Gosport Independent Panel: Publication of Report

Debate between Jeremy Hunt and Bernard Jenkin

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

I am happy to do that. All the families who think they had a relative affected have been part of the panel process, and they were all invited for a briefing by Bishop Jones this morning in Portsmouth. We will provide ongoing support and counselling if necessary through the Department of Health and Social Care, which was a specific request of Bishop Jones. We are also conscious that when people read the news, they may suddenly decide that they or a loved one were affected by this. We have set up a helpline so that people can contact us and we can help them to trace whether they too have been affected.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

Does not every instance of people being scared to speak out and relatives finding it too difficult to complain underline the importance of the Healthcare Safety Investigation Branch, which the Secretary of State has established? I remind him that I am chairing the Joint Committee of both Houses that is carrying out prelegislative scrutiny of the draft Health Service Safety Investigations Bill. When we report on 24 July, will my right hon. Friend undertake to bring that into law as quickly as possible? That will afford the safe space that people need to report such matters without fear or favour.

[Mr Hunt]

Absolutely. I commend my hon. Friend for his work and for being one of the colleagues in this place who have thought and talked about the importance of getting the right safety culture in the NHS. The Healthcare Safety Investigation Branch matters because in situations such as this, it could have been called in, done a totally independent investigation, got to the truth of what was happening quickly and prevented a recurrence of the problem. That is one of a number of things that we need to think about.

NHS: Learning from Mistakes

Debate between Jeremy Hunt and Bernard Jenkin

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

I contrast the tone of the hon. Lady’s response with that of the shadow Health Secretary. Although I by no means agree with everything she said, she does make some important points.

It is not the case that we have delayed the medical examiners scheme. In the previous Parliament, we had pilots so that we could understand exactly how the examiners would work. That is relevant to the hon. Lady’s other point about audit, with which I completely agree. One thing that medical examiners will be able to do is to look for unexpected or unexplained patterns in deaths. Obviously, the vast majority of deaths are routine, predictable and expected, but those examiners will be able, looking at audit tools, to identify where there are things to worry about, which is why this is an important next step.

With respect to whistleblowers, I will reflect on what the hon. Lady says. We are trying to eliminate the need for things ever to get to the point where someone has to become a whistleblower. We want to ensure that people are supported to speak out about mistakes they have seen or made and concerns that they have, and that they are confident that they will be listened to. We are publishing a table today about the quality of the reporting culture. Much of the raw data that allow us to rank trusts on the quality of reporting data come from the NHS staff survey, which asks staff how valued they think they are, and how safe and easy it is to raise concerns. That is why this is a big step forward.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my right hon. Friend for his statement and for taking forward so many of the recommendations that were made a year ago in the Public Administration Committee’s report on investigating clinical incidents in the NHS. I particularly thank him for implementing the creation of a safe space, which has been a controversial and difficult subject because some people think that this is about hiding stuff, when in fact it is about getting people to speak much more openly and freely. Will he say something about how that will be implemented without primary legislation?

[Mr Hunt]

I thank my hon. Friend for his question. He and I have talked many times and thought very hard about how we can learn lessons from the air industry. He is one of the people who came to me first to say that if we want to set up an equivalent to the air accidents investigation branch, we need to give people in the healthcare world the same legal protections that others have when they are speaking to that branch, and that is at heart of the statement that I have made to the House today.

The point about safe space is very, very important. This is not about people getting off scot free if they make a terrible mistake. There is no extra protection here for anyone who breaks the law, commits gross negligence or does something utterly irresponsible. Patients still have those protections. What they gain is the comfort that we will get to the truth and learn from mistakes much more quickly. Every single patient and bereaved family says that the most important thing is not money, but making sure that the system learns from what went wrong. We will ensure that we construct the safe space concept, and I do not rule out extending that beyond the investigations of the healthcare safety investigation branch.

Junior Doctors Contracts

Debate between Jeremy Hunt and Bernard Jenkin

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

The trouble with commissions is that they tend to take rather a long time to come up with their conclusions, and we need to sort out these problems now. That is why the Chancellor promised an extra £3.8 billion for the NHS next year, and why we said that we want 5,000 more GPs working in general practice, which will help out-of-hours services. We have a five-year plan that the NHS has the funding to implement, and that will transform out-of-hospital services. I hope that those developments will address the right hon. Gentleman’s concerns.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my right hon. Friend for his patience and resolution in bringing this matter to a conclusion. Does he share the real sadness that so many of us feel that these wonderful young people who come into the health service to be doctors with such high ideals are caught up in this terribly debilitating and damaging dispute? I ask him to reinforce his efforts to engage and speak directly with junior doctors and the medical profession as a whole and not allow the disruptive behaviour of the British Medical Association to destroy the relationship that we need to have with our doctors.

[Mr Hunt]

My hon. Friend is right. There was absolutely no reason to have this dispute, because the things that we are trying to sort out—seven-day care and safer care for patients—are what every doctor wants to happen. Indeed, they choose medicine as a profession from the highest of ethical motives, and we want to support them. I share his sadness that it has come to this, but given that the counter-party in the situation is not willing to budge, we have to take action to remove uncertainty and to do the right for patients and for doctors. I will certainly continue to engage. The new commission headed up by Professor Dame Sue Bailey will also look at wider issues of morale, which will make a big difference.

NHS Reform

Debate between Jeremy Hunt and Bernard Jenkin

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

The hon. Gentleman makes an important point. As part of what I said in my statement, we are looking at how we train doctors. My hon. Friend the Member for Weaver Vale (Graham Evans) talked about creating a learning culture, and the big change that we need to make is creating a culture in which people feel supported to speak out about any concerns or anything on which they think they can see a way of doing something better. They must not feel that that could threaten their career prospects. We do not have that culture in the NHS at the moment, but we need it if the NHS is to be the world’s largest learning organisation, as I argued in a speech this morning. I think staff are up for it, but it is a big change.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my right hon. Friend very much for his extraordinarily embracing response to the Public Administration Select Committee report on clinical incident investigation. We started less than a year ago with the germ of an idea, and it has turned into what amounts to a radical reform of safety investigation in the health service. That is a tribute to him and to the Committee’s witnesses, but it is a tribute to the health service itself that it has embraced the idea, which is a big change that I believe will be transformative.

May I pick up on the Secretary of State’s reluctance to provide special legislation for the immunity of those giving evidence to the new patient investigation body? Will he keep an open mind on the subject? If he wants that body to be truly independent and to have a special status, he should remember that the marine accident investigation branch and the air accidents investigation branch have specific legislation to provide for such immunity. Public interest disclosure protection must not be challenged by freedom of information requests, given that freedom of information has been extended into areas where we never imagined it would go. We have to be specific in legislation that that cannot happen in this instance.

[Mr Speaker]

Too long—I hope the answer will be somewhat briefer.

Maternity Services (Morecambe Bay)

Debate between Jeremy Hunt and Bernard Jenkin

Tuesday 3rd March 2015 Commons Chamber

[Mr Hunt]

No one has done more than the right hon. Lady to try to improve the standard for complaints, with the excellent work she did with Professor Tricia Hart. We are in the process of implementing her recommendations, but as the right hon. Lady knows, with the fifth largest organisation in the world, it is one thing to make a commitment in this place, but another to make it happen on the ground. There is definitely much work to do.

I also agree with the right hon. Lady’s comments about James Titcombe. This is a man who gave up his job working in the nuclear industry to come down to London and work in the CQC so that he could actively be part of the culture change that he wanted to see in the NHS. I do not think anyone could have done more than that. It is truly remarkable.

As the right hon. Lady has mentioned Wales, let me say that we have put 20 trusts into special measures in England and it is inconceivable that there will not be trusts with similar problems in Wales. I urge her to encourage the Labour party in Wales to look at introducing a special measures regime and a chief inspector of hospitals in Wales, because that has had such a powerful effect on improving standards of care in England.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my right hon. Friend for his statement and Dr Bill Kirkup for his excellent report. Let me reassure him and the House that the Public Administration Committee is also preoccupied with the failings of the parliamentary and health service ombudsman in the conduct of these cases. I, too, have met James Titcombe on many occasions and have been extremely impressed by his extraordinary commitment to making sure that he is heard so that so many others can be heard.

May I also point out that the report reeks of the confusion that exists between CQC and the PHSO about what their respective responsibilities are? If we are talking about accountability, what we need is an organisation that is accountable for investigating clinical incidents in the NHS, whether they are down to particular local problems or broader systemic problems—by which we mean not that that is an excuse for what goes wrong; rather, it is so those systemic problems can be put right. I therefore very much welcome what my right hon. Friend has mooted will be the task of Sir Mike Durkin: to look at how that capacity can be developed, in the same manner, perhaps, as the air accidents investigation branch of the Department for Transport.

[Mr Hunt]

Dr Mike Durkin will be delighted that he has been promoted and given a knighthood for his wonderful work on patient safety, but it has not happened yet, even though he certainly deserves it. I thank my hon. Friend for his understanding of the complexity of these issues and the importance of the need for culture change. The work of his Committee has not been to scratch around the surface; it has tried to think hard about the solution. He is absolutely right that we need to end regulatory confusion. We now have a strong CQC, which is doing incredible inspections and is trusted across the system. However, we need a system in which people can get independent external advice quickly, which is why he was right to alert me to the potential of an air accidents investigation branch equivalent. I hope that is something that could be helpful for the ombudsman as well.

Francis Report: Update and Response

Debate between Jeremy Hunt and Bernard Jenkin

Wednesday 11th February 2015 Commons Chamber

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I commend my right hon. Friend for his statement and thank Sir Robert Francis for his excellent report, which, as the Secretary of State knows, goes to the heart of the Public Administration Committee’s inquiry into clinical incident investigation. It comes as no surprise that we still have severe problems in the NHS. Perhaps the “freedom to speak up” guardian role needs to provide complete legal protection for people speaking up, immunity from freedom of information requests so that the information and the names cannot be exposed maliciously, and the capacity to investigate what is reported to them on a completely independent basis. We look forward to his giving evidence to our Committee.

[Mr Hunt]

I thank my hon. Friend for his interest in the issue of culture change, including at his local hospital, which I visited last week and where I was pleased to see a change in culture happening, despite some very severe problems. It is excellent that PASC is doing this inquiry, and his suggestions sound very worth while. We will consider them as part of our consultation—in fact I would encourage his Committee to submit them formally, to ensure that we give meaning to these “freedom to speak up” guardians.

NHS Major Incidents

Debate between Jeremy Hunt and Bernard Jenkin

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

Declaring a major incident is the decision of the local hospital trusts, and that is right. But it is important that, before they make that decision, they should take proper account of the impact on the rest of the local health economy. That is what every responsible hospital wants to happen, and that applies to the hon. Gentleman’s area as well as everywhere else.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

Following the declaration of a major incident at the accident and emergency unit of Colchester hospital, we now await the Care Quality Commission report into that incident, which will be published very shortly. We want the report to tell the truth, but it is harder to tell the truth in a political atmosphere where there are people who want to gloat over these challenges to get votes.

[Mr Hunt]

My hon. Friend is absolutely right. I have spoken to the chief executive of the hospital, and I must say that she and her staff are doing a good job in turning around a very difficult situation. What they want is support. We have issued sensible guidance that tells hospitals that if they declare a major incident, they must take account of the impact on the rest of their local health economy. A responsible Opposition would support such guidance, and not to try to turn it into a political football.

NHS (Five Year Forward View)

Debate between Jeremy Hunt and Bernard Jenkin

Monday 1st December 2014 Commons Chamber

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I welcome every word of my right hon. Friend’s statement, not least because his fourth pillar on culture change echoes the work done by the Public Administration Committee on complaints handling and the need for openness. His statement addresses all the needs and challenges we face in north-east Essex: the problems of openness and transparency in the local hospital and the need to transfer more of what the hospital does back to the community providers—to the multidisciplinary providers that need to be in the community. I welcome the £1 billion fund for developing community facilities, but how is he going to persuade the CCGs to transfer some of their commissioning power to these units? A hospital in Harwich, which was built under the last Labour Government, has two operating theatres that have never been used because the CCG, and its predecessor the primary care trust, would not commission services through those facilities.

[Mr Hunt]

I thank my hon. Friend for his long-standing support for the importance of transparency in driving up standards in health care. He has championed that for his own hospital, which has had particular issues on that front, but also through his role in this House, and he is absolutely right to do so. On his substantive point, we will get CCGs to do what he suggests through the reforms that I have announced, which will encourage them to take a holistic view of the health care received by the patients for whom they are responsible. In particular, we have got to move away from commissioning care piecemeal—commissioning a certain number of hips or a certain number of mental health consultations—and start looking at patients and all their needs in the round. If we commission in that way, we can avoid a number of the human tragedies that have come to light.

Patient Safety

Debate between Jeremy Hunt and Bernard Jenkin

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

First, I will ensure that throughout the system when we have failures in care we are completely transparent about them and do not seek to brush them under the carpet. That is a very important change. Secondly, yes there is pressure on ambulance services, just as there is pressure in most parts of the NHS now, but under this Government our ambulance service is taking 1,000 more people every day on emergency journeys. We should credit it with doing a very good job in difficult circumstances.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I commend my right hon. Friend for being determined to create a different and more effective safety culture in the NHS, just as in the airline or oil and gas industries. Does he accept that publishing more data is only part of the equation and will not necessarily change attitudes and behaviours, particularly if those data are then gamed at another target? We must tackle attitudes and behaviours at source—in the operating theatre, the GP’s surgery and throughout the whole service—to get that better safety culture.

[Mr Hunt]

As ever, my hon. Friend speaks wisely. The first step is to be open and transparent about where the problems are, and I hope today will be a step in that direction. In the end, however, if we are to change things we must create a learning culture in all our hospitals so that the word goes out from the top down that the management is interested in hearing from staff if they have concerns about safety, because it wants to learn from those concerns and put them right. One of the messages I have been trying to get across is that that does not cost money; it saves money. We spend £1.3 billion a year on litigation and £800 million on adverse events. If we are feeling, as everyone is, a tough climate financially, this is a positive thing to do for that reason as well.

Mid Staffordshire NHS Foundation Trust

Debate between Jeremy Hunt and Bernard Jenkin

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

I have concerns about how much that service is used. My particular concern is not so much whether employers are checking before they employ someone, but whether they are informing the service that an employee should be referred to it for delivering inappropriate care. That is something that we will look at.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I remind my right hon. Friend that the Public Administration Committee is conducting an inquiry into complaint-handling across the public service and that Essex recently had an instance of failure at our local hospital, where complaints were not properly handled. How does my right hon. Friend intend to deliver on his statement that “all patients will be able to access independent help in making their complaint”? May I suggest to him that, rather than setting up a new structure or body, perhaps the ombudsman is the right body to help facilitate those complaints, because it would create a one-stop shop for them?

[Mr Hunt]

We have avoided setting up a new structure or body in our response to the recommendations made by the right hon. Member for Cynon Valley. As for how we will make sure that this happens, I agree with my hon. Friend that the ombudsman is the final port of call if someone is not satisfied with the way in which their complaint has been treated. That is incredibly important, and the ombudsman has herself agreed that she will handle vastly more complaints and go into detail a lot more than she does at present, which is welcome. Prior to that stage, however, lots of people feel that complaining directly to the trust, which has to be the first step, is a very daunting and difficult process and that they want independent help. That is why we have said that it will be an absolute requirement for trusts to show people how they can access that independent help and, indeed, to be prepared to make the finance available so that they get that help. There will also have to be signs on every ward telling people exactly how to do that.

Hospital Mortality Rates

Debate between Jeremy Hunt and Bernard Jenkin

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

According to Professor Jarman on the radio this morning, the answer is that it has been falling slightly.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I welcome the fact that Colchester general hospital is not being put in special measures. That expresses Monitor’s confidence in the current leadership of the hospital, which is already implementing improvements in the areas that it told the Keogh report about, which are reported to be the matters of concern. I also welcome my right hon. Friend’s emphasis on leadership, and openness and trust of leadership, but does he accept what we are finding in the Public Administration Committee’s inquiry into complaints handling in public services that that lack of trust and openness is found not just at trust level, but goes right up the command chain of the health service and has historically existed in the Department of Health? How will he challenge that culture and define the right kind of leadership that should be taught by the leadership academy?

[Mr Hunt]

My hon. Friend makes a very important point. The simple way we can change that culture, which will not be easy and will not happen immediately, is by making sure that where there is failure, there is someone who is independent and able to speak up about that failure without fear or favour—someone to be the nation’s whistleblower-in-chief. That is what we must have with the new chief inspector of hospitals, modelled on the chief inspector of schools and how well the whole Ofsted regulation system has worked. That has to be the first step; there must be no hiding place when there is failure. From there, we will have the pressure on the whole system, right the way up to Ministers, to make sure that failure is sorted out.

A and E Departments

Debate between Jeremy Hunt and Bernard Jenkin

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

That target led to many problems, as the hon. Lady well knows. She might remember, from the 2005 general election campaign, the issues of people being denied appointments for three, four or five days because GP surgeries were being paid to meet specific 48-hour appointments. That is one issue. Too often, if people call GPs for an appointment, they are told that the earliest they can have one is in two, three or four weeks, which makes them think, “What are my alternatives?” and leads them into A and E. We must think about how we can change that and alter the incentives in GP contracts so that they can give the kind of service to their lists they would like to.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

Do I need to remind my right hon. Friend that the outgoing Labour Government in 2010 left a note on the desk of the Chief Secretary to the Treasury saying, “There’s no money left”? Is not the challenge the need to make the NHS work on more or less flat funding—though we are doing our best to increase it—while dealing with huge increases in demand? Is not the only answer to do more in the general practice setting, where it can be done more responsibly, more local to patients’ needs and more cheaply, in order to take the pressure off A and E services?

[Mr Hunt]

My hon. Friend speaks extremely wisely. We must do just that, particularly for the frail elderly, people with long-term complex conditions, because they are the people for whom an A and E department can be a bewildering place, especially if it knows nothing about them and cannot access their medical records. Prevention is far better than cure, and I agree that that is one way of doing it.

Mid Staffordshire NHS Foundation Trust

Debate between Jeremy Hunt and Bernard Jenkin

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

I am happy to do so.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

May I commend my right hon. Friend’s emphasis on leadership? In Colchester, we have seen periods of good and bad leadership, and good leadership is self-evidently the right answer to hospital management. Can I therefore ask him to lay more emphasis on what constitutes good leadership and trust between good leaders and their employees in the health service right through the system, including from Sir David Nicholson downwards, and not to rely overmuch on regulation, which is no substitute for good leadership?

[Mr Hunt]

I agree wholeheartedly. It is very important that we understand that the benefit of the new inspection regime will not just be that it identifies failing hospitals, but outstanding hospitals too, so that we have a good model of leadership in the system from which other managers can learn. Yes, it is really important to have the right relationships between managers and their staff, but we should not mandate or regulate that from the centre. We want to have a system where people can learn from each other.

Accountability and Transparency in the NHS

Debate between Jeremy Hunt and Bernard Jenkin

Thursday 14th March 2013 Commons Chamber

[Mr Hunt]

I absolutely agree with my right hon. Friend. We will respond to the Francis report this month, as the Prime Minister has committed to do, and make plain measures to ensure that the situation cannot continue. My right hon. Friend is right to raise that point.

[Mr Jenkin]

rose—

[Mr Hunt]

I will make some progress and then I will take more interventions.

My response will detail how we intend to restore accountability to the boards of hospitals, and today I have removed the ability of any hospital to insert gagging clauses on patient safety in compromise agreements made with senior staff. My hon. Friend the Member for Bristol North West asked whether that will be retrospective, and I have written to all trusts to remind them of their responsibilities towards whistleblowers in respect of contracts and compromise agreements already signed. If we are to protect patients, we need an atmosphere of openness and transparency in the NHS—something to which the motion rightly refers.