Health and Care Bill

Debate between Jeremy Hunt and Andrew Murrison

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Jeremy Hunt]

I absolutely agree with the hon. Lady, who knows about acute services. I also point to recent evidence from Norway that shows the same for general practice: patients who see the same GP over and over again go to A&E departments less than patients who see different GPs.

[Dr Murrison]

The hon. Member for Central Ayrshire (Dr Whitford) is absolutely right about acute safety; I speak from personal experience. My right hon. Friend is right about general practice, but the issues are different. In general practice, the issue is chronic long-term care: patients need to know that practitioners have a view of their condition that spans a long period—sometimes generations. The issues are very different in acute and primary care, but they come to the same thing.

Does my right hon. Friend agree that part of the problem with the workforce is not recruitment, but retention, particularly the retention of senior doctors in their mid-50s? It pains me to say it in this consensual debate, but the root cause is the GP contract and the consultant contract brought in by the last Labour Government. Those contracts incentivise people—in my demographic, as it happens—to leave, potentially leaving the service short of 10% of their entire career.

[Jeremy Hunt]

My right hon. Friend is right that there are problems with the GP contract. I do not want to get into too many discussions about doctors’ contracts in this very consensual debate, but Conservative Members have to take responsibility for not having remedied the pensions anomaly, which gives people an incentive to retire much earlier than we would want. We have to address that issue.

Lots of people might reasonably ask whether I did enough to address the issues in the nearly six years that I was Health Secretary. The answer is that I set up five new medical schools and increased by 25% the number of doctors, nurses and midwives we train. However, that decision was taken five years ago and it takes seven years to train a doctor, so not a single extra doctor has yet joined the workforce as a result.

That is the nub of the problem: the number of doctors, nurses and other professionals we train depends on the priorities of the current Secretary of State and Chancellor. As a result, we have ended up with a very haphazard system that means that although we spend about the average in western Europe on health, as a proportion of GDP, we have one of the lowest numbers of doctors per head—lower than any European country except Sweden.

Coronavirus Bill

Debate between Jeremy Hunt and Andrew Murrison

2nd reading & 2nd reading: House of Commons
Monday 23rd March 2020 Commons Chamber

[Jeremy Hunt (South West Surrey) (Con)]

The Health Secretary is not in his place—understandably—but I want to start with a tribute to him. I think I am the only other person in this House who has sat behind his desk, and I can testify that even without a pandemic it takes years off your life. The Health Secretary has made himself exhaustively available. He has worked tirelessly, and no one could have done more or better to prepare the NHS for the crisis we now face. I also want to thank the shadow Secretary of State for the way that he has risen to the challenge of his role. All of us as parliamentarians are proud of the exchanges that we have had this afternoon and on many occasions.

Ordinarily, our role as MPs is to scrutinise every detail of legislation, to understand it and to try to improve it. There are many questions about this legislation, but we are in a national emergency and every day we delay could cost lives. So I support the Bill 100% and I encourage all colleagues to do the same. A week ago, the Government said we were four weeks behind Italy. That then changed to three weeks behind Italy, and today our mortality rates are just two weeks behind Italy. Our hospitals, especially in London, are filling up. We have had a critical incident at one, and others say they are running out of ICU beds. According to the papers, we have one nurse fighting for her life in an intensive care unit. One London hospital has seven doctors with the virus in just that one hospital. Yet still people are going to shops, parks, beaches and holiday homes as if nothing has changed. It may be too late to avoid following Italy, but to have any chance at all of doing so we must move now to lockdown rules that ban non-essential travel. It is time not just to ask people to do social distancing, but to enforce those social distancing rules—not next week, not this week, but right away. I support the call by the shadow Secretary of State to do that, and it is very important we do so as soon as we possibly can.

The Bill can help in two areas. The first is on protective equipment for staff. Last week, Sir Simon Stevens told the Health and Social Care Committee that there were sufficient national supplies of PPE, but there were distribution problems. Since then, I know that the Government have moved heaven and earth to try to resolve those. All hospitals have had deliveries, and I pay tribute to the Health Secretary and everyone in the Department for achieving that, but there is still a lot of concern on the frontline. The main reason for that is because on 6 March Public Health England downgraded the recommendations as to what PPE doctors should use. That appeared to be at odds with World Health Organisation recommendations. I understand that has now been clarified by Professor Keith Willett in a message sent out on Friday that does bring our advice more into line with WHO guidelines.

Most importantly, the advice now makes it clear that doctors should wear goggles if there is any risk of being sprayed, but obviously doctors would feel vastly more secure with more extensive protection, such as full-length gowns and FFP3 masks. Is not the solution just to order manufacturers to make more of that vital equipment—not just a little more, but massively more? If that needs legal powers, the Bill should give the Government those powers to require every factory that is able to devote itself to the production of that life-saving equipment to do so.

Numerous doctors have died across the world, including Dr Li Wenliang, the courageous Chinese doctor who first tried to blow the whistle on this virus. Twenty-three doctors have died in Italy. This weekend, France lost its first doctor. None of us wants that here. Given the total determination of the Health Secretary to protect our frontline staff, would he urgently look into whether we need to manufacture more of the highest-grade equipment?

[Dr Murrison]

Does my right hon. Friend share my dismay at my being told just now that masks and PPE that were meant to be delivered to my authority, Wiltshire, tomorrow, will now be delivered on 9 April? I am not sure what the situation is in Surrey, but that seems extraordinary. Does he also agree that it has to be the right PPE—it cannot simply be a paper face mask from B&Q, as we heard earlier? It needs to be appropriate, and people need to know how it works. When they wear it, they are likely to have to work harder, because wearing PPE is not easy or straightforward.

[Jeremy Hunt]

My right hon. Friend knows, as a clinician— and I am concerned—that in our desire to get PPE out we have not understood the vital role that local authorities play in this. Residents in care homes are extremely vulnerable, and their carers need that equipment, so I very much support his concern about that.

The second area where the Bill needs to do more is testing. A week ago today our strategy changed from mitigation to suppression. I strongly support that change in strategy. Suppression strategies are being followed very successfully in South Korea, Taiwan, Hong Kong, Singapore and China, which appear to have turned back the virus. Here, all our public focus has been on social distancing, but testing and contact tracing to break the chain of transmission are every bit as important, if not more important. Those countries that have turned back the virus rigorously track and test every case and every suspected case, then identify every single person with whom a covid-19 patient has been in contact to take them out of circulation. As a result, those countries have avoided the dramatic measures and some of the economic damage that we have seen in Europe.

South Korea has avoided national lockdown, despite having a worse outbreak than us; Taiwan introduced temperature screening in malls and office buildings, but kept shops and restaurants open—it has had just two deaths. In Singapore, restaurants remain open and schools are reopening, although working from home is discouraged. Again, in Singapore, there have been just two deaths. Ten days ago in this country, we went in the opposite direction, and stopped testing in the community. How can we possibly suppress the virus if we do not know where it is? So far, we have had 281 deaths, tragically. According to the modellers, there is about one death per 1,000 cases, which means that we have just under 300,000 cases in this country. According to the same modellers, the number of cases is doubling every five days, which means that at the end of next week we will have about 1 million cases or more in this country. Unless we radically change direction, we will not know where those 1 million cases are.

The Prime Minister talked about expanding testing from 5,000 to 10,000 to 25,000, which is welcome. He even talked about 250,000 tests a day, which would be more than anywhere in the world—I welcome that ambition, but ambition is not the same as a national plan, and we have not seen a national plan on testing.

Nazanin Zaghari-Ratcliffe

Debate between Jeremy Hunt and Andrew Murrison

Monday 7th October 2019 Commons Chamber

[Dr Murrison]

I said in my opening remarks that the hon. Lady’s constituents can be proud of her, and they truly can be. Her passion shines through. I really do share her frustration, but I must resist the suggestion that the Government are in some way dragging their heels in this matter. That is absolutely not the case, and I think she probably knows that to be so. I have read out a series of diary dates on which we have made contact with the Iranian regime at the highest level, and we will continue to do so.

The hon. Lady has to understand that the tools we have in our toolbox are limited. She draws comparison with the Australians; I said in my earlier remarks that we have to accept that although Nazanin has Iranian-British dual nationality, Iran does not accept that she also has British nationality. That lies at the heart of this issue. Jolie King is a British-Australian national. That is the difference. It is invidious to compare consular cases and I am certainly not going to be drawn into doing so, not least because many of those who find themselves discommoded by the Iranian regime want us to keep their plight under the radar. That is their choice and that of their family.

In respect of any assistance that the UK Government can give in consular terms, of course we will provide that when the opportunity arises. We will do everything we possibly can to assist Gabriella if it is the family’s wish that she returns to the UK. As things stand, we do not have access to Nazanin, as we believe we should. We will continue to lobby hard; we should be able to access her and to have proper oversight of the legal machinations in Tehran so that we can assist her where we can, but we are up against a regime that has, up to this point, been impervious to our pleas on her behalf. We will continue to do that. I absolutely give the hon. Lady the assurance, which she requests, that we will continue to do all in our power to ensure that this poor woman returns to her family at the earliest opportunity.

[Mr Jeremy Hunt (South West Surrey) (Con)]

I understand the issue relating to how the Iranian Government treat dual nationals, but is it not imperative that we send out a signal from the House that every British citizen is equal and all British citizens will receive the highest standards of support from the British Government? My biggest sadness as Foreign Secretary was not being able to bring Nazanin home. Will my right hon. Friend confirm to the House that the highest duty of the state is the protection of its citizens, and that nothing—no other priorities—will stand in the way of reuniting this innocent woman with her loving husband and daughter?

[Dr Murrison]

I absolutely agree with my right hon. Friend and pay tribute to him for the hard work that he put into this case and the cases of other dual nationals in relation to Iran. I have to say that, as a newly arrived Minister in the Department he used to lead, I was genuinely impressed by the attention that he gave to so-called consular cases. He was absolutely rigorous in the application of his time and energy to these cases, and the case of Nazanin was certainly top of his list. I pay tribute to him for that.

Gosport Independent Panel: Publication of Report

Debate between Jeremy Hunt and Andrew Murrison

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

The hon. Lady is absolutely right to raise that matter. The nurse concerned, Anita Tubbritt, talks in the report about her concerns and the pressure that she was put under, and it was a brave thing to do. When the hon. Lady reads the report, she will see that nurse auxiliaries and others who were not professionally trained clinicians also came forward with concerns and were also worried about the impact that doing so would have on their own career. That is what we have got to stop because, in whatever part of the UK, getting a culture in which people can speak openly about patient safety issues is absolutely essential.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I was a junior doctor at the Royal Hospital Haslar in Gosport, which is just around the corner from the Gosport War Memorial Hospital, so I know that hospital fairly well, and I also know that the people of Gosport will be disappointed and distressed by this, since they very much value their community hospital.

Does the Secretary of State agree with me that there is an issue about the governance of smaller institutions, as we have seen in the past? I in no way wish to disparage the excellent work done by community hospitals, of which I have been a champion for many years, but will he look specifically at the pages in the report that touch on this? There is an issue about governing and ensuring safety in small institutions—whether in general practice or in hospitals?

[Mr Hunt]

I think that that is actually an excellent point, and we should definitely look at it. Big hospitals have clear lines of accountability—boards, chief executives—but those often do not exist in community hospitals and there is no one who can say they are the boss of that trust, so we should look at that.

NHS Long-Term Plan

Debate between Jeremy Hunt and Andrew Murrison

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

I always listen to the hon. Lady very carefully when she talks about the social care sector. I would say to her that while we are not announcing a new long-term plan for social care today, we are making some very important commitments to the NHS and the social care system, including the commitment that we will not allow the pressure from the social care system on the NHS to increase further. That means that, even before the date she mentioned, we are going to have to look very carefully at the settlement for social care.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate my right hon. Friend, whose commitment to our NHS is very clear. Does he agree with me, however, that the Commonwealth Fund indicator that really matters concerns clinical outcomes, some of which he referred to in his statement, and on that the news is not good? Will he do everything he can to make sure that the increased funding he has announced today is absolutely dedicated to improving outcomes for stroke, cancer and heart attack, on all of which we still lag well behind countries with which we can reasonably be compared?

[Mr Hunt]

I absolutely agree 100% with my hon. Friend, and we really must look at outcomes. The Commonwealth Fund was kind enough to say that that was actually one of the areas in which we are one of the fastest improving Commonwealth Fund countries. However, it has to be said that that was from a very low base, and we need to sort that out.

Breast Cancer Screening

Debate between Jeremy Hunt and Andrew Murrison

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

We are indeed talking to the charities operating in this sector about how we can best provide all kinds of support, including mental health support, as well as clinical guidance. We often talk in the House about the challenges facing the NHS, but it is important to note that breast cancer is an area in which survival rates have been improving, and have actually been catching up with those in other European countries. The NHS deserves great credit for that, despite today’s very serious failing.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I commend my right hon. Friend for the way in which he brought this very bad news to the House, and the hon. Member for Leicester South (Jonathan Ashworth) for the way in which he responded to it.

As my right hon. Friend will know, breast cancer is not just about survival nowadays; it is also about quality of life after treatment. Will his contact with those who have been affected extend to those who have been treated, but who may have had to be treated in a more radical way than might have been the case had their cancers been picked up earlier?

[Mr Hunt]

Absolutely. As my hon. Friend will know from his own medical background, it is impossible to know that until there is a detailed case note review, but we will certainly undertake that review for anyone who thinks they may have been affected.

NHS Staff Pay

Debate between Jeremy Hunt and Andrew Murrison

Wednesday 21st March 2018 Commons Chamber

[Mr Hunt]

This constitutes an investment by the Treasury of £4.2 billion, and the normal Barnett consequentials will apply, so it is perfectly possible for the Labour Government in Wales to replicate this deal if they choose to, but we know, of course, that had they replicated the increases in funding to the NHS in England, the NHS in Wales would have had an additional £1 billion spent on it over the past five years.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

rose—

--- Later in debate ---

[Dr Murrison]

I warmly welcome this announcement and congratulate my right hon. Friend, the trade unions and NHS Employers on reaching this deal. One problem facing our NHS is that of people not returning to work after they have had caring responsibilities. What elements of the deal will encourage more people to consider coming back into the workforce? I am thinking, in particular, of the non-pay elements and the reform of pay structures that he has mentioned.

[Mr Hunt]

The most important thing about the deal is that it will discourage people who might be reaching breaking point, because of personal circumstances, from packing it all in and leaving the NHS family. There is a particular proposal to allow much greater flexibility in the buying and selling of annual leave, so that people who need to work less because of things that happen at home, and perhaps people who want to work more, find it much easier to do so. This is therefore part of a much bigger shift towards the flexible working that we know everyone wants these days.

Oral Answers to Questions

Debate between Jeremy Hunt and Andrew Murrison

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

The hon. Lady may have noticed a little thing called Brexit that happened last year, which is the cause of understandable concern. If she looks at the facts about how many doctors came from the EU to the NHS in the year ending this March, in other words, post-Brexit, she will see that 2,200—[Interruption.] Someone asked about nurses. I happen to have that information here: 4,000 nurses joined the NHS from the EU in the year ending in March.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

One of the consequences of free movement in the European Union is that proportionately we take in rather fewer doctors, in particular, and fewer nurses from the Indian subcontinent and other places. What assessment has the Secretary of State made of the capacity to revisit the strong relationship we had with those workforces in the immediate post-war years?

[Mr Hunt]

My hon. Friend makes an important point. We want to attract the brightest and best into the NHS from all over the world, wherever they come from, if there is a need. The only caveat I would make is that we have imported a number of doctors from very, very poor countries that actually need those skills back home. We have to recognise that we have international responsibilities to make sure that we train the number of doctors and nurses we need ourselves.

NHS Shared Business Services

Debate between Jeremy Hunt and Andrew Murrison

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

The Minister responsible is the Under-Secretary, my hon. Friend the Member for Oxford West and Abingdon. This case happened before she was in post, so I took personal responsibility given it was such an important issue. I will write to the hon. Gentleman with more details about how the east midlands has been affected.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Does the Secretary of State agree that it is vital that we move towards a fully paperless national health service, but that it will be very difficult to do so as long as national health service trusts cannot talk to each other electronically? Radiological images, for example, are often not available when consultants see patients, who therefore have to have the test again, which is contrary to all the precepts of good practice in the Ionising Radiations Regulations 1999.

[Mr Hunt]

My hon. Friend is absolutely right. This is a very big part of our transformation plans for the NHS. Where the NHS does well internationally is in out-of-hospital records; our GP records are among the best of any country’s. GPs have done a fantastic job over the past 15 years in keeping all their records electronically, and they provide a lifetime snapshot of a patient’s history. Where we are less good is in our hospital records, where one can still find paper records in widespread use. That is not just very, very expensive but—he is quite right—unsafe at times.

Mental Health and NHS Performance

Debate between Jeremy Hunt and Andrew Murrison

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I was in touch with what was happening in the NHS every single day throughout the Christmas recess. As someone who has worked in a hospital, the hon. Lady might question whether it is particularly helpful for NHS hospitals to have visits by high-profile politicians right at their busiest periods. I have been very closely in touch. She talks about the problem at London ambulance service. That was a problem staff have been trained to deal with. The staff of her own hospital worked extremely well, but they do not welcome attempts—she is making one this afternoon—to politicise the problems the NHS faces.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

On the changes to the four-hour standard that the Secretary of State heralded, what can be done to incentivise and upskill GPs who may wish to take a closer interest in minor and moderate illnesses, including the use of nurse-led minor injury units?

[Mr Hunt]

They have a very important role. Some of the most successful and best-performing trusts, such as Luton and Dunstable, have a very good streaming process at the A&E front door, with good alternatives when it is not appropriate for people to go to an A&E department. We need to learn from that. Nurse-led units can be very important. GP-led units can make a big difference, too. It will not be the same everywhere, for reasons of space if nothing else, but there is a solution that everywhere can adopt.

Oral Answers to Questions

Debate between Jeremy Hunt and Andrew Murrison

Tuesday 20th December 2016 Commons Chamber

[Mr Hunt]

The best thing we can do to narrow the gap is make sure that we continue to invest properly in the NHS and social care system, and make good progress on public health, which often has the biggest effect on health inequalities. That is why it is good news that we have record low smoking rates.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

With acute hospital bed blocking at a record high, do Ministers agree that it is a great pity that so very few of the 40 sustainability and transformation plans now in the public domain deal directly with step-down care and, in particular, with community hospitals?

Health Service Medical Supplies (Costs) Bill

Debate between Jeremy Hunt and Andrew Murrison

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is right in that we see demand for NHS services, which includes treatment and drugs, increasing by a total of around £30 billion over the next five-year period, which is a huge amount and certainly more than we as a country can afford without changing practice. That is why we are implementing a very challenging series of efficiency reforms designed to make sure that we can afford to continue current levels of NHS service on the £10 billion increase this Government are putting in. Part of that is indeed measures such as those in this Bill to control the drugs bill. My hon. Friend is also right that going forward over the next 25, rather than five, years we will be seeing the bigger issue of the accelerating pace of innovation in science. That provides great opportunities for the NHS, but potentially great pressures for the budget, and I am sure we will continue to discuss those issues extensively in this House.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

What assessment has my right hon. Friend made of the impact this Bill might have on the parallel trade in pharmaceuticals, which he will know has both costs and benefits for the NHS and for patient care?

[Mr Hunt]

My hon. Friend obviously knows about these matters in a great deal of detail and should be reassured that this Bill should prevent people who are part of the current voluntary pharmaceutical price regulation scheme—PPRS—from parallel-importing through European subsidiaries, which currently under single market rules we are not able to do anything about. That loophole will be closed.

The first element of the Bill relates to controls on the cost of branded medicines. For many years the Government have had both statutory and voluntary arrangements in place with the pharmaceuticals industry to limit the overall cost of medicines to the NHS. Companies can choose to join either the voluntary scheme or the statutory scheme. Each voluntary scheme typically lasts for five years before a new scheme is negotiated.

The current voluntary scheme is the 2014 PPRS. The objectives of that agreement include keeping the branded health service medicines bill within affordable limits while supporting the availability and use of effective and innovative medicines. For industry, the PPRS provides companies with the certainty and backing they need to flourish both in the UK and in the global markets.

The current PPRS operates by requiring participating companies to make a payment to the Department of Health of a percentage of their NHS sales revenue when total sales exceed an agreed amount. So far the PPRS has resulted in £1.24 billion of payments, all of which have been reinvested back into the health service for the benefit of patients.

Junior Doctors: Industrial Action

Debate between Jeremy Hunt and Andrew Murrison

Monday 5th September 2016 Commons Chamber

[Mr Hunt]

The pressures in the NHS mean that there is a need for more doctors for all sorts of reasons, and we do not have as many doctors as we need at the moment. That is why this Government are training more doctors and putting an extra £10 billion into the NHS. The manifesto that the hon. Lady stood on just over a year ago would not have put that sort of funding into the NHS and would have meant that we were unable to train that number of extra doctors. We are doing that, but it takes time and we need to ensure that services are safe while we are getting there.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate my right hon. Friend on his balanced and reasonable approach in the negotiations despite provocation from people who really should know better. Does he agree that there cannot have been a single occasion in the history of the NHS other than this in which the General Medical Council—the body responsible for professional standards—has effectively had to intervene to stop a strike? Will he also admit that we might have underscored the centrality of Sir Bruce Keogh’s four clinical standards a little more when introducing the notion of the seven-day NHS?

Junior Doctors Contract

Debate between Jeremy Hunt and Andrew Murrison

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

Health Education England is absolutely clear that it has to run national training programmes, and that is why it has to have standard contracts across the country. As the hon. Lady knows well from her previous role on the Front Bench, in reality foundation trusts have the legal right to set their own terms and conditions, but they currently follow a national contract; that is their choice, but because they do that, I used the phrase “introduction of a new contract” this afternoon. I expect, on the basis of current practice, that the contract will be adopted throughout the NHS.

I enjoyed working with the hon. Lady when she was shadow Health Secretary, but on this issue, she was quite wrong, because she saw the WhatsApp leaks, which revealed that the British Medical Association had no willingness or desire for a negotiated settlement in February, precisely when she was saying at the Dispatch Box that I was the one being intransigent. She gave a running commentary on the dispute at every stage, but when those leaks happened, she said absolutely nothing. She should set the record straight and apologise to the House for getting the issue totally wrong.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate my right hon. Friend on the patience that he has shown on this matter, and on the deal that was agreed back in May—it is a good deal. Apropos of the remarks of the hon. Member for Hackney North and Stoke Newington (Ms Abbott), who speaks for the Opposition, does the Secretary of State agree that it is indeed important to maintain morale in the health service? We need to be very careful about striking special deals for one particular part of the workforce, and the perception that that might be unfair. Would he further agree that we need to avoid the temptation of addressing every single grievance of a particular workforce? That is more properly within the bailiwick of managers locally than national contracts.

[Mr Hunt]

My hon. Friend obviously speaks from experience and very sensibly on this issue. In this House, of course, we think about the actions of politicians, Ministers and so on, but for doctors in a hospital, the most important component of their morale is the way that they are treated by their direct line manager. One of the things that worries me most in the NHS, looking at the staff survey, is that 19% of NHS staff talk about being bullied in the last year. That is ridiculously high. We need to think about why that is. The reality is that it is very tough on the frontline at the moment. There are a lot of people walking through the front doors of our NHS organisations, and we need to do everything that we can to try to support doctors and nurses, who are doing a very challenging job.

Junior Doctors Contract

Debate between Jeremy Hunt and Andrew Murrison

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

The hon. Gentleman is right. A seven-day NHS is not just, or not even mainly, about junior doctors, although they are a very important part of the equation. We will need a new contract for consultants and we are having constructive negotiations with them. Many other people working in the NHS are already on seven-day contracts, so there will not necessarily be a contractual change, but the hon. Gentleman is right to say that we will need, for example, diagnostic services operating across seven days so that the junior doctor who works at the weekend will be able to get the result of a test back at the weekend. Those are all part of the changes that we will introduce to make the NHS safer for patients.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I warmly congratulate both sides on reaching this agreement. Our NHS is different at weekends, and my right hon. Friend is right to inculcate Sir Bruce Keogh’s four key clinical standards on a Sunday and a Saturday. Does he agree that it is important not simply to rely on mortality data, which are often difficult to interpret, to underpin the case for a seven-day NHS? Will he look closely at other metrics based on clinical standards for things like routine lists for upper gastrointestinal endoscopy on a Saturday and Sunday? Will he also look at palliative care, which of course does not feature in any hospital mortality data?

[Mr Hunt]

My hon. Friend speaks, as ever, very wisely on medical matters. I particularly agree when he talks about palliative care; it has got better, but there is a long way to go. We have recent evidence that it is particularly in need of improvement where we are not able to offer seven-day palliative support.

Junior Doctors Contracts

Debate between Jeremy Hunt and Andrew Murrison

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

I will tell the hon. Lady what is unsafe for patients. It is not standing up to the BMA when it behaves in a totally unreasonable way with a Government who are determined to make NHS care safer. With the greatest respect to her, because she is new to the House, she should appreciate that previous Labour Governments did not stand up to the BMA, and that is why we are left with many of the problems that we face today.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

The Health Secretary is doing the right thing for patients, and I welcome his statement. However, does he accept that there is more to be done in contractual terms for the NHS workforce if Sir Bruce Keogh’s 10 clinical standards are to be implemented? Although he may not wish to reflect on it at this particular point in time, what does he think can be done to improve contracts for non-training grades and consultants in the NHS?

[Mr Hunt]

My hon. Friend speaks very wisely and also from experience on these issues. He is right. I have tried to make the point in my statement that a seven-day NHS is not just about junior doctors—it is about the whole range of services; it is about consultants, diagnostic services, general practice. As we seek to move towards a seven-day NHS, we will also be expanding the NHS workforce to ensure that the current workforce does not bear all the strain by itself. This is an opportunity. We have had lots of comments today about morale. I simply say this: the way to improve morale for doctors is to enable them to give the safest possible care to patients. At the moment, much of the frustration from doctors is that they do not feel able to give the safe care they would want to. We want to change that and to work with the BMA to make that possible.

Junior Doctors Contracts

Debate between Jeremy Hunt and Andrew Murrison

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

With respect, that precisely encapsulates the problem. The hon. Gentleman has interpreted the fact that I want to do something about excess mortality rates, which mean that a person admitted at the weekend has an 11% to 15% higher chance of death than if they were admitted in the week—that is proven in a very comprehensive study—as an attack on the medical profession. Nothing could be further from the truth. It was actually the medical profession—the royal colleges and Professor Sir Bruce Keogh—that first pointed out this problem of the weekend effect. We are simply doing something about it.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

The Health Secretary rightly mentioned the excellent Salford Royal, which the BMA has used to suggest that the new contract is not necessary, because of the progress that it has made on seven-day working and on Sir Bruce Keogh’s clinical standards. However, is it not the case that what might be right in a large hospital in a densely urban centre might not be applicable right across our national health service? Is that not why the very radical changes to working practices that he is rightly prosecuting are necessary?

[Mr Hunt]

Yes, there are some hospitals that have managed to eliminate the difference between weekend and weekday mortality under the current contracts, but there are only a few. Having talked more widely with the medical profession, it is clear that we need a sustained national effort—contract reform is part of that effort—if we are to promise uniformly across the NHS that we will provide every patient with the same high-quality care, every day of the week. Part of that is having a modern contract for junior doctors that deals with the anomalies that they themselves recognise in the current contract; that is why this is the moment for wider reforms.

Oral Answers to Questions

Debate between Jeremy Hunt and Andrew Murrison

Tuesday 22nd March 2016 Commons Chamber

[Dr Andrew Murrison (South West Wiltshire) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The latest performance figures show the challenges that the NHS faces in coping with extraordinary levels of demand. Despite these pressures, however, the Government are making good progress in our ambition that NHS care should be the safest and highest quality in the world. Figures from the Health Foundation show that the proportion of patients being harmed has fallen by more than a third in the past three years, that MRSA infections have nearly halved since 2010, and that C. diff infections fell by more than a third over the same period.

[Dr Murrison]

The “Five Year Forward View” said that the NHS would need between £8 billion and £21 billion extra from the Treasury by 2021. It got a commitment of £8 billion, which was opposed by the party opposite. Can the Secretary of State say when the Stevens plan will be formally reviewed, and where in the range between £8 billion and £21 billion he expects the real requirement will be found to lie?

[Mr Hunt]

We are actually putting in £10 billion of additional public money to support the NHS over the next few years. That means that we need to find between £20 billion and £22 billion of efficiency savings. We will be reviewing the progress of the plan as we go through it, but I want to reassure my hon. Friend that I meet the chief executive of NHS England to view the progress of the plan every week and that we are absolutely determined to ensure that we roll it out as quickly as possible.

NHS: Learning from Mistakes

Debate between Jeremy Hunt and Andrew Murrison

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

Well, quite a lot. For example, we have increased the number of nurses by more than 10,000 since the Francis report was published, to ensure that we do not have a problem with safety on our wards. We recognise that it is incredibly important not to have short-staffed wards, and we are making more reforms in this Parliament to ensure that we recruit even more nurses. It would be good to have some support from Labour on that.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate my right hon. Friend on his statement, although I hope that it draws on experience from other healthcare economies, as well as on the aerospace sector. When things go wrong, it is right that the NHS is frank about it and, where necessary, compensates people for what may be long-term management issues. Currently, negligence settlements are based on provision in the private sector and do not necessarily anticipate that people will be treated and managed in the NHS, which means that the service effectively pays twice for mistakes. As the Secretary of State seeks to close the Simon Stevens spending gap, perhaps he will reflect on that. I would be grateful if he could say to what extent he thinks that excessive negligence claims are influenced by the rather perverse way in which they are currently calculated.

[Mr Hunt]

Someone looking at our current system independently might say that some things are difficult to understand, including the point raised by my hon. Friend and the fact that we tend to give bigger awards to wealthier families because we sometimes take into account family incomes when we make them. We are considering that area, but we are cautious about reducing the legal rights of patients to secure a fair settlement when something has gone wrong. In the end, this is about doing the right thing for patients, and the most effective way of reducing large litigation bills—I know my hon. Friend will agree with this—is to stop harm happening in the first place, and that is what today is about.

Junior Doctors Contracts

Debate between Jeremy Hunt and Andrew Murrison

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

We need senior decision-makers to be present. They are the most important people when it comes to delivering seven-day care. Most of the medical royal colleges accept that a junior doctor who has had a substantial amount of training does qualify as a senior decision-maker, which is why we need them more.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

The BMA has taken the oversubscribed political sub-speciality of spin doctoring to a whole new level. May I express my admiration for the Secretary of State for his ability to keep his cool under the sort of provocation that he has had, and ask how a 13.5% increase in pensionable pay could possibly lead to problems with recruitment and retention?

[Mr Hunt]

My hon. Friend speaks with personal knowledge. One of the things that has been wrong with junior doctors’ contracts for many years is that basic pay is too low. They therefore feel under huge pressure to boost basic pay by premium working, and that has led to some of the distortions that we see. So, yes, it is a significant increase in basic pay, which will be a very big step forward.

Oral Answers to Questions

Debate between Jeremy Hunt and Andrew Murrison

Tuesday 9th February 2016 Commons Chamber

[Mr Hunt]

The hon. Gentleman should give a slightly more complete picture of what is happening in his hospitals. There are nearly 2,000 more operations every year, 7,000 more MRI scans, and 7,000 more CT scans than there were five years ago. When it comes to the issue of deficits, we are tackling the agency staff issue. That happened because trusts were responding to the Francis report into what happened in Mid Staffs. Rightly, they wanted to staff up quickly, but it needs to be done on a sustainable basis. I simply say to him that if we were putting £5.5 billion less into the NHS every year, as he stood for at the previous election, the problems would be a whole lot worse.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Does my right hon. Friend not agree that running costs in the NHS, which vary from £105 to £970 per square metre per year as highlighted by Lord Carter, are wholly unacceptable, and that the concept of a model hospital to bring the worst up to the standard of the best, which was also highlighted by Lord Carter, has great merit?

[Mr Hunt]

My hon. Friend knows about these things from his own clinical background, and he is absolutely right. We are now doing something—it is probably the most ambitious programme anywhere in the world—to identify the costs that hospitals are paying. From April, we will be collecting the costs for the 100 most used products in the NHS for every hospital. That information will be shared. We are the biggest purchaser of healthcare equipment in the world, so we should be paying the lowest prices.

Southern Health NHS Foundation Trust

Debate between Jeremy Hunt and Andrew Murrison

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

I can give the hon. Gentleman that reassurance. Trusts understand that that is already happening and has been happening. All trusts will have families that have been in touch with them with concerns about potentially avoidable or preventable deaths. I hope that this will be a reminder to all trusts that they need to take those concerns very seriously indeed.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

The disparity in excess deaths between vulnerable groups at Southern Health is truly shocking, but of course responsibility for looking after the people in question spans health and social care. Is my right hon. Friend content that we have in place the informatics that will allow outliers to be identified, and therefore rectification to be under way? One assumes that that could easily be done by NHS England, but at the moment the informatics seem to be problematic in this respect.

[Mr Hunt]

My hon. Friend is absolutely right. That is why Professor Sir Bruce Keogh is developing a methodology to help us understand the number of avoidable deaths and the reporting culture at a trust level. We have a good methodology for understanding the number of avoidable deaths on a national level. The Hogan and Black analysis says that about 3.6% of deaths have a 50% or more chance of being avoidable. However, we will not get real local action until we localise it, and that is the next step.

Oral Answers to Questions

Debate between Jeremy Hunt and Andrew Murrison

Tuesday 17th November 2015 Commons Chamber

[Mr Hunt]

Obviously, I am very concerned to hear what the hon. Lady says. I know that my right hon. Friend the Minister of State has been looking at this issue and is very willing to talk to her about it. Alternative provision has been made, but she is right to make sure that her constituents have access to urgent and emergency care seven days a week.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Does my right hon. Friend agree that full hospital services does not mean full services in every hospital, and that if we are to achieve our ambition of driving down excess weekend deaths, we will have to look again at concentrating services in regional and sub-regional centres, and, in addition, make sure that we network properly among smaller hospitals, where they exist?

[Mr Hunt]

My hon. Friend speaks very wisely on this issue. Yes, this is not about making sure that every hospital is providing every service seven days a week. It is about making sure that in an urgent or emergency situation, people can access the care they need and that, for example, high dependency patients are reviewed twice a day, even at the weekends, by consultants. That happens across all specialties in one in 20 of our hospitals, which is why it is so important to get this right.

Oral Answers to Questions

Debate between Jeremy Hunt and Andrew Murrison

Tuesday 13th October 2015 Commons Chamber

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Unfortunately, every time I open a page of my local newspaper these days I am met with the beaming face of yet another general practitioner in his mid-50s who has decided to throw in his hand after many, many years of serving his community. These doctors are best placed to manage patients in primary care and ensure that they do not have to go to secondary care or A&E. What analysis has my right hon. Friend made of the reasons these experienced professionals are leaving the profession prematurely, and what will his reforms do to stem the tide?

[Mr Hunt]

My hon. Friend makes a very important point. We have done extensive analysis, because of our commitment to transform the role of general practice, of the issues. They include too much bureaucracy and form-filling, which means that doctors do not spend enough time with patients, and a sense that successive Governments have not invested in general practice and primary care. That is exactly what we seek to turn around with the “Five Year Forward View”.