South London Healthcare NHS Trust
Jeremy Hunt Excerpts(12 years, 5 months ago)
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Dame Joan Ruddock (Lewisham, Deptford) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the trust special administrator’s report on South London Healthcare NHS Trust and the NHS in south-east London.
The Secretary of State for Health (Mr Jeremy Hunt)
I have today published the final report of the trust special administrator to South London Healthcare NHS Trust and laid it before Parliament. I received the report yesterday and must now consider it carefully. I am under a statutory duty to make a decision by 1 February on how best to secure a sustainable future for services provided by the trust.
The trust special administrator began his appointment on 16 July. He published his draft report on 29 October and undertook a consultation on his draft recommendations between 2 November and 13 December. More than 27,000 full consultation documents and 104,000 summary documents were distributed during the consultation and sent to 2,000 locations across south-east London, including hospital sites, GP surgeries, libraries and town halls. A dedicated website was established to support the consultation, the TSA team arranged or attended more than 100 events or meetings and the consultation generated more than 8,200 responses.
I understand the concerns of hon. Members and, indeed, the people living in areas affected by the proposals, especially in Lewisham. They have a right to expect the highest quality NHS care, and I have a duty to ensure that they receive it. However, they will understand that it would not be appropriate for me to give a view on the report’s recommendations only one day after receiving it. To do so would be pre-emptive and would prejudice my duty to consider the recommendations with care and reach a decision that is in the best interests of the people of south-east London.
However, I have made it clear that any solution would need to satisfy the four tests outlined by the Prime Minister and my predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), with respect to any major reconfigurations: the changes must have support from GP commissioners; the public, patients and local authorities must have been genuinely engaged in the process; the recommendations must be underpinned by a clear clinical evidence base; and the changes must give patients a choice of good-quality providers.
The challenges facing South London Healthcare NHS Trust are complex and long standing, but to fail to address them is to penalise other parts of the NHS from which resources must be taken to finance the biggest deficit anywhere in the NHS. To date, it has not proved possible to ensure that South London Healthcare NHS Trust can secure a sustainable future for its services within its existing configuration and organisational form. In appointing a special administrator to the trust, the Government’s priority was to ensure that patients continue to receive high-quality, sustainable NHS services, and I will consider the special administrator’s report with that objective in mind.
Dame Joan Ruddock
I thank the Secretary of State for his reply. Neither I nor my hon. Friends the Members for Lewisham East (Heidi Alexander) and for Lewisham West and Penge (Jim Dowd) are opposed to change or to greater efficiencies, but we are opposed to the destruction of Lewisham hospital, which is a solvent, well-regarded trust that meets all its performance and financial standards.
There is a fundamental question at stake. My right hon. Friend the Member for Leigh (Andy Burnham) has made it clear that the powers associated with the failure regime under which the TSA acts were not intended to be used to encompass the services of other hospitals. Yet in order to tackle the huge financial deficit sustained by South London Healthcare Trust, the TSA proposes to close Lewisham hospital’s accident and emergency services, including the acclaimed children’s A and E, to end all medical and surgical emergency care and to demolish maternity services. He then proposes to sell off half the hospital’s land. That cannot be justified. Each year around 120,000 people use Lewisham A and E, more than 30,000 children use the children’s A and E and more than 4,000 babies are born in the hospital. There is no current capacity at any of the other hospitals in the area to provide for those patients.
These proposals amount to a major reconfiguration by the back door, and they are opposed by virtually all the health professionals in the area and by the people of Lewisham. Does the Secretary of State believe that a reconfiguration of services in south-east London is necessary? If he does, he needs to propose one with the relevant consideration for patient safety and health care standards and that meets his four tests. These proposals do none of that and must be rejected.
Mr Hunt
First, I want to recognise the right hon. Lady’s real concerns about the proposals that have been made. I also recognise that they reflect the concerns of many of her constituents and, indeed, many people in Lewisham. Her point about scope is one I replied to in my letter to the right hon. Member for Leigh (Andy Burnham) before Christmas. I have taken legal advice on that and been told that under the unsustainable provider regime, which the previous Government put into law, an administrator must initially look at a trust’s defined area, but if they conclude that the defined area is not in itself financially sustainable—they have a duty to come back with a financially sustainable solution—and if it is necessary and consequential, they need to look at a broader area. Of course there is interrelation between different parts of the south-east London health care economy. However, I will be getting fresh legal advice on that point, because I recognise that it is extremely important.
I welcome the fact that the right hon. Lady recognises that changes need to be made. I also hope that she understands that I have a duty to address this issue, which has affected hospitals in the South London Healthcare Trust area for many years. The deficit of the trust amounts to £207 million in the period since it was set up, and that is money that must be taken away from other parts of the NHS. I have a clear duty to address that issue. I will not comment on specific proposals today, but I will be very happy to meet her and her colleagues from Lewisham in order to hear from them directly about their concerns. Indeed, I will be meeting the trust special administrator on 10 January so that I can ask him any questions about his proposals before I make my decision, which must be within 20 working days.
Bob Stewart (Beckenham) (Con)
I remind my right hon. Friend that the Beckenham Beacon is not only modern, but extremely central. I stress the incredible value it could have in south London. I very much hope that the services currently provided there will increase, rather than decrease, at the end of this consultation.
Mr Hunt
I thank my hon. Friend for again speaking up for his constituents, as indeed I have done as a constituency MP on many occasions. I want to reassure him that the four tests we have outlined for any major changes to health care services would indeed apply to the Beckenham Beacon and that, were there to be any changes, we would need to be satisfied that they would have strong, local, clinical support, that his constituents had been properly consulted and that there was clear evidence that change would be beneficial.
Andy Burnham (Leigh) (Lab)
I apologise for missing the start of proceedings on this urgent question.
It has long been accepted that difficult decisions are needed to secure the sustainability of health services in south-east London. That is why recommendations from the review, “A Picture of Health”, were agreed under the previous Government. The trust special administrator has adopted many of those proposals, which we welcome.
However, the review presented today goes way beyond that and takes the NHS into new territory. It uses powers passed by the previous Government in a way that was never intended and, in so doing, sets a worrying precedent whereby normal processes of public consultation are short-circuited and back-door reconfigurations of hospital services are pushed through. The Health Act 2009, which I took through this House, states that
“the administrator must provide to the Secretary of State and publish a draft report stating the action which the administrator recommends the Secretary of State should take in relation to the trust.”
In making recommendations that have a major impact on another trust, is the Secretary of State not going beyond the powers this House has given to him? He has acknowledged that he needs to commission fresh legal advice, which suggests to me that the legality of the process is in doubt. Will he publish all the legal advice he has been given so far and give a commitment that any new legal advice he commissions will be made available?
As this is a financially driven process, the people of Lewisham have justifiable concerns about whether it is safe to close their A and E and downgrade the maternity services. Is the Secretary of State satisfied that a clinical case has been established behind these major changes? Given that all A and E departments in south London are currently overstretched and operating at full capacity, people will need to be convinced that these changes will not put lives at risk.
Finally, will the Secretary of State give a guarantee today to the people of Lewisham that, if he accepts the TSA’s recommendations, they will have the full consultation rights that come with any hospital reconfiguration, including the ability to challenge the clinical case and, if necessary, to refer it to the Independent Reconfiguration Panel? This process is attempting to rewrite the rules on making changes to hospital services, bypassing the intention of the House. It will send a shiver through any communities without a foundation trust, as it raises the prospect that their hospital will be able to be used as a pawn to solve problems in another.
People in Lewisham feel a huge sense of unfairness and I am sure that that will be shared by people across the House. The onus is on the Secretary of State to justify the changes and ensure that rules governing hospital changes are fair and respect the essential rights of all communities to be fully consulted and involved in any decision affecting their services.
Mr Hunt
We have followed to the letter the processes laid down in the law that the right hon. Gentleman’s Government passed. We followed the procedure extremely carefully. This is the first time that the procedure has been invoked, so we have taken extra legal advice to make sure that the processes followed strictly adhere to the letter of the law. I will continue to take legal advice, because I want to make sure that we absolutely follow the wishes of the House in how we carry out the procedure.
Unlike the right hon. Gentleman’s Government, we have introduced new safeguards for any major changes made to NHS services. Those safeguards did not exist when the right hon. Gentleman was Health Secretary. We have said that we will not accept any changes unless there is proper consultation of the local population, clear evidence and clear local clinical support. We made that commitment in the four tests, which did not exist under his Government.
I will not accept any of the changes that the special administrator proposes unless I am satisfied that all four tests have been met. They include proper local consultation, because I consider that to be extremely important.
Gareth Johnson (Dartford) (Con)
The report mentions an increase in elective surgery in Darent Valley hospital—my local hospital, which is just over the Kent border with south London. Although the hospital has enjoyed extra funding from the Government, it still has capacity issues. Will the Secretary of State ensure that the knock-on issues are taken into account before he makes any decision?
Mr Hunt
My hon. Friend makes a very important point. One of the most important things that I have to consider in the next 20 days is what he describes as the knock-on impact of all the proposed changes. I have a duty to find a solution that is financially and clinically sustainable for the South London Healthcare NHS Trust area. However, I need to consider the knock-on effects everywhere else, including in Lewisham and my hon. Friend’s constituency.
As well as legal advice, I will be seeking clinical advice and want to make sure that my officials agree with the financial considerations made in the report. I will consider all that advice in enormous detail before I come to any decisions.
Heidi Alexander (Lewisham East) (Lab)
I am grateful to the Secretary of State for agreeing to meet Members with Lewisham constituencies about this matter. Representatives of the Save Lewisham Hospital campaign, which is made up of local GPs, local hospital doctors and the public, are also very keen to meet the Secretary of State to put our case directly to him about why it is important to retain a full, admitting A and E and full maternity service at Lewisham. Will he agree to meet them?
Mr Hunt
I want to meet colleagues from the House but, as I am sure the hon. Lady will understand, I want to be careful not to restart the whole consultation process that has been happening in what I believe is a very thorough way in the past few months. However, one of the things that I will be considering very carefully—and I will listen to any points that the hon. Lady makes when I meet her—is whether the consultation has been done properly, as it needs to be done and as was intended by the legislation. I will not accept any changes unless I am satisfied on that point.
Dame Tessa Jowell (Dulwich and West Norwood) (Lab)
I welcome the Secretary of State’s apparently open-minded approach to the proposals, which have caused enormous clinical alarm in our hospitals as well as local concern.
Two particular issues affect my constituents and those of my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman) in relation to King’s College hospital. I ask the Secretary of State to take them seriously. First, should the proposed closures at Lewisham hospital go ahead, that will impact on the King’s College hospital paediatric A and E, which is already overstretched; the staff have enormous concern about their ability to meet any additional demand.
Secondly, will the Secretary of State agree that discussions currently under way to merge the managements of King’s College hospital with those of Guy’s and St Thomas’s should be suspended while the extensive reorganisation threatens the stability of a number of hospitals? If they were to go ahead in parallel, that would risk engulfing our hospitals with preoccupations about reorganisation rather than there being a focus from our world-class hospital staff in south London on treating the patients that we represent.
Mr Hunt
The right hon. Lady makes two important points. As she knows, I visited King’s College hospital just before Christmas and was incredibly impressed by what I saw. I visited the geriatric ward and was really impressed, and I am sure that the paediatric service is outstanding as well. It came across to me as an extremely well run hospital. I will, of course, make sure that I consider the impact of the changes proposed by the trust special administrator on King’s, just as I will consider the impact on all surrounding hospitals.
With respect to the merger proposals, because the legislation requires me to come to a decision within 20 working days, the right hon. Lady will find that I have to make and publish my decision quickly enough to ensure that any impact from the changes is properly considered by the people pursuing the possibility of a merger between King’s, Guy’s and Tommy’s.
Mr Nick Raynsford (Greenwich and Woolwich) (Lab)
The Secretary of State will understand that I have not been able to read the entire trust special administrator’s report in the hour or so I have had access to it. However, while I was reading the report, it became clear that a great deal of concern was expressed during the consultation about the implementation of the proposals. Indeed, the report highlights the fact that following previous reorganisations, costs have increased rather than reduced as a result of the very process of reorganisation.
Given those worries, will the Secretary of State agree to meet representatives from other boroughs, who are equally concerned? I remind him that he declined my request for a meeting on the trust special administrator’s draft report; I hope he will not decline to meet now that we have the full report. In particular, will he consider the implications for patient care and services of a major reorganisation, which can be disruptive and fail to deliver the savings envisaged?
Mr Hunt
I heed absolutely the right hon. Gentleman’s warning that reorganisations are not always the panacea that they are made out to be. We need to be absolutely clear that, if we accept the proposals, they will deliver a sustainable, robust and clinically sound outcome for the right hon. Gentleman’s and neighbouring constituents, as the trust special administrator believes they will. I shall be delighted if the right hon. Gentleman attends the meeting with other MPs affected by the proposal. I shall hear what he has to say further at that meeting.
Clive Efford (Eltham) (Lab)
The Secretary of State has to recognise the serious contradictions between the proposals in the trust special administrator’s report and the Conservative manifesto before the last general election. If he were to accept the proposals, particularly in relation to A and E, that would be a serious betrayal of promises made to the electorate. There are also the changes expected from the “A Picture of Health” proposals for Queen Mary’s hospital in Sidcup in relation to overnight elective surgery. How much is the Secretary of State bound by the specific promises made in the Conservative manifesto before the election when it comes to making a decision on the report?
Mr Hunt
We were concerned in the run-up to the last election at the pace and scale of many of the reconfigurations pursued by the last Government. That is why when we came into office we paused the reconfigurations and introduced the four tests—an additional safeguard to make sure that reconfigurations were not done without local clinical support.
We wanted to avoid what had happened so often, including in my own constituency—an alliance of Health Ministers and NHS managers riding roughshod over what local people wanted. We wanted to stop that, so we put in place new systems. I hope that the hon. Gentleman will be comforted by the robustness and thoroughness of the processes that we are now going through.
South London Healthcare Trust
Jeremy Hunt Excerpts(12 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I wish to inform the House that the trust special administrator appointed to South London Healthcare NHS Trust provided me with his final report on 7 January 2013. It makes recommendations to me in relation to securing a sustainable future for services provided by that organisation.
Details about the appointment of the administrator, Matthew Kershaw, were given in a written ministerial statement issued on 12 July 2012, Official Report, columns 47- 48WS.
The report was provided to me in accordance with chapter 5A of the National Health Service Act 2006, as introduced by the Health Act 2009, and has today been laid before Parliament and made publicly available at:
www.dh.gov.uk/health/2013/01/south-london-healthcare/
Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
I would like to thank Matthew Kershaw for the work he has carried out in producing his report. This is the first time the trust special administrator’s regime has been used since the last Government introduced the provisions which were enacted in the Health Act 2009. In accordance with the legislation, in addition to producing his recommendations on the future of the trust, Mr Kershaw has also been responsible for managing South London Healthcare NHS Trust and maintaining services for patients while the board is suspended pending the outcome of the regime. I do not underestimate the demands this has placed on him.
In triggering this regime, the Government’s priority was to ensure that patients continue to receive high-quality, sustainable NHS services. At the time Mr Kershaw was appointed last July, South London Healthcare NHS Trust was overspending by £1 million a week. In the last financial year, the trust had a deficit at over £65 million, the largest in the country. Left to itself, the trust’s very severe financial position would have continued in a downward spiral of continuing deficits and ultimately threaten the quality of care for patients across south-east London.
The challenges facing South London Healthcare NHS Trust are complex and long standing. To date, it has not proved possible to ensure that South London Healthcare NHS Trust is able to secure a sustainable future for its services within its existing configuration and organisational form. The Government’s priority is to ensure the delivery of a long-term, viable solution for services provided by the trust if it cannot be made sustainable. All responses to my predecessor’s statutory consultation on whether to trigger the regime, including from South London Healthcare NHS Trust itself, stated that a solution for the trust cannot be viewed in isolation from broader service provision within south-east London.
In accordance with my statutory duty, I will consider the trust special administrator’s recommendations carefully and make a final decision by 1 February that can secure sustainable services for the people of south-east London. In considering the recommendations, I will examine particularly:
whether the recommendations are likely to provide a sustainable long-term financial position which will secure high-quality services in the local area for the future; and
whether the recommendations have regard to the Government’s four key tests for local service reconfiguration. These are support from GP commissioners, strengthened public and patient engagement, clarity on the clinical evidence base and support for patient choice.
Ultimately, my priority is to ensure that all NHS hospitals live within their budgets and achieve the best quality care, best patient outcomes and best patient experience for all their NHS patients.
I will inform the House of my decision as soon as reasonably possible afterwards.
Health Allocations 2013-14
Jeremy Hunt Excerpts(12 years, 6 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today I am informing the House that the NHS Commissioning Board has announced the allocations to clinical commissioning groups (CCGs) for 2013-14 of £63.4 billion.
The board’s overriding objective is to improve outcomes for patients and to reduce health inequalities. Together with ensuring stability during transition, this has driven the decisions the board has taken in the approach to allocations for next year.
All CCGs will receive an identical increase of 2.3%, which will ensure that funding is stable in the first year of the new commissioning arrangements and supports a smooth transition. The board is also initiating a review of the approach to allocations, not just confined to CCG allocations, to give the best opportunity to improve outcomes for patients and tackle health inequalities.
Full details of the allocations have been placed in the Library and can be seen at: www.commissioning board. nhs.uk/files/2012/12/ccg-allocations-13-141.pdf. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
NHS Consultants and Junior Doctors' Contracts
Jeremy Hunt Excerpts(12 years, 6 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 report by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) “Review of compensation levels, incentives and Clinical Excellence and Distinction Awards schemes for NHS Consultants”. The report has been laid before Parliament today (Cm 8518). The report was to all four UK Health Departments. I am grateful to the chair and members of the DDRB for their report.
The recommendations in the report are wide ranging. As well as making recommendations on a new approach to national and local awards, it suggests the contract needs to recognise different stages in a consultant career by introducing a break point in the pay scale and a new principal consultant grade, that would cover up to 10% of the consultant work force at any one time.
The report sets out the case for change and the Government accept the key principles underlying the report. In particular, we agree that clinical excellence awards should recognise current not past excellence and that there is a compelling case for changes in the consultant contract. Local NHS organisations need to have a consultant contract that meets their needs and is fit for purpose for the future.
I recognise that there may be some concerns within the medical profession over the report. The Government are therefore committed to work with the profession on these recommendations with a view to reaching agreement with doctors’ representatives on how they should be implemented.
I am particularly mindful of the position of doctors who hold current pensionable and consolidated awards and on the impact of the DDRB’s proposals for national awards on the most senior doctors including clinical academics. It will be important to ensure that their reward packages remain competitive so that we continue to recruit and retain the most able consultants in the UK and provide appropriate incentives to encourage clinical excellence and innovation; not only in patient care but also in medical research and teaching.
The Government do not necessarily accept that consultants should be prohibited from holding awards simultaneously in the old and new schemes. This will depend on the final scheme design and should be considered as part of transition planning to ensure that all consultants retain appropriate incentives for continued excellence while avoiding paying twice for the same activities.
I am also prepared to consider the issue of pensionability of future awards as there is nothing inherent in a career average pension scheme that prohibits this. I therefore believe that longer-term national awards can remain pensionable. I would also be prepared to consider affordable proposals on pensionability of future local awards.
In advance of these discussions, we intend shortly to launch a specific consultation about discontinuing two anomalies in the current schemes.
We wish to work with the profession and employers to ensure that pay arrangements for doctors are affordable and sustainable in the long term. We will therefore also be seeking to agree changes to doctors’ contracts to better support seven-day working in the NHS. A move to seven-day working must be approached alongside better availability of community services and primary care. An NHS fit for the future needs to be delivering the same quality of service at the weekend as it does during the week and pay arrangements need to reflect this.
We are also today publishing a report commissioned from the NHS employers organisation by the four UK Health Departments on the junior doctors’ contract. The incentives in the current contract operate in a way that militates against the best quality training and restrict the service contribution made by doctors in training. We therefore wish to agree changes to ensure pay arrangements for juniors are also fit for purpose.
I am ambitious to see early progress on implementing these changes. I would wish to see a heads of agreement reached by the spring of 2013 on changes across both contracts with the intention of implementation beginning from April 2014. With the agreement of the devolved Administrations, this will be taken forward on a UK-wide basis, while respecting any differences arising from devolved responsibilities.
Copies of both reports are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. The report on the junior doctors’ contract has been placed in the Library.
“Liberating the NHS: No decision about me, without me”
Jeremy Hunt Excerpts(12 years, 6 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today I am publishing “Liberating the NHS: No decision about me, without me”, Government response and the Department’s NHS choice frameworks for 2012-13 and 2013-14. The response document and the choice frameworks 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 consultation document, “No decision about me, without me—Further consultation on proposals to secure shared decision-making”, published on 23 May 2012, set out proposals to provide patients with more opportunities to be involved in decisions about their care and to make choices. A small number of focused consultation questions were asked which sought views on whether the proposals were realistic and achievable and whether there were any issues that had not been recognised sufficiently. The consultation ran for 14 weeks from 23 May to 31 August 2012.
The majority of the 172 responses received to the consultation were broadly supportive of the proposals as a means for patients to become more involved in their care, in partnership with professionals.
Some respondents outlined concerns that greater choice did not equate to the wider adoption of shared decision-making. We agree with this principle and set out in the response document the clear importance of both proposals to increase patient involvement and patient choice.
Other themes were raised regarding the practical implementation of the proposals relating both to patient involvement and patient choice. The response document addresses the comments made by respondents and sets out how we are implementing the proposals to increase patient involvement and patient choice.
The Department’s NHS choice framework for NHS funded care and treatment in England will set out, for the first time, the choices that people can expect to be offered. This will raise awareness of these choices, including where people have legal rights to make choices, as well as setting out where they can find information to support these choices and what they can do if they are not given the choices they are entitled to.
NHS Funding
Jeremy Hunt Excerpts(12 years, 6 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
We have heard a lot of bluster and nonsense today. At its heart is an extremely uncomfortable truth for the Opposition: this Government are spending more on the NHS than Labour would have spent. That spend has moved away from consultancy and the back office to the front line, so the NHS is now performing better—I know that it is uncomfortable, but it is true—than it ever did under Labour. That means more treatment—[Interruption.] This might not be what Opposition Members want to hear, but they might as well listen. That means more treatment, more care and more lives saved. The previous Government talked the talk on the NHS, but it is this Government who have delivered an NHS of which we can be immensely proud.
Mr Hunt
I said that I would make a little progress, if that is all right.
I must confess to being both surprised and delighted at this afternoon’s motion, because I would have thought that the last thing the right hon. Member for Leigh (Andy Burnham) would want to do was remind the nation of his opposition to our increasing the NHS budget. The motion is about spending, but we can spend only what is in our budget. What did he say about budget and spend during his failed bid for the leadership of his own party? [Interruption.] I think that right hon. and hon. Members on the Opposition Benches should listen to what those on their Front Bench are saying. He said:
“It is irresponsible to increase NHS spending in real terms”.
So let me ask him to clarify this to the House: does he stand by his comment that it is irresponsible to increase NHS spending?
Andy Burnham
Yes, I do. I said in my speech that the NHS should be protected in real terms at the front line. That is what the Secretary of State has not done. I cannot believe that he is contradicting the contents of the letter from Andrew Dilnot. He really needs to tread very carefully before he goes any further.
Mr Hunt
Let me say very gently to the right hon. Gentleman that he can hardly come to this House criticising us for an alleged cut in NHS spending if his own plans would have led not to higher but to lower NHS spending. We are increasing spending by £12.5 billion, and he thinks that that is irresponsible.
Grahame M. Morris
Will the Secretary of State at least acknowledge that the previous Labour Government increased resources in the NHS from £30 billion when we took office to over £100 billion when we left office in 2010?
Mr Hunt
I will confirm for the hon. Lady that the nurse-to-bed ratio has gone up so that nurses are spending—[Interruption.] Perhaps the Opposition will want to hear about issues of care. The average bed is getting two hours of nursing care per week more than under Labour.
Let me give the right hon. Member for Leigh another chance to clarify Labour policy on health spending. In Wales, Labour has announced plans to cut the NHS budget by 8% in real terms despite an overall settlement protected by Barnett. Given that the motion condemns an alleged cut in NHS spending, will he, once and for all, condemn the choice that Labour made in Wales? If he does not want to do that, let me tell him what the British Medical Association says is happening in Wales. It talks of a “slash and burn” situation and “panic” on the wards. Would he want that to be repeated in England? If not, he should not sit idly by but have the courage to condemn the choice that Labour has made in Wales.
While we are on the subject of Wales, the right hon. Gentleman will know that NHS patients there are five times less likely to get certain cancer drugs than English NHS patients, but the Labour Welsh Health Minister has said it would be “irresponsible”—the same word that the right hon. Gentleman used—to introduce a cancer drugs fund in Wales. Does the right hon. Member for Leigh support what Labour is doing with regard to cancer drugs in Wales—yes or no?
Susan Elan Jones (Clwyd South) (Lab)
Can the Secretary of State tell us whether that has anything to do with the cuts in capital spend from Westminster central Government? Does he have any comment to make on National Audit Office figures showing that spending on health in Wales is higher than that in England, or does that not fit with his fictitious version of events?
Mr Hunt
I gently remind the hon. Lady that this is about the choice made by the Labour Government in Wales. They had a choice. They could have protected the NHS budget—they had the money under Barnett to do that—but they chose not to do so, and that is supported by the right hon. Gentleman.
Julian Smith
Does it surprise my right hon. Friend that we heard nothing from Labour Members about productivity, innovation or the Derek Wanless report, which demonstrated that Labour’s health spending led to lower productivity rather than higher productivity?
Heidi Alexander (Lewisham East) (Lab)
Will the Secretary of State give way?
Mr Hunt
I am going to make a little progress, if I may.
The right hon. Member for Leigh rather helpfully spelled out the difference between his position and our position when he admitted in the New Statesman that we are spending more than he wanted to spend on the NHS. He said of the NHS budget:
“They’re not ring-fencing it. They’re increasing it.”
In respect of NHS spending, he said:
“Cameron’s been saying it every week in the Commons: ‘Oh, the shadow health secretary wants to spend less on health than us’…it is true, but that’s my point.”
It was a good point, because we are spending more and he would have spent less. So why on earth call an Alice in Wonderland Opposition day debate condemning levels of spending in the NHS when he has so clearly put it on the record that he wanted that spending to be less?
Mr Graham Stuart (Beverley and Holderness) (Con)
Does my right hon. Friend agree that it is disingenuous, should it be allowed by the Deputy Speaker to say that, of the shadow Secretary of State and Labour Members—
Mr Deputy Speaker
Order. I do not think we can have “hypocrisy” either, so we will have the Secretary of State instead.
Heidi Alexander
The Secretary of State seems to be very keen to ask questions of our Front Benchers. Why will he not answer the question put to him by my hon. Friend the Member for West Ham (Lyn Brown)? How many nurses have lost their jobs on his watch? I do not want to be told about the nurses-to-beds ratio—answer the question.
Mr Hunt
It is because we have protected the NHS budget that the number of clinical staff in the NHS has gone up and not down. [Interruption.] Okay, let me explain this, because there is a very important point here. Unlike Labour Front Benchers, I do not want to micro-manage every hospital in the country and tell them exactly how many doctors and how many nurses they should have. I want them to put money on the front line, and the result is that the number of clinical staff—doctors, nurses, midwives and health visitors—has gone up and not down.
Mr Deputy Speaker
Order. I am sure that the hon. Member for Broxbourne (Mr Walker) is not going to walk out after his intervention and will stay a little longer.
Mr Walker
The meeting is in thirteen minutes.
My right hon. Friend knows that it is not just about funding but about good management. He cannot be responsible for management across the NHS, but in the East of England ambulance service there are question marks over the quality of its senior management. Will he find time to cast his eye over those senior managers?
Mr Hunt
I assure my hon. Friend that I am aware of the concerns that he raises, which are frequently raised with me by the Minister of State, my hon. Friend the Member for North Norfolk (Norman Lamb), who has a constituency in the east of England. I follow that situation carefully.
Let me now deal with the substance of the motion. I have always talked about spending going up from the first year of the comprehensive spending review—the first year when this Government had full control of the budget and were responsible for setting the spending plans. In 2011-12—[Interruption.] The shadow Secretary of State should listen to the facts. He tabled the motion, so he probably should hear the answer, although I know it is not what he wants. In 2011-12, spending went up by £2.5 billion in cash terms—0.1% in real terms—on 2010-11. This year, 2012-13, it will go up again, as it will in every year of the Parliament.
Andy Burnham
Would the Secretary of State care to remind the House of the commitment in the coalition agreement? Could he read that out for us?
Mr Hunt
I have just said that spending will go up in every year of the Parliament. Let me point out to the right hon. Gentleman that these are small real-terms increases, albeit ones that he bitterly opposed. That is why, given the uncertainties around GDP deflators, Andrew Dilnot’s letter says, in the sentence that the right hon. Gentleman did not want to read out, that
“it might also be fair to say real terms expenditure has changed little over this period.”
There it is, exposed for all to see: a bogus Labour motion trying to paint a picture of cuts to the NHS budget when even the head of the UK Statistics Authority says that the broad picture of NHS spending is that it has been protected in real terms—something that almost certainly would not have happened had Labour been in power.
Andy Burnham
I am struggling to believe what I am hearing. The Secretary of State is saying that Andrew Dilnot agreed with him that there had been real-terms increases in every year of this Parliament—[Interruption.] That is what he just said at the Dispatch Box. Let me quote Andrew Dilnot again, for the sake of accuracy. He said that
“we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10”.
How can the Secretary of State square what he has just told the House of Commons with what is in Andrew Dilnot’s letter? Is he saying that Andrew Dilnot is wrong?
Mr Hunt
Some politicians walk into the same trap not once but twice. Let me give the right hon. Gentleman the sentence that comes straight after that, which he did not want to quote. It says that
“it might also be fair to say that real-terms expenditure had changed little over this period.”
That is what Andrew Dilnot is saying, which is why the motion is so completely bogus.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
I am no statistician, but my understanding of that English is that things have not changed much. However, the Secretary of State has consistently said that he and the Government have pledged to implement an increase. There is nothing in that letter to suggest that any increase has occurred.
Mr Hunt
The right hon. Lady’s party has been saying that spending has been cut, and it had the foolishness to call an Opposition day debate on the basis of a letter from Andrew Dilnot that states that, broadly speaking, spending has remained unchanged. That is why, at its heart, the motion is bogus.
The sad fact is that this is not the debate that the Opposition planned to have, two years into this Parliament. The right hon. Gentleman dreamed of coming to the House to remonstrate about an NHS that was on its knees and that was not delivering for the public. He wanted to argue about waiting times, but they have gone down, with fewer people waiting a long time for an operation than at any time under Labour. He wanted to argue about treatments, but there are more people getting new hips and knees and many other treatments than under Labour. [Interruption.] Opposition Members should listen to this. He wanted to argue about cancer, but 23,000 people are now getting drugs under the cancer drugs fund that Labour refused to set up.
Today, the right hon. Gentleman has tabled a motion criticising the decisions taken by the coalition and my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) on NHS spending in our first two years in office. This is also about how we spend the money, as many of my hon. Friends have said. What are the decisions that the right hon. Gentleman is criticising? They are precisely the decisions that mean that the NHS is now performing at record levels, and vastly better than at any time under Labour.
Let us look at those decisions. There was the decision to reduce the number of managers by 7,000 and transfer resources to the front line. There was also the decision to cancel Labour’s disastrous attempt to embrace the technology revolution that cost billions and set the NHS back by years. Then there was the decision to end the wasteful consultancy spend, which has now been cut by 39%. [Interruption.] The right hon. Gentleman needs to listen to this. There was the decision to stop the scandal of unsustainable private finance initiative projects that left the NHS with a £73 billion debt and £1.6 billion-worth of repayments every year. [Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Christmas is coming. Let us show a little bit more Christmas spirit towards each other. Members on both sides of the House want to hear the Secretary of State.
Mr Hunt
I could not agree with you more, Mr Deputy Speaker. I am trying to give the House some good news, but it is difficult for the Opposition to take it in.
There was also the decision, championed by both coalition parties, to transfer that money to the front line, so we now have more clinical staff, including 5,000 more doctors; better access to drugs, including £600 million invested in the cancer drugs fund; 500,000 more elective admissions every year than under Labour; over 3 million more out-patient appointments every year than under Labour; nearly 1 million more going through accident and emergency every year than under Labour; and 1.5 million more diagnostic tests every year than under Labour. On top of all that, we have 60,000 fewer people waiting longer than 18 weeks than under Labour; 90% fewer people waiting more than a year than under Labour; clostridium difficile down more than a third compared with under Labour; MRSA halved compared with under Labour; and the number of people facing the indignity of mixed-sex wards down by 98% compared with under Labour.
Of course the NHS faces huge challenges with an ageing population and increasing demand, but we are now facing up to those challenges with ambitious plans to tackle dementia, to reduce mortality rates for the big killer diseases to the lowest in Europe, to embrace the technology revolution—but getting it right this time—and to improve the quality of care which, in parts of the system, has been allowed to become shockingly poor for far too long. All those priorities were ignored by Labour in office and, even worse, they have been rejected by Labour today as a “meaningless list”. Those were Labour’s words. Well, tell that to the 157,000 people who die from cancer every year, or the 800,000 people who have dementia, or the people whose families suffer from the poor care that we read about every week in the newspapers.
None of the improvements to the NHS, and none of the ambitions for our NHS, would be possible without the extraordinary dedication of our doctors, nurses and front-line professionals, to whom I pay tribute today. But none of them would have been possible either if we had not increased the NHS budget and NHS front-line spend, contrary to what Labour intended and wanted. Labour’s plans would have meant less spending in real terms on the NHS, and vastly less spending on the NHS front line. No clever fiddling with baselines can obscure the harsh reality that Labour’s policy towards the NHS is a mass of contradictions that fools nobody—certainly not the brilliant doctors, nurses and professionals who have given their lives to saving and improving the lives of others. I urge the House to reject this ridiculous motion.
Liz Kendall (Leicester West) (Lab)
During this debate, Ministers and the few Government Members who have spoken have either denied that the Government have broken their promise to increase NHS spending or have claimed that it does not matter, as if the Prime Minister’s clear, direct and personal pledge to voters can easily be swept to one side. They—perhaps with the exception of the hon. Member for Southport (John Pugh)—have also skated over or ignored the waste, confusion and utter distraction of their back-room NHS upheaval.
In contrast, Opposition Members have talked about the harsh reality of the double whammy of cuts and reorganisation on their constituencies. My hon. Friend the Member for Lewisham East (Heidi Alexander), my right hon. Friends the Members for Lewisham, Deptford (Dame Joan Ruddock) and for Rother Valley (Mr Barron), my hon. Friends the Members for Corby (Andy Sawford), for Bolton West (Julie Hilling) and for Easington (Grahame M. Morris), and the hon. Member for Strangford (Jim Shannon) spoke powerfully about their concern that changes to local services are being driven by money alone, not by improving patient care. I also pay tribute to my right hon. Friend the Member for Cynon Valley (Ann Clwyd), who spoke with bravery and compassion about the unacceptable standards of care in parts of the country, which must be tackled.
Perhaps the most worrying example of the combination of cuts and reorganisation that the Government are forcing through involves what is happening to cancer networks. Those groups of local specialists were set up more than a decade ago under Labour’s 2000 cancer plan to help tackle one of Britain’s biggest killers. It is widely acknowledged that cancer networks have played a central role in improving mortality rates, cancer survival rates and equality of cancer care, and they have done that on small budgets with few staff, offering good value for taxpayers’ money. Crucially, the specialist local skills of cancer networks are vital to making even greater improvements that cancer patients need and deserve in the future.
Ministers have repeatedly promised to protect budgets for cancer networks. On 31 January last year, the then Health Secretary told the House that
“cancer networks funding is guaranteed during the course of 2011-12.”—[Official Report, 31 January 2011; Vol. 522, c. 612.]
On 27 November this year in a debate on the NHS mandate, the new Health Secretary told the House:
“Cancer networks are here to stay and their budget has been protected.”—[Official Report, 27 November 2012; Vol. 554, c. 127.]
Those promises have been broken.
In response to a freedom of information survey from Labour, cancer networks report budget cuts of 13% in 2011-12 alone—[Interruption.] The Secretary of State shakes his head but he can look through all the figures, including individual examples, if he wants to see those cuts. In total, budgets have been slashed by 26%—by a quarter—since the Government came to power.
The Government’s national cancer director, Professor Mike Richards, at least has the honesty to say that
“cancer networks will have a smaller proportion of the budget in future.”
I understand that the Health Minister in the House of Lords, Earl Howe, has also been forced by an urgent question to admit that less money will be available to cancer networks.
Mr Hunt
First, these networks are brilliant. They are a good thing and they have done a huge amount. The Government support them and we are expanding them. That is why instead of just having cancer, cardiac and stroke networks, we will also have networks for dementia and maternity. The budget for those networks is going up by 27%.
Liz Kendall
The budget for cancer networks has been cut by a quarter. The Secretary of State is not expanding those networks but merging them and diluting their specialist expertise, as I will show. The cuts and the Government’s NHS upheaval mean that cancer networks have lost one fifth of their staff, withdrawn or scaled back current work, and put future projects on hold—[Interruption.] The Secretary of State is still denying that so let me tell him what the networks actually say.
The Arden cancer network in Coventry and Warwickshire says that it has lost its vital chemotherapy nurse. The Peninsula cancer network in Devon and Cornwall says it has had to turn down £150,000 from Macmillan Cancer Support to fund a programme for cancer survivors because its future is so uncertain. Essex cancer network says that posts have been removed, its staff are in a redeployment pool, and that it will have
“no presence in Essex from April 1st next year.”
Instead of supporting those vital local experts, as well as specialists in heart and stroke networks, the Government are merging them into 12 generic clinical networks that cover bigger geographical regions and far more health conditions. No one is against sharing the skills and experience of cancer and cardiac networks. However, as Maggie Wilcox, a former palliative care nurse, breast cancer patient, president of Independent Cancer Patients’ Voice and the layperson on the recent review by the Department of Health into breast screening said,
“subsuming cancer networks into generic clinical networks could be disastrous for cancer patients…you cannot be both a specialist and a generalist.”
That is especially important in an area as complex and fast-developing as cancer. Staff will not be able to make the same depth or scale of improvements if they are forced to cover a large area and more conditions with fewer members of staff.
The Secretary of State ploughs on regardless, denying that there is a problem and telling BBC Radio 5 Live that it is too early to know what will happen. How utterly complacent and out of touch. Networks are already disappearing. Their staff have left or are looking for jobs because their future is in such disarray. With their reckless NHS reorganisation, the Government have wasted not just taxpayers’ money but the knowledge and expertise of specialist staff, and patients are paying the price.
Liz Kendall
I do not think the Secretary of State understands that in a really complex and fast-developing area such as cancer, we need to know about individual, specific issues and concerns. If there are fewer staff covering bigger areas and more health conditions, we will not get specialist expertise.
If the Secretary of State does not believe me, perhaps he would like to comment on what Dr Mick Peake, the clinical lead for NHS cancer improvement and the national cancer intelligence network, has said. He has stated:
“With the shift towards GPs commissioning, the need for this expert…clinical advice will become ever more crucial…I am worried that in the process of reorganisation of the networks…we will lose many expert and very committed individuals, and that this could impact on the quality of commissioning and cancer services in the future.”
What will be the impact on patients, who are what the network is supposed to be about? Let us take prevention. Who has championed prevention by increasing the uptake of screening programmes? Cancer networks. Who trains GPs to spot the signs of cancer so that patients get earlier diagnosis? Cancer networks. Who has helped patients get their tests and scans done in days, not months, and slashed waits for cancer specialists to two weeks? Who has helped hospitals compare their performance, use the best drugs and treatments and transform patient information and support, and who has been central to setting up the new national cancer outcomes database, which the Government rightly say will help reduce cancer variations and drive improvements in future? Cancer networks. So why is the Secretary of State diluting—[Interruption.] Oh, now he switches to talk about the cancer drugs fund, because he knows that by stripping away vital local expertise, he is putting care at risk.
When the Secretary of State tells Radio 5 Live that he does not know why Labour is flogging this issue, calls cancer networks a mere pilot and says that his upheaval will be in patients’ best interests, cancer specialists, patients and Opposition Members know that he is wrong. We know that he cannot sustain the progress on cancer and make even more improvements in future when he is ripping away the foundations of better cancer care. As Earl Howe has just told Members of the Lords, it is “perfectly correct” that the share of the pot that cancer networks will be able to get will be smaller next year than it is this year. I rest my case.
The Prime Minister said that he would increase spending on the NHS, but NHS spending is lower in real terms today than it was when Labour left office—broken promise No. 1. Health Ministers repeatedly claim that they have protected cancer network budgets—broken promise No. 2. No top-down NHS reorganisation, mental health a priority and social care budgets protected—broken promises three, four and five. The list goes on. The Prime Minister claims that his priority can be summed up in three letters—NHS. That very same organisation is responding with its own three letters—SOS. I commend the motion to the House.
UK Life Sciences
Jeremy Hunt Excerpts(12 years, 6 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today, the Prime Minister has announced the Government’s intention to pump-prime the sequencing of 100,000 whole genomes over the next three to five years. This work will initially focus on cancer and rare diseases which, together with infectious diseases, are already showing patient benefit.
The potential of the information contained in the human genome is recognised as one of the most important health care opportunities of modern times. This initiative will include funding for staff training and developing bioinformatics support to prepare the NHS to make the paradigm shift from sequencing individual genes to scanning whole genomes. It will change fundamentally the way we view disease, monitor its progression and use this knowledge to transform health care. It will help patients get targeted treatments for them as individuals. The NHS Commissioning Board will lead on a delivery framework and service design with an aim to have contracts in place by April 2014 at the latest.
The Department of Health is working closely with colleagues in the Department for Business, Innovation and Skills and the NHS Commissioning Board to ensure that clinicians, patients, researchers and the wider public are involved in promoting the adoption of genomic technology to provide better health care and help research and the wider economy. The Government will also put in place careful safeguards for the storage each patient’s genome sequence and the use of anonymised data for research, which will be overseen by the chief medical officer for England.
This new initiative will form part of the next phase of the “Strategy for UK Life Sciences”, launched 12 months ago by the Prime Minister, which declared our commitment to a sector we see as vital to the UK’s long-term economic prospects. This work will also complement “Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS”, published by Sir David Nicholson, the NHS chief executive, which is updated today. The UK is well placed to play a world-leading role in this next phase of the biomedical revolution, thanks to its first-class science and research base and the unique position of the NHS as a single health care provider. We remain at the forefront of genetic science innovation, translating this into real benefits for NHS patients. The Government and the NHS Commissioning Board will ensure that NHS patients benefit and that there is a clear strategy to take advantage of opportunities in genomics.
In addition, the Minister for Universities and Science, my right hon. Friend the Member for Havant (Mr Willetts), Department of Business and Skills is today announcing that part of the science capital committed in the Chancellor’s recent “Autumn Statement 2012” will be for projects in the life sciences: in synthetic biology; regenerative medicine; and biologies.
NHS Pay Review Body/Senior Salaries Review Body
Jeremy Hunt Excerpts(12 years, 6 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 reports of the NHS Pay Review Body (NHS PRB) and the Senior Salaries Review Body (SSRB) on market facing pay for their respective remit groups, which have been laid before Parliament (CM 8501 and Cm 8507). I am grateful to the chairs and members of the review bodies for producing these reports.
The Chancellor of the Exchequer on 7 December 2011 and I on 23 December 2011 asked the NHS PRB to consider how to make pay more market facing in local areas for NHS Agenda for Change (AfC) staff. The remit was for England only.
The NHS PRB found that the AfC pay system already has more extensive market facing features than in many other pay systems in large, national employers, in both the public and private sectors, to respond effectively to local labour markets. Additional freedoms are also available to foundation trusts introduced in legislation by the previous Government.
The NHS PRB found that there was not the firm evidence which would be essential to justify further top-down investment in additional market-facing pay in the NHS at this time. They do not recommend the introduction of centrally designed pay zones this year. Instead, the NHS PRB recommended a fundamental review of high-cost area supplements (HCAS), appropriate use of local recruitment and retention premia and regular review of AfC, including its flexibilities, with any negotiations brought to a conclusion at a reasonable pace. The NHS PRB agreed that should any market-facing approaches emerge from these developments they should be introduced incrementally to take account of affordability.
The Government welcome and accept all of the recommendations of the NHS PRB, including a review of HCAS and will take this work forward in partnership with NHS trade unions and the NHS Employers organisation. The priority is to continue to develop the AfC system and ensure that national terms and conditions are fit for purpose and support the recruitment and retention of good quality staff in the most cost-effective and efficient way.
The Chancellor and I wrote in similar terms to the chair of the SSRB. However, the Department of Health’s evidence noted that from 1 April 2013, the only NHS staff within the remit of the SSRB will be those relatively few very senior managers (VSMs) employed by the Department’s special health authorities and executive non-departmental public bodies, together with a small number in ambulance trusts that have not yet become foundation trusts. All other NHS organisations are free to determine their own pay and terms and conditions for their VSMs.
The SSRB recommended that no additional locality pay measures be added to the new VSMs’ national pay framework as the evidence pointed clearly to the market for VSMs being national rather than local. They observed that the new pay framework already has some flexibility, with safeguards, which should enable the NHS to recruit and retain sufficient numbers of suitable VSMs.
The SSRB also recommended that all NHS VSMs should be assimilated into and paid according to the new pay framework, on the basis of job weight, once the current NHS reforms have been fully implemented. Our view is that, to avoid increasing pay and costs unnecessarily, the new framework should apply to all new appointments. Existing VSMs should normally remain on their existing terms and conditions unless adjustments are required to comply with equal pay legislation.
The Government welcome and accept the recommendations of the SSRB, apart from the recommendation to assimilate all VSMs on to the new pay framework.
Oral Answers to Questions
Jeremy Hunt Excerpts(12 years, 7 months ago)
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Barbara Keeley (Worsley and Eccles South) (Lab)
1. How many (a) health visitors and (b) nurses there were in the NHS in May 2010 and the latest month for which figures are available.
The Secretary of State for Health (Mr Jeremy Hunt)
The number of full-time equivalent qualified nurses and midwives employed in the national health service in England in May 2010 was 310,793, and in August 2012 it was 304,566. The number of full-time equivalent health visitors in May 2010 was 8,092 and in August 2012 it was 8,067, with an additional 226 health visitors employed by organisations not using the electronic staff record.
Barbara Keeley
I thank the Secretary of State for that answer. The recent Care Quality Commission report found that 10% of NHS hospitals did not meet the standard of treating people with respect and dignity, and underpinning that poor care were high vacancy rates and hospitals that have struggled to make sure they have enough qualified staff on duty at all times. That shows us the real impact of losing those thousands of nurses. So does he agree that it is urgent that this Government take action when understaffing in the NHS results in poor care?
Mr Hunt
I absolutely agree with the hon. Lady that nowhere in the NHS should allow low staff numbers to lead to poor care. What was interesting about the CQC report, which was a wake-up call for the whole NHS, was that institutions under financial pressure, as the whole NHS is, are delivering excellent care in some places and delivering care that is unsatisfactory and not good enough in other places. On her specific question about nurses and nurse numbers, it is important to recognise that across the NHS as a whole the nurse-to-bed ratio has increased. Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.
Miss Anne McIntosh (Thirsk and Malton) (Con)
Will the Secretary of State give an instruction, irrespective of the numbers, that we go back to traditional nursing methods, as now that we have an almost all-graduate nursing profession we seem to have lost touch with true, caring nursing?
Mr Hunt
I have some sympathy with what my hon. Friend is saying, although it is important to recognise, as we have this debate about nursing, that the vast majority of nurses in the NHS do an outstanding job and we are very lucky to have them giving their lives to the NHS. Next week, at the chief nursing officer’s conference, we are launching a new vision for nursing, which will put compassion and the patient at the heart of what nurses do. I hope that will address some of her concerns.
Andy Burnham (Leigh) (Lab)
Last week, official statistics revealed that 7,134 nursing jobs had been lost under the coalition—almost 1,000 of them in the last month on the Secretary of State’s watch. The very next day, the Care Quality Commission warned that 16% of hospitals in England are not meeting the CQC standard for adequate staffing levels. Is this not prima facie evidence that the NHS and patients are not safe in his hands? Will he urgently intervene to stop the job losses?
Mr Hunt
The reason why the CQC undertook its shocking investigation into the state of care in our country was that this Government introduced dignity and nutrition inspections, which never happened when the right hon. Gentleman was Secretary of State. He talked about numbers employed in the NHS, so let us look at them. Yes, there has been a 2% decline in the number of nurses, but there has been an increase in the nurse-to-bed ratio. There has been a 4% increase in the number of midwives, a 5% increase in the number of doctors and an increase of more than 50% in the number of health visitors—their number went down when he was in office. How much worse would those numbers have been if we had had the cut in NHS funding that he wanted?
Mary Macleod (Brentford and Isleworth) (Con)
2. What steps the Government are taking to raise awareness of and help those who have brain tumours.
Graeme Morrice (Livingston) (Lab)
4. How much the NHS spent on consultancy in (a) 2010-11 and (b) 2011-12.
The Secretary of State for Health (Mr Jeremy Hunt)
The amount spent by strategic health authorities, primary care trusts and NHS trusts on consultancy services in the financial years 2010-11 and 2011-12 was £291 million and £278 million respectively—a 39% fall in expenditure, compared to the last year of the previous Administration.
Graeme Morrice
In 2010 the former Secretary of State said he was
“staggered by the scale of the expenditure on management consultants”.
However, in the past year alone foundation trusts have increased their spend on consultancy by 25% and NHS trusts have increased their spend by 13%. Is the new Secretary of State just as staggered?
Mr Hunt
With respect to the hon. Gentleman, a 39% fall in consultancy expenditure compared to the last year of the previous Administration is something that we are rather proud of. If he wants to know what the Health Secretary is directly responsible for, direct Department of Health expenditure on consultancy in the past year was £3 million. In the last year of the previous Government it was £108 million.
Andrew Bridgen (North West Leicestershire) (Con)
Has my right hon. Friend made any recent assessment of the total efficiency savings achieved in the NHS over the past two years under the Nicholson challenge?
Andrew Gwynne (Denton and Reddish) (Lab)
The Secretary of State cannot have it both ways. Is he aware that in the past year alone Monitor spent more than £9 million on NHS transition costs, with a staggering £5.6 million of that being squandered on management consultants? Is this not a further sign of a Government with their priorities all wrong, wasting precious public money on management consultants to push through a reorganisation that nobody wanted, while they are handing out P45s to our nurses?
Mr William Bain (Glasgow North East) (Lab)
5. What estimate he has made of the number of foundation trusts considering plans to opt out of NHS national pay agreements.
Pauline Latham (Mid Derbyshire) (Con)
6. What recent assessment he has made of the cancer drugs fund.
The Secretary of State for Health (Mr Jeremy Hunt)
Since October 2010, more than 23,000 patients in England and more than 1,600 patients in NHS East Midlands have benefited from the additional £650 million funding for cancer drugs that this Government have committed to providing.
Pauline Latham
I thank my right hon. Friend for that answer, but I have previously raised in the House a constituency case where the NHS East Midlands cancer drugs fund would not pay for drugs that other CDFs would pay for, such as Avastin for second-line treatment of bowel cancer. Sadly, my constituent has since died because she could not get funding for the drugs she needed, having spent all her own money funding the treatment herself. Will my right hon. Friend meet me and my late constituent’s consultant, Dr Bessell, to discuss how we can end this postcode lottery?
Mr Hunt
Proud as we are of the cancer drugs fund, to hear such stories is extremely distressing, and our first thoughts are with the family of my hon. Friend’s constituent. We will of course look into the issue she raises, which is a cause of great concern. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), is a neighbouring MP and would be happy to meet her to discuss the matter.
Liz Kendall (Leicester West) (Lab)
The reality is that the Government are ripping away the foundations of better cancer care. The former Health Secretary made a clear promise from the Dispatch Box to protect cancer network funding, but the NHS South East London and greater midlands cancer networks both say that their budgets and staff have been slashed. The NHS medical director, Sir Bruce Keogh, says that cancer networks are an NHS success story, and Macmillan Cancer Support says it is nonsensical to cut their specialist expertise. Why do the Government not agree?
Mr Hunt
Cancer networks are here to stay and their budget has been protected. They are extremely important. The hon. Lady uses hyperbolic phrases such as “ripping away the foundations of better cancer care”, so perhaps she would like to talk to the 23,000 people who have benefited from the cancer drugs fund that her Government failed to introduce.
George Freeman (Mid Norfolk) (Con)
I congratulate my right hon. Friend on the cancer drugs fund and the ring-fencing of the budget for cancer, which delivers important benefits in research, not least by funding new treatments by new companies that would not otherwise be able to sell their product and by generating important evidence on health economics. As a Mo-bro, I am very aware that medicines are better than surgery. Will he give the House some reassurance that the Government plan to renew the cancer drugs fund?
Mr Hunt
We are committed to finding a way of ensuring that people who have benefited from the cancer drugs fund—23,000 to date—can continue to receive that kind of support. That is something we can do because we protected the NHS budget, unlike the Labour party, which wanted to cut it.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
7. What steps he is taking to ensure that primary care trusts do not ration access to NHS treatments and operations.
Simon Hughes (Bermondsey and Old Southwark) (LD)
14. What the process is for deciding the future of health care provision in south-east London; and if he will make a statement.
The Secretary of State for Health (Mr Jeremy Hunt)
The trust special administrator at South London Healthcare NHS Trust will be making recommendations to me on the future of the trust’s services. Those recommendations will inevitably impact on the services provided by other trusts in the south-east London health economy.
Simon Hughes
When the Secretary of State considers outer south-east London health arrangements, and problems that are not at all of his making, will he bear in mind that all five Members of Parliament for Southwark and Lambeth are clear that plans by King’s Health Partners for a super-trust across Lambeth, Southwark and beyond should be put on hold until we know the implications for inner south-east London of any changes that happen further out?
Mr Hunt
I will certainly bear in mind the right hon. Gentleman’s comments. The decision time scale for the South London Healthcare NHS Trust is very quick as prescribed in the National Health Service Act 2006. I must make a decision on that by 1 February, so the situation will soon become clear.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
24. The trust special administrator’s report proposes the closure of the full A and E service at Lewisham hospital —which currently sees 115,000 people a year—and asserts that 30% of that department’s work can be transferred to the community. Will the Secretary of State provide evidence of how that can be done, especially considering a cash-strapped NHS and a local authority that is suffering from deep cuts by his Government?
Mr Hunt
I remind the right hon. Lady that the Government have not cut the NHS budget; we have protected the NHS budget. There is an ongoing consultation on the proposal that she mentions. It will finish on 13 December and I hope she will contribute to it. I will receive the recommendations of the trust special administrator at the beginning of January, and I will then make my decision.
Clive Efford (Eltham) (Lab)
The 2010 Conservative manifesto stated:
“We will stop the forced closure of A and E and maternity wards, so that people have better access to local services,”.
They then closed the accident and emergency department at Sidcup, having promised to save it, and they now plan to close the A and E at Lewisham hospital. Is that not a betrayal of people in south-east London and the NHS?
Mr Hunt
The hon. Gentleman should talk to the shadow Minister on the Opposition Front Bench, the hon. Member for Leicester West (Liz Kendall), who said yesterday that she would not automatically oppose all reconfigurations. The coalition Government have introduced four tests, which were not used by the previous Government. Those tests state that we will not impose closures of A and E and maternity units unless there is local clinical support, and evidence that it will benefit local people and improve patient choice. The tests exist to provide precisely the safeguards about which the hon. Gentleman is concerned.
Chris Ruane (Vale of Clwyd) (Lab)
15. What recent assessment he has made of the treatment of repeat episode depression by (a) drugs and (b) mindfulness-based intervention.
Jack Dromey (Birmingham, Erdington) (Lab)
T1. If he will make a statement on his Departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
I am pleased to report an NHS performing at record levels. There are half a million more out-patient appointments every year since the last election, nearly 1 million more people go through A and E every year, and there are 1.5 million more diagnostic tests every year. To clarify a previous answer, the number of health visitors will go up by more than 50% during the course of this Parliament.
Jack Dromey
The Erdington walk-in centre is at the heart of our high street. It is much loved, much used and cost-effective, yet it is at risk of closure because of the combination of a £76 million reduction in expenditure by Birmingham primary care trusts and health service reorganisation. Thousands of local people have expressed their concern and elected a users committee. Will the Secretary of State meet the users of the centre and me?
Sir Tony Baldry (Banbury) (Con)
T2. The new mandate for the NHS includes a very welcome objective for it to be a world leader in end-of-life care. Can we have an indicator in the commissioning outcomes framework on deaths in preferred places of care to ensure that new commissioning groups prioritise better end-of-life care, and to ensure that those who want to die peacefully at home have the best opportunity to do so?
Mr Aidan Burley (Cannock Chase) (Con)
T4. Yesterday, I received a letter from the chief executive of Monitor, which asked me and the Asset Transfer Unit to undertake feasibility work to develop a professional business case for the local community to take ownership of Cannock Chase hospital. This would be done through its transfer to a community interest company, which would then take over running the hospital estate, securing the building for the people of Cannock Chase. Will the Secretary of State welcome these proposals, which would be the first of their kind in the UK, and work with us as we develop a plan for the local community to own its hospital?
Mr Jeremy Hunt
I congratulate my hon. Friend on his campaigning and hard work on this issue, which represents an interesting way forward for community hospitals. I wish him every success and I know that hon. Members in all parts of the House will watch carefully what happens in Cannock.
Heidi Alexander (Lewisham East) (Lab)
T5. I would like to press the Health Secretary further on the unsustainable providers regime, which has been enacted in the South London Healthcare NHS Trust. Given that the statutory guidance for that regime explicitly states that it is not to be used as a back-door route to service reconfiguration, why are Lewisham A and E and maternity services earmarked for closure? If that is not a service reconfiguration, can he tell me what is?
Mr Hunt
What this issue is addressing—it was legislation introduced by the hon. Lady’s Government in 2006—is a clearly unsustainable situation with South London Healthcare. The proposals have to look at making sure that there is sustainability throughout an entire local health economy. I have not made any decisions at all. I will wait for the proposals to come to me at the end of the year, and I will then make my decision in January.
Andrew George (St Ives) (LD)
T6. There is mounting evidence that clinical care failure is as much to do with inadequate staff levels as anything else. In view of that, do Ministers agree that it is worth looking at the merits of establishing mandatory registered nurse to patient ratios across secondary and tertiary care wards?
Mr Jeremy Hunt
I will absolutely look into that issue. We are keen to ensure that people with rare diseases, including rare cancers, are not discriminated against because it is more expensive to do the research and get the drugs necessary to treat them.
Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)
The Minister will be aware that the process of making Kalydeco available to people with cystic fibrosis in England is much further advanced than in Scotland, where the G551D gene is two to three times more prevalent—a point highlighted by the Daily Record yesterday in respect of seven-year-old Maisie Black from Burnside in my constituency. Will the Minister clarify that the roll-out in England will not be restricted, so that young children, who have the least accumulated lung damage and therefore most to benefit, do not lose out on the chance of benefiting from this transformational drug?
Mr Stewart Jackson (Peterborough) (Con)
Last week it was a great pleasure to visit Age UK Peterborough, whose No. 1 priority is dementia care, which coincides with the NHS priorities that my right hon. Friend the Secretary of State outlined earlier this week. Will he put in place procedures to make available capital moneys for the construction of dementia care facilities locally?
Mr Jeremy Hunt
I can announce that we have already put in place such funds, because dementia is one of the biggest challenges we face across the entire health and social care system. We need more capital funds, but we also need massively to increase the shockingly low diagnosis rates. At the moment, only 42% of the 800,000 people with dementia are being diagnosed properly and therefore getting the treatment they need.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Is the Secretary of State worried about the high level of qualified managers leaving the NHS—fleeing the NHS—to go to other places or retire early when there are few people in clinical commissioning groups with any management experience at all?
Mr Hunt
There is always a role for excellent managers in the NHS, but this Government’s priority is front-line clinicians, which is why the number of doctors has increased by 5,000 since we have been in power and why administration costs have been cut, which will save the NHS £1.5 billion every year.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
Is the Secretary of State disappointed by the low number of GPs who have come forward to take on accounting officer roles in clinical commissioning groups, and can he say why he thinks that is?
Mr Jeremy Hunt
I am actually very encouraged by the enthusiasm of the GPs who are running clinical commissioning groups up and down the country. They are going to transform services and, most of all, they are going to integrate services at a local level. That is something that has long been talked about but not delivered before in the NHS.
NHS Commissioning Board (Mandate)
Jeremy Hunt Excerpts(12 years, 7 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 regarding the publication of the Government’s first mandate to the NHS Commissioning Board.
The NHS is the country’s most precious creation. We are all immensely proud of the NHS and the people who make it what it is—a service that last year delivered half a million more outpatient appointments, nearly 1 million more A and E attendances and 1.5 million more diagnostic tests than the year this Government came into office; and it is doing so while meeting waiting time targets, reducing hospital-acquired infections and virtually eliminating mixed-sex wards. The essence of the NHS is its values: universal and comprehensive health care that is free and based on need and not the ability to pay.
Today I am proud to publish the first ever mandate to the NHS Commissioning Board. From now on, Ministers will set the priorities for the NHS, but for the first time, local doctors and clinical staff will have the operational freedom to implement those priorities using their own judgment as to the best way to improve health outcomes for the people they look after. That independence comes with a responsibility to work with colleagues in local authorities and beyond, to engage with local communities to create a genuinely integrated system across health and social care that is built around the needs of individual people.
The mandate makes clear my responsibility, as Secretary of State for Health, to uphold and defend the enduring values that make the NHS part of what it is to be British. It also sets out my priorities for the NHS Commissioning Board over the next two years and beyond, linked closely to the NHS outcomes framework, the latest version of which I am also publishing today.
The priorities set out in the mandate closely reflect the four key priorities I have identified to Parliament as my own. Let me take each of them in turn. My first priority is to reduce avoidable mortality rates for the major killer diseases, where despite increases in life expectancy our survival rates are still below the European average in too many areas. If our mortality rates were level with the best in Europe, we could save as many as 20,000 lives every year—20,000 personal tragedies that could be avoided, but are not. It cannot be right that we are below average for cancer survival rates, that for respiratory diseases we are the worst in the EU 15, or that our performance on liver disease is getting worse, not better. Today I call on the NHS Commissioning Board, working with Public Health England, local government, clinical commissioning groups and others, to begin a concerted effort to bring down avoidable mortality rates in this country.
The mandate asks the board to make measurable progress to improve early diagnosis, giving more people quicker access to the right drugs and treatment where they need it; to reduce the wide and unacceptable variation between different parts of the country, both in terms of inequality of health outcomes and variability of performance by NHS trusts; and to support a renewed focus on prevention, working with local authority partners to help people quit smoking, drink less, eat better and exercise more.
My second priority is to build a health and care system where the quality of a person’s care is valued as highly as the quality of their treatment. When we place ourselves in the hands of others, we should be confident that we will be treated well, our dignity respected and that that will be the case regardless of our age or mental state, or whether we are in a hospital, a care home or our own home. For most people, most of the time, that is already the case, but too often it is not. The appalling revelations from places such as Mid Staffs and Winterbourne View bring home the desperate need for change. We must go beyond the enforcement of minimum standards. We must raise our game so that the NHS is recognised globally for its commitment to the highest standards of care for all, just as it is recognised for its commitment to the highest standards of treatment for all.
The mandate asks the NHS Commissioning Board to ensure that GP-led commissioning groups work with others so that vulnerable people, particularly those with dementia, learning disabilities and autism, receive safe, appropriate, high-quality care. It also asks the board to improve standards of care during pregnancy and in the early years of children’s lives. This will include offering women the greatest possible choice over how they give birth, giving every woman a named midwife who will be responsible for them both before and after the birth, to reduce the incidence and impact of post-natal depression through early diagnosis and better intervention and support.
The mandate asks the board to measure and understand how people really feel about their care through the new friends and family test, asking patients whether they would recommend the care they receive to their friends or family. The test will cover hospital and maternity services in 2013, with other parts of the NHS following soon after. The mandate also asks the board to drive up standards of care by championing a transparency revolution within the NHS. This will make us the first country in the world to publish comparative information on performance throughout the health-care system, including on clinical commissioning groups, local councils, providers of care and consultant-led teams. Mental health, long the poor relation, must have parity with physical health. The mandate asks the board to make clear progress in rectifying that, particularly by looking at waiting times and rolling out the programme of improved access to psychological therapies.
My third priority is to improve dramatically care for the third of people in England who live with a long-term condition such as asthma, diabetes or epilepsy. As a group, they account for more than half of GP appointments and nearly three quarters of hospital admissions. That has a huge impact on the individuals concerned—an impact that can be compounded by the way in which they are dealt with by the NHS. We need to do better.
The mandate therefore asks the board to help those who rely heavily on the NHS by harnessing the power of the technology revolution. Labour’s NHS IT projects failed, wasting billions, but we must not allow that failure to blind us to how technology can transform treatment and care throughout the system. I am today asking the board to ensure, by 2015, that all NHS patients in England can access their GP records online; that, in at least parts of the country, those records are integrated with other medical records across the health and social care system, so that a single record can follow a patient seamlessly from ambulance to hospital, to GP clinic and to their own home; and that everyone can book GP appointments and order repeat prescriptions online, as well as contact their GP by e-mail. I am also asking that significant progress be made towards ensuring that 3 million people with long-term conditions benefit from telehealth and telecare by 2017.
With respect to people with long-term conditions, the mandate also asks the board to ensure, by 2015, that more people have the knowledge and skills to control their own care, and that carers have the information and advice that they need about the support that is available to them, including respite care.
My final priority is care for older people, specifically those with dementia. Already, one in three people over the age of 65 lives with dementia. Shockingly, even though the right medicines can make a huge difference to people’s quality of life and that of their families, we diagnose fewer than half of those with the condition. I want the diagnosis, treatment and care for people with dementia to be world-leading. The mandate therefore asks the NHS Commissioning Board to make significant progress in improving dementia diagnosis rates and to ensure that the best treatment and care is available to everyone, wherever they live. We also want hospitals, and indeed all NHS organisations, to make significant progress in becoming dementia-aware and dementia-friendly environments.
The mandate covers other important areas of NHS performance, including research, partnership working, the armed forces covenant and better health services for those in prison, especially at the point when they are integrated back into the community. The mandate also sets the NHS Commissioning Board’s annual revenue budget, which for 2013-14 will be £95.6 billion, with a capital budget of £200 million. An important objective for the board is therefore to ensure good financial management, as well as unprecedented and sustainable improvements in value for money across the NHS.
We are the first country in the world to set out our ambitions for our health service in a short, concise document that is centred around patients. Its clarity and brevity will help bring accountability, transparency and stability to the NHS. The last Government sent endless instructions to strategic health authorities and primary care trusts, constantly bombarding them with new targets, new directions and new priorities, and drowning the NHS in red tape and bureaucracy. In stark contrast, the mandate is just 28 pages long. It signals the end of top-down political micro-management of the NHS—an approach that failed to get the best treatment for patients and the best value for taxpayers. The mandate demands much closer integration between secondary and primary care, and between the NHS and social care. It requires a new style of leadership from the NHS, with local doctors and nurses free to innovate in the way that they commission care. I look to the board to develop their leadership skills so that they can do that. The mandate will make it easier for Ministers to hold the health and care system to account, and easier for Parliament to hold Ministers to account for their stewardship of the system. It is a historic step for the NHS, and I commend the statement to the House.
Andy Burnham (Leigh) (Lab)
The Secretary of State has just reeled off an impressive wish list, but people across the NHS will be asking a simple question: how on earth can he ask the NHS to do more, when we learn today that 61,000 jobs have been lost or are at risk in the NHS? His statements are dangerously at odds with the reality on the ground and risk raising unrealistic expectations. Across England, services are under severe pressure with ambulances queuing outside A and E, patients left on trolleys in corridors for hours on end, and increasing numbers of A and E and ward closures. No wonder nurses’ leaders today warn that the NHS is “sleepwalking into a crisis.” To listen to the Secretary of State, however, it is as if none of that is happening.
A toxic mix of reorganisation and real-terms cuts risks plunging the NHS into a tailspin. Today, people will have been hoping for a mandate for common sense to restore sanity to an NHS that is in danger of losing the plot, and for instructions to protect the front line. Well, they will have been disappointed.
The Secretary of State glosses over finance, but let me give the House the facts. He and his predecessor promised to reinvest all efficiency savings in the NHS front line—[Interruption.] Yes, they say, yet we learn that £3 billion of NHS money has been swiped back by the Treasury. When will the Secretary of State stand up to the Treasury and keep promises that the Government have made to the NHS? While the NHS front line takes a battering, the Government keep throwing money at a back-office reorganisation that nobody wanted. A full £1 billion has been spent on redundancy packages for managers, more than 1,000 of whom have received six-figure payouts while 6,000 nurses get P45s. That is the scandalous reality of the coalition Government NHS.
Will the Secretary of State confirm that a single payoff of £324,000 was made to the former chief executive of NHS Bolton? How would he care to justify that to NHS staff in Bolton who are losing their jobs? There could be no clearer illustration of a Government whose priorities are completely wrong.
Let me turn to some of the specific points set out by the Secretary of State. First, he makes welcome commitments on care for older people. If that is his priority, however, why are there no instructions in this mandate to stop commissioners from imposing restrictions on essential operations for older people? Last year, there were 12,000 fewer cataract operations than in 2009-10. Older people were told that they could have an operation in one eye but not in two. The Government boast about shorter waiting lists, but that is because people cannot get on those lists in the first place. A postcode lottery is running riot and there is nothing in this mandate to stop it.
The Secretary of State’s promises on dementia will be nothing more than hollow words until he faces up to the crisis in council budgets for adult social care. Across England, older people and carers are facing a desperate struggle as council services such as home helps are cut to the bone. Millions of people are facing ever higher care charges—cruel coalition dementia taxes—as councils are forced to put up the cost of meals on wheels and other services. If the Secretary of State really wants to help people with dementia, when will he act to stop this scandal?
Let me turn to mortality rates. Over the past decade, the deaths from heart attacks fell by 50% in men and 53% in women, and the NHS achieved the biggest drop in cancer deaths among the 10 most developed nations. It is widely accepted that the clinical networks established by the previous Government played a significant role in that success. Indeed, the NHS medical director, Professor Sir Bruce Keogh, called them “an NHS success story”. Why, then, is the Secretary of State proceeding with brutal cuts to cancer, heart and stroke networks? Surely the best way to meet the ambitions he has set out is to build on that track record of success, not destroy it.
The Secretary of State promises to implement the Labour amendment to the Health and Social Care Act 2012 to ensure “parity of esteem” between physical and mental health. However, the opposite is happening as the NHS reverts to its default position and places mental health services first in line for cuts. Will he confirm that mental health spending was cut in real terms last year, and what will he do to reverse that? He says he wants a transparency revolution, but across the country local people are being shut out of crucial decisions affecting local NHS services. If he believes in “No decision about me without me,” will he today commit to consult Greater Manchester patients with long-term conditions on whether they want ambulance services to be run by a bus company? Will he act to stop details of contracts under his “any qualified provider” regime from being kept secret from local people under “commercial confidentiality”? The truth is that patients are being shut out as his friends in the private sector fill their boots.
In the weekend’s papers, this mandate was called the first contract with the NHS—the new language of the coalition NHS, in which competition and contracts replace care and compassion. Yes, the Secretary of State has today published a new mandate, but we needed a change of direction. The Government have put the NHS on a fast track to fragmentation. Today, they have unfairly and unrealistically raised expectations on a battered NHS, thinking they have cleverly contracted out responsibility to the national Commissioning Board. I have news for them. The chaos in the NHS starts and ends with the guilty men and women on the Government Benches. We will hound them and hold them to account for the damage they are doing.
Mr Hunt
This is an incredibly important document for the NHS, and I think that we were all expecting a bit more than the same old hollow rhetoric from the right hon. Gentleman.
There could be no greater commitment to the NHS than to protect its budget at a time of unprecedented austerity. This Government have protected the NHS budget; the right hon. Gentleman said that that would be irresponsible. The Government take action; he uses words. The picture he paints of the NHS in crisis is not the picture recognised by thousands of doctors and nurses up and down the country. Of course, with an ageing population, the NHS is doing more than ever before. Nearly 1 million more people every year are in A and E than when he was Health Secretary, but it is meeting all its waiting times targets and has virtually eliminated mixed-sex wards, and hospital-acquired infections are going down. This NHS is performing exceptionally well.
Let me address some of the points that the right hon. Gentleman made. On finance, in the figures he gave, I think he was alluding to the fact that, in the first year the coalition was in power, it worked to Labour’s NHS budgets. There was an underspend in that year, as there was in each of the last four years that Labour was in control. In three of those four years, the underspend was higher than it was when my right hon. Friend the Leader of the House was Health Secretary. Let us talk about redundancy payments. The reforms introduced by my right hon. Friend will save the NHS—[Interruption.]
Mr Speaker
Order. I appreciate that there are very strong feelings on these matters, but Opposition Front Benchers must not shout at the Secretary of State as he is responding to questions. He must be heard. Everybody will have a chance—Members can rely upon me to ensure that—but the Secretary of State must be heard.
Mr Hunt
The redundancies in management and administration will save the NHS £1.5 billion every year—£1.5 billion that can be spent on the front line. We should compare that with the £1.6 billion the NHS must spend every year to deal with the right hon. Gentleman’s disastrous private finance initiative policies that left the NHS with £73 billion of debt overhang.
Let us talk about clinical networks, which are extremely important. We have four clinical networks—for cardio, cancer, maternity and mental health—and they will continue. The budget that the networks are using is increasing and not decreasing under the Commissioning Board.
The right hon. Gentleman said that ambulance services in Manchester would be run by a private bus company. I am sure the House will be interested to know who the Health Minister was when the guidelines that allow private bus companies to bid to run ambulance services were drawn up. It was the right hon. Gentleman. He was in post when that happened.
The right hon. Gentleman describes the mandate as a wish list. He should tell that to the 570,000 people who have dementia, for whom Government Members want to do a better job. He should tell it to people who suffer from cancer. They have below-average European survival rates, but we want them to have the best survival rates in Europe. He should tell it to the families and carers of people who are worried about the level of care they receive in certain parts of the system.
Government Members are determined to aim high for our NHS, because we believe in it. We believe it is doing incredibly well in difficult circumstances, but it can do even better. The right hon. Gentleman should also want an ambitious NHS. Just because he did not have those ambitions when he was Health Secretary does not mean that the Government should not aim high to make our NHS the best in the world.
Mr Stephen Dorrell (Charnwood) (Con)
I apologise to you, Mr Speaker, and to the House for my inability to control modern technology.
Does my right hon. Friend think it striking that, when he presents the first mandate of the NHS Commissioning Board to the House of Commons, we hear a lot of synthetic rhetoric from the Opposition Front Bench, but not a single disagreement with any one of his propositions from the Dispatch Box or in the mandate? Does that not demonstrate—this has always been the Conservative case—that there is a shared commitment to the ideals of the NHS, and that the difference is our ability to deliver it effectively?
Mr Hunt
I hope my right hon. Friend is right that there is agreement on the goals in the mandate, because they have been drawn up after extensive consultation with the people of this country and are important priorities, particularly as we grapple with an ageing society. I agree with him that it does not the help the NHS to descend to the rhetoric we heard from the right hon. Member for Leigh (Andy Burnham). There is a very important and legitimate debate about the right way to achieve shared goals. Government Members do not believe the right way is through performance management from the Department of Health and trying to echo out every part of the system. We believe the right way is to empower local GP-led groups to make changes on the ground. That is at the heart of the reforms.
Frank Dobson (Holborn and St Pancras) (Lab)
I can understand the Secretary of State’s desire to give operational freedom to people in each locality, and his desire, as he says in his document, to reduce the inequalities of treatment between one area and another, but how does he intend to reconcile those two objectives?
Mr Hunt
The approach the reforms take is this: when there are inequalities in treatment, and when one hospital is particularly good at certain operations and another hospital is not as good, the best way to drive up performance is to make that information available in a way that has never happened before. More than anything, peer review drives the NHS. A very important part of the programme will be to roll out plans similar to those we have rolled out for cardiothoracic surgery, for which a performance comparison by consultant team, not just by hospital, has led to a dramatic improvement in survival rates from heart operations. We need to roll that out across many other disciplines. We also need to be able to compare local GP-led group with local GP-led group, and local authority with local authority. That will be a far more effective way of driving change than the old top-down way. That was tried under different Governments many times and in many ways, but it was never as successful as it was meant to be.
Paul Burstow (Sutton and Cheam) (LD)
I welcome the statement, and particularly the actions that are being taken to deliver parity of esteem between physical and mental health, and to drive improvements on dementia. Those two things are linked by the common frustration of family carers, who feel that their voices are not always heard or understood within the NHS, and that there is too much variation in this country when it comes to identifying carers and ensuring that they get access to the breaks they so often need. Can the Secretary of State assure us that the mandate will ensure that people who need breaks get them before they have a breakdown?
Mr Hunt
I thank my right hon. Friend for the work he did at the Department, which is widely recognised on both sides of the House. He is right to talk about the critical role of carers. We have spoken a lot today about dementia. Dementia puts huge pressure on partners of the people affected. Very often, because we do not give the support we need to give at an early stage, people with dementia end up having to go to residential homes, whereas with that support, they would be able to stay at home happily for much longer. It is a critical issue. I hope he will be pleased to see in the section on long-term conditions explicit mention of the role of carers. We will follow the matter closely as the NHS Board implements at a local level the support he mentions.
Mr Bob Ainsworth (Coventry North East) (Lab)
My constituent Michael Wade was wrongly refused surgery for a life-threatening condition. What in the mandate improves patients’ rights, or will they have to continue to have to rely on MPs and campaigning local newspapers?
Mr Hunt
Any such examples are totally unacceptable. The rights that people have to the treatment they need clinically are enshrined in the NHS constitution. There will always be a need for MPs and other campaigners to highlight problems in the system, but we hope to make it much easier by exposing unacceptably low levels of clinical care much earlier than happens currently. As a result of the changes in the next two years we will see the NHS becoming the most transparent health care system of any in the world, which we hope will enable us to identify failures before they lead to the kind of tragedy the right hon. Gentleman mentions.
Mr John Baron (Basildon and Billericay) (Con)
I understand that the Government are adding the one and five-year indicators for all cancers to existing indicators in the NHS outcomes framework. That is very welcome. It will particularly help those with rarer cancers, and the all-party group on cancer has long lobbied for it. Will the Government work towards ensuring that the commissioning outcomes framework, which measures clinical commissioning groups, mirrors those one and five-year indicators, which are terribly important in encouraging earlier diagnosis so that we have coherent policies at the national and local level?
Mr Hunt
May I thank my hon. Friend for his work campaigning on cancer? He is absolutely right. We want to make sure that we pick up rarer cancers, so we are moving towards a composite indicator for cancers with the one and five-year measures. He is absolutely right that, properly to drive improvement, we need to compare not just hospital and consultant-led teams, but local GP-led commissioning groups, so that where there are successful outcomes everyone knows that. To get that comparison to work, we have to ensure that we compare the demographics. Part of the work we are doing is to understand how we can meaningfully compare CCGs, so that the public can truly understand who is doing best and who needs to do better.
Stella Creasy (Walthamstow) (Lab/Co-op)
The Secretary of State talks about operational independence on the ground for doctors and CCGs. He did not mention anything in his statement about sexual health care. One issue that we have been struggling with for some time in Walthamstow is the limitations of doctors who have decided to deny women even the most basic contraceptive services. We are still struggling with how the new mandate and new services will deliver them. Will the Secretary of State meet me and women from Walthamstow to discuss the issue, so that we can be confident that the changes will not lead to a further deterioration in sexual health care services across the country?
Mr Hunt
We will publish a sexual health strategy at the end of this year that will look at variation in services across the country and at the kind of problems the hon. Lady raises. It will be led by the public health Minister, my hon. Friend the Member for Broxtowe (Anna Soubry), who will be happy to meet the hon. Lady to discuss the issue further.
David Tredinnick (Bosworth) (Con)
My right hon. Friend’s statement will be widely welcomed, especially his emphasis on an integrated system based on the needs of people. Does he not agree, however, that there is far too little use of complementary medicine outside private health care, and that greater use of herbal medicine, acupuncture and the much under-utilised resource in this country of homeopathic medicine, homeopathic doctors and the Society of Homeopaths, would be a good thing? Seventy per cent. of pregnant women in France use homeopathic medicine.
Mr Hunt
There are parts of the country where acupuncture is available on the NHS. This will be clinically led. It needs to be driven by the science, but where there is evidence, and where local doctors think that it would be the best clinical outcome for their patients, that is what they are able to do.
Mr Dennis Skinner (Bolsover) (Lab)
As a customer of the national health service, I was lucky enough to have cancer treatment and a heart bypass in those days—halcyon days, almost, by comparison—when 80,000 nurses and 20,000 doctors were recruited, and the money increased from £33 billion to well over £100 billion. Does the Secretary of State know that the optimistic outlook that existed in those days has now been replaced by a climate of fear? That is what I find at the sharp end in hospitals when I go to see the same people I met at the end of the last century. What I say to you is that the figures might sound grand and all the rest of it, but when you start sacking 60,000 people in the national health service, set against a background of elderly people living longer—people like me who need the treatment—the net result will be a catastrophe and not those halcyon days of yesteryear.
Mr Hunt
Let me say to the hon. Gentleman that we have 17,000 fewer managers than when his party was in power. We also have 3,500 more doctors and there are more clinical staff in the NHS today than when his party left office, so I think the record speaks for itself. There is not a climate of fear—I reject that. There is an understanding that the NHS is under a lot of pressure, with an ageing population and more people using and needing its services every year. That is why today’s package is so important to support the NHS in delivering what the public need.
Dr Sarah Wollaston (Totnes) (Con)
At long last, the NHS will be operationally independent, and genuinely clinically led. I welcome the mandate: it is an excellent and ambitious target for the NHS. Will the Secretary of State reassure the House that, in these challenging times, efficiencies made in the NHS will be genuinely reinvested in patient services?
Mr Hunt
My hon. Friend, as a GP, will recognise from the mandate that a lot of the improvements that we need in the NHS are in primary care. The budget for the NHS is protected, but demand for services is going up, so we need to make these changes. I will give her one example where I think that this is particularly important. The number of hours it will save GPs if the majority of prescriptions are ordered online, which does not happen at the moment, could transform life for more than 8,000 GP surgeries up and down the country.
Jeremy Corbyn (Islington North) (Lab)
One of the great problems the NHS has is the millstone of private finance initiative costs that are so damaging to so many hospitals. The other millstone is the huge profit made by the private sector on contracted out and privatised services. Is it not time for the Government to give a clear directive to the NHS to employ its staff to deliver its services and borrow money in the traditional way to build new facilities, so that public money goes into a public service and the public are not lining the pockets of the banks and private health providers instead?
Mr Hunt
I hope we can move beyond the debate about public good, private bad and private good, public bad that has dogged the NHS for many years. I believe there is a role for the independent sector and the voluntary sector. Of course, the primary role will be for the traditional NHS. However, when the private and voluntary sectors are used will not be a matter not for politicians or parties; but for local doctors on the ground. I think that in the vast majority of cases, they will want to use and contract with traditional NHS services, but it is important that they have the choice to do what is in the interests of the patients for whom they are responsible.
Henry Smith (Crawley) (Con)
For too many years in my Crawley constituency health decisions were made by people who were nowhere near that location. I am delighted that under this Government decisions are being returned to local clinicians and local people. We have seen results already—the local CCG has started a dementia pilot with money from the Department of Health. Will my right hon. Friend join me in congratulating that kind of vision, both in Crawley and elsewhere?
Mr Hunt
I am more than happy to do that, because when it comes to conditions such as dementia there is no one right solution, and doctors’ surgeries and hospitals will have different approaches in different parts of the country. We want everyone to take ownership of the problem. I hope that what is happening in Crawley will be noticed by other parts of the country, so that we can spread best practice everywhere. That is the point—we want to allow innovation to happen in a way that has never happened before.
Grahame M. Morris (Easington) (Lab)
This is a hugely significant occasion. It is the one opportunity that Parliament will have to call the Secretary of State to account for the priorities that he sets for the NHS Commissioning Board, so may I refer him to his pledge to improve cancer outcomes? Given that he made a pledge to the House on 23 October to make available to anybody who required it innovative radiotherapy, how does that square with giving back to the Treasury £3,000 million that could otherwise be used to buy advanced and innovative radiotherapy equipment?
Mr Hunt
Let me remind the hon. Gentleman, as I reminded the right hon. Member for Leigh, that for the four years that preceded this Government, there were underspends, including when the right hon. Gentleman was Health Secretary, and in three of those four years the underspend was higher than it was in our first year in office. But we do want innovative cancer treatments to be available. That is why we introduced, among other things, the cancer drugs fund, which was not introduced by his Government and which has transformed the lives of thousands of cancer sufferers.
John Pugh (Southport) (LD)
I welcome the statement, particularly the use of IT and online resources, but how will we avoid the previous errors of Connecting for Health and its huge costs?
Mr Hunt
That is a very important question. We are going to avoid that because I will not be signing any big national IT contracts. The initiative will be locally led and locally driven. Guidelines will be laid down to make sure that all the systems developed in different parts of the country are inter-operable. That is very important, but we will not have any grand plans nor will there be a big single database, so we can thereby avoid some of the problems. We must none the less be prepared to grasp what technology changes can mean for the NHS, just as they do for the rest of society.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
On 23 October I raised with the Secretary of State unacceptable delays of two and a half hours for the transfer of patients from ambulances to James Cook University hospital accident and emergency in Middlesbrough on 27 September. Last Thursday night for one hour and last Friday morning for one hour, owing to bed pressures, patients in ambulances were diverted from James Cook to North Tees hospital, and 14 planned operations were cancelled the same Friday and the following Saturday. Is not the mandate completely dependent on whether the Secretary of State is in control of the remit of his Department?
Mr Hunt
The mandate makes it clear that waiting times targets must be met. That is a very important part of the mandate. I continue to be extremely concerned by what the hon. Gentleman tells me about what is happening in his constituency, and I look to his local NHS to come up with a sustainable, rapid solution.
Mr Philip Hollobone (Kettering) (Con)
As the Secretary of State saw for himself when he visited Kettering general hospital recently, the NHS is very good at treating people but perhaps is not quite as good at preventing people from getting ill. Given that prevention is better than cure and often less expensive, what is there in this mandate that will encourage up-front health care before patients are admitted to hospital?
Mr Hunt
There is something critically important in the mandate that will do that, which is that by making the NHS operationally independent we are giving commissioning responsibilities to local GP-led groups for the first time, and GPs understand the importance not just of primary care but of prevention. So I think we will see much more innovation, along with the co-operation that the NHS has with local authorities and the new health and wellbeing boards, to make sure that there is a much bigger focus on prevention than there has been in the past.
Valerie Vaz (Walsall South) (Lab)
Will the Secretary of State confirm that if there is an underspend in the NHS Commissioning Board financial allocation, that will stay in the NHS and not go back to the Treasury?
Mr Hunt
As the hon. Lady knows, we manage our finances extremely carefully but we do have underspends. We try to minimise them and there has been a real-terms growth in spending—actual money spent in the NHS, compared with Labour’s plans. In the first year of the review there was a real-terms increase and we will continue to manage NHS finances with a commitment to protecting the budget, which did not ever happen when the right hon. Member for Leigh was in post.
Mr David Burrowes (Enfield, Southgate) (Con)
I welcome the Secretary of State’s priority to reduce the disparity in health outcomes, not just across the country but across local areas. Will he reassure me that the mandate, delivered in partnership with local health and wellbeing boards and local GPs, will end the scandal—Labour’s legacy—that from the west of the borough of Enfield to the east, the age mortality rates decrease by more than 10 years?
Mr Hunt
My hon. Friend is right. That is why, at the heart of the mandate, is an information revolution so that the public can understand exactly how well different parts of the system work, and so that we create the right pressures on the system to improve where performance is poor. I agree that the central, top-down structures that we had before did not allow that to happen. If we had cut the budget, as the Opposition wanted, it would have been even more difficult now.
Keith Vaz (Leicester East) (Lab)
Tomorrow, as the Secretary of State knows, is world diabetes day. I discovered that I had diabetes only because of a chance visit to my local GP. I welcome what the right hon. Gentleman said about including diabetes in his mandate, but will he mandate the local health authority to test all its patients? Today marks the start of the Hindu new year—Diwali. In this new year statement that he is making today, will he ensure that everyone is tested for diabetes in their local practice?
Mr Hunt
As the right hon. Gentleman will know, we are losing 24,000 people unnecessarily every year by not properly recognising the symptoms of diabetes. That is incredibly important. We have made it clear that reducing mortality rates—preventing avoidable mortality—is a major priority of this Government, so I expect this to be a key priority for GP practices and for local authorities throughout the country.
Andrew George (St Ives) (LD)
I welcome my right hon. Friend’s statement today and the mandate, and note that it is based on the NHS constitution, which states that it is founded on a common set of principles and values. So in a week when GPs have become millionaires by selling off their interests in parts of the NHS, may I suggest a further test, beyond the friends and family test—a patients before profit test? Will that be introduced?
Mr Hunt
The outcome that we want is for more patients to live longer and more healthily than ever before. The right thing for me to specify in the mandate is that we want the NHS to deliver improved patient outcomes. Sometimes that will involve using the independent sector and the voluntary sector, but in the vast majority of cases it will mean working within the traditional NHS. If we deliver those improved outcomes, we will be doing the right thing by patients throughout the country.
Jim Shannon (Strangford) (DUP)
Minister, may I thank you for your statement on the mandate and in particular your reference to the armed forces covenant? Mental health has been the poor relation for too long. The statement says that mental health will be elevated to parity with physical health. Can the Minister explain how those who have fought in the wars in Iraq and Afghanistan in particular and who have seen the awfulness and the brutality of war will be helped through the mandate?
Mr Speaker
Order. I always listen extremely carefully to the hon. Gentleman, who has asked a very serious question. I hope he will take it in the right spirit if I say that my medium-term ambition is to persuade him to cease to use the word “you” in asking questions in the House. But his question has been heard and it will now be answered.
Mr Hunt
The hon. Member for Strangford (Jim Shannon) may know that there is a mental health helpline specifically for veterans because we recognise the importance of this decision. He will also have seen from the mandate that mental health is mentioned in virtually every part of it, whether in the context of avoiding mortality from extreme mental illness or helping people with long-term conditions, which would also cover post-traumatic stress disorder.
Steve Brine (Winchester) (Con)
The Secretary of State rightly places survival rates at the top of his agenda and identifies the importance of early diagnosis. When it comes to breast screening, the switch to digital is critical in spotting cancer early. Does he agree that the NHS must move faster in making that switch to digital?
Mr Hunt
I absolutely agree. That can be hugely transformational in terms of patient outcomes. Many patients would be astonished to know that a full medical record is not available to consultants in hospitals before they operate on them. We need to put that right because it could transform the decisions that surgeons take in extreme cases. So my hon. Friend is right, and we must press on with this very fast.
Helen Goodman (Bishop Auckland) (Lab)
The Secretary of State and the whole Government are keen to deliver public services using the internet and online. He mentioned in particular people with long-term conditions being able to communicate with their doctors online. The Department for Work and Pensions has found that 6.5 million people who will be entitled to universal credit have never used a computer. Has he any knowledge at all of how many of those with long-term conditions are computer literate?
Jeremy Lefroy (Stafford) (Con)
I welcome my right hon. Friend’s objectives, particularly on the quality of care and—I would add—patient safety, which is so important. With an ageing population—a 50% increase in the number of over-60s by 2045 has been predicted—equality of access will require most clinical services to be close at hand. How does he expect to hold the board to account over its duty to reduce inequalities of access?
Mr Hunt
The waiting time targets are among the board’s responsibilities under the mandate. Having care close to home is a key priority for many patients, often because they think that the quality of care will be better, if it is at a local hospital or—even better—in their own home. One major change resulting from the increased role for GPs under the mandate will be much better support for domiciliary care, which will enable people to live at home for longer.
Alison Seabeck (Plymouth, Moor View) (Lab)
The tension between the postcode lottery and local commissioning has been discussed, but of paramount importance is how the budgets filter down to the various groups. The Secretary of State just said that funding to the cancer, stroke and heart networks will increase, yet a paper from the NHS Commissioning Board talks about funding cuts from £18 million to £10 million. I am afraid that the veracity of his figures is often challenged. Would he like to put the record straight on the figures?
Steve Rotheram (Liverpool, Walton) (Lab)
In priority 4—dementia—the Secretary of State states that the NHS Commissioning Board is mandated to ensure that the best treatment and care are available to everyone, wherever they live. Can he guarantee that there will be no postcode lottery, and that people with dementia in Liverpool will get the same treatment as the best in the rest of the country?
Mark Durkan (Foyle) (SDLP)
I think we can all welcome the four stated priorities of the new mandate, not least in respect of cancer, mental health and dementia, and I recognise that the statement will have predictive implications for devolved policy making as well. Is the Secretary of State confident that the means and methodology are there to fulfil this mandate? Are resources sufficient and responsibilities sufficiently clear? Will this be workable in practice, or just a worthy presentation from a Minister?
Mr Hunt
The mandate sets some very high ambitions in challenging times, but those ambitions can help to reduce costs and make the NHS more sustainable. Embracing the technology revolution should mean that we give people better care, as should allowing clinicians more time to spend with patients and allowing nurses to spend more time with the people they are responsible for, but those things should also save the system money. There is not an either/or, but I accept the hon. Gentleman’s point that this is very ambitious.
Kevin Brennan (Cardiff West) (Lab)
Does the Secretary of State’s commitment to parity of esteem for mental health services include a promise that under his watch spending on mental health services will not decline in proportion to spending on physical health services?
Mr Hunt
The hon. Gentleman will understand that the purpose of such a mandate is not to set specific financial objectives but to set outcomes for patients, and then to let local professionals on the ground—doctors and nurses—decide how best to deliver them. The mandate is clear, however, that we want parity of esteem for mental health and to improve equality of access, which at the moment is much better for physical health than for mental health.
Helen Jones (Warrington North) (Lab)
The stroke networks have been hugely successful at reducing mortality and inequalities of treatment in this country, yet their future is now in doubt, staff are being lost and their funding is not guaranteed. What can the Secretary of State do to assure those involved in stroke care that his mandate will ensure that they are properly funded and resourced?