NHS Funding

Debate between Jeremy Hunt and Cheryl Gillan

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

When the right hon. Gentleman and I worked in government, we both campaigned hard on many occasions for more funding for the NHS, including mental health—a particular priority for both of us. The answer to his question is yes, and that is why we are putting in more money in this Parliament. My own view is that in future Parliaments we will need to continue to increase the amount of funding going in to the NHS. The only point I would make is that what funds the NHS is a strong economy, so we have to make sure that increases in NHS funding are sustainable and compatible with a strong economy. That is something that this Conservative Government have a very good track record of delivering.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

The plans to achieve savings from community pharmacies are causing a great deal of concern in my constituency. The patients group at the John Hampden surgery and residents in and around Prestwood believe that the plans may result in the closure of our excellent rural pharmacy in Prestwood. What reassurances can the Secretary of State give to my constituents today that no pharmacies will close that are more than a mile from any other pharmacy? Will he make sure that he takes into account the implications for GPs’ workloads when looking at pharmacies?

[Mr Hunt]

First, the people of Prestwood are lucky to have such an assiduous MP to campaign for their interests in Parliament today; indeed, my right hon. Friend always does so. I can give her that reassurance, because in the package of efficiencies we set out—it is right that we ask pharmacies to make efficiencies in the way they are run, just as we are asking the rest of the NHS to make efficiencies in the way it is run—we are protecting all pharmacies that are a mile or more from any other pharmacy. In that sense, we are absolutely determined to protect provision for her constituents and all our constituents who depend on rural pharmacies.

NHS: Learning from Mistakes

Debate between Jeremy Hunt and Cheryl Gillan

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

The hon. Lady had the chance to be constructive. I do welcome her commitment to a safer NHS, but we need actions and not just words from the Labour party if its conversion to improving patient care is to be believed. She mentioned the junior doctors’ strike. Patients and their families will have noticed that, when it came to the big test for Labour—whether to back vulnerable patients, who need a seven-day NHS, or the British Medical Association, which opposes it—Labour has chosen the union. She brought up the topic, so let me just remind the House of what Nye Bevan, the founder of the NHS, said about the BMA:

“this small body of politically poisoned people have decided to…stir up as much emotion as they can in the profession…they have mustered their forces on the field by misrepresenting the nature of the call and when the facts are known their forces will disperse.”—[Official Report, 9 February 1948; Vol. 447, c. 36-39.]

Bevan would have wanted high standards of care for vulnerable people across the whole week and so should she.

The hon. Lady also challenged the Government on safety, so let us look at the facts. Under this Government: MRSA down 55%; clostridium difficile down 42%; record numbers of the public saying that their care is safe; the proportion suffering from the major causes of preventable harm down by a third during my period as Health Secretary; and 11 hospitals with unsafe care put into special measures and then taken out of special measures, with up to 450 lives saved according to that programme. Before she gets on her high horse, she should compare that with Labour’s record: avoidable deaths at Mid Staffs, Morecambe Bay, Basildon and many other hospitals; care so bad we had to put 27 hospitals into special measures; the Department of Health under Labour a “denial machine”, according to Professor Sir Brian Jarman; and contracts that reduced weekend cover in our hospitals passed by the last Government. They made a seven-day NHS harder—we are trying to put that right. The hon. Lady mentioned money, but she stood on a platform to put £5.5 billion less into the NHS every year than this Government. On the back of a strong economy, we are putting more resources into the NHS. A strong NHS needs a strong economy, and Labour had better remember that.

Let me look at some of the other points the hon. Lady raised. What I said in my statement about the GMC and NMC guidance was that, having said it would change, that guidance has changed and it is now clear that people are going to be given credit in tribunals for being open and honest about things that have gone wrong. She challenged me about the timing for the introduction of medical examiners, so let me remind her of the facts: the Shipman inquiry third report recommended medical examiners in 2003, Labour failed to implement that over seven years, and in six years we are implementing it, which is what I announced today. I am confident that there will not be additional burdens on local government.

The hon. Lady talked about the issue of supporting trusts that do not have the right reporting culture, and that is exactly what we are doing today, because we have published the names of not only the trusts that do not have a good reporting culture, but the names of those that do have a good reporting culture—trusts such as Northumbria Healthcare NHS Foundation Trust, Oxleas NHS Foundation Trust and many others. The trusts that are struggling with this can learn from them.

The hon. Lady says that I need to do more, but, with respect, let me say that the measures we have taken on openness, transparency and putting quality at the heart of what the NHS does and needs to stand for go a lot further than anything we saw under the last Labour Government. I say to her that it says rather a lot that, on a day when this Government have organised a summit, with experts from all over the world, on how to make our hospitals safer, the Labour party is lining up with unions against safer seven-day services. I urge her to think again and to choose the more difficult path of backing reform that will help to make our NHS the safest healthcare system in the world.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

What a shame that the hon. Member for Lewisham East (Heidi Alexander) did not take the opportunity today to condemn the strikes. Supporting unions and not patients will not impress anyone.

May I welcome my right hon. Friend’s excellent statement, join him in paying tribute to the people who work in our NHS, and particularly welcome the setting up of the healthcare safety investigation branch and the system of medical examiners, which will contribute to better results and better outcomes in the health service?

The Secretary of State has taken a personal interest in sepsis, particularly by responding to the UK Sepsis Trust and Dr Ron Daniels, the Mead family, who tragically lost their son, William, and other relatives of patients who have died of sepsis. He knows that the ombudsman report of September 2013 contained many recommendations, including a request for a public awareness campaign, which could save lives. Will the Secretary of State tell us what progress he has made with that, because the relatives who are campaigning seem to have been waiting a long time for this public awareness campaign that they believe will help greatly?

[Mr Hunt]

I thank my right hon. Friend for her campaigning work on sepsis. Indeed, I have met the Mead family with her. She does a fantastic job with the all-party parliamentary group on sepsis. We announced a plan in January last year as this is a major area where we need to increase knowledge both inside the NHS and among the general public. As I mentioned a couple of weeks ago at a meeting organised by the all-party group, we are now looking at putting in place a public information campaign. We need to establish whether that should be about just sepsis, or whether it should be a more general public information campaign to help parents to understand when they need to worry about a fever, which is very common among small children and might be due to reasons other than sepsis, with meningitis being an obvious one. We are doing that detailed work now and we want to get this absolutely right, but I commend her persistence in ensuring that we deliver our commitments in this area.

William Mead: 111 Helpline

Debate between Jeremy Hunt and Cheryl Gillan

Tuesday 26th January 2016 Commons Chamber

[Mr Hunt]

I agree with the broad thrust of the hon. Lady’s remarks. Of course she speaks with the authority of an experienced clinician herself. In this case, the tragedy was that there was actually a doctor who spoke to the Mead family on the night before William died, and he did not spot the symptoms. It is not simply a question of access to a doctor, but ensuring that doctors have the training necessary. However, as she says, dealing with cases such as this can be very difficult. The doctor’s view on that occasion was that, because the child was sleeping peacefully, it was fine to leave him until morning when, tragically, it was too late. Other doctors would say that that is a mistake that could easily have been made by anyone, which is why the report is right to say that it is about not individual blame, but a better understanding of the risks of sepsis. She is right in what she says. As we are trying to join up the services that we offer to the public, it is a good principle to have one number that we dial when we need advice on a condition that is not life-threatening or a matter for a routine appointment with a GP, and 111 is an easy number to remember. However, we need to ensure that there is faster access to clinicians when that would count, and that those clinicians can see people’s medical records so that they can properly assess the situation.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

As chair of the all-party group on sepsis, may I also pay tribute to the Mead family, who are now campaigning to ensure that no other child suffers in the same way as William? The Secretary of State has taken a great deal of interest in the UK Sepsis Trust and the work that it has been doing with the APPG. He will know that we are pressing for a campaign similar to the F.A.S.T campaign for strokes, as early diagnosis can save lives. Will he now consider very seriously funding such a campaign for sepsis, because there are thousands of deaths that could be prevented by a campaign that makes everyone aware of the signs of sepsis?

[Mr Hunt]

I am happy to undertake that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), will look urgently into whether such a campaign would be right. I can reassure my right hon. Friend that the package that we put together and announced last January did contain what most people felt was necessary, but we can always look at whether more needs to be done. I commend her for her campaigning on the issue of sepsis. On a more positive note, when the NHS has decided to tackle conditions such as MRSA and clostridium difficile, it has been very successful. In the past three years, the number of avoidable deaths from hospital-acquired harms—the four major ones—has nearly halved, so we can do this. We should be inspired by the successes that we have had to make sure that we are much, much better at tackling sepsis.

Southern Health NHS Foundation Trust

Debate between Jeremy Hunt and Cheryl Gillan

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

I thank the right hon. Gentleman for his comments. I hope I did address that by saying that the first time was when we realised there were issues around the tragic death of Connor Sparrowhawk. That is what started the process and led to the independent investigation. Because NHS England wanted it to be very thorough, that investigation went right back to 2011 and up to 2015. It looked at all unexpected deaths in that period, and at the reporting culture and lessons that had or had not been learned as a result. A lot of action has been taken. I can also reassure the right hon. Gentleman that during that period we have been implementing the recommendations of the Francis report, which has meant that throughout the NHS there is a much greater focus on, and transparency in, patient safety.

It is important to give the NHS credit. During the past three years, we have actually seen a 25% increase in the number of reported incidents. I think people are treating this much more seriously than in the past, but there is much more to do.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

I, too, welcome my right hon. Friend’s statement and the news that he plans to accept the recommendations of this very sobering report. Will he reassure the House that anyone found to have been deliberately contributing to patient neglect or failing to investigate avoidable deaths will be held to account both by the professional regulators and the full weight of the law?

[Mr Hunt]

I can of course give my right hon. Friend that assurance, but there is a note of hesitation in my response. That is partly because professional standards, as my right hon. Friend knows, are not a matter for politicians—they have to be set independently by the General Medical Council and the Nursing and Midwifery Council—and partly because if we are going to improve the reporting culture, which in the end is what the report is about, we have to change the fear that many doctors and nurses have that if they are open and transparent about mistakes they have made or seen, they will get dumped on. That is a real worry for many people. Part of this is about creating a supportive culture, so that when people take the brave decision to be open about something that has gone wrong they get the support that they deserve.

Junior Doctors Contract

Debate between Jeremy Hunt and Cheryl Gillan

Monday 30th November 2015 Commons Chamber

[Mr Hunt]

The hon. Lady is right that this is about the excess mortality rates of people admitted at the weekend—not of people who are already in hospital at the weekend. I am afraid that she is mistaken in her characterisation of the rest of the Government position. Clinical standards are clear: people admitted at the weekend, or at any time, should be seen by a consultant within 14 hours, but that is true in only one in eight hospitals across seven days of the week, which is why sorting out the consultant contract for urgent and emergency care matters. Although the opt-out in the consultant contract applies only to elective work, half as many consultants are available in A&E on Sunday as are available during the week, although Sunday is one of the busiest days of the week, so it is not just about junior doctors. However, if we are going to make life better for junior doctors, we need to make sure that they have more senior cover and do not feel clinically exposed, which is what independent studies have said they feel.

Governments of any party must have the right to set the terms and conditions of an employment contract. That is a right that no part of the public sector has moved away from, and it is a vital right for all employers. I have simply said that I will not move towards any new contract while negotiations are happening during this time-limited period. That was what my statement clearly said, and the BMA for its part has said that if this agreement is honoured, it will remove the threat to strike during that period.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

I congratulate the Secretary of State on coming here today on this very important matter. All parts of the House support him in trying to find a negotiated solution to this knotty problem. However, if the strike goes ahead—although we very much hope that the BMA will see sense and agree to the terms so far put on the table—I understand that the BMA has not been willing to provide assurances that it will ask its members to provide urgent and emergency cover in areas where patients may be at risk. What more can the Secretary of State do to encourage the BMA to make that statement? That is what will be worrying patients out there.

[Mr Hunt]

On the overall picture, we must be clear that this is not about asking junior doctors to work a lot of extra hours for free. We expect that as we have increased take-up of seven-day services and more people working antisocial hours, particularly on Sundays, that might lead to a higher pay bill, but we need to make sure that the proposals for the workforce that we have at present protect average pay and mean that as we move to seven-day services, they are affordable by hospitals. To answer my right hon. Friend’s question, we respect the right of doctors to strike, even though it is very disappointing when they choose to do so, but they have said on this occasion, in a way that is quite unprecedented, that they will withdraw urgent and emergency care on 8 and 16 December. All we have said to them is that if there are areas where we are not able to make alternative arrangements for urgent and emergency care by, for example, using other front-line clinicians, we would like their support in those specific areas, not across the whole country, in asking junior doctors to step in on those cases in the interests of patient safety. We have not yet had those assurances, but we very much hope we will get them.

Jimmy Savile (NHS Investigations)

Debate between Jeremy Hunt and Cheryl Gillan

Thursday 26th February 2015 Commons Chamber

[Mr Hunt]

The hon. Gentleman makes an important point, and I have great sympathy for his constituent. The information was not collated centrally. There were a number of reports about which we might have been sceptical if we had read them in isolation, but when we read them together with other reports, we see a pattern and we can conclude, as the investigation has done, that those incidents did indeed take place. That is one of the big learning points: we have to collate information that different victims provide at different times, to ensure that proper judgments can be made and that action can be taken.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

It has been truly sickening to read in the report that over two decades, money, influence, celebrity and people being star-struck could allow Savile the licence serially to abuse so many people, particularly in our local Buckinghamshire hospital at Stoke Mandeville. I really welcome the apologies from the Secretary of State and from our local chief executive officer, Anne Eden, who has given a heartfelt apology and praised the courage of those who have come forward. May I press the Secretary of State further on mandatory reporting? It is exceedingly important that we start that consultation as rapidly as possible. It was obvious that the proposed clause in the Serious Crime Bill was flawed in many ways. When will he start the consultation, and when will the terms of reference be available? Will he now undertake to legislate as soon as the consultation has produced results?

[Mr Hunt]

I can certainly give that undertaking: we will start the consultation as soon as possible and if the conclusion is for legislation, we will legislate as soon as possible. I hope that my right hon. Friend understands that there is a great deal of complexity involved in getting this right. It is very important to talk to victims and to people who are looking at the evidence on mandatory reporting, which happens in other parts of the world, with very mixed results. Most importantly, we want to avoid the unintended consequence of a decision being taken against the interests of a child or vulnerable person because people are following a legalistic process which undermines the proper professional judgment made on the ground.

Francis Report: Update and Response

Debate between Jeremy Hunt and Cheryl Gillan

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

I welcome the broadly constructive tone that we have heard today. May I say, in that spirit, that I hope that that represents a change in substance from some of the other exchanges we have had on these topics? The right hon. Gentleman tried to vote down the legislation that set up the new chief inspectors and he opposed the holding of a public inquiry into Mid Staffs. If we are to have constructive agreement across the House, I do think we need to agree on substance as well as on tone. Let me just take the individual points he mentioned.

We are completely committed to death certification. That was recommended in the wake of the Shipman inquiry. The right hon. Gentleman’s Government took a very long time to do anything on this and we have been trying hard to do it. It is a complicated thing to get right. On the question of looking properly at avoidable deaths, I just want to say this. It is very difficult, when one looks at case notes, to work out whether a death was avoidable or not, but we think we have a methodology to do that. It is more difficult to relate that to individual trusts, but we want to try to achieve that as well. I was disappointed at the weekend that when we announced that, his response was that it was unambitious. Two weeks earlier, he had published Labour’s 10-year plan for the NHS, which did not actually mention reducing avoidable deaths at all. What we are proposing is the most ambitious thing that any health care system has proposed anywhere in the world, and I hope it will have his full support.

On the right hon. Gentleman’s comments about not generating a climate of fear, he is absolutely right; it is really important, in getting the culture right, to make sure that people are supported to speak out and that there is not, as an unintended consequence, the kind of bullying and intimidation that Sir Robert says is all too common today. I suggest to him that one of the reasons for that climate of fear has been over-dependence on top-down targets as a way of running the NHS. That is what has created the fear in managers that sometimes has led them to treat their staff in the wrong way. What would be very constructive would be a recognition from Labour that that top-down targets culture did go too far, and that we need to rely on transparency as a way of improving performance as a much better tool than endless new targets.

In anything we do—this is something else where I agree with the right hon. Gentleman—we must look very closely at making sure that we learn these lessons in the social care sector as well. That is particularly clear when we look at the scandal of what happened in Rotherham. That is why, when we introduced the new CQC inspection regime following the original Francis public inquiry, we did not just set up a chief inspector for hospitals but set up a chief inspector for general practice and for adult social care. We are now getting the same Ofsted-style transparent rankings of how good care is in care homes, and indeed in domiciliary care. I know that he, like me, is concerned about 15-minute care visits. I think those inspections will help to root out those problems.

With respect to nurse numbers, I really do think that is something on which, if the right hon. Gentleman wants to be constructive, he should commend the Government’s efforts. We have 8,000 more nurses in our hospital wards than we had four years ago. Of course, as a short-term response a lot of hospitals are employing nurses through agencies. That must only be a short-term response. We need proper long-term commitment to institutions, which we do not get with agency staff, but I commend hospitals that have said, “While we try and get enough staff in place for the long term we are not going to wait, because we need to make sure that patients are safe today.” They want to do what it takes to do that.

Finally, on the risk register, I simply remind the right hon. Gentleman that when he was Secretary of State he blocked the publication of the risk register. As a Minister, he said:

“This would inhibit the free and frank exchange of views about significant risks and…management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]

More broadly, I just want to say this. There are many patients and whistleblowers looking at today’s exchanges and wanting to see constructive agreement on the way forward. I think we can get a measure of that. What they say they want is not just words, but actions.

As we put staff and patients first in England, will Labour do the same for patients in Wales and today commit to a Keogh review of high mortality hospitals, commit to a chief inspector of Welsh hospitals and commit to protect staff who speak out in Wales, as we want to do in England? Will he commit to putting right a top-down culture that prioritised the needs of the system over the needs of individuals? Will he, as we do, recognise that that is always the danger of treating the NHS as a political possession and not as a service for patients? Patients must always come first. Staff who want to do the right thing for patients should always be heard. Our NHS deserves nothing less.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

May I endorse the Secretary of State’s remarks on Wales, having seen it at first hand? Having seen at first hand a constituent who was a whistleblower, and how her career and her family life have been so badly affected after she did the right thing, I know that what the Secretary of State has done today will be widely welcomed.

On the Public Administration Committee, we took evidence from the CQC and others, and it became very obvious that there is still a major problem with complaints procedures for patients and their relations. Patients often tell me that they are afraid to complain about the way that they are being treated in whatever NHS establishment they are in. Is there some way in which the Secretary of State can ensure that there are clear instructions in all NHS establishments on how patients and their relations can raise their valid concerns without their worst fears being realised?

[Mr Speaker]

Order. The right hon. Lady, whom I know extremely well as a Buckinghamshire colleague, rather like Treebeard does not believe in unnecessary or undue haste, but if I could suggest to colleagues that questions could be pithy rather than too leisurely I think we would all profit from that. The same goes, of course, for the Secretary of State, from whom we expect characteristically pithy, succinct responses.

Managing Risk in the NHS

Debate between Jeremy Hunt and Cheryl Gillan

Wednesday 17th July 2013 Commons Chamber

[Mr Hunt]

I am going to make some progress and then I will give way.

In addition, in September the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart will present their recommendations on how we can turn NHS complaints handling into an engine for improving compassionate care.

The right hon. Member for Leigh mentioned nursing numbers. Getting the right number of staff on wards does matter, and where that is not happening for hospitals in special measures it will be sorted out. However, to suggest that that is the only issue, or indeed the main issue, is completely to misunderstand what has gone wrong. Eight of the 11 failing hospitals had increases in nurse numbers since 2010, but they still needed to go into special measures. Training, values, clinical safety and, above all, leadership are often as important.

Labour has been calling for mandatory minimum staffing numbers. Let us look at what the experts say about that idea. Robert Francis said:

“To lay down in a regulation, ‘Thou shalt have N number of nurses per patient’ is not the answer. The answer is, ‘How many patients do I need today in this ward to treat these patients?’”

He also said:

“The government was criticised for not implementing one, which it is said I recommended, which I didn’t.”

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

I am grateful to my right hon. Friend for giving way, because he knows that Buckinghamshire Healthcare NHS Trust was included in the statement yesterday. The trust welcomes his leadership and the opportunity to improve its performance, so that it can give the best possible care to patients in Buckinghamshire. Does my right hon. Friend agree that training goes to the heart of quality, particularly of agency staff? Would he like to say something about the competence, quality and checks that are made on agency staff, which will help to improve the health service across the country?

[Mr Hunt]

My right hon. Friend makes an important point. There are many locums who work extremely hard and are very committed. However, it is true that one feature of a number of the failing hospitals in yesterday’s report was that they had a high proportion of locum staff. It is harder to build up a sense of teamwork if there is a huge turnover in the people working in NHS organisations, and I know that many will reflect on that.

Hospital Mortality Rates

Debate between Jeremy Hunt and Cheryl Gillan

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

I am sure that the right hon. Gentleman, who is one of those predecessors, would accept at a quieter moment outside the Chamber that one of the biggest mistakes made during his time as Secretary of State—or at least it was initiated then—was the appalling change that was made to the regulation of hospitals. The CQC was stripped of expert inspectors, and hospitals began to be inspected by generalists. The same group of people would inspect a slimming clinic, a dental practice, a GP’s surgery, and a major London teaching hospital. That very significant mistake lies at the heart of the reason why the CQC approved and certified so many failing hospitals.

I am happy to work with the right hon. Gentleman, and to say that honest mistakes were made and we will put them right, but today there must be honesty about what those mistakes were.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

Patients and their families outside this place will join me in congratulating the Secretary of State on his brave decision not to sweep NHS failures under the carpet.

You and I know, Mr. Speaker, that Buckinghamshire contains many areas of health care that are of high quality, but the report identifies some failings, one of which is the quality of out-of-hours and weekend nursing and medical cover for acute medical patients. That is clearly linked to difficulties relating to the recruitment, retention and availability of competent clinicians and nurses. What more can the Department do to help our trusts improve out-of-hours provision and, in particular, the quality of temporary staff, so that those problems can be eliminated?

[Mr Hunt]

My right hon. Friend is right. Serious problems were identified in Buckinghamshire relating to out-of-hours care and also to dementia patients, who themselves often need help out of hours. I raised the difficult issue of the GP contract because, in order to solve such problems, we need more joined-up care in the community. The Chancellor has announced an additional £2.8 billion for joint commissioning arrangements between local authorities and health care bodies, and I think that the combination of those two measures will secure a vastly improved out-of-hours service for my right hon. Friend’s constituents.

Mid Staffordshire NHS Foundation Trust

Debate between Jeremy Hunt and Cheryl Gillan

Tuesday 26th March 2013 Commons Chamber

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

I thank the Secretary of State for coming to the House and making a statement that helps to restore our confidence in the NHS, which has been so badly undermined by Labour’s appalling stewardship. Will he take steps to ensure that any complaints procedure provides protection to patients and relatives who raise concerns?

[Mr Hunt]

My right hon. Friend makes an important point. The thing about complaints procedures is that we must have a system that is not about process and whether there is a response to a complaint in three days. The question is whether a hospital looks at and learns from a complaints procedure and changes its behaviour. That is what the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart are looking into. Hospitals will be inspected against best practice to try to encourage as many of them as possible to adopt the very best complaints procedures.