Immigrants (NHS Treatment)
Jeremy Hunt Excerpts(12 years, 3 months ago)
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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(12 years, 3 months ago)
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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(12 years, 3 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.
Review Body on Doctors' and Dentists' Remuneration
Jeremy Hunt Excerpts(12 years, 3 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 41st report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The report has been laid before Parliament today (Cm 8577). Copies of the report are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. I am grateful to the chair and members of the DDRB for their report.
We welcome the 41st report of the Review Body on Doctors’ and Dentists’ Remuneration and note its observations and:
accept its recommendations in respect of salaried doctors and dentists; and
accept the recommendation of a 1% increase in GP pay but abate the recommended allowance for GP practice staff costs from 3.4% to 1% to reflect public sector pay policy, giving an overall increase in general medical services payments of 1.32% rather than the 2.29% recommended by DDRB.
We will take forward DDRB’s suggested actions, which will help us continue to improve our support for the DDRB’s important work.
Reducing Preventable Mortality
Jeremy Hunt Excerpts(12 years, 4 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today, I am publishing “Living Well for Longer: A call to action to reduce avoidable premature mortality”. This document focuses attention on premature mortality and challenges the health and care system to do something about it.
Despite the great strides that have been made in improving the health of the nation in recent decades, far too many people are dying too young from diseases that are largely preventable. We want England to be among the best in Europe when it comes to tackling the leading causes of early death, starting with the five big killer diseases—cancer, heart, stroke, respiratory and liver disease. If everyone had access to the best diagnosis and treatment that is already available, we could avoid an extra 30,000 deaths per year by 2020.
Our ambition to reduce our rates of premature mortality to the level of our European peers is ambitious and challenging. Government will play their part but cannot do this alone. It will take concerted action across the health and care system locally and nationally. The call to action therefore poses some challenging questions and is designed to generate open and honest debate, leading to action, to see what more we collectively can do to reduce premature mortality. If we as a country are to tackle the challenge we face, we need to make improvements across the spectrum of prevention, early diagnosis and treatment.
“Living Well for Longer” also sets out actions to drive transparency and accountability. I want every locality in the new system to understand how it compares for health outcomes with similar areas in England and how England compares across Europe. Knowing how well we are doing is critical to driving improvement.
My Department has worked closely with partners across the health and care system, including the statutory and third sector, in developing this call to action. We will bring these partners together over the coming months and years to see how well we are doing in reducing premature mortality, and to see what more we can do together.
We are also publishing today a “Cardiovascular Disease Outcomes Strategy”. This strategy will contribute to delivery of improved mortality rates by providing advice to local authority and NHS commissioners and providers about actions in relation to cardiovascular disease that can help deliver our ambition.
Copies of “Living Well for Longer: A call to action to reduce avoidable premature mortality” and of the “Cardiovascular Disease Outcomes Strategy” have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
The documents are also available at: www.dh.gov.uk/health/2013/03/mortality.
Oral Answers to Questions
Jeremy Hunt Excerpts(12 years, 4 months ago)
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Angie Bray (Ealing Central and Acton) (Con)
1. What assessment he has made of the benefits of comparative performance data in raising standards in the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
Comparative performance data are essential to raise standards in the NHS. I have therefore commissioned a review from the Nuffield Trust to consider whether aggregate ratings of provider performance should be used in health and social care, and if so, how best this should be done.
Angie Bray
My right hon. Friend will be aware that NHS North West London has made considerable use of comparative performance data to justify closing four A and E departments in one concentrated part of its area. Charing Cross, Ealing, Hammersmith and Central Middlesex are the four A and E departments closest to my constituents, who will be wondering how their closure will raise standards of health care provision locally. Does my right hon. Friend appreciate that there will be strong support among my constituents for any calls to review the decision and the use of comparative performance data?
Mr Hunt
I first congratulate my hon. Friend on campaigning extremely hard on behalf of the views and concerns of her constituents throughout the process of the decision that was finally made by NHS North West London last Tuesday. Comparative performance data have a very important role to play, particularly with regard to excess mortality of people who use A and E on weekends. I am, however, aware of my hon. Friend’s concerns and will consider them carefully if, as is likely, the decision is reviewed by Ealing council.
Grahame M. Morris (Easington) (Lab)
I thank the Secretary of State for his previous answer. Comparative data are essential in compiling an evidence base on which to plan effective health interventions. Will he use the radiotherapy data sets that his Department publishes as a basis to inform planned investments in advanced radiotherapy systems, particularly in regions like mine which lack such equipment?
Mr Hunt
I know that the hon. Gentleman asks a lot of questions about radiotherapy. We use a strict evidence base before we make any investments. We also want to embrace innovation, but our absolute priority is to save as many lives as possible from cancer. He will know that we are in the lower half of the European league tables when it comes to cancer survival rates, and that is something that we are determined to put right.
John Pugh (Southport) (LD)
On collecting performance data, has the Secretary of State seen the NHS Confederation publication “Information overload: tackling bureaucracy in the NHS”, which points to a great deal of duplication in information? What is his reaction to it?
Mr Hunt
There is far too much bureaucracy in the NHS, which is why I have asked the chief executive of the NHS Confederation to report to me on how we could reduce the bureaucratic burden on hospitals by a third. If there is a lesson from the Francis report on the tragedy at Mid Staffs, it is that we need to free up the time of people on the front line to care, which is what they went into the NHS to do.
Mr Jamie Reed (Copeland) (Lab)
The hon. Member for Ealing Central and Acton (Angie Bray) asked a key question. Under the secondary legislation being introduced by the Secretary of State under section 75 of the Health and Social Care Act 2012, local commissioning groups will be forced to allow private providers into the NHS. These private providers will be exempt from the Freedom of Information Act, which will make it harder for patients to compare data between providers. It cannot benefit NHS patients for core clinical services to be given to private providers that do not have to conform to the same standards of transparency as those in the NHS. Will the Secretary of State see reason, ensure a level playing field for the NHS and withdraw the section 75 regulations without delay?
Mr Hunt
Who exactly are the section-75 bogeymen that the hon. Gentleman hates: Whizz-Kidz who are supplying services to disabled children in Tower Hamlets, or Mind, which is supplying psychological therapy to people in Middlesbrough? The reality is that those regulations are completely consistent with the procurement guidelines that his Government sent to primary care trusts. He needs to stop trying to pretend that we are doing something different from what his Government were doing when in fact we are doing exactly the same.
Rehman Chishti (Gillingham and Rainham) (Con)
2. What support his Department has given to local authorities in respect of their new public health responsibilities.
Simon Hughes (Bermondsey and Old Southwark) (LD)
3. What recent assessment he has made of the future demand for accident and emergency and maternity services at (a) Guy’s and St Thomas’ NHS Foundation Trust and (b) King’s College Hospital NHS Foundation Trust.
The Secretary of State for Health (Mr Jeremy Hunt)
I have accepted the trust special administrator’s broad recommendations on the future of A and E and maternity services in south-east London. Appendix E of the administrator’s final report outlines the forecast A and E activity and births in south-east London, and the methodology used to determine that information. That includes activity at Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospital NHS Foundation Trust.
Simon Hughes
I am grateful for the Secretary of State’s answer. Following his statement and decision, does he recognise that there are still two significant concerns? The first is that any downgrade of A and E and maternity services in Lewisham will put pressure on the other trusts which they cannot cope with. The second is that there is not yet support among all GPs and clinicians, including in Lewisham, for the current plan. Will he assure me that he will seek their support before anything is implemented, and that he will give us the assurances that we need?
Mr Hunt
I recognise the concerns that the right hon. Gentleman outlines. As he knows, we have allocated £37 million to help the other four A and E departments that will take the 25% of cases that will no longer go to Lewisham to deal with that extra capacity. He is right to say that the way in which the plan is implemented will be critical. We need to do it properly and extremely carefully to ensure that we meet the concerns that he talks about.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
When the Secretary of State announced his decision to downgrade Lewisham’s A and E services and transfer the patients to St Thomas’ and King’s, he said that Sir Bruce Keogh, the medical director of the NHS, had reviewed those proposals and that:
“He believes that…these proposals…could save up to 100 lives every year”. —[Official Report, 31 January 2013; Vol. 557, c. 1075.]
Having read Sir Bruce Keogh’s review, I can tell the House that he makes no mention whatsoever of saving 100 lives each year. Will the Secretary of State now apologise for misleading the House?
Mr Speaker
Order. Just before the Secretary of State replies, I ought to say to the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) that she is perhaps suggesting that the Secretary of State may have inadvertently, rather than deliberately, misled the House. Could she just confirm that? A nod of the head would suffice.
Mr Speaker
That is the right hon. Lady’s suggestion, and it is for the Secretary of State to respond as he thinks fit.
Mr Hunt
Thank you, Mr Speaker.
Sir Bruce Keogh accepts the calculations that were made in the proposals put forward by the trust special administrator that the plans would be likely to save about 100 lives a year, because they would allow the hospitals in south-east London to move towards the London quality standard, which would mean reducing excess mortality at weekends. Sir Bruce Keogh accepted that, and I accepted his view of it.
Heidi Alexander (Lewisham East) (Lab)
Demand for A and E services at Guy’s and St Thomas’ and at King’s will go through the roof if Lewisham’s full A and E closes. The Secretary of State may claim that he is keeping a smaller A and E at Lewisham, but that is nothing more than dangerous spin. No blue-light ambulances will call at Lewisham under his plans, and even the College of Emergency Medicine says that they do not meet its definition of an emergency department. How on earth can the Secretary of State be so confident that other hospitals in south-east London will be able to cope once he has taken the axe to Lewisham?
Mr Hunt
I recognise that the hon. Lady has been campaigning hard for her constituents, but she massively overstates her case. The reality of the proposals is that 25% of the people who go to Lewisham A and E will no longer go there—the most complex cases among her constituents, who will get better treatment as a result. Those 25% will be spread among four other A and E departments, and we are allocating £37 million to help them upgrade their capacity. That is a sensible proposal that will save the lives of her constituents.
Andrew Gwynne (Denton and Reddish) (Lab)
Local Members of Parliament are right to raise concerns about future capacity at Guy’s and St Thomas’ and at King’s. The recent King’s Fund report showed that between October and December 2012, many A and E departments in England faced their worst winter in almost a decade. Standards of care are deteriorating, with too many people waiting too long to be seen and many being left on trolleys in corridors or waiting in ambulances stuck outside A and E. Does the Secretary of State now accept that the NHS is struggling to cope with the toxic mix of cuts and reorganisation, and that patients in south-east London and elsewhere are paying the price for this Government’s mismanagement of the NHS?
Mr Hunt
Really, from a party that closed or downgraded 12 A and E departments when in office, I would expect a slightly more mature attitude to an extremely difficult and complex problem. We will not take any lessons in meeting A and E targets from that lot. The reality is that we met our A and E targets last year, but in Wales, where Labour cut the NHS budget by 8%, they have not met their A and E targets since 2009.
Mr Russell Brown (Dumfries and Galloway) (Lab)
4. What the reason is for the time taken to produce the Government’s sexual health policy document; and when he now expects it to be published.
Mrs Madeleine Moon (Bridgend) (Lab)
7. What funding his Department has allocated to research into pre-senile dementia.
The Secretary of State for Health (Mr Jeremy Hunt)
The National Institute for Health Research supports a wide range of research, including a number of studies of pre-senile dementias, more commonly known as early-onset dementias. This includes 85 studies recruiting patients with dementia and a further 17 in the set-up phase.
Mrs Moon
I declare an interest.
Dementia in the ageing population is beginning to be better understood and recognised—I appreciate the Government’s efforts on this—but there are also the frontotemporal dementias, such as Pick’s, corticobasal degeneration, Lewy body, progressive supranuclear palsy, Parkinson’s and stroke-related dementias, which are early onset. There is less understanding and awareness of these dementias. I welcome the Government’s commitment to research in this area, but we also need to extend understanding among nurses, general practitioners and care providers. Will the Government ensure that this wider understanding is available and extended?
Mr Hunt
I thank the hon. Lady for her interest in early-onset dementia. She is absolutely right: there is a widespread lack of understanding of dementia in general, and of early-onset dementia in particular. In addition to the research that I mentioned in my earlier answer, we are also looking at a major programme to engage GPs. Sadly, some GPs still think that it is not worth diagnosing someone with dementia, and there is a lack of understanding that we absolutely have to put right.
Jason McCartney (Colne Valley) (Con)
Government and charitable spending on dementia research is 12 times lower than spending on cancer research, with £590 million a year being spent on cancer research and only £50 million being invested in dementia research. What steps can we all, including the Government, take to increase the amount of investment in dementia research?
Mr Hunt
My hon. Friend makes an important point, and he will be pleased to learn that the Government are more than doubling the amount of money that we put into dementia research. We need to catalyse the private sector companies because although they know that the size of their potential market of people with dementia is huge, they have been frustrated in their attempts to find the breakthrough medicine that we urgently need. We need to use the research to excite their interest and keep them focused on this truly tragic disease.
Julian Sturdy (York Outer) (Con)
8. What steps his Department plans to take to improve dementia diagnosis rates and to reduce regional variations in such diagnoses.
The Secretary of State for Health (Mr Jeremy Hunt)
There are unacceptable variations in the level of dementia diagnosis across the country, and we are committed to driving significant improvements. We have asked local areas, through the NHS mandate, to make measurable progress in improving dementia diagnosis over the next two years.
Julian Sturdy
In North Yorkshire and York, only 43% of those suffering from dementia receive a diagnosis. Given the ageing population in the county, that means that about 7,000 people with dementia remain undiagnosed. Does my right hon. Friend agree that the clinical commissioning groups have a large role to play in the delivery of dementia services, and will he tell us what support those groups will get?
Mr Hunt
My hon. Friend is absolutely right. It is a tragedy for those 7,000 people and their families that they are not getting a diagnosis. With a diagnosis, medicines and drugs could have a big impact and stave off the condition for between one in three and one in four people, and support services could also be put in place for carers. We need a massive transformation, and we need to make it much easier for people to get a diagnosis. We need much better understanding among GPs, as I mentioned earlier, and among hospitals as well, given that 25% of all in-patients have dementia.
Henry Smith (Crawley) (Con)
13. What steps he has taken to support research on the most common causes of premature mortality.
The Secretary of State for Health (Mr Jeremy Hunt)
We are still far too low in the European league tables for premature mortality, particularly in respect of cancer, liver disease and respiratory diseases. I have therefore made improving our performance a key priority.
Henry Smith
Can the Minister say a little more about what is being done to prevent early mortality as a result of heart disease?
Mr John Baron (Basildon and Billericay) (Con)
19. It is widely accepted that late diagnosis of cancer makes for premature mortality. Will the Government recommend the inclusion of proxy measures such as staging and accident and emergency admissions in the outcomes indicator set, as a way of complementing the one and five-year survival measures? That would give us a more complete picture of how CCGs are performing in encouraging earlier diagnosis.
Mr Hunt
I congratulate my hon. Friend on his campaigning. No sooner do we agree to the inclusion of one indicator in relation to early cancer diagnosis than he finds another that should also be included.
I will certainly consider the issue that my hon. Friend has raised, but I think that there is a broader question about the role of GPs. They should see themselves as being in the front line when it comes to early diagnosis of not just people who walk through the doors of their surgeries, but people in their communities who are at high risk. That is a much more fundamental change that we need to think about.
Paul Blomfield (Sheffield Central) (Lab)
14. What was the change in the level of spending in real terms on adult mental health services in 2011-12.
Alun Cairns (Vale of Glamorgan) (Con)
15. What recent estimate he has made of the potential savings to the NHS of making better use of technology.
The Secretary of State for Health (Mr Jeremy Hunt)
PricewaterhouseCoopers estimates that the NHS could save £4.4 billion every year through proper investment in IT, which is one of the reasons I set the NHS the challenge of becoming fully paperless by 2018.
Alun Cairns
I am grateful to the Secretary of State for his answer, but can he assure me that investment in new technology will release resources for patient care, rather than follow the pattern over the past 15 years, when investment in new technology has detracted from the available resources?
Mr Hunt
My hon. Friend makes an important point. In encouraging such investment, we are thinking about the nurse who recently reported that in order to admit someone to trauma she had to fill out a 22-page admission form and another 10 forms after that. The whole point of this move is to free up the time of professionals on the front line so that they can spend more time with patients.
Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)
The Secretary of State will be aware that the general practice extraction service contract has recently been awarded to French IT firm Atos Healthcare. Given the concerns expressed by the Public Accounts Committee and the National Audit Office about the way in which Atos has performed in respect of other contracts let by the Government, what has the Secretary of State got in mind to ensure that there are safeguards for patient data under the general practice extraction service contract?
Ms Margaret Ritchie (South Down) (SDLP)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
The last month has seen the Government take two radical steps that will fundamentally improve the quality of health care in this country. First, in our response to the Francis report on the appalling tragedy at Mid Staffs, we announced the setting up of a chief inspectorate of hospitals based at the Care Quality Commission. That will introduce compassionate care, patient feedback and expert peer review into a system that has been too long dominated by targets and box-ticking. Secondly, in response to the Dilnot report, the Government announced a long-term solution to the funding of social care, which will both help thousands of low-income pensioners avoid having to sell their homes and make us one of the first countries in the world where it is as normal to save for social care costs as it is to save for a pension.
Ms Ritchie
This week I will meet my constituents Neal and Rita Denvir, whose son, Fionn, made a miraculous recovery from meningitis. Many are not so fortunate, however, so will the Secretary of State pledge his support to the Meningitis UK “Beat it now” campaign, and include the newly licensed vaccine for meningitis B in the NHS childhood immunisation programme, so that no family has to live with the terror of that terrifying disease?
Mr Hunt
As the father of two young children, I completely share the hon. Lady’s passion for this issue and I am happy to give my support to Meningitis UK. The decision on whether to include a meningitis jab in the immunisation campaign is made by an independent expert panel, and I will always follow its advice.
Nick Herbert (Arundel and South Downs) (Con)
T2. We used to believe that tuberculosis was beaten in this country, but the number of instances of it is increasing, and there were more than 9,000 new cases last year. Does that not suggest, particularly when the incidence of drug-resistant TB is a concern, that a comprehensive public health strategy is needed to tackle the disease? What steps is the Department taking to lead that strategy?
Andy Burnham (Leigh) (Lab)
I am sure that, like me, the Secretary of State has spent recent weeks absorbing the Francis report and its recommendations; there are lessons for everyone at every level, particularly on staffing. New analysis to be published later today will show that the NHS is set to lose 12,000 nurses over the course of this Parliament, raising doubts about its ability to respond to Robert Francis’s recommendations on staffing. Will the Government say today whether they accept those recommendations and the principle of a minimum staff-to-patient ratio?
Mr Jeremy Hunt
If the right hon. Gentleman had read the Francis report carefully he would have, first, observed that the appalling tragedies covered in that report happened between 2005 and 2009, when nursing numbers were going up. So to say that this is an issue about nursing numbers is to miss the point completely. This is not an issue where there is a quick fix; it is an issue about the NHS having become dominated for far too long by a culture of targets at any cost. Unpicking that culture is the biggest challenge we face if we are to return a culture of compassionate care to the NHS.
Andy Burnham
I have read both Francis reports, and I think it is essential that everybody learns the lessons—that is what I said—including Labour Members. It is also important that we do not repeat the mistakes, and the first Francis report said that the problems were caused because the trust cut staff to dangerously low levels. The most worrying thing from the analysis that will be published today is that four in 10 of the jobs being lost come directly from services linked to the care of older people. Does the Secretary of State therefore agree that there is a danger that the NHS is already failing to learn the lessons of the recent past? Will he join me in sending a message to the NHS that care of older people should be a priority for improvement, not an easy target for cuts?
Mr Hunt
If we are to learn the lessons of the Francis report and admit to our mistakes, perhaps the right hon. Gentleman will reflect on the fact that, because we decided to protect the NHS budget, there are 8,000 more clinical staff in the NHS today, yet he still wants to cut the NHS budget from its current levels, as he confirmed only last December.
Mr Christopher Chope (Christchurch) (Con)
T3. In today’s edition of the Daily Express, the Prime Minister promises to prevent immigrants freeloading on our NHS. Words are one thing, but can the Secretary of State spell out exactly what actions will be taken to deliver on the Prime Minister’s pledge?
Mr Jeremy Hunt
I am happy to confirm to my hon. Friend that we intend to take some profound steps in this area, because we have a national health service, not an international health service. We have to ask whether it is appropriate for us to be giving free health care to short-term visitors, to students, to people on temporary visas. We will be saying more about that issue shortly.
Paul Blomfield (Sheffield Central) (Lab)
T6. On 13 March 2012, the former Secretary of State said of the Health and Social Care Bill:“There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector.”—[Official Report, 13 March 2012; Vol. 542, c. 169.]However, the new NHS competition regulations break those promises by creating a requirement for almost all commissioning to be carried out through competitive markets, forcing privatisation through the back door, regardless of local will. Will the Secretary of State agree to make the regulations subject to a full debate and vote of both Houses?
Mr Jeremy Hunt
If the hon. Gentleman had listened to my previous answer, he would have heard that the regulations are consistent with the procurement guidelines that his own Government sent out to PCTs. It is not our job to be a champion for the private sector or the NHS sector; we want to be there to do the best job for patients. That is the purpose of the regulations.
Tessa Munt (Wells) (LD)
T4. Two years ago, the Prime Minister welcomed the installation of CyberKnife, the latest in cancer radio surgery equipment at the world-leading Royal Marsden cancer centre, as an example of how the NHS has progressed. Since then, the Royal Marsden has invited successive Health Ministers to visit the cancer centre but no one has accepted the invitation, and I am aware that Ministers have been to see other cancer treatment systems. Will the Secretary of State follow the Prime Minister’s lead and visit the Royal Marsden to see for himself the great progress that has been made there?
Mr Andy Slaughter (Hammersmith) (Lab)
Last week’s decision to close four north-west London A and Es, including Charing Cross and Hammersmith in my constituency, will shortly be on the Secretary of State’s desk, as he predicts. It was referred by Labour Ealing council because Tory Hammersmith and Fulham council supports the closures. Will the Secretary of State refer the matter for independent review? This is the biggest hospital closure programme in the history of the NHS. It will see a world-class hospital downgraded to 3% of its size.
Mr Jeremy Hunt
I am aware how concerned people are throughout north-west London about the proposals. If the matter is referred to me by Ealing council, I will indeed ask the independent reconfiguration panel for its independent view on the proposals.
Mr John Baron (Basildon and Billericay) (Con)
T9. The cancer drugs fund has been a huge success and has helped up to 25,000 patients, but the negotiations between the Government and the pharmaceutical companies on its replacement—value-based pricing—is causing real uncertainty for cancer patients and clinicians alike. For example, will new medicines be available to new patients under the new system and what guidance is being given to local cancer drugs funds as they wind down? Can we please have clarity urgently?
Social Care Funding
Jeremy Hunt Excerpts(12 years, 5 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 funding of care and support in England.
As we get older, none of us can have any way of knowing what care needs we will eventually face. Some will be blessed with a long and healthy life, but many others will be less fortunate. Today, many older people and people with disabilities face paying the limitless, often ruinous costs of their own care with little or no assistance from the state. Although those with assets of less than £23,250 receive support, those with assets above this level receive none. That is desperately unfair, particularly for those who have worked hard all their lives to pay off their mortgage, save for their future or have something to pass on to their loved ones, only to see their property sold and their savings wiped out. This is something that happens to more than 30,000 people every year or 100 people every day.
The system we have also sends out the wrong message: that people are better off not saving for their future because any savings may only disappear in a puff of smoke. So today I can announce the Government’s radical plans to transform the funding of care and support in England—bringing a new degree of certainty, fairness and peace of mind to the costs of old age, disability and living with long-term conditions, while ensuring that the greatest level of financial support goes to those with the greatest need. We propose to introduce a cap on an individual’s financial contributions towards the cost of care and a significant increase in the level of assets a person may hold and still receive some degree of support from the state.
In 2010, this Government asked economist Andrew Dilnot to look at the whole issue of funding for care and support. The independent Dilnot commission published its recommendations in July 2011. In response to those recommendations and following extensive engagement with the care and support sector, we published the care and support White Paper and the progress report on funding reform in July 2012. In the progress report, we accepted some of Andrew Dilnot’s main recommendations, including those for a consistent, nationally set eligibility threshold for care and support, and universal deferred payments, whereby no one will have to sell their home in their lifetime to pay for care costs. I would like to take this opportunity to thank Andrew and his team for their excellent work.
A core principle set out by the Dilnot commission was that people should contribute to the costs of their own care, but those costs should be limited and protected against the potentially catastrophic costs of care. That should come through a cap on those costs and an extended means test. One person in 10 will be faced with care costs in excess of £100,000, with a small number facing costs significantly higher still. To give everyone peace of mind, from April 2017, we will introduce a cap on the amount that someone over state pension age will be liable to pay.
The Dilnot commission’s original suggestion was for a cap of £25,000 to £50,000 in 2010-11 prices—the equivalent of £30,000 to £61,000 in April 2017 prices. Despite the extremely challenging economic situation in which we find ourselves, we have come as close to that range as possible. The cap will be set at £61,000 in 2010-11 prices or £75,000 once it is introduced in April 2017.
The intention is not that people should have to pay up to £75,000 for their care costs, but that by creating the certainty that this is the maximum they will have to pay, they can then make provision through insurance or pension products so that they are covered up to the value of the cap, thereby reducing the risk of selling their home or losing an inheritance that they have worked hard to pass on to their family. Young people who already have care needs when they turn 18 will now receive free adult care and support when they reach 18. People who develop a care need after 18 but before state pension age will be protected by a cap that is below the £75,000 threshold.
The other measure we propose is to increase significantly the amount of assets a person can hold and still receive financial support for their residential care home costs. Currently, this is set at £23,250. If a person has assets valued above this level, including in some circumstances the value of their home, they receive no support. The Dilnot commission recommended this threshold be raised dramatically to £100,000 in 2010-11 prices. We accept this recommendation.
From April 2017, the threshold will be increased so that those with assets worth £123,000 or less, equivalent to Dilnot’s recommended level, will all receive some degree of financial support for their care costs. People with the fewest assets will receive the most support. This will, for the first time, provide financial protection for those with modest wealth, while ensuring that the poorest continue to have all or the majority of their costs paid.
Everyone will benefit from the peace of mind that a cap will bring. The introduction of a cap and the extended means-tested support will help many people in the most challenging circumstances. We expect up to 16% of older people who need care to face costs of £75,000 or more—but, of course, none of us knows whether we will be in that 16%. Everyone will benefit from the peace of mind that these changes will bring, and by 2025 up to 100,000 more older people will receive financial support with their care costs as a result.
The Chancellor and the Treasury have rightly insisted that we identify how we pay for the additional costs of these proposals. In this day and age, making promises that cannot be paid for makes those promises meaningless —so we have identified exactly how to pay for them. These reforms will cost the Exchequer £1 billion a year by the end of the next Parliament. With the agreement of the Chancellor, these will be met in part by freezing the inheritance tax threshold at £325,000 for a further three years from 2015-16. The Chancellor and the Chief Secretary have agreed that the remaining costs over the course of the next Parliament will be met from public and private sector employer national insurance contributions revenue associated with the end of contracting out as part of the introduction of the single-tier pension.
These two new proposals join others previously announced when we published the draft care and support White Paper last summer, and they include from 2015 the ability of people to defer the payment of residential care costs so that no one need sell their own home to pay for them during their lifetime. Also from 2015, a national minimum eligibility threshold will be introduced to end the lottery of local access that can see support provided to someone in one area, but not in another.
Taken together, today’s proposals and those already set out in the draft Care and Support Bill represent a new era of support for the elderly and disabled in England. Thanks to the certainty these proposals introduce, rather than people feeling they have to hoard every penny in case the very worst should happen, or that they are powerless and there is no point in saving at all, people will be able to plan and prepare sensibly for the future. They will be supported by a wider range of financial products becoming available in the market, which will be designed to help people to plan and prepare for their later years and to reassure them about how much they will pay. We will work with the care and support sector—with local authorities, charities, care providers and individuals—and with the financial services industry to develop the plans and introduce them practically.
Our society is ageing. By 2030, the number of people over 85 will double, and the number of people with dementia will exceed 1 million. As the number of older people with such long-term conditions increases, we need to become a society in which people prepare and plan for their social care costs as much as they prepare and plan for their pensions. Sadly, that is an issue that Governments of all colours have long failed to tackle.
While many other things need to be done to prepare for an ageing population, these reforms herald an historic change in the way in which care and support are funded. The economic circumstances are challenging, but these commitments demonstrate our determination to help people who have worked hard, saved, and done the right thing to prepare for the uncertain hand that fate deals all of us in old age. Because we are introducing these reforms within the time scale and at the thresholds set out, they will also be sustainable and consistent with our overriding priority, which is to reduce the deficit inherited from the last Government.
We want our country to be one of the best places in the world in which to grow old. These plans will give certainty and peace of mind in regard to the cost of care, ensuring that we can all have the support that we need without facing unlimited costs, while also ensuring that the most support goes to those in the greatest need.
I commend my statement to the House.
Andy Burnham (Leigh) (Lab)
I thank the Secretary of State for his statement, and for early sight of it. I agree with him that our current social care system in England is the worst of all possible worlds: a cruel lottery whereby people go into later life with everything for which they have worked on the roulette table, and the most vulnerable are always the biggest losers. That needs to change.
The Secretary of State has tabled a modest plan that will make the system fairer than it is today, and we congratulate him on that. We welcome elements of what he has announced today. A cap of £75,000 will protect people from the catastrophic costs of care, and raising the means-test threshold will help more people on lower incomes to obtain some help with care charges. This is a step forward, but it is a faltering one. The House has been presented with a flawed prospectus today. Vulnerable people will still face rising care charges and homes will still be lost, notwithstanding valiant attempts to put the best possible spin on things in the weekend media. Yesterday the Deputy Prime Minister made the big claim that the Government were going to “crack” the care “conundrum”. Today, when we are faced with this meek package, that sounds suspiciously like overselling. Stephen Burke, the director of United for All Ages, has described the cap as
“the dampest of damp squibs”.
Yesterday, on The Andrew Marr Show, the Secretary of State said:
“I've been hauled before the Speaker before and I wouldn’t want that to happen again and so I don’t want to go into the details.”
Now that we have heard the details, perhaps the Secretary of State could explain on which part of his statement the media had not been pre-briefed. It is disappointing that the media rather than the House were briefed first on a statement that was of such importance to so many people. It is also disappointing that the Government have abandoned any effort to build a cross-party consensus before rushing to announce its proposals, and that they have chosen to rewrite the Dilnot report with figures of its own, breaking its careful logic.
More specifically, there are four problems with what has been announced today, and I will address each in turn. First, it fails the fairness test. We will only have a durable solution if it can answer this question: will it help every person and every couple to protect what they have worked for, whatever their wealth and savings? I am afraid that the answer is no. According to Demos, a £35,000 cap would benefit about 3.2 million pensioners. A per-person cap of £75,000 will benefit just 1.4 million. For the average couple, the cap is £150,000. That might be enough to protect detached houses, but it will not protect the average semi-detached home in large parts of England.
As Andrew Dilnot said today, the cap
“is higher than we would have wanted —£11,000 higher than the top end of our range—and I regret that”.
Will the Secretary of State confirm that people with modest to average homes and savings are not protected under his plan? Is this not a plan for the few and not the many, and further proof that we are not all in it together?
The Secretary of State claims that insurance companies will step in with new products to help more people to protect their assets, but in evidence to the Health Committee, the Association of British Insurers said that it did not believe that the capped cost model would result in a market for pre-funded care insurance. So what further confidence can the Secretary of State give the House today that such a market will in fact emerge?
Secondly, the plan is at best a partial solution. With this decision, the Government have prioritised the funding of a cap on care costs with new money, over and above addressing the crisis in council care budgets. Will the Secretary of State confirm that this was against the advice of Andrew Dilnot to the cross-party talks? In practice, it will mean that vulnerable people will continue to face rising charges, as councils put up fees to cope with the growing shortfall in their budgets, making it more likely that those people will, in time, have to pay right up to the new £75,000 cap. To many people, that will not feel like progress.
More than £1.3 billion has been cut from local council budgets for older people’s care since the coalition came to power. Care charges are rising above inflation, and councils are warning that, by 2024, they will be overwhelmed by the costs of care. Does the Secretary of State accept that forecast, and if he does, how will the plans he has announced today help to address it? If he fails to face up to the current crisis in council funding, is it not the case that, with care charges rising, today’s announcement will feel like a con? It is true that the Government have raised the capital threshold, and I have said that we welcome that, but can the Secretary of State give the House any confidence that the extra support that people receive through a more generous means test will not be more than offset by increasing care charges caused by collapsing council budgets?
What people might not know is that the cap reflects not what people actually pay for care but a local authority average, and that it does not include accommodation costs. That was not mentioned in the Secretary of State’s statement. Will not people feel conned if the Government do not make that clearer?
The third problem is that this package disguises yet another coalition U-turn, this time on inheritance tax—[Interruption.] It is ironic, I must say. In 2007, a flagship pledge was made to increase the inheritance tax threshold to £1 million. Just eight weeks ago, the Chancellor said that he would increase the threshold in two years’ time. What has happened in the past two months to make him change his mind? Is not this the quickest coalition U-turn yet? The irony will not be lost on people that the Government are now increasing death taxes to pay for their plan. The Secretary of State has also said the rest will be made up from national insurance. Does he think it is fair to ask the working age population to pay for something else, rather than older people?
Finally, the proposal fails to meet the scale of the challenge of the ageing society. It will not lead to more integration of care. Instead, it will entrench the separation between two separate systems: a free-at-the-point-of-use NHS and charged-for social care. Would it not have made more sense, rather than developing these piecemeal plans in isolation, to have set them out as part of a single vision for a sustainable health and care system in the 21st century? The Secretary of State has made progress, but he has missed an opportunity to produce a long-term plan that is fair to everyone and built on cross-party consensus. He has settled for a timid solution when what older people needed was a far bigger and bolder response.
Mr Hunt
Really! The right hon. Gentleman talked about a flawed prospectus, but what we had from the Labour Government during their 13 years in power was no prospectus whatever. This was in Labour’s manifesto in 1997, then the Government had a royal commission in 1999. There was a Green Paper in 2005, followed by the Wanless review in 2006. The problem was going to be solved in the comprehensive spending review of 2007, but then we had another Green Paper in 2009. Let us compare that with a coalition that commissioned a report the moment it came into office, said after a year that it accepted the principles of the report, and has now, just two years later, announced how it will implement it and pay for that implementation.
Let me go through some of the things that the shadow Secretary of State has said. He quoted one stakeholder, Stephen Burke, but let us look at what some of the others have been saying. The Joseph Rowntree Foundation has said that
“the cap and threshold are welcome measures, and a welcome sign that the government is taking responsibility for addressing care funding.”
Andrew Dilnot said today:
“I recognise the public finances are in a pretty tricky state and it doesn’t seem to me that”—
what the Government are proposing is—
“so different from what we wanted”.
Or we could talk about Age UK, which says it
“has always supported the principle of a cap”
and welcomes the fact that we are increasing what it describes as
“the current miserly upper means test threshold”.
A lot of stakeholders welcome today’s announcement, but recognise that we are in extremely difficult financial circumstances and that that is why we have to be responsible with public finances.
The right hon. Gentleman talked about the cap of £75,000, which is indeed higher than the upper limit proposed by Andrew Dilnot, but to describe this as only helping people on higher incomes is fundamentally to misunderstand how a cap works. First, potentially more than 70% of the £1 billion a year that this will cost the Government by the end of the next Parliament is going to socially disadvantaged families. This is a highly progressive measure, and as well as increasing the cap we are increasing the threshold above which people do not get any help, from £23,000 to £123,000—exactly the kind of thing that some of the most disadvantaged families on the lowest of incomes will benefit from most.
The right hon. Gentleman talks about the Association of British Insurers—he needs to get up to date. It describes this as
“potentially another positive step forward in tackling the challenges of an ageing society.”
[Interruption.] If he wants some more quotes, let us look at what financial services companies are saying. Aegon UK says it
“welcomes today’s announcement and the clarity it brings on state support.”
Legal & General says it is
“pleased the Government has decided to move forward with Andrew Dilnot’s proposals.”
As for local authority budgets—the shocking state of which, by the way, we inherited from the last Labour Government—the Government said in the spending review that the NHS health budget would give £7.2 billion of support for health-related needs to local authorities during the course of this Parliament.
On inheritance tax, what the right hon. Gentleman does not understand about today’s measures is that fundamentally, they are helping people to protect their inheritance from the lottery of social care costs. The randomness of someone not knowing whether they will be the one in 10 who suffers over £100,000 in care costs is eliminated by a proposal that allows everyone to plan and prepare for their own social care costs.
The right hon. Gentleman describes this as a modest plan and says we have neglected the scale of the problem. Of course, in dealing with an ageing population many other issues need to be dealt with. He talked about the problem of integration, which we are solving by devolving power to clinical commissioning groups on the front line, a reform that Labour opposed, and by integrating technology, a reform on which Labour failed. Also, Labour did nothing about dementia, leaving us with less than half the people with dementia being diagnosed. We are now tackling that problem. We saw last week the issues of treating older people with dignity and respect. We are tackling that problem—Labour left it for far too long.
The problem is not that our solution is too small, but that it was too big for Labour to solve when they were in office. When it comes to making Britain a better country to grow old in, this Government are taking action where the last Government failed.
Mr Stephen Dorrell (Charnwood) (Con)
Does my right hon. Friend agree with the view expressed by Tony Blair to the Labour party conference in 1997 that it should be a priority for the British Government to sort out the unfairness that prevails in our system of care for the elderly? Does he further agree with me that when our right hon. Friend the Leader of the House was Health Secretary, he set up the Dilnot commission within weeks of this Government taking office, and that the package my right hon. Friend has announced today was described today by Andrew Dilnot as being not so different from the one recommended by the commission set up by our right hon. Friend?
Mr Hunt
I absolutely agree with my right hon. Friend’s points; he speaks wisely, as ever. I, too, want to pay tribute to the work that my predecessor, our right hon. Friend the Leader of the House, did in laying the ground and making the big call that we needed to have the Dilnot commission, and in last year publishing the care and support White Paper, which moved this agenda much further forward than in any of the 13 years of the previous Labour Government. My right hon. Friend is also right about the fundamental randomness and unfairness. Of course, we are not saying that the Government will pay for all the social care costs we encounter—public finances could not possibly be in a state to allow that to happen. However, this provides certainty and allows people to plan, so that they can cope with the randomness and unfairness of the current system and know that it will not put their precious inheritance at risk.
Barbara Keeley (Worsley and Eccles South) (Lab)
At £75,000 the cap on social care is far too high to help people in an area such as Salford. The Secretary of State has talked about insurance products developing to help people meet the costs of the cap. In our inquiry into social care, we on the Select Committee on Health were told that this country has no market at all in long-term care insurance—not only that, but no country in the world has a working market in pre-funded long-term care insurance. Is it not wishful thinking of the highest order to talk about people being able to rely on products that do not exist either here or anywhere else in the world?
Mr Hunt
I am afraid that what the hon. Lady says sums up the attitude of the Opposition; they thought it was wishful thinking to try to solve this problem, whereas we are getting on with a solution. We do not have those financial products available at the moment, but the whole point of these structures is that we will help to create a market in which it is possible to have them. The point of the cap is to allow the hon. Lady’s constituents, even people on lower incomes, to plan and make provision, not only for costs of more than £75,000, but for any costs they have up to £75,000. In combination with that, we are increasing the threshold for Government support from £23,000 to £123,000.
Dr Sarah Wollaston (Totnes) (Con)
I warmly welcome today’s statement, particularly the rise in the asset threshold, as I well remember my former patients’ shock when they realised that for anything over £23,250 they would have to meet their entire costs. However, may I ask the Secretary of State to look again at the impact there will be on rural local authorities, for example, Devon’s, which has the fifth oldest population in England?
Mr Hunt
I will certainly do that, and I am grateful for my hon. Friend’s comments. I would just say that it is in some of those areas with the highest proportion of older people that the impact of the current lottery in care provision is so dramatic and needs addressing so quickly. I therefore hope that her constituents will welcome the certainty in these proposals, but I will certainly look at and identify whether any particular issues are raised in rural areas.
Grahame M. Morris (Easington) (Lab)
The Minister has concentrated on the impact on the frail elderly, but does he recognise the other care crisis highlighted recently in a report published by four leading disability charities? What will these proposals do to assist in providing social care to working-age disabled people, who make up about a third of social care recipients? The shortfall we have estimated is about £1.2 billion—that is the gap between social care budgets and needs.
Mr Hunt
These proposals will go some way to addressing that problem. First, children who reach adulthood— the age of 18—with care costs will continue to receive the support they need without any qualification at all. Adults who become disabled during their working life will have a cap, but it will be a lower one. So we will be able to offer very important support to both those groups.
Andrew Percy (Brigg and Goole) (Con)
I welcome this statement as it moves the system on from where it is today. However, for a lot of communities the social care costs are so much more expensive, particularly in rural areas with very elderly populations, and they are more likely to hit that cap more quickly. So can my right hon. Friend assure us that everything will be done to ensure that the cost of care in these more expensive areas is brought down to something more in line with the rest of the country?
Dr William McCrea (South Antrim) (DUP)
No one can deny that elderly and vulnerable people across the United Kingdom live in fear of having to go into care and what that would mean to them. This is not only about England; it is about the rest of the United Kingdom. So what discussions has the Secretary of State held with the devolved Administrations to ensure that our elderly citizens have certainty, fairness and peace of mind about the costs of old age, such as he claims his plan will bring?
John Pugh (Southport) (LD)
I welcome the statement. Regardless of the details and figures announced today, does this overall approach not promise certainty and predictability where previously there was anxiety and uncertainty? Is that not the big gain?
Mr Hunt
That is the main point of what is being announced today. We are not able, with the public finances as they are, to offer a huge amount of support, but what we can do is give the certainty that means that for the first time people will be able to plan and make provision for their social care costs. We will be one of the first countries in the world that does that, which is why this is a very encouraging and very important day for people who care about the tremendous uncertainties associated with growing old.
Hazel Blears (Salford and Eccles) (Lab)
The Alzheimer’s Society has said today that capping care costs is a step in the right direction, but a £75,000 cap is so high that it will help only the few. The Secretary of State knows that there are 800,000 people in this country living with dementia now, and his announcement today, however welcome it is, does not deal with the community care costs that those people face day to day. This costs a billion pounds in, but there is £1.3 billion out of community costs to local authorities. How will he fill that gap?
Mr Hunt
The right hon. Lady knows well the challenge and the crisis that we face because of dementia, and she has spoken movingly on the issue. What I would say about what the Alzheimer’s Society is saying is that to look at the cap in isolation is to misunderstand these proposals. For many people with dementia, the most significant thing will be the increase from £23,000 to £123,000 in the threshold at which they get state support. That is a big step forward.
The cap is not saying that we expect people to pay £75,000 towards their care costs. We are saying that that is the maximum anyone will have to pay, which makes it possible for people to make provision in their pensions and in insurance policies. One in three of us will get dementia, and we do not know whether we will be among those one in three. This proposal will allow people to put some certainty in place—to make plans now, which means that when they are dealing with the nightmare of either themselves or someone in their family having to cope with dementia, they will not have the double whammy of having to worry about losing their house as well.
Julian Smith (Skipton and Ripon) (Con)
Many older people across North Yorkshire have been waiting decades for this kind of certainty, so I thank the Secretary of State for bringing that to them. May I urge him to use his laser vision, which he has shown on this matter, to make health budgets and social budgets work much more closely together?
Mr Hunt
My hon. Friend is absolutely right: that is perhaps the biggest remaining issue that we have to face in the NHS and social care system today. There are interesting parts of the country, such as Torbay, where it is happening very effectively, but anything he can do in North Yorkshire to make it happen more speedily and more effectively will be very welcome.
Chris Bryant (Rhondda) (Lab)
Mining constituencies have some of the highest percentages of home ownership in the country, so this issue affects them. Further to the question asked by the hon. Member for South Antrim (Dr McCrea), what discussions has the Secretary of State had with the Welsh Assembly, because I presume that there will be a Barnett consequential—money going to Wales as a result of today’s announcement? How much will that be?
Mr Christopher Chope (Christchurch) (Con)
Is it possible to have some transitional arrangements, because four years is a long time to wait for a family who are already paying care costs? Is it not possible to increase the capital allowance, for example by £20,000 a year, from now on? Is it not possible to allow care costs in excess of £75,000 to be set against future inheritance tax?
Mr Hunt
I understand where my hon. Friend is coming from. All I can say is that we had very strictly to produce a package that is affordable within the current financial constraints. For that reason, we have come up with the package we have. It is the earliest we think we can afford to do this and the lowest cap we think we can afford, but I will of course reflect on his comments.
Fiona Mactaggart (Slough) (Lab)
My question follows on from the previous one about what will happen between now and 2017. Many families are frightened about care costs and the statement has nothing for them. Their loved ones are likely to die in the next four years—2 million people will die before this is implemented. What is the Secretary of State doing additionally for local councils, which are trying to help people in that situation?
Dr Julian Lewis (New Forest East) (Con)
I warmly welcome the rise in the assets threshold, but I am not clear about one aspect. People such as my father had to sell their home to pay the costs of residential care. It is being suggested that accommodation and food will not be covered by the proposals, but, given that the residential care aspect is so important, can my right hon. Friend give us reassurance?
Mr Hunt
These proposals cover the care costs, but we will be making an allowance for accommodation and food of £1,000 a month at 2017-18 prices. The reason for doing that is that a person would face those costs whether or not they were in a residential care home, and we think it would be wrong to create a system where that person was better off financially being in a residential care home than living at home.
Ian Lucas (Wrexham) (Lab)
Beveridge committed to “the cradle to the grave” as the principle in health care. It is clear today that the Government have given up on the public sector contributing to the pre-£75,000 figure. Has he any idea or has he inquired how much the cost of provision would be for a family to obtain cover for that first £75,000?
Mr Hunt
I think the hon. Gentleman needs to study these proposals with a great deal more care. If he had listened to them, he would know that we are extending dramatically the help available to people who have to pay up to £75,000, by increasing the threshold from £23,000 to £123,000 at 2017-18 prices.
Margot James (Stourbridge) (Con)
I warmly welcome the action that my right hon. Friend has taken today. To the critics who say that the cap should be lower, would he not say that the main purpose is to provide protection for those people who face catastrophic charges, which are roughly 10% to 15%? Is that not the main point? Does he agree further that this represents a fair resolution between the people’s responsibility to save for their retirement and the responsibilities of the community to protect those to whom catastrophic charges might apply?
Mr Hunt
My hon. Friend, as so often on health matters, is absolutely right. This is about a partnership between the state and the citizen, recognising that the state is not able to bear all these costs on its own, and trying to create the incentives and the certainty whereby private citizens are able to make provision for their own social care costs in the way that they make provision for their pension and, as such, is a very important step forward.
Geraint Davies (Swansea West) (Lab/Co-op)
These proposals mean that someone with a £200,000 house pays £75,000, and someone with a £400,000 house pays £75,000. Would it not be fairer if the first £200,000 was charged at, say, 20%, and the second £200,000 at 40%, so that someone with a £200,000 house would pay £40,000 and someone with a £400,000 house would pay £120,000, so that instead of a flat-rate charge, we would have a progressive charge within the financial envelope? Will the Secretary of State consider a fairer system, rather than a flat-rate poll tax?
Mr Hunt
People whose houses have lower value benefit from the fact that we are increasing the threshold at which support is available. Because of that increase in the threshold, they will get some support towards paying for their £75,000, which people with higher value houses will not get.
Mr John Redwood (Wokingham) (Con)
Does the Secretary of State see any difficulty in this coalition Government pre-empting a future Chancellor of the Exchequer over tax policy, when I thought everybody in the House wanted a different kind of Government after 2015, who might have their own ideas?
Mr Hunt
We have funded these proposals until 2020 on plans that have been agreed by the Liberal Democrats and the Conservatives. We hope very much that we will have the support of the Opposition for these plans as well. Then we can have a national consensus around them, which is what we need because in the end, if we are to create that certainty in the markets, people need to know that whichever Government are elected, they support the basic approach that we are endorsing.
Dr Eilidh Whiteford (Banff and Buchan) (SNP)
These proposals will not apply in Scotland, where people already receive personal and nursing care as they need it, when they need it, regardless of their income. Is the Secretary of State aware that this approach has helped to reduce substantially the number of people requiring long-term hospital beds, has also helped to reduce NHS bed-blocking, and has enabled thousands of elderly, frail people in Scotland to live in their own homes, rather than face the crippling costs of moving into residential care?
Mr Hunt
There are some things that we can learn from Scotland and some things that we cannot learn. Scotland has a very good record in identifying people with dementia, and the point that the hon. Lady makes about helping people to live at home for longer is a very good one. Care costs incurred in domiciliary care for people who are living at home will count towards the £75,000 cap, so we hope to have many more flexible ways for people to provide for themselves and be able to live at home happily and healthily for longer.
Andrew Stephenson (Pendle) (Con)
I welcome today’s statement. Most welcome to my constituents will be the increase in the means-test threshold of state support from £23,000 to £123,000. Given that December’s figures from the Land Registry put the average house price in my constituency at only £114,000, will my right hon. Friend confirm that these proposals represent a very good deal for Pendle home owners, most of whom are on low incomes and of only modest wealth?
Mr Hunt
That is absolutely the point. The group of people we are targeting with these proposals are not the most vulnerable, because they already get all their care costs covered if their assets are less than £23,000, but the people one step up from that, who in many cases have worked hard, saved all their lives and paid off their mortgage, but have a house that is not of sufficient value to cover the social care costs they need. I hope that these proposals will be very welcome in Pendle.
Pat Glass (North West Durham) (Lab)
Can the Secretary of State assure me and my constituents that any gains they may make from his proposals will not be completely wiped out by the massive cuts to local authority care budgets—£120 million this year alone in my own local authority?
Mr Hunt
We have looked very carefully at the cuts that local authorities are facing in England in order to make sure that that should not compromise adult social care. They are not ring-fenced budgets. That is why we put in an extra £7.2 billion of support from the Department of Health’s budget where there are health-related needs. We are watching this very carefully throughout the country.
Mr Philip Hollobone (Kettering) (Con)
People in my constituency will want to congratulate the Secretary of State on grasping this nettle. Can he confirm that after 2017 there will be some kind of index-linking on the liability cap and the asset threshold? Is there now an implied permanent link between the yield from inheritance tax and the nation’s social care costs?
Mr Hunt
I do not think that there is an implied link in the way that my hon. Friend suggests, but I will reflect on his comment to check that I fully understood his brilliant insight. Automatic indexation is of course a matter for future Governments and future Parliaments, but it is certainly our intention that the proposals we are making will continue to take account of changes in the cost of living.
Barry Gardiner (Brent North) (Lab)
I welcome aspects of the Secretary of State’s statement. Does he agree that the security in old age that he is seeking to put in place will not be effective for as long as companies such as Phoenix Life are able to offer people like my constituent, Mr Gerard Burton, £221 a month for the rest of his life, at the age of 84, in return for half his house? Will the Secretary of State speak to his colleagues in the Treasury to ensure that there is great scrutiny of precisely what financial products are being offered in this domain?
Mr Nick Gibb (Bognor Regis and Littlehampton) (Con)
This statement will be very welcome in my constituency, which has a very high proportion of retired and elderly people. May I warmly congratulate my right hon. Friend on gripping a problem that has eluded previous Governments? Can he confirm that the new higher savings threshold of £123,000 will not include the value of a couple’s home when the spouse or dependant of the person in residential care still resides in that home?
Diana Johnson (Kingston upon Hull North) (Lab)
On the financial products that will be available, will the Secretary of State produce evidence so that constituents in Hull can find out what kind of figures we are talking about as regards their protecting themselves for the future?
Mr Hunt
I am making the announcement today, so we have to give the financial services industry some time to respond to the proposal. However, the indications are encouraging, and I think that we will all see, in plenty of time for the 2017 start of this plan, what products are available. There may be separate products, but it may also be something that becomes part of people’s pension planning. In the same way that people decide what arrangements they want in their pension for an annuity and for a lump sum payment, payment towards these costs up to the level of the cap may become another part of the pension plan. We need to let the pension and insurance industries have the time to respond and to come up with these plans.
Paul Burstow (Sutton and Cheam) (LD)
Does my right hon. Friend agree that, in evaluating these proposals, the public need to understand the nasty little secret at the heart of social care in this country, which is that we have among the harshest of means tests and that that leads to people facing catastrophic costs? Will he also ensure, in making these reforms, that he provides the Joint Committee examining the draft Care and Support Bill with all the necessary details of how this will be implemented?
Mr Hunt
I would be happy to do that and I am grateful to the right hon. Gentleman’s Committee for its work to date on pre-legislative scrutiny. He will understand why I was not able to go into details when we met to discuss the Bill last week. He is absolutely right: dealing with that threshold is one of the most important things and I am sure we will benefit from good scrutiny, as we have done to date.
Julie Hilling (Bolton West) (Lab)
I want clarity about what the costs include. My mother’s journey has involved eight months in residential care and she is now back home where carers visit her four times a day. Would either of those count towards the eventual £75,000 cap?
Alun Cairns (Vale of Glamorgan) (Con)
I pay tribute to the Secretary of State for the significant progress he has made on this issue, which was ignored for so long by the Labour party. The shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), has called for a bigger and bolder response. What estimate has my right hon. Friend made of the potential costs of a bigger and bolder response, and does he not think that any such criticism should have allied to it a source of funding in order for it to have any credibility?
Mr Hunt
I thank my hon. Friend for his question. The shadow Health Secretary complained this morning that we have not adopted the precise cap that Andrew Dilnot said he would have liked. That would have cost an extra £2.4 billion a year by 2020, on top of the plans that we have announced. It is up to the Opposition to tell us how they would find that money if that is what they want to happen.
Steve McCabe (Birmingham, Selly Oak) (Lab)
Is it not likely that the decline in domiciliary services will accelerate to the point at which people are forced to enter residential care? Has the Health Secretary factored those rising costs into his calculations?
Mr Hunt
The care costs that people have at their home will be included in the amount calculated towards the cap, so what we are hoping for is the opposite—that this proposal will lead to an expansion of domiciliary services. I think that people will welcome that. At the heart of controlling our social care costs, both financially and on a human level, is a structure that allows more people to live at home, happily and healthily, for longer than is currently the case.
Jason McCartney (Colne Valley) (Con)
Does my right hon. Friend agree that, to be credible on social care funding, any package needs to be fully funded, unlike yet more random, pie-in-the-sky, unfunded spending commitments?
Mr Hunt
Absolutely. There was a time when the Labour party would have considered a package that will be worth £1 billion a year by the end of the next Parliament to be a significant investment, but after its free spending ways of a billion here and a billion there, we are now talking real money.
Charlie Elphicke (Dover) (Con)
May I congratulate my right hon. Friend on a meaningful step forward in the social care debate, with a proper settlement? The shadow Health Secretary made a spending commitment of a £35,000 cap; for the record, how much would that spending commitment cost the country?
Mr Hunt
What the shadow Secretary of State said this morning would have cost the country an extra £2.4 billion on top of the proposals that we are outlining today. Labour Members need to say whether they would pay for that by increasing taxes or by reducing spending, but perhaps they are thinking of adding to the deficit.
Martin Vickers (Cleethorpes) (Con)
I, too, welcome my right hon. Friend’s announcement and the progress he has made. However, he will be aware that in a constituency such as Cleethorpes, which I represent and where a terraced house can cost less than £75,000, vulnerable and elderly people will still be concerned about the figures that are being tossed around. Will my right hon. Friend ensure that his Department passes the information to local authorities and local organisations that advise such people, in the hope that they can clearly understand the commitments?
Mr Hunt
We will be happy to do that. I think that my hon. Friend’s constituents will value the fact that the horrifically low threshold of £23,000, beyond which they get no help at all, will be raised significantly to the £100,000 threshold, in 2010-11 prices, that Andrew Dilnot recommended. Under the draft Care and Support Bill, all local authorities will be obliged to give a care assessment and access to financial advice to everyone in their area in order to make sure that constituents such as those of my hon. Friend are given the information they need.
Glyn Davies (Montgomeryshire) (Con)
I, too, greatly welcome the framework for social care that the Secretary of State outlined in his statement. The Barnett consequentials should mean an extra £10 million for Wales if the proposal costs about £1 billion. What discussions has he had with the Welsh Government to encourage them at least to invest the Barnett consequentials in social care, given that it is as big a problem in Wales as it is in England?
Mental Health (Registered Practitioners and Approved Clinicians)
Jeremy Hunt Excerpts(12 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
In my oral statement on 29 October 2012, Official Report, column 32, I said that I had asked Dr Geoffrey Harris to conduct an independent review into the technical irregularities that had occurred within four strategic health authorities (SHAs)—North East, Yorkshire and the Humber, West Midlands and East Midlands—with regard to the functions of approving registered medical practitioners and approved clinicians under the Mental Health Act 1983. In addition, I asked Dr Harris to consider this matter in the context of the new NHS structures that come in to force from April this year in order to identify whether any lessons need to be learned.
Dr Harris has now submitted his report to me. “Independent review of the arrangements made by SHAs for the approval of registered medical practitioners and approved clinicians under the mental Health Act 1983” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
In summary, Dr Harris found that the SHAs involved did not overtly or wittingly delegate the functions concerned. However, he identified two key principles as to how the technically irregular delegation happened. First, the SHAs concerned should have been aware that, where a function has been conferred by statute on a public authority, the public authority may not further delegate the performance of the function to another body unless expressly permitted to do so.
Secondly, the SHAs considered that, because they remained accountable for the functions, the delegation of the operation of the approval arrangements to mental health trusts through contracts was not something that risked legal irregularity. The report sets out the factors that led to this situation in more detail.
In the second part of his review report, Dr Harris recommends that every organisation in the post-April 2013 NHS, including the Department of Health, should undertake a process of due diligence. To guide this process he sets out four key principles:
that there is a clear and secure location of responsibilities across the system and that all organisations taking on transferred functions, and receiving new ones, should have a full understanding of them;
that each organisation is assured that it has the authority to exercise its powers and duties. All of the bodies must be cognisant of the duties and powers conferred upon them by Parliament, or delegated to them by the Secretary of State, and recognise that this provides the essential authorisation for all decision making and action;
that each organisation ensures it has the appropriate capability and capacity to carry out its functions; and
that there should be a process of continuing audit, that is once the functions of the organisations are settled, understood and resourced, that there is periodic audit of their discharge;
Finally, Dr Harris recommends that all bodies should include material in their governance statements for 2012-13 and for all subsequent years, which confirms that any arrangements in place for the discharge of their current statutory functions have been checked for any irregularities, and that they are legally compliant.
I have accepted all of Dr Harris’ recommendations, and will ensure that the Department and the NHS now take these forward.
South London Healthcare NHS Trust
Jeremy Hunt Excerpts(12 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I would like to make a statement on the future of South London Healthcare NHS Trust.
The NHS exists to provide patients with the highest levels of care and compassion, and it does so in a way that is more equitable than the system in any other country in the world—it provides comprehensive care, free at the point of need. But to be true to those values, different parts of the NHS need to be financially sustainable. Financial problems left unaddressed become clinical problems, not least because money used to fund deficits cannot be used for patient care. The South London Healthcare NHS Trust is the most financially challenged in the country, with a deficit of £65 million per annum.
It currently spends some £60 million a year, or 16% of its annual income, to service two private finance initiative contracts signed in 1998. For this and other reasons, repeated local attempts to resolve the financial crisis at the trust have failed. As a result, the trust is losing more than £1 million every week. In the three years since it was formed in 2009, it has generated a deficit of £153 million. That figure will rise to more than £200 million by the end of this financial year, a huge amount of money that has to be diverted away from front-line patient care.
After consulting with the trust, its commissioners and the London strategic health authority, my predecessor as Health Secretary, my right hon. Friend the Leader of the House, instituted the special administration process, which includes a period of intense local engagement. Matthew Kershaw, former chief executive of Salisbury NHS Foundation Trust, was appointed as the trust special administrator in July 2012. I would like to put on record my thanks to him and his team for his exceptionally detailed and thorough work.
Mr Kershaw had the extremely difficult task of finding a clinically and financially sustainable way forward for the South London Healthcare NHS Trust. Reluctantly, he concluded that only by looking beyond the boundaries of the trust to the wider health community could he put forward a viable solution. I support that analysis.
I received his recommendations on 7 January. Six of his seven recommendations were as follows: first, that over the next three years, all three hospitals within the trust, Queen Elizabeth hospital in Woolwich, Queen Mary’s in Sidcup and the Princess Royal in Bromley, should make the full £74.9 million of efficiencies he has identified; secondly, that Queen Mary’s in Sidcup be transferred to Oxleas NHS Foundation Trust and developed into a hub for the provision of health and social care in Bexley; thirdly, that all vacant or poorly utilised premises be vacated, and sold where possible; fourthly, that the Department of Health pay the additional annual funds to cover the excess costs of the PFI buildings at the Queen Elizabeth and Princess Royal hospitals; fifthly, that the South London Healthcare NHS Trust be dissolved, with each of its hospitals taken over by neighbouring NHS and foundation trusts; and sixthly, to aid implementation, that the Department of Health write off the accumulated debt of the trust so as not to set the new trusts up to fail, that the Department of Health provide additional funds to cover the implementation of his recommendations and that a programme board be appointed under an independent chair, reporting to Sir David Nicholson as chief executive of the NHS Commissioning Board, to ensure the changes are effectively delivered. I have accepted each of these recommendations in full.
As a consequence of what he found, Mr Kershaw also recommended that services be reconfigured beyond the confines of South London Healthcare NHS Trust across all of south-east London. This part of his recommendation included reducing the number of accident and emergency departments across the area from five to four, replacing the A and E department at University Hospital Lewisham with a non-admitting urgent care centre, reducing the number of obstetrician-led maternity units from five to four and downgrading the current obstetrician-led maternity unit at University Hospital Lewisham to a stand alone midwife-led birthing centre. Each obstetrician-led maternity units would also have a midwife-led birthing centre. The recommendation also included co-locating paediatric emergency and in-patient services with the four A and E units, with paediatric urgent care provided at Lewisham, Guy’s and Queen Mary’s hospitals. Finally, he recommended that University Hospital Lewisham should become a centre for non-complex elective procedures, such as hip and knee replacements, to serve the entire population of south-east London.
The public campaign surrounding services at Lewisham hospital has highlighted just how important it is to the local community. I respect and recognise the sense of unfairness that people feel because their hospital has been caught up in the financial problems of its neighbour. However, solving the financial crisis next door is also in the interests of the people of Lewisham because they too depend on the services that are currently part of the South London Healthcare NHS Trust. None the less, I understand their real concerns about how any changes could affect their access to vital health services. Those concerns are echoed by Lewisham clinical commissioning group and many clinicians at Lewisham hospital. I have had in-depth discussions with the hon. Members representing those affected who have reflected those concerns to me.
As a result of those concerns, I asked the NHS medical director, Professor Sir Bruce Keogh, to review the recommendations and to consider three things: whether there was sufficient clinical input into the development of the recommendations; whether there is a strong case that the recommendations will lead to improved patient care in the local area; and whether they are underpinned by a clear clinical evidence base, as set out in the third of the four tests for reconfigurations.
On the matter of clinical input, a highly experienced clinical advisory group, led by local GP, Dr Jane Fryer, and including eight trust medical directors, six clinically qualified clinical commissioning group chairs, the London ambulance service medical director, the local director for trauma and three directors of nursing, supported the trust special administrator. Further scrutiny and challenge was provided by an external clinical panel, which included representatives from the Royal Colleges of Midwives and of Obstetricians and Gynaecologists. The panel was chaired by Professor Chris Welsh, the strategic health authority medical director for the midlands and the east of England. Both groups included respected national and local clinicians. They built on years of previous work in this area and held a series of clinical workshops in August and September last year. Sir Bruce was satisfied that there had indeed been sufficient clinical input.
On the issue of better care and clinical evidence, the recommendations provide for the adoption, for the first time in south-east London, of the 2012 pan-London standards for acute care, which are the standards that all six local CCGs have said that they want to commission for emergency and maternity care. They define the best available clinical practice and set the bar higher than that provided by most other acute providers in England.
Sir Bruce agreed that the adoption of these standards could not be achieved without a reduction in the number of sites delivering acute in-patient care. Such a reduction will enable the necessary concentration of resources and senior clinical staff. A similar approach has already led to significant improvements in stroke, major trauma and cardiovascular disease services throughout London, saving hundreds of lives.
For both emergency and maternity care, Sir Bruce found no evidence that patients would be put at risk through increased journey times. The whole population of south-east London will continue to be within 30 minutes of a blue light transfer to an A and E department, with the typical journey time being on average only one minute longer. Accessing consultant-led maternity services will involve an increase in journey times on average of two to three minutes by private or public transport. Sir Bruce therefore concluded that there should be no impact on the quality of care due to the small increase in travel time.
On the issue of maternity services, the expert clinical panel advising the TSA was not willing to support the increased risk to patients of having an obstetrician-led unit at Lewisham without intensive care services. As achieving the London-wide clinical standards will be possible only with the consolidation of the number of sites with these facilities, Sir Bruce supports the proposal for this unit to be replaced with a free-standing, midwife-led unit at Lewisham hospital. This will continue to deal with at least 10% of existing activity and potentially up to 60%, and £36 million of additional investment has been earmarked to ensure that there is sufficient capacity at other sites.
Turning to the emergency care proposals, Sir Bruce was concerned that the recommendation for a non-admitting urgent care centre at Lewisham may not lead, in all cases, to improved patient care. While those with serious injury or illness would be better served by a concentration of specialist A and E services, this would not be the case for those patients requiring short, relatively uncomplicated treatments, or a temporary period of supervision. To better serve those patients, who will often be frail and elderly, and would arrive by non-blue light ambulances, Sir Bruce recommends that Lewisham hospital should retain a smaller A and E service with 24/7 senior emergency medical cover. With these additional clinical safeguards and the impact that this is likely to have on patient and clinician behaviour, Sir Bruce estimates that the new service could continue to see up to three quarters of those currently attending Lewisham A and E.
Allowing Lewisham to retain its A and E would help to reduce the level of increased demand at hospitals with larger A and E services, while an additional £37 million of investment will further expand services at these hospitals for more serious conditions. Sir Bruce advised that patients with those more serious conditions should now be taken to King’s, QE, Bromley or St Thomas’s—not for financial reasons, but to increase their chances of survival.
On the issue of paediatric care, Sir Bruce recognised the high-quality paediatric services at Lewisham and that any replacement would have to offer even better clinical outcomes and patient experience. His opinion is that this is possible, but dependent on very clear protocols for primary ambulance conveyance, a walk-in paediatric urgent care service at Lewisham, and rapid transfer protocols for any sick children who would be better treated elsewhere. He is clear that this will require careful pathway planning and will need to be a key focus of implementation.
With these caveats, Sir Bruce was content to assert that there is a strong case that the recommendations are likely to lead to improved care for the residents of south-east London and that they are underpinned by clear clinical evidence. He believes that overall these proposals, as amended, could save up to 100 lives every year through higher clinical standards.
Yesterday, 30 January, as no viable alternative plan had been put forward, and in light of Sir Bruce’s opinion, I decided to accept the recommendations of the trust special administrator, subject to the amendments suggested by Sir Bruce. It is important to be clear that my acceptance of these recommendations is conditional on Monitor approving the proposals relating to foundation trusts, and on my Department negotiating an appropriate level of transitional funding with organisations such as King’s Partners.
Owing to the size of the task, there is a significant level of risk associated with achieving the identified savings. I recognise that the additional clinical safeguards that I have put in place will marginally increase these financial risks, but on balance I have made the judgment that this is worth it if it means that local patients are reassured that they will gain from an additional better service, rather than losing their A and E.
I believe the amended proposals meet the four tests required for local reconfigurations and I am therefore content for the process now to proceed to implementation. I expect the South London Healthcare NHS Trust to be dissolved by no later than 1 October 2013. The implementation of these proposals will be challenging and complex. It needs to be planned for carefully and will not happen overnight. I call on all organisations, hospitals and commissioners to offer their full support during the coming years to achieve the ambition of these proposals for the benefit of the people of south-east London, and I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
Just when we thought this Government’s mismanagement of the national health service could not get any worse, it just has. Let us be clear about what the Secretary of State has announced today. He has at last accepted recommendations that were agreed by the previous Government but then delayed by his predecessor’s moratorium, thereby deepening the financial problems of South London Healthcare NHS Trust. And he has rejected an outrageous proposal that Lewisham hospital should lose its accident and emergency department—a proposal that never should have been made in the first place, but which has cost more than £5 million of precious NHS cash on accountants in the process, enough to give some of the 5,000 nurses who were sacked their jobs back.
But the Secretary of State has accepted the principle that a successful local hospital can have its services downgraded to pay for the failures of another trust. That takes the NHS into new territory. The Secretary of State has just crossed a line and set dangerous precedents—namely, that in his new market-driven NHS, finance takes precedence and any hospital, no matter how successful, is vulnerable to changes through backdoor reconfiguration, that success can be punished and failure rewarded, and that a community can see its A and E and maternity services downgraded without proper consultation and without clinical justification.
There will be no cheers for the statement in Lewisham and it will send a chill wind through any community worried about its hospital services. There is now utter confusion about the Government’s policy on hospital reconfiguration. In three years, they have gone from moratorium to pandemonium. Across the country, half-baked cost-driven proposals to close A and Es and maternity units are being foisted on local communities without evidence of how that can be done safely and without putting lives at risk, yet at the same time, A and Es everywhere are under severe pressure. Thousands more patients are waiting for more than four hours to be seen and there are queues of ambulances lined up outside.
In that context, it is simply not tenable to downgrade any A and E department without first establishing a clear clinical case for how it can be done without compromising patient safety, but that is what the Government are doing here. They have set up a financially driven process and thrown together a clinical justification that is not independent but drawn up in his own Department, leaving the Secretary of State’s so-called four tests in tatters. Let me remind him that the fourth test is that any proposal for change must have “demonstrable support from commissioners”. Let me quote to him the chair of the Lewisham clinical commissioning group, Dr Helen Tattersfield, who has said:
“If the TSA proceeds as currently planned it is my belief that not only will this result in a reduction of quality and provision of health services for Lewisham residents with huge risks to health outcomes but also the effective end of clinical commissioning in Lewisham.”
It is clearly the case that the proposals that the Secretary of State has announced today will lead, in Dr Tattersfield’s words, to a reduction of quality and provision in Lewisham. These changes are opposed by the doctors he promised to put in charge of the NHS, and therefore clearly fail the fourth test that he has set out.
Furthermore, is the Secretary of State confident that what he has announced today is legal? We warned him that he was going beyond the powers in the Health Act 2009. He said that he would commission fresh legal advice. Will he publish it today so that there can be a proper debate on the legal position? He mentioned PFI, but is it not the case that the schemes he mentioned were initiated and negotiated under the Major Government? He said that he had consulted South London Healthcare NHS Trust, but is it not a fact that it found out about this process from the media?
This decision will damage fragile trust in the way that the NHS manages changes to hospitals. The Government need to get back to first principles. Will the Secretary of State confirm, learning from this debacle, that in future no proposal to downgrade or close A and E and maternity services will ever get out of the starting blocks if it does not have a proper clinical case to support it?
Will the Secretary of State today issue an apology to the people of Lewisham? How on earth are they expected to have confidence in the figures he has announced from a clinical review thrown together—cobbled together —in his Department in a matter of days? He has caused huge distress to them but he has also failed to listen to them. Thousands of people have put their lives on hold to fundraise, to lobby, to campaign: 52,000 names on a petition; 25,000 people on a march. This community have rallied together to defend their local hospital, led by the fantastic efforts of the local MPs, but more than that, they have fought valiantly for every community worried about this Government’s cavalier approach to our country’s most valued institution. This community have stood up to an out-of-touch Government who think they can treat some of more deprived parts of our country with utter disdain. This community have achieved something today, but I am certain that they will continue the fight—and let me say that they will have our support. Will the Secretary of State confirm that what he has just announced takes away their right of appeal to the Independent Reconfiguration Panel? If that is the case, are they not justified in continuing the fight to stop this Government riding roughshod over the people of Lewisham and south London?
What we have seen here today is the first glimpse of the new market-driven NHS that the Government have created, where the moneymen and not the medics are calling the shots. We have seen another chapter in the unfolding omnishambles that is this Government—this one, sadly, could be entitled the Lewishambles. We have seen a scandalous waste of money on a solution that will not be acceptable to people in Lewisham—and it is not acceptable to people anywhere. The Secretary of State is asking this House to accept the unacceptable. We will not do that for Lewisham and we will not do it for anywhere else.
Mr Hunt
I am afraid that the shadow Health Secretary clearly wrote his response before he read my statement. Listening to him this morning, he has never sounded further away from being part of the Government-in-waiting that he aspires to be.
Let me say this to the right hon. Gentleman: the apology over what is happening in South London Healthcare NHS Trust needs to come from Labour Members, because they were the people who failed to resolve this problem over very many years. It was their party that set up two PFI deals, signed in 1998, which have been incredibly dangerous. It was their party that created a financial situation that means that £1 million every week is being bled from front-line patient care in order to fund a deficit, and that 100 lives every year are not being saved that could be saved in Lewisham and the whole of south-east London.
What I did not hear from the right hon. Gentleman was any contrition about the fact that this incredibly difficult problem was something that his Government and, indeed, he as Health Secretary totally failed to resolve. Let me remind him that the legislation that I followed actually came from the Labour party, which passed it when it was in government. He asked me to confirm that the people of Lewisham have no right of appeal to the IRP against this decision, but who was it who stripped them of that right to appeal? It was him when his Government passed the legislation. Nothing that he has said has contained a single alternative proposal to deal with this problem. If he was being responsible as shadow Health Secretary, he would have come up with just one proposal, but he did not come up with a single one or tell the House about any of his ideas.
The right hon. Gentleman talked about the pressure on A and E, but we will take no lessons from him. We met our A and E targets last year, whereas in Wales, where the Labour party is cutting the NHS budget by 8%, the A and E targets have not been met since 2009.
I am afraid that what we have heard—I hope that other contributors will strike a different tone—is a very disappointing response from the Labour party. The shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), who is not on the Opposition Front Bench today—perhaps this will explain why—has said that Labour would not do what she called the “easy politics” of opposing every single reconfiguration, but what we have heard this morning is easy politics from a party that closed at least 12 A and Es and at least nine maternity units while it was in office. The right hon. Gentleman needs to recognise that the responsible thing for a Health Secretary to do is that which will save the most lives, and that is what I have announced this morning.
Robert Neill (Bromley and Chislehurst) (Con)
My hon. Friends the Members for Old Bexley and Sidcup (James Brokenshire) and for Bexleyheath and Crayford (Mr Evennett) are on duty on a Public Bill Committee, but they wish to associate their views with my question. We thank the Health Secretary and congratulate him on taking a tough but necessary decision to deal with a mess that was not of his making and that was inherited from the Labour party. Does he accept that, thanks to the intervention of Sir Bruce Keogh’s review, more care has been taken, with both an evidence base and a consultation, than under the previous Government with regard to the reduction of A and E services at Queen Mary’s, Sidcup? Will he also help me by explaining the likely time frame for the conclusion of discussions with King’s Partners on transitional funding, which is particularly important for those of us whose constituents are predominantly served by the Princess Royal university hospital in Farnborough?
Mr Hunt
I thank my hon. Friend for his constructive involvement in all the discussions we have been having to resolve this difficult issue, particularly with respect to his own constituents. He is absolutely right, because in the end the things that matter most are the clinical considerations. I thought it was extremely important to take advice from the NHS medical director, Sir Bruce Keogh, and I have taken that advice. He is absolutely clear that this will save lives, which is my biggest responsibility.
My hon. Friend is also right to say that the success of these proposals depends on negotiations with King’s Partners about the potential merger that it is involved in, and we want to conclude those as quickly as possible. They are a very important part of this issue. It is our ambition to proceed as quickly as possible for the sake of the people of south London, who need certainty about the future provision of their health services, but we have some difficult negotiations to conclude in order to make that happen.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
The only reason the proposals to close the A and E at Lewisham and downgrade the maternity services have not gone ahead in full is, of course, because of the enormous protests of over 50,000 local people and the almost total opposition of all consultants and GPs, including the GP commissioning group. Today’s proposals are an absolute sham and a shambles and utterly unacceptable to all of us who represent people in Lewisham.
Does the Health Secretary agree that, instead of allowing this rushed TSA process, which is completely unsuitable for the reconfiguration that he now proposes, he should allow the GP commissioning group to do the job for which he set it up, namely to lead a consultation process, properly, in order to understand the clinical needs of local people, whether the merger between Lewisham and Woolwich hospitals should go ahead, and to meet the real clinical needs of the local people? Will he also acknowledge that no due diligence was done in respect of the proposals, and that Lewisham hospital will need the strongest guarantees that it will not be led into a new, unsustainable trust by his proposals?
Mr Hunt
May I say to the right hon. Lady that a “sham and a shambles” are what I inherited and what I am dealing with, not what I am bequeathing through my announcement this morning. With respect to the GP-led clinical commissioning group in Lewisham, of course I understand its opposition to the proposals put forward by the trust special administrator, but it supports the principle that complex procedures should be done from fewer sites. That is an important point. Inevitably, when we are reducing the number of sites for complex medical procedures, the people in the areas where those procedures will no longer happen will often be opposed to the changes. That is what has happened here, but the group supports the principles behind what the trust special administrator has said.
The right hon. Lady’s concern that we are setting up a new trust that will not be sustainable is precisely why I am taking this extremely difficult decision today. Lewisham hospital has proposed that it and Queen Elizabeth hospital in Woolwich should be allowed to work out their own way of dealing with the deficit, but that was precisely the problem that happened when the South London Healthcare Trust was set up. Trusts with deficits were put together in a marriage that, in the end, failed to address those difficult decisions. My responsibility to her constituents is to address those issues and to give them certainty about the provision of their health services. Already, her constituents who have a stroke or a heart attack do not go to Lewisham hospital. They go to Tommy’s or Guy’s or other places where those specialist services can be delivered, and they get better treatment. We are expanding that principle through what I am announcing today, and it will save around 100 lives a year. That is something that she should welcome.
Bob Stewart (Beckenham) (Con)
I find it rather strange that a successful hospital is being slashed when others are being saved. I am particularly concerned about some of the figures on which these decisions have been made, and I really require my right hon. Friend to justify the financial figures that support this case. I am personally very worried about where babies will be born in Lewisham, and about the loss of the full A and E services there. I am not very happy about this, and I clearly do not support the closure.
Mr Hunt
There is not a closure. Let us talk about maternity deaths. London has a higher rate of maternity deaths than most other parts of the country, and that is something that any responsible Health Secretary should try to tackle. The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives agree that the way to reduce the number of maternal deaths, in which London does not score well, is to centralise the facilities that deal with the more complex births in fewer sites, where surgeons can get more experience and deliver better clinical outcomes. That is what this proposal is doing. It will lead to fewer maternal deaths in Lewisham and south-east London. It will also mean that, for the first time, south-east London will do something that it does not do at the moment, which is to meet the London-wide clinical quality standards. That must be the most important thing for the people of south-east London.
Heidi Alexander (Lewisham East) (Lab)
The Secretary of State’s announcement today might appear to offer something of a lifeline to Lewisham’s A and E, but it is far from the emergency and maternity services that my constituents and the people of south-east London deserve. I remain concerned about maternity services in south-east London. Between April 2011 and November 2012, maternity services were suspended 37 times in south-east London. There are 4,000 babies a year born at Lewisham. Can the Secretary of State give me an assurance that the money spent on increasing capacity for maternity services at other hospitals will be spent in the hospitals where Lewisham mums will actually go?
Mr Hunt
The hon. Lady is absolutely right that any change such as this has to be done extremely carefully, and we are investing an extra £36 million to expand the capacity of neighbouring consultant-led maternity services to make sure that they can cope with the extra demand, but may I urge the hon. Lady to understand the clinical rationale behind what is happening? London has halved its stroke mortality rate, because it reduced the number of hospitals treating people with strokes from 32 to eight. As a result, her constituents in Lewisham now go for their stroke treatment to the Princess Royal and King’s. That has led to fewer deaths in Lewisham and many other places. We need to do the same for high-risk pregnancies, and the Royal College of Obstetricians and Gynaecologists has established that women with high-risk pregnancies would prefer to travel a little further if that means they will get better clinical outcomes, which is what this is all about.
Simon Hughes (Bermondsey and Old Southwark) (LD)
I appreciate the thoughtful way in which the Secretary of State has tried to deal with a problem that is absolutely not of his making, and I appreciate the fact that he has changed key recommendations and that there will be a continuing A and E service at Lewisham, dealing with up to 75% of the work. However, like other colleagues, I do not therefore understand why there cannot be continuing maternity care there as well, because the key point is that there should be intensive care provision on the site and maternity care services should be provided. I also say to him honestly that I have not heard of any evidence that the key fourth test—support from GP commissioners—has been passed, and I ask him to give me an assurance that no plans will go ahead until and unless the GP commissioning body in Lewisham agrees.
Mr Hunt
Let me take those two points in reverse order. First, on GP commissioners, all six local commissioning groups support the principles upon which these proposals were developed. To meet the London-wide clinical quality standards, which are not being met in south-east London at present, it is necessary to centralise the provision of more complex services in the same way that we have already successfully done for heart attacks and strokes. That principle applies as much to complex births and complex pregnancies as it does to strokes and heart attacks, and it will now apply for the people of Lewisham to conditions including pneumonia, meningitis and if someone breaks a hip. People will get better clinical care as a result of these changes. That is the most difficult project in all the work of the trust special administrator. The project has been to try to resolve an unsustainable financial situation while improving clinical care for the people of south-east London, and I think that, in the end, we have got a set of proposals that does that.
Dame Tessa Jowell (Dulwich and West Norwood) (Lab)
The Secretary of State will be aware of the dismay with which this statement will be heard across south London. Whatever eloquent argument he advances, the people of south London will take from what he said that the maternity and A and E services at Lewisham have been downgraded.
I have had the opportunity to look briefly at the wording of his statement, and I am alarmed by the degree of risk that Sir Bruce Keogh identifies, particularly in relation to the relocation of the paediatric service. The clinical outcomes to which he refers are dependent on extremely difficult interconnections among ambulance services, receiving staff and inpatient beds, and rely on them all working effectively. He rightly recognises the knock-on effect for other hospitals, and my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), my hon. Friend the Member for Streatham (Mr Umunna) and I, together with all south London MPs, also recognise those knock-on effects. Given that King’s college hospital has seen a fourfold increase in cancelled operations since 2009-10, we are therefore very concerned about the consequences for the care of the constituents whom we represent. We are also concerned that the responsibility for the PRU, which King’s is prepared to welcome, will be properly and adequately financed.
Mr Hunt
The right hon. Lady talks about the risks that Sir Bruce alludes to in his analysis of the trust special administrator’s proposals. Those risks are precisely why I have not accepted the proposals in their entirety and have put in place a series of additional safeguards.
Not resolving this issue, which is effectively what the Labour party is calling for because it has put forward no alternative proposals, would carry a high degree of risk. It would mean that south London would not meet the London-wide clinical quality standards. It would mean that £1 million a week would continue to be diverted from front-line patient care into funding an unsustainable deficit. That would be bad for her constituents and those in neighbouring constituencies.
We must look at the south-east London health care economy as a whole, but the objective must be to improve the services that people receive. That is a difficult balance to get right, but I think that we have the right balance in the proposals that I have outlined this morning.
Mr Stephen Dorrell (Charnwood) (Con)
Does my right hon. Friend agree that the very difficult decisions that he has announced to the House reflect the application in south London of something that is needed across the health service—a willingness to address difficult issues, but led always by clinical evidence on how to deliver the best possible outcomes for the patients who rely on the service?
Mr Hunt
I entirely agree with my right hon. Friend. It would be totally irresponsible for me as Health Secretary to fail to take a decision that could save as many lives as I believe this decision will save. If we are to save more lives in A and E and reduce the number of maternity deaths in London, it involves taking difficult decisions. The disappointment for me is that the Labour party has chosen to jump on an Opposition bandwagon, rather than putting forward its own solution to deal with the clinical issues in south-east London. Unfortunately, the Opposition are playing to the gallery. That is not what a Government-in-waiting should be doing.
Jim Dowd (Lewisham West and Penge) (Lab)
I start by congratulating the Secretary of State on admitting in his statement something that has been denied from the outset: that this is a reconfiguration. Indeed, it is a back-door reconfiguration.
I do not think that my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock), my hon. Friend the Member for Lewisham East (Heidi Alexander) and I can adequately represent the outrage and anger of the people of Lewisham at the sheer unfairness of this proposal. The Secretary of State is wrong to say that Matthew Kershaw concluded that his review needed to go wider than South London Healthcare NHS Trust; he started from that premise and said so openly at the meeting in July at the office of the Secretary of State’s predecessor.
Is the Secretary of State aware that even the maternity proposal will mean that a double rota is necessary at King’s College hospital and Queen Elizabeth hospital Woolwich, because it will increase the expected annual number of births at both units to more than 8,000? That will lead to worse services and less choice for patients. The fact that it does not have the support of local commissioners does not seem to register with the Secretary of State.
Will the Secretary of State say whether it was really necessary to spend £5.5 million of taxpayers’ money to demonstrate that his four tests are meaningless and that the guarantees and undertakings of this Tory-Liberal Government are worthless?
Mr Hunt
First, let me say to the hon. Gentleman that this is a reconfiguration. However, the normal processes for reconfigurations have been suspended because of legislation that was passed by the Government who were in power until 2010 and whom he supported.
The trust special administrator, Matthew Kershaw, looked extensively at whether there was an option within South London Healthcare NHS Trust to solve the problem. He invited expressions of interest from other people who might run the hospitals in the group, but nobody was able to come forward with a proposal that would solve the problem within the geographical confines of the trust. Indeed, nobody—not the Labour party, nor any of the people who oppose these changes—has come forward with a proposal that would not impact on neighbouring health care economies.
The hon. Gentleman spoke about choice. Choice is not just about the number of hospitals that one could go to, but about the number of good hospitals that one could go to. Nowhere in south London currently meets the London-wide clinical quality standards. As a result of my decision today, the whole of south-east London will meet those standards and it will have some of the highest quality care in London for people who use A and E and maternity services.
On the cost of the process, £5.5 million is the cost of failure—the total failure of the last Government to address this issue when they could have done, rather than bequeath the highest deficit anywhere in the NHS.
Nick de Bois (Enfield North) (Con)
The Secretary of State recognises that Lewisham is the victim of an unfair decision as a result of failed PFI and failed finance, which were not of his making. He will recognise the striking similarities with Chase Farm hospital, which has also been downgraded because of the appalling PFI arrangements at neighbouring hospitals. He knows that I utterly oppose that decision. Given the present concerns, particularly with regard to implementation, will he meet me and a cross-party delegation to look closely at these matters?
Mr Hunt
I recognise how hard my hon. Friend has campaigned on behalf of his constituents and how deeply they feel about these issues. He knows that the decision has been made. We want to get the safe implementation of that decision absolutely right and I would be more than happy to meet him to discuss how we can best ensure that that happens.
Clive Efford (Eltham) (Lab)
The Secretary of State inherited a mess that was created by his Conservative predecessor, who abandoned the “A picture of health” process. That led to the betrayal of my constituents in respect of what they expected to come out of that process, particularly at Queen Mary’s hospital Sidcup. When he opposed “A picture of health”, the former Secretary of State said that he would decide on that closure based on what local clinicians said. In this process, it is clear that local clinicians are opposed to the closure of the A and E. Will the Secretary of State therefore say what value he places on the views of the local commissioners, who are completely opposed to what he proposes?
Mr Hunt
Of the six local clinical commissioning groups, five support these proposals. One group is against the proposals, but it accepts the principles behind them, including the idea that to deliver higher quality care, we must perform complex surgery at fewer sites. That will mean that more of the hon. Gentleman’s constituents have better care outcomes. I remind him that if his Government had resolved this problem when they were in office before 2010, none of us would be having this discussion today.
Mr Nick Raynsford (Greenwich and Woolwich) (Lab)
The Secretary of State has accepted all Matthew Kershaw’s recommendations. He will know that the trust special administrator recommended a substantial investment package to support the changes that he recommended, including £161 million of capital funding and £55 million of transitional funding over three years. In his statement, the Secretary of State referred to just £36 million of capital spending for maternity and £37 million for A and E. That is £73 million lower than Mr Kershaw’s recommendation. There was no reference in the statement to the transitional funding of £55 million. Will the Secretary of State confirm whether Mr Kershaw’s funding recommendations have been accepted?
Mr Hunt
We accept that very detailed analysis was used by Matthew Kershaw to come up with those numbers. We will look at them very carefully. However, we need to have sensitive negotiations with the new partners who will be part of making this solution happen before the final numbers are agreed on.
Teresa Pearce (Erith and Thamesmead) (Lab)
When modelling future need, what account did the administrator or the Secretary of State take of the fact that there will be increased health needs due to the increases in child poverty and homelessness in my constituency, as is predicted by every expert on these matters? The efficiency proposals rely to a large extent on keeping vulnerable elderly people out of hospital and caring for them in the community. Given the local authority budget cuts and the fact that some private companies that deliver those services in Bexley in my area are slashing the wages and conditions of staff, how does the Secretary of State think those services will be improved? Will he urgently review the services for elderly people to ensure that they stack up with the proposals that he has outlined today? This morning, the Secretary of State has said a number of times that these plans will save lives. I sincerely hope that he is right. If time shows that he is not right, will he resign?
Mr Hunt
In such matters, what a Minister does is take very seriously the medical advice they are given—I am sure the hon. Lady’s party was exactly the same when it was in power. Medical advice suggests that the way forward I am deciding on and announcing this morning will save 100 lives, and I am taking the decision on that basis. The hon. Lady would do no differently in my shoes.
For child poverty, changes in demography are taken into account in the modelling used, but the overriding priority has been to improve clinical services. That will make the biggest difference to the most socially disadvantaged people, including the frail elderly who—I agree with the hon. Lady—are often the least well served by our current NHS structures and the silos between what is done by local authorities and the NHS. I and my ministerial colleagues in government are currently doing a lot of work to break down those barriers and offer a more integrated service to the frail elderly, so as to avoid some of the problems mentioned by the hon. Lady.
Kate Hoey (Vauxhall) (Lab)
Surely the Secretary of State understands—even if Sir Bruce Keogh does not seem to do so—the huge effect that downgrading the maternity unit at Lewisham will have on King’s college and St Thomas’ hospitals. They are full to the seams and will not be able to cater easily for increased numbers of women. What exactly is the Secretary of State offering hospitals such as mine in terms of finance? Will he lay out clearly that this kind of merger of King’s college hospital, Guy’s and St Thomas’ and the mental health trust is not the way forward when it has been brought in from the top by those same experts who get it wrong so often, and when local people have had absolutely no involvement? In view of the disruption taking place, will he say that it is absolute nonsense for millions of pounds to be spent on consultants and business plans to bring together a huge organisation that will not be in the interests of local people?
Mr Hunt
On the merger, may I gently point out that I want to follow the hon. Lady’s advice if she is against people deciding things from the top down. It is for local trusts to negotiate such things, and they must do so on the basis of what is in the clinical interest of the population they serve. I will not be a Secretary of State who steps in and stops those things happening, unless they amount to a reconfiguration, in which case procedures are in place that require proper democratic support for any changes.
On the changes to maternity provision in Lewisham, we have allocated £36 million to expanding the capacity at those other hospitals that will take on more complex and high-risk births as a result of the proposals, and we will work closely with those trusts to ensure that that capacity is in place. I agree with the hon. Lady that it is extremely important for such work to be done in a meticulous way so that we get the better clinical outcomes we want as a result of what I am announcing today.
Mr Kevin Barron (Rother Valley) (Lab)
I sat on the Health and Social Care Bill Committee. The principle in that Bill, which became an Act last year, was that clinicians will be in charge. The lead clinical commissioner has said that this downgrading would pose a huge risk to health outcomes in Lewisham. How does that square with the provisions of that Act passed in this House last year?
Mr Hunt
Clinicians and commissioners have been closely involved in these proposals which, as the right hon. Gentleman will know from reading my statement, affect the broader south-east London area covering six clinical commissioning groups. Five of those groups support the proposals. One does not, but it supports the principles behind them, which is that more complex procedures must be carried out on fewer sites. We have had the benefit of the clinical input of senior people such as Sir Bruce Keogh, and many of the royal colleges have been involved in the external clinical advisory group, which had significant input on the proposals. One question I asked Sir Bruce was whether there had been sufficient clinical input, and his conclusion was that yes, there had been.
Oral Answers to Questions
Jeremy Hunt Excerpts(12 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
Despite the huge improvements that have been made over the last decade in the outcomes for people with cardiovascular disease, it is still one of the biggest killers in England and the largest cause of disability. That is why we are developing a CVD outcomes strategy, which will set out where there is scope to make further improvements in patient outcomes in this area.
Neil Carmichael
I am chairman of the all-party parliamentary group on vascular disease, which recently produced a report highlighting the need for early diagnosis and intervention, and the additional risks associated with obesity and diabetes. Is the Secretary of State willing to meet me and some of my colleagues to consider how we can improve outcomes for sufferers of vascular disease?
Mr Hunt
I thank my hon. Friend for his excellent work with the all-party group and for the group’s constructive response to our consultation on the outcomes strategy. I am more than happy to meet him and other representatives of the all-party group. With an ageing population and rising levels of obesity, we cannot be complacent about cardiovascular disease and have much to do.
Helen Jones (Warrington North) (Lab)
The Prime Minister promised before the election that there would be no reconfigurations or closures unless there was clinical and local support. Why then has the Secretary of State decided to break up the existing vascular network centred on Warrington hospital, meaning that emergency patients face a trip to Chester by ambulance, when this has neither clinical support nor support in the local community? When did that policy change, or was it just an election promise that the Conservatives never intended to keep?
Mr Hunt
We believe in the clinical networks, including the network for cardiovascular disease. We have increased the funding for those networks by 27%. However, we want them to include mental health and maternity services. We think that it would be wrong to do what the Labour party wants, which is to concentrate that funding on cardiovascular disease and cancer, and deprive of the clear benefits of such networks the 700,000 women who give birth on the NHS every year and the nearly 1 million people who will be diagnosed with dementia.
Tim Farron (Westmorland and Lonsdale) (LD)
Given that the majority of vascular interventions are acute in nature, following trauma or cardiac episodes, is it not reckless for NHS Lancashire and NHS Cumbria to be talking about moving vascular services away from the Morecambe bay area, meaning that people from the south lakes and north Cumbria will have to travel as far as Preston, Blackburn or Carlisle to receive treatment? Will the Secretary of State meet me, other local MPs and local consultants to discuss how we can put the matter right for local people?
Mr Hunt
We are very keen to ensure that all reconfigurations of services have strong local, clinical support. We are making good progress in this area. There is always a trade-off between access, which I recognise is extremely important in a rural constituency such as the hon. Gentleman’s, and the centralisation of services, which sometimes leads to better clinical outcomes. I am happy to arrange for him to meet me or one of my colleagues to discuss his concerns in more detail.
Keith Vaz (Leicester East) (Lab)
Those with diabetes, such as myself, are five times more likely to get cardiovascular diseases. Last year’s National Audit Office report indicated that 1 million diabetics did not get their nine checks. What steps will the Secretary of State take to ensure that those checks are made available to all diabetic patients?
Mr Hunt
I congratulate the right hon. Gentleman on his campaigning work for people with diabetes, and I am aware that there are 24,000 premature deaths every year because we are not as good as we need to be at tackling the disease. It is shocking that only half those with diabetes are getting the full set of nine checks that everyone with diabetes should be getting every year, and when we publish the cardiovascular disease outcomes strategy—which I hope will be in spring—I hope we will address some of his concerns about how we can do a better job for diabetes sufferers.
Jim Shannon (Strangford) (DUP)
Deep vein thrombosis is the leading direct cause of maternal deaths across the United Kingdom. Will the Minister consider interaction with the regional assemblies, including the Northern Ireland Assembly, to agree a UK strategy to address that issue?
David T. C. Davies (Monmouth) (Con)
2. What recent steps he has taken to reduce hospital waiting times in England.
Andrew Percy (Brigg and Goole) (Con)
3. What representations he has received from clinicians in Yorkshire and the Humber on the decision to close the children’s heart surgery unit at Leeds children’s hospital.
The Secretary of State for Health (Mr Jeremy Hunt)
I know that some are disappointed at the decision by the Joint Committee of Primary Care Trusts and want to see children’s congenital heart surgery continue at their local hospitals. However, the Safe and Sustainable review was an NHS review, independent of Government. Under the circumstances, and given that legal proceedings and a review by the independent reconfiguration panel are under way, my hon. Friend will understand that it is not appropriate for me to comment further.
Andrew Percy
One hundred and seventy clinicians from across Yorkshire and northern Lincolnshire have written to express their dismay at the decision, stating that for time-critical transfers it
“exposes a number of children to the risk of death,”
largely because it will require transfers to Newcastle, where services are not co-located. Does that not prove that the decision does not enjoy clinical support in Yorkshire and north Lincolnshire and that it is simply not true that this has been a clinically led review?
Mr Hunt
I have seen the letter to which my hon. Friend refers and I understand that these are extremely complex issues. Let me reassure him that when I take my final decision, it will be on a clinically led basis. I will do that when I have received the IRP’s report, which I am due to receive by 28 March.
Mr Kevin Barron (Rother Valley) (Lab)
The independent reconfiguration panel has already visited Leeds and I understand that it will visit again before that date. If it decided that both Leeds and Newcastle ought to stay open, would that be agreed?
Mr Hunt
I will make my decision when I have the IRP’s final recommendation. Obviously I cannot speculate on what the final decision will be, but let me reassure the right hon. Gentleman, as I did with my hon. Friend the Member for Brigg and Goole (Andrew Percy), that my decision will be taken on the basis of clinical need—in other words, what will save the most lives.
Martin Vickers (Cleethorpes) (Con)
I note my right hon. Friend’s comments about his final decision being based on clinical advice, but will he also give consideration to patients and families in areas that are more remote from the centre, such as my constituency? This decision causes extra strain and cost to families and will also mean that they will not go to Newcastle, and therefore Newcastle will not achieve its target number of operations.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
I understand the Secretary of State’s reluctance—quite rightly—to comment on the processes he is going through, but will he confirm that he expects full transparency in the review process? That means all the minutes of the JCPCT being given to the review process and none of them being redacted.
Mr Speaker
I must say to the House that if we are to get through the questions we need shorter questions and shorter answers from now on.
Priti Patel (Witham) (Con)
6. What steps he is taking to ensure that patient experience is a priority for the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
Improving the quality of care throughout the NHS is a key priority for the Government, and one of the things we are doing to make that happen is, for the first time, asking all NHS in-patients whether they would recommend the care they received to a friend or member of their family.
Priti Patel
My constituents have consistently been let down by the failure of the last Government and a debt-ridden PCT to invest in local community health services. Will my right hon. Friend join me in encouraging the new clinical commissioning groups to respond to Witham’s growing population and health needs by investing in localised community health care?
Mr Hunt
I am happy to do so, and I commend my hon. Friend for her campaigning, because if we invest properly in community health services, we can allow the frail elderly, who are among the biggest users of the NHS, to stay at home happily, healthily and for much longer. That must be a key priority for us all.
Barbara Keeley (Worsley and Eccles South) (Lab)
At the last Health questions, the Secretary of State told me:
“Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.”—[Official Report, 27 November 2012; Vol. 554, c. 122.]
Quoting national average nurse-patient ratios does not help to improve the patient experience, but cutting 7,000 nurses sure does affect it. We have unsafe levels of care in 17 hospitals. Will he treat this issue a bit more seriously and do something about those unsafe levels?
Mr Hunt
With respect to the hon. Lady, she cannot talk about alleged cuts in the NHS while her Front-Bench team support a policy of real cuts in the NHS budget. In the last Opposition day debate, the right hon. Member for Leigh (Andy Burnham) said that he thought it was irresponsible of the Government to increase the NHS budget in real terms. That means he wants a real cut in the NHS budget, which would make the staffing issues to which she referred much, much worse.
Mr Stephen Dorrell (Charnwood) (Con)
Does my right hon. Friend agree that one of the most effective things we can do to improve the patient experience of health and care is to improve the co-ordination, not just between the hospital service and community-based health services, but between the NHS and social care, and to put in place the infrastructure, including the IT infrastructure, to make that real?
Mr Hunt
My right hon. Friend makes an extremely important point—in fact, I will be giving a speech on this tomorrow—because, in the end, if it is not possible to see a full medical record of some of these frail elderly or heaviest users of the NHS going in and out of the system throughout the year, it is not possible to give them the integrated, joined-up care that they desperately need. This will be a very big priority for us.
Andrew Gwynne (Denton and Reddish) (Lab)
One of the biggest drivers of patient experience on hospital wards is the dedication and care of the nursing staff, but, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said, the Care Quality Commission has identified 17 NHS hospitals that are operating with unsafe staffing levels, putting vulnerable patients and especially older people at risk. Frankly, it is the Secretary of State’s job to ensure that every NHS hospital operates with safe staffing levels, so does he now think it was a mistake to strip out almost 7,000 nursing posts from our NHS?
Mr Hunt
It is my job, and that is why the Government have protected the NHS budget. The hon. Gentleman’s Front-Bench team, on the other hand, want to cut it in real terms. He has to think carefully before he starts talking about all these so-called cuts, given that his shadow Health spokesman wants to cut the NHS budget in real terms. [Interruption.] That is what he said last December. I agree with the Care Quality Commission that it is totally unacceptable for hospitals to have unsafe staffing levels. The commission also said, however, that budgets and financial issues were not an excuse, because those budget pressures existed throughout the NHS and many hospitals were able to deliver excellent care despite them.
David Morris (Morecambe and Lunesdale) (Con)
7. What steps he is taking to improve the survival rates of cancer, stroke and heart disease patients.
The Secretary of State for Health (Mr Jeremy Hunt)
Our cancer strategy set out the ambition to save 5,000 lives by 2014-15 through earlier diagnosis, cancer screening and improved access to treatment. We are working on an outcomes strategy for cardiovascular disease.
David Morris
Will my right hon. Friend tell the House how many patients have benefited from the cancer drugs fund to date?
Mr Hunt
I am happy to inform my hon. Friend that 25,000 people have benefited to date from the cancer drugs fund, which the previous Government failed to introduce. On top of that, 53,000 more people every year are being admitted for chemotherapy and 219,000 more cancer treatments are happening every year than happened in any year under the last Labour Government.
Grahame M. Morris (Easington) (Lab)
21. I have previously raised with the Secretary of State the opportunity cost—in terms of cost and effectiveness —of the proton beam therapy system. Given that expert opinion—in the form of the national radiotherapy advisory group—is divided, and given that the cost of the proton beam therapy system is 100 times more than other advanced radiotherapy systems that my region and others lack, why is he proposing to spend £125 million on it?
Mr Hunt
I recognise that the hon. Gentleman has a long-standing view on this matter. I am guided by clinical advice. Over the next two years, we will publish the cancer survival rates by multidisciplinary team across the country in all the major cancers for the very first time. That will give us a much better objective base from which we can work out what the most effective treatments are.
Mr Nick Gibb (Bognor Regis and Littlehampton) (Con)
20. Despite the fact that the incidence of breast cancer peaks in the 85-plus age group, the peak age for breast surgery is for women in their mid-50s and 60s. Does that not confirm the findings of the Royal College of Surgeons-Age UK report that, despite trends towards older people leading healthier lives, many older women are missing out on curative surgery, from which they are perfectly fit enough to benefit?
Mr Hunt
My hon. Friend will know that last October we outlawed age discrimination, and if that is the reason for this happening, it is totally unacceptable. We have to recognise that cancer is one of our biggest killers and that the over-85s are a key group if we are going to tackle it. He will welcome today’s news about making available drugs to tackle breast cancer, which may mean that surgery will no longer be necessary.
Mr Jim Cunningham (Coventry South) (Lab)
19. Will the Minister tell us what the reduction in size of the Department’s cancer policy team will be after April 2013, and whether any of the team’s functions will be removed to other bodies or scrapped?
Nick Smith (Blaenau Gwent) (Lab)
8. When his Department plans to publish its proposed new sexual health policy document.
Ian Swales (Redcar) (LD)
9. What recent assessment he has made of the number of health care appointments and operations which are postponed.
The Secretary of State for Health (Mr Jeremy Hunt)
My Department collects data on the number of cancelled elective and urgent operations, which show that these remain very low compared to total activity. We do not collect information on postponed appointments or operations. The NHS must make arrangements locally to minimise postponements and cancellations to avoid the inconvenience to patients.
Ian Swales
I thank the Secretary of State for that answer. This is an issue in my area, with the chief executive of South Tees hospital saying that one factor is excessive use of A and E for non-urgent cases, resulting in pressure on hospital resources. What can the Secretary of State do to make sure that A and E units are used only for genuine accidents and emergencies?
Mr Hunt
My hon. Friend makes a very important point. I am concerned that 114 non-urgent operations were cancelled in the South Tees area between November and January, which is significantly higher than this time last year. He is right that we need to think about the model for an A and E service. Nearly 1 million more people go through A and E every year than they did two years ago. We have to recognise that for A and E services to be sustainable, we need to think about people who would better off seeing their GP or going to an urgent care centre.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Is the Minister aware that health care appointments are still bedevilled by the number of people who do not show up, even for appointments with consultants and senior hospital staff? Is it not about time that we looked at a simple system, in which people could pay up front a small amount of money that they get back when they turn up? I am sure that my constituents, as good Yorkshire people, would take their appointments much more seriously if they got their money back when they turned up?
Mr Hunt
I am interested to hear that suggestion from the Labour Benches, which is not necessarily where I would have expected it to come from. The hon. Gentleman might be surprised at my response, which is that I would be very concerned about such a system. I understand the issue and I think we need to modernise the process of GP and hospital appointments. Technology can play a good role in that, for example by giving people text reminders of appointments that they have booked. My concern is that the system suggested by the hon. Gentleman would put people off going to see their doctor if they needed to. I would not want to do anything that deterred people from using the NHS who most need to do so.
Kate Green (Stretford and Urmston) (Lab)
10. What estimate he has made of the number of patients who waited longer than four hours for treatment in accident and emergency departments in 2012; and if he will make a statement.
The Secretary of State for Health (Mr Jeremy Hunt)
We want to make 2013 the year we break down the stigma associated with dementia and transform the care and treatment received by the one in three over-65s who will get the condition at some stage. Today, the Alzheimer’s Society published a map showing the totally unacceptable variations in dementia diagnosis across the country, with some areas diagnosing fewer than a third of people who have the condition, thereby denying them the medicine and support that would help them live happily at home for much longer. We are determined to put this right.
Annette Brooke
Given that next week is designated as cervical cancer prevention week and we know that many women ignore, or do not recognise, the early symptoms of cervical cancer, what action will the Secretary of State take to raise awareness of cervical cancer symptoms?
Mr Hunt
That is a very important point. Every year we screen about 3.5 million women for cervical cancer and we think we save about 4,500 lives, but we could save many more. Our “Be Clear on Cancer” campaign is highlighting the four clear symptoms people need to watch out for: unexplained bleeding, weight loss, pain, and lumps.
Paul Blomfield (Sheffield Central) (Lab)
T3. The Minister of State earlier failed to answer the key question on midwife numbers, so I wonder whether the Secretary of State could take it on. Before the last election, the Prime Minister made a firm pledge to increase the number of midwives by 3,000. Will the Secretary of State tell the House whether that pledge will be honoured or discarded along with all the other promises on the NHS?
Mr Hunt
The number is up by 800 already, but as the Labour Front-Bench team knows, it takes some time to train midwives. I say to the hon. Gentleman that none of the investment in additional midwives would be possible if we had a real-terms cut in the NHS budget, which is what his Front-Bench team wants.
Mr Douglas Carswell (Clacton) (Con)
T2. Many of my constituents in Jaywick have complained about local GP services, saying that there are too many locums and inadequate provision. In order to attract and retain good GPs in an area with a challenging work load, the local commissioning body needs to be able to offer them more favourable terms. Will the Minister ensure that there is sufficient local flexibility so that the commissioning body can do that?
Mr Hunt
My hon. Friend makes a very important point, putting his finger on a key issue: the 24-hour availability of GP services. That is going to be crucial as the NHS goes forward. The NHS medical director, Bruce Keogh, is looking at the whole issue of seven-day working in the NHS and will certainly be examining what flexibility needs to be given to local areas to make that possible.
Mike Gapes (Ilford South) (Lab/Co-op)
T4. On 30 December, ambulances in north-east London were diverted from the Whipps Cross, Queen’s and Homerton hospitals, with only the accident and emergency units at the Royal London hospital and the King George hospital in Ilford being open. Last week, on 8 January, Queen’s hospital in Romford was again diverting ambulances. Will the new Secretary of State look at the decision of his predecessor, whom I see on the Bench near him, and cancel the insane decision to close the accident and emergency unit at King George hospital?
Mr Hunt
The decision has been taken, but we have made it absolutely clear that we will not proceed with implementing it until there is sufficient capacity in the area, particularly at Queen’s hospital in Romford, to cope with any additional pressures caused by it, and that undertaking remains.
Miss Anne McIntosh (Thirsk and Malton) (Con)
T5. The NHS has confirmed that North Yorkshire is the only part of the country that will inherit a £19 million debt, which has to be carried by the new clinical commissioning groups. That was the situation we were promised we would never be in. What is the Secretary of State going to do to urgently address the chronic underfunding of rural areas for the NHS in North Yorkshire?
Mrs Mary Glindon (North Tyneside) (Lab)
T6. As one in three women who get cancer are over the age of 70, can the Minister say when the newly launched Be Clear on Cancer campaign will be rolled out nationally?
Iain Stewart (Milton Keynes South) (Con)
T9. Many of my constituents are concerned by the Care Quality Commission’s recent findings at Milton Keynes hospital, which came despite an increase in nursing staff since 2010. What reassurances can my right hon. Friend give my constituents that the problems are being rectified and that they will be able to enjoy high-quality care?
Heidi Alexander (Lewisham East) (Lab)
T8. Last week, the Secretary of State refused my request to meet a small group of local GPs, hospital doctors and residents who are opposed to the closure of accident and emergency and maternity at Lewisham hospital, yet in his former role he seemed very happy to trade hundreds of texts with Rupert Murdoch’s lobbyists about the purchase of BSkyB by News Corp. Why is it one rule for Rupert Murdoch’s lobbyists and another for doctors in Lewisham?
Mr Hunt
I think that the hon. Lady might perhaps read Lord Leveson’s conclusions before she starts hurling about allegations, many of which came from her side of the House, that were later shown to be totally false. With respect to the decision on Lewisham hospital, I thought that we had a very useful meeting last night with the south London MPs who are directly affected. She understands that the process put into law by her party and her Government means that I cannot reopen the entire consultation and start seeing some groups without seeing all groups that are affected. That is why I am limiting the discussions I have with colleagues, but I think that that is the right thing to do.
Paul Burstow (Sutton and Cheam) (LD)
The evidence is compelling that improved access to talking therapies for children and adults makes a huge difference to their mental health. Will the Minister therefore assure me and the House that the NHS Commissioning Board will have the necessary dedicated teams to ensure that the adult improving access to psychological therapies—IAPT—programme is delivered and that the new children’s programme is, too?
Mrs Madeleine Moon (Bridgend) (Lab)
Today’s edition of The Daily Telegraph carries an article on dementia, including a quote from a GP who says that it is not useful to give an early diagnosis when there are no drug or care needs. Does the Minister agree that that GP, like many others, fails to realise that for pre-senile dementias in particular, early diagnosis allows planning and allows families to understand the confusion created by altered personalities, behaviour, emotional responses and language skills?
Mr Hunt
I know that the hon. Lady spoke very movingly in the debate on dementia last week and I wholeheartedly agree with her. The medicines available for people with dementia do not help everyone, but we do not know that until we try them. By diagnosing only 42% of people with dementia, as is currently the case, we are denying nearly two thirds of dementia sufferers the chance to see whether they could benefit from those medicines and, as she rightly says, the chance to plan their care, which could mean that they could live at home for much longer.
Mr John Baron (Basildon and Billericay) (Con)
The all-party group on cancer is delighted that the one and five-year cancer survival indicators have been included in the CCG outcome indicator set. We have campaigned for that in the belief that it will drive forward earlier diagnosis, as the Secretary of State knows. Can he clarify how CCGs will be held to account through that indicator set? For example, what action will be taken on underperforming CCGs?
Mr Hunt
I congratulate my hon. Friend on his campaigning on cancer issues through the all-party group. The NHS Commissioning Board is held to account through the mandate, which clearly states that we must make tangible progress towards having the lowest mortality rates in Europe for cancer and a number of other major diseases. I will expect the board to clamp down hard on CCGs who fail to deliver on what needs to happen for them to deliver on that promise.
Dan Jarvis (Barnsley Central) (Lab)
Cancer Research UK has expressed deep concern about the fragmentation of cancer services and the climate of uncertainty that makes it harder to improve them due to the Government’s NHS reorganisation. I appreciate that that is not the fault of the Secretary of State, but he has the power to do something about it. Will he listen to Cancer Research UK and stop the fragmentation of cancer services?
Mr Hunt
Of course, I understand the concerns of Cancer Research, and I know that the hon. Gentleman understands the personal tragedy that cancer can cause. The change in the clinical networks is happening because we want them to cover dementia, which we were talking about earlier, mental health services and maternity and paediatric services. It is right that they should do so, but I want to make absolutely sure that as we go through the restructuring the benefits of the cancer clinical networks remain as strong as ever.
Pauline Latham (Mid Derbyshire) (Con)
Will my right hon. Friend look at the east midlands cancer drugs fund? While I welcome the cancer drugs fund enormously, the east midlands will yet again underspend, leaving some of my constituents paying for their own treatment because they have been refused funding. Will my right hon. Friend please get his Department to investigate why?
Valerie Vaz (Walsall South) (Lab)
How will the Secretary of State assess the effect of the cancer drugs fund on cancer survival rates?
Mr Philip Hollobone (Kettering) (Con)
Kettering has the sixth fastest household growth rate in England, and accident and emergency admissions to Kettering general hospital are now at 12% year on year. Will the Secretary of State ensure that the NHS funding formula reflects the very latest population estimates?
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
Penalties on readmission rates were introduced to improve clinical practice, but patients suffering from sickle cell and thalassaemia in my constituency and elsewhere cause hospitals to be fined for readmission, even though it is often in the patient’s best clinical interest. Will the Minister once again reconsider exempting sickle cell and thalassaemia from the penalty?
Mr Hunt
The biggest safeguard is the fact that the Government have made it one of our key priorities to improve mortality rates for cancer to the best in Europe. That means we are putting in a huge amount; for example, we are investing £450 million in early diagnosis. There are many other measures, which shows how seriously we take it.
Natascha Engel (North East Derbyshire) (Lab)
My 92-year-old constituent, Ron Lewin, was referred for minor oral surgery. He was eventually written to by the specialist, who said that waiting lists were very long and that assessment appointments were available in 18 weeks, but that they did offer an independent service if he wished to be seen earlier. Independent obviously means paying to jump the queue. Is that how the Government propose to cut waiting lists?
Zac Goldsmith (Richmond Park) (Con)
Will my right hon. Friend’s Department make an assessment of the effects on local air quality and public health of a potential third runway at Heathrow, and will he submit those findings to the Davies commission on airport capacity?
Alex Cunningham (Stockton North) (Lab)
My constituent, Elaine Catterick, has had a serious operation at the James Cook hospital on Teesside cancelled twice in three months—once with just a few hours’ notice. She has also learned that there are twice-daily meetings at the hospital to decide whose operation should be cancelled next, as staff struggle to cope with spending cuts. I hope that is not what the Secretary of State wanted from his reforms, so what is he going to do about it?