UK Life Sciences
Jeremy Hunt Excerpts(11 years, 5 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(11 years, 5 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(11 years, 5 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(11 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I would like to make a statement 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?
Regional Pay (NHS)
Jeremy Hunt Excerpts(11 years, 6 months ago)
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Andy Burnham
These are the same staff whom we were celebrating during the Olympic games, just a few months ago, for everything that they contribute to the NHS and to the care of others, but Ministers sit there and do absolutely nothing. It is disgraceful that any staff in the NHS should be treated in such a way.
This is no academic threat. These are the panic moves of an NHS that is experiencing increasing distress, in which control has been lost because it is facing the biggest financial challenge in its history. After the election, the £20 billion Nicholson challenge should have been the only show in town, but the previous Secretary of State was allowed to proceed with his vanity reorganisation of the NHS. Instead of focusing on saving money, the NHS has been busy wasting it: £1.6 billion, and rising. A full £1 billion has been spent on redundancies—1,300 people have received six-figure payouts, and l73 have received more than £200,000—while 6,000 nurses are losing their jobs. That is scandalous.
As unforgiveable is the Conservative party’s repeated inaccurate boast on NHS funding. I checked on the Conservative party website today, and in the “Where we stand” section it says this:
“We have increased the NHS budget in real terms in each of the last two years.”
Andy Burnham
The Secretary of State nods, because he has made similar statements. I want to know whether he stands by those words as a truthful and accurate statement.
Andy Burnham
He says he does, so let me refer him to table 1.8 of the Treasury’s “Public Expenditure Statistical Analyses 2012”. On NHS spending it shows the following: for 2010-11, a 0.6% real-terms cut; for 2011-12, a 0.1% cut. Those are the facts. How on earth can the Secretary of State say today that he stands by—[Interruption.] The figures are there in black and white. There have been two years of real-terms cuts in the NHS. If anyone does not believe my analysis, a Department of Health press release from July 2012 confirms what I have said:
“PESA figures released today show that in real terms NHS spending has reduced.”
So I ask the Secretary of State this: will he today remove that untrue statement from the Conservative party website? It is giving a false impression of what is happening in the NHS. Perhaps it is designed to give the impression that the drastic moves on pay are a local matter not of Ministers’ making. This is the real picture, however: the Government have forced the NHS to fund a £1.6 billion reorganisation it did not want—even though they promised that would not happen—from a falling budget which they still claim is increasing.
All trusts have been put in a difficult position by this Government, but that is no excuse for some taking the easy way out by taking it out on staff. If they are allowed to do that, they will damage something that serves the wider good.
The “Agenda for Change” system introduced by the last Government represented a significant step forward, and I want to set out the compelling economic, social and health policy arguments in its favour. First, it brings stability to the service. Unlike other areas of economic activity, health care depends upon certainty and predictability. As an essential emergency service, it needs to be there for people day in, day out. Volatility helps no one. All communities need a full complement of clinical grades and professions. Local or regional pay is not conducive to stable services. If one area starts seeking to poach staff from another, no one wins, as we will get instability and, over time, an inflationary pressure that is hard to control at local level.
That brings me to the second reason in favour of national pay. All the evidence suggests that a national approach to pay and conditions helps to reduce costs and risks to the NHS. Market-based systems tend to cost more, not less.
There is also the hassle and distraction factor of every individual NHS employer or regional group going through the annual process of pay negotiation and setting. Trusts rushing to break away from the national pay system forget that. They are also forgetting the risks of the pre-“Agenda for Change” days, when individual trusts would bear the full legal exposure of failure to implement equal pay legislation. It would seem that there are a few short memories in the NHS. People are forgetting that the advent of a national pay system has insulated the NHS from those risks, which have impacted on other parts of the public sector, such as by bringing more turbulence in recruitment and retention.
I do not think the 32 trusts involved in the breakaway have fully thought through the consequences of their position. For instance, national pay is reflected in the calculation of the tariff under the payment by results system, so are these trusts expecting to be paid at national tariff rates by commissioners while paying staff regional rates? I find it hard to see how that could be justified. So, in effect, they are not only pulling down the system of national pay that helps to give stability for everyone; they will also end up pulling down the national tariff system.
The third health policy reason for national pay is the most compelling. National pay helps with the recruitment of staff in the areas where they are most needed. If we follow through the logic of the argument of proponents of a broken down system of regional or local pay, it will end in a proposal to pay people less in areas where unemployment is highest and wages are lowest. The problem with that argument is that those areas are also the most deprived parts of our country where the health challenges are greatest. It is often much harder to work on the NHS front line in areas of higher health need and deprivation. We need to work hard to attract the most motivated staff to those areas, and I simply do not see how that will happen if the offer to work in the areas where the pressure is greatest includes being paid 15% less.
In the end, care is a people business and this race-to-the-bottom approach simply does not deliver the quality people are looking for. We have seen that approach in social care: a crude race to the bottom and a cut-price, minimum-wage business. That simply does not work.
It is true that pressures vary from place to place and the job is not the same everywhere, but the principle that a health visitor, a physiotherapist or a midwife should be paid broadly the same for doing a similar job is a good one. It is fair to staff, and we should stick with it.
That brings me on to the fourth reason: the social and economic case. All the evidence points to regional pay in public services causing damage to the regional economies of England. Rather than stimulate the south-west economy, it has been estimated that regional pay would take £140 million out of it.
It is not just the public sector making that argument. Some 60 academics wrote to The Times to say that, and businesses in the north-east have written to the Chancellor raising their concerns. They said:
“Now is the time for the country to unite and focus on growth, not risk a divisive and harmful policy such as this.”
They are right. An NHS with national pay is a one-nation policy. What is happening in the NHS risks cementing the regional divides and creating an unequal Britain.
Taken together, those four reasons stack up a compelling case for keeping a system of national pay in the NHS. Losing it will be bad for the NHS, bad for the economy and bad for society.
I know that the force of that argument is not only felt on the Opposition Benches. Debates such as this one usually divide Members along tribal lines, but there are Members in all parties who represent areas where the jargon of “market-facing pay” means one thing: crude pay cuts for the staff who work so hard to serve their constituents day in, day out. What I find encouraging is that Members on both sides of the House whose constituencies would be affected by these changes have had the courage to speak out against them.
It is not just Liberal Democrat Members who are doing so. I am encouraged by the fact that a number of Conservative Members have expressed serious concerns. The hon. Members for Brigg and Goole (Andrew Percy), for Stafford (Jeremy Lefroy), for Carlisle (John Stevenson) and for Hexham (Guy Opperman) have all spoken out, and I can do no better than repeat the words of the hon. and learned Member for Torridge and West Devon (Mr Cox):
“I am extremely cautious about any change that might further depress incomes in our area or that might act as a disincentive to those in the medical profession to work here.”
The Government Front-Bench team would do well to listen to those concerns, as I suspect they are widely held across this House.
The Government’s amendment does absolutely nothing for the 88,000 NHS staff in the south-west who are worried about the future. It does nothing for the businesses worried about regional divides. It ducks the issue, and lets local and regional pay creep in through the back door. If the Secretary of State has any belief in a national health service, he must step in tonight, stop the breakaway and uphold the principle of national pay in the NHS. I commend the motion to the House.
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“notes that the Agenda for Change pay system, introduced by the previous administration in 2004, already includes regional flexibilities, including high cost area supplements and recruitment and retention premiums; further notes that the previous administration also introduced local pay variation in the courts services; recognises that the previous administration established foundation trusts and in so doing removed the power of the Secretary of State to issue directions to trusts over matters of pay; accepts that the rt. Hon Member for Leigh had the opportunity to change this through legislation when he was Secretary of State but chose not to; looks forward to the publication of the NHS Pay Review Body report on the case for further reform to the pay system; supports the view expressed by the Chief Secretary to the Treasury at the GMB union conference that there will be no change unless there is strong evidence and a rational case for proceeding; and calls on the Government to continue to support employers and trade unions to work together for the benefit of patients and staff.”
What we have just heard is a shocking attempt to talk down the NHS and to misrepresent my views and those of the Government. As a former Secretary of State, the right hon. Member for Leigh (Andy Burnham) should know better.
I am glad, however, that the right hon. Gentleman has called this debate today, as it gives me a good opportunity to sing the praises of NHS staff up and down the country for the brilliant work they are doing. It is work that, contrary to the tone of the right hon. Gentleman’s comments, is delivering an NHS that is performing better than ever despite extremely challenging financial circumstances: an NHS where infection rates are at their lowest levels since the introduction of mandatory surveillance; an NHS where, despite what the right hon. Gentleman and his colleagues would have people believe, the number of patients waiting over 18 weeks is at the lowest ever level; an NHS where, for the first time since “call connect” was introduced, all ambulance trusts are meeting their category A8 performance measure; an NHS with more clinical staff than ever before, including 3,500 more doctors and 900 more midwives; and an NHS where performance measures on accident and emergency, cancer care, dentistry and waiting times are all being met.
Compared with the situation at the last election, we have an NHS treating almost a million more people in accident and emergency, carrying out over half a million more out-patient appointments, and conducting over one and a half million more diagnostic tests. None of that would have been possible if we had introduced the cuts proposed by the right hon. Gentleman at the last election. Instead, despite the huge pressure created by Labour’s deficit, we are actually increasing spending on the NHS by £12.5 billion.
Let me start by saying thank you to the many NHS staff who have made that possible—to more than a million people who work night and day, often in incredibly challenging circumstances. We owe them a debt, which is why the scaremongering we have heard this afternoon from the right hon. Gentleman is inaccurate at best, and downright irresponsible at worst.
Derek Twigg (Halton) (Lab)
One way in which the Secretary of State can express his thanks is by ruling out regional pay. Will he tell us now whether he will do so, because it is a major concern for my constituents, who have written to me in their dozens over the past two or three weeks?
Mr Hunt
May I just answer the question put by the hon. Member for Halton (Derek Twigg)? Let me make it clear: we are not proposing to abolish “Agenda for Change”; we are not proposing an end to national collective bargaining; we are not proposing the abolition of national pay scales; and current pay scales will not be cut. What we are doing is supporting the changes brought in by the previous Labour Government to ensure there is sensible flexibility in pay across the whole country.
Mr Anderson
The Secretary of State mentioned people working night and day. Does he agree with the agreement in “Agenda for Change” that people should get additional pay for working night shifts, both because such shifts are antisocial and as compensation for not only the impact on family life but the fact that people who work night shifts tend to die earlier?
Mr Hunt
I support the principles behind “Agenda for Change”, which were introduced in 2004 by the Labour Government of which the right hon. Member for Leigh was a member. I also support a number of other flexibilities introduced by the Government—the right hon. Gentleman supported the legislation—in respect of foundation trusts.
Mr Bradshaw
The south-west cartel is not about flexibilities introduced to allow hospitals to attract staff and pay them more, as they in fact did; it is about a regional pay system. The Secretary of State has to decide: is he for or against the south-west cartel? Does he say yes or no?
Mr Hunt
Perhaps the right hon. Gentleman will explain why he voted for the Health and Social Care (Community Health and Standards) Act 2003, which gave foundation trusts the freedom to introduce their own terms and conditions. Until he explains that, which we are simply supporting, I am afraid that his position is extremely tenuous.
Hugh Bayley (York Central) (Lab)
The NHS budget is actually going down. It is certainly much more constrained than it was under the previous Government, so if the Secretary of State accelerates the regionalisation of pay, it will presumably fall in low-pay areas such as mine in Yorkshire and rise in the leafy suburbs of Surrey, which he represents. Will the health budget then be transferred from poorer areas in the north of England to the high-pay places in the south?
Mr Hunt
Let me remind the hon. Gentleman that he supported the 2003 Act, which gave foundation trusts the power to set their own terms and conditions. Let me also remind him that this Government have increased the NHS budget in real terms—something that the right hon. Member for Leigh said was “irresponsible”. Let me say clearly that we are not changing the allocation of resources to different parts of the country, but we are allowing the flexibilities that the Labour Government introduced for local NHS managers to make sure that they get the benefit. If the hon. Member for York Central (Hugh Bayley) listened to what I said about a million more people being treated in accident and emergency, one and a half million more diagnostic tests being carried out, and about half a million more out-patient appointments being dealt with, he would understand that all our constituents are benefiting from that. That is because we have the flexibilities that that Government introduced.
Andy Burnham
The Secretary of State said again that in 2010-11 and 2011-12 the NHS budget increased in real terms. Is he saying that Her Majesty’s Treasury has got its figures wrong?
Mr Hunt
No. Let me just remind the right hon. Gentleman that the budget increase in the NHS that this Government committed to and that this Government announced was something that he said would be “irresponsible”. We have ignored that, and I have been completely clear that the NHS budget went up.
We support recruitment and retention pay—an amount that can be as much as 30% of a person’s salary, and which the Opposition, if they were consistent in their opposition to regional pay, would presumably wish to abolish. We support the London weighting, which is, again, a form of regional pay that we would be planning to abolish if we listened to the Opposition’s arguments today.
Mr Hunt
The hon. Lady might want to think about her own constituents before she jumps on that bandwagon. We also support high-cost area supplements. Why should trusts not be able to offer higher packages to lower-paid staff living in expensive areas beyond the capital so that they can live nearer to where they work? If we listened to the Opposition and their trade union sponsors, that, too, would be banned. This Government support the right of local trusts to determine how best to reward their own staff, so they can recruit, retain and motivate the people whom patients rely on every single day. That includes the right of each employer to choose their own terms and conditions or to use national terms and conditions, should they wish.
Yasmin Qureshi
I was not in this House when the earlier legislation and policies were being put through, but the question for today is: will someone working in London be paid the same as someone doing the same work in Bolton? Will the Secretary of State reassure us that the fundamental change to that arrangement will not take place?
Mr Hunt
May I gently remind the hon. Lady that she stood for election on a manifesto that did not include abolishing the 2003 Act or the Health Act 2006, which gave foundation trusts the freedom to set their own pay and conditions? [Interruption.] I ask Labour Members to let me answer the question. May I also remind her that the previous Government, whom she supported, introduced “Agenda for Change”, which does not pay the same amount throughout the country for the same work? It actually includes a lot of flexibility for regional pay.
Steve McCabe (Birmingham, Selly Oak) (Lab)
So far, the Secretary of State is describing what he sees as the benefits of flexibility. I put it to him that if a number of regions adopt the south-west’s approach, he will eventually be confronted by the fact, as the Secretary of State, that the poorest parts of this country will not be able to attract the doctors they need. What will he do then?
Mr Hunt
All we are doing is supporting what the hon. Gentleman’s Government did, which was to introduce flexibilities for the people who run foundation trusts to set pay and conditions in order to get the best health care in their areas, including in his constituency, in that of the right hon. Member for Leigh and in mine. The previous Labour Government did not just support that; they legislated to require it. They introduced foundation trusts—
Mr Hunt
I am going to make some progress now. The previous Labour Government introduced foundation trusts in 2003, giving them the power to set their own terms and conditions, just like NHS trusts. Indeed that Government went further, removing the remaining powers of the Secretary of State to intervene. Then, in 2004, the right hon. Gentleman’s Government included regional pay as a firm principle of “Agenda for Change”. Then they legislated to confirm these principles in the Health Act 2006. Who was the Health Minister then? It was the right hon. Gentleman.
The right hon. Gentleman recently referred to this flexibility as a “loophole”. It is not a loophole; it was one of the central planks of that Government’s policy. Let us consider the following:
“The challenge now must be to genuinely free the very best NHS hospitals from direct Whitehall control.
We plan to do this…by removing the Secretary of State's powers of direction over NHS Foundation Trusts…
Exercising these freedoms will give NHS Foundation Trusts precisely the sort of autonomy that is commonplace for hospitals elsewhere in Europe.”
Those are not my words, but those of his colleague and former Health Secretary, Alan Milburn, when he introduced foundation trusts.
The question that the right hon. Gentleman has to answer—he has completely failed to do so—is why, as Health Minister, he legislated for these powers if he disagreed with them. If he disagrees with them, why did he not overturn them when he had a chance to do so as Health Secretary? Either he has changed his mind or the unions which bankroll his party have changed it for him. Whichever is the case, it is a pretty sorry state of affairs for a party that claims to aspire to power.
Andy Burnham
The Secretary of State has misrepresented the former Government’s position twice, and on NHS spending. Let me just ask him about regional pay. He said he is building on what we did. When we left office not a single NHS trust in this country had opted out of the national “Agenda for Change” system—that is a fact—because we defended the principle of national pay. He has just said to my right hon. Friend the Member for Exeter (Mr Bradshaw) that he will not condemn the cartel in the south-west, and that he wants trusts to choose whether to opt in to national pay or regional pay. Should he not tell Liberal Democrat Members and the people sitting behind him that he supports local and regional pay in the NHS?
Mr Hunt
That is a funny way of defending the principle of national pay: legislating to give foundation trusts the ability, for the first time ever, to set their own terms and conditions. I do not know how the right hon. Gentleman defines it, but that does not seem to me to be in any way logical.
Sarah Newton (Truro and Falmouth) (Con)
I represent an area with a very high cost of living. Does my right hon. Friend agree that trusts trying to balance their books should not do so at the expense of modestly paid care assistants and nurses?
Mr Hunt
I agree that I want local trusts to have the freedom to get the best health care for people in their areas, including my hon. Friend’s constituents. I agree that that means recruiting and retaining the very best staff and ensuring that they are highly motivated. My hon. Friend makes an important point: we must think about areas where the cost of living is lower, but we must also think about areas where it is higher. People in my constituency who work for the NHS have to commute from Portsmouth because they cannot afford to live near the hospitals and community health centres where they work. That is why an element of flexibility is a very important principle.
Mr Hunt
I want to make a little more progress, and then I will perhaps take one or two more interventions.
NHS employers have the ability to set their own terms and conditions, but the vast majority prefer to use national terms and conditions, and provided that those remain sustainable and fit for purpose, they are likely to continue to do so. I welcome the national negotiations between NHS employers and NHS trade unions, and I urge both sides to bring the negotiations to a swift and successful conclusion. Unfortunately, the time it is taking for agreement to be reached is encouraging some employers, such as those in the south-west consortium of NHS and foundation trusts, to examine alternative provision. Sadly, it appears that the people who bankroll the Opposition—particularly Unite—would rather put their members’ jobs at risk than work with employers to find an acceptable solution to help the NHS meet its financial challenge—[Interruption.] I am sorry they do not want to hear this—
Mr Speaker
I am grateful to the hon. Gentleman, but that is a point of debate that he might wish to develop further if he is successful in catching my eye. We will leave it for now.
Mr Hunt
I ask the right hon. Member for Leigh, rather than irresponsibly scaremongering, to do something positive by doing everything in his power to encourage his trade union friends to work in the best interests of their members, of patients and of his constituents and mine to come to a speedy resolution. I suspect he has rather more influence with the unions than I do in that regard. Even with a protected NHS budget—something that he thought was “irresponsible”—the NHS must do significantly more within its limited means, and as its single largest expense the pay bill cannot be immune to change. It represents between 60% and 70% of total expenditure in most NHS organisations and costs more than £43 billion in the hospital and community services sector alone.
Jack Dromey
I was involved in the process that led to the groundbreaking agreement “Agenda for Change”. It was a national agreement that contained certain flexibilities but it explicitly rejected regional pay. Regional pay is now proposed in the south-west. Does the Secretary of State support that move or condemn it?
Mr Hunt
I support proper negotiations between NHS employers and unions to revise, reform and improve “Agenda for Change” so that it is fit for the very different financial circumstances in which the NHS now finds itself. The vast majority of NHS trusts and foundation trusts, including in the south-west, would rather negotiate on national pay scales, but that means the unions being realistic about what is sensible in this financial climate. That is why employers need to use the system more efficiently and effectively, extending the use of high-cost area supplements when they can be justified to tackle the recruitment and retention issues that affect a particular area or region.
Like the previous Government, we want to retain the flexibility that allows individual employers to use recruitment and retention premiums and, like the previous Government, we want any changes to be introduced incrementally in full partnership with NHS employers and trade unions.
Mr Hunt
I have already given way to the right hon. Gentleman once.
The greatest risk to national terms and conditions is that they will become rigid, inflexible and no longer fit for purpose. If that happens, employers will be more likely to use the freedoms given to them by Labour to abandon “Agenda for Change”, which was where those freedoms came from, and introduce local terms and conditions.
The Opposition has a clear choice. They can wolf whistle to their trade union sponsors in a hollow attempt to distance themselves from legislation that they passed, or they can prioritise the interests of low-paid NHS employees by encouraging the unions to work for constructive, negotiated improvements to “Agenda for Change”. Sadly, this afternoon’s debate shows that they have made that choice—the motion is nothing more than a shameless attempt to frighten the hard-working staff of the NHS.
The debate is scandalous scaremongering from a party that did more to introduce regional pay during its time in office than any other Government in history and outrageous opportunism from a party that wanted to cut the NHS budget. Rather than singing to the tune of their trade union paymasters, the Opposition should be telling them to get around the table and negotiate seriously on “Agenda for Change”; rather than scaring NHS employees, the Opposition should be celebrating their achievements; and rather than talking down the NHS, the Opposition should, painful though it is, be celebrating the achievements of a Government who have delivered record NHS performance. I urge my colleagues to support the amendment.
Mental Health (Approval Functions) Bill
Jeremy Hunt Excerpts(11 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Andy Burnham (Leigh) (Lab)
Detaining people under the Mental Health Act raises fundamental questions of individual liberty and public safety, requiring the most careful consideration. I am sure that there is general agreement across the House that the circumstances in which we find ourselves today are far from ideal. Members on all sides will want to use the time we have to satisfy themselves that the measures that the Government are asking the House to approve today are justified.
Emergency legislation tends to be forward looking in its scope, so the retrospective nature of the Bill before us is unusual and potentially troubling for Members. As I said yesterday, we will need to be sure that this is the only real course of action available and that it is not setting a precedent whereby emergency legislation can be used as a convenient means of correcting administrative failings, which could in itself breed a culture of complacency in public administration.
In asking those legitimate questions, however, we must have at the forefront of our minds the simple fact that the uncertainty which has arisen in the past week affects thousands of highly vulnerable people and their families, as well as having serious implications for patients and public safety. If we leave that uncertainty hanging, it will have the potential to cause real harm to the individuals concerned, and to damage public trust in our systems of individual and public protection.
The Secretary of State was right to act quickly, and to come to the House yesterday to make his exceptional and urgent request for legislation. I am surprised that he did not make the case for that legislation to the House in person today, but the Opposition have nevertheless concluded that, on balance, the public interest is best served by our supporting the Government in the swift action that they propose, and we will ensure as far as possible that that pragmatic approach is reflected in the other place.
In reaching our judgment, I think we can take some comfort from the fact that the main mental health organisations, as well as the Royal College of Psychiatrists, are, for now, supporting the Government’s course. However, concerns and questions have already been raised today—not least by my right hon. Friend the Member for Oxford East (Mr Smith)—which have not been fully answered. I must say to the Government that it is vital for the fullest possible answers to be given to the House today before any approval is given to this exceptional retrospective measure. I shall be seeking answers not just to the questions that I am about to ask, but to questions that the Secretary of State did not answer yesterday. There are matters of detail here, but matters of principle also arise, and I want to cover both in my speech.
The Secretary of State for Health (Mr Jeremy Hunt)
May I clarify something? I had intended to make the Second Reading speech earlier, but I will be winding up the debate, and during that speech I shall seek to address any points raised by the right hon. Gentleman—and, indeed, any outstanding points raised by other Members.
Andy Burnham
I thank the Secretary of State for his intervention. We understand that these are urgent matters, and I am sure that he is receiving briefings from the Department, but I think that there is a sense among Opposition Members that that is not good enough, and that he should have been here to answer the questions that were asked. We appreciate that he will be winding up the debate, but I hope he will take careful note of all the questions that are asked, and will give every Member present the fullest possible answer.
First things first: let us begin with the detail. I think it would help the House to know more about the extent of the checks that have been carried out on the 4,000 to 5,000 cases involved. The very fact that the number remains vague suggests that there has not yet been a thorough case-by-case review. Does the Minister—or, indeed, the Secretary of State—agree that it is essential to conduct such a review, and to put a precise number on the extent of the problem? I asked yesterday whether the Department could tell us how many of the people concerned were in high-security hospitals. I think that that is an important aspect of the issue, and I should be grateful if the information could be given to us at some point this afternoon. Without detailed case-by-case checks, how can we be sure that this procedural defect was the only technical irregularity in the process that was operating in the four SHAs concerned? We need to be reassured that there are no further problems that will need to be corrected at a later date.
That brings me to another question that was not answered yesterday. Families of the people involved will have heard yesterday’s news, and will no doubt have been unsettled by it. Does the Secretary of State agree that it is important for the Government to make arrangements, urgently, for direct communication to take place with the families who have been directly affected so that the issue can be explained to them more fully, and in isolation from some media coverage that may not give them the reassurance and support that they seek? Have such arrangements been made, and has any facility been provided enabling questions to be answered so that people can be given that reassurance and support?
That, in turn, brings me to another important point. If the Government were to leave a vacuum in terms of advice and communication, it could of course be filled by less scrupulous elements of the legal profession seeking to initiate compensation claims. We have already read warnings today that efforts may be made to encourage patients to sue for £500 or £600 a day, the amount that a prisoner would receive in compensation for unlawful detention. I am sure the Secretary of State agrees that any such activities would be highly unsettling, and would amount to the potential exploitation of vulnerable people. I hope he will join me in sending the clearest of messages to the legal profession that that would not be at all welcome. On the other hand, we would not want to see any curtailment of individuals’ legitimate right to challenge the decisions made affecting their liberty as a result of the Bill.
Andy Burnham
That is a good point. So many cases are involved that challenges may have already been in progress before this technical problem arose. There may have been complaints about the nature of the decision-making process, the number of professionals involved, or any matter relating to the process by which the decision was made.
I hope that it will reassure the hon. Gentleman to learn that I have been given access to Government lawyers—the Secretary of State promised that yesterday, and I am grateful to him for arranging it—and I have been assured that the Bill will not wipe away an individual’s right to issue a legal challenge on a different point of process. That is a fundamentally important point, and I am glad that the hon. Gentleman has given me an opportunity to put it on the record. We would certainly not support the Bill if it were intended to wipe away an individual’s rights retrospectively, and I am sure that the hon. Gentleman would not either. We are grateful for that reassurance from the Government.
Along with the urgent steps that are being taken to correct the legal position, we need a review of how this came about in the first place. If it had happened in a single SHA, the explanation might have been easier to ascertain and understand, but the fact that it happened in four SHAs points to a more widespread issue of concern. It raises the question whether the problem arose from historical practice among clinicians and NHS bodies in the four regions concerned, or whether a piece of Department of Health guidance that was circulated in the past may have been responsible. I hope that the Minister or the Secretary of State will be able to enlighten the House further.
We want the Harris review—which I support—to cover all the technical issues surrounding mental health, so that the House and the public can be absolutely certain that no other technical failures or breaches of regulation have been identified. Let me make two appeals to the Secretary of State. First, I ask him to consider widening the remit of the review, and ensuring that in future it can take the broadest possible view of arrangements for sections under the Mental Health Act 1983. Secondly, I ask for the review to be conducted as swiftly as possible, so that it can inform the current reorganisation of the NHS.
It seems to me that the crux of the issue is the interrelationship between the 1983 Act and the potential for reorganisations of the NHS to disturb important existing arrangements and procedures for the carrying out of these essential public functions. That is the crux of the matter. I accept that a problem may have arisen as a result of the introduction of SHAs and PCTs in 2003, and we will have to wait and see whether that was the case. Regardless of the answer to that, however, the Government still have to face a relevant and current issue: they have to be absolutely sure that the changes they are proposing—and which the Opposition continue to believe are unnecessary and highly disruptive to an NHS that is functioning well for the vast majority of people—will not run the risk of causing further confusion.
We have not had anywhere near enough clarity from the Secretary of State—or his predecessor, the right hon. Member for South Cambridgeshire (Mr Lansley), who has just left the Chamber—on how some of the essential functions of NHS bodies to do with safeguarding and public protection are to be handled in the new NHS structure. Many months have passed since the publication of the Government’s first White Paper, yet there are still doubts in the minds of clinicians and others practitioners on the ground. That is an indictment, and shows the confusion the reorganisation has created. We are seeing the emergence of myriad new bodies in the NHS whose functions are not yet fully understood or specified by the Government. This crowded landscape has the potential to cause for further uncertainty. I therefore today ask for more clarity on this matter.
As things currently stand, what will the NHS arrangements be for sectioning people under the mental health provisions to be introduced from April 2013? I do not yet know with confidence what those arrangements are, and if I do not know there is a good chance that the wider public and many people working in the NHS have no idea. The Government need to answer these questions.
There is a further specific question the Department needs to answer, and it goes to the heart of the issues under discussion. I am sure I heard the Secretary of State say yesterday that the secondary approval function that SHAs are meant to carry out will come back to the Department of Health following the Government’s current reorganisation of the NHS.
Andy Burnham
The Secretary of State is nodding from a sedentary position, so I assume that is correct. Surely, therefore, a concern arises that the SHA part of the process is no more than a rubber-stamping exercise. The Department will be entirely remote from the local situation on the ground relating to the individuals involved and the clinicians and institutions making the judgments. If this process is taken up to the national level, will that not give rise to more concerns that mistakes might be made in the future, because of the distance between the process of approval and the individual cases on the ground? Has the Secretary of State had discussions with mental health organisations about whether they believe those arrangements are acceptable? I must say that I have serious concerns about them.
The Secretary of State for Health (Mr Jeremy Hunt)
I start by apologising to any Members who had hoped to intervene on me at the start of the debate, but I hope that I will now be able to give a fuller answer not just to any interventions, but to speeches made by right hon. and hon. Members. I thank the Opposition and the whole House for the very responsible attitude that they have taken towards this extremely sensitive and difficult issue. I intend to respond fully to all the points made by right hon. and hon. Members about the need to act so fast and retrospectively. Those are important issues that deserve the fullest attention.
It is important to record our appreciation at this stage for the invaluable help and advice that we received from partners outside the House, such as Mind, Rethink and the Royal College of Psychiatrists. Their primary concern is naturally those whom they represent so ably, but we are genuinely grateful for the mature and calm way in which they have responded. Everyone in the House has shared the same ultimate objective—to do what is best for the patients directly affected by a technical error.
Let me go through the points raised in the debate. I shall try to respond as fully as I can. With respect to the devolved Administrations, I have spoken to Health Ministers in Wales and Northern Ireland today, and I spoke to the Advocate-General for Scotland yesterday. They have been extremely supportive of the position that the Government and the whole House have taken, and they understand the need for speed. In Wales it is a sensitive matter because the Welsh Assembly is in recess, but I managed to speak to the Health Minister and go through the issues involved.
A number of Members asked about the extent to which we will be communicating with patients. We are working closely with the Royal College of Psychiatrists as to the best way to do this. That also extends to the families and carers of patients. Sir David Nicholson, the chief executive of the NHS, is writing to all strategic health authorities, stressing the need to communicate broadly across all mental health organisations, including patients and their families, and including, as has been mentioned, not just the patients who are directly affected, but potentially other patients who have been detained under the Mental Health Act, who may also have concerns. We have not been able to complete that communication exercise at this stage, because of the speed necessary to pass the Bill, but we will need to make sure that it proceeds as a matter of urgency.
Andy Burnham
We welcome the exercise being carried out by the NHS chief executive, but it is not the same as a personal communication to the individuals directly affected, so will the Secretary of State address the specific point of whether or not they will receive explanatory information from him or the Department?
Mr Hunt
Yes. What Sir David Nicholson is doing is ensuring that all SHAs have a proper communication process in place, but we want to follow clinical advice on the appropriateness of individual communications with individual patients. Where we are advised that is clinically sensible, we must ensure that it happens, but we want to listen to the advice carefully because of the vulnerability of some of the patients involved. The right hon. Gentleman makes an extremely important point. We must do this properly but, as I know he will agree, we must proceed with extreme care and caution.
I will start with some of the issues that the right hon. Gentleman raised, particularly the role of the review being conducted by Dr Geoff Harris. He is absolutely right that it needs to be done speedily because of the changes being introduced by the Health and Social Care Act 2012. I want to reassure him that Dr Harris’s review will not be simply a retrospective review; he will not just be asking, “Why did this happen?” He will also be stepping back and asking, “Where might this happen again and are our governance procedures sufficient to ensure that it does not?” In particular, he will look at the new structures that will be put in place over the next few months to give us good and independent advice on whether we have the safeguards in place to prevent this from happening again. That is an important point.
With regard to how many people are affected, the figure is up to 5,000. We think that the number includes all the patients at Rampton and 57 patients at Ashworth, but we are still verifying the exact numbers. I will keep the right hon. Gentleman informed as more information becomes available.
The right hon. Gentleman’s other point was about the new arrangements that are being put in place. He wondered, legitimately, whether, as the powers are returning to the Department of Health following the abolition of the SHAs—he was correct to pick that up from my comments yesterday—there is a danger that the process could be more remote for local areas. We will keep him informed of our plans in that regard, but we do not intend to have a single national panel doing this. We intend to have a structure that draws on local and regional expertise to help us to make the right decision on the suitability of doctors for the role. That is also something we hope Dr Harris will advise us on when he conducts his review.
I will move on to some of the comments made by the right hon. Member for Oxford East (Mr Smith). Independent oversight is also something we will ask Dr Harris to look at. He is independent and he is looking at it. We will also ask him to look at the general issue of independent oversight and whether it has been missing in the structures we have had to date and, therefore, whether it contributed to the concerns that we are now addressing.
The right hon. Gentleman and the hon. Member for Wolverhampton North East (Emma Reynolds) raised another issue: the wording we have been using, the fact that we believe there are good arguments for saying that the detentions that happened as a result of approvals made by the doctors in the four SHAs were and are legal and, therefore, why we feel the need for emergency retrospective legislation. It is a reasonable question. The answer is that we believe that there is legal precedent for why, in so sensitive a situation, a court, in deciding whether a detention was lawful or unlawful, would consider what the will of Parliament was when it passed the original law. Therefore, we believe that we have a good argument for why a court should rule that these detentions were and are lawful.
However, because of the technical irregularity in the process of approving some of the doctors who made the decisions in the four SHAs, that argument could be challenged. That is also an important part of the advice we have received. It is because it is so important to put the decisions beyond doubt, with respect to this narrow and technical issue, that the Bill is so incredibly important. However—this might help to address some of the concerns raised during the Opposition winding-up speech—this piece of retrospective legislation refers only to that narrow and technical issue. If people question the grounds for their sectioning under the Mental Health Act on clinical grounds and claim that the wrong clinical judgment had been reached, for example, or if they do not agree with what the panels have said, the Bill will not affect their right to challenge the decision and, if the court upholds the challenge, to get compensation if they have been detained. The Bill relates only to the very narrow issue of the technicality.
Mr Andrew Smith
I am grateful to the Secretary of State for giving way and for his response to one of my earlier points. As he is adopting a belt-and-braces approach to this—a sort of “We think it was lawful, but let’s make absolutely sure” approach—would it not also be wise to arrange, if not in the Bill then as an executive action, for the doctors in question to be re-approved by the correct process?
Mr Hunt
The right hon. Gentleman makes an extremely important point. I am pleased to reassure him that that has happened. That was one of the first things that happened, and it was completed yesterday, so all the doctors who are currently making these approvals in the four SHAs were approved using the correct process. We are confident that the problem will not arise in future, but we still have the issue of the decisions they took when the technical process had not been followed.
We have taken a number of actions to deliver parity of esteem for mental health services. I wholeheartedly agree with the concerns that have been raised about mental health issues having been for too long the poor relative in a number of areas. The right hon. Member for Leigh (Andy Burnham) will know that in July we published the implementation framework for our mental health strategy, “No health without mental health”. We have legislated, with his party’s support, for parity of esteem. The operating framework for the NHS expands access to psychological therapies, which is one of the key things we can do. The number of people accessing psychological therapies has increased to 528,000 people this year, which is more than double the figure for last year, and the amount of money going into it has increased from £364 million to £386 million. Those therapies have a very good success rate of about 45%, and we think that we can get it up to 50%. I want to reassure right hon. and hon. Members that we note the general view of the House that more emphasis needs to be put on mental health services.
Andy Burnham
But overall there has been a significant real-terms reduction in spending on mental health, as the figures given by the right hon. Gentleman’s colleague in the House of Lords a few weeks ago indicate, which suggests that the NHS is making disproportionately more redundancies in the field of mental health than in other areas and that it is reverting to that default position. Therefore, although I appreciate the Secretary of State’s words at the Dispatch Box today, the reality on the ground suggests that, as ever, mental health is bearing the brunt of some of the reductions and redundancies taking place and that the capacity of people to deal with these kinds of issues will perhaps be reduced. What will he say about safeguarding against that?
Mr Hunt
The right hon. Gentleman makes an important point. I believe that in actual terms the spending on mental health has increased slightly, but when we take inflation into account it might have gone down slightly in real terms. I do not think that it is a significant drop, but overall, as he knows, the NHS budget has been protected. I would be extremely disappointed if, as we go through a process of finding important efficiency savings in order to meet the increased demand on the NHS, the picture that he paints were to be the case, but I will be watching the situation very carefully. I will expect him to hold me to account for my commitment to ensuring that mental health services are properly addressed.
Crucially, it is not just about what we say but about what we deliver, particularly as regards the progress that we make towards improving access to mental health services, which were never included in the waiting times targets that were introduced by the previous Government. There are obviously financial implications in doing that, but we are working on it. Parity of esteem needs to include access to mental health services and not just the availability of those services.
Mr Andrew Smith
Does not parity of esteem also, crucially, need to apply to research funding—a point that was made earlier during the urgent question on Winterbourne?
Madam Deputy Speaker (Dawn Primarolo)
Order. We are again going very wide of the Bill and the points that are supposed to be made in relation to it. The right hon. Gentleman’s question does touch on that, but I would be grateful if the Secretary of State, in responding, returns to the Bill by focusing on the items that we will be voting on today.
Mr Hunt
The answer to the right hon. Gentleman is yes. I will now return to the specific questions asked about the Bill.
The hon. Member for Southport (John Pugh) talked about the important issue of discrimination—that is, whether we are behaving differently because these patients have a mental illness. Removing discrimination does not mean treating everyone exactly the same. In fact, we will remove discrimination in the mental health field by better understanding the vulnerabilities and needs of people who have serious mental health problems, and that might mean treating them differently to account for that. The hon. Gentleman is absolutely right to say, as was the hon. Member for Hackney North and Stoke Newington (Ms Abbott), that important human rights issues need to be considered. I want to reassure him that, even in the four SHAs where the technical irregularity in the approval of doctors arose, the criteria were as rigorous as those used to make the clinical assessment that it was necessary to detain someone under the Mental Health Act. The same quality of expert advice was drawn on in order to make those decisions.
The right hon. Member for Oxford East asked why we are not limiting the legislation to the four SHAs where we have identified this technical irregularity. That is because we do not know at this stage whether the problem may have predated the establishment of SHAs—we should remember that these powers go back to the Mental Health Act 1983—and therefore, to make sure that we deal with the problem in its entirety, it is better to include the whole country in the legislation lest we find at a later date that the problem had existed in other parts of the country, perhaps prior to the foundation of SHAs.
On human rights, I have signed a piece of paper saying that I believe that the Bill is compliant with the European convention on human rights. I did that on the advice of Government lawyers and of the Attorney-General. The Attorney-General believes that, were a case to be brought now, people would be entitled only to nominal compensation because this is a technical, not a substantive, irregularity, and it is therefore not, on this occasion, a breach of people’s human rights to pass a law retrospectively.
The hon. Member for Arfon (Hywel Williams) asked why this has taken so long—why, for example, the Mental Health Commission did not identify the problem in its years of existence. That is a very important question. I cannot pretend that I have the answer now, but I want Dr Harris to look into that issue in enormous detail because I want to know whether there is a risk that other errors, similar or related, might exist in other parts of the system. The House needs to understand much better whether we should be concerned about that and whether the right governance procedures are in place.
The hon. Gentleman mentioned advocacy. As he will know, all patients have a right to an independent mental health advocate, but that process has not always worked as well as it should. I want to use the opportunity of the transfer of those responsibilities from primary care trusts to local authorities to make sure that we have proper procedures in place so that people really do get the advocacy support that they need.
Let me confirm to the hon. Gentleman—we received this piece of information as my hon. Friend the Minister was speaking—that someone approved in one SHA is able to practise in other SHAs. That is partly why the legislation needs to be UK-wide. We have had a lot of discussions about this with doctors’ representatives, particularly the Royal College of Psychiatrists. I do not believe that there are any implications for the second doctor or the social worker, but if I receive advice to the contrary I will write to him to let him know.
I think that I have covered most of the points raised by the hon. Member for Wolverhampton North East. She asked what is going to happen when the SHAs are abolished. We will be asking Dr Harris to address that when he carries out his independent review.
Finally, I turn to the hon. Member for Hackney North and Stoke Newington and her important comments about the seriousness with which we must treat any retrospective legislation. She referred to what Hayek said about that, with which I wholeheartedly agree. I did not think that we would be agreeing across the Dispatch Box about Hayek, but there it is. She made the important point that due process is about respecting technicalities, so we cannot brush it aside. That is why this legislation is necessary. A failure of due process—a failure to observe technicalities—puts us in an extremely difficult situation where ordinarily we would want to say that due process should be observed in all circumstances and that we should not pass retrospective legislation on that. In this particular case, however, it would have been against the clinical interests of 5,000 highly vulnerable people were we simply to consider that single legal perspective; the broader clinical perspective needs to be recognised.
The advice that I received from Professor Sir Bruce Keogh, the medical director of the NHS, was very important in persuading me that we needed to take the route of emergency retrospective legislation. He said that the alternative, which was to go through all 5,000 people and redo the entire sectioning process now that all the doctors have been properly validated, presented serious clinical risks to those individuals. It is a very difficult matter. As the hon. Lady and I are trading political thinkers, perhaps I could refer her to Isaiah Berlin and say that sometimes important moral principles are not totally consistent with each other. This is one of those occasions, and we have to weigh her very important points about the need to avoid retrospective legislation, even on technicalities, against the clinical interests of a highly vulnerable group of people.
Dan Byles
In a previous life, I sat on the board of a Mental Health Act scrutiny committee in a west midlands mental health trust. Does my right hon. Friend agree that this retrospective change does not in any way undermine the fact that every single one of the patients he has mentioned has been through a very robust system of checks and balances throughout the sectioning process in order to be sectioned, and then while they are sectioned, and has access to a very robust appeals mechanism that the Bill in no way undermines?
Mr Hunt
My hon. Friend is absolutely right. The key point is that those patients are free to challenge any element of the clinical decisions made as part of that very thorough process. This proposed law is about the technical irregularity only, and it is precisely because of the legal risks associated with that irregularity that we think it is necessary, in the interests of those 5,000 people, to enact this Bill.
Mr Hunt
If the patient wishes to challenge their clinical assessment, they are free to do so and the Bill will not affect that in any way. It is important that that point is understood. In fact, the Bill is very narrowly defined for that precise reason, and I think that is why the Attorney-General felt comfortable saying that it complied with the ECHR.
In conclusion, we have had a constructive debate on this very important and sensitive issue, but there are broader lessons to be learned about the importance, more generally, of mental health issues, and I and my colleagues in the ministerial team will take those very seriously as we progress. I am grateful to all hon. and right hon. Members present for their contributions to this debate.
Question put and agreed to.
Bill accordingly read a Second time; to stand committed to a Committee of the whole House (Order, this day).
Mental Health (Approval Functions) Bill
Jeremy Hunt Excerpts(11 years, 6 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Perhaps I can assist in this matter. I do not believe that there is a drafting error, but the hon. Lady is absolutely right to scrutinise every word of the Bill carefully and ask questions.
Clause 1 does not mention “any doctor” because it is about the power for an SHA to delegate the authority in question, not about a doctor’s decision or clinical ability. It refers to the person who approves that power of delegation. I hope that that clarifies the matter.
Ms Abbott
We have listened to what the Secretary of State and the Minister have said. We remain concerned about the broad nature of the clause, but we rest our case.
Question put and agreed to.
Clause 1 accordingly ordered to stand part of the Bill.
Clause 2 ordered to stand part of the Bill.
The Deputy Speaker resumed the Chair.
Bill reported, without amendment.
Third Reading
Mr Jeremy Hunt
I beg to move that the Bill be now read the Third time.
This has been a distinctly unusual process for the House, and one that is unprecedented for recent Members. Only after hard—if very rapid—consideration over the weekend did I decide that emergency legislation was the only safe course, and recommend that to the Prime Minister.
Retrospective legislation affecting an individual’s right to liberty is a major step, and it would be intolerable to have any doubt about such an important part of the law. Such a situation would be unacceptable for patients, their families, and doctors and nursing staff in NHS and independent hospitals. I have been insistent throughout that the clinical needs of patients should take priority within the law, and that legislation should be as tight as possible to ensure that patients’ legal rights are protected.
I thank Opposition Members for the way they have responded and for making it possible to legislate in such short order. I also thank hon. Members generally for their constructive challenge and scrutiny. Although there is need for urgency, it is essential that the Bill is properly tested, which hon. Members have done.
The House has acted wisely and swiftly in the interests of up to 5,000 highly vulnerable people. It has recognised the important human rights issues involved, and balanced that with clinical advice about the best interests of those people. I commend the Bill to the House.
Mental Health Act 1983
Jeremy Hunt Excerpts(11 years, 6 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I wish to make a statement about an issue relating to the Mental Health Act 1983.
It has become apparent that there are some irregularities around the way in which doctors have been approved for the purpose of assessing patients for detention under the Act. For assessments and decisions under certain sections of the Act, including detention decisions under sections 2 and 3, three professionals are required to be involved—two doctors and an approved mental health professional. The latter will usually be a social worker.
In 2002, when strategic health authorities came into being, the then Secretary of State properly and lawfully delegated his function of approving doctors under the Act to them. However, it came to light last week that in four of the 10 SHAs—North East, Yorkshire and Humber, West Midlands and East Midlands—between 2002 and the present day the authorisation of doctors’ approval appears to have been further delegated to NHS mental health trusts.
I was made aware of the issue and kept up to date with the actions being taken last week. Our latest best estimate is that approximately 2,000 doctors were not properly approved, and that they have participated in the detention of between 4,000 and 5,000 current patients within institutions in both the NHS and independent sectors. Rampton high-secure hospital is in one of the affected areas, and some patients at Ashworth high-secure hospital are also included.
There is no suggestion that the hospitalisation or detention of any patient has been clinically inappropriate; that the doctors so approved are anything other than properly qualified to make such recommendations; or that these doctors might have made incorrect diagnoses or decisions about the treatment that patients needed. All the proper clinical processes were gone through when these patients were detained. We believe that no one is in hospital who should not be and that no patients have suffered because of this. The doctors would have had no reason to think that they had not been properly approved. They acted in good faith and in the interest of their patients throughout this period.
In the light of our legal advice, we do not believe that any decisions made about patients’ care and detention require review because of this irregularity. Doctors should continue treating patients currently detained under the MHA in the usual way. We have received advice from the First Treasury Counsel that there are good arguments that the detentions involving these particular approval processes were and are lawful, but the counsel also argues the need for absolute legal clarity. The legal advice is that this should be resolved through emergency retrospective legislation.
As soon as the irregularity was identified, my Department worked swiftly to identify the best course of action and to put the necessary preparatory work in place. It first became aware of the problem last week. Officials immediately sought initial legal and clinical advice. We then swiftly analysed possible options, including the option of reassessing all potentially affected patients, working with the health leads in the regions affected and clinical experts from the Royal College of Psychiatrists.
When I was briefed on the situation, I asked for detailed information on the time it would take and the clinical risks involved in reassessing all potentially affected patients. On Friday, I asked for an emergency Bill to be drafted over the weekend, as a matter of contingency. I also briefed the Prime Minister personally the next day. Following further discussions and analysis over the weekend, the decision to introduce emergency legislation was taken yesterday, and we have since worked to prepare the necessary materials.
At all times, my priority has been to resolve the situation in a way that follows clinical advice about the most sensitive way to deal with a highly vulnerable group of individuals. We have also worked to remedy the problem as it relates to current and future detentions. As of today, all the doctors involved have been properly approved. The accountable officers for the four SHAs in question have written to Sir David Nicholson, chief executive of the NHS, to confirm they have made the necessary changes to their governance arrangements. Furthermore, the accountable officers in the remaining six SHAs have written to Sir David to confirm that they have, in the light of this issue, reviewed their own arrangements and that they are in full compliance with the Act.
Although we believe there are good arguments that past detentions under the Mental Health Act were and are lawful, it is important that doctors, other mental health professionals and, most importantly, patients and their families have absolute confidence in the decisions made. That is why, in relation to past detentions, we have decided that the irregularity should be corrected by retrospective legislation. Although we are aware of the problem in only the four areas going back to 2002, the proposed legislation will apply in principle to the approval of all doctors under the Mental Health Act since its introduction in 1983. The proposed legislation will retrospectively validate the approval of clinicians by those organisations to which responsibility was delegated, up to the point when all the relevant doctors were fully re-approved and their status put beyond doubt. The legislation will not deprive people of their normal rights to seek redress if they have been detained for any reason other than the narrow issue of the delegation of authority by the strategic health authorities, nor will it affect any future detentions or legitimise any similar failures in future. We are proposing to introduce the draft legislation to this House and, through best endeavours, looking for it to complete its passage through all the appropriate stages in this House and the other place as soon as is practicable.
While addressing the technical issue, it is also important that we get to the bottom of how this happened and that we learn any lessons to help inform the operation of the new system architecture from April 2013. As such, I have asked Dr Geoffrey Harris, chair of NHS South and former chair of Buckinghamshire mental health trust, to undertake an independent review to look at how the responsibility was delegated by the four SHAs and, more broadly, the governance and assurance processes that all SHAs use for delegating any responsibilities. I will also ask him to look at this issue in the context of the new NHS structures that come into force from next April and to see whether any lessons need to be learned. It is imperative that the review is swift, and I have asked Dr Harris to report to me by the end of the year with recommendations to ensure that every part of the system employs the highest standards of assurance and oversight in the delegation of any functions.
I stress to the House that I have reviewed with lawyers, clinicians and NHS managers possible alternatives to introducing this retrospective legislation. I have been advised that all alternatives would be highly disruptive to many of the most vulnerable patients and would deprive many other patients of the care they need while any action is undertaken. However, all the advice I have received has been unequivocal in stressing the need for absolute clarity of the legal status of any hospitalisation or detention of patients, in the interests of those patients, their families, those caring for them and the wider public. That is why, in such exceptional circumstances, this retrospective legislation is being proposed. Both a Bill and the accompanying explanatory notes will be published this afternoon. I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
I thank the Secretary of State for his statement and for notice of it. Detaining people under the Mental Health Act raises the most serious issues of fundamental rights and of patient and public safety. Any reported failure will therefore always be a matter of the highest concern. I know this House will want to get to the bottom of the unacceptable breaches of procedure that we have just heard about. However, I am sure I speak for both sides in saying that the House will have been reassured by the Secretary of State today on three crucial points: first, that no patient has been wrongly detained, received care that was not clinically appropriate or will see their legal rights restricted by the legislation; secondly, that no doctor was unqualified to make decisions; and, thirdly, that urgent action is being taken to correct the situation and bring the clarity that is so essential.
Let me now turn to the serious questions that need to be answered. Will the Secretary of State say more about the events that brought this issue to light last week? Was it discovered in one SHA first, and by what process did the Department establish that it extended to three more? When exactly was the Department made aware, when was the Secretary of State informed and what action has been taken to establish the full extent of the problem? Have extensive checks been undertaken in all 10 SHA areas, and is he absolutely confident that no more patients and families are affected than the 4,000 to 5,000 he has mentioned?
I want to press the Secretary of State for more information on the people affected. Will he say whether he has any plans for direct communication with the patients and families affected? Are the patients living not only in the four regions mentioned but in all parts of the country? How many are in high-secure hospitals, and how many could pose a risk to the public?
We understand and support the Secretary of State’s wish to remove any doubt about the legal status of the patients concerned, but that must be set against the undesirability of asking the House to legislate tomorrow on an issue that it has found out about only today. Over the next 24 hours, will he ensure that Members have access to the fullest possible information, including a summary of the legal advice he has received?
There will be concerns about precedent. This is the first time that the House has been presented with emergency legislation in this area that will affect people’s rights. The public will want to know that it is being used in exceptional circumstances as a last resort, and not as a convenient means of correcting administrative failures. Will the Secretary of State therefore explain precisely what alternatives to legislation were considered, and why it was decided that they were not acceptable in these circumstances?
Let me turn to the investigation. We support the review under Dr Harris that will try to get to the facts and ensure that lessons are properly learned. We do not want to prejudge it, but is the Secretary of State in a position to confirm today whether the review is already proceeding on the basis that this is a failure of policy implementation rather than a defect in the original legislation? That is important, as practitioners working in this field will not want any unnecessary question marks hanging over the Mental Health Act 1983.
We also need clarity about the future. This area is currently the responsibility of SHAs, which are due to be abolished next April. So, as well as establishing the historical facts, will the Secretary of State ask his review to consider whether the new arrangements for sections, following the Government’s reorganisation of the NHS, are sufficiently well understood? Will he also ask the review to advise on how any danger of further confusion arising from the process of transition can be prevented?
I commend the Secretary of State for the pragmatic approach he is taking to this difficult issue. His request of the House is exceptional, but failure to act could cause unnecessary distress and uncertainty to many thousands of vulnerable patients and their families, and present risks to public safety. We will press him for answers in the areas that I have outlined, but we believe that his action is justified. He will have our support in removing any uncertainty.
Mr Hunt
First, I thank the right hon. Gentleman for the co-operation that he has shown to me and my Department over the weekend. There are occasionally moments when issues of public safety and patient well-being transcend the normal political divides, and I greatly appreciate his co-operation on this matter.
Let me deal with the important questions that the right hon. Gentleman has asked. The issue arose when a challenge was made to the authorisation of one doctor in Yorkshire and Humberside and, in dealing with that challenge, the irregularity in the way in which all authorisations had happened became apparent. Following further investigation, we discovered that this had happened in four other SHAs. We found out about this early last week, and I was informed towards the end of last week. Immediate action was taken to ensure proper validation last week of all the doctors who are currently taking section 12 decisions under the Mental Health Act, and that was completed as of today.
We have done exhaustive checks on the other SHAs, which is part of the reason why we asked all the SHA bosses to write to Sir David Nicholson—which they have all done today—to confirm that their processes in this area are in order. We do not believe that this issue affects any patients other than the ones we have talked about, to date. However, because people move and are moved to different hospitals and places of detention, it might be happening in other parts of the country beyond the four SHAs in which the irregularities in authorisation happened.
The right hon. Gentleman will understand that it is not the practice for Governments to publish legal advice because we want to continue to be able to receive frank legal advice in the future. However, I am happy to answer any questions about the legal advice and, as he knows, I am happy for him to talk to my Department’s legal advisers to satisfy himself on the precise legal situation.
Let me move on to the really important point about the alternatives that we considered, as it is highly exceptional to bring in emergency legislation. The right hon. Gentleman will know that authorities are allowed to detain someone under the Mental Health Act for 72 hours while the correct processes are followed to section them. Although, as I mentioned, we believe we have good arguments to show why these detentions were lawful, we did not know what a court might have decided if the detentions were challenged. We could have faced literally having to redo the entire process for 4,000 to 5,000 patients within 72 hours. Given the high level of vulnerability of many of them, we could not find a means of doing that in an orderly way that protected their well-being. I received clear medical advice from the NHS medical director, Professor Sir Bruce Keogh that that would not be an appropriate course of action. We looked at the position carefully and because we were trying to explore other alternatives we did not come to the decision to introduce emergency legislation until this weekend.
I can confirm that we do not believe that this has highlighted a defect in the legislation. We are not seeking in the emergency draft Bill to change the Mental Health Act. This is purely retrospective legislation dealing with some specific procedures under that Act; it will have no impact as this goes forward.
The right hon. Gentleman is absolutely right that we must be sure to minimise the confusion as we move towards the new structures. Under them, the problem would have been resolved, with the power reverting from strategic health authorities to the Department of Health. I do not want to be complacent: if this problem happened in one area, we want to be sure that it cannot happen in others.
Mr Stephen Dorrell (Charnwood) (Con)
I welcome the prompt action taken by my right hon. Friend and the support he has secured from Opposition Front Benchers for putting this sensitive matter on a secure legal footing. Is not the key point the fact that no patient has been sectioned and no doctor has been authorised who would not have been sectioned or authorised under the legislation? Is not the purpose of the emergency Bill, as always with retrospective legislation, simply to put the position as Parliament intended it to be in the first place?
Mr Hunt
My understanding is exactly the same as that of my right hon. Friend. The key point is that this was a technical irregularity, but we do not believe that any patient has been sectioned, detained or hospitalised who would not have been if the correct procedures had not been followed. It is none the less very serious that this technical breach happened; that is why, as well as correcting the technical breach and providing absolute clarity, we are conducting this review to make sure that we do everything we can to avoid anything similar happening again—even under completely different structures than the SHAs.
Derek Twigg (Halton) (Lab)
I do not necessarily disagree with anything the Secretary of State said, but I noted that he used the term “we believe”, which means that it is not simply factual at this point that no one has been detained who should not have been. It would be worth the Secretary of State addressing the reverse position: does he believe that no one who should have been detained has been released and then gone on to commit a serious offence?
Mr Hunt
As a result of the technical irregularities that we have identified and put right, I do not believe that what the hon. Gentleman describes has happened. Let me explain that when I say “we believe”, it reflects the advice we have had that there are good arguments on why the detentions were and are lawful, but that is not to say that those arguments cannot be challenged or that a court would necessarily agree with us. That is why it is necessary to take this unusual step of introducing emergency legislation.
Mr Charles Walker (Broxbourne) (Con)
Removing the liberty of ill people is serious business, and deserves to be taken seriously. That has not been the case for the past decade, or perhaps even longer. I hope that, as we go forward, we can ensure that people who are ill get the representation and advocacy they deserve and that they—and, most importantly, their rights—are taken seriously.
Mr Hunt
My hon. Friend is absolutely right. As a result of the new structures in the NHS, responsibility for ensuring that all patients who are threatened with detention receive the advocacy to which they are entitled under the Mental Health Act will be transferred from primary care trusts to local authorities. We will use this opportunity to review the arrangements, talk to local authorities, and do all that we can to ensure that those functions are discharged in the way my hon. Friend seeks.
Andrew Percy (Brigg and Goole) (Con)
Two mental health trusts that do a fantastic job in my constituency, Humber NHS Foundation Trust and Rotherham, Doncaster and South Humber NHS Foundation Trust, have been involved in this. Can the Secretary of State tell us how many patients have been affected by what has happened in trusts, so that if families approach us we can offer them the information that they require?
John Howell (Henley) (Con)
Does the Secretary of State agree that speed is of the essence in the provision of clarity, and will he accept our congratulations on having moved with such commendable speed?
Mr Hunt
I am grateful to my hon. Friend for saying that, but I think that we should extend our gratitude to the Opposition on this occasion. It is possible to move with speed only when there is cross-party co-operation, and I think that everyone has recognised the seriousness of the situation.
John Pugh (Southport) (LD)
Given the huge, overwhelming concentration on the subject of detention during the passage of the National Health Service Act 2006, which revised the Mental Health Act 1983, why was this departure from the law not brought to Members’ attention, or, indeed, to light? Someone in the Department of Health must be answerable, surely.
Mr Hunt
The truth is that no one in the Department of Health knew that this irregularity was happening. I do not think that anyone in the system knew that it was happening, until the issue arose in Yorkshire and Humberside when a particular decision was challenged. However, the hon. Gentleman is right: there is an important question mark over why it was possible for the irregularity to continue for so long without being noticed. I think that we need to listen to what Dr Harris says about why he believes that it was possible for it to continue for so long, and to act on his advice.
Guy Opperman (Hexham) (Con)
I declare an interest, as someone who represented a number of individuals under section 12 of the Mental Health Act—and also as someone who is owed money by the state for the work that he did on behalf of such individuals three and a half years ago, but I leave that to one side.
I welcome the drafting of retrospective legislation to resolve this problem, but has advice been obtained on whether the section 12 patients will retain any right to challenge their original detention procedures by way of judicial review?
Mr Hunt
My hon. Friend makes a very important point. All the patients’ rights to challenge their detention are preserved, with the exception of their rights relating to the technical irregularity over the authorisation of doctors under section 12. If they are challenging any other clinical or legal due-process decision, they are free to continue to do so: that will be completely unaffected by the retrospective legislation.
Iain Stewart (Milton Keynes South) (Con)
Can my right hon. Friend explain the position of trusts such as Milton Keynes PCT, which was part of South Central strategic health authority but is now part of East Midlands SHA? I understand that that is one of the SHAs that were affected. Will my right hon. Friend look into whether any issues have arisen from that transfer?
Mr Robert Buckland (South Swindon) (Con)
I welcome my right hon. Friend’s approach, which is responsible and right. May I urge him to ensure that the review being undertaken by Dr Harris will include the effect of the changes in NHS structures on all relevant provisions of the Mental Health Act—for example, the provision of information about bed availability to courts under section 39?
Rehman Chishti
I am so sorry, Mr. Speaker.
I am very grateful to the Secretary of State for his statement. Despite the irregularity, sections 2 and 3 of the Mental Health Act give patients an automatic right to a tribunal hearing, and the tribunal will have been able to consider their applications for release.
South London Healthcare NHS Trust
Jeremy Hunt Excerpts(11 years, 6 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 in July by my predecessor is publishing a draft report today making 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.
In accordance with chapter 5A of the National Health Service Act 2006, as introduced by the Health Act 2009, the trust special administrator has provided me with a copy of the draft report, which has today also been laid before Parliament. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. The report will also be available at: www.tsa.nhs.uk.
I will consider the detail of the draft report but do not anticipate commenting on its recommendations at this stage. It is for the trust special administrator to now consult locally on his draft recommendations. That consultation will run from 2 November to 13 December. Significantly, it will give the public, patients, NHS staff and NHS commissioners, as well as all other key stakeholders, the opportunity to have their say about the future of services currently provided by South London Healthcare NHS Trust and the wider south-east London health economy.
Following consultation, the trust special administrator must make final recommendations to me as to the action I should take in relation to the trust in a final report by 7 January 2013. I expect those recommendations to consider the views of all persons and organisations taking part in the consultation. It will be for me, as Secretary of State, to make a final decision about whether or not to accept the administrator’s recommendations by 1 February 2013, after having also considered the responses to the administrator’s consultation. I will publish my final decision and the reasons for it, and lay a notice of such, in Parliament.
A key objective of the Government is to ensure that all NHS organisations deliver high-quality services to patients that are clinically and financially sustainable for the long term. The provisions in chapter 5A of the National Health Service Act 2006, referred to as the regime for unsustainable NHS providers, give the Government a mechanism to address fundamental, systemic issues that have rendered an NHS trust such as South London Healthcare NHS Trust unsustainable.
Past efforts did not succeed in putting South London Healthcare NHS Trust on a sustainable path. Using the regime is about protecting services for patients in the context of an organisation that is no longer sustainable and to ensure that a prolonged, challenging situation can be resolved speedily to give certainty to NHS staff. Despite some recent improvements in clinical performance, there are significant concerns about sustaining them because of the trust’s very considerable financial challenges. As the House has previously been informed, in 2011-12, South London Healthcare NHS Trust incurred the largest financial deficit of any of the 248 NHS provider organisations in England, at over £65 million. The trust is losing well over £1 million of taxpayers’ money a week, which means that vital resources are being diverted from other parts of the NHS. I am clear that patients and NHS staff of the trust must be given the benefit of services, in future, that can be delivered on a sustainable footing.
In making my final decision, next year, on the future of South London Healthcare NHS Trust and the services it provides, my objective will be to ensure that services are delivered more efficiently and to a high standard for the people of south-east London. Patients and taxpayers deserve this.
I fully understand that use of the regime may be unsettling for NHS staff and local residents. However, no decisions have been made at this stage and everyone affected should rest assured that the Government are seeking to bring about further improvements in quality of care as well as dealing with the financial challenges of South London Healthcare NHS Trust through a stable and sustainable solution that will benefit everyone.
Dementia Funding
Jeremy Hunt Excerpts(11 years, 6 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I am announcing a £50 million capital funding in 2013-14 for the NHS and local authorities to work with providers to create care environments to help people with dementia live well with the condition.
Dementia is one of the biggest challenges we face as a society as our population ages and we are determined to transform the quality of dementia care for patients and their families. In March, the Prime Minister launched his challenge on dementia, which sets out the Government’s ambition to increase diagnosis rates, raise awareness and understanding and to double funding for research by 2015.
Research by the King’s Fund demonstrates that good design can help with the management of dementia. People with dementia are less likely to get confused or become distressed within an environment designed with their needs in mind. Examples include an intelligent use of colour to mark out different areas to aid memory, clearer signage and the opportunity to take part in activities such as gardening.
Local authorities working in partnership with social care providers and the NHS will have the opportunity to bid for a share of £50 million capital funding to invest in 2013-14 in improved care environments to help people with dementia and their carers manage their condition better. The funding is aimed at expanding the range of health and care services offering dedicated dementia friendly environments—and to stimulate further use of supportive environments to help the growing number of people with dementia get the best possible care.
Projects that are successful in securing funds will form part of a national pilot to disseminate best practice and evidence across the NHS and social care system of the best examples of “dementia friendly environments”. The findings and evidence will be used to develop future guidance in this area, assisting organisations that provide services to people with dementia as well as commissioners of services and local health and wellbeing boards to become one of the best in Europe.
The criteria for applying for funding and the deadline for receipt of applications will be announced shortly. The successful projects will begin from April 2013 and will be subject to national evaluation.