Care Bill [Lords]

Debate between Jeremy Hunt and Jim Dowd

Tuesday 11th March 2014 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for her work in Committee. That is an aspiration that we all share, and some of the results from the pilots are extremely encouraging in terms of the extra care and support we are able to give people. End-of-life care is a priority for everyone, so I share her enthusiasm that we can make progress on that very important area.

Financial security must be combined with confidence in the standard of care received. A year on from the Francis report, we are debating a Bill that will help us to deliver 61 commitments that we made in response to it. We are restoring and strengthening a culture of compassionate care in our health and care system.

Robert Francis’s report said that the public should always be confident that health care assistants have had the training they need to provide safe care. The Bill will allow us to appoint bodies to set the standards for the training of health care assistants and social care support workers. These will be the foundation of the new care certificate, which will provide clear evidence to patients that the person in front of them has the skills, knowledge and behaviours to provide compassionate high-quality care and support.

New fundamental standards will ensure that all patients get the care experience for which the NHS, at its best, is known. In his report, Robert Francis identified a lack of openness extending from the wards of Mid Staffs to the corridors of Whitehall. We want to ensure that patients are given the truth when things go wrong, so the Bill introduces a requirement for a statutory duty of candour which applies to all providers of care registered with the CQC. The Francis inquiry also found that providing false or misleading information allows poor and dangerous care to continue. We want to ensure that organisations are honest in the information they supply under legal obligation, so the Bill introduces a new criminal offence for care providers that supply or publish certain types of false or misleading information.

The care.data programme will alert the NHS to where standards drop and enable it to take prompt action. To succeed, it is vital that the programme gives patients confidence in the way their data are used. For that reason we have today amended the Bill to provide rock-solid assurance that confidential patient information will not be sold for commercial insurance purposes.

Patients also need to have confidence that where there are failings in care they will be dealt with swiftly. At Mid Staffs that took far too long. That is why the Care Bill requires the CQC to appoint three chief inspectors to act as the nation’s whistleblowers-in-chief. Their existence has started to drive up standards even in the short time they have been in their jobs.

Perhaps most fundamentally, the Bill re-establishes the CQC as an independent inspectorate, free from political interference. The Bill will remove nine powers of the Secretary of State to intervene in the CQC to ensure that it can operate without fear or favour. The Bill will also give the CQC the power to instigate a new failure regime and will give Monitor greater powers to intervene in those hospitals that are found to be failing to deliver safe and compassionate care to their patients. For the most seriously challenged NHS providers, there needs to be a clear end point when such interventions have not worked. The Bill makes vital changes to the trust special administration regime, established by the Labour party in 2009, to ensure that an administrator is able to look beyond the boundaries of the trust in administration to find a solution that delivers the best overall outcome for the local population.

[Jim Dowd]

I realise that the Secretary of State was not in office when the TSA process was started in the South London Healthcare NHS Trust, but he did accept the report of the administrator and, of course, appealed against the High Court decision that found against him. Will he clarify and put on the record that it is the coalition Government’s view, and the view of their constituent parties, that the people of Lewisham should not have an accident and emergency unit; should not have a maternity unit; should not have a paediatric specialty; and that two thirds of the hospital site should be sold off? Those were the recommendations of the TSA, which he wanted to accept.

[Mr Hunt]

Let me first tell the hon. Gentleman that the TSA did not recommend the closure of the A and E unit at Lewisham hospital, and he knows that perfectly well.

I will say what this Government are determined to ensure does not happen again. Mid Staffs went on for four years before a stop was put to it. Patients’ lives were put at risk and patients died because the problem was not tackled quickly. The point of these changes today is to ensure that, when all NHS resources are devoted to trying to solve a problem and they fail, after a limited period of time it will be possible to take the measures necessary to ensure that patients are safe. I put it to the hon. Gentleman and to all Opposition Members that if they were in power now they would not be making the arguments that they have been making this afternoon, because it is patently ridiculous to say that we will always be able to solve a problem without reference to the wider health economy. They know that: it was in the guidance that they produced for Parliament when they introduced the original TSA recommendations. What Government Members stand for is sorting out these problems quickly and not letting them drag on in a way that is dangerous for patients.

Changes to Health Services in London

Debate between Jeremy Hunt and Jim Dowd

Wednesday 30th October 2013 Commons Chamber

[Mr Hunt]

I commend my hon. Friend for raising this issue with me consistently. I know his very real concern is to make sure that when those changes are made they do not have an adverse impact on his constituents. I will go back and make absolutely certain that no changes will be made until it is certain that they are clinically safe.

[Jim Dowd (Lewisham West and Penge) (Lab)]

Why does the Secretary of State find it so difficult to realise that he is not above the law? Both the Court of Appeal and the High Court have made it plain that his flagrant disregard for the law in trying to destroy Lewisham hospital cannot stand. Why does he not have the decency to abandon his proposals; apologise to the people of Lewisham and the staff and users of Lewisham hospital; and share his humiliation with the Leader of the House, the previous Secretary of State, who launched this illegal programme in the first place?

[Mr Hunt]

There is no humiliation in doing the right thing for patients, and I will always do that. Sometimes it is difficult and we have battles with the courts, but no one is above the law. I have said that I respect the judgment made by the court yesterday, and that is what I shall do.

Health and Social Care

Debate between Jeremy Hunt and Jim Dowd

Monday 13th May 2013 Commons Chamber

[Mr Hunt]

Because that is what the independent medical advice I have received has told me. The right hon. Lady should be very careful about the Newark statistics, because the increase in mortality rates, which is worrying and should not happen, happened before the A and E was downgraded. It is very important that we do not get the figures wrong.

[Jim Dowd (Lewisham West and Penge) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress.

Before I took the right hon. Lady’s intervention, I was talking about joined-up care. The truth is that Labour’s disastrous IT contract wasted billions and failed to deliver the single digital medical record that would transform the treatment received by so many vulnerable older people. Yes, it was a financial scandal, but it was also a care scandal. Last year, 42 people died because they received the wrong medicines. There were more than 20,000 medication errors that caused harm to patients, and 127,000 near misses. On top of that, structures such as payment by results were left unreformed for more than 13 years, making hospitals focus on the volume of treatment over and above the needs of individual patients. The Care Bill will help to address those issues by promoting integrated care. It creates a duty on local authorities and their partners to co-operate on the planning and delivery of care; it emphasises the importance of prevention and the reduction of people’s care needs; and, by making personal budgets the default and not the exception, it will significantly increase the control people feel over their care.

[Mr Hunt]

It is the right hon. Gentleman who has a problem with the difference between rhetoric and reality. Let me tell him about the reality of what happened to integrated care under Labour. Between 2001—[Interruption.] The right hon. Gentleman intervened, so perhaps he would like to hear the reply. We are talking about integrated care. On his watch, between 2001 and 2009—eight years during which Labour was in power—hospital admissions went up by 36%. In Sweden, where people started thinking about integrated care, such admissions went up by 1%. That is how badly Labour failed to do anything about integrated care when it had the chance. We are doing something about it. If the Opposition listen, I shall explain what.

[Jim Dowd]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress.

The third question that the Care Bill addresses is about sustainable funding for care. We are all going to have to pay more for social care costs, either for ourselves or our families. Tragically, every year, up to 40,000 people have to sell the homes that they have worked so hard for all their lives to fund their care.

Our system does not just fail to help those who need it; it actively discourages people from saving to ensure that they have the funds. In 1997, Labour promised a royal commission on long-term care. The commission reported in 1999, and its recommendations were ignored. We then waited 10 whole years for a Green Paper, which arrived in 2009 and, again, was able to deliver nothing.

In stark contrast, in just three years, the coalition Government commissioned a report from Andrew Dilnot, have accepted it and are now legislating for it. The Care Bill will introduce a cap on the costs that people have to pay for care in their lifetimes. With a finite maximum cost, people will now be able to plan through their pension plan or an insurance policy. With a much higher asset threshold for state support, many more people will get help in paying for their care.

South London Healthcare NHS Trust

Debate between Jeremy Hunt and Jim Dowd

Thursday 31st January 2013 Commons Chamber

[Mr Hunt]

I entirely agree with my right hon. Friend. It would be totally irresponsible for me as Health Secretary to fail to take a decision that could save as many lives as I believe this decision will save. If we are to save more lives in A and E and reduce the number of maternity deaths in London, it involves taking difficult decisions. The disappointment for me is that the Labour party has chosen to jump on an Opposition bandwagon, rather than putting forward its own solution to deal with the clinical issues in south-east London. Unfortunately, the Opposition are playing to the gallery. That is not what a Government-in-waiting should be doing.

[Jim Dowd (Lewisham West and Penge) (Lab)]

I start by congratulating the Secretary of State on admitting in his statement something that has been denied from the outset: that this is a reconfiguration. Indeed, it is a back-door reconfiguration.

I do not think that my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock), my hon. Friend the Member for Lewisham East (Heidi Alexander) and I can adequately represent the outrage and anger of the people of Lewisham at the sheer unfairness of this proposal. The Secretary of State is wrong to say that Matthew Kershaw concluded that his review needed to go wider than South London Healthcare NHS Trust; he started from that premise and said so openly at the meeting in July at the office of the Secretary of State’s predecessor.

Is the Secretary of State aware that even the maternity proposal will mean that a double rota is necessary at King’s College hospital and Queen Elizabeth hospital Woolwich, because it will increase the expected annual number of births at both units to more than 8,000? That will lead to worse services and less choice for patients. The fact that it does not have the support of local commissioners does not seem to register with the Secretary of State.

Will the Secretary of State say whether it was really necessary to spend £5.5 million of taxpayers’ money to demonstrate that his four tests are meaningless and that the guarantees and undertakings of this Tory-Liberal Government are worthless?

[Mr Hunt]

First, let me say to the hon. Gentleman that this is a reconfiguration. However, the normal processes for reconfigurations have been suspended because of legislation that was passed by the Government who were in power until 2010 and whom he supported.

The trust special administrator, Matthew Kershaw, looked extensively at whether there was an option within South London Healthcare NHS Trust to solve the problem. He invited expressions of interest from other people who might run the hospitals in the group, but nobody was able to come forward with a proposal that would solve the problem within the geographical confines of the trust. Indeed, nobody—not the Labour party, nor any of the people who oppose these changes—has come forward with a proposal that would not impact on neighbouring health care economies.

The hon. Gentleman spoke about choice. Choice is not just about the number of hospitals that one could go to, but about the number of good hospitals that one could go to. Nowhere in south London currently meets the London-wide clinical quality standards. As a result of my decision today, the whole of south-east London will meet those standards and it will have some of the highest quality care in London for people who use A and E and maternity services.

On the cost of the process, £5.5 million is the cost of failure—the total failure of the last Government to address this issue when they could have done, rather than bequeath the highest deficit anywhere in the NHS.

--- Later in debate ---

[Mr Hunt]

Clinicians and commissioners have been closely involved in these proposals which, as the right hon. Gentleman will know from reading my statement, affect the broader south-east London area covering six clinical commissioning groups. Five of those groups support the proposals. One does not, but it supports the principles behind them, which is that more complex procedures must be carried out on fewer sites. We have had the benefit of the clinical input of senior people such as Sir Bruce Keogh, and many of the royal colleges have been involved in the external clinical advisory group, which had significant input on the proposals. One question I asked Sir Bruce was whether there had been sufficient clinical input, and his conclusion was that yes, there had been.

[Jim Dowd]

All paid for.