how good and safe their local hospital was. Instead of a zero-harm attitude to patient safety, we have a culture of compliance and the bureaucratic morass that is the current Care Quality Commission. Thirdly, Labour failed to spot clear warnings when things went wrong. The Francis report lays out a timeline of 50 key warning signs between 2001 and 2009. Why did Ministers not act sooner? If those warnings were not being brought to the attention of Ministers, why did they not build a system in which they were? Instead, there was a climate in which NHS employees who spoke out about poor care were ignored, intimidated or bullied.
Alan Johnson
The Secretary of State is making an interesting speech and there is no way that the Labour party can escape criticism for what happened at Stafford. Does he accept, however, that before 2000 there was no independent regulation of the NHS and no standardised mortality ratios, complaints in hospitals stayed in the hospital and there was no recourse to any independent observance of those complaints, and A and E—a particular problem at Stafford—was a data-free zone?
Mr Hunt
I accept that progress was made in the collection of data and that the previous Government set up a star rating system. The problem, however, was what it measured. It did not measure the quality of patient care but basically focused on access targets. It was possible for a hospital to get a three-star rating by transforming its 18-week access targets, even at the expense of patient care.
Stephen Barclay
It is correct that improvements were made in the collation of data. In fact, the Dr Foster data were published in national newspapers from 2001, but what is remarkable is that they were not acted on. That is the central charge for Ministers. We were the world leader in the collation of mortality data. We had the data, but Ministers did nothing with them.
Mr Hunt
I will make some progress.
The question the right hon. Member for Leigh needs to answer is why he refused 81 separate requests to set up that public inquiry. He says that he did not want to distract the hospital from the essential task of making immediate improvements, but does he now accept that if he wants people to take his party seriously on NHS accountability he needs to apologise? That was a mistake. Until we have a proper apology—not just for what happened, but for the catastrophic policy mistakes made by his party—no one will believe that Labour would not make the same errors of judgment again. On the Government Benches, we are clear that accountability, dignity and respect for patients, particularly vulnerable, older people who are unable to speak out for themselves, must be embedded in every corner of the NHS.
We will announce measures to set up a proper, independent peer review inspection regime led by a new chief inspector of hospitals that will not simply look at targets, but make judgments on whether hospitals are putting patients first. We will set up a single failure regime, where the suspension of the board can be triggered by failures in care as well as failures in finance; a patient-centred culture, by making the friends and family test a key part of the hospital inspection regime; clinically led commissioning, so that key decisions are made by people who see patients in their own surgeries; and an overhaul of the hospital complaints procedures led by the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart. We will do that with the minimum of upheaval. It is worth emphasising that Robert Francis himself says that the changes he calls for can largely be implemented within the system that has now been created by the new reforms.
Mr Hunt
I am going to make some progress.
This debate is about accountability. I have been doing this job for six months, and in nearly every exchange on the Floor of the House, the Opposition have avoided engaging in substance, preferring instead to make baseless allegations about the Government’s motives in respect of the NHS. I put it to the House that we have shown our commitment to the NHS time and again through a protection of the budget; a willingness to face up to big challenges, whether in clinical commissioning, the funding of social care or the need to ensure that care is prioritised throughout the system—
Mr Hunt
No, the right hon. Gentleman needs to listen to my point. If Labour is truly committed to the NHS, it, too, has to show that it has learned. I did not hear that in his speech. Labour Members need to accept that they made some terrible policy mistakes that led to a culture of neglect. They must recognise that the party that claims to speak for the most vulnerable in society betrayed many vulnerable people, with tragic consequences. Only then will the public know that the lessons of Mid Staffs have been learnt—not just by the NHS, not just by civil servants, not just by Government, but by all sides of this House.
Alan Johnson
On the question of a public inquiry, when Francis reported on his first inquiry, commissioned by my right hon. Friend the Member for Leigh, he made the point that it was about people affected being able to come and tell their story, and Francis said in his first report:
“I am confident that many of the witnesses who have assisted the inquiry in written or oral evidence would not have done so had the inquiry been conducted in public.”
It is very important that that first inquiry allowed people to come forward. The right hon. Member for South Cambridgeshire (Mr Lansley) may also well have been right to make the second stage of that a public inquiry, which was authorised because of one of the Francis recommendations, because we now have all the information, provided before a Queen’s counsel, about what happened there.
Francis is very clear about no blame being apportioned to any Minister. It is of course right for Ministers to be accountable if anyone knew what was going on and did nothing to stop it, or if something that was going on was a result of a Government edict or policy, but that was not the case at Stafford.
Targets had to be introduced to get a grip on this terrible situation of lack of access to health care. Targets did not cost lives; they helped to save lives. They were accompanied by the resources, the capacity and the political will that transformed waiting lists of 18 months to two years to a maximum of 18 weeks and an average of nine.
This is what Francis said about targets:
“It is important to make clear that it is not suggested that properly designed targets, appropriately monitored cannot provide considerable benefits and serve a useful purpose…indeed the inquiry accepts that they can be an important part of the health system in which the democratically elected Government of the day sets its expectations of providers who are funded by the taxpayer.”
The right hon. Member for Charnwood (Mr Dorrell) was absolutely right to say that long waiting lists have dogged the NHS since it was created in 1948. Rudolf Klein, the great historian of the NHS, says every Health Secretary shouted their orders from the bridge and the crew carried on regardless. Something had to be done to deal with that, and it was done.
Mr Jeremy Hunt
Does the right hon. Gentleman not accept that the issue was not targets, but the failure to put in place safeguards to stop managers twisting a targets culture into a culture of targets at any cost? That was the fundamental policy mistake. The lack of those safeguards meant Mid Staffs could happen.
Alan Johnson
The Secretary of State is right. Of course there need to be safeguards to ensure any system has a backstop to stop people misusing targets. The guidance from the Department of Health was very clear. In no way must the pursuance of targets interfere with the need for good patient care. The Stafford chief executive must have translated that into saying it was fine to put receptionists on triage nursing. With all due respect to the Secretary of State, I do not think that he or any of his successors or predecessors can make regulations to meet every eventuality, including for someone like that chief executive of the Mid Staffs trust.
Barbara Keeley
Indeed. It is disturbing that the people responsible for advising Ministers on legislation are not aware of what is going on. In fact, they started by trying to tell me that they thought that community services were still expanding, as they had been up to 2010. They did not have a picture of the services. Indeed, they told us that there was no routine collection of waiting times for mental health services and they did not have data on readmissions. They did not even seem to understand the trends involved in those important issues.
The exchange left me feeling very concerned about accountability in our new NHS structures. If staff at the most senior levels of the Department of Health who are responsible for strategy and legislation have no idea what is going on in health services across the country, that is serious. The major restructuring of the NHS seems to us—this has been mentioned by fellow members of the Health Committee—to represent a decline in accountability.
We need to learn from good practice to improve patient safety, which has been touched on by my hon. Friends the Members for West Lancashire (Rosie Cooper) and for Walsall South (Valerie Vaz). A major review is taking place of the 14 hospitals with the worst mortality rates. In recent Health questions, I told the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) that good practice in hospitals with low mortality rates should be investigated alongside the review of high mortality rates and poor practice in the worst-performing 14 hospitals. He did not take that point on board, so I will try again today.
I want to talk about what has been achieved at my constituency’s local hospital trust, Salford Royal NHS Foundation Trust. I visited the hospital recently in the wake of the Francis report and was impressed to hear what it has achieved over the past five or six years. It already seemed to have in place many of Robert Francis’s recommended actions, which I touched on earlier. Salford Royal has taken action on nurse staffing ratios, which my right hon. Friend the Member for Leigh (Andy Burnham) touched on; reducing MRSA infection and pressure sores; the transparency of patient information; and involving clinical staff in quality improvement.
Mr Jeremy Hunt
I completely agree with the approach that the hon. Lady is taking. One of the jobs of the new chief inspector of hospitals will be to identify the outstanding hospitals, the safest hospitals and the hospitals with the best compassionate care, so that other hospitals can learn to do the same things.
Barbara Keeley
That is very good. I hope that the Secretary of State will make that point to the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, because he did not seem to appreciate it when I made it to him in Health questions.
Let me touch on what other hospitals might find if they start looking at the excellent practices at Salford Royal. I do not underestimate the importance of the terrible examples that we have heard about, but at the same time, my trust has had a quality improvement strategy since 2008, with specific projects that are aimed at reducing falls, unexpected cardiac arrests, surgical site infections, sepsis and other harms. Because harm tends to be caused to patients much more over the weekend—we have seen many examples of that in the cases that we have looked at—the trust has moved back to seven-day working in an attempt to achieve the same standard of care on the weekend and overnight as people receive on a weekday during working hours.
I believe that having the right nurse staffing ratios is vital to patient safety, but that issue keeps being glossed over by NHS leaders and Ministers. I have asked questions about it repeatedly in this House. Salford Royal uses a safe staffing tool to ensure that it works to safe staffing levels. There are minimum staffing requirements throughout the hospital and incident reports are completed if the ratios are not met. Each division reviews its staffing establishment every day and escalates concerns if the numbers fall below the minimum safe level. Salford Royal is a mentor site for nurse rounding which, as we have heard, means that nurses go round their patients each hour to ensure that their needs are being met.
My right hon. Friend the Member for Cynon Valley gave examples that showed the impact of hospital-acquired infections. All the work that is done to reduce MRSA and other infections is crucial. As in the other examples of flattened hierarchies that we have heard about, anyone at Salford Royal can challenge others on issues related to infection control. There is also mandatory training in aseptic non-touch techniques.
Teams design their own quality improvement projects in a clinical quality academy. There has been a specific quality improvement project over the past two years that is aimed at reducing the number of pressure ulcers. Each pressure ulcer is declared, the root causes are analysed and the patients are involved in the investigations. Nurses can monitor the positioning of patients on their hourly rounds and help to turn them if required. Those examples of good patient care can help us to get over the kinds of awful care that have been described today.
My final point is about transparency. Patients and families can check the harm data, because they are shown on a whiteboard at the entrance to every ward. The board records not only how many days it is since the last MRSA infection or pressure ulcer, but provides assessment scores on 13 fundamental nursing standards. Such public reporting to patients and families is important because it aids accountability and helps staff to feel accountable for the standards on their ward. We need that now more than ever.
Unsurprisingly, Salford Royal has achieved the highest rating in the NHS staff satisfaction survey for acute trusts in the NHS. Staff are supported to challenge existing systems and test new ideas to improve standards. I am aware of how much of a contrast that is to what we have heard this afternoon. The NHS is a system in which one area has had a catastrophic failure at all levels of patient safety, while other areas have achieved the highest standards of safety and patient care. We must look at both if we want to understand why that is.
NHS Pay Review Body
Jeremy Hunt Excerpts(13 years, 4 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I am responding on behalf of my right hon. Friend the Prime Minister to the 27th report of the NHS Pay Review Body (NHSPRB). The report has been laid before Parliament today (Cm 8555). Copies of the report are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. I am grateful to the chair and members of the NHSPRB for their report.
We welcome the NHS Pay Review Body’s 27th report, note its observations and accept its recommendations in full.
I am pleased to confirm that:
all NHS staff on agenda for change pay, terms and conditions will receive a 1% rise in their basic pay effective from 1 April 2013: and
those NHS staff on agenda for change pay, terms and conditions who work in London will receive a 1% increase to the minima and maxima of their high cost area supplement.