Francis Report: Update and Response

Debate between Jeremy Hunt and Frank Dobson

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

As indeed we learn from you, Mr Speaker.

I welcome the question from my right hon. Friend, who is a former Secretary of State for Wales. People will want to know that these lessons will be learned in Wales. In the original Francis response, we set out clear plans for the way in which hospitals should make it clear, in every ward of every hospital, how one can complain not just directly to the trust, but to independent external organisations, such as the ombudsman, if necessary.

[Frank Dobson (Holborn and St Pancras) (Lab)]

May I warn the Secretary of State not to think that because he has decided something and because a circular has been issued, something has happened? In 1998, against a lot of opposition, I insisted that the whistleblowing law should apply to the NHS. I also issued a circular banning the use of gagging clauses. As I said in my discussion with Sir Robert Francis on this whole issue, it clearly did not work.

[Mr Hunt]

I thank the right hon. Gentleman for what he did when he was Health Secretary. I am well aware that in the world’s fifth-largest organisation, nothing happens just because someone issues a circular, which is why some of what we have announced goes beyond what Sir Robert precisely recommended. For example, by publishing avoidable death rates by hospital trust, we want to make the energy for change come from inside trusts, not from their being told to do things by Ministers. However, I welcome what he did as Secretary of State, and I hope we can do some other positive things.

National Health Service

Debate between Jeremy Hunt and Frank Dobson

Wednesday 21st January 2015 Commons Chamber

[Barbara Keeley]

rose—

[Frank Dobson (Holborn and St Pancras) (Lab)]

rose—

[Mr Hunt]

I am going to make progress, but I will give way later.

I want to look at the pressures that the NHS is facing, because the right hon. Member for Leigh asked about the direct causes. There are more than 1 million more over-65s than there were four years ago. Many older people become particularly vulnerable when it is cold, which is why winters are always difficult for the NHS. The truth is that over successive decades, we have made older people more dependent on emergency care by under-investing in primary and community care, reducing the responsibility of GPs for out-of-hours care, removing the personal responsibility for patients from GPs, and failing to integrate health and social care.

The right hon. Gentleman spoke as if that was nothing to do with Labour. However, he knows what damage was caused by the GP contract changes in 2004, he knows that his Government failed to integrate health and social care for 13 years, and he knows that where Labour runs the NHS today—in Wales—the performance is even worse. Instead of debating constructively, he chose to start this year by putting up a scaremongering poster that implied that the NHS would cease to exist if this Government were re-elected. That is not good enough. The whole country can see that, for him, it is not about the ward, but the weapon; it is not about the patients, but the politics. For this Government, it is about the patients.

--- Later in debate ---

[Mr Hunt]

What the last Government did, that was right, was to say that—[Interruption.] I am just saying what the last Government did right. The hon. Member for Worsley and Eccles South (Barbara Keeley) might want to hear this, because I do not usually compliment the last Government.

To bring waiting times down to 18 weeks, the last Government said that they would support the NHS by allowing the private sector to do some operations. We have continued that policy, not changed it. The result, the hon. Lady will be pleased to know, is that 6,000 more operations are happening every year in her constituency under this Government than in 2010.

For this Government, it is about the patients. That is why we increased the NHS budget; why we hired 9,000 more doctors and 6,000 more hospital nurses; why we are doing nearly 1 million more operations a year than four years ago, with fewer long waits than ever; why we have increased cancer referrals by half, saving an estimated 1,000 lives every single month; and why we have learned the lessons of Mid Staffs by putting in place safe staffing, having independent inspections and turning around six failing hospitals.

Patients say—[Interruption.] The right hon. Member for Leigh should listen to what patients say, because he did not do that when he was Secretary of State. Patients say that their care is safer and more compassionate than ever, with the independent Commonwealth Fund saying that under this Government, the NHS has become the best health care system in the world.

[Frank Dobson]

rose—

[Mr Hunt]

I give way to the former Secretary of State.

[Frank Dobson]

Will the Secretary of State confirm that the only reason why he has been able to recruit British doctors is that the previous Government increased recruitment into medical schools by 35%?

[Mr Hunt]

I welcome the fact that the previous Government increased training places, but as the right hon. Gentleman will know, having been Secretary of State, those doctors have to be paid for. The NHS budget has not been cut, as the shadow Secretary of State wanted, so we can afford to pay for those doctors. There are 219 more doctors serving the constituents of the right hon. Gentleman because of the decision that this Government took to protect the NHS budget.

Even more important than what we have done for patients in this Parliament is the fact that, under this Government, the NHS has developed its own plan for the next five years, the “Five Year Forward View”. Because we have a strong economy, we can back that forward view with a record £2 billion extra for the NHS front line next year alone.

Part of our commitment to the NHS—this is a real difference between the Government and the Opposition—is that we face up to difficult decisions, including on pay. No one wants to be more generous to staff who work long hours than I do, but the official advice that I received as Secretary of State was clear: the cost of accepting the pay review body’s recommendation would be £450 million, which would mean that hospitals might lay off between 6,000 and 14,000 nurses.

It is easy for Labour to support a pay strike, but it is deeply cynical if it cannot pay for its promises, as it knows it cannot. Labour claims to stand up for staff, but will it today stand up for patients by condemning the strike right in the middle of winter, which was supported by only 4% of NHS workers, or do the votes and financial support of the unions matter more? The test of a party that aspires to govern is not the easy decisions that it makes, but the tough ones. We have seen nothing brave or principled from Labour today.

A and E (Major Incidents)

Debate between Jeremy Hunt and Frank Dobson

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right about that, and it is very important. Targets matter, but not targets at any cost. It is worth remembering that, over the four years we were seeing the tragedy unfold in Mid Staffs, it was meeting its A and E target the majority of the time. So it is very important that patient safety is the priority. That is why we have to support NHS trusts when they have major incidents and why we have to make it clear that, although targets matter, trusts need to be sensible and proportionate in their efforts to meet those standards.

[Frank Dobson (Holborn and St Pancras) (Lab)]

Does the Secretary of State accept the truth of the assertions by A and E doctors and nurses that the call handlers working for the 111 service are referring far more patients to A and E than happened when NHS Direct was staffed by nurses, who exercised professional discretion?

[Mr Hunt]

It is always important to keep the algorithms used by call handlers—111—under review. I say to the right hon. Gentleman that 111 is part of the way we have been able to relieve pressure on A and E departments. Calls to 111 doubled this Christmas, and 27% of the people who called it said that they had been planning to go to an A and E department but did not do so following the call. That is a very important way of relieving pressure on our A and E departments.

UK Ebola Preparedness

Debate between Jeremy Hunt and Frank Dobson

Monday 5th January 2015 Commons Chamber

[Mr Hunt]

Yes, I am. I join the hon. Gentleman in commending the actions of the Nigerian authorities. What has happened in Nigeria in respect of Ebola shows a great deal of hope for what is changing in Africa more generally. There was a perception that all African countries would find it as challenging to deal with Ebola as Sierra Leone, Liberia and Guinea have found it, but it is clear that a generation of African countries have developed substantially and are able to respond in a much more effective way. That is a very encouraging change from what might have been the case 10 or 20 years ago.

[Frank Dobson (Holborn and St Pancras) (Lab)]

I thank the Secretary of State for his statement. I am in no position whatever to comment on the effectiveness of the screening and suspect that no one else in the Chamber is. On long-term preparedness, it is several decades since Peter Piot, now director of the London School of Hygiene and Tropical Medicine, first identified Ebola. Worldwide, not enough has been done to address the problems. We should not be looking for a vaccine now; it should have been looked for years ago. I hope the Secretary of State gives full support to the rare disease consortium that has been established by the London School of Hygiene and Tropical Medicine, Imperial college and the Royal Veterinary College to look at infectious diseases that are capable of crossing from one species to another, and in particular this species.

[Mr Hunt]

The right hon. Gentleman is absolutely right. Peter Piot is a remarkable man who came to Downing street to advise the Prime Minister and me early in the development of the Ebola crisis. He is well worth listening to on this subject.

The right hon. Gentleman also makes a good point in that the global response to Ebola was far from adequate. The World Health Organisation has some important lessons to learn, and tomorrow my right hon. Friend the Secretary of State for International Development and I will meet Margaret Chan, when we will no doubt talk about those lessons. In an era of globalised travel, it is important that we have a much faster and more effective response when we have outbreaks of deadly viruses.

NHS (Five Year Forward View)

Debate between Jeremy Hunt and Frank Dobson

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

The commitment to a paperless NHS is not a commitment to the creation of paperless hospitals by 2018; it is a commitment to the creation of a paperless NHS so that, with patients’ consent, information can flow seamlessly between different parts of the system. The interface between primary care and secondary care, and social care, is a very important part of that process.

[Frank Dobson (Holborn and St Pancras) (Lab)]

Will the Secretary of State tell the House how much money is now being diverted from patient care to the negotiation of legally binding contracts between commissioners and suppliers of services, or will he confirm that he cannot do so because he does not bother to collect the information?

[Mr Hunt]

What I will confirm to the right hon. Gentleman is that the rules on the contracting out of services are the rules that we inherited from the Labour Government, although he personally might not have introduced them had he remained Health Secretary throughout those 13 years.

Mid Staffordshire NHS Foundation Trust

Debate between Jeremy Hunt and Frank Dobson

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

I did not hear Deb Hazeldine this morning, but I have met her on a number of occasions, and she is an extraordinary, powerful advocate for the changes that we need to make in the NHS. I have had discussions with my right hon. Friend the Leader of the House about the possibility of debating this on the Floor of the House, and I would very much welcome the opportunity to do so. My right hon. Friend deserves great credit for the fact that he was one of the earliest people to push for a full inquiry. I hope that the shadow Secretary of State will now accept that it was wrong not to have a public inquiry—it was blocked so many times by the Labour party—because we have learned so much from what Robert Francis has been able to say, and the NHS will be the better for it. Great credit should go to my predecessor, who is sitting here now, who took the decision to have that public inquiry.

[Frank Dobson (Holborn and St Pancras) (Lab)]

Does the Secretary of State not agree that the horrors of Mid Staffs were taking place at the same time that wonderful first-class care, from both a clinical and compassionate point of view, was available in many hospitals throughout the country? Is he confident that the measures that he is putting forward now will ensure that the worst performing hospitals will raise their standards to those of the best?

[Mr Hunt]

We have to wait and see, but we have put in place a radical, tough new Ofsted-style inspection regime. The point of that regime is not just to identify hospitals where care is unsafe, but to identify outstanding hospitals, so that hospitals in difficulty have hospitals from which they can learn, and we create a culture, just as we have in schools, where failing schools learn from outstanding schools and have a pathway to improvement. That will make a big difference. As the right hon. Gentleman knows, we now have 13 hospitals in special measures, and I am sure there will be more as the inspection process gets under way. But we will also have the great hospitals that we can learn from, which will mean that this can be a positive process for the NHS.

A and E Departments

Debate between Jeremy Hunt and Frank Dobson

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

As ever, my right hon. Friend speaks with great wisdom. When it comes to the frail elderly, the key is to have a system that heads off problems before they arrive so that people do not find that they end up having to be rushed into A and E in the middle of the night. That can often be the very worst place for someone with advanced dementia or any condition that makes them extremely fragile and vulnerable. We need to integrate systems properly, and that did not happen under the previous Government. One of the key work streams of the vulnerable older people’s plan will be to look at barriers to integration, particularly the barriers to joint commissioning of social care and health. We intend to make good progress on that front.

[Frank Dobson (Holborn and St Pancras) (Lab)]

Does the Secretary of State accept that when NHS Direct was operating, nurses had the professional competence to decide not to refer people to A and E, and to provide reassuring advice? They have been replaced by call handlers who, understandably, opt to send people to A and E because they have neither the professional competence nor the professional confidence to do anything else?

[Mr Hunt]

I agree that there have been teething problems with 111 and we are addressing those problems. [Hon. Members: “ Teething problems?”] There is laughter on the Opposition Benches. We are hitting our A and E targets at the moment, and 111 is available in more than 90% of the country. We are dealing with those teething issues, but I take on board the right hon. Gentleman’s point. The 111 service needs to be quicker at getting advice to people from a GP or a nurse. The fundamental issue with 111 is that giving the public an easy number to remember has highlighted how inaccessible GP out-of-hours services have become. We have to address that if we are to restore public confidence in 111.

NHS Commissioning Board (Mandate)

Debate between Jeremy Hunt and Frank Dobson

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

I hope my right hon. Friend is right that there is agreement on the goals in the mandate, because they have been drawn up after extensive consultation with the people of this country and are important priorities, particularly as we grapple with an ageing society. I agree with him that it does not the help the NHS to descend to the rhetoric we heard from the right hon. Member for Leigh (Andy Burnham). There is a very important and legitimate debate about the right way to achieve shared goals. Government Members do not believe the right way is through performance management from the Department of Health and trying to echo out every part of the system. We believe the right way is to empower local GP-led groups to make changes on the ground. That is at the heart of the reforms.

[Frank Dobson (Holborn and St Pancras) (Lab)]

I can understand the Secretary of State’s desire to give operational freedom to people in each locality, and his desire, as he says in his document, to reduce the inequalities of treatment between one area and another, but how does he intend to reconcile those two objectives?

[Mr Hunt]

The approach the reforms take is this: when there are inequalities in treatment, and when one hospital is particularly good at certain operations and another hospital is not as good, the best way to drive up performance is to make that information available in a way that has never happened before. More than anything, peer review drives the NHS. A very important part of the programme will be to roll out plans similar to those we have rolled out for cardiothoracic surgery, for which a performance comparison by consultant team, not just by hospital, has led to a dramatic improvement in survival rates from heart operations. We need to roll that out across many other disciplines. We also need to be able to compare local GP-led group with local GP-led group, and local authority with local authority. That will be a far more effective way of driving change than the old top-down way. That was tried under different Governments many times and in many ways, but it was never as successful as it was meant to be.